Mr. C and his son have come to see Mrs. C, 65 years old. In a few days, it will be Easter weekend, an opportunity to perhaps get together as a family. A pleasant prospect they discuss with Mrs. C to take her mind off the distressing environment of the intensive care unit (ICU). As they have been doing for several days already, they adopt a positive attitude with the aim to comfort their loved one and to feed the illusion of a possible recovery. As they have explained to the ICU team, their strategy is to focus discussions with Mrs. C on her life outside the hospital, a life that might be waiting for her. It seems that there is no denial here about the gravity of their loved one’s situation. However, they have told the nurses that they hope that Mrs. C. does not suspect something. By doing so, they are also protecting themselves from what they imagine would be the impact of telling Mrs. C about her life-threatening prognosis. They have expressed concerns about what they would say to her, what they would talk about, what they could share with her if the certainty of her death was openly acknowledged. Open discussion about death is inconceivable for them at this stage as it would mean that each of them would have to deal not only with their loved one’s death but also with the possibility of their own death—a subject avoided by most people as it brings up a lot of feelings: anxiety, fear, awkwardness, sadness. Thus, the angst generated by this situation prevents an authentic meeting “here and now”, and so the family prefers to dream of meeting up “elsewhere and in the future”. In doing so, they avoid talking about death and can pretend that she may get better, come home and return to her previous life—at the risk of confiscating the patient’s voice and her capacity for action. They have opted for what sociologists Barney Glaser and Anselm Strauss [1] call “mutual pretence awareness”, where everyone involved knows the patient is dying, including the patient him/herself, but all pretend otherwise. It is different to “open awareness” (everyone can acknowledge that the patient is dying), “closed awareness” (the patient is not aware of his own impending death) and “suspicion awareness” (the patient suspects he is dying but no one tells him). Strauss and Glaser show that the expectation of death by both the dying and the relatives is a key to understanding the interactions between them.

At the request of the team, the psychologist is called upon to offer support to the patient. When she arrives at Mrs. C's bedside, her husband and her son are there, on either side of her bed. The intubation tube may have interfered with the interview, but noticing the slate near the bed the psychologist engages in conversation with the family standing before her. After introducing herself and offering to spend a moment with the patient in the presence of her family, the psychologist asks Mrs. C. if she has any questions she would like to ask or concerns she would like to express. Without hesitation, Mrs. C. grabs the slate and starts writing.

At the foot of the bed, the psychologist waits for the answer and observes the scene: Mr. C and his son, who read the words as Mrs. C. writes them down; who look at each other; and who silently move away, returning to their chairs on either side of the bed. Mrs C. holds out her slate. The psychologist reads aloud, lending her voice for a moment to this woman who does not have one: “"Death and leaving my whole family behind", these are your two concerns at the moment”. Mrs. C has generated an “open awareness context” [1] in which clinicians, family and patients all acknowledge that the patient’s condition is terminal.

These few words signal the end of the illusion of a return to normal life, they can no longer pretend. The way she seized the slate reflects her urgent need to express herself: Mrs. C. is asking to be recognised in her questioning and in her experience. Although her relatives could not talk to her about it, she knew she was living the end of her life. Mrs. C. lives and knows. She needed her loved ones to know. The disease does not make her gullible. Her strong character is preserved: this meeting has allowed her to say what she had to say. From her bed, without a voice, she was able to say that she knew and to ask that everyone recognise what she is experiencing. Thus, she managed to come out of the isolation in which she was trapped, even though she was at the centre of her family’s concerns. She actively resumes her place in her story: she refuses to be the object of a plot, but prepares to live this experience with them all. She has gained a sense of control as well as recognition of her personhood.