To the Ones Facing Death
Letters to my patients, day 14
What would it take for you to find peace in the reality of death?
You find yourself caught up in the fear of it all. The diagnosis came unexpectedly, blindsiding you and your husband. It was October and harvest season was in full swing — he had enough on his plate, you didn’t want to be an added burden. That’s the main reason you remained silent about the back pain since it first started in May.
But when it became too much to handle, that ER visit told you both everything you didn’t want to know. Advanced pancreatic cancer.
Our first meeting was a chemotherapy education visit — one packed with information, medication reviews, symptom management — generally a long talk. But you were in pain, so we tried to keep things brief.
Once the treatment starts working, the pain should improve as the mass shrinks.
I say this naively. My experience with stubborn cancers is limited and this will be a lesson in setting realistic expectations for future patients.
This statement was not wrong, the chemotherapy should shrink your tumor and that should relieve your pain. But you should also know, that would be the best case scenario. And not every case is the best case scenario.
Yours wasn’t.
We fought hard, side by side, for 2 months — lengthy visits managing symptoms, working with the palliative care team to find relief, trying new medications, your 2 hour drives from the farm into town. I’m sure it was all a haze as you went through the motions.
It was Christmastime when I heard the news. You were admitted to the local hospital and had decided to go on hospice. Comfort cares only, no more chemotherapy. A noble choice, as the time we had been buying you wasn’t worth its weight in gold.
But I still wonder, were you scared of death or ready when it came? Or both.
You were the first patient I walked alongside from diagnosis to treatment to death. At least, to the notification of death. I wish I could have been beside you in the hospital too, holding your hand in solidarity.
While I ruminate on many aspects of the care I provided for you during those two months, I recall being so caught up in managing your symptoms that we did not discuss death itself. My only consolation is that, close to the end, you had a wonderful palliative care doctor who was likely having this conversation with you. But someone should have told you sooner. We should have talked about death.
I would have asked how your grandkids were taking this diagnosis, if your children were planning a visit, what the holiday plans were. I would have told your husband to make sure someone else was in charge of Thanksgiving dinner, you needed rest. And then I would have stopped tip-toeing around the conversation and asked how you felt about dying.
Does the thought of death scare you? What do you believe about death and any life after that? Why does that make you fearful? Do you have any unresolved conflict? Are you able to reconcile with your loved ones? Do you feel satisfied with the life you lived? Are you holding back or being open with your family? Have you told your husband how you feel, about all of this? Do you think you are ready to die?
I’m not sure how I would answer that question, currently I am not ready to die. But I am comfortable with the idea of dying, at peace with the knowledge that death will come for each of us. There is a difference between being okay with it and being ready for it.
In order to be ready for death, ideally we would have taken the time to think about it before it happens.
I hope that you were ready when your time came, that you found comfort in your husband’s support and family’s presence, that you embraced the anticipated rest with a peaceful heart.
And next time, let’s talk about dying sooner than later.
When you are faced with the reality of death, take what you need:
It is okay to be afraid about death.
I have lived a good life — it was not perfect, but I did the best I could.
I will find those I have wronged and attempt to make things right.
Goodbyes are painful, but my family will heal through their grief.
I will release the expectations I have had for my life and make peace with dying.
I will continue to take it one day at a time.
Thank you for being here,
Recommended reads:
“You only die once - make it memorable for others.” A story of how death can be more than a time of sorrow.
An excellent explanation and why I wish I could sit alongside my patients during their last days of life — we have already been through so much together.
“The zip code for death is always located in some other land than where we live.” We often avoid thinking of our own death, but there does come a time when we need to.
This is part of a 31-day series of letters to my patients — those undergoing a work-up, diagnosis, or treatment for cancer. Topics are also focused on those caregiving and supporting individuals affected by cancer. This is not an easy journey, but you do not have to do it alone.
This is not intended to be medical advice — please consult your healthcare team for individual medical expertise. *Multiple details changed for patient protection while maintaining the integrity of the story.
Let me know what topics you hope to see this month! I have many of the days filled, but not all of them. I would love to hear your thoughts, experiences, or questions.
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