Reflections Before Good-bye: The Four Things That Matter Most

Personally, in the two years during which The Four Things That Matter Most has gone from an idea to a manuscript, these statements have worked on me in unanticipated, marvelous ways. As “Please forgive me,” “I forgive you,” “Thank you,” and “I love you” resonated within me, they gradually became a continuous practice—a meditation.

Each statement became a Zen-like tool for being mindful of the qualities of forgiveness, gratitude, and love. In practicing the Four Things as an attitude to be cultivated, they have begun to transform my relationship to the world and experience of life.

It’s not easy to maintain this attitude for long and I’m still working on it. (They call meditation a practice for a reason.) I’m not “enlightened,” but it has been en-lightening and enlivening to let go of old baggage, to wipe clean the emotional slate of old debts and grudges.

From Blame to Forgiveness, Appreciation, and Love

Perhaps every generation to some extent blames the older generation for making mistakes that affected their lives. As I watch many of my own generation, the baby boomers, dealing with our aging parents, sometimes I hear echoes of adolescent struggles, old frustrations, resentments, and unresolved anger. Boomers’ parents have been called the Greatest Generation, and it may be true. They made many sacrifices, endured hardships, and yet worked hard to achieve all they could. But it is also true that none of our parents were perfect.

It turns out, neither are we. Parenting has been (remains) a humbling experience. As my own children enter adulthood, only now do I fully grasp the job description. Fortunately, for us all, being a good parent doesn’t require being perfect. This makes practicing forgiveness, appreciation, and love so important.


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We baby boomers grew up in the prosperous post–World War II era, bathed in generosity, showered with advantages by our parents. Now, of course, boomers are in charge of things in private and public sectors of society, and it’s our turn to give back.

how well we care for the most frail and elderly people in our society is the central social and moral test my generation will face. And it’s not going to be an easy test to pass. We face unprecedented challenges that our parents could not have foreseen or prepared us to encounter.

Rising to the Challenges of the Millennium

A tidal wave of social need related to aging, illness, and caregiving is headed in our direction. For the first time in human history, in the third millennium there will be more old people than young people on the planet.

In addition to the graying of the population, boomers have been far more mobile than our parents ever were. We often live many miles from our parents and in-laws. We have smaller families. Many of us work multiple jobs to make ends meet. There are fewer potential caregivers with whom to share the care.

The advent of chronic illness, which is, after all, an invention of the late twentieth century, adds to the challenge. Throughout the ages people have died quickly of heart, liver, lung, kidney disease, or cancer. Now people often live reasonably well with those illnesses for years, protracting the last phase of life. These trends are converging to create the perfect storm, a social tsunami of caregiving need that threatens to overwhelm our children’s generation and us.

We must rise to these challenges. It will take creativity, collaboration, and an unwavering commitment, but we can do it. As we care for our parents and as they die, we become the next generation in line to face the end of life.

The models of care we build today will determine the quality of care we receive tomorrow. It behooves us to nurture forgiveness, gratitude, generosity, and love in ourselves—and model these qualities for our children.

Generational and Personal Lessons Seem Entwined

These generational and personal lessons seem entwined. Mahatma Mohandas Gandhi once advised, “We must become the change we want to see in the world.” Perhaps if we were each to expand forgiveness, gratitude, and love in our own lives, the collective influence of our healthy, loving relationships would reverberate across our generations and into the future.

For myself, I’ve decided that by continuing to practice the Four Things, my relationships will, hopefully, grow stronger and more loving. If I can become the change I wish to see, my friends and family may take notice and respond in kind. And maybe, by earnestly practicing forgiveness, gratitude, and love now, I’ll be adept before it’s time to say my last good-bye.

©2014 by Ira Byock from 'The Four Things That Matter Most',
published by Atria Books, a division of Simon & Schuster, Inc.

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The Four Things That Matter Most - 10th Anniversary Edition: A Book About Living by M.D. Ira Byock M.D.The Four Things That Matter Most - 10th Anniversary Edition: A Book About Living
by Ira Byock M.D.

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About the Author

Ira Byock, MDIra Byock, MD, is a leading palliative care physician, author, and public advocate for improving care through the end of life. His research and writing have helped to define quality of life and quality of care for people living with advanced medical conditions. Dr. Byock is Chief Medical Officer of the Institute for Human Caring of Providence Health and Services system and is a Professor of Medicine and Community & Family Medicine at the Geisel School of Medicine at Dartmouth. More information is available at IraByock.org.