07/30/2026
This comes from my new book, "When Words Have New Meaning,” which is a reflection on the way life, especially love, loss, grief, and the sacred work of end-of-life care, reshapes the words we always thought we understood.
In this chapter, I sit with the word "quality," a word we use so easily and so often. My hope is that, as you read this, it might begin to feel different, that it might expand, deepen, or settle in a new place within you. Because sometimes a word we have spoken our whole lives is simply waiting to be seen in a new light.
"Quality"
It is a word we use easily, casually, as if it is something that can be measured and ranked. Better. Worse. Enough. Not enough. But at the end of life, quality becomes something else entirely. It stops being about outcomes and starts being about presence.
There are moments when I have to say the quiet part out loud: we cannot change where this is going. The outcome is not something I can fix or reverse, no matter how much I might wish I could. And yet, this is where the work begins. Because while we may not be able to change the ending, we can change how someone lives inside of it.
Quality of life, at the end of life, is not about prolonging time, it is about softening it.
Of course, there is the physical, pain matters, breath matters, and comfort matters. I want bodies to hurt less, to struggle less, to rest more easily. That part is obvious, and it is essential. But quality does not stop at the body. If it did, the work would feel incomplete.
Quality is also emotional, it is psychological, and it is spiritual. It lives in the questions people carry and the fears they don’t always say out loud. It lives in relationships that feel unfinished and in stories that are aching to be told one last time. It lives in the need to be seen as a whole person, not just as a patient whose body is failing.
Sometimes honoring quality means knowing when it is not my role to lead. There are social workers who hold the complexities of family dynamics, chaplains who tend to matters of faith, doubt, and meaning, and family members who know the history, the humor, and the rituals that make someone feel like themselves. Quality of life is often a team effort, whether spoken or unspoken.
And sometimes, quietly, unexpectedly, it means sitting at a bedside. It means listening.
When someone begins to talk about what they are experiencing, I don’t rush to organize it or solve it. I let it land. I hold their words. Occasionally, I hold their secrets. Not to carry them forward, but to keep them safe in that moment, to let them know they are not alone with what they are feeling, and that their story matters, even now. To me, this is quality.
It is dignity without conditions. It is autonomy, even as independence fades. It is asking, again and again, “what matters to you right now?” and then doing our best to honor the answer. Sometimes the answer is relief from pain. Sometimes it is being at home. Sometimes it is a familiar voice, a favorite song, a hand to hold, or the simple comfort of being treated with respect. At the end of life, people need to feel held. Not fixed. Not hurried. Held.
They need to know that their wishes matter, that their needs are not an inconvenience, that their life, right up to its final moments, still has meaning. Quality of life, in this space, is about creating gentleness where we can. About making room for comfort,
connection, and care, even when everything else feels out of control.
We may not be able to change how the story ends. But we can change how it feels to live inside the last chapters. And sometimes, that is everything.
xo
Gabby
You can find my book here:
https://a.co/d/04BBJsdp
