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.

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.

Niko often deviated from the norm though not as he’d imagined. It was more like a train track askew just enough to tilt toward tipping. Pain. Nausea. Diarrhea. He had it all. Nothing seemed to work the way it was supposed to. His body abandoning him. His experience curious because his symptoms didn’t match the scans that at times showed “stable” disease. Each day arrived toting the unknown. Unable to predict symptoms or mood, anticipatory anxiety became anxiety itself. The light in his eyes dangling edge close. Everything was wearing on him. The sense Niko sought to make of his illness began to take too much energy. Curiosity requires presence and he needed to conserve.

Prior to being diagnosed Niko had experienced periodic pain and noticed some weight loss. He didn’t necessarily feel like himself, yet there wasn’t anything that struck him as alarming. Until there was. We do that sometimes, don’t we? We feel something, hear something, see something and we let it pass. It’s an afterthought. No big deal. Then it returns like a boomerang. Persistence has a way of getting its needs met. There were days, no more than a few at a time, when an opening would be created, and he could catch a break. Joy existed in those moments even as the shadow lingered, and the hauntings happened. Death still hovered juxtaposed to hope exploring itself.

It is no small practice reaching somewhere deep within to access happiness when the truth is you’re being haunted. When do we learn to compartmentalize? At times Niko would lie on the couch in a fetal position holding his physical pain along with the anguish of all that would never happen. The momentum of what would be his life’s work was just picking up. There were so many plans and the excitement that comes with happy anticipation. It would all go undone. I wonder of the receipt of its landing, that moment of reckoning. He was sad. It was sad. With time Niko’s suffering grew steadier than his happiness. Yet the light in his eyes dangled still as he continued to practice being with dying.

To reconcile life at the intersection of death usually takes time. Fewer people are ready to exit this grand experience. It’s a process that each person arrives at (or not) in their own way. Reconciliation involves true looking, turning toward rather than away. It’s different from hope. Where hope involves wanting something to be other than it is, reconciliation is a practice in acceptance even when accepting means letting go. Rather than fight or swim against the current, we consciously allow the current to carry us. There is no manipulation or directing the course. We give in to allowing and this reduces our suffering even when the pain continues.

Eventually, Niko gave in. He didn’t quit. He allowed. As a truth seeker, it was a path he was destined to take. That happens when we turn toward and enter in. Niko had always wanted to find the source, find the meaning to it all, and with time he found a way to do just that. His spiritual path took him on a journey inward where he accessed a level of understanding that released him from any holdings. His hope evolved to peace. There was no longer cause to fight against what was happening. He had won differently.

Letting go

There is no manual for dying, no guide that leads us down its steep and narrow road. We walk. We pause. We accept in fits and starts, and we deny in the interim; still everything moving us to life’s end. Consciously or unconsciously, we are releasing everything. Some things—like death—not a tight grip can hold. This is the natural in and out flow of life. This is also one of the biggest practices we will face: letting go. What an honor to be in the throes of that imperfect practice.

Kissiah Young, MSW is a medical social worker in Outpatient Palliative Care with Kaiser Permanente San Francisco. Her background runs the gamut from academia to hospice care.