In his book, Dr. Gawande explains that a doctor’s concern with terminal illness is whether the patient wants chemo or not, whether they want to be resuscitated or not, and when they want to go into a hospice. But people with serious illness have priorities beyond just living longer. A child-in-law might be the right person to help with the overwhelming anxieties of the terminally ill — anxieties about death, suffering, what will happen to loved ones, and whether they’ve completed their life’s task.

“Conversations about end-of-life issues can mean the difference between well-being or needless suffering during this critical period. An in-law can gently steer the dying person toward these conversations,” says Rabbi Dr. Glass.

In The Etiquette of Illness, Susan P. Halpern gives pointers on how to create the space for people to open up. She suggests asking, “Do you want to talk about how you’re feeling?” rather than “How are you feeling?” The open-ended nature of the question makes it less demanding, and allows the ill person to decide if they want to respond or not.

And then listen, even if the conversation is one you’d rather avoid. Try not to prompt a cheerful answer, which blocks the ill person’s ability to discuss how he’s really feeling. What he needs and wants the most might be someone who won’t fall apart when he describes his concerns and fears.

It’s okay to let the ill person know you feel uncomfortable; they might be feeling uncomfortable, too. Feel free to apologize if you think you’ve said the wrong thing. If the patient needs to cry or express anger, that’s all right, too; those are natural responses to a distressing situation.

Interviewing the terminally ill in-law is an ideal way to let them talk and develop a sense that their life is complete, and a child-in-law, who isn’t already intimately knowledgeable about every detail of the family legend, might be the perfect person to do it. Old photos and jewelry boxes can provide the perfect prompts.

Miriam Karp, a chaplain at the University of Cincinnati Medical Center and at Bethesda North Hospital, encourages children-in-law not to be afraid to take on such a project.

“Be natural and let them talk,” she suggests. “Start out light. They might surprise you and go deeper. Everyone wants to be heard and to leave a legacy. Telling one’s memories is healing. It can give someone an overview of her life, and help her see the arc and meaning of it. That’s a gift.”

“My sister-in-law did that when my mother-in-law was terminally ill,” says Rachel. “She interviewed her about her whole life — her childhood, her parents, what it was like when she was a newlywed, and how it felt becoming a mother the first time and then many times after that. She asked about what she was most proud of about each of her children,” something that might be difficult for a child to ask, what with sibling rivalry for a mother’s love.

The Peacemaker

Unfortunately, a crisis can be a catalyst for machlokes. This is especially the case when an entire family is experiencing anticipatory grief, which is often expressed through anger and loss of control over emotions.

“Though a crisis amplifies the level of sensitivity, it’s typically not all of a sudden — it’s usually a continuation of what’s always been,” says Deena Mendlowitz, clinical director of The Family Institute of Neve Yerushalayim. “For instance, there may be family politics that were in play before the parent got sick that are now being highlighted.

“But,” she continues, “we can look at the crisis as an opportunity. Sometimes an outsider, such as a child-in-law, can influence what’s happening in the nuclear family. They can bring people together by being supportive, considerate, and warm.”

When the child-in-law who’s keeping the peace is married to one of the children who is giving his siblings trouble, she’s doubly suited for the job. Mrs. Mendlowitz says that many relationships involve a triangle.

“Sometimes, two corners of the triangle have to create a relationship that doesn’t involve the third.” A child-in-law may be able to create a relationship that sidesteps the impasse that her husband has reached with his siblings, and then reboot their relationship on a different footing. “The goal,” says Mrs. Mendlowitz, “is to open a conversation that’s respectful, that allows each person to be seen and heard and validated.”

But fools rush in where angels fear to tread. Delicate situations have to be handled strategically. “People may be spontaneous and impulsive,” Mrs. Mendlowitz warns. “It’s often helpful to slow down, to be thoughtful about strategies that will be successful. Consider: ‘What will the impact be?’ and ‘How can I create messages that will be helpful?’

“Identify the message you want the family to hear, and think about who is the best messenger. There may be a doctor, a rav, or a child who everyone listens to, or there may be a child-in-law who fills those shoes.”

Fighting Denial

Rachel, whose mother-in-law had a highly aggressive cancer, saw that her husband’s family hadn’t grasped the seriousness of the situation. “My husband and I both work in health care. Maybe that made it easier for us to realize that she didn’t have a lot of time left. Many of my husband’s siblings didn’t understand her prognosis, and it was hard for us to tell them.

“Hashem can do anything, but she was getting more and more ill, and we were afraid they’d regret not having spent time with her in her last months. My husband was straightforward with his brothers and sisters. ‘You need to go visit Ma now,’ he told them, ‘because if you don’t, you’re not going to see her.’ ”

Denial isn’t stupid or naïve. It’s a coping mechanism. “We use it to protect ourselves. But it’s hard for people who are not in denial to watch, because it seems so foolish. That said, a family member’s job is not to break someone out of their denial. The person in denial knows what’s going on, deep down, but he needs the protection that denial offers.”

Children-in-law can protect the family by supporting and encouraging them, and only then offering them the tools they need to slide out of denial and start using other coping mechanisms. When children-in-law pitch in to help, saying, “I’ll be here for you” and “Let’s make a plan,” they give a feeling of safety.

“It’s not the in-laws’ place to tell everyone they’re unrealistic,” says Chaplain Karp. “They might ask, ‘Would you be open to hearing what a rav says, or a doctor who is also a friend?’ The job of a child-in-law is showing empathy and quiet support. The child-in-law can be there as a sounding board; family members may need to talk out their feelings before they can bring themselves to say, ‘I can see that she’s not likely to make it.’ ”

Caring for the Caretakers

When a terminal illness is prolonged, even for just a few months, caretakers can burn out. They may even suffer a more severe version of burnout called “compassion fatigue,” which takes the caretaker beyond exhaustion and leaves her feeling hopeless and indifferent about the patient’s care. The caretaker may exhibit pessimism and cynicism that are not normally part of her character. Irritability and sleep disturbances are also symptoms.

Since children of the patient are often at least part-time caregivers, their spouses will be the first to notice. The child-in-law who gets the whole picture, and yet is somewhat removed from it, can have an easier time organizing shifts to prevent caretaker burnout and compassion fatigue.

“This is where a lot of families fall apart,” says Chaplain Karp. “I see this a lot in the hospital. If there are already fracture lines, this is the place where they’re most likely to get worse. Some siblings feel they’re doing all the work while the others feel they’re just dominating.

“As an outsider, a child-in-law can talk without accusing. Use a spreadsheet or pie chart to put the problem into tangible focus. Once the problem is visual and clear, it’s not so hard to say, ‘He can only do three shifts a week. Who’s going to take over on Wednesday nights?’ Help your spouse convey his limits.”

Empowering caretakers involves talking to those around them. “It’s best done by someone who understands enough family history to know who is the most responsible child and how she got that role, and how to reach out to the siblings who avoid doing their share,” says Mrs. Mendlowitz. “Once the organizer has a clear idea of what’s needed, both financially and in bubby-sitting hours, she can communicate that in a clear, open, non-hostile way.”

They can also encourage the other children-in-law to be more supportive of the caretakers. Even a phone call extending moral support can be significant.

When Tova K.’s mother-in-law began suffering from dementia, her sister-in-law Baila couldn’t cope. Tova took over the care of her mother-in-law and saw right away why Baila had been overwhelmed — the hostility and suspicion, common in the early stages of dementia, were hard to live with. But her burden was eased a little when Baila phoned to say, “I promise not to believe anything she says about you if you promise not to believe anything she says about me.”

Even when caretaking is taken care of, all the children-in-law are going to have to extend themselves more than usual to give their spouses space. “Because the attention is primarily on the sick person, the family of the patient usually isn’t given a chance to talk about how they’re doing, to vent and process,” says Chaplain Karp. “Just caring about your spouse and listening to them, and supporting them in their pain and confusion and exhaustion, is huge.

“And if it feels like the family has lost their equilibrium, it’s because they have. Try to understand consciously what’s happening and accept it. The more conscious you are of what’s happening, the more you can support your spouse with grace, instead of feeling like the rug is slipping out from under you.

“Remember, it’s not going to be like this forever. Lean into that, and you’ll find the koach and patience you need to walk this path with dignity. If you can offer support, your spouse will be grateful that you covered for him and gave him the ability to focus on his parent.

“And sometimes,” Chaplain Karp concludes, “just keeping your mouth closed and remembering that they’re stressed and not their best can be the most challenging and important thing you can do.”

Delicate Decisions

When Veronica Tomasic’s mother, Jillian, entered the hospital, she temporarily became her mother’s decision maker in health matters. It was a natural fit because Ms. Tomasic, an attorney, is sometimes appointed by the court to make health-care decisions for patients who cannot make them for themselves.

“In my work, I’ll visit clients in the hospital and speak to the doctors and nurses about their care, as one professional interacting with another professional,” says Ms. Tomasic. But it was dramatically different when it was her own mother.

“I quickly learned that I’d entered an alternate universe as far as decision-making was concerned,” she says. “As a patient’s family member, I was an outsider. Doctors spoke to me warily and cautiously. They never offered information and were always in a hurry to move on, despite my best efforts to be concise when talking with them. Nurses seemed to be under orders not to say anything.

“I was constantly gauging how far to push, how assertive or compliant to be, to obtain the information I needed so I could make informed choices. It seemed that the hospitals functioned like vast conveyor belts. As a family member with questions and a need to know, I was a wrench in the works, interrupting the efficient production of medical treatment.”

In the past, families accepted whatever the doctor recommended, but now, families are more inclined to voice their opinions. Doctors are also more pressed for time than they used to be. And family members will be upset by bad news, while professional surrogates will not. So medical staff try to avoid time-consuming and emotionally draining interactions with patients’ families. “This has caused an erosion of the doctor-patient relationship,” says Ms. Tomasic.

The frustration of being kept in the dark about medical decisions is something many children-in-law are familiar with, but it’s often their siblings-in-law — not doctors – who are keeping them out of the loop.

“Normal families make you feel like ‘you’re my child,’ and if you’ve been married a long time, you’re lulled into thinking that — until it’s time to make major decisions for your parents-in-law,” says Dafna, a clinical social worker. “Then it’s clearly not your party. Parents have decided many years ago which child they’re going to rely on when they need help.” It’s usually a daughter, and daughters-in-law have to realize that, even though they may be the first to notice when a parent needs help.

“When my mother-in-law was in the hospital after a stroke,” Dafna says, “I stayed with her all day. I started making arrangements for her to be transferred to a rehab facility so she could learn to eat and walk again. Then my 20-year-old nephew walked in. He thought Mama could get the same therapy at home. He took her to his mother’s house — my husband’s sister — and the therapy never happened. Mama never walked or ate well again.”

That was a revelation to Dafna. It shocked her into realizing that her opinions would never make much of a difference. “When my sister-in-law let her son make such a stupid move, something in me snapped. I went crazy and started yelling at my husband. ‘I cannot believe the way you’re letting your parents be treated, I’d never let this happen to my parents,’ I told him. You get stuck because you love your parents-in-law, but I regret that I got so involved, because in the end, I wasn’t the primary caretaker.”

Dafna hasn’t abandoned her mother-in-law. “We have a policy that we’ll do whatever we can to help,” she says. “We take Mama to her doctor appointments and stuff, and my husband will gently point out realities he thinks his sister has overlooked, but it’s a delicate balance.”

Now her mother-in-law is supposed to get a feeding tube. “What am I supposed to do? It’s hard to step back,” says Dafna. “If it were my parents, I’d fight to the end to make sure they got the care they need. But that’s not my role here. Although I may not agree with what my sister-in-law is doing, it’s not my place to protest. She’s doing her best. And you come to realize that when you’re not in charge, maybe you don’t have the full picture.”

If siblings are working together to make decisions, communication is the only tool that can make it as likely as possible that everyone will come out satisfied. “Families feel they know each other well, and many family members assume that they know what the others want, or at least, what’s good for them. But assumptions are a poor basis for decisions.” The important thing is to listen. Let the other people know that you understand what they’re feeling. And then, they may be more willing to reassess the situation.

The New Normal

A wise child-in-law keeps an eye on her spouse in the weeks and months after shivah, says Chaplain Karp. It often takes a while for the new reality of life without a parent to set in. Feelings that are just beginning to surface may be overwhelming, and different things, like Yamim Tovim and simchahs, can trigger new waves of feelings. Kaddish is a big commitment, and caring for the surviving parent may also be pulling at one’s spouse.

“Because people’s reaction to crisis is to go into survival mode to protect themselves, the spouse of the bereaved may be the only one able to see beneath their functional public mask,” she says. The mourner may need his wife’s empathy and support more than he realizes.

A crisis can be an opportunity to shake up family relationships and move them to a better place, adds Mrs. Mendlowitz. Siblings who didn’t talk much can discover a common language when they’re forced together. Often, once the crisis is over, they stop communicating, but don’t let that happen, she says.

“Sometimes, an in-law is enough of an outsider to the family system to sense which dynamics could be nudged in another direction,” says Chaplain Karp. “They’re more open to new ideas for shifting the way the family interacts.

“There are so many easy ways to stay in touch. A family WhatsApp offers closeness and interaction without the stress of ‘too heavy, too much.’ An in-law, who’s not hurting as badly as the family, may find it easier to encourage her spouse and other siblings-in-law to share memories, send out questions, and encourage bonding. It can be an ideal way to draw out the quieter one who gets overwhelmed by the more dominant sibs in real-life gatherings.

After a family tragedy, it’s tempting to try to “move on.” It would be nice to keep moving, to put the sadness and any conflict the tragedy engendered behind us. But a death in the family is not a bone that will reset; it’s a change in reality that will never be reversed. A wise child-in-law will take advantage of it to gently massage family relationships into a healthier place.

(Originally featured in Family First, Issue 737)