by Charlene Thurston,RN,ANP,Director of Hospice,from Spring 1993 Hospice Currents Newsletter
As I’ve come to work with more than one-hundred people facing death, I have had opportunity to witness, up close, how ordinary men and women cope with the most challenging of life’s crises. – the diagnosis of a life-threatening illness. I’m often asked how people can endure living with such an ominous threat. As I’ve worked with many different people, I’ve noticed that there are those who come, after a period of adjustment, to cope fairly well, and can go on living, growing and loving right up until the final moments of their death.

There are others who, once they’ve heard their diagnosis, withdraw, isolate themselves from people who care about them, and,in a sense stop living fully before their time of death.

What accounts for these differences in response, and how can people move closer to the possibility of living life fully even in the face of death?

In my experience, I’ve noticed that people cope better if they allow themselves to face the diagnosis. As horrible and as painful as it may be, if they can look at it and allow themselves to grieve over it, instead of trying to block all thought of it from their minds, they then have a chance to move beyond their emotional anguish and use their energy to complete their lives. But in order to move forward at all, it is crucial not to become paralyzed by the fear of the diagnosis.

Reaching out for, and accepting help, information and support becomes very important. Often people have frightening ideas or fantasies about what is going to happen to them. (They might have known someone, or heard about someone with a similar illness and assume their illness will follow the same course.) Most lay people have little accurate information to draw upon, and often some planned time spent with a health care professional who will take the time to answer questions honestly and carefully, will do a great deal to allay fears. It is essential that all patients have at least one health care professional who is available, knowledgeable, compassionate and committed to being there for him or her throughout the course of the illness.

It is equally important that communication within the family be open and honest. So often I see patients who don’t discuss their illness with their family, and families which don’t discuss the illness with the patient. Each is trying not to upset the other, but meanwhile the subject is consuming their lives.

As I watch people who cope best, they are the ones who are open with their families about their feelings, their regrets, their plans, and who work together to face each day. Shedding tears is a natural way to release emotions. Patients and their families should not be afraid that someone may cry if a painful subject is discussed. Tears often bring people closer together.

Support groups are also valuable. They provide a safe opportunity in which to discuss with others who have a similar illness, any problems, fears,ideas and strategies for dealing with difficult issues. The camaraderie that develops among people facing similar issues is very helpful. Studies have recently been done showing the value of support groups.

Spiritual issues rise to the surface when one is faced with the possible loss of one’s life. Questions of the meaning of life, our value as individuals, and what happens after death are common. Remaining engaged in life, finding a sense of purpose even as the body fails, and feeling spiritually connected to a higher power help people find meaning in this difficult season of life and bring them to a stage of acceptance. The value of nourishing the spirit through meditation, prayer or connecting with nature cannot be overemphasized. The best possible preparation for facing and coping with a life-threatening illness is to live everyday with all our affairs in order, not only business affairs, but relationships as well. When faced with the end of life, it is important that people complete their “unfinished business”, saying, “I love you,” “I’m sorry,” “Thank you,” and “Good-bye” to those they care about. To have lived life fully, with a sense of hope, faith, love, and meaningfulness can keep us prepared.

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

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