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Letting Go

By Richard C. Frank, MD

holding hands

A patient of mine whom I had become very close to was dying of cancer. I visited her at home because she was too weak to come to the office. She had stopped eating days before and was only taking sips of water now. It was painful to see the devastating effects cancer had wrought on her face and body. She smiled upon seeing me, I embraced her and sat down; she wanted to talk. She expressed her gratitude for her wonderful family, comfortable home, excellent medical insurance and all the wonderful medical professionals who cared for her along the way. She felt at peace, her children were married with their own children and were on a good course. She did worry about her husband. But it had been a four year battle with pancreatic cancer and she was done. “I’ve been holding on for everyone else and for me. But I want to let go now. It’s time. They just have to understand.” I felt privileged to be in her presence at that moment, to support her coming to terms with her impending death. Over the next several days she gathered her husband and children, then siblings and close friends and let them all know she was saying good-bye. Not long afterward she passed away.

I attend regular multi-disciplinary team meetings with a visiting nurse and hospice agency in my community. I hear the social workers, nurses and chaplains talk often about whether or not a person who is dying is “letting go.” “They can’t let go.” “Their children won’t let them let go.” “The doctor keeps giving chemo, he won’t let go.” “They need to hear that it’s ok to let go.” “They finally let go and were at peace.”

These caring professionals want their dying patients to die with dignity and grace and they feel that letting go is essential to accomplishing this. But it is scary to let go. It means admitting powerlessness and that the outcome is not in your hands.  It takes bravery to face the end of life, the disconnection from loved ones and from this world. And many fear the unknown of what comes after death. But resistance until the end does not lead to a sense of peace. We know that people with a strong support system and those with strong religious beliefs do face death with more inner peace and less turmoil.

I have seen this at work very often in my own practice of oncology. I have become aware of the need to tell patients that it is ok to let go. The most common situations include: When a patient has reached the point that there is no more that can be done to battle their cancer; when there are more treatments that could be given but none that have a very good chance of meaningfully prolonging their life or improving the quality of their lives; when the patient asks if it is alright if they stop trying and just let go and let nature take its course. In these situations, I feel that it is my role as the patient’s oncologist to support them in the choices that are right for them and to let them know when more treatment will likely do more harm than any good.

As a society, we have trouble letting go as we near the end of life. To some it means giving up all hope which they feel is unacceptable. But at some point hope has to shift to having a peaceful ending; hope is never lost. Sometimes not all family members can accept a patient’s desire to stop treatment, enroll in a hospice program and let go. Too many cancer patients in our society are in hospice for fewer than three days and many more for less than a week. But this is not nearly enough time to say what needs to be said and do what needs to be done. It takes time to achieve a sense of peace with the events that are unfolding beyond anyone’s control. It takes time to adequately express the love and grief that all involved are feeling so that there are no regrets in the future.

What are your thoughts and experiences with letting go?

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