Palliative Medicine for Serious Illness:
Acceptance of the Unthinkable
Dr. Ira Mandel MD, MPH, is Medical Director of Pen Bay Healthcare’s Hospice and Palliative Care program As a hospice physician, I see a wide range of patients. In the last year, I took care of patients ranging in age from 21 to 105 years old. Many had cancer while others had heart, lung or Alzheimer’s disease. Some had simply become quite old and their bodies were worn out.
In addition to seeing patients of varying ages and diagnoses, I've witnessed different patients’ acceptance of their own death.
The thought of dying seemed utterly unthinkable for some when they were still enjoying their lives. Even for the patients well in their 90s, thinking of dying still seemed unfathomable despite their failing health and imminent death.
Whether or not we are hospice patients, most of us neither think about, nor consider the idea of dying. We are more concerned about spending time with family, our children or other loved ones.
We all know our time will eventually come. Death strikes people of all ages every day, from the very young to very old. No one will or has ever beaten death. Death is not a matter of “if” but only of “when.”
Some people accept their impending death while others cannot accept death even as they take their final breath. Why do some people accept their fate and others try to deny their own mortality?
The answers are varied. Most patients who are not ready to die feel they have much more they want to do with their life. Many patients worry about their family's welfare once they are gone. Some are fearful of death.
Other patients tell me that “I’ve had a good life. I’ve done everything I wanted to do. I’ve lived so long that most of my family and friends are gone and my body no longer works. I can’t do what I love anymore and death would be better than living any longer. Dying would end my suffering and let me join people I loved who have already died. I am ready to go!”
Depending on the acceptance or denial of approaching death, the impact may be dramatic for the patient and their family. Death will come either way, but it can either follow a period of “living well” followed by a "dignified" death with a comfortable patient and supported family. Alternatively, it can follow a period of uncontrolled physical and emotional suffering and a "tormented" death for the individual and loved ones. Acceptance often makes a big difference in the quality of life lived and how death will be experienced after the patient learns of their diagnosis.
Think about your own life and imagine you’ve received news of your impending death. How you would respond? If you can learn acceptance, your death will be much more likely to occur the way you would have wanted it. You owe it to yourself and your family to consider the unthinkable: no one can escape death and it can happen at any time. Once you accept this fact, your life should be fully embraced and fully lived. Then when your death approaches, it can be fearlessly met, with dignity and without suffering. It is a choice we all can and must make. May you make your choices well.Ira Mandel, M.D., MPH is a Palliative Medicine physician and is medical director of Pen Bay Healthcare’s Hospice and Palliative Care program. He provides compassionate care with a team of health professionals who honor the wishes of patients with serious illnesses. His monthly column seeks to inform the public about choices they may wish to consider. Disclaimer: All people described in this column are not actual patients but are derived from many hundreds of patients Dr. Mandel has treated over many years.