My father-in-law died on my partner’s birthday.
It wasn’t a sad thing; it was a blessing. My partner said it felt like a final gift from his dad — knowing he was no longer suffering. He was finally at peace.
He had been battling cancer for over three years and had been dying from it for over three months. As hard as it was to accept his death, it was harder watching him struggle through those last few months.
He was on painkillers, feeling better than he had in years, and was unconvinced that he was slowly dying, despite being in hospice care. Thanks to a cocktail of opioid painkillers and prescription steroids–he could walk, lie down without pain, and feel his strength coming back. He had asked his wife one day “Why is everyone so sure I’m dying? I feel great!”
But he was dying. His prostate cancer had come back after being in remission for years. The past three years had been full of return trips to his many doctors. Chemo treatment, targeted radiation treatment, hormone therapy, and more.
Finally, the treatment had stopped working. The cancer metastasized to his bones. Slowly, and with the help of the intense painkillers he was on, his body would start to shut down. He would either die of the cancer or die of the painkillers.
Within his last week, he was at peace.
He had been battling cancer for so long, but he could finally accept that it would take him. It was a hard realization, but it helped all of us accept his passing. His terminal illness was reaching its final stages.
Yet for years prior, this man had not been himself. He knew, somewhere in the back of his mind, that this diagnosis — his cancer returning — would be the death of him. Internally, he beat himself up. Over not going to enough checkups, over not doing something sooner, over failing to take care of himself. Yet everyone on the outside — all his family and close friends — knew that he had done everything he could.
None of this was his fault, and yet he allowed the doubt and depression to consume him. This man who was always working on projects was suddenly bedridden. He could hardly find the motivation to get up every morning. Because of his terminal status, he was chronically depressed.
Chronic and terminal illnesses go hand in hand with a sense of hopelessness.
It’s easy to fall prey to depression, anxiety, and other psychological conditions when your body is out of your control. Yet even when given a terminal diagnosis, patients need mental health support to help them through their final months. Without it, their condition only worsens, their body succumbing to not only the disease but the overwhelming stress.
My father-in-law needed mental health support and was able to get help through his hospice care, but it only came after years of battling depression alongside his cancer.
Whether you’re a patient struggling with a terminal illness or you’re a health professional trying to help terminal patients, it can be tricky to find solace despite a terminal diagnosis.
Yet mental healthcare is just as vital at the end of life as it is during any other point in life.
Coming to Terms With Death
One of the biggest struggles for patients facing a terminal illness is the idea of dying. Whether you’re religious or not, the big question of “what’s next?” can haunt anyone. It can be extremely difficult to accept the loss of yourself, and there is often a lot of uncertainty around when it will finally happen.
Even if you have a few weeks to live, you may end up living for a few more months, to even a few years. Whatever the case may be, your care will switch from attempting to find a cure, to alleviating painful symptoms and focusing on your personal comfort. However, with that comes a new set of challenges: grief and acceptance.
Although your family will grieve after your passing, you will have to go through your own stages of grief before your journey comes to an end. And although these stages often appear as stepping stones, you may easily phase in and out of each stage, often coming back to earlier stages on bad days or struggling to accept everything, even at the very end.
Those five stages of grief are:
- Denial: A lack of belief in what is happening to you.
- Anger and Resentment: Anger with your situation mixed with anger at nurses, doctors, and family members that are trying to help you.
- Bargaining: Hoping that if you do something, it’ll fix everything.
- Depression: Feeling hopeless once you acknowledge the situation: there’s nothing more you can do to change it.
- Acceptance: Acknowledging what happened or is happening and moving forward despite it.
Unfortunately for many terminally ill patients, they get easily stuck in the depression phase. They acknowledge that they are going to die, but they feel powerless and are unable to move on.
This can make the final chapters of their life increasingly difficult, as the depression will further exacerbate their symptoms, potentially getting in the way of them enjoying their final months.
Luckily, there are those out there that have the training to help terminally ill patients accept their condition. Primarily, through the help of mental health counselors and social workers, patients can find a sense of peace through therapy and even mental health medication management. They can also suggest coping mechanisms and ways to maintain self-care during your final months.
Finding a therapist that fits your needs can be a difficult task, but any therapy is better than none at all. Hopefully, once a professional has become available, they can help you process your grief, find ways to cope and provide you with essential tips for self-care.
Remember, getting help for depression is in your own hands — once you acknowledge the mental state you’re in, all you need to do is ask for help in order to get it.
Self-Care While Dying
Self-care is vital for every human, but even more so when you’re entering your final months on this earth. It can be difficult to find self-care; it typically requires doing what you love and spending time with those you love. Unfortunately, that’s not always possible when your body is struggling to meet your physical needs. When poor health forces you into bed rest, coping with symptoms and medications, and struggling with the added burden of depression or mental illness.
However, by focusing on what you can do and want to do, rather than what you cannot do, you may be able to find some comfort in self-care.
One study done in Texas found that fatigue was the most common symptom that negatively affects the quality of life for terminal patients. Fatigue is certainly an issue that can be difficult to overcome, and oftentimes the best way to combat fatigue is simply to sleep as often as possible. But this can get in the way of participating in what you love.
The study noted that for the patients that were surveyed: “Helpful self-care strategies included budgeting time and energy, maintaining contact with family and friends for support, and prayer.” By focusing on the things most important to them — family and social support, spirituality, physical well-being, and functional independence — patients were able to improve their overall quality of life.
Social support, such as finding support groups (both physical and even those online), can provide a great deal of comfort by allowing you to connect with people going through a similar situation.
For example, cancer support groups can not only help you find a community to support you by listening to your story, but it may also grant you new perspectives that could make your final journey a little easier. Whether it’s through the sharing of stories or the comparing of treatment plans, you can feel your spirit uplifted and know that you are not alone on this path.
Additionally, many support groups also provide extended support for family members, which can help you resolve any current issues or even get closer with those you love. Plus, you can rest assured that your family will be able to receive help and grief counseling after your journey has ended.
Finding the End-Of-Life Care You Need
However, it’s not just personal self-care and therapy that can help terminally ill patients feel at ease — having a supportive medical team can also make all the difference.
Compassionate nurses are especially important for terminal patients. With my father-in-law, he had a wonderful family physician and oncologist, but the nurses that helped him through hospice made all the difference for both him and his family.
They understood one of the most important elements to nursing: maintaining the dignity of the patient, as well as creating a personal connection between staff and patient.
The hospice team that helped him was also well staffed (which helps prevent burnout among their team). They offered a social worker and religious counselor and regularly met to discuss care management for the patient. Additionally, they maintained a high level of care focused on both the patient and the family.
All these aspects are essential to maintaining the high standards expected of palliative and hospice centers.
Hospice care often gets a bad rap as there have simply been far too many stories of poor hospice care. The fact that many patients don’t recover often feels like hospice care is dangerous.
Good hospice care can not only improve the quality of life for terminal patients, but it can also provide relief to the family and even prolong the life of the patient — even if it is for only a few more weeks.
However, finding quality care should happen even before hospice care becomes essential. Whether you’re confronted with a terminal or chronic illness, finding accessible and reliable mental and physical health treatment can make a huge difference in your quality of life.
There are things you can do to ensure your final months are full of peace and support. No matter what your journey may be,
Mental health is important in all stages of your life — even near the end. I hope, like my father-in-law, you’ll be able to find peace, too.