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Living One Day at a Time
The Will to Survive
How You May Feel When Time is Limited
Your Inner Strength
Few people like to think about dying. We all know that death will come, but
most of us spend little time thinking about it.
Approaching death often brings a change in how we look at life and what we
value. For many people, having a serious illness leads them to live one day at
a time rather than to put off until tomorrow, next week, or next year what
could be done or said today.
One patient expressed his philosophy this way:
"The death rate for any generation is 100 percent. We all die. However,
I know what probably will kill me, while most people don't. We have no
guarantee of how long we will live. But I believe it is truly the quality of
life, not the quantity, that is most important."
There is no right or wrong way to face the end of life. Do what is most
comfortable and useful for you. Many people with a serious illness are able to
find peace of mind by coming to terms with their emotions and beliefs about
life and death. You may be able to find meaning for yourself, in your own way
and at your own pace.
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.
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 in this booklet 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.
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.
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