People approach the loss of a life in different ways. Many never consider that they can choose an attitude toward dying. For patients and caregivers alike, deciding on an attitude to deal with difficult times can actually ease the suffering that so often surrounds the dying process.
"Dying is easy; it's living that's hard," said a weary man to his wife after enduring several strokes and a heart attack. Elderly people who have been ill for a long time and have no hope for recovery may be accepting and even eager to hasten the dying process.
Other patients demonstrate such a determined attitude and such a mighty will to live that they almost convince others they will escape death. Actually, some do. In spite of all predictions to the contrary, even after facing a terminal diagnosis, they live on, at least for a while. Ray was not one of them.
At 54, strikingly handsome, with dark wavy hair and a tinge of gray at the temples, Ray was successful in all the ways the world admires. A powerful, self-made multimillionaire, he had a beautiful wife, two married daughters, and a grandchild on the way. Ray owned vintage cars, boats, a local mansion, and vacation homes in warm climates. He took pride in his benevolent control of a small empire; he established a model profit-sharing plan for employees; he gave generously to his church and community. However, a ruthless, fast-moving killer -- pancreatic cancer -- proved an invincible enemy.
I met Ray after he traveled the world in efforts to tame his beast or at least slow its relentless takeover of his body. Reluctant to enter hospice care because it represented failure to him, at the urging of his physician he finally agreed to hospice for pain and symptom management and for the support available to his distraught family.
Ray had a rage to live. Fighters like him do not give up easily. Familiar with power, they hate to relinquish control or lose any battle. No matter the odds, even when there is no cure, until the last moment they struggle to beat back death.
Ray explained, "I would give away everything I own just to spend one more day with my family. They love me; they depend on me; I see how devastated they are and I can't do anything to help them."
"No one ever died wishing they had spent more time at the office," goes an old saying. The closer people move toward death, the more they seem to realize what is most important in life. You can't work in hospice for very long before learning that loving relationships are the glue that binds people together after everything else -- titles, careers, awards, and material possessions -- melts away. In the end, the only wealth that mattered to Ray was his family.
Even as his body gave out, his ferocious spirit fought on. When he was encouraged to relax, he protested, "Don't you understand? If I relax, I'll go to sleep. If I go to sleep, I won't wake up." Ray was right. When he finally closed his eyes out of exhaustion, he died almost immediately. Acceptance was never a choice for him.
If Ray was at one end of the attitude continuum, Morrie Schwartz was at the other. In Tuesdays with Morrie, Mitch Albom wrote about his beloved college professor who was dying of amyotrophic lateral sclerosis. ALS is a wasting neurological disease with no cure.
Morrie too grieved the fading away of his well-loved life, but he did so with an attitude of graceful acceptance that inspired admiration throughout the world. Morrie believed that true liberation is letting go of everything. Instead of fighting like Ray, Morrie took pleasure in spending his remaining moments with friends and family. Always the professor, sharing his bountiful wisdom, he reminded others that they are more than flesh and bones. With his model he taught that death is not terrible but the next phase of an eternal journey.
Not everyone clings to life with Ray's tenacity or faces the end of life with the grace of Morrie Schwartz. Ultimately, the meaning one gives to any life circumstance determines one's response. Everything can be taken from a person but one thing, and that is "to choose one's attitude in any given set of circumstances." In these words, Nazi concentration camp survivor Viktor Frankl wrote of his suffering in Man's Search for Meaning and thereby offered hope to countless others who feel helpless in the vise of escalating events.
"Don't be afraid to endure some emotional suffering," advised a hospice social worker. "Seeking to escape all suffering can interrupt or delay the process. Sometimes experiencing the darkness for a while allows us to move to a deeper place." Those who are willing to acknowledge and experience suffering, and talk about it with a trusted friend or counselor, may come to a better understanding of the meaning of their trials. Without seeking to avoid the process, they may achieve tremendous personal growth, compassion for themselves and others, and a new understanding of their purpose in life.
For patients and loved ones who choose a hopeful attitude, the wisdom of a hospice nurse may be useful. "Hope is the last thing to go," she said. "Almost everyone hopes for a long and healthy life. If we learn we have a life-threatening illness, we hope that the diagnosis is wrong, or that we will recover, or that the illness will go into remission. If a condition worsens, we are likely to hope to live as long as possible. Given only a short time to live, we hope to spend quality time with those we love. When only days remain, we hope to stay free of pain and anxiety and to find the words to express affection and gratitude to loved ones. When only hours remain, we hope that death will be peaceful. Hope reaches even beyond death; most of us hope that family and friends will remember us and that we will be together again."
November is National Hospice and Palliative Care Month. To learn more visit http://www.caringinfo.org