I was probably forty or so the first time I heard the expression "an elephant in the room" meaning that there is something VERY BIG and most likely PAINFUL to talk about. We all know it, we sort of allude to it but no one actually says "it". We keep dancing around the topic and never bring it up. Then after some time has gone by, we all somehow feel more comfortable having said nothing about what is really looming on the horizon.
Often that is what a visit with a hospice patient is like. So instead of hearing or sharing some profound thoughts about death I get something like: "It is important to keep your legs working, without them you're in trouble." Then the real evasive stuff is always wrapped in some comment about stuff from the past: I had a friend who always named her bird "pretty boy." As soon as one died, she got another and called it "pretty boy." There is always the old stand by, "I'll probably be going home soon, I wish someone would tell me what's going on."
This past week on one of my visits it was apparent to both the patient and myself that the end was coming very soon. Again no conversation about it but the eye contact was way more telling than in the past and that hug goodbye, well, it might have been.