THE BLOG
04/25/2016 12:05 pm ET Updated Apr 26, 2017

Dying Should Be a Selfish Endeavor

My patient Rona is dying. She has been my psychoanalytic patient for 30 years and has struggled against her cancer for 15 years. She has had Stage 4 cancer for seven years. She fought the good fight, a valiant fight, and truly, for many years, it had seemed as though she were indefatigable. She has been telling me that she is dying for a few months now, and in spite of her being bone-thin, I still saw and heard life energy in her. Her voice and spirit were strong in spite of her frail body. Although she needed help to make it up the two flights of stairs to my office, still she plowed through it, and never missed a session.

Until she did. Two weeks ago, she explained that she had simply slept through the session. She had begun painkillers. After not wanting to pollute her body for many months with the toxicity of painkillers (and this, in spite of being on chemo and immune therapies for the cancer for all of the 15 years of her cancer ordeal -- she was a bit irrational about the reluctance to take any painkillers other than Advil), she finally relented to the more powerful morphine drugs -- the ones reserved for hospice patients. And she began to live her life through the haze of a drugged sleepiness, but with considerably less pain.

Rona wanted to die at home, with her beloved husband of 38 years at her bedside. Home Hospice was arranged. Through Medicare, she was awarded the use of a home health care person two days a week, for an hour and a half each day.

Rona described her husband as trying to help her, trying to assist her in sitting up, helping her to eat, getting her to the bathroom. She described that (in spite of his having been a physician) he kept pulling her arm in the wrong way, or positioning her leg at the wrong angle. He was trying. She appreciated his feeble attempts, because they were his bestowal of love. But, the fact was, the only time she could really move without pain was when the home health person came. At those times, twice a week, Rona got a shower. She wanted one every day. She wanted to still be able to stand, and look in the mirror (though the sight of her thinness horrified her); she wanted to brush her hair and put on a little lipstick to meet the day -- even though meeting the day meant greeting it from her bed.

Rona had one desire before her death. She had told me every year, each year that she was in analysis with me, that Easter was her favorite holiday. She looked forward to her whole family gathering together -- to the grandchildren hunting for the eggs, to the meal that all shared. She liked that there were no presents. Christmas was always more taxing than she felt it was worth, with the pressure to find the perfect gift, the stress of needing to be "happy." Easter was, for her, just about family. Not about happiness. Not about shopping. Not even about eating. Just about family gathering together.

Rona made it to Easter. And, indeed, her family came from around the country, knowing that it would be their last Easter with her. They gathered around her bedside. And then Rona did a remarkable thing. She asked each of them what they were going to say at her funeral. She wanted to hear her eulogy. They cooperated with her request, and told her what only her spirit would have heard on that imminent day that they were all awaiting with reluctant anticipation. She heard a great outpouring of love with their "live eulogy." But she heard more. She heard that she had been "seen," really "seen" for all the years that she had shared with her family. Rona had always felt defensive about her intelligence because of not going to college (though, in fact, she had a keen, innate intelligence). She had never considered herself especially pretty (though she had an appealing, attractive femininity about her). Rona defined her best qualities, and what she valued most about herself, as her warmth, her acceptance of people in a non-critical way, her generosity, her willingness to give. And, all this is what her family said to her in their live eulogy. Of all the gifts that Rona had ever gotten in her life, she felt that her family's recognition of "seeing" all this in her was the greatest gift of all. She and I laughed at her great invention -- a living eulogy: a eulogy for the still alive rather than for the recently dead. We decided that a live eulogy should be implemented by all as a way of dying.

The family left. And Rona was left alone with her thoughts, her feelings, and her bodily pain. We talked again about the home health person coming twice a week. I asked if she could get more time from her. She said "Yes, but we would have to pay out of pocket." I asked how much. "$125 for the day." That seemed like a bargain to me. I asked her if she wanted to do that -- hire the woman for more time. Rona answered that she would have to discuss it with her husband. I said, "Really?"

Rona had spent her adult life working in her husband's medical practice. She ran his office. She worked every bit as hard as he did caring for his patients, doing the billing, organizing appointments and filing insurance claims. It is possible that she worked even harder than he did.

I found it odd that she felt that she needed to discuss with him -- as in "ask his permission" -- to spend their money to make her dying days more comfortable. It was the dark side of Rona's unrelenting giving: her giving to her own sacrifice. I asked her about this -- why she didn't feel entitled to spend the money. She talked (as any loving partner would have) about wanting him to have enough money to make his ensuing years without her comfortable. It sounded reasonable. But still: she was dying. Why couldn't she decide to make her dying more comfortable? Why couldn't she, at these last moments on this planet, decide to make her life just a little easier to endure, as endure had become all of what these last months and days had come to mean? To be just a little selfish, perhaps?

I asked if she thought that she could make, at least, her dying a selfish endeavor.

I have come to this point with cancer patients in the past. I think of it as the point when their life meets their destiny: the funnel point, the end of a long journey of encroaching awareness. It's the moment when it seems as though all energy of that person's life has spiraled down, from a wide entry point, and coalesced into one intense, infinitesimally small point of energy -- a funnel of life energy/life purpose/life meaning. And, it seems as though that moment represents the most important challenge, the most important lesson of that life, and it represents a moment when the person can embrace the destiny they were meant to have, live it, and learn from it. Or not.

My patient, Miriam, too, had been given a cancer diagnosis. But unlike Rona, her body had not yet been fatally ravaged by her disease. Her funnel point came when she realized that she was spending her life caring for her brother who had become a quadriplegic from a motorcycle accident. In allowing herself to finally see that her brother had to live his own life, as limited as it was, Miriam made the decision to reclaim her own. And as she embraced recapturing the propulsion movement of her own life, instead of piggybacking on her brother's, her cancer mysteriously (miraculously) disappeared.

The funnel point, when there is a rapid reversal of the direction of how one has lived his or her life, may look like selfishness. It may even FEEL like selfishness. But, I see it rather, as the crucial point at which one is faced with a decision of living one's own life.

This profession that I practice -- psychoanalysis -- doesn't promise happiness, wealth, or bodily health. (It may result in any of those, but they are mere secondary gains.) Its only promise -- a rather limited ambition for a timely and costly endeavor -- is freedom: the freedom to have of all one's thoughts and feelings, and the freedom to be able to translate that complex, contradictory and stunningly rich domain of the interior of one's mind and psyche into words: the freedom of articulatable awareness.

Unlike Miriam, Rona met that place at a time when her decision to reverse the energy direction of her life was too late to save her. But she is now getting a shower every day; her dying with just a bit of selfishness has changed the way she is living with dying. Sometimes, that is all we, as healing practitioners, can do.