Hello again. Dr. West contacted me recently and stated that there had been a number of responses and question related the column I wrote on Death and Dying some time ago. He asked if I would respond to these wonderful people who voiced their concerns about this issue. I couldn’t believe that it been that long since I have written a column about anything, and I do apologize! I guess it is true that when people retire, they find that they are busier than ever! With Dr. West’s approval, I hope to remedy that situation, and promise to write at least two columns a month, especially if your questions and comments keep on coming.

I’ve read all of the comments from everyone and hope and pray that all of you are still with us. Several of you asked about the possibility of finding peace while living with knowledge that one has a probable terminal illness, and how to actually live knowing that you are dying.

Of course this is difficult and of course you are going to find yourself thinking about how this is going to happen and whether or not you will suffer at the end, and feel anger that this has happened to you, and grieve for your newly perceived “lost longevity”, and for the loss of everything and everyone you love. Every emotion and painful thought you experience is completely normal; all of us will experience some or all of these psychological and emotional stressors on a daily basis. The key is dealing with them to enable you to live to the fullest extent you are able while living with this knowledge and the treatment issues come with the territory.

There are several helpful ways to deal with the thoughts and stressors. First, do not try to suppress them. You will not be able to do so anyway. Acknowledge them, verify that they are realistic and that there is very little or perhaps nothing you can do about the factual situation. Once you have done that, play Scarlett O’Hara; tell yourself that you will think about this again tomorrow, but that for today, it is enough! Second, keep on planning to do things that bring you pleasure; whether it is visiting with friends, having dinner at a nice restaurant when you have enough appetite to enjoy it; spending time with family even if too many people around you make you anxious; limit people to one or two at a time and tell them why you need to do so. Plan to go to a movie, concert or other pleasurable event at a time when you are between treatments so you can enjoy the event with reasonable confidence. Third, don’t put off anything you have really wanted to do in your life. One of you mentioned using money that been saved for retirement to take a cruise you’ve always to take. I can tell you that’s what I would do! I would try to eliminate any possible regrets I have some control of; obviously we all have regrets about actions we may have taken in the past, but we have no control over these; try to control what you can! Don’t feel guilty about it either, remember, you may be making wonderful memories for those you leave behind! Another of you mentioned that all of these thoughts and stressors get in the way of enjoying the very, very precious time you do have left. This is so true, don’t let them rob you of whatever enjoyment life still has to offer! Dr. Goldberg mentioned that the time you have left is the most precious commodity in the world! Use it well!

Lastly, I would like to address the fear of pain and suffering at the end of life that so many of you expressed. Most patient’s physical pain is very well eliminated with so many of the wonderful medications available for this purpose. Many patients are placed on a Morphine drip that can be increased as required; this can be done at home with in-home health care, in Hospice care, or in the hospital. At some point while on a narcotic drip, the patient will become non-responsive, major body systems fail, and the patient will die. There is no pain and the patient is unaware at this point in time. If someone needs to speak to the patient to finish some unfinished business; the amount of the drug can be reduced to induce consciousness, however this will cause discomfort for the patient and should rarely happen. Patients and families should speak to their physicians about where they want to be as their terminal stage begins, what is expected to occur and how these symptoms will be handled by the physician. Pain is generally managed well no matter where the patient decides he or she wants to be when they die; suffering is an existential matter and is usually related to occurrences in life for which the patient feels remorse or regret. I would encourage anyone to try make amends wherever possible, and if this is not possible, to discuss these regrets with your Minister, Priest, or Rabbi. This is almost always immensely helpful and usually generates a more peaceful passing.

There is so much more that can be said on this subject. We have really only scratched the surface! Death and the process of dying is a huge mystery. I have been fortunate to be with many people at the moment of death and that has been an enormous blessing. However, like all of you, I know that when my time comes, I will experience all of the same fears, concerns, regrets, and grief that are part and parcel of the human process.

Bye for now!

Leah

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