A man goes to see his doctor and the doctor says his test results came in and that he has bad news and really bad news:
“Well, Doc, give me the really bad news first.”
“I’m sorry but you have cancer.”
“That’s awful. OK, now give me the less bad news.”
“You have Alzheimer’s disease.”
“Oh well,” the man sighs, “At least I don’t have cancer.”
I start this article with perhaps a little chuckle because as the song goes, “Just a spoonful of sugar helps the medicine go down.” And actually this joke is a little outdated since a recent study says the No. 1 most-dreaded diagnosis for Americans is no longer cancer, but rather, any one of the diagnoses that affect the memory, like Alzheimer’s.
In my work with hospice patients and their families, I learned a lot about people’s reaction to their diagnosis. Usually by the time hospice was called in, the stages-of-grief process regarding the diagnosis has already been completed. Just as a reminder of Elizabeth Kubler-Ross’ stages of grief: denial, bargaining, depression, anger, and acceptance.
Once medicine has done all it can do to effectively treat the disease, the grief process involving a terminal diagnosis starts the stages of grief all over again. I had the honor of working with a young man who was dying of cancer. From diagnosis to death took about a month. This was clearly a very fast-moving cancer. The young man had the same disease in his teens and effectively had been cured when the disease came back fast and furious in his late 20s. There were no treatments the doctor could offer.
This young man told me he had done everything on his “bucket list” and that he was OK with dying. He added that if he had more time, he would certainly add more to his bucket, but that option did not seem to be in the cards for him. His mother told me that she was treasuring every moment she was having with her son, fixing his favorite foods, even though he had for the most part lost his appetite, looking at picture albums and reminiscing about their life together, and simply soaking him in as much as possible in his last days.
One of the benefits of a cancer diagnosis is that it usually gives people time to go through their stages of grief, do the things they had been putting off. Going through those stages is very beneficial not only to the person who has the diagnosis, but also for loved ones.. Often I hear about people with terminal diagnoses staying in the stage of denial. All of these stages are important for the healing process for both the person who has the diagnosis and the loved ones.
Medicine offers hope; hope usually leads to denial. That is a tough pill to swallow, so here’s another joke to lighten the mood:
A man walks into a bar and sits down. He takes his hat off and on top of his head is a big bull frog.
“Whatcha got there, Buddy?” the bartender inquires.
The frog says, “I don’t know. It was a bump on my butt a few days ago.”
I almost always find that my favorite jokes are the ones that surprise me with the punch line. I usually remember them, too, and the shorter the joke the better. I think laughing at and telling jokes is another great way to fend off the dreaded dementia.
Am I suggesting that if you get a fearsome diagnosis, do you just give up any hope of getting better? Not really. However, I do believe that if I were told I might not live very long, I would get a second or even third opinion and choose the one that gave me the most time. Sometimes diagnoses can be wrong and even the treatments that are medically recommended usually come with a percentage of success rate.
I had a nursing colleague who had an aneurysm. The doctor told her husband that she had a 10 percent chance of survival with the brain surgery and if she survived she had a 10 percent chance of being able to return to normal function. She not only survived the surgery, but she also was able to return to working as a nurse a couple of months later. I also have had patients tell me that they were told they had a 90 percent cure rate with treatment and they were on hospice, because they were in the unlucky 10 percent.
To play it safe, what I do is go through all the stages of grief whenever the opportunity arises. So when I have any concerns I plunge right into the stages of grief. This is pretty much how I greet the morning:
I wake up and say, “Oh, it can’t be morning already.” (Denial.)
Then I roll over so I can’t see the clock and say, “Maybe if I just take a little nap I will be more ready for the day.” (Bargaining.)
I don’t go back to sleep and I start questioning my life decisions as to why I have to get up. “I am worthless when I am this tired and I make bad decisions when I do not go to bed early enough to get the rest I need; I am a bad person.” (Depression.)
Then I realize that I have to go to the bathroom and I know I have to get up. I feel my body is betraying me. (Anger.)
While finding blessed relief from my call of nature, I remember that today is Saturday and I have a fun day planned. I smell the coffee brewing because I remembered to set the timer on the coffee pot and I have time to go back to bed for awhile with a cup of coffee. (Acceptance.)
Lenora Trussell, R.N., is an end-of-life tour guide. She is available for presentations, workshops, and as a travel planner for that pesky end-of-life journey we are all destined to take. If you have questions, comments, suggestions, she can be reached at firstname.lastname@example.org.