An email I received from a reader provoked this article. She wrote “I’m 50 years old, sitting in a hospital room with my 43 year old husband, who is trying to recover from surgery for esophageal cancer. His diagnosis in early March sent me into a tailspin, triggering many unresolved fears that I have around the concept of mortality.” Like so many of us, this woman was thrown into the chaos of dealing with matters of life and death. Unfortunately, we do not do serious illness and death well in this country. Most of us don’t know what to say, what to do, or how to comfort one another. We never learned how because we live in a society that treats death like an invisible elephant in the room. Like a soldier having his first experience under fire in battle, nothing prepares you for the thoughts, feelings, and devouring experience of facing your own brink of death or that of a loved one.

Here are four sanity-saving and powerful keys to coping well when critical illness or death catches you by surprise.

Acknowledge and accept what is happening. Trying to pretend things are other than how they are only postpones dealing with reality. And, the only moment of our lives when we have any choices is the present one. So, it is important to do whatever is necessary to face the truth head on and settle into it so you can decide how to proceed. Pay attention not only to the news you are receiving, but to how you are reacting. Bear witness to what is happening inside yourself. Are you shocked? Angry? Unable to listen? In denial? Wanting to believe this is a lab error? These are all perfectly normal responses, but they do not serve as a solid foundation from which to respond to the situation.

As stated in a previous post:

Acceptance is a conscious choice to drop all forms of resistance to whatever has come present in the moment and making the most of it. Acceptance isn’t about liking or approving of something. It is about letting life flow and unfold without getting in the way. It is about being receptive rather than exerting resistance to what comes present.

(For more about acceptance see my previous article on the topic.)

Love yourself. It is not uncommon to be critical of your own ability or lack thereof to face the rigors of critical illness and death — your own or that of a loved one. Don’t hold your behavior up against some fantasy standard of how you “should” be thinking, feeling, and behaving. Stay present in the truth of how it IS for you and love yourself through it. That means not “shoulding” on yourself. Give yourself permission to be a mess mentally, physically, and/or emotionally. It means recognizing that you are in new territory and don’t have a reference point for what is “normal.” Choose to be kind and compassionate towards yourself and others in the situation, and allow yourself to experience your negative thoughts and feelings. When you deny or bottle them up, they build up pressure within you that will inevitably result in either an unattractive outburst or an implosion of negativity into your physical being. Let yourself be however you are. If you are the caregiver, it is easy to feel guilty or selfish for caring about your own comfort and well-being when your loved one is facing a life or death challenge. Remember that you must only give to others from your overflow. When your giving depletes your own needed resources, it is natural to feel resentment, anger, and self-pity. It is not bad to feel these things – they are perfectly normal reflections back to you that you are not taking care of yourself and need to do so. If you find yourself unable to cope – reach out for professional help – someone who can bear witness to your authentic experience and can teach you how to support yourself through it. Seek help from someone with seasoned experience dealing with dying, death, and bereavement.

Don’t attempt to protect others from the truth. When you tell yourself you are protecting another from a devastating truth, actually you are preventing them from having their own experience. This attempt to put a lid on or deny reality, is a choice to try to control the situation rather than allowing it to be as raw and real as it is. This is a decision based on fear. Alternatively, when we are authentic and tell the truth – no matter how unpleasant, we are respecting the other person’s right and ability to cope and are keeping the door of honest, intimate exchange open rather than playing the game of pretending the stakes aren’t as high as they are. Go against everything you have been taught about the great death taboo. Our society has trained us to avoid the “D” word. I say, “Say it outloud! Death is as essential to the human experience as life is – be vulnerable to it. Tell your loved ones what you are thinking and feeling. Talk about your beliefs – what matters to you and what you believe to be true. Give voice to your fears so others can love you through the experience.

Maintain mindfulness. Matters of life and death have a timeless quality, yet involve an endless bombardment of new thoughts, feelings, and experiences. Hold the intention of staying current with what is happening in the moment. We have all kinds of defense mechanisms for dealing with bad news – denial, shock, anger, isolation to name a few. Know that these are normal. Use some good questions to move yourself back into a functional awareness of what is happening. For example, ask yourself “What is the most loving thing I can do for myself in this moment?” or “How do I really feel about this?” “What are my options?” If you are the partner or loved one of the patient, consider asking these questions both of yourself and the patient. If a complicated hospitalization or prolonged illness is involved, keep a daily journal of what is happening for the patient medically, physically, mentally, emotionally, and spiritually. These notations often hold essential keys for better understanding the situation.

We may not have any control over the fact that we are all a phone call away from tragic news. However, we do have the ability to affect how we handle that news. Just do your best – that’s all any of us can really expect of ourselves.

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