William Ramshaw resides in the expansive Pacific Northwest. He is a six-year survivor of pancreatic cancer and has written a memoir Gut Punched! Facing Pancreatic Cancer.
Discussing the possibility of dying is an unfortunate reality for many patients with cancer and their loved ones, but it isn't a talk that should be avoided. In fact, it can lead to more healing and understanding.
Beyond grueling military deployments to godawful places around the world, the hardest thing I've ever had to do is to have a conversation with a good friend whose cancer battle has turned against them. What do you say to them? What can you say? Avoiding talking about what is happening simply doesn't work. Dwelling on it doesn't work either. So how do you talk with them?
Being a six-year pancreatic cancer survivor who thought he wouldn't make it drove me to read a raft of books on death and dying. Three of my favorites (if I can use that word) are Being Mortal by Atul Gawande, How We Die by Sherwin Nuland and Knocking on Heaven's Door by Katy Butler. All excellent, but none of them offers much on how to talk with someone who is dying. Why not? I suppose these are thorny conversations most of us don't want to have but it makes them no less important to have. Closure is so important. Everyone needs to wrap things up.
I'm still learning. Before my pileup with pancreatic cancer, I got word one of my good friends, also a pastor (I'll call him Ricky) was in the hospital with brain cancer. With his hospital being a couple of blocks from where I worked, I walked over late in the day. My visit lasted maybe two minutes. I was not prepared. Arriving at his doorway, his room was dark. Peering in I could see him lying in a bed draped with IV lines surrounded by machines, listless. From the doorway, I said, "Hey Ricky it's Bill. How you doing?" but he was unresponsive. Not knowing what else to do I bolted.
Later whenever I saw him for coffee or lunch, I always asked how he was doing, but his reply was always the same, "God healed me." For me, anytime someone throws down the "God-card" there isn't much more that can be said. Months later, after hearing he had entered hospice care, I called to ask when a good time would be to see him only to be told he'd died earlier that morning. I had no closure. Only deep sadness.
Two years later, things had changed for me. On the mend and after spending months being treated for my pancreatic cancer, over lunch another good friend (I'll call him Mike) dropped the words, "I haven't been eating well. My doctors found a spot on my pancreas they want to look into." to which I replied, "Oh that's not good."
Extensive testing followed leading to the discovery of widespread esophageal cancer. Mike's doctors wanted to do surgery but after they could not assure him it would make any difference in his outcome, he declined. His march to the end began.
Over the following months, he and I stayed in touch, exchanging emails, talking on the phone and having an occasional lunch. Nonetheless, I was still surprised when he called me to say he had been admitted to the hospital. Unlike my earlier visit with Ricky, I was prepared for this visit with Mike. We talked about his life and how his cancer had changed it. Before leaving I offered to pray with him and his wife, but he declined. Two days later he cratered. I returned to see him one last time. Ashen with hollowed-out eyes, he looked like a ragdoll propped up on an oversized pillow. This time he could only speak at most three words at a time. Staying only about five minutes, his wife walked with me to the elevator and said, "Mike asked me if he could quit fighting. I said, 'Yes'." A day later she called me to say he'd died.
So, how do you talk with someone who is losing their battle?
Clear the air.
Not talking about the obvious doesn't help. Acknowledge what is going on and then move on. Clear the air.
Let them drive the conversation.
Once the topic of possibly dying is on the table, if they want to talk about it, they will. Don't force the conversation. Let them drive it.
Remain upbeat (for them and you)
By being upbeat I don't mean a happy happy put a smiley face on everything outlook. What I do mean is focus on what's going right and not what's going wrong. Fighting cancer is a tough job. Things often don't go well. Test results often disappoint. But amid this, focus on what's working. Remain upbeat.
Don't hang back. Help.
Not everyone wants or needs help, but others do need it. Unfortunately, many won't or can't voice their need. It could be as simple as mowing their lawn or bringing over a meal or two. Or taking them to a doctor's appointment. Watching their kids. Whatever. Do something. Often this is a matter of doing rather than asking. Let your heart guide you but also use common sense. Don't hang back. Help.
Mourn with them.
When the door is closing on someone's life, there is a deep sense of loss. Things not done. Words not said. Acknowledge this with them but don't let it sink you along with them. Being a strong friend is better than being one in despair. Mourn with them but let it consume you too.
It remains. The hardest thing I have ever done it to have a conversation with a good friend whose cancer battle has turned against them.