.webp)
Medicine defines a terminal condition as a disease with no viable cure. A disease that will last for as long as the affected person is alive. In that regard, a terminal condition could be something as relatively “benign” as early diabetes with no organ damage (far from a death sentence, but usually a diagnosis for life) or something as dire as Metastatic Pancreatic Cancer, which usually has a months survival prognosis.
For the sake of this blog, I’ll talk about a terminal condition as a disease through which the person is expected to die relatively soon, and definitely much sooner than their healthy life expectancy. Under this definition, we can think of advanced cancers, advanced organ failures (heart failure, liver failure, pulmonary insufficiency) or advancing neurodegenerative diseases (Parkinson’s, Alzheimer’s) as classic examples of terminal conditions.
Fear around death is as deeply imprinted in us as thirst for water and need for connection. It’s an almost automatic response. What I want to do in this short article is try to look at and beyond this fear, and offer some tools for dealing with it.
When dissecting how people fear around the idea of a terminal condition, top of the list in my clinical experience is fear of physical suffering. This speaks to fear of uncontrolled pain primarily, and also fear of body malfunction and having to endure the day to day in tragic bodily disregulation.
I like to remind patients that physical pain is almost always amenable to successful medical management. In the hands of a palliative care physician, physical pain can be dramatically decreased with sophisticated pain medication regimens which allow patients that are still mobile and functional to live lives that resemble normalcy, even while enduring a terminal condition. AND, for the few patients that have very difficult to control pain, the option of adding sedatives to a pain regimen, with the intention of causing chosen levels of decreased consciousness or dissociation (mentally being outside of body) is ALWAYS an option.
Definitely second on the list. Particularly for those with strong caregiving or providing parts (see articles on IFS and parts), it is a struggle to watch loved ones stress and disrupt their lives for the sake of one’s care. I often reflect to my patients “yep, you’re playing the role of the sick one of the family, and I know it sucks”.
IFS can be useful for dealing with this fear. By trying to understand the voices within us that ache when we are to be cared for, we can discover -and heal- beautiful young parts of us carrying burdens of unworthiness, deservingness (I need to deserve to receive) and love-ability (am I loveable enough to deserve this amount of care?), among others. To be cared for as we exit this earth is part of the contract of life, in the same way we were cared for when we entered existence. Making this a less abrasive experience by exploring our internal world can be a source for tremendous healing, even as our bodies are facing the opposite journey.
We are all on a spiritual path. However, we can become ostracized so easily in our modern world, that access to this knowing is limited. Unable to sense our spiritual oneness as humans, as nature, as the universe, as eternal, we become confined to these bodies, these belongings, this particular story of mine, which increases the sense of finality of a terminal condition, making the process more difficult.
Kneeling to the absolute loss of a terminal condition can -paradoxically- become a door opener to spirituality. I’ve seen this. People -not necessarily the bravest of them either- who “forgive themselves for dying”. Or in other words, “stop resisting” and embrace radical acceptance of their reality. These people can experience a beautiful spiritual awakening.
Helpful tools here include the aid of a spiritual guide. Chaplains and other professionals can be of help here, however, I have met my share of priests and other religious leaders who dialogue with death with nothing but panic and “miracle” expectations, all which do very little to help with spiritual suffering.
Finally, I am a strong believer in the role of psychedelics in this regard. There’s a mounting bulk of data on psychedelics in terminal disease and how they can aid in spiritual suffering. In my personal and professional experience, I believe few agents are as dynamic, gentle, and compatible with complex medical circumstances as Ketamine. Ketamine can help remove the “panic” element from a terminal condition, allowing an internal constructive dialogue to set in. Furthermore, ketamine can help us rediscover aspects of our consciousness that have been blocked from our awareness, like our connectivity, our continuity, and the undeniable truth that we are in this existence because we are being thoroughly held.
For me, this one is the most heart-breaking one. We suffer because we foresee the severing of our most important attachments on this earth. This premonitory grief can be a source of incredible amounts of pain, like many griefs. It is this pain that often keeps tired terminal grandparents on the “medical battle” for their lives, so they can make it to one more graduation, so a grandson can have one more birthday.
Furthermore, our human relations are usually irrevocably changed by our terminal disease experience. You name it, I’ve seen it. The concerns of the wife of a terminal lung cancer patient, with him wanting to make love to her “before he dies” while on oxygen, and trying to catch his breath. The endless fights between patients and loved ones pertaining to the intake of food and water. Partners expressing their grief by having adulterous relationships. We are complex beings -us humans- and we travel through the journey of terminality with all our complexity.
I have also seen terminal conditions as a chance to take relationships to a new level. Yes, the time together is short, but each second together has been infused with much more life than we had before. That’s the paradox of death, it is filled with life. Particularly if we are able to dialogue and understand our panic, hoping it can relax enough to let us be open-hearted. We might find that in death our closest relationships have been infused with a new truthfulness, a new selflessness, a new love, that would not have been available to us if time hadn’t become precious.
