An internal dialogue on how one might deal with a terminal diagnosis
Many people’s greatest fear is of getting a terminal disease with a likely long, painful ending. The following explores how one might successfully deal with it.
Imagine that you’ve just had a second opinion confirm that you have terminal cancer. Both doctors believe you have a few months to live, that surgery to remove the main tumor followed by aggressive chemotherapy and radiation would give you a 25% chance of living another year or two. Alternatively, you could opt to have just palliative care, which wouldn’t extend your life but would address pain issues and otherwise improve your quality of life.
Here is a fictional internal dialogue that such a person might have:
Person: I’m not going to have any treatment now. If I get bad pain, I’ll take the morphine, whatever.
Alter ego: Are you sure? You would have a 25% chance of another year or two.
Person: Surgery and then aggressive chemo and radiation means months of alternating among pain, puking, and exhaustion, all for just a 25% chance of a year or two, which would probably be a bad-quality year or two.
Alter ego: Don’t you want to increase your chances of seeing your child get married? They say they’re thinking about getting married next year.
Person: Who knows whether they actually will? And honestly, while seeing that would be great, I don’t think that’s worth the misery of surgery and aggressive radiation and chemo.
Alter ego: You’re not worried about the cost of treatment are you? It wouldn’t cost you a penny.
Person: It wouldn’t cost me a penny but when people opt for expensive, cost-ineffective treatment, it raises the cost of health care for everyone. If I’m dying, at least I want to die ethically. That will help give meaning to whatever time I have left.
Alter ego: You’ve tried to live ethically and so you want to die ethically.
Alter ego: What else are you going to do to die ethically?
Person: Mainly, I’m just going to try to be a nicer person. That’s what matters. When I’m gone, my legacy is in how I’ve benefited the living.
Alter ego: Are you going to keep working?
Person: Absolutely. Every customer I serve well contributes to my legacy. If I retire and just travel and watch movies, I’m squandering the precious time I have left.
Alter ego: What about the family?
Person: I’ll try to be kind to them. For example, I’ll try hard not to complain. I didn’t tell them when I was diagnosed with Stage 2 nor when I had the chemo. And I’m glad I didn’t—it spared them a lot, and having told them would have done me no good.
Alter ego: Isn’t it selfish not to tell them now? At least some of them would want to know, maybe to resolve old disputes.
Person: I really think, deep down, most or even all of them would rather I didn’t tell them until the very end.
Alter ego: But will you at least spend more time with the family now?
Person: Somehow, knowing I’ll die soon, the old saw about “blood is thicker than water” doesn’t feel compelling. I was thrust into my family at random and I don’t like some of them. If I want to be with people, it’s mainly my close friends, and yes, my sister. But most of the family? I don’t think so.
Alter ego: What about your will? You’ve been procrastinating doing it forever.
Person: Yes, now is the time.
Alter ego: Are you going to leave your money to family?
Person: I’ll ask family to take whatever personal possessions mean something to them—like my sister has always loved my dining room table. But I’m going to give my money to charity.
Alter ego: Are you going to tell them you’re doing that?
Person: That serves no purpose. They’ll just pressure me not to, and I want to decide without pressure. I worked hard for my money. Shouldn’t I have the right to decide what the right thing to do with it is?
Alter ego: But what charity?
Person: I want to donate to something that otherwise would go unfunded. I’m very pro-choice but giving my money to NARAL would be just a drop in the ocean. These days, resources for school programs for gifted kids have almost completely been reallocated to the lowest achievers: “No Child Left Behind.” I believe that all kids are entitled to an appropriate-level education, especially gifted kids, who have so much potential to be wise leaders, bridge builders….
Alter ego: And find a cure for cancer.
Person: Yes, find a cure for cancer. So I’m going to leave the money to some organization that works on behalf of gifted kids–maybe a nearby school’s foundation, earmarking it specifically for gifted kids and their teachers.
Alter ego: You also need to make a living will and give it to the doctors, and when it comes time, tape it over your bed. You know you don’t want to be kept alive by extraordinary means.
Person: Right—a tube shoved down my throat when I’m already in bad pain and going to die soon anyway? Nope.
Alter ego: Right.
Person: And then there’s hospice. Dad spent his last six months in in-home hospice and it was a blessing. He wanted to die in his home and he was able to, with the hospice nurses making sure he died as comfortably as possible. That’s how I want to go.
Alter ego: You’ve done enough thinking about this crap for now. Do something fun.
Person: Somehow, what I feel like doing now is helping another customer. When I’m done working for the day, I’ll do something for myself, like maybe start writing my memoir.
Alter ego: Maybe with a glass of wine?
Person: I think champagne.
Alter ego: Champagne? You’re nuts!
Person: And I plan to be a little more nutty.
Marty Nemko holds a Ph.D. specializing in education evaluation from U.C. Berkeley and subsequently taught there. He is the author of seven books and an award-winning career coach, writer, speaker and public radio host specializing in career/workplace issues and education reform. His writings and radio programs are archived on www.martynemko.com.
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