How on earth to follow Kate’s piece last week?  She spoke so eloquently about the words and the silences that are such a part of life when the elephant of dying is in the room. She also reminded us of how demanding it is to accompany someone towards their end, even for people who are experienced at it. When I started working for the NHS in the 1970s I was based at Cromer Hospital in Norfolk. Small though it was, at that time the hospital undertook quite major operations. The operating theatre was primitive by modern standards – there was no air conditioning, and when it got too hot the staff used to open the windows. From my office I could see and hear the surgery going on.  With the wind coming straight from the North Sea the rate of post-operative infection was low! What struck me then was the esprit de corps of the theatre team, and their often irreverent humour. I realised that the latter was a compensation for the underlying tension that is always there in theatre, however routine the procedure.  The unexpected was always lurking, as was the recognition that “getting it wrong” could well have disastrous consequences. Kate’s description of her relationship, as a therapist, with Pete, reminded me of the similarities in atmosphere between the operating theatre in Cromer and the hospice where I worked.  There too was the humour which acted so effectively as a safety-valve for tension.  Working day in, day out with people who are nearing the end of their lives brings staff and volunteers many encounters of an intensity similar to that of Kate’s with Pete.  Underneath there is always uncertainty as well. There is the inevitable uncertainty about the progress of the illness and the closeness of death, but also a self-questioning about the words and the silences.  People only die once – they only have one chance to get it right. This puts a lot of pressure on carers. How can they be confident about what should be said or done, and when? When we are alongside someone coming to the end of their life, one of the most creative and difficult things we can do is to listen. Listening involves much more than hearing spoken words. Communication can be primarily non-verbal.  We need all our emotional, mental and intuitive antennae to be working hard if we are truly to hear what is being said behind the words, or through the facial expressions or other body-language. To listen authentically in this way requires us too to listen to ourselves – perhaps even more difficult than listening to another. Developing an awareness of our own inner reactions, our fears and experiences, takes practice and is never complete.  Without it, though, it is so easy to be clumsy without realising it, or to blunder in without thinking because it makes us feel a bit better. Adequate caring of the kind I have described, and seen in action, requires a deep personal commitment rather than a so-called professional detachment.  It is a response of loving concern where two human beings meet in some of the most profound encounters that we can experience. Undoubtedly it is demanding, but immensely rewarding too. Duncan