Nita is a 42-year-old housewife who has been diagnosed with cancer of the uterus with extensive metastasis throughout her internal organs. She has been apprised of her situation and advised that she would probably have about 1 year of life left. Since then the situation in the whole family has become extremely despondent and each day is difficult to live for every member of the family. Nita’s behavior is difficult to predict. She is occasionally very stubborn, sometimes irritable and angry, cries a lot and has started spending an excess amount of money on religion and beggars while cribbing for the expenses made in the domestic work and on her medicines. Her family too is going through an emotional roller coaster.
Death is a universal and unavoidable phenomenon. It arouses strong feelings of dread and fear in dying people as well in their providers. It is a universal reminder of life and its meanings. It imbues humans with values, passions, wishes and the impetus to make the most of time. People who become aware of the process of dying go through various emotions. There may be a need to deny the process. This gets replaced by intense anger and indignation. The person becomes irritable, demanding and critical. They blame themselves, friends, family members and God. This may be followed by severe guilt. Depression sets in when the person realizes the inevitability of death. A pervasive despondency creeps in with the impending loss of life. Finally there is acceptance and a consequent preparedness for death. There is a dynamic tension between acceptance and denial. There is a clustering of intellectual and affective states of the mind. Emotions of anguish, terror, acquiescence, surrender, rage, envy, disinterest, pretense, taunting and yearning dominate. They resent being treated like children and not being considered when important decisions are made. They all sense a change in attitude and behavior of people around them. But they still maintain a sense of hope till the last moment. Simple people with less education, sophistication, social ties and professional obligations have less difficulty in facing this crisis compared to people of affluence who lose a great deal more in terms of material luxuries, comfort and interpersonal relationships. People who have gone through a life of suffering, hard work, gratification in jobs have shown greater ease in acceptance of death with peace and dignity compared to those who have ambivalently been controlling their environment, accumulating material goods and a great number of social relationships but few meaningful interpersonal relationships which could be available at the end of life.
All who are dying are aware of the seriousness of their illness whether they are told or not. They do not share this knowledge with everybody. It is painful to think of such a reality, and any implicit or explicit message not to talk about it is usually gladly accepted. But then there will be a time when they will need to share their concerns, lift the mask, to face reality and take care of vital matters while there was still time. They will always welcome the possibility to talking with someone who cared for them. They will, of course, test you in one way or the other to assure them that you were actually willing to talk with them. They would be relieved if they do not have to play a game of superficial conversation when deep down they are so troubled with real or unrealistic fears. Many will never use the word death or dying but talk about it in disguised ways. A perceptive person can answer their questions or concerns without using the avoided words and still be a great help to them. These people respond often with almost exaggerated appreciation to someone who cares and who takes a little time out. They are deprived of such kindness in a busy world and it is not surprising, then, that a little touch of humanity elicits an overwhelming response.
What you can do:
First of all you have to take a good hard look at your own attitude towards death and dying before you can interact patiently and without anxiety with the dying person. The terminally ill have very special needs which can be fulfilled if you take the time to sit and listen and find out what they are. The most important communication is to let them know that you are willing to share some of their concerns. The need of the dying person is to leave something behind, to give a little gift, to create an illusion of immortality perhaps. You have to display maturity in dealing with the dying person. Assure them of your availability whenever they need you. Let them know that they can request your presence whenever they are ready to share their concerns. Offer them an opportunity to relieve their feelings of guilt, sins or worry. Convey to them that the reactions that they are displaying are quite normal. Explain to them that they need not endure agonizing pain as a means of reducing their fear of retribution. Help them work through some of their conflicts while they are sick and come to a deeper understanding and perhaps appreciation of the things they still have to and can enjoy. Break their monotony, the loneliness and the purposeless, agonizing waiting. Do not talk in euphemisms but concretely, in straightforward, simple language about the very things that are uppermost in their minds – pushed down occasionally but always coming up again. Talk about their reactions, their strengths, their hopes and frustrations. Listen and do not hurry. Acknowledge their sense of service when they feel that they are of no use to anybody. Validate their importance of their own communication. Sometimes it becomes too late for words and yet that is the time when you want to cry the loudest for help. It is hard for you as are in the process of losing someone forever. This is the time for silence and this silence goes beyond words. You know that if you have the strength and the love to sit with a dying person, that this moment is neither frightening nor painful but a peaceful cessation of life. It makes you aware of the uniqueness of each individual in this vast sea of humanity.