Month: September 2023

My wife died earlier this year. Five years ago, there was cancer in her pancreas. We tried to cut it out, but some of it relocated to her liver. With treatment, she lived in that state for several years, several good years. But eventually the cancer blocked her bile ducts. No longer able to process food, she starved. “Died of cancer” means many things, but for my wife, it meant starvation.

In her case, there was a fairly rapid transition from coping to starving. She went to the hospital one day for a regular appointment, and they looked at her liver numbers and said “We’re admitting you to the hospital right now.” She didn’t even feel that bad, but the numbers weren’t lying. Things were breaking down, breaking down for the last time. They weren’t going to get better.

I want you to know that we were very fortunate with medical care. We live close to an excellent cancer center. Insurance was not a problem. The medical professionals we worked with were all you could hope for: compassionate and competent. They did what they could to help my wife. But this last stay in the hospital was driving her crazy. She wanted to come home. She wanted to come home even though she knew she was very very sick. She wanted to see the flowers in her yard. She wanted to be with her cat.

She knew what the score was. She had been living under the heavy stone of this disease for more than four years. And she had spent the last two weeks in a noisy, shared hospital room, losing sleep, unable to eat, and getting increasingly bad news. She had had enough. At this point she had a serious argument with her doctors. She said I want to go home. They said we can’t let you leave. She said I’m going to walk out. They said: Of course you can, but you will be doing it against medical advice. You are too sick to leave.

It was tense.

I want to stress this: the doctors at the hospital were very good, very helpful. They were committed to making their patients healthy. But for my wife a return to health was no longer an option. Now all of their instincts were somehow wrong-footed, misaligned. They were suggesting short-term interventions that no longer made sense, because they would be painful and expensive and they couldn’t possibly bring her even one more day of health.

Image by Midjourney

This is when hospice entered the scene. And everything changed. The exit door, the door so recently blocked by stern, disapproving professionals, swung wide open. Discharge was fast and easy. It was so strange to leave the hospital knowing that you were not, under any circumstances, going to return.

Here is the basic premise for hospice care: they’re not trying to fix you. They’re trying to make you comfortable. The hospice staff set us up at home, and the hospice doctors visited. And I realized that I had gotten accustomed to doctors looking with alarm at everything related to my wife’s medical situation. Good lord! Look at these liver numbers! These platelet counts! This x-ray! Not good. Not good at all. You start to feel broken all the time.

Under hospice care, we moved from doctors who were always alarmed to doctors who were calm. We would hear numbers, and I knew these numbers were terrible. I knew they represented desperate brokenness. But the hospice doctors weren’t alarmed. They were calm. This is what their calmness said: you aren’t broken. You are here and you are whole and I am here with you. You were never broken.

It meant so much to me. Even for those of us living without serious disease, it’s easy to feel broken most of the time. You’re off the path of health. You’re making so many mistakes, so many poor choices. And yet here is this radiating calm. It is a profound shift, a shift from constantly feeling broken, off the path of health, to being on the path that binds us all. The path which must, after all, be life itself. You are not broken. You are on the great arc. You are part of the tapestry, perfect and endless. You were never broken.

One day you will die. And you won’t die because you break. You will die because that is what happens to all those who live. The lucky. You were never broken.

When someone close to you dies, people want to offer condolences. Lots of people. The notion is of course that those who comfort take care of those who grieve. But if you’ve been in the unfortunate position of navigating loss, you know it doesn’t always work that way. Sometimes those who grieve need to take care of those who comfort.

What are the rules for condolence? Our shared secular culture doesn’t offer much guidance. Many people are at a loss. They feel awkward. They don’t want to cry, and they don’t want to see you cry. They want to say something, but the words feel false. They want to fix something that they know cannot be fixed. In short, they need to be let off the hook so they can move quickly out of the danger zone.

“There are no words.”
“I don’t know how you manage it. I couldn’t do what you’re doing.”
“If there’s anything I can do for you, let me know.”

All words of comfort are welcome, but sometimes you see people floundering. This is where counter-consolation can be helpful. “Thanks. I appreciate it. You’ve done enough already.” You can see their relief as they move away, as they merge back into the traffic of life.

Recently I’ve had time to ponder the nature of this awkwardness. Is it simply the case that our happy-success culture doesn’t give people the grounding they need to embrace suffering? That’s part of it. But I think there’s something else going on too.

I think people are afraid of catching bad.

We all have an innate understanding of infectious disease: don’t loiter with the sick lest you sicken. Similarly, deep in our psyche is a less rational notion of infection, that being around bad things can make you susceptible to them. That’s what I mean by “catching bad.” It’s uncomfortable to be around people who are under a cloud, because that cloud might rain on you.

Image by Midjourney

I can relate. When my wife was sick with pancreatic cancer, I met a man whose wife had died of pancreatic cancer. He was willing to talk to me about his experience, but I didn’t want to hear it. My wife was still alive. I didn’t want to catch bad.

Seeing things through this lens makes some behavior more clear. Let’s say I’m trying to comfort you, and I say “I don’t know how you manage it. I couldn’t do what you’re doing.” What I’m really saying is something like this: “You can handle this, and God knew that, and so he sent this malady to you.” It follows logically that I should proclaim that I can’t handle it, thereby keeping God off my case. You’re heroic and I’m not! You’re strong and I’m not! The more distance I put between you and me, the better. Your grief competence is a disaster magnet. My grief incompetence is a shield. It will protect me from catching bad.

I find it useful to think about catching bad, because when you see it, when you see yourself squirming under its influence, you can stop and observe that it’s not really a thing. It’s a superstition based on magical thinking. This lets you settle into more helpful behavior: embrace the awkwardness. Be with the afflicted. Cry and bear witness to crying. Listen more than you talk. We all know you can’t fix what’s happened. But you can sit here next to me and watch the sun set. And maybe tell me a story about that time my wife gave you a ride home from swim practice, and you both were laughing so hard at a joke that she missed her turn off Storrow Drive. I would like that.