Listen – book review

‘But what do I say?’ Jess, a Cumbria Constabulary recruit, looks terrified. She’s been asked to break the news to Nancy Jones that her husband, who she waved off this morning, has been killed in a road traffic accident. While Nancy is today played by a staff member, this role-play scenario is experienced by police officers and healthcare professionals across the country every day. 

In ‘Listen: How to find the words for tender conversations’, Dr Kathryn Mannix suggests that while there is no single ‘right way’ to break unwelcome news, there are wrong ways, which are not just about the words we use. Instead of offering a script, Mannix uses stories – some from her own experiences, others fictional – to review and discuss some key principles and skills for those tasked with such difficult conversations. 

Many police officers will recall the first ‘death message’ they delivered. In chapter three, ‘Building bridges’, the author recalls running away from a difficult conversation with a patient who asked her if she was going to die. Despite knowing this was very likely, Dr Mannix replied, ‘of course not’, removing the patient’s opportunity to say goodbye to her family. The patient died the following morning. 

Mannix explains that empathy, rather than sympathy, enables us to identify sufficiently with someone’s suffering and to accept that there is no way to ‘fix it’. Such an approach will avoid the ‘at least -isms’ that the author speaks of, such as ‘at least he is not suffering anymore’ or ‘at least it was quick’. Mannix sees these as over-simplifications that ‘demean a person’s suffering’.

Instead, we are encouraged to be ‘willing to be present’, acknowledging someone’s sorrow. This in-built desire to solve problems adversely affects our listening skills too. When did we last really listen to someone – not ‘thinking about formulating an answer’, but just ‘listening to understand’? 

Like many officers, I have dithered ‘on the threshold with a mouthful of marbles’ when I needed to have a difficult conversation with someone. The ‘inner voices’ that the author talks about fed my anxiety and worries about ‘lack of confidence, experience, time, or not knowing the answers to questions asked’.  

It requires courage to take the first step – ‘I have some very sad news’. This ensures that the person we are talking to understands we have something serious to say. It gives the person who we are talking to the opportunity to request the presence of another in advance of hearing the disturbing news. 

Mannix refers to ‘opening the box’, ‘using silence’ and questioning the significance we usually place on eye contact during conversations. The expectation or insistence on prolonged eye contact has no place during tender conversations. Instead, she suggests that by respecting someone’s silence, we can look away for a moment, ‘holding a space for them’ in which to experience the pain of their loss.  

Returning to our recruits in Cumbria Constabulary, Jess is receiving feedback from a trainer and a member of the charity Survivors of Bereavement by Suicide, where all volunteers have been on the receiving end of ‘death messages’. Echoing words used by Dr Mannix, Jess is advised to: 

• give someone time to take the news in 

• let them know you are sorry for their loss, thereby acknowledging their pain 

• stay clear of terms like ‘the deceased, the body’ or defining them by their relationship to the person receiving the news – use the dead person’s name, as it really does make a difference 

I recommend ‘Listen’ – and not just for professionals whose duties require them to break bad news. It is for all of us who, at some point, may need to find the words during our own tender conversations.  

• This article was peer reviewed by Sergeant Stuart Henderson, North Yorkshire Police