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In addition to working toward
mutual understanding, gather all the medical information you
can from your doctor or from reputable sources such as the
national organization dedicated to your loved one’s condition
(e.g., the Alzheimer’s Association, the American Cancer
Society, or the American Heart Association). However, as much
as information from the medical side can supplement the conversation,
understand that these facts alone are not the only considerations.
Beliefs and emotional responses, no matter how unscientific
or irrational, are a significant part of how humans make decisions.
If treatment decisions do not match with the patient’s
attitudes and beliefs, he or she is unlikely to adhere to
them. To get cooperation, it is important that the patient
feel comfortable with how the decisions were made.
If your family is having trouble
with the decision-making process, you may want to call in
an objective third party for assistance. Social workers, clergy
and counselors are professionals who can help clarify values
and open lines of communication.
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Resolving difficult relationships
Recognizing that a serious illness
threatens the future, most families will benefit from creating
happy times together. If the patient survives, wonderful!
And if not, then you will have created a positive environment
for the weeks, months, or days he or she has left. It may
be that relations have been strained with the patient, who,
for example, may have been difficult in the past, or unavailable.
Many families have grudges that go back for decades. Although
it may be worthwhile to process past history, most of the
time, when faced with the possibility of losing a family member,
relatives decide that their feelings of love are more important
than their feelings of anger and resentment. Focusing on a
positive closure to the relationship becomes the highest priority.
Whether you are facing a terminal
illness or not, resolving difficult relationships is very
healing. It lifts a weight that lies heavily on the heart.
Resolution typically involves saying five things: "I
forgive you. Will you forgive me? Thank you. I love you. Good-bye."
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Extending and requesting forgiveness
Many people think that forgiving
means forgetting. The latter feels impossible, so they stay
forever stuck in the hurts of the past. In truth, it is not
possible to forget pain caused by another, especially someone
you had expected to be kind and nurturing. It is, however,
possible to forgive. Forgiveness means anchoring an event
in the past and understanding it in its own context. At any
given time, each of us is doing the best we can given the
circumstances and our abilities and resources. It may not
be the best that can be done or what we might do at another
time with 20:20 hindsight. Understanding this about ourselves
allows us to understand and forgive others. Hurts cannot be
undone, but we can choose to keep the pain alive or let it
remain in the past where it will not cloud the present and
the future.
Forgiveness is not always easy.
You may have to give up your anger, your justifiable righteousness,
or a special position in the family you hold because of what
was done to you. If you are having trouble forgiving, it might
help to talk with friends, spiritual advisors, or a counselor.
They can help you identify what you might "lose"
if you allow the other person’s actions to be laid to
rest.
Most who have forgiven even
egregious incidents describe the experience as very liberating.
The process gives you an opportunity to make a much-needed
connection with a person who at one time meant a lot to you.
Recognizing that the opportunity may disappear, many families
faced with serious illness take the plunge and find forgiveness
while they still have time to enjoy each other’s company.
For those who are asking for
forgiveness, you are taking a courageous and cleansing step.
Many people who accomplish this feel uplifted afterward and
relieved of a heavy burden of guilt. Although it can be frightening,
it is also liberating to honestly and humbly acknowledge your
shortcomings. Most people respond positively to a genuine
gesture of reconciliation. But even if the person you care
for responds with bitterness or is negative about your request,
rest assured that you have done something very powerful to
clear the slate. You have opened a place in your own heart
and served as a model for others to reach for their integrity.
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Showing gratitude
Thank-yous are free, and there
are not enough of them being passed around. Many terminally
ill patients have jokingly wished they could be present to
hear all the nice things people will say about them at their
funeral. So, why wait? Any one of us deserves to be thanked
for the many good things we have done during our lives. As
well, there are undoubtedly people in our lives who should
be acknowledged for their positive contribution. If you or
someone in your family is seriously ill, write a letter, make
a phone call. One family held a dinner while the father was
still moderately strong, and each of them told him what they
appreciated about him and how he had touched their lives.
Whether you are the patient or a family member, saying thank
you is one of the most powerful gifts you can give.
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Expressing your love
One day when comedian Steve
Martin was sitting in silence with his dying father, out of
the blue the father said, "I wish I could cry. I wish
I could cry." Despite his discomfort, Martin pushed through
and asked his father, "What do you want to cry about?"
To his surprise, his dad said, "For all the love I received
and couldn’t return." Later, when describing their
interchange, Martin reflected that it was "as though
an early misstep had kept us forever out of stride. Then,
two days from his death, our pace was aligning and we were
able to speak."
In the face of pending death
or later during the mourning period, one of the most-often
heard regrets is "I never got to tell him I loved him."
In her book Facing
Death and Finding Hope, Christine Longaker notes
that the deepest pain is often the love we held back. Although
there may be many valid reasons for holding back, people
who work with the seriously ill have found that priorities
change, especially near the end of life. One of the greatest
gifts of the process is realizing that it is our social
relationships that give life meaning. This realization is
as powerful for the patient as it is for family members.
Expressing our love becomes a top priority.
Although we may not feel comfortable
letting go of old positions and risking vulnerability, most
families find that taking this risk yields unimaginable positives.
If you are uncomfortable sharing your feelings in person,
you might want to write them in a letter. For those patients
who lack stamina, dictating the letter to a friend or hospice
volunteer is also an option. Interestingly, dictating to someone
who is uninvolved or whom you hardly know may make it easier
to express what is deepest in your heart.
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Saying good-bye
Havelock Ellis once said, "The
art of living lies in a fine mingling of letting go and hanging
on." This is true also of sickness and of dying. If healing
is the restoration of balance between mind, body, heart, and
spirit, there are times when that balance cannot be met by
the spirit remaining in a body that is losing its ability
to thrive. True healing, the release from suffering, may require
a shedding of our physical form.
It can be very difficult to
accept that death is imminent. We know in our minds that it
waits for all of us, but our hearts are not always willing
to agree. Sometimes we have trouble letting go because there
is unfinished business with a friend or relative. Sometimes
a simple "I love you" or "Please forgive me"
is all it takes to resolve even decades of unsettled dynamics.
If there are no unresolved issues in a family, it still can
be difficult for the patient to let go and surrender to the
inevitable when surrounded by all his or her reasons for staying.
For instance, many family members want to be present at the
moment of their loved one’s death. However, it is not
uncommon for a patient to pass away during the half-hour when
a nurse or volunteer remained while all the relatives left
a days-long vigil to get something to eat. Guilty as the family
members may feel at not having been there for the actual moment
of passing, it appears that many patients find it easier to
let go when those they love are not in the room.
Often patients know that they
are dying, and it is family members who resist the idea. One
man in his late thirties, dying of melanoma, related that
he had come to terms with dying but found it very difficult
to be around his mother. He "knew where he needed to
go," but each day she would visit his bedside with great
enthusiasm and energy. Ignoring the wasting of his body, his
difficulty breathing, and his struggle with pain, she would
exhort him to fight the disease: "We can beat it. You
just need to try." Much as he loved his mother, it took
considerable strength for him to weather her daily pep talks.
Of course she meant well, but her entreaties took valuable
time they could have spent reminiscing, enjoying his children
together, or just sitting and holding hands. Ultimately, the
last week of his life, she did accept that he was not going
to live. She was able to say good-bye and tell him that although
she would miss him terribly, she would be okay. She told him
that what she wanted most was for him to be comfortable and
to know that she was able to let him go. Soon thereafter he
slipped into a coma and then gently passed away.
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The "gift" of a terminal illness
Many people find that spending
time with someone who is dying actually teaches them quite
a bit about living. For instance, we don’t have to wait
for a terminal diagnosis to resolve conflicted relationships.
Anytime is a good time to wipe the slate clean and start anew
with people who have been important to you. Whether you have
a terminal condition and are actively dying or seem to be
healthy with decades yet to live, the truth is that we will
all die some day. Our time here is limited. The gift of a
terminal illness is that it encourages both the patient and
family members to spend the days they have left living the
way they wished they had spent all the days they have lived
already. Keeping relationships open, clear, and loving on
a daily basis is one way to limit your regrets when your own
time comes.
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