Understanding Fear and Death

I thought about dying a lot, and what life for my family would be after I died. I was not paralyzed by this; but up until then—even while taking care of so many cancer patients who did not survive—the reality and inevitability of my own death was compartmentalized someplace way back in my brain, not a part of my conscious thought or everyday life. Then after the illness, the compartment door sprang open and it became front and center. You think about your illness and mortality every day—multiple times a day. Like breathing, it is always there and happens without thought. In some ways it was liberating as I made choices on a different timeline with my own, new sense of prioritization. We splurged on family vacations. I thought about what added value more than my previous duty-bound tasks. But the issue of death, my death, was there all the time.



Over the years, I think about it less. But it is still there; persistent.



If you talk to cancer survivors, it’s there for them as well. For a very long time. Forever.



So how is this of any use for all of you who care for cancer patients? Well, first of all, it’s a good idea to think of minority rights. Majority opinion does not always lead to the correct path. Many cancer caregivers believe we should publicly celebrate the completion of a patient’s course of chemotherapy. However, a minority of patients in your cancer center are fully aware that their death is right around the corner. Their prognosis is fully defined. Nobody is more important than these patients. They and their families are following their path as best they can, even if the path is palliative. Treat them with respect, consideration, and empathy. Consider that loud celebrations when another patient completes chemotherapy might be especially painful for them. Think about the patients who can’t help but think of their mortality. So conduct more private celebrations. Walk in the shoes of those who will not be with us next year…