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John Roberts Cancer Journal March 28, 2009: LETTING GO

March 28, 2009

A discussion, understanding, and acceptance of death, whether months or years ahead, is an essential part of fighting cancer. It is not morbid or depressing or ceasing to fight. Dealing with it honestly, while fighting, is part of the process of designing the comfort of final days, however distant, and should be done sooner, not later. Cancer fighters are tough, and know how to accept the reality of possibilities as part of their mental discipline. We cannot fight what we do not understand.

Don’t let go too soon, but not too late either.

Letting go is not the inability to hold on before slipping into the void; it is a planned transition to a destination, or at least a final and properly-timed acceptance that is combined with peace and understanding. Letting go means moving on to something better before an accepted death; otherwise it is just giving up, a failure.    ––John Roberts    Sometimes I wonder if I should just let go.––Therese Roberts, author’s mother, dying of cancer,still fighting, hours before she did so in the presence of her mother and family.The goal of all life is death.––FreudWe must learn to let go to make room for the thingswe have prayed for and desired.––Charles Fillmore There’s an important difference between giving up and letting go.––Jessica HatchiganI wait… wait for the mists and for the blacker rain.––F. Scott FitzgeraldThe act of dying is also one of the acts of life.––Marcus Aurelius, MeditationsLetting go is a normal part of the process of dying that may be managed by the patient. The person may realize, or the doctor may inform, that there is nothing more that can be done to cure; the new objective is to make the remaining time comfortable and to assist in the various mental processes that try to enable a passing in peace and understanding. This may take months, or just hours. In any case, it involves a change of attitude and focus. It does not mean taking down the barriers and wishing for death that will take advantage of no further resistance. It means shifting to attitudes that have been prepared in advance so that the final mental state is what one wishes. It therefore bypasses the resignation of defeat to a new stage of preparation and acceptance.Letting go may permit a sense of relief, a new peace of mind without the rigor of fight, and a transition to a new kind of hope. We have been fighting long and hard, and may be unwilling to change that, ever. But, our stubborn refusal to accept the inevitable may mean only more painful but useless treatment and further suffering by both patient and loved ones. Aggressive treatment may do more harm, and shorten life, compared to palliative treatment designed to improve comfort. There are choices in a hospice setting when death is certain, even if the timing is not. The fear of dying may prevent a patient from accepting an easier passage. Frank discussions earlier may help in reaching decisions later. In the broad picture of life, a few more days of aggressive prevention may be less important than a more restful and expected passing. This permits a smoother, less abrupt end that may be better for all. The change to final acceptance may also mean a change in the patient’s needs and preferences. A new silence and solitude may be desired, which may be disturbing to loved ones who wish to continue communicating and expressing love. The best interests of the patient must be seen, prepared for, and followed. It may be that the patient, with full understanding, will lead loved ones to the final farewell.