So in my theory classes we were having a discussion and focus on end of life care. Within the next couple weeks, I had the pleasure of working with a patient that had newly been diagnosed with cancer in my clinicals.
That may not sound like a pleasure, but this person was. Honestly, there was a steady flood of calls and her designated visitor was attentive, so we did not have a lot of opportunity to talk over anything deep, other than her immediate needs and my immediate obligations to those needs. This individual was optimistic and vibrant, feeding as much support into her support network as she was receiving, from the look of it.
Cancer is one of those places where a lot of people have to think about their own mortality for the first time, a part of why I think it has such a significant place in the cultural conscience. Everyone's first understanding of death is uniquely their own (a pet, a grandparent, or whatever else), but there is a common thread of humanity that grows out of it. Our temporality is what makes so many things worthwhile, knowing that time is limited gives us push and motivation to do a number of things even subconsciously.
I can hazard a guess at what they might have been feeling, but I certainly won't claim to know for surety. This individual was old enough that they had likely experienced death and loss before, enough to have an understanding. However, there' something very different in facing one's own mortality. We have some feelings of empathy as we start to learn and apply the concept of death, yet my experience is that it's a wholly different beast when it is applied to oneself. My guess is that this individual was processing some in the background but mostly seeking to reassure their loved ones, to keep them from worrying. They also talked about their faith in no uncertain terms, which was a great source of comfort. I feel this was probably a mix of both faith and bravado. I do not discount their faith at all, but when there are that many platitudes flying around, I have to wonder if they're covering for or preventing genuine processing.
It happened that I was able to run into this person again on another clinical day. The feeling in the room was very different. There had been some complications--they were exhausted, hurting, and feeling at least a little miserable. That doesn't mean that faith was any less strong, but they were discouraged in that moment. It hurt my heart to see that change, from the vibrancy to that ominous quiet. I took some time to ask them about a project they had told me about the first time, something that was near and dear to them. We walked in the hallway. There was a minor procedure that I volunteered to help with, partly to spend some additional time in that room; I lingered specifically, just to be present. And there were a couple of flashes of a true smile and other times where quiet companionship was more important.
That place was familiar, too. I've circled the drain a couple of times before--there is an interesting point when one realizes "oh, this might actually be it." I distinctly remember thinking that I didn't care how it was over anymore, whether I got better or died, just so long as it was over. And I was okay with that in the moment. There would be more processing and grief to work through later--still is--but I remember that moment with clinical detachment. It was a simple fact. Death was okay. Death is a thing that is. In my experience of that circling the drain moment, I opted not to accelerate death's timeline, but I wasn't going to deny it either and that was a heavy thing to process later. And there was peace in letting that go, in simply waiting and not demanding one outcome or the other. That's what the final threads felt like to me.
I don't think this patient was that far--there was a lot yet that we could do and try for them--but I think they had a growing awareness that some of those places existed. Or maybe I am projecting far too much on them. But I had to think again on my own thoughts and opinions of death, how I got to those conclusions, and whether those ideas needed additional scrutiny by seeing components through another person's eyes. I did a fair bit of listening that day and plenty of my own thinking.
We don't know how to talk about death in our culture very well. Persons that need to talk about it can be brushed off and hurt when they don't feel heard--think about a family member that refuses to talk about a particular family member dying, who refuses to acknowledge it let alone discuss funeral arrangements and last wishes in advance. On the one hand, I get that it's upsetting; on the other, I've seen it directly hurt someone and heard plenty of stories where not having the discussion when there was a chance has led to some serious issue with the surviving family, both on the pastoral and medical side of the conversation. I feel strongly that there is more harm in not talking about death, that there is a significant disservice in brushing those discussions off until they are forced upon you.
Death is a driving force that makes us human. Remembering that there is a lack of permanency gives me far more encouragement than it does dread. There is hope in that. I can direct pieces of that motivation. I have power to do things today and a finite amount of time to consider what is and is not important to me. While I don't look forward to losing a loved one or the dying process, I do not fear death itself.
Hell of a proclamation, maybe, and concerning, too, to folks that might feel I have clearly thought about death too much, yet there we have it. Not talking about death has not helped us--there are a number of different defense mechanism that we can utilize to help us through some of the more uncomfortable parts. Personally, I prefer humor, and I daresay that it's a common thread in the medical world to develop a dark sense of humor as part of that coping. That is the only way some folks CAN talk about it, as a punchline, but we can't always stay there. Sometimes, a bit more reflection in chewable pieces makes the reality of it a bit easier to swallow.
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