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The Topic You Shouldn’t Avoid

Wendy Baer, MD - Blogs
By Wendy Baer, MDPsychiatric oncologistFebruary 02, 2016
From the WebMD Archives

For two years, Bob and Kelly had been extremely busy fighting Bob’s stage III colon cancer – night and day, 7 days a week. They’d spent countless hours researching and discussing which medical centers to visit and which clinical trial Bob might join.

But there was one topic Kelly and Bob had not talked about: Death.

Knowing that Bob was already under incredible stress, Kelly felt reluctant, even anxious, about approaching the topic. “I am worried he will be more stressed out if I bring up anything about death. But trying to hold it all in is really hard, I almost have to hold my breath to not say anything about it.”

While it’s an understandably difficult conversation to have, talking about death yields important benefits:

First, there are always many decisions to make about medical care, especially at the end of life. If Bob and Kelly share with each other, and write out, their wishes regarding CPR, ventilation and feeding near the time of death, then neither one is left with the enormous stress of having to make that decision alone. And if you know your loved ones wishes, you are less likely to have guilt after they die about the decisions made. Writing out your wishes may also be done with your medical team on special form called “Advance Directive.”

The second benefit of having a death decision is that talking about death actually leads to less anxiety. When people are able to recognize death as part of life, they reach a healthy psychological stage called “acceptance.” Once acceptance is achieved people are able to move forward with processing the worry and sadness, and make plans for living fully while they can. Kelly heard about acceptance and then living fully from another member of her caregiver support group, Tom, whose wife has ovarian cancer. “For months we had been spending all our time going to doctors, managing medicines, and lying around the house watching TV. One afternoon my wife said we had to face the fact that her life was going to be limited by cancer, so we talked about death for a couple hours. Ever since that discussion we think more about what we like, what matters to us, and how to make those things a reality.” Tom and his wife worked out a chemo schedule with the oncologist that allowed them to finally visit their daughter in Canada, a trip they had been dreaming about for months. “If we had not had that talk about dying, we might never have started focusing on what we wanted out of life!”

Of course there will be some anxiety and sadness when thinking about the death of a loved one. After Kelly and Bob talked about death, they still had lots of emotions, but these emotions were not nearly as painful as when Kelly was trying to “hold it all in.” If the emotions do start to overwhelm them, Kelly and Bob use specific helpful thoughts, along with five deep, slow breaths, to calm down. For Bob and Kelly the helpful thoughts are: “We have done all we can to be ready, there is a plan in place. We have things to look forward to tomorrow. For now, we are here, and that is good enough.”

Dealing with death, and discussing death with your loved one, is not easy. However, having the discussion, writing out your wishes, and prioritizing what matters most to you, allows you to live as fully as possible, even with cancer.

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About the Author
Wendy Baer, MD

Wendy Baer, MD, is the medical director of psychiatric oncology at the Winship Cancer Institute of Emory University in Atlanta. Dr. Baer helps patients and their families deal with the stress of receiving a cancer diagnosis and going through treatment. Her expertise in treating clinical depression and anxiety helps people manage emotions, behaviors and relationships during difficult times.

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