"We're all going to die," is what my wife Kate used to say with both humor and anxiety as we sailed into heavy weather with our young children. It was mostly funny back then. Now, having come very close to my own death from cancer and having opened my clinical practice to couples and families dealing with cancer, I am living with our mortality daily. It's not getting easier. In the first months of my illness when I had very little chance of surviving a year or two, I had a kind of faux equanimity as in "I've been blessed with a good life. Everyone has to go sometime." etc. It drove my wife crazy. Oddly enough as I got better, finished chemo,and my odds improved, I got progressively more scared. The intial shock and psuedo calm wore off and I became in years two and three a hypochrondiacal shivering mess of fear. Mostly my wife and my doctors handled my relentless concerns with this or that symptom with a gentle tolerance. Kind of like the way I used to handle my wife's anxiety on my sailboat. hmmmmm.
In my practice, I am seeing an extraordinary range of coping strategies in the face of the implacable reality of encroaching death. As in my last entry, I want to give you brief glimpses of what transpires behind the closed doors of the therapy hour.
Here's #2
“I think we’re doing pretty well all things considered,” Henry started with a smile. He looked very thin, pale, and gaunt. Paula’s eyes filled again. Henry and Paula have been a very happy couple with three quite accomplished daughters. They describe having wonderful marriage, family life and professional lives. They’re last girl just entered Harvard. Nine months ago he got diagnosed with pancreatic cancer. It won’t be very long now and they both know it. They came into therapy really wanting to manage Henry’s illness and death as lovingly and carefully as they could for each other and for their girls. They have worked their tails off in therapy and immediately utilized any techniques, suggestions, and homework assignments I could offer. They both say that the taking daily alternating turns listening to each other i.e. "two of them paying attention to one of them at a time" is really helpful for them particularly because they are coping quite differently. Paula is a physician like my wife Kate and painfully aware of what going through this disease and death would look like. She was feeling the feelings for both of them. Henry was a surgeon and he was calm and steady in the face of his own incipient mortality which was sometimes very difficult for Paula to hear. So when it was her turn to be heard and held, he could bring his full kind and caring attention to her fears about what was going to happen, how the girls would cope, and even how she would go on alone. When it was his turn, she contained her emotions so that there was room for him to talk about his own vulnerabilities and grief. The thought of not being able to walk his daughters done the aisle ripped him apart. He had never been able to feel like he could talk about his feelings with Paula before because he felt his emotions would make her too upset.
In addition, last month, as part of helping them work with their daughters around confronting Henry’s death we met with the five of them they went through some family scrap books and shared favorite memories. The room was full of laughter and tears.
I enjoyed seeing Henry and Paula. I was very fond of them and felt very good about our work together. However, it was very clear that we were at the beginning of the end. Henry was beginning to get weaker and sicker. He had finished all treatment and was meeting with the Palliative care team and about to start Hospice. As I saw them walk out of todays session holding hands, I was haunted by the idea that the next time I saw him might be in the hospital, the next time I might see the girls would be at the funeral.
