Finding a silver lining

As a palliative care physician, I have had the unique experience of being at the bedside of thousands of dying patients. Arguably, this has given me a window into the most mysterious chapter of life.

Let us define ‘dying’ as a process that starts sometime in the last year of life. For most, the thought of our own dying is often buried under a convenient blanket of functional denial. But, not for me.

This would be counterproductive, even impossible, in my field of work. Although I’m not ready to die, I’m not scared. When it comes to dying, there’s no better counsel than this; learn to accept this inevitable phase of life, learn to accept that our very existence is transient.

My advice? Take the proverbial blinders off and find your bliss even in the last year of life. Ironically, facing, instead of fighting, mortality can be liberating.

You will see it coming

Approximately 90% of Canadians will die from a progressive life-limiting illness. Others will die of more sudden causes. This means that, unlike a sudden death, most of us will have the luxury of time.

At some point in our life we will be diagnosed with a condition or two that will move through predictable stages, like an illness ‘table of contents’. The last chapter won’t appear out of nowhere; rather, it will come in sequence. As a result, the benefit of knowing when our time is limited, is that we are then free to plan how we want to spend the last year of our life.

You can remain hopeful

Some argue that if we face, head on, the limitations of human existence that we threaten our ability to maintain hope throughout an illness. This is not my professional experience. Most people can, and do, remain hopeful throughout their entire illness journey with one caveat; hope can only be resilient if it changes naturally as a person moves through each illness chapter.

When matched with the reality of the illness, hope can remain as high in the end as it was in the beginning of the illness. For example, right after a diagnosis, people may hope for curative treatment. Later in the illness, when this is no longer possible, they may hope for alternate treatment options. Hope in the final chapters may focus on quality of life, good symptom management, the wellbeing of a person’s family, or for a peaceful death.

Hope is not quashed by illness unless it is stuck in an unrealistic earlier illness chapter. Hope can evolve if you keep it real. Be brave enough to go through the illness journey armed with realistic information about the big picture and a long view of the illness.

Don’t get stuck in the wrong chapter.

Grieving starts the healing before death

When patients and families are properly ushered with truth throughout their illness, they subconsciously begin the grieving process even before the death.  This may sound horrible, but actually it can be therapeutic.

For the patient, it enables them to reconcile losses and this can help them prioritize what’s most important to them before they die. So, a person may grieve the loss of their ability to work any longer, but then move on to marvel at the time they can now spend with their family.

For family, this preparatory grief readies them for the inevitable loss of their loved one. When the person has passed, much of the grieving has already occurred and they may be surprised to find themselves more ‘okay’ than anticipated. The bereaved may experience a more gentle landing because they knew it was coming and grieving had already started.

In contrast, when people die suddenly, there is no time to prepare our hearts for the loss. A less obvious challenge is when people are in such deep denial about their illness, or the advancement of their loved one’s illness, not only does hope get stuck, the death will unnecessarily feel sudden instead of expected.

Role-models of humanity

Dying is a stage of life that has a ‘bad rap’.  But the truth is, it is riddled with important life lessons. A dying person has the chance to demonstrate bravery in the face of their illness and strength of personhood even though the body is weakened. They can show the people around them how to humbly accept help and care when they can no longer do for themselves.

The dying still teach the rest of us about being human. This important role-modelling can bring great meaning to a dying person’s existence.

Families are also great mentors. Their selfless accommodations, commitment, compassion, and vow to ‘honour and care’ for their loved one is palpable to those around them.

Don’t worry about a dramatic ending

The dying process itself isn’t peppered with pain. It is marked by weakness, low energy and loss of appetite over a period of time. It is a fading, like a light dimmer, not a switch. It is a chapter, not a page. There is time to make this chapter as meaningful as other life stages, if you open your eyes, and face your mortality.

We readily pay homage to other stages of life…birth, puberty, teenage, young adulthood etc. Why not dying?  The more we pretend that it isn’t part of being human, the more we miss out on the silver linings when this chapter inevitably comes.

I’ve witnessed the angst and suffering that accompanies denial.

In comparison, those who can walk two roads balancing hope and truth, can exploit the benefits of knowing they have limited time.