Special Section: Palliative Care
RECONCILIATION: A PRACTICE IN LETTING GO Kissiah Young, MSW Nothing lasts forever, particularly life. Its duration unknown to all. Each day moves then fades into the next until the next is the last. This thing called life must be the greatest magician. We are here and then we are not. We appear then disappear. Maybe we see death coming; given a diagnosis and know that it is en route. Maybe not. Often it arrives like a thief in the night and takes us from ourselves leaving behind fingerprints of grief. But what about the undoing, the life that slowly unravels when the floodgates open? What happens in the space between living and being told that you are dying? Hope. It seems hope creates a crack just wide enough for the light to get in. Cancer has long been a thief, robbing unprovoked. Yet it seems to remain insufficient a cause to contemplate dying. Death has always been separated from self—other than, not applicable; it’s ‘out there somewhere.’ And so, to consider death intimately feels warzone foreign. Why would we do that? Even cancers that seem to be synonymous with death—to the diagnosed— are never synonymous with dying. Without missing a beat our mind seeks to minimize the diagnosis, make cancer manageable. We start pulling out all the IOUs due us. It’s time to cash in, get well stocked and armored to fight forward. We access our hope card. “Dear God,”—it may begin, followed by stressing how we’ve done our best to fly under the radar. We haven’t asked for much, and now need a favor. We bargain. Death remains too distressing to consider. As a medical social worker, I exist in the gray with patients. Thoughts, feelings, confusion—the existential—fall outside of the black and white keeping me closely connected to a patient’s inner process. It isn’t linear, and at times may not appear to make any sense. Yet it is real. The journey of one patient continues to linger with me more than two years later. Something about its push-pull—open then contract only to open again then contract—nature affected me. It also intrigued me. It made me think about how in an instant any one of us could go from who we are to the struggle found in reconciling the before diagnosis with the after. 28
An Anomaly Niko was a sensitive man in his early 40s with an affecting spiritual life. He and I connected from that very first clinic visit, pre-pandemic back when hugs took place—we exchanged hugs. “I’m an anomaly,” he told us in that initial visit. “I’m not going to be like any patient you’ve ever had.” He was right. He had a certain stillness. His presence felt intentional. As a therapist, Niko centered his life work around redefining masculinity and healing generational trauma. He was intrigued by the mystical and practiced connecting the dots of life to discover the meaning of things. Niko extended this same practice to his cancer diagnosis. It was to be part of his spiritual journey. Through tears he’d worked hard to allow himself to have, Niko talked about his pain. It was physical. It was existential. If only he could understand the source of his diagnosis—make some connection to any traumatic tethering—then he could work to undo it. There are some things in our lives that haunt us. They are like shadows we cannot get away from, a dark lingering that threatens. We forget, or perhaps do not realize, that the only way for the shadow to disappear is to fade into it. Become one. Niko sought to become one with this illness. He was curious about it; tiptoed in the shadows to understand. He also sought to fight against it, and win.
Diagnosis: Stage IV pancreatic cancer
Of all the cancers pancreatic is there alongside a few others at the top of a common "do not want” list. It’s one of those cancers typically synonymous with death and arrives with one message: poor prognosis. There are things that patients do not know that certain medical providers know so well it startles: the trajectory of disease with or without treatment. Often the urgency fast-forwards time. While the doctor plans the course of treatment the patient scrambles to connect the dots. Hope unable to establish rapport. It gets pressed against pervasive symptoms and treatment. There isn’t enough light coming through the crack to hold it all.
SAN FRANCISCO MARIN MEDICINE OCTOBER/NOVEMBER/DECEMBER 2021
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