When neurologist and writer Oliver Sacks learned of his terminal cancer diagnosis at the age of 81, he poignantly shared his mindset in a New York Times op-ed: “I feel grateful that I have been granted nine years of good health and productivity since the original diagnosis, but now I am face to face with dying,” he wrote. “It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can.”
While not everyone facing the end of their lives can or will take to writing widely-read Op-Eds in the New York Times, death, in its myriad forms, awaits us all and, as a result, so do the many facets of grief. Should you be facing your own mortality at this time, we hope these words can help in some way.
Be patient with your unique grieving process
There’s no set way in which we should or need to grieve, but by accepting that we will grieve, for however long and in whatever forms, is the first step in coping when you’re facing death.
Grief is a wide-ranging and complex emotion that manifests both mentally and physically. Perhaps you’ve lost your appetite and are feeling severely depressed, or perhaps you’ve immediately lost interest in the things that used to bring you joy. You might be feeling aches and pains in addition to your illness, be exhausted and sleep for too long, or find yourself experiencing anxiety and insomnia. You may be flooded with regret or guilt for things left undone or unsaid, or filled with anger at the world around you. You might feel that life is unfair.
All of these feelings are a valid, normal and most importantly, essential human response to facing one’s death. If emotions are like waves, then the emotions surrounding the knowledge that your life is coming to an end must be like tsunamis - there’s no swimming out of it, only clinging on until you find your footing again.
Even Sacks, prior to writing about his experience and thought-process, must have taken the time to grieve before he was ready to share his thoughts with the world. The most important thing for you to do right now is take the time to acknowledge and accept your grief in whatever shape it takes.
Explore the hope and even joy that can be found in uncertainty
In his posthumously published memoir When Death Becomes Air, Stanford neurosurgeon Paul Kalanthi describes the process of coming to terms with terminal lung cancer at the age of 35:
“The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.”
In the two years between his diagnosis and death, Kalanthi also became a new father to an infant girl named Cady, and part of what helps him come to terms with his death is both the writing process itself and the peace in knowing that his daughter will not only live on, but that she will have his words to remember him by.
“Words have a longevity that I do not,” he writes, before addressing Cady, “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”
While you may not feel called to write a memoir, don’t overlook the hidden pockets of hope, illumination and stillness that reveal themselves when you allow yourself the time to grieve. This can, like grief itself, take many shapes. Perhaps you’ll find the inspiration to pursue something you’ve always wanted to do, or repair a broken relationship that is meaningful to you. Or it could simply mean recalibrating how you spend your time, focusing on what matters most and thinking about what you’ll leave behind.
Prioritise the time you have left
Faced with his impending death, Oliver Sacks resolutely laid out a plan for the rest of his days:
“Over the last few days, I have been able to see my life from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.
On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.
This will involve audacity, clarity and plain speaking; trying to straighten my accounts with the world. But there will be time, too, for some fun (and even some silliness, as well).
I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends.”
Kalanthi, on the other hand, exhausted by his cancer, found peace within a different approach:
“Part of the cruelty of cancer, though, is not only that it limits your time, it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. But even if I had the energy, I prefer a more tortoise-like approach. I plod, I ponder, some days I simply persist.”
As with grief, there is no wrong or right way to spend your last days, only that you honour your true self and desires.
If it helps, try to get a clear picture of what the end might look like
The actual process of dying can induce fear in the boldest of us, and for many, remains one of life’s great mysteries. Just like the way we’re born into the world, our deaths - both our ideas and experiences - are equally unique to each of us.
Regardless of where you are in your grieving process, it can help to talk to both loved ones and professional carers about your fears and anxieties about the actual process of dying. Like putting a face to a name, understanding what the physicality of death entails can go far in helping you mentally prepare for and accept what’s to come.
A counsellor, doctor, or palliative care specialist are just a handful of professionals who can potentially walk you through what exactly happens as your body and mind prepares itself in the moments leading up to death. For many people, knowing what to physically expect can be one of the key steps to acceptance.
Seek and accept help
You may feel alone in facing death, but you are not. Whether you seek out the comfort of family and friends, or you want to talk through how you’re feeling with a professional, now is the time to get the help you need, for both your physical comfort and mental wellbeing.
The physical and emotional burdens of facing death are heavy that no one is meant to nor expected to go it alone. The aforementioned counsellor, doctor, and palliative care specialists are here to help you during this intense and often lonely time. You may benefit from specific therapies, including cognitive behavioural therapy (CBT), which has been proven to help terminal cancer patients ease unnecessary emotional and physical suffering, promote more meaningful interactions with loved ones, and improve your overall quality of life.
Likewise, many people have found specific support groups to be a crucial part of their overall support systems and emotional wellbeing. For even more tailored help, you and your family might look into hiring a death doula, a support person who can help you both handle and adjust to the administrative and emotional preparations necessary for end-of-life.
Though no single form of therapy or person can provide all the answers you might be seeking at this profound moment in your life, the connections you make now, both with others and with yourself can transform the way you interact with your grief and your legacy.
As Kalanthi writes, “Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete.”
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