Dr. Nuland opens Chapter 2 of How We Die saying, "No one dies of old age, or so it would be legislated if actuaries ruled the world." Later in the chapter he introduces a perspective on aging that can serve Healthy Survivors well.
When young parents are dying, they face the loss of everything they know and hold dear. Arguably their greatest pain is losing the chance to raise their child(ren). To help such parents find hope in desperate times, I offer a suggestion:
An Oncology Times article caught my eye: "Relieving Major Depression in Cancer Patients: Specific 'Biopsychosocial' Method Found Useful." It reviewed a study that addressed the impact of an intervention developed to treat depression, reduce stress and help patients develop coping strategies.
Sometimes I fear saying the wrong things when trying to comfort a bereaved friend. The temptation to say nothing can be strong. So to conclude this series on grief and acceptance, I've decided to share a recent letter to a friend.
But first, I want to mention that I expect to continue learning, gaining insights that will help me find gentler, stronger, more comforting words for future letters.
When I wrote the letter, it was the best I could do with what I knew then and where I was at the moment. Both my writing the letter and my sharing it here reinforce the notion that the best we can do is the best we can do. And the best is good enough.
If only we had access to an easier, less painful path through grief that heals. We can escape the pain of an incision if anesthetized while the two sides of the wound knit nicely together. In contrast, loss of a love causes pain, without which healing doesn’t progress.
The "medicines" that ease the pain of grief are facts and hope. May you find help in the knowledge it will not always be like this and that your pain reflects having enjoyed true love. May you find comfort in the hope that you always feel his love and that someday soon you begin to feel more joy than pain when remembering him.
I wrote the essay (below) after the death of a treasured colleague in the prime of life. For me, the message is applicable to the loss of a love of any age. I hope you find it comforting in some small way as you remember your loved one. May his memory be a blessing.
Patent Pending: The Measure of a Life
"So young!" I cry. "Too soon. Cut short, it feels. How could this be?"
The teacher nods sympathetically and then drops a hint, "Your measurement is wrong."
"You're wrong!" I think to myself, trying to hide my anger. "My numbers add up perfectly, every way I count them. I can calculate to the minute. To the second, if you like." I think longingly of all the days that he might have had, the dreams now gone forever. "I'm sure my numbers are accurate," I say, my veneer of calm slipping. "Which is why it's not fair. Not right. Surely, a mistake."
The teacher once again nods, “Your readings are correct, but look at your yardstick.”
"My ruler?" Suddenly I remember an afternoon in my youth when the world was a wonder and I was thirsty. I demanded the tall slender glass, absolutely sure it held more juice. When handed the stubby tumbler, I was furious. I got less, I protested. It's not fair! So my mother poured the contents of each glass into side-by-side identical measuring cups. At first, I thought it was a trick. Or magic. Then I saw I was wrong. Just as the difference in height of the orange menisci had disappeared, so, too, did my anger. I was once again happy, my thirst quenched. And thereafter I knew: My mind can deceive me if I use the wrong measuring tool.
"So how does one measure a life? “ I ask.
"Not by how many, how quickly, how far. Not by how much.”
"What matters is not what one does, but how. With purpose? With loving kindness?”
"Can I know the heart of someone who is gone? How? “
"By focusing on the imprint in the sand or the ripple in the pond.”
I don't understand.
“When an artist is done, do you measure how much paint is on the canvas or how long it took to put it there? Do you add up the notes on the score or the words in the book? Stop counting the number of nails the carpenter used and stop looking for the price tag on the curtains if you want to see the home in the house.”
I'm beginning to see that mournful measuring can lead me away from truth into anger or despair. "So, please, tell me, I yearn to know, the reproducible irreducible measure of a life. Is there such a thing?"
“You want a unit, like an inch or a pound?”
"I want to know the measure of a life."
“I told you that one way to measure is by looking at what's left behind. There are other ways, but they all require faith.”
"You must believe—have trust in measures that are unlike inches or pounds. And then you can know.”
"What other measures?“
"A measure that convinces you Michelangelo's meticulously painted Sistine Chapel and Picasso's Dove, created with but one deft brush stroke, are both masterpieces. A measure that assures you an eight-year-old child's Haiku is as complete as Moby Dick. A baby's giggle? As glorious as Beethoven's Ode to Joy.”
"Does this measure count heroism? Quiet acts of fortitude? Generosity? Honor? Duty? Beauty? Does this measure weigh-in love?“
"A single kiss can be eternal. But beware: All that glitters is not gold. Measure wisely and you won't be fooled.”
My desire for a measure reminds me of a time when I was a doctor and needed an exact weight of one of my patients. I can still see my old office scale: the stand-up kind whose big round face had numbers around the edge except at 12 o'clock, where two words marked the spot. I can still picture my patient lumbering onto its platform, his weight far exceeding capacity and forcing me to look elsewhere for my answer.
Yesteryear's exasperation is today's comfort: Were my friend to step on a scale-of-life, he would surely, as did my patient, send the needle spinning wildly—once, twice—before it slowed down to a stop, the tip of the arrow pointing to Patent Pending.
Most of this series has focused on grief at the end of life. But grief also plays a role in Healthy Survivorship at the time of diagnosis and evaluation, treatment, recovery and long-term survivorship.
The preceding four posts on grief and acceptance set the stage for a closer look at how patients can be Healthy Survivors at the end-of-life. In other words, how can you both get good care and live as fully as possible after a diagnosis of terminal disease?
Yesterday's post linked to an editorial by two well-credentialed psychiatrists with special interest in end-of-life care. Their studies led them to consider grief as "the state of emotional unrest and frustration associated with wanting what one cannot have."