Reflection on death, acceptance and palliative care

Just talking about it, about death, about the end, can make us so uncomfortable that we avoid thinking about it at all costs.  And when you’re talking about yourself, this discomfort can become fright, fear and even distress. This is normal, we have been taught to “protect ourselves from death”, to avoid it altogether, physically, mentally and spiritually. We live in a framework of subjective thought of immortality that creates a false sense of control, which is likely of adaptive origin. As we age, we adjust to the unrelenting reality that we will die one day, either from illness or simply from old age.  

However, a cancer diagnosis significantly accelerates this whole process. The “feeling of control” is lost and a sea of unknowns overwhelms the person. What kind of cancer do I have? What treatment will I get? What are the side effects? and the million dollar question, Will I be cured? Will I die? And if so, How long do I have left? This is where a long journey of introspection and re-evaluation of values, priorities and needs begins, with the idea of dying directly or indirectly present.  

 Each of us has a life experience that conditions and/or dampens the biopsychosocial impact of living with cancer. Tools and skills that we have incorporated together with protective and risk factors, which facilitate or hinder the acceptance of the present and reconciliation with the past.  

 Acceptance of the present comes from the acceptance that there is an end. It’s a no-brainer. Despite this, it is so complex to carry out. Not only does it depend on the individual, the person’s immediate environment also participates and influences in a bidirectional way.  

 The cancer patient is faced with a constant acceptance process with every diagnosis, every treatment, every test, every medical appointment… dynamic and ambivalent. Healthcare professionals are essential actors that modulate and guide patients along this path through their interactions and interventions. They are essential to understanding the present and the subsequent intellectual acceptance of the different situations.  

 It is important not to confuse resignation with acceptance. The first invites inaction, speaks in the negative. The second encourages construction and the achievement of objectives, speaking positively. The individual knows his/her reality, accepts it and sets goals to be met. A fine line separates both attitudes and approaches to life.  

Accepting death is not the same as resigning oneself to dying. It’s quite the opposite. It’s accepting that you are alive.  

October 9th, World Hospice and Palliative Care Day. 

 When we hear the term palliative care, it is understandable that we think of the stereotypical images of a person in their final moments of life and receiving medical care on their deathbed. This is far from reality. This is part of it, but not the whole picture.  

 These images correspond to the last scene of a movie, that final take after many, which closes and makes all storyline that preceded this moment make sense or not. That is where the great nuance lies.  

 Today, palliative care teams come on scene almost from the start of the film and accompany the protagonist throughout the entire story. What do they do? They accompany. They help the person to understand, to process, to cope with the good and bad times, and their maximum goal is to help overcome. Palliative care teams do not merely relieve the physical pain we imagine in that final scene. They also help support the patient during his or her psychological and existential suffering at different times during the process.  

 Dying well is just as important as living well. Defining health solely as being free of disease is just as mistaken as thinking that we only aspire to die without pain.  

 We are spiritual beings with spiritual needs. Palliative professionals accompany patients in their self-discovery and support them during their physical suffering using the existing scientific knowledge.  

“Helping someone die well is just as important as helping to save someone’s life.” 

 Luis Molina Olmos 

Psychologist and palliative care nurse 

MatchTrial

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