Four Things Matter Most: Don’t Wait Till Death Approaches to Use These Words

Four Things Matter Most (photo of author Ira Byock, M.D.)

Ira Byock, M.D.

“Love and death are the two great gifts that we pass on—and usually they are passed on unopened.”  —Rainer Maria Rilke

By Cat Saunders

Gather your courage and consider this scenario: You’re sitting quietly at home when the telephone rings. You answer it and find out that the person closest to you has just been killed in an accident.

After the shock, and after you get the necessary details, what’s your first thought? If you’re like many people, you might think back to your last interaction.

Did you share a leisurely meal together, or were you both rushing about frantically? Were your last words friendly, or had you been arguing? Did you take time to embrace before parting ways, or did you forget to even say goodbye?

Most importantly, were you up to date with each other—no unfinished business, no unexpressed appreciation, no “I love you’s” left unsaid?

When I was 12 years old, my best girlfriend died suddenly and unexpectedly. In between waves of shock and grief, I felt guilty about some things I’d said to her in the weeks before her death. Although I’d also been supportive, my hurtful words still haunted me.

Thus, at the ripe old age of 12, I vowed to treat people as if each time I see them may be the last time I see them.

This doesn’t mean I don’t have disagreements with people. Nor does it mean I don’t struggle sometimes with unresolved issues with family or friends. Sometimes I act like a total ignoramus, and sometimes when I act responsibly, people still feel hurt by me. Nonetheless, I aspire to uphold my vow.

There are four things that help me stay on track with this. I first heard about these things in 1985, when I met one of my most important spiritual teachers, Dr. Ihaleakala Hew Len.

In those days, Ihaleakala traveled the world with the Hawaiian kahuna, Morrnah Nalamaku Simeona (now deceased). Together they taught a forgiveness process called Ho’oponopono to thousands of individuals and organizations, including the United Nations. Ihaleakala still teaches Ho’oponopono, which is designed to cut and clear karmic ties.

In addition to teaching me Ho’oponopono, Ihaleakala taught me that there are only three things worth saying.  This three things are: I love you, I forgive you, please forgive me. Over the years, I’ve noticed that Ihaleakala (ee-ha-lee-AH-ka-lah) is also big on gratitude, so it would be fair to add “thank you” to that list.

Because Ihaleakala taught me the power of those four phrases, I was excited when another man I deeply admire wrote an entire book on the subject. The book is by Ira Byock, M.D., and it’s called The Four Things That Matter Most (Simon & Schuster).

Dr. Byock is a nationally recognized authority in palliative and end-of-life care.  He currently serves as Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire. Ira came into my life in 1999 when I interviewed him about his first book, Dying Well, as part of my series of articles on death (see “The Remarkable Value of Dying Well“).

When I first read Dying Well, I was deeply moved not only by the stories, but by the physician telling them. Ira is a natural-born storyteller with a heart as big as the sky. When he talks about his patients and their families, it’s as if you’re there with them.

Ira’s stories in The Four Things That Matter Most are equally poignant. In the face of serious illness and impending death, he shows how people can use the Four Things to heal relationships and transform their lives. The four guiding statements he offers are: please forgive me, I forgive you, I love you, and thank you.

Through humankind’s earliest form of teaching—storytelling—Ira’s books make it easier for people to “try on” different ways of being with death and dying. However, as Ira makes clear in his books, you don’t have to wait for illness or death to help you grow.

As long as you’re here, it’s not too late to use the Four Things to clean up unfinished business and breathe new life into your relationships. Don’t wait. Connect with those you care about and speak from your heart: I love you…I forgive you…please forgive me…thank you. These are the four things that matter most.


This article was originally published in Evergreen Monthly (April 2004) and updated in November 2016.

To contact Dr. Ira Byock or learn more about his work, please visit irabyock.com.

For more information about Ho’oponopono, you can read Cat’s interview with Dr. Ihaleakala Hew Len, “100% Responsibility and a Hot Fudge Sundae.”



Cat Saunders, Ph.D., is a counselor in private practice in Seattle, Washington. She is also the author of Dr. Cat’s Helping Handbook: A Compassionate Guide for Being Human (available through Amazon). Contact Cat by emailing her or by calling 206-329-0125 (24-hour voicemail).