Portal de Periódicos da CAPES

A Letter to Friends

2001; Elsevier BV; Volume: 21; Issue: 4 Linguagem: Inglês

10.1016/s0885-3924(00)00269-4

1873-6513

NULL AUTHOR_ID,

Empathy and Medical Education

It really does appear that I am close to the end. While I do not abandon hope, a six- to eight-month prognosis is now the most realistic estimate my doctors can provide. In short, my death has taken on an imminence it formerly did not have. Naturally, I have shed many tears over this. Though I have known my disease was terminal all along—indeed, when first diagnosed in March of 1998, I was given about a year—the capacity for fantasy and denial is strong. Given my general good health—the fact that, even with the horrors of chemotherapy, I have maintained a very high quality of life—it was easy for me to foster the hope that death was at least a year or so off. That no longer seems the case. Accepting the fact that I will probably not see my 40th birthday is very difficult, a task that I have yet to and may never complete. Moreover, so unpredictable is the disease that when all therapies cease to function, we don't know how long it will be. In truth, it is as likely that I will be dead in three months' as in six months' time. What dreadful things to say to a friend! I cannot tell you how it saddens me to see the sorrow and pain my illness has caused in those I love. Still, I think truthfulness is the best way to approach such hard realities. For me, what is most important is quality of life. I am, by no means, giving up. I intend to continue to fight this disease with all the intelligence and determination I can muster. I am receiving excellent medical care. Nevertheless, I do not find the denial of death helpful. Frankly, the most disturbing responses I have encountered to my illness—the responses that, however well-intentioned, leave me with an awful unhappiness— are the “miracle” stories, both secular and spiritual. Everyone has some story—a pilgrimage to Lourdes, a special macrobiotic diet, some scientist in Arizona, who “cured” someone who was also given “just a few months to live.” I don't doubt that such things happen. I know too much about cancer to underestimate the sheer unpredictability of the disease. But I also know that telling such stories —at least to me—is like telling a person facing bankruptcy that you have a friend who bought a lottery ticket for just one dollar and, what do you know, now the friend is a millionaire! Reality, faced with intelligence and compassion, I have always found far more consoling than even the most elaborate fantasy. Moreover, among the greatest assets I have in facing death is a life-partner, and a medical team that are my loyal allies in jealously protecting the quality of my life. I simply refuse to sacrifice all the good things I have—to spend every minute, every dollar, every bit of physical strength— searching down cures. I want the time I have remaining to be of the best possible quality, so that I can do what I enjoy—being with and loving those around me. Of course, I'm terribly afraid of pain and of what the disease can do to me. But right now the pain is under control. I'm not very symptomatic, and I'm enjoying life. I always return to this point, but it cannot be emphasized or repeated enough. I HAVE A GREAT LIFE! A beautiful home, a job so wonderful that you can hardly imagine, the best partner in the world, family and friends who are an ongoing fountain of love and support. There are so many happy, warm, delicious, funny, thought-provoking moments in each day that I refuse to let go of a single one of them. I intend, as the poet says to “suck all the marrow out of life.” And I find that when friends accept the bad news and, acknowledging the unspeakable sadness of all this, nevertheless join me in living the ongoing celebration that is my life, then those friends become the best allies in fighting this disease. Dying a good death is, I have found, the last great challenge of living a good life. However well-intentioned, those who will not accept the reality that a loved one is dying, do no service in helping with that last great task. My hope is that my friends join me in helping me to die a good death. On the most practical level, I am hoping like hell that it's not painful. That I am active and working as long as possible. That I am able to enjoy my life as near in time as possible to the moment I draw my last breath. Most of all, however, I want to be a good human being—a good friend, brother, uncle, husband, son, co-worker, comrade—all the things by which I have defined success in life, but that disease and death can take from us. I don't want a preoccupation with my own pain or misfortune to impede my ability to love, to be generous, to keep on being interested in and excited about the lives of others. In realizing that last and most important hope, I know that my friends and family will help me.