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The Four Things That Matter Most: A Book about Living
Four simple phrases--"Please forgive me," "I forgive you," "Thank you," and "I love you"--carry enormous power to mend and nurture our relationships and inner lives. These four phrases and the sentiments they convey provide a path to emotional well-being, guiding us through interpersonal difficulties to life with integrity and grace. Dr. Ira Byock, an international leader in palliative care, explains how we can practice these life-affirming words in our day-to-day lives. Too often we assume that the people we love really know that we love them. Dr. Byock demonstrates the value of "stating the obvious" and provides practical insights into the benefits of letting go of old grudges and toxic emotions. His stories help us to forgive, appreciate, love, and celebrate one another and live life more fully. Using the Four Things in a wide range of life situations, we can experience emotional healing even in the wake of family strife, personal tragedy, divorce, or in the face of death. With practical wisdom and spiritual power, The Four Things That Matter Most gives us the language and guidance to honor and experience what really matters most in our lives every day.
7 pages, Audio CD
First published January 1, 2004
255 people are currently reading
3680 people want to read
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Displaying 1 - 30 of 141 reviews
September 20, 2015
Wow. What a touching book.
I asked a trusted hospice doctor to recommend a good book about the beauty of life, love, death, and hospice care. The Four Things That Matter Most: A Book About Living, was just what I was hoping for, and more.
The book emphasizes the importance of four healing phrases in any relationship, even when each person is well and thriving. The phrases, I love you, I forgive you, please forgive me, and thank you, have allowed the patients of Ira Byock, palliative care MD, to heal their souls and complete (not end) their relationships. At first, I was concerned that the explanations of each phrase would be long-winded and redundant, but Byock illustrated each one beautifully with tender stories of patients who experienced tranquility, joy, and forgiveness after using these phrases with their loved one.
Oh, did I cry.
Being in critical health care, I witness death, regret, love, pain - all and any of the above. I have always been somewhat overly empathetic and the thought of losing my loved ones can feel unbearable. Reading this book and working in healthcare have each helped me to come to terms with the (often unspoken) mortality of life. Byock gracefully highlights the miracle of life, even the end, in a way that brought me peace and filled my heart.
This book fulfills the "book that made you cry" section of the Pop Sugar 2015 Ultimate Reading Challenge. http://www.popsugar.com/love/Reading-...
I asked a trusted hospice doctor to recommend a good book about the beauty of life, love, death, and hospice care. The Four Things That Matter Most: A Book About Living, was just what I was hoping for, and more.
The book emphasizes the importance of four healing phrases in any relationship, even when each person is well and thriving. The phrases, I love you, I forgive you, please forgive me, and thank you, have allowed the patients of Ira Byock, palliative care MD, to heal their souls and complete (not end) their relationships. At first, I was concerned that the explanations of each phrase would be long-winded and redundant, but Byock illustrated each one beautifully with tender stories of patients who experienced tranquility, joy, and forgiveness after using these phrases with their loved one.
Oh, did I cry.
Being in critical health care, I witness death, regret, love, pain - all and any of the above. I have always been somewhat overly empathetic and the thought of losing my loved ones can feel unbearable. Reading this book and working in healthcare have each helped me to come to terms with the (often unspoken) mortality of life. Byock gracefully highlights the miracle of life, even the end, in a way that brought me peace and filled my heart.
This book fulfills the "book that made you cry" section of the Pop Sugar 2015 Ultimate Reading Challenge. http://www.popsugar.com/love/Reading-...
February 4, 2017
The author states that this is a book about living. I agree. Even though the stories he included are mostly about his experience with dying patients, the author is able to show how one can find peace and purpose in dying by saying four things that really matter. Those 4 things can heal and positively impact future generations to live their lives with more love, understanding and compassion. Even if you are very healthy and not dealing with a loved one's end of life, this book is worth a read. I am so glad I found it. I am already practicing with success the 4 things and enriching my relationships as a result.
January 13, 2019
The 4 things that matter most: "Please forgive me," "I forgive you," "Thank you," and "I love you." This book is filled with stories that illustrate how helpful these phrases can be for emotional wellness in relationships.
I really appreciated that the book mentioned that in times of lucidity for Alzheimer's/dementia patients, there are sometimes words spoken that are just what the recipient needs to hear. That situation happened to me when my grandmother was dying years ago, and I was glad to know that despite her not knowing me in that very moment, she knew that I had been there that day. It was really touching to me that it was important for her to tell me that her granddaughter had been there earlier.
Another tidbit of information I learned in this book was that the word "good-bye" originated from "God be with you." I was touched with how it was intended to be a blessing for others in daily interactions.
I'm thankful to have been introduced to this book during a time when I'm not dealing with grief of a loss and have the opportunity to capitalize on this in my relationships going forward.
I really appreciated that the book mentioned that in times of lucidity for Alzheimer's/dementia patients, there are sometimes words spoken that are just what the recipient needs to hear. That situation happened to me when my grandmother was dying years ago, and I was glad to know that despite her not knowing me in that very moment, she knew that I had been there that day. It was really touching to me that it was important for her to tell me that her granddaughter had been there earlier.
Another tidbit of information I learned in this book was that the word "good-bye" originated from "God be with you." I was touched with how it was intended to be a blessing for others in daily interactions.
I'm thankful to have been introduced to this book during a time when I'm not dealing with grief of a loss and have the opportunity to capitalize on this in my relationships going forward.
May 12, 2020
3.5 Stars.
Negatives: this was a bit simplistic, boring, and not the best written book. The stories for the most part were downers, not uppers.
Let me summarize the book so you don't have to read it unless you want to:
When saying Good-Bye to someone, whether you are dying, they are dying, or you are being separated for a long time and might not see them again (for example, break-up, divorce, someone going off to war or to live in another country indefinitely), it is VERY IMPORTANT to say FOUR Things.
The Four Things when saying Good-Bye:
"I Love you."
"Thank you."
"I forgive you."
"Please forgive me."
I think the first two are what matters most--if the relationship has been an Intimate one with good communication.
However, if there have been hurts or abuse or misunderstandings or one person has loved the other much more, than the last two are equally important.
Quote: "There is no remedy for Love is but to Love More." Henry David Thoreau
New concept which I learned--and is SUPER VALUABLE, has to do with forgiveness.
If someone has hurt you, you will get closure much sooner and healing, if you forgive them.
You forgive them because YOU deserve peace, NOT because THEY deserve forgiveness.
I already knew that.
What I didn't know was this:
"We can DECIDE to forgive someone. First and foremost, Forgiveness is an act of volition and will. "
"The Forgiveness that the Four Things require has nothing to do with FEELING one way or another.
Avi could hate his father; you might hate someone, too. What was necessary was for Avi to SAY 'I forgive you' to his father so Avi wouldn't have to carry around the weight of his unresolved relationship to his father after his father died."
Best quote:
"It is wrong to think that people need to FEEL forgiveness in order to GIVE forgiveness."
I also liked that the counselor told Avi that when he said "I love you" to his father, he didn't have to think of the father he hated, who had hurt him and rejected him so badly, but Avi could say it to the father he wished his father could have been.
In other words, saying the Four Things is about closure.
It is great if you love the person and have gratitude toward them, and don't have anger toward them--then you can skip the forgiveness if there is nothing to forgive, just express the thanks and love and tell them what they've meant to you.
But if there is anything unresolved, you can ease the other's road to the next life or their life beyond you immeasurably just by SAYING the Four Things--even if you don't mean them 100%.
And just SAYING you forgive someone, and deciding to forgive them, can allow you to let go of the negative energy, to dissolve the hatred and anger, even if some of the pain of loss still lingers.
It is the courageous act of the saying those things that is powerful.
As hard as it is to say Good-Bye, saying these things or some version of them, makes that awful experience of losing someone less dreadful and can be tremendously uplifting and joyful.
Negatives: this was a bit simplistic, boring, and not the best written book. The stories for the most part were downers, not uppers.
Let me summarize the book so you don't have to read it unless you want to:
When saying Good-Bye to someone, whether you are dying, they are dying, or you are being separated for a long time and might not see them again (for example, break-up, divorce, someone going off to war or to live in another country indefinitely), it is VERY IMPORTANT to say FOUR Things.
The Four Things when saying Good-Bye:
"I Love you."
"Thank you."
"I forgive you."
"Please forgive me."
I think the first two are what matters most--if the relationship has been an Intimate one with good communication.
However, if there have been hurts or abuse or misunderstandings or one person has loved the other much more, than the last two are equally important.
Quote: "There is no remedy for Love is but to Love More." Henry David Thoreau
New concept which I learned--and is SUPER VALUABLE, has to do with forgiveness.
If someone has hurt you, you will get closure much sooner and healing, if you forgive them.
You forgive them because YOU deserve peace, NOT because THEY deserve forgiveness.
I already knew that.
What I didn't know was this:
"We can DECIDE to forgive someone. First and foremost, Forgiveness is an act of volition and will. "
"The Forgiveness that the Four Things require has nothing to do with FEELING one way or another.
Avi could hate his father; you might hate someone, too. What was necessary was for Avi to SAY 'I forgive you' to his father so Avi wouldn't have to carry around the weight of his unresolved relationship to his father after his father died."
Best quote:
"It is wrong to think that people need to FEEL forgiveness in order to GIVE forgiveness."
I also liked that the counselor told Avi that when he said "I love you" to his father, he didn't have to think of the father he hated, who had hurt him and rejected him so badly, but Avi could say it to the father he wished his father could have been.
In other words, saying the Four Things is about closure.
It is great if you love the person and have gratitude toward them, and don't have anger toward them--then you can skip the forgiveness if there is nothing to forgive, just express the thanks and love and tell them what they've meant to you.
But if there is anything unresolved, you can ease the other's road to the next life or their life beyond you immeasurably just by SAYING the Four Things--even if you don't mean them 100%.
And just SAYING you forgive someone, and deciding to forgive them, can allow you to let go of the negative energy, to dissolve the hatred and anger, even if some of the pain of loss still lingers.
It is the courageous act of the saying those things that is powerful.
As hard as it is to say Good-Bye, saying these things or some version of them, makes that awful experience of losing someone less dreadful and can be tremendously uplifting and joyful.
July 20, 2014
Simple yet in no way simplistic. This book in its clarity presents wisdom on completing a relationship with another human being- in your life or not- that ultimately I feel helps us to deepen a relationship with ourselves. My Dad gave me this book at a time when my family was in the hospice process of an elder. Working through the book took longer than the hospice process itself for me and that felt right in my life at that time. Not only did it give me tools for moving through the hospice process but it helped me to re frame and clarify other relationships as well. I mentioned this book to a friend just the other day. If you are ready to have this exploration of self it is a wonderful process of gentle revolutionary evolution and exploration.
June 25, 2014
I have used this book 4 times as I wrote to family members to whom I was estranged. All 4 people responded by thanking me for writing and for opening communication.
May 16, 2020
It's about relationship. I like the author's style. What's interesting here are the stories of real people. It gives context on how and when to say the right words. To express the right feelings.
After reading this, I feel like writing a letter to my father. Although he's already gone, putting into words all I wanted him to know might somehow makes some good for both of us.
Those words I didn't tell my father didn't come up, partly because of shyness and embarrassment, but mostly because they're hard to find. It requires digging into oneself, and a bunch of maturity.
I knew my father knew I have loved him in a special way, and vice versa. Surely we couldn't express it well enough with bare words. Thus, the living memory of each moment spent together was more powerful than an awkward set of words, which might have destroyed the beauty of it.
Still, the harder the exercice, the brightest the reward and I feel our relationship could have flowered more especially in the last years when I was more distant.
The author says we can still benefit from saying such words after one dies, because the relationship continue and I believe so.
"Death ends a life, not a relationship. people who die live on in our thoughts and our feelings."
After reading this, I feel like writing a letter to my father. Although he's already gone, putting into words all I wanted him to know might somehow makes some good for both of us.
Those words I didn't tell my father didn't come up, partly because of shyness and embarrassment, but mostly because they're hard to find. It requires digging into oneself, and a bunch of maturity.
I knew my father knew I have loved him in a special way, and vice versa. Surely we couldn't express it well enough with bare words. Thus, the living memory of each moment spent together was more powerful than an awkward set of words, which might have destroyed the beauty of it.
Still, the harder the exercice, the brightest the reward and I feel our relationship could have flowered more especially in the last years when I was more distant.
The author says we can still benefit from saying such words after one dies, because the relationship continue and I believe so.
"Death ends a life, not a relationship. people who die live on in our thoughts and our feelings."
November 19, 2019
I really like Ira Byock. His book, "Dying Well" was a transformative book for me after mom died. Again though, I wish I'd been able to read that and this book before the event had actually occurred. Hospice is still so new, and we're so afraid to talk about dying as a society that so many important things are left unsaid. All I was given was a pamphlet about the dying process that was left on the kitchen table. The things I could do now with all this knowledge.
I forgive you, please forgive me, thank you, and I love you. I wish I'd had the chance to say these things to mom. I can't do that now, that chance is gone, but I can be better about my current relationships with loved ones. The Four Things are good to keep in mind.
I forgive you, please forgive me, thank you, and I love you. I wish I'd had the chance to say these things to mom. I can't do that now, that chance is gone, but I can be better about my current relationships with loved ones. The Four Things are good to keep in mind.
July 23, 2022
I listened to this book at almost double speed and still barely finished. It has a great concept! But it isn't enough to fill a book. Basically, you need to tell a person 4 things to heal a relationship, and you best do it before they die, though you can do so afterwards.
1. I forgive you for...
2. Forgive me for...
3. Thank you for...
4. I love you.
You don't have to use words for these statements, but it is more powerful if you do. The end.
1. I forgive you for...
2. Forgive me for...
3. Thank you for...
4. I love you.
You don't have to use words for these statements, but it is more powerful if you do. The end.
This entire review has been hidden because of spoilers.
January 14, 2018
I learned about this book through my church. It is especially important for when you or someone you love is at the end of life, but something that everyone could read to to prioritize relationships now.
Read
February 13, 2019Only read about half b/c overwhelmed with self help this month.
I forgive you. Please forgive me. I love you. Thank you.
I forgive you. Please forgive me. I love you. Thank you.
April 11, 2024
everyone should read this book
July 3, 2025
A book I think everyone should read. It's eye opening and thought provoking.
March 9, 2017
This book is about focusing on the things that are most important. A doctor who sees many people die has learned that there are a few important things that help give families and relationships closure and completeness at the end. They can be summed up in four phrases. Be sure to say: Please forgive me. I forgive you. Thank you. I love you.
We don't need to wait until someone is dying to say these things and focus on forgiveness, gratitude, and love in our relationships. Consciously, mindfully, honestly expressing how we love and appreciate and feel about those most important to us will help us live happily and without regret every day. I thought there were some good points here. Some of my favorites:
"Life tends to get better when people can move from leaving important things unsaid to broaching these topics and feeling confident that they have communicated clearly with good intentions to the most important people in their lives (p. xvii)."
"'Wake up, everyone! It's time to visit and have a heartfelt talk with Mom, Dad, Grandma, or Grandpa.' Even people with advanced dementia who can't speak or string words together may still understand some words. And they definitely can feel and respond to your emotions (p. xxi)."
"Please forgive me. I forgive you. Thank you. I love you. These four simple statements are powerful tools for improving your relationships and your life (p. 3)."
"Ask a man who is being wheeled into transplant surgery or a woman facing chemotherapy for the third time what's on his or her mind and the answer will always involve the people they love. Always (p. 4)."
"Thankfully, not all good-byes are final--but goodbyes can be meaningful. It's important to say good-bye in a way that affirms our relationship and acknowledges our connection to one another (p. 6)."
"Whatever time you have together today is a chance to say the things that would be left unsaid. In fact, 'stating the obvious' is important at times like this (p. 12)."
"Our core relationships do not, in all ways, end with death. The people who are most important to us become part of our...soul (p. 13)."
"The best way to help someone who is ill, lonely, depressed, or dying is by just showing up. Being there communicates to the person how much he or she really matters to you (p. 16)."
"Far more than pain or any other physical symptom, isolation evokes feelings of helplessness and hopelessness. This isn't only true when people are dying--it's true for everyone (p. 16)."
"We are complete in our relationships when we feel reconciled, whole, and at peace. People say they feel complete when, if they were to die tomorrow, they'd have no regrets--they would feel they had left nothing undone...or unsaid (p. 18)."
"Whenever we are able to open up and become vulnerable and honest with ourselves, we allow the opportunity for profound transformation. People who acknowledge that their lives may soon be over tend to have little patience with pretense, including their own. In the naked honesty that accompanies death's approach, many people feel a need to apologize for having been self-centered, irresponsible, or just plain wrong (p. 26)."
"We know that our family and friends are the most important parts in life, but we tend to get distracted, enmeshed as we often are in the work and family responsibilities that fill our daily lives (p. 27)."
"The knowledge of being loved, even when you are separated from each other, sustains you and provides you with inner strength and comfort (p. 33)."
"We do not have to wait until we or someone we love is dying to practice forgiveness (p. 37)."
"'I've written letters to each of my children that are in our safe-deposit box. I tell them how much I love and am proud of them, and how confident I am in the choices they'll make in life. I wrote, 'If we were having an argument just before I died or if there are things left unresolved between us, you can be sure that I know that our disagreements are tiny in comparison to our love. Please forgive me for not always understanding and for nagging and worrying too much. Being your mother is the best thing I ever did (p. 49)!'"
"It took a lot of strength to relinquish her pride and pretense of motherly perfection and acknowledge even that mistakes had been made (p. 53)."
"A wound need not be severe for it to influence your relationships, your emotions, and your ability to enjoy a social life (p. 59)."
"One of the most important lessons I have learned over the years from people who were dying is the wisdom of self-forgiveness (p. 78)."
"No illness affects two people in exactly the same way.... Richard explained that Susan's real torment in those months after the diagnosis was self-imposed. She struggled with questions of what she had done to bring this on herself (p. 82)."
"'It is terribly hard to hear that someone you love and know is pure of heart is suffering from self-doubt and guilt (p. 83).'"
"None of us need wait to accept ourselves.... Feelings of unworthiness and self-loathing cause untold suffering. They can make people feel alone and unwanted in a roomful of friends (p. 86)."
"If you are stuck in guilt about being ill and unworthy of love, you won't be able to experience the acceptance others have for you. You will never be able to understand or feel how important and valued you are in their eyes (p. 89)."
"Our imperfection is a sign of our humanity. It makes us real (p. 90)."
"As adults we tend to think that our accomplishments and standing in society somehow shield us from the supposed indignity of physical dependence. This is an illusion (p. 90)."
"In such inherently ungraceful circumstances, dignity resides in wise recognition of one's predicament and a gracious acceptance of help from others (p. 91)."
"The principle of shared responsibility is evident in a thousand expectations and norms of behavior not only within the body politic, but also in the civic communities of towns and neighborhoods and in workplaces, social clubs, and congregations. It is the mark of a healthy community that members care for one another during periods of stress and need, and can be counted on to do so (p. 93)."
"If it is a sibling, parent, or close friend who is seriously ill, fulfilling our responsibilities may well require juggling other responsibilities and schedules and showing up for however long and however often we're needed.... The truth is we already are a burden to our family and friends. There is no way to avoid it--and it would be unhealthy to try (p. 94)."
"Don't wait 20 years to have a real conversation with the people you love. Don't wait 20 years to say sorry. Don't wait 20 years to forgive. Don't wait 20 years to ask for forgiveness. And, most important, don't wait 20 years to tell the people you love that you love them (p. 103)."
"To forgive someone is the most courageous thing you can do (p. 106)."
"'I am the one who must stop it.' That line changed my life. I realized that I could say that: 'The cycle stops here (p. 106)!'"
"'I realized that person who stabbed us is in pain and needs help (p. 108).'"
"'There is more hunger for love and appreciation in this world than for bread (Mother Teresa, p. 109).'"
"People think it's not necessary to express thanks. They say, for example, 'She knows how much I appreciate all she has done for me.' When I hear that, I reply, 'Good, then it'll take no time at all to tell her again (p. 111).'"
"'Thank you for all your love. Thank you for putting up with me!' This is one place where being redundant never hurts (p. 112)."
"Once you get started, I encourage you to be as specific as possible. The inverse of taking things for granted is to be mindful--and thankful--for small kindnesses. Our relationships, and indeed our lives, can too easily become habitual, insulating us from experiencing what a miracle it is to be alive, and how much is given to us each moment (p. 112)."
"Please take a moment to thank someone you love when he or she smiles at you. The next time you put your child to bed or before you and your spouse retire, try enumerating everything he or she did that day that touched you, that fulfilled his or her responsibilities in your life together, that acknowledged the connection you share (p. 115)."
"Gratitude and joy are intimately fused, and practicing gratitude is a sure way to bring joy into our lives (p. 117)."
"Even with advanced dementia...small miracles do happen. Moments of startling clarity can flash like lightning and leave us breathless. For me, such events reveal the wisdom of continuing to express appreciation and affection for those we love, even when we think all is lost (p. 125)."
"All of a sudden she looked me right in the eyes and said, 'Thank you, Princess. I'm sorry this is so hard.' 'I was dumbfounded... I said, 'I love you so much, Grandma.' And she said, 'I know, I love you, too, Laurie. You have brought me so much naches,' she said, using the Yiddish word for joy. And that was it. She hugged me and I just cried in her arms. Then she was just quiet and a moment later, I was 'Ma'am' again (p. 129)."
"The absence of gratitude can erode a person's health and quality of life (p. 130)."
"Family life tends to be messy. Boundaries of privacy that are expected in other relationships simply don't exist within families. Parents and children commonly intrude in one another's personal affairs.... Family dynamics are just that, dynamic (p. 131)."
"Anger constrains our options. If pain and regret make you see only the wounds and ways of defending yourself from being hurt again, practicing gratitude--starting with gratitude for life itself--can expand your perspective on the world and your options for living (p. 143)."
"We should never underestimate the possibility for change and growth in any human being. Emotional health and happiness are ours to create (p. 145)."
"'What keeps us alive, what allows us to endure? I think it is the hope of loving, or being loved (Meister Eckhart, p. 147).'"
"Love is the most powerful of human emotions. And 'I love you' is arguably the single most important sentence in any language. 'Love is its own because!'.... Love requires no justification. It has inherent value. If you love someone, no other reason for loving--or living--is needed (p. 149)."
"Communicate forgiveness, gratitude, and love in a way the person you're communicating with can understand. The more explicit you are, the better (p. 153)."
"Love is an active verb. Authentic loving care involves touching people tenderly. Touching people who are ill or debilitated for the sake of their comfort and even to elicit pleasure is entirely wholesome. We don't do nearly enough of it (p. 158)."
"We belong to one another and that, it seems to me, is the best part of being alive (p. 163)."
"By trying to sanitize illness and dying we inadvertently separate and isolate people we love--and we isolate ourselves. Isolation is the opposite of loving connection (p. 163)."
"We may avoid people who are dying because of a subconscious level of magical thinking we worry that death is somehow contagious. We shouldn't worry--we're already infected (p. 163)."
"'For one human being to love another human being: that is perhaps the most difficult task that has been entrusted to us, the ultimate test and proof, the work for which all other work is merely preparation (p. 164).'"
"When life is short, each moment can become precious and perfect. We shouldn't have to wait for death's approach to realize this essential truth of living. When we come fully into the present, moment to moment, we have the sense that we're living life to the fullest and each moment is a celebration (p. 165)."
"When Yvette was finally able to accept the unacceptable--that her daughter was dying--it provided an opening into a realm of communication and connection with her daughter. She couldn't change what was; she could only shift her attitude. She chose to see Gabrielle as a gift (p. 173)."
"There is intense joy that comes to us and we want to celebrate the true miracle of our love for one another (p. 174)."
"'There is no remedy for love but to love more (Henry David Thoreau, p. 183).'"
"Among the men in Peter's family, the currency of relationships was time together and the language of relationships was work--principally carpentry, from framing to fine finish work, as well as electrical wiring, plumbing, cement and tile work (p. 185)."
"Each parting can remind us that our lives are precious (p. 193)."
"Today s a good day to make the Four Things explicit (p. 203)."
We don't need to wait until someone is dying to say these things and focus on forgiveness, gratitude, and love in our relationships. Consciously, mindfully, honestly expressing how we love and appreciate and feel about those most important to us will help us live happily and without regret every day. I thought there were some good points here. Some of my favorites:
"Life tends to get better when people can move from leaving important things unsaid to broaching these topics and feeling confident that they have communicated clearly with good intentions to the most important people in their lives (p. xvii)."
"'Wake up, everyone! It's time to visit and have a heartfelt talk with Mom, Dad, Grandma, or Grandpa.' Even people with advanced dementia who can't speak or string words together may still understand some words. And they definitely can feel and respond to your emotions (p. xxi)."
"Please forgive me. I forgive you. Thank you. I love you. These four simple statements are powerful tools for improving your relationships and your life (p. 3)."
"Ask a man who is being wheeled into transplant surgery or a woman facing chemotherapy for the third time what's on his or her mind and the answer will always involve the people they love. Always (p. 4)."
"Thankfully, not all good-byes are final--but goodbyes can be meaningful. It's important to say good-bye in a way that affirms our relationship and acknowledges our connection to one another (p. 6)."
"Whatever time you have together today is a chance to say the things that would be left unsaid. In fact, 'stating the obvious' is important at times like this (p. 12)."
"Our core relationships do not, in all ways, end with death. The people who are most important to us become part of our...soul (p. 13)."
"The best way to help someone who is ill, lonely, depressed, or dying is by just showing up. Being there communicates to the person how much he or she really matters to you (p. 16)."
"Far more than pain or any other physical symptom, isolation evokes feelings of helplessness and hopelessness. This isn't only true when people are dying--it's true for everyone (p. 16)."
"We are complete in our relationships when we feel reconciled, whole, and at peace. People say they feel complete when, if they were to die tomorrow, they'd have no regrets--they would feel they had left nothing undone...or unsaid (p. 18)."
"Whenever we are able to open up and become vulnerable and honest with ourselves, we allow the opportunity for profound transformation. People who acknowledge that their lives may soon be over tend to have little patience with pretense, including their own. In the naked honesty that accompanies death's approach, many people feel a need to apologize for having been self-centered, irresponsible, or just plain wrong (p. 26)."
"We know that our family and friends are the most important parts in life, but we tend to get distracted, enmeshed as we often are in the work and family responsibilities that fill our daily lives (p. 27)."
"The knowledge of being loved, even when you are separated from each other, sustains you and provides you with inner strength and comfort (p. 33)."
"We do not have to wait until we or someone we love is dying to practice forgiveness (p. 37)."
"'I've written letters to each of my children that are in our safe-deposit box. I tell them how much I love and am proud of them, and how confident I am in the choices they'll make in life. I wrote, 'If we were having an argument just before I died or if there are things left unresolved between us, you can be sure that I know that our disagreements are tiny in comparison to our love. Please forgive me for not always understanding and for nagging and worrying too much. Being your mother is the best thing I ever did (p. 49)!'"
"It took a lot of strength to relinquish her pride and pretense of motherly perfection and acknowledge even that mistakes had been made (p. 53)."
"A wound need not be severe for it to influence your relationships, your emotions, and your ability to enjoy a social life (p. 59)."
"One of the most important lessons I have learned over the years from people who were dying is the wisdom of self-forgiveness (p. 78)."
"No illness affects two people in exactly the same way.... Richard explained that Susan's real torment in those months after the diagnosis was self-imposed. She struggled with questions of what she had done to bring this on herself (p. 82)."
"'It is terribly hard to hear that someone you love and know is pure of heart is suffering from self-doubt and guilt (p. 83).'"
"None of us need wait to accept ourselves.... Feelings of unworthiness and self-loathing cause untold suffering. They can make people feel alone and unwanted in a roomful of friends (p. 86)."
"If you are stuck in guilt about being ill and unworthy of love, you won't be able to experience the acceptance others have for you. You will never be able to understand or feel how important and valued you are in their eyes (p. 89)."
"Our imperfection is a sign of our humanity. It makes us real (p. 90)."
"As adults we tend to think that our accomplishments and standing in society somehow shield us from the supposed indignity of physical dependence. This is an illusion (p. 90)."
"In such inherently ungraceful circumstances, dignity resides in wise recognition of one's predicament and a gracious acceptance of help from others (p. 91)."
"The principle of shared responsibility is evident in a thousand expectations and norms of behavior not only within the body politic, but also in the civic communities of towns and neighborhoods and in workplaces, social clubs, and congregations. It is the mark of a healthy community that members care for one another during periods of stress and need, and can be counted on to do so (p. 93)."
"If it is a sibling, parent, or close friend who is seriously ill, fulfilling our responsibilities may well require juggling other responsibilities and schedules and showing up for however long and however often we're needed.... The truth is we already are a burden to our family and friends. There is no way to avoid it--and it would be unhealthy to try (p. 94)."
"Don't wait 20 years to have a real conversation with the people you love. Don't wait 20 years to say sorry. Don't wait 20 years to forgive. Don't wait 20 years to ask for forgiveness. And, most important, don't wait 20 years to tell the people you love that you love them (p. 103)."
"To forgive someone is the most courageous thing you can do (p. 106)."
"'I am the one who must stop it.' That line changed my life. I realized that I could say that: 'The cycle stops here (p. 106)!'"
"'I realized that person who stabbed us is in pain and needs help (p. 108).'"
"'There is more hunger for love and appreciation in this world than for bread (Mother Teresa, p. 109).'"
"People think it's not necessary to express thanks. They say, for example, 'She knows how much I appreciate all she has done for me.' When I hear that, I reply, 'Good, then it'll take no time at all to tell her again (p. 111).'"
"'Thank you for all your love. Thank you for putting up with me!' This is one place where being redundant never hurts (p. 112)."
"Once you get started, I encourage you to be as specific as possible. The inverse of taking things for granted is to be mindful--and thankful--for small kindnesses. Our relationships, and indeed our lives, can too easily become habitual, insulating us from experiencing what a miracle it is to be alive, and how much is given to us each moment (p. 112)."
"Please take a moment to thank someone you love when he or she smiles at you. The next time you put your child to bed or before you and your spouse retire, try enumerating everything he or she did that day that touched you, that fulfilled his or her responsibilities in your life together, that acknowledged the connection you share (p. 115)."
"Gratitude and joy are intimately fused, and practicing gratitude is a sure way to bring joy into our lives (p. 117)."
"Even with advanced dementia...small miracles do happen. Moments of startling clarity can flash like lightning and leave us breathless. For me, such events reveal the wisdom of continuing to express appreciation and affection for those we love, even when we think all is lost (p. 125)."
"All of a sudden she looked me right in the eyes and said, 'Thank you, Princess. I'm sorry this is so hard.' 'I was dumbfounded... I said, 'I love you so much, Grandma.' And she said, 'I know, I love you, too, Laurie. You have brought me so much naches,' she said, using the Yiddish word for joy. And that was it. She hugged me and I just cried in her arms. Then she was just quiet and a moment later, I was 'Ma'am' again (p. 129)."
"The absence of gratitude can erode a person's health and quality of life (p. 130)."
"Family life tends to be messy. Boundaries of privacy that are expected in other relationships simply don't exist within families. Parents and children commonly intrude in one another's personal affairs.... Family dynamics are just that, dynamic (p. 131)."
"Anger constrains our options. If pain and regret make you see only the wounds and ways of defending yourself from being hurt again, practicing gratitude--starting with gratitude for life itself--can expand your perspective on the world and your options for living (p. 143)."
"We should never underestimate the possibility for change and growth in any human being. Emotional health and happiness are ours to create (p. 145)."
"'What keeps us alive, what allows us to endure? I think it is the hope of loving, or being loved (Meister Eckhart, p. 147).'"
"Love is the most powerful of human emotions. And 'I love you' is arguably the single most important sentence in any language. 'Love is its own because!'.... Love requires no justification. It has inherent value. If you love someone, no other reason for loving--or living--is needed (p. 149)."
"Communicate forgiveness, gratitude, and love in a way the person you're communicating with can understand. The more explicit you are, the better (p. 153)."
"Love is an active verb. Authentic loving care involves touching people tenderly. Touching people who are ill or debilitated for the sake of their comfort and even to elicit pleasure is entirely wholesome. We don't do nearly enough of it (p. 158)."
"We belong to one another and that, it seems to me, is the best part of being alive (p. 163)."
"By trying to sanitize illness and dying we inadvertently separate and isolate people we love--and we isolate ourselves. Isolation is the opposite of loving connection (p. 163)."
"We may avoid people who are dying because of a subconscious level of magical thinking we worry that death is somehow contagious. We shouldn't worry--we're already infected (p. 163)."
"'For one human being to love another human being: that is perhaps the most difficult task that has been entrusted to us, the ultimate test and proof, the work for which all other work is merely preparation (p. 164).'"
"When life is short, each moment can become precious and perfect. We shouldn't have to wait for death's approach to realize this essential truth of living. When we come fully into the present, moment to moment, we have the sense that we're living life to the fullest and each moment is a celebration (p. 165)."
"When Yvette was finally able to accept the unacceptable--that her daughter was dying--it provided an opening into a realm of communication and connection with her daughter. She couldn't change what was; she could only shift her attitude. She chose to see Gabrielle as a gift (p. 173)."
"There is intense joy that comes to us and we want to celebrate the true miracle of our love for one another (p. 174)."
"'There is no remedy for love but to love more (Henry David Thoreau, p. 183).'"
"Among the men in Peter's family, the currency of relationships was time together and the language of relationships was work--principally carpentry, from framing to fine finish work, as well as electrical wiring, plumbing, cement and tile work (p. 185)."
"Each parting can remind us that our lives are precious (p. 193)."
"Today s a good day to make the Four Things explicit (p. 203)."
March 24, 2022
Dr. Ira Byock is an international leader in palliative care. He has worked with many families as they say goodbye to a loved one. His insights and stories help us appreciate, forgive, love and celebrate our dear ones and show us how to live life more fully. This book is easy to read and touching, without being overly sentimental or dramatic. It contains good, basic information on how to heal relationships that have been broken and how to say farewell to someone who is facing the end of life.
July 29, 2017
This book does not reveal any new thoughts. But, it reiterates what simple words can do to people in life, especially at the end of life. It was written by a physician who works in hospice. Very basic words and feelings that are too easily overlooked in life.
April 21, 2008
Again, a wonderful book for anyone working with terminally ill patients or their families. Also a great book to live by - advice for anyone who desires to live their life without regrets.
September 30, 2009
Good message but I felt he got to the point in the introduction. A little redundant.
November 2, 2016
Evocative. Stirring. Powerful. Emotional. Made me cry, reflect and re-evaluate. Permeated into my dreams. Be prepared to do some work. You cannot avoid personal growth when you read this book.
June 18, 2023
This small volume by Dr. Ira Byock, an international leader in palliative care, has been around for some time, first published in 2004 and now out in a Tenth Anniversary Edition. In its pages, Byock shares with readers four things which have helped guide his practice, first in emergency medicine and later in hospice and palliative care. They are four simple phrases, made up of eleven words, which have proved useful in helping to heal interpersonal relationships during times of tragedy, when facing death or a time of profound challenge. His hope is by sharing how these words have helped others, people will use them at any stage of their life when they feel the need.
The four simple phrases are: “Please forgive me”, “I forgive you”, “Thank you”, and “I love You”. Byok believes that by using these words to heal troubled relationships, it will allow those involved let go of old grudges and toxic feelings, and feel more emotionally whole. He has gathered a number of stories to show how these words have helped others to settle family strife, navigate personal tragedy or face inevitable physical decline and death.
Underlying his narrative is a reminder that we are all human and despite living in a world that strives for perfection, we all make mistakes. None of us will ever be perfect and we should neither expect it of others or ourselves. We are all a product of our past experiences and in the process of growing up, have gathered our own personal emotional scars. We love people, sometimes hurt them and at other times they hurt us. These scars do not simply disappear, but remain, many buried deep in our psyche. Some individuals find it easier to share their past pain, while others either consciously or unconsciously, choose to hang on to it. When people are deeply hurt, they often cannot imagine any end to the anger or the hatred they feel. They simply cannot imagine a resolution is possible. In these cases, Byock explains how consciously deciding to stay angry, discards much healthier options.
The concept of forgiveness shared here is different from what some readers may expect. Forgiveness does not mean absolving someone of their responsibility for the harm they have caused or making excuses for someone else’s bad behavior. It is not the same as forgetting someone has hurt you. Byock believes the notion of “forgiving and forgetting” is ridiculous advice. To forgive someone you don’t have to forget; instead, real forgiveness involves remembering. It means accepting the past for what it was without necessarily excusing it. Even if the other person does not respond in kind, at least we rid ourselves of any guilt we carry in the part we played and move on. It is a generous act that is more about yourself than the person being forgiven. Whether the other person benefits from your forgiveness is not the issue; the issue is the quality of YOUR life. Relationships involve two people; you can only take care of your part.
Byock reinforces how important it is not to postpone important conversations and decisions; you never know what the next day will bring. He speaks to his experience with those near death who have little patience for pretense. Time is short and as death approaches, they may feel a need to apologize for having been self-centered, irresponsible or just plain wrong. These are moments when this simple tool may be useful, when people may be struggling with things that need to be said and shared before it is too late.
This small volume is a practical guide to help readers experience what really matters most in life and is now a recognized handbook for many working in palliative care. It is a simple book about both dying and living. It is also a call to make the most of the limited time we all have on this earth.
The four simple phrases are: “Please forgive me”, “I forgive you”, “Thank you”, and “I love You”. Byok believes that by using these words to heal troubled relationships, it will allow those involved let go of old grudges and toxic feelings, and feel more emotionally whole. He has gathered a number of stories to show how these words have helped others to settle family strife, navigate personal tragedy or face inevitable physical decline and death.
Underlying his narrative is a reminder that we are all human and despite living in a world that strives for perfection, we all make mistakes. None of us will ever be perfect and we should neither expect it of others or ourselves. We are all a product of our past experiences and in the process of growing up, have gathered our own personal emotional scars. We love people, sometimes hurt them and at other times they hurt us. These scars do not simply disappear, but remain, many buried deep in our psyche. Some individuals find it easier to share their past pain, while others either consciously or unconsciously, choose to hang on to it. When people are deeply hurt, they often cannot imagine any end to the anger or the hatred they feel. They simply cannot imagine a resolution is possible. In these cases, Byock explains how consciously deciding to stay angry, discards much healthier options.
The concept of forgiveness shared here is different from what some readers may expect. Forgiveness does not mean absolving someone of their responsibility for the harm they have caused or making excuses for someone else’s bad behavior. It is not the same as forgetting someone has hurt you. Byock believes the notion of “forgiving and forgetting” is ridiculous advice. To forgive someone you don’t have to forget; instead, real forgiveness involves remembering. It means accepting the past for what it was without necessarily excusing it. Even if the other person does not respond in kind, at least we rid ourselves of any guilt we carry in the part we played and move on. It is a generous act that is more about yourself than the person being forgiven. Whether the other person benefits from your forgiveness is not the issue; the issue is the quality of YOUR life. Relationships involve two people; you can only take care of your part.
Byock reinforces how important it is not to postpone important conversations and decisions; you never know what the next day will bring. He speaks to his experience with those near death who have little patience for pretense. Time is short and as death approaches, they may feel a need to apologize for having been self-centered, irresponsible or just plain wrong. These are moments when this simple tool may be useful, when people may be struggling with things that need to be said and shared before it is too late.
This small volume is a practical guide to help readers experience what really matters most in life and is now a recognized handbook for many working in palliative care. It is a simple book about both dying and living. It is also a call to make the most of the limited time we all have on this earth.
November 16, 2021
The Four Things, covered in the synopsis, are simple. Not simplistic but simple acts…that can also be so difficult for some of us. The author quotes Lily Tomlin as saying , “Forgiveness means giving up all hope for a better past.” Funny, but absolutely true.
Read with my hospice book club, the Four Things aren’t just for people who are dying, or even outwardly sick. These practices can foster better relationships without illness being involved. Sadly, until death or imminent death is involved, often repairing relationships doesn’t get the attention it needs for healing to take place.
The author is a story teller, and the stories he shares personalize and crystallize the points he makes. He also addresses the embarrassment or shame some feel for becoming dependent while they are Ill. Since I experienced this personally and see it in my patients, I found his practical advice with a completely different perspective as excellent.
I’ve already recommended this book to several other people. It could be slightly helpful or life changing.
Read with my hospice book club, the Four Things aren’t just for people who are dying, or even outwardly sick. These practices can foster better relationships without illness being involved. Sadly, until death or imminent death is involved, often repairing relationships doesn’t get the attention it needs for healing to take place.
The author is a story teller, and the stories he shares personalize and crystallize the points he makes. He also addresses the embarrassment or shame some feel for becoming dependent while they are Ill. Since I experienced this personally and see it in my patients, I found his practical advice with a completely different perspective as excellent.
I’ve already recommended this book to several other people. It could be slightly helpful or life changing.
July 27, 2024
The four things that matter most are revealed right at the beginning of the book as:
1. Please forgive me.
2. I forgive you.
3. Thank you.
4. I love you.
Wow, I thought; we can try to apply them in our relationships all the time, not just when someone is dying.
The author assures us that it's worth reading the book even though he's already told us the main points, because of the real-life stories of people who have done the four things. He also said that although he works with patients who are at the end of their lives, along with their families, we can apply the four things even if a loved one has already died.
There were far too many examples, and I got bored after a while. In addition, the narrator would alter his voice when he was quoting a patient and it was usually breathy and almost melodramatic. I think I would be offended to hear myself portrayed in such a way.
I finally got to the end and was disappointed that nothing more was said about loved ones who are already gone, which was something I wanted to learn more about.
1. Please forgive me.
2. I forgive you.
3. Thank you.
4. I love you.
Wow, I thought; we can try to apply them in our relationships all the time, not just when someone is dying.
The author assures us that it's worth reading the book even though he's already told us the main points, because of the real-life stories of people who have done the four things. He also said that although he works with patients who are at the end of their lives, along with their families, we can apply the four things even if a loved one has already died.
There were far too many examples, and I got bored after a while. In addition, the narrator would alter his voice when he was quoting a patient and it was usually breathy and almost melodramatic. I think I would be offended to hear myself portrayed in such a way.
I finally got to the end and was disappointed that nothing more was said about loved ones who are already gone, which was something I wanted to learn more about.
Read
August 9, 2024The Four Things that Matter Most is a succinct but exceptional treatise on how we may face death, our own or that of a loved one, without remorse and regret. From my perspective, it ought to be required reading. Being able not only to forgive, but to actually say the words, "I forgive you," and "Please forgive me,' to say, "Thank you," and "I love you," to clear the air and express all of the feelings so often kept to ourselves is necessary to unburden the spirit, and to let go of our loved ones in peace.
Dr. Byock uses anecdotes from his practice to illustrate the power of these words. Putting ourselves and our situations in those of the characters' in this book makes it clear how important it can be to face death with open hearts, clear minds and leaving nothing unsaid. The Four Things that Matter Most is an important read.
Dr. Byock uses anecdotes from his practice to illustrate the power of these words. Putting ourselves and our situations in those of the characters' in this book makes it clear how important it can be to face death with open hearts, clear minds and leaving nothing unsaid. The Four Things that Matter Most is an important read.
May 27, 2019
This work started a bit slow for me, someone whose background is in hospice, and currently palliative care, but it picked up with a force that touched me. The stories that we experience, and become a part of, along the way, can be very eye-opening, inspiring, and profound in ways that words cannot touch. This work shares a glimpse of that. I appreciate the tender observations, the connection, and the authentic approach that Byock had with those he encountered. This is real life stuff. At some point, we will all experience the end of the road, and what that looks like remains a mystery; however, our ability to tap into the four things, and to practice "completing" relationships, is something we can do, and, if we so choose, it becomes a gift to self and other.
July 4, 2019
As other reviewers have noted, be prepared for tears! The Four Things That Matter Most is not just a tear-jerker, however. It’s a handbook for life and for preparing for death, something we have a hard time doing in America. For those of us with elderly family members in poor health, it’s a much needed guide for doing what’s right to benefit not only the person dying, but ourselves as well. The anecdotal stories, taken from Dr. Byock’s personal experiences as a hospice and palliative care director, provide a myriad of ways of tackling those four things: Please forgive me. I forgive you. Thank you. I love you. I bought a hard copy of the book, and I’m so glad that I did, because it will be an invaluable reference for the rest of my life.
December 18, 2021
Maybe some helpful suggestions for those new to the subject; the stories became redundant.
However, I take issue with the societal judgement that one must forgive in order to find peace. Any person who was a victim of physical, emotional or sexual abuse is led to believe that, confronting an abuser, hoping for an apology sets up the victim to further trauma if the acknowledgment or lack of contrition is not forthcoming. Additionally, the very trauma of that confrontation can be damaging.
Forgiveness is a religious and social concept that promulgates the connotation of moral superiority in bestowing said forgiveness. This is absurd. Additionally, victims are misled to believe they have obligation to accept an apology - which they do not.
However, I take issue with the societal judgement that one must forgive in order to find peace. Any person who was a victim of physical, emotional or sexual abuse is led to believe that, confronting an abuser, hoping for an apology sets up the victim to further trauma if the acknowledgment or lack of contrition is not forthcoming. Additionally, the very trauma of that confrontation can be damaging.
Forgiveness is a religious and social concept that promulgates the connotation of moral superiority in bestowing said forgiveness. This is absurd. Additionally, victims are misled to believe they have obligation to accept an apology - which they do not.
July 5, 2023
"Please forgive me", "I forgive you", "Thank you", "I love you"—the four things that matter, especially before we say “goodbye” at the end of life. As a palliative care expert, Dr. Byock has seen the healing power of these words many times. “The specter of death reveals our relationships to be our most precious possessions,” he states. Through a variety case studies, Byock shows his readers just how powerful those twelve words can be, if we say them. “Life presents us with a choice: we can choose to protect ourselves from emotional pain—or we can acknowledge our vulnerability and open ourselves to the loss that love will ultimately entail.” For those in the second half of life, this choice is key to the blessing we say at parting: “God be with you.”
January 21, 2019
As a military and clinical chaplain -
I've reread this book at least 4-5 times. And yes, this book has impacted my care in major ways. Who would have thought four simple things hold so much weight?
I love you.
Thank You.
Forgive Me.
I forgive You.
Even when I when I'm not fishing these four things out in a comfort care, palliative care, or any dim high acuity context that involves a hint of transitioning into low quality of life and death/dying, these four things end up resurfacing in ... somehow, someway. This just proves that Byock knows his craft, and I am truly grateful he's written an easy to read book that highlights these major themes.
I've reread this book at least 4-5 times. And yes, this book has impacted my care in major ways. Who would have thought four simple things hold so much weight?
I love you.
Thank You.
Forgive Me.
I forgive You.
Even when I when I'm not fishing these four things out in a comfort care, palliative care, or any dim high acuity context that involves a hint of transitioning into low quality of life and death/dying, these four things end up resurfacing in ... somehow, someway. This just proves that Byock knows his craft, and I am truly grateful he's written an easy to read book that highlights these major themes.
May 9, 2020
“The Four Things That Matter Most” was written by a doctor who spent 15 years in emergency medical practice and more than 25 years in hospice and palliative care. The extraordinary experiences of people facing life’s end, whose stories Dr. Byock tells in this book, demonstrate that by taking the time and caring enough to express forgiveness, gratitude and affection, we can renew and revitalize our most precious connections – our relationships with those people who have been an integral or intimate part of our lives. This book reminded me about what really matters in life and how we can honor each relationship every day. -Barbara
September 15, 2020
This book was a good read. Lots of great stories to read and get real life examples from are included. The ideas of the 4 things means saying; thank you, forgive me, I forgive you, and I love you. The books talks in particular about how important it is to have those conversations early and often so that when the unavoidable ending hits for any of us we have a clear conscious and can have fond memories and less regrets in our relationships. I enjoyed the read and it had good concepts, I rated it 3 stars because in my head 4 and 5 star books mean I would reread them and I don’t feel I need to reread this one. Especially when so much of this is covered in other books also.
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