Living Each Day

We are all born with the will to survive. Exactly what influence this has on diseases — especially cancer — has been debated for a long time. But there is little argument that a strong desire to live can enhance the quality of life. Many people with terminal cancer have lived far longer than expected. They often share a positive attitude about the value of life. They also seem to have a combination of hope, endurance, willpower, and courage. When asked to explain how they have managed, they often give answers such as, "I'm needed too much at work," or "I can't die until my grandchild is born." They do not want to give up or retreat from living. A keen interest in daily events helps to get them through uncomfortable treatments or disease-related problems. This does not mean that a positive attitude alone necessarily will lengthen your life. Nor does it mean that you are doing something wrong if you are sick and not getting better. But emphasizing the positive aspects of your life can add meaning, purpose, and comfort to your remaining time.

 

How You May Feel When Time is Limited

Each of us is unique, and we each find our own way to live and die. Still, many patients with advanced cancer have many feelings in common and may approach this time in their lives in similar ways.

You may not experience all the emotions discussed here or in the exact way they are described. Your feelings may come, go away, and then come again. Information is presented to reassure you and those close to you that your reactions are not unusual; they are a part of the way we, as humans, make peace with ourselves.

When patients are first told or first realize that their cancer can no longer be treated effectively, they often react by denying that this could be happening to them. They believe they will find a way to beat the odds. This is a way of coping with an overwhelming situation, and it may be helpful at first. With time, however, patients and their loved ones are often able to face reality.

One patient explained it this way:

"The reality of death does not go away by denying it. When you do this, you can miss the comfort you get from sharing fears and concerns. You miss the sense of well-being you get knowing you have taken care of your loved ones." The feeling of "No, not me!" often changes to "Why me?" This question may result from feelings of anger and rage. You may be angry with the doctor, family members, neighbors, your disease, and even yourself without good cause. This is a normal reaction, and with some time, if you can accept and understand your anger, hopefully it will pass. It may help to talk about your feelings with your family, a close friend, or a social worker. It also may help to keep in mind that you are not responsible for your disease.

Next you may begin to realize that there is no answer to the question, "Why me?". Your anger is not the solution, and you may find yourself "bargaining" for a longer life. People make all kinds of promises in hopes of a longer life. A promise might be "If I can live just one more month, I'll go to church every day," or "If I just can see my son married, I won't ask for more."

It is not unusual to bargain. In fact, taking notice of what you ask for and then working to accomplish your wishes may help relieve some anxieties about things left undone and words left unsaid.

At times you may feel depressed because you have lost control of some aspects of your life or your independence. It may help to focus on what you value most in life — family, friends, or other things that you cherish — rather than on what you cannot change.

As your illness progresses, depression from losses that already have occurred may give way to grief over the people and life you are going to lose. This grieving should not be discouraged; it must be worked through to gain peace of mind and acceptance. Frequently, talking through these feelings with a loved one, clergy, social worker, counselor, or support group can ease the grieving process.

During this time, you may find yourself wanting to have fewer people around. It may help you and your family and friends to understand that this type of withdrawal often occurs toward the end of life. Conversation may not be needed as long as someone who cares for you is nearby. A smile or a gentle touch sometimes can say much more than words.

Not all people who face the end of life are able to find peace and accept death; however, with time and support from those around you, acceptance is often possible. You need to know that everything that can be done for your peace and comfort will be done. Don't be afraid to ask for such support and assurances.

 

Your Inner Strength

Most people are overwhelmed emotionally when they first learn that their cancer no longer can be controlled. They may not be able to cope as well as they did in the past. Sometimes they may temporarily lose their will to live, but their reactions often change with time.

Your feelings of hopelessness may change because of physical and emotional reserves you didn't know you had. Calling on your inner strength can help revive your spirits and your drive to enjoy each experience and each day. Concentrating on the present instead of the future can be helpful. For many patients, the future becomes the end of each day.

As one person explained:

"Before this happened I had a 5-year plan, a 10-year plan, even a 20-year plan. No more. What I realized was that I could only die in the future, but I was alive right now, and I always would be alive in the here and now." Others prefer to plan ahead—days, months, even a year or so. This reaffirms to themselves and others that they are not finished with living and accomplishing goals. With places to go and things to do, life stretches before them.

Your plans may involve doing things that you enjoy each day. You may want to plan a few "special days" with family members or friends—a day outing, a concert, or an afternoon together. Or you may want to focus on fulfilling a lifelong dream, such as taking a trip. Without a plan, whether it is general or very specific, you may find that your time consists only of routine daily activities. But try not to do too many activities. Becoming tired may weaken your defense against depression and despair and may make coping with your illness more difficult.

Some people view their illness as a challenge to be met or a battle to be fought. They think of each day they survive as a victory.

One woman expressed her outlook this way:

"I get satisfaction by being engaged in the fight. It's me and my doctors against the cancer, and we know we might not win in the end. But by God, we're going to give it a run for its money." Others cope by rethinking what is important in their lives and what is not.

As one person said:

"Disease rearranges your values, and you cast off things. You reduce the trivia to a minimum; you simplify life." It may be helpful to put together a "living legacy" — a book, cassette, video, piece of artwork, or poem that reflects who you are — to share with your family and other loved ones.

However you choose to cope, your inner strength can help you live each day as fully as possible.

 

What You Can Do for Yourself

Living with a serious illness can be discouraging. You will have good days and bad days, just as you did before, and your ability to deal with these changes may vary. In the morning you may feel down, but by afternoon your outlook may improve. On one day, you may have little energy, but on another, your mood and spirit may rebound. During the bad times, try to remember the good moments and remind yourself there can be more good times ahead.

Taking charge of your life is one way to help yourself. Take an active role in the kind of care you receive. Participate in daily activities with your family and friends.

Do things for yourself that make you feel good, such as attending religious services or encouraging visits from friends. Let others help you. Let them know what they can do for you and what you can do for yourself. They will be grateful for specific suggestions. Your caregivers may recommend things that don't seem as important to you now, such as exercise, medications, and food. But these measures will help you keep your strength and independence for as long as possible. Working with your caregivers and family helps you maintain a sense of control, purpose, and hope.

Set the tone for those around you. Making those around you feel comfortable now will help them to be comfortable around you throughout your illness.

As one patient said:

"You have to do this because no one knows how you want to be treated, and they may be waiting for a cue. No one else will talk about it unless you do." At the same time, remember that you don't have to be noble and heroic if you don't feel that way. Sometimes loved ones may want you to try to keep your feelings of sadness or anger inside because they can't face their own painful emotions; however, your feelings are important and need to be shared.

 

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