Cover image for The four things that matter most : a book about living
The four things that matter most : a book about living
Byock, Ira.
Personal Author:
Publication Information:
New York : Free Press, [2004]

Physical Description:
viii, 227 pages ; 23 cm
General Note:
Includes index.
Format :


Call Number
Material Type
Home Location
Item Holds
BF637.C45 B93 2004 Adult Non-Fiction Non-Fiction Area
BF637.C45 B93 2004 Adult Non-Fiction Non-Fiction Area

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Four simple phrases -- "Please forgive me," "I forgive you," "Thank you," and "I love you" -- carry enormous power. In many ways, they contain the most powerful words in our language. These four phrases provide us with a clear path to emotional wellness; they guide us through the thickets of interpersonal difficulties to a conscious way of living that is full of integrity and grace.
In The Four Things That Matter Most, Dr. Ira Byock, an international leader in palliative care, teaches us how to practice these life-affirming words in our day-to-day lives. Too often we assume that the people we love really know we love them. Dr. Byock reveals the value of stating the obvious and provides insights into how we burden ourselves by hanging on to old grudges unconsciously and unnecessarily. He shows us how to avoid living with those awkward silences and uncomfortable issues that distance us from the people we love and erode our sense of well-being and joy. His insights and stories help us to forgive, appreciate, love, and celebrate one another more fully.
The inspiring stories in The Four Things That Matter Most demonstrate the usefulness of the Four Things in a wide range of life situations. They also show that a degree of emotional healing is always possible and that we can experience a sense of wholeness even in the wake of family strife, personal tragedy, divorce, or in the face of death. With practical wisdom and spiritual punch, The Four Things That Matter Most gives us the language and guidance to honor and experience what really matters most in our lives every day.

Author Notes

Ira Byock, M.D. , is a leading palliative care physician and longtime public advocate for improving care through the end of life. He is past president of the Academy of Hospice and Palliative Medicine and cofounder of Life's End Institute: Missoula Demonstration Project, Inc., a community-based research and quality improvement organization focused on end-of-life experience and care. He heads the national Promoting Excellence in End-of-Life Care program for the Robert Wood Johnson Foundation. He is director of palliative medicine at Dartmouth Hitchcock Medical Center and a faculty member of Dartmouth School of Medicine. More information is available on

Reviews 2

Publisher's Weekly Review

Byock, a physician specializing in end-of-life care, argues that four crucial phrases-"I forgive you"; "Please forgive me"; "Thank you"; and "I love you"-are the key to improving important relationships. Gathering poignant and uplifting examples from his palliative care work at Dartmouth Hitchcock Medical Center, Byock shows how "these four short sentences carry the core wisdom of what people who are dying have taught me about what matters most in life." (As the publicity sheet would have it, this is like "Every Day with Morrie.") Healing is always possible, Byock says, even after years of distance or rejection; he tells, for example, of a cold father who re-engaged with his family months before his death in a freak accident, and of a man dying of colon cancer whose gratitude for a good life made his passing less painful. This is important, inspirational stuff, but while Byock allows plenty of page-time for patients and their loved ones to explain the joy of reconnecting, little room is left for them to describe how they got to a place from which they could reach out. A caring counselor, or Byock himself, usually acts as the catalyst for healing in the cases described; it seems this book is designed to play the same role for readers, but there's no saying that things will go as smoothly as they seem to on the pages. Byock's enumerations on his ideas sometimes overlook the complexity of most lives: "Live each day as fully as possible" might be a tall order for someone railing against a debilitating or terminal disease. Still, few readers will be left unmoved as they ponder their own and loved ones' mortality through Byock's fervent call to reconciliation. (Mar.) Copyright 2004 Reed Business Information.

Library Journal Review

The very same words that allow a life to end peacefully can help readers lead tranquil, meaningful lives. In his work as a palliative care physician, Byock (director, Dartmouth Hitchock Medical Ctr.; Dying Well: The Prospect for Growth at the End of Life) has witnessed the incredible power of four simple sentences: "Please forgive me," "I forgive you," "Thank you," and "I love you." With considerable empathy and wisdom, he introduces and draws conclusions from his patients' stories. In doing so, Byock also potently demonstrates how readers can use the four sentences to help fill their "instinctive impulse to give and receive love" and heal rifts. Like Barry Neil Kaufman's No Regrets: Last Chance for a Father and Son, this is narrative self-help; while it will suit some readers, it may irk those who require to-do lists and points of emphasis (for that, see Harold H. Bloomfield's Making Peace with Yourself). Fine for large self-help collections and essential for hospice collections. (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.



Chapter One: Saying the Four Things Please forgive me. I forgive you. Thank you. I love you. These four simple statements are powerful tools for improving your relationships and your life. As a doctor caring for seriously ill patients for nearly 15 years of emergency medicine practice and more than 25 years in hospice and palliative care, I have taught hundreds of patients who were facing life's end, when suffering can be profound, to say the Four Things. But the Four Things apply at any time. Comprising just eleven words, these four short sentences carry the core wisdom of what people who are dying have taught me about what matters most in life. The Wisdom of Stating the Obvious Ask a man who is being wheeled into transplant surgery or a woman facing chemotherapy for the third time what's on his or her mind and the answer will always involve the people they love. Always. The specter of death reveals our relationships to be our most precious possessions. I've lost count of the number of times I've met people in my office, an emergency room, or a hospice program who have expressed deep regret over things they wish they had said before a grandparent, parent, sibling, or friend died. They can't change what was, but without fail their regrets have fueled a healthy resolve to say what needs to be said before it's too late -- to clear away hurt feelings, to connect in profound ways with the people who mean the most to them. Everyone knows that all relationships, even the most loving, have occasional rough spots. We assume that the people we love know that we love them, even if we've had our disagreements and tense moments. Yet when someone we love dies suddenly, we often have gnawing doubts. We are all sons or daughters, whether we are six years of age or ninety-six. Even the most loving parent-child relationship can feel forever incomplete if your mother or father dies without having explicitly expressed affection for you or without having acknowledged past tensions. I've learned from my patients and their families about the painful regret that comes from not speaking these most basic feelings. Again and again, I've witnessed the value of stating the obvious. When you love someone, it is never too soon to say, "I love you," or premature to say, "Thank you," "I forgive you," or "Will you please forgive me?" When there is nothing of profound importance left unsaid, relationships tend to take on an aspect of celebration, as they should. A deep, natural drive to connect with others lies at the heart of what it means to be human. The Four Things can help you discover opportunities to enliven all your important relationships -- with your children, parents, relatives, and close friends. You need not wait until you or someone you love is seriously ill. By taking the time and by caring enough to express forgiveness, gratitude, and affection, you can renew and revitalize your most precious connections. The Practice of Good-bye It's been said that life is a sexually transmitted condition with a terminal prognosis. Having worked for years in close proximity to death, I have come to understand viscerally that we live every moment on the brink. We are, each one of us, at every moment, a heartbeat away from death. Seen against the backdrop of our certain mortality, our differences are dwarfed by our commonality -- and the importance we hold for one another. The stories in The Four Things That Matter Most are drawn from the experiences of people who have stood at death's door, and from their loved ones who learned to use the Four Things in their own daily lives. These stories inspire us to open to the potential for emotional wholeness at any moment in our lives -- even in our most troubled relationships. When I work with people who are approaching the end of life, I emphasize the value of saying the Four Things and I also encourage them to say good-bye. The Four Things offer essential wisdom for completing a lifelong relationship before a final parting. Thankfully, not all good-byes are final -- but good-byes can be meaningful. It's important to say good-bye in a way that affirms our relationship and acknowledges our connection to one another. The word good-bye derives from "God be with you," a blessing that was traditionally given at parting and, in some churches, still is. The protection and God's help of presence and guidance can be requested whether two people expect to be separated a few hours or forever. In leaving nothing unsaid, we can recapture this original meaning, so that, in saying good-bye, we are actually blessing one another in our daily interactions as well as when we face major life challenges or crises. It only takes a moment to shift the way you say good-bye from a reflex to a conscious practice. Your good-bye and your blessing can become treasured gifts to other people as you part. Expanding the Realm of the Possible Our world is bounded by our imagination. This may sound philosophical, but I mean it in a most practical, tangible sense. Helen Keller once wrote, "Worse than being blind would be to be able to see but not have any vision." When a formerly cherished relationship is marred by unkindness, bitterness, or betrayal, we often assume that healing is beyond our grasp, but this assumption can create a self-fulfilling prophecy. Do you really want to have such a limitation on your vision for your life? The extraordinary experiences of the people whose stories I tell in this book demonstrate that healing and wholeness are always possible. Even after years of alienation, of harsh criticism, rejection, or frustration, you can establish -- or re-establish -- authentic understanding and appreciation of others with the help of the Four Things. Even as people confront death (their own or others'), they can reach out to express love, gratitude, and forgiveness. When they do, they consistently find that they, and everyone involved, are transformed -- for the rest of their lives, whether those lives last for decades or just days. Stories and experiences of people who have courageously used the Four Things enlarge our vision and imagination, expanding the realm of the possible for us all. Restoring Closeness The Four Things are powerful tools for reconciling the rifts that divide us and restoring the closeness we innately desire. When bad feelings occur in our close relationships, we tend to put off the work required to make things right. We always assume we'll have another chance...later. That's understandable, but it's a mistake. Feeling resentful toward the people we love, or once loved, feeling distant from them, erodes our own happiness. A brush with death often instills in us a newfound appreciation for the gift of life. Simple pleasures -- a cup of tea, sunshine on one's face, the voices of our children -- feel like miracles. When we've had a close call that shakes us up, the anger we've felt toward people closest to us no longer seems significant. Ill will dissolves in love, appreciation, and affection, and we recognize the urgency of mending, tending, and celebrating our relationships. Because accidents and sudden illness do happen, it is never too soon to express forgiveness, to say thank you and I love you to the people who have been an integral or intimate part of our lives, and to say good-bye as a blessing. These simple words hold essential wisdom for transforming that which matters most in our lives -- our relationships with the people we love. Copyright (c) 2004 by Ira Byock, M.D. Excerpted from The Four Things That Matter Most: A Book about Living by Ira Byock All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

Table of Contents

Part 1 The Four Things
Chapter 1 Saying the Four Things
Chapter 2 The Healing Power of Words
Chapter 3 Completing Relationships
Chapter 4 Transformations
Part 2 Forgiveness
Chapter 5 Loved Ones Live On Inside Us
Chapter 6 Resolving a Legacy of Pain
Chapter 7 The Emotional Economics of Forgiveness
Chapter 8 Extreme Acts of Forgiveness
Chapter 9 Forgiving Yourself
Chapter 10 Living with Uncertainty and Illness
Part 3 Thank You
Chapter 11 Practicing Gratitude
Chapter 12 The Unexpected Grace of Reconnection
Chapter 13 The Family Dynamics of Gratitude
Part 4 I Love You
Chapter 14 Creative Ways of Saying the Four Things
Chapter 15 Loving the Body
Chapter 16 Living Every Day as if It Were Your First -- or Last
Chapter 17 Lives Intertwined with Love
Part 5 Good-bye
Chapter 18 Nothing Left Unsaid
Chapter 19 The Mysterious Magic of Some Good-byes
Chapter 20 Good-byes That Are Gifts Through Time
Chapter 21 Good-byes That Celebrate Life
Afterword Reflections Before Good-bye