The Power of Presence: How "What Do I Say?" Helps Us Face One of Life's Hardest Conversations

In a quiet hospital room, a social worker once found herself at a loss for words. A patient was dying, and the weight of the moment felt immense. Unsure of how to offer comfort, she turned to Dr. Rita Layson, a leader in hospice care in Greensboro, NC, and admitted, "I don't know what to say." That moment of vulnerability planted the seed for what would become "What Do I Say?"—a program designed to equip professionals, caregivers, and community members with the skills to communicate with the seriously ill and dying.

Now, more than two decades later, the "What Do I Say?" program, provided by Piedmont AHEC and AuthoraCare Collective, continues to guide participants through one of life's most difficult realities. Led now by Risa Hanau, MSW, LCSW, Clinical and Community Educator, and Debbie Garner, MSW, Social Worker, the program blends education, introspection, and shared experiences to help attendees navigate conversations about death and dying with compassion and confidence.

A Program That Stands the Test of Time
Originally funded by a grant, the program was developed with the vision of making its teachings widely accessible. "Once the program was created and copyrighted, it was sent to all hospices in North Carolina and South Carolina," Debbie recalled. "Eventually, it even became available through the National Hospice and Palliative Care Organization, reaching professionals across the country."

But despite its longevity and widespread impact, the fundamental need for this program remains unchanged. "One thing that hasn’t changed is that people are still desperate to learn how to interact and have these hard conversations," Risa said. "Societally, we still struggle to talk about death." Medical advancements have extended life expectancy, but they have not erased the inevitability of loss. And while people today are more proactive about healthcare decisions, many still lack end-of-life plans. The need for meaningful, informed conversations is as urgent as ever.

More Than Just a Class
While "What Do I Say?" began as a resource for hospice and hospital staff, its reach has extended far beyond traditional healthcare settings. Over the years, the program has welcomed participants from diverse fields—dentists, prison staff, private counselors, and nursing home administrators. "Death impacts everybody," Risa emphasized. "You may think you don’t work with anyone who’s dying or knows someone who is, but the reality is—you do."

This inclusivity has only expanded in recent years. The shift to virtual sessions during the COVID-19 pandemic allowed many participants from outside the Piedmont area to join, broadening the program’s impact. "Now we do one virtual session and one in-person session each year," Debbie explained. "That way, we can reach even more people."

A Shared Experience of Learning and Growth
At its core, "What Do I Say?" is about human connection. The program doesn’t just teach—it fosters deep, personal reflection. "We encourage participants to share their stories because we all learn from each other," Debbie said. "Risa and I continue to grow from these conversations."
One of the most poignant teaching tools used in the program is an unexpected one—the movie E.T. A pivotal scene, in which the alien E.T. lies sick and dying, mirrors the fear, helplessness, and emotional weight that often accompany end-of-life moments. "It’s an analogy for how people react to death," Risa explained. "E.T. is isolated, vulnerable, and unfamiliar. The mother in the film reacts with fear, the children with innocence and attachment. It sparks conversations about suffering, fear, and the different ways people respond to death." 

The program’s impact extends far beyond the classroom. "We see people leave with tools they can use—not just professionally, but personally," Risa noted. "They don’t just listen to a lecture; they experience it. They live it throughout the day, and they walk away knowing they’ve already begun to put these lessons into practice."

Creating a Safe Space for Difficult Conversations
Perhaps the most remarkable aspect of "What Do I Say?" is the sense of community it creates. Attendees often enter hesitantly, unsure of what to expect. By the end of the session, connections have formed, and conversations flow freely. "It’s almost support-group-like," Risa observed. "There’s something nurturing happening, even in an educational setting. Each class is different because of who attends and what is shared."
Debbie agreed. "One of the most sacred moments is when participants open up about their personal losses. It takes incredible vulnerability to speak about grief among strangers, and we hold those conversations with deep respect. We always check in throughout the day, making sure everyone is okay. And at the end, we often hear how much the program has meant to them—both professionally and personally. That’s when we know we’ve made an impact."

A Lasting Legacy
For 22 years, "What Do I Say?" has provided a space for learning, reflection, and connection. It has helped countless individuals—whether healthcare professionals, caregivers, or simply people navigating the reality of loss—find their voice in life’s most difficult moments.
"At the heart of this program is a simple, but profound, goal," Debbie said. "To give people the tools to have conversations that matter. Whether it’s silence, a well-chosen phrase, or simply being present, we help participants find what works for them. And in doing so, we help them be there for others in the moments that matter most."

Amber Wilkins, Continuing Professional Development Coordinator for Piedmont AHEC, works to coordinate all “What Do I Say?” sessions. “I have seen first-hand the conversations that happen in these rooms with Debbie and Risa,” she said. “These difficult conversations are ones we all must face, and I am proud Piedmont AHEC helps provide this opportunity for our community and beyond.”

Piedmont AHEC is proud to present the next "What Do I Say?" session is taking place on March 14, in-person at AuthoraCare Collective in Greensboro, NC. To register for this unique program, click here.