One of the most vulnerable positions to be in as a client is trusting a therapist with your end of life process. Some of us have the privilege of living into old age, some of us die suddenly by accident. And some of us get cancer, and have some time to face our death, but not as much as if we were much older.
I have had the honor to support someone through this process, and from this honor I received many gifts and understanding of the end of life. I’d like to talk about what I learned supporting someone with cancer through the end of life. Every day of this process, I experienced extreme grief, humility, gratitude, love, and perspective.
Death can be a very lonely process, people who are sick don’t want to share their anxiety and grief with their family, especially if their family still has hope. Having and sharing hope can also feel very difficult, because people who are sick don’t want to get the hope of their families up just to let them down. So many of these feelings are repressed when someone thinks that they will die. It can be helpful to have space to share these things in therapy because it’s a more neutral space, and the therapist (although invested in you) is not invested in the same way as your family, which makes it easier to experience the highs and lows with you.
We don’t know when we will die, and trying to understand the timeline can be excruciating, anxiety provoking, and devastating. Just like the living go through the stages of grief after someone passes, someone who is living but approaching the end of their life must go through the stages of grief with their own ability to live. The stages of grief are denial, bargaining, anger, grief, and acceptance. Not everyone has the time to complete this process before they move on.
There are so many pressures that come with losing the ability to live. These pressures include setting one’s affairs in order. One must make sure that they prepare their family and friends for their death, and they must prepare themselves to be able to say goodbye. Many people experience extreme emotional pain in this process, it is perhaps the most painful thing that we will ever have to do. And our families aren’t ready to say goodbye. They are often in various stages of grief, including extreme anger that their parent/child/sibling/friend is dying.
As one’s body grows weaker and they lose energy, they can’t do what they used to be able to do. Asking for help is extremely vulnerable. Pretending to be in a good mood becomes impossible when you feel pain. Being lucid becomes difficult. People want to hide. They may not know when it’s time to start a relationship with a caregiver, and they don’t want to put everything onto family, but they also don’t want to offend their family by hiring people to help. The reality is that simple things become hard. And people begin to experience the loss of agency that they have had as adults.
Near the end, we enter an alternate state of mind. Approaching the transition is a psychedelic experience on its own. Reality changes. Many people with cancer accept pain medication, use cannabis to help them eat. But eating becomes harder as the body shuts down. So does everything. Many people take the option of using morphine and pain medication. A clear and sober mindset no longer exists with hunger and tiredness and medicine. The raw experience of being alive still while ones body shuts down is an altered state of consciousness.
The afterlife is the unknown. Nobody can speak to what happens the second before we die, the second we take our last breath, or after. We don’t know. Some people see death as final, the Buddhists call the transition “Continuation”, because they believe that we continue into afterlife. Our society has an addiction to the need to know things, but the reality is, we don’t know everything. As one moves toward continuation, they prepare for the unknown, a concept that we often do not face, and are even afraid of. As we face our own death, we must lean into this fear to accept the unknown of after life, and a part of this process is understanding our own beliefs around the soul and the spirit and how they live on.
I want to share what it was like from my side, which is something I normally don’t share in regular weekly therapy with non end of life clients. With the end of life clients, my boundaries no longer applied to the therapy in the same way. I was transparent, about who I am, what my life is like, and how I feel as the person sitting in front of me opens their heart to me at the end of their life. I cried, a lot, every time after session and sometimes in our sessions. I appreciated being alive in ways I had never noticed before. My body, the sound of the leaves as I walked down the street, what it feels like to run through the woods or smell salty air. I said goodbye to relationships that don’t serve me with a new perspective that every second of life is important. In comparison to facing death, most of the things that we worry about don’t seem as important. As we approached the transition, I did anything and everything I could to help. With releases I talked to family members and nurses, hospice, and anyone I could to make the process easier. And when the transition happened, I continued to grieve, but also, to remember, because people don’t actually leave us when they continue on.
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