Facing the End

What to Do When You Get a Terminal Diagnosis

I write to those of you who have received a terminal prognosis. Having worked with hundreds of dying people, I know I can only imagine the shocks of incredulity, fear, and despair you have endured since you received this news. I know that only someone who has faced the same news can really understand how you feel, how your life has changed. Other people have walked the path you now face, though. Over my years of hospice work, they have allowed me to be their witness and companion. What follows is the essence of what they have taught me.

You have never died before. How do you prepare? You have already been knocked with a wallop out of the ordinary distractions at the surface of life, out of the taken-for-granted next breath. You are already beginning to live with an intensity and urgency you may have never known before.

The end of life is a time when all the spiritual suggestions for living, accumulated throughout the ages, become insistent, illuminated, written in capital letters. As others who are living close to the end of their lives have discovered, these suggestions have always been offered not so much to make us "good" or saintly persons, but because they speak about what


--what makes living, and especially living with dying, easier somehow, fuller, and, though it may sound impossible as you read these words, more deeply satisfying.

The time of sickness will be the hardest time. As hundreds of hospice patients have described it to me, you will be up with a good test, down with every new discomfort, every new change in your body's functioning. Your relationship with hope will transform. The very meaning of the word will change for you--as will time, and priority, and even your sense of who you are. The first advice I think my hospice teachers would offer you is to simply breathe and learn to detach a tiny bit, watching yourself as you go through these changes and remembering that you are not these symptoms.

Practice equanimity



Wrap up the loose ends of your life. Practically, wrap up your connection with the world of things. Empty yourself now of all that is not essential. Lighten your load. Physically and spiritually, remember that although medicine has given us much to make living easier, it has made dying a bit harder. Think about what you want for yourself in terms of medicine's ability to artificially prolong life. Ask yourself questions--and make your answers known. What is the minimum quality of life with which you're willing to still live? What do you want for yourself at the hour of your death? What will give you strength? (And, if it will give you strength then, turn to it now.) You should know that you will experience a profound transformation, that will move you through a painful chaos, a perhaps now-unimaginable surrender, and a grace-filled experience of Spirit. Prepare yourself for it. Recognize it when it happens.

Practice responsibility
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Kathleen Dowling Singh
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