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How should you live when you know you are going to die?
This may be the ultimate and eternal question – an issue we all need to address, but thankfully is not obliged to do so until the end is crystallized by our own illness or that of 'loved one. Humans may be the only animal that can understand mortality, but that's usually not something we're worried about until that happens.
This is a question that I often face as a doctor treating seriously ill patients. One morning, a few months ago, I met an older man suffering from an aggressive cancer that had turned a passionate runner into a voracious reader. He looked up from his diary when I entered the hospital room.
"His [a] strange feeling, you know, reading about a world you will never see. "
After several cycles of chemotherapy, more toxic than others, he decided to have enough. He could travel long distances without thinking of death, he said, until the sight of a distant date or curiosity about a recently proposed bill. bring to light the inevitable reality: his days were limited.
"I mostly read biographies now," he said. "Reading about other lives helps me understand mine."
I began to wonder if the secret of a good death was not looking to the future, but looking back – whether the retrospective examination could be more therapeutic than the prospective preparation. I thought how often I focused only on helping patients: how many weeks or months of life they could expect, what procedures they should or should not consider. These discussions, although important, do not address what research has revealed about the deeper desires and needs of critically ill patients.
Nearly 20 years ago, a basic study of the Journal of the American Medical Association examined what patients and physicians consider the most important end of life. Many answers were predictable and consistent from one group to the other. Doctors and patients, for example, felt it was important to preserve dignity, control pain and other symptoms, and manage finances properly.
But the discrepancy between doctors and patients is revealing – and suggests both a missed opportunity and a path of progress.
Patients were much more likely to express that it was important to feel that their life was complete, to be at peace with God and to help others in a way or to from another.
In other words, feel that their lives mattered.
More and more books suggest that history is a powerful but underutilized way to create this sense of matter: reflect on the past and create a narrative of his life, what it meant, who you are and why.
Humans are natural storytellers. We have tremendous power to frame a story. The same series of events – becoming a parent, getting a divorce, losing a loved one, finding a job – can be a story of resilience and restoration, unhappiness and regret. The psychologist Dan McAdams calls the creation of a "narrative identity" the process of bringing coherence to a life story. People better identify important life issues as they get older, and those who are able to find the positive from the negative are generally more satisfied with life.
Doctors are also storytellers by profession. But we have always focused on describing the evolution of the disease instead of helping patients make sense of their lives. However, creating opportunities for patients to reflect on their life experiences could be an important means of healing, whether it is end of life or halfway.
In a study conducted in 2018, researchers asked veterans with post-traumatic stress disorder to participate in either five 30-minute writing sessions during which they reflected on traumatic experiences, or on a one-to-one basis. a rigorous 12-week Cognitive Processing Therapy (TPC) program, online treatment for PTSD. The study found that short writing sessions were just as effective in reducing the symptoms of PTSD as the CPT-intensive resource program.
Other works suggest that the details of narration matter. Looking back and listing events in life does not seem to help. It is the construction of a narrative – exploration of links, formulation of a plot – that is essential to achieve a coherent sense of self.
And even pronouns seem to be of importance.
Using the first, second, or third person when thinking about past experiences can be of strategic benefit. The use of the third person, for example, seems to allow us to better understand the evolution of our evolution over time, while the first person encourages us to seek continuity. Reflecting on challenges using the generic "you" – "you win, you lose" or "what can you do?" – can help to create a psychological distance from a difficult situation and universalize it. ;experience. "I" made the answer to the center of attention; "You" binds him to the human condition.
Can we make better use of the past when the future is exhausting? I often struggle with my caregiving role for end-of-life patients. I know what I can do more curative than what I usually do: pain medications, laxatives, intravenous fluids. On the contrary, they are both more difficult and more basic. S & # 39; sit. Listen. Exploring what all this meant
"I say to myself," said my patient. "Even though I would not be here to see it, I helped shape the world of the future. At least my little part. "
Dhruv Khullar (@DhruvKhullar) is a physician and assistant professor of health policy at Weill Cornell Medicine, and director of policy outreach at the Center for the Study of Practice and Physician Leadership at the Physicians Foundation.
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