‘I can’t find the words.’ Right now, there is quite likely to be a conversation you are trying to avoid. It is probably one that is important to you, but it has a quality of discomfort to it. Perhaps the conversation requires sharing of a difficult truth; enquiring about information that may be life-changing; proposing something that risks rejection; discussing a topic that will unleash strong emotions; consoling someone experiencing sorrow. There is a push-pull of commitment: the need to act and yet the fear of vulnerability. Not just yet. Soon, but not just yet: I will call, or visit, or make that appointment. We stand on the brink, unsure how to begin.

Now Dorothy is giving a masterclass in dealing with unwelcome news. She is sitting down. Why didn’t I sit down? She has taken Mrs de Souza’s hand in hers and she is stroking Mrs de Souza’s shoulder with her other hand. I know Dorothy has three patients in the observation unit who are all very sick, and that she can’t spend much time here, and yet here she is bending time, extending it by sounding unhurried, making every second count as she focuses her attention on Mrs de Souza.

‘This is very shocking, my love,’ she purrs to Mrs de Souza. ‘Very shocking. Did you know he had a bad heart?’ Mrs de Souza lifts her head and takes a sobbing breath. Dorothy hands her a tissue from the box on the table. Mrs de Souza blows her nose, then says, ‘He’s had a bad heart for years. He was in here with his first heart attack a couple of years ago and we nearly lost him. He’s had more pains recently, that angina pain, and the doctor changed his tablets …’ She trails off.

‘Were you worrying about him?’ asks Dorothy, a question I can see reaching to the weeping woman’s soul.

‘He wouldn’t rest,’ Mrs de Souza sighs. ‘He worked too hard. I told him he was lucky to survive last time.’

‘So you thought he might die last time?’ asks Dorothy, gently, and Mrs de Souza stares into the middle distance, mopping her eyes and nodding.

‘I think we’ve been on borrowed time,’ she whispers. Dorothy waits. ‘He wasn’t well this morning: stressed by something at work, he looked grey and I told him to stay off, but …’ and she shakes her head, weeping more quietly now, sorrow instead of shock, sadness in place of anger.

It is fascinating to watch the way Dorothy has used questions to help Mrs de Souza step from her knowledge of her husband’s heart disease, past his first heart attack, into her recent worries about his health and to her very specific concern this morning. She has built a bridge for Mrs de Souza to walk across, and in answering Dorothy’s questions Mrs de Souza has prepared herself for this unwanted and yet not entirely unexpected moment. She has told Dorothy the Story So Far.

‘I am so sorry, my love,’ says Dorothy. ‘He wasn’t conscious when the ambulance arrived, and his heart was beating very slowly at first and then it stopped. The team did all they could …’ She pauses again, and in that pause I see the path I could have taken: a conversation about the past, the wife’s concerns, her worry today. I was so busy making sure I told her the dreadful news that I didn’t bring her to a place where she could receive it. Dorothy has wound back the story and then brought her, step by step, to this place: now we can move forward a little further.

‘Would you like to come with me to see him?’ asks Dorothy. ‘He’s lying on a bed around the corner, and you can sit with him there if you would like to.

‘Would you like us to contact somebody for you? Your family? A priest? Anyone who can support you here?’

Mrs de Souza says she would like a Catholic priest to be called, and Dorothy takes her by the hand to lead her from the room. As they pass me, Dorothy says, ‘Make us a cup of tea, we’ll be in cubicle three. Bring one for yourself, too.’

Then Dorothy takes Mrs de Souza to sit with her dead husband. When I deliver the tea, Mrs de Souza thanks me Dorothy has reconstructed the whole transaction, skilfully yet simply, by using gentle questions about what Mrs de Souza knew, to help her to recognize that she was already expecting bad news.

It doesn’t matter whether it’s asking someone out on a date or talking about our funeral arrangements with our dear ones: sometimes our own emotions and sometimes our concern about theirs hold us back. Finding a way to begin that allows both people in the conversation to feel confident of being respected and heard sets a tone of collaboration for the rest of the discussion.

It’s stories, not rules, that change people.

To get started, we need to bear in mind whether the circumstances are right. ‘Right’ has to mean ‘good enough’, because we’ll never find the perfect moment. If the time is right, and the setting allows us a chance to talk, that is probably about as good as it gets. The style guide has two pieces of wisdom here: the first is that the other person has a right to choose, too.

A safe place will usually offer some privacy. It might mean freedom from interruption, or somewhere that is familiar and reassuring. It may mean waiting for the person’s supporters to join them, either to listen or to be participants in the conversation, giving the person a sense of security; or it may mean beginning sooner, so they can seize a chance to talk without the pressure of extra people in the room.

The power of that invitation was to give Irene a sense of control. That simple change enabled her to choose when to talk, and she also decided what to do to cheer herself up at the end of the conversation.

‘See you tonight? Seven-thirty outside the cinema?’ ‘Yes, fine, see you later!’ But if there’s more than one cinema, or I’m not certain how long it will take me to get there, I may need a pause to give me thinking time before I say, ‘I’m not sure I can be there by seven-thirty. What time does the film start?’ Now you need some thinking time, too: to remember the start time, or to calculate whether the advertisements before the film will allow us some leeway, or to remind yourself if there’s a later showing of the same film. The presence of silences during the conversation has the effect of slowing everything down. Slowing down allows us to focus better on what is being said, and for many people this slowing also reduces any anxiety they felt coming into a conversation that might be important, emotional or long-awaited. [...] Remain aware, though, that an ‘expectant silence’ can seem threatening to someone who does not feel ready to explore their uncomfortable thoughts:

Think of listening as a waltz, a dance that progresses in triple time: question, question, check; question, question, summary. Without frequent recaps and summaries to check understanding, it is easy to drift into believing that we have understood the story when in fact we have formed inaccurate assumptions about what we have heard.

Asking the other person to summarise from time to time is another useful way to share responsibility in a conversation, and it is particularly important if they are receiving new information as the discussion progresses.

We can check our understanding of the speaker’s emotions using questions like ‘Is telling me this making you feel sad?’ or ‘Do you feel angry while you are remembering this?’ Or we can name the emotion we observe, and check our observation for accuracy: ‘You sound excited about this. Are you?’ or ‘To me, this all sounds quite scary. Does it make you feel anxious?’ Offering our interpretation of the emotions we are observing may give the speaker pause for thought: they may have been so caught up in their emotions that they have not processed them.

Remember: you don’t need to know what to say. Listen fully, and don’t be distracted by wondering what to say next [...] Just listen. Trust yourself; just like feet move in rhythm to unfamiliar music, when it is time to speak words will come to you, and they will come from your heart instead of your head. The task is not to solve, it is simply to listen.

Occasional interruptions to check understanding don’t usually put the speaker off. In fact, they help the speaker to feel properly listened to. They also further slow the conversation. Reducing the speed at which someone pours out the mixture of ideas and emotions and words and memories and possibilities swirling around in their head helps them to express it more clearly. Often simply saying it out loud helps the person to review the whole situation and see a new way to deal with it.

How would bearers of unwelcome news perceive their task if they understood that, upon breaking such news in a tender and supportive manner, the distress the recipient will inevitably feel will enable them to frame their response to the situation?

When we engage in a tender conversation with somebody, we create a safe place for them to suffer. We don’t cause their suffering, but we can accompany and support them in it.