[MOL] Caregiving series 3 of 4...Supporting a person with cancer... [01238] Medicine On Line


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[MOL] Caregiving series 3 of 4...Supporting a person with cancer...



Supporting a person with cancer through illness and death

'Grace and Grit - Spirituality and Healing in the Life and Death of Treya Killam Wilber' by Ken Wilber, published by Shambhala (Boston and London), 1991, 422 pages, 14-99.

This is a very moving and enlightening book about Treya Killam Wilber's five year struggle with cancer and her brave dying. Interspersing Treya's journals with his own narrative, her transpersonal psychologist husband Ken Wilber recounts an epic tale of ups and downs - medical, emotional and spiritual - that has relevance to all families hit by cancer. Treya during her illness co-founded the American organisation The Cancer Support Community. From them you can obtain useful papers by Treya and Ken on 'What Kind of Help Really Helps?', 'On Being a Support Person', 'On Visualisation' and 'Health, Wholeness and Being' ($15 donation each, address below). This book however describes many of the ideas in these papers and shows a great deal of insight in its tackling of the themes that worry a cancer patient and the patient's family - as the following adapted extracts indicate.

Is the person responsible for cancer?

To what extent, for instance, is the person responsible for having got cancer? To what extent do they need to change to get better? Ken gives his assessment in a conversation with Treya:

'Cancer is about 30% genetic, 55 % environmental and 15% emotional, mental, existential, spiritual'

Right now, from all the evidence I've seen, I'd say that with cancer it's about 30% genetic, 55 % environmental (drinking, smoking, dietary fat, fibre, toxins, sunlight, electromagnetic radiation, etc), and 15% everything else - emotional, mental, existential, spiritual. But that means that at least 85% of the causes are physical, it seems to me.

I don't know what caused the cancer, and I don't think anybody does. The people going around saying that cancer is caused primarily by repressed emotions or low self-esteem or spiritual anaemia - they don't know what they're talking about. There is no credible evidence whatsoever for those notions; they're basically put forward by people who are trying to sell you something anyway.

'Why don't you use cancer as a spur to change all those things in your life that you wanted to change anyway?'

Since nobody knows what caused your cancer, I don't know what you should change in order to help cure it. So why don't you try this. Why don't you use cancer as a metaphor and a spur to change all those things in your life that you wanted to change anyway? In other words, repressing certain emotions may or may not have helped cause the cancer, but since you want to stop repressing those emotions anyway, then use the cancer as a reason, as an excuse, to do so. I know advice is cheap here, but why not take the cancer as an opportunity to change all those things on your list that can be changed?

Is being resigned to die bad for your health?

Then there's the question, is it dangerous to feel accepting and resigned about dying? If you don't focus entirely on a strong will to live, will this bring on an earlier death? Treya ponders deeply on this issue and concludes:

'I can both desire to live and be willing to let go when the time comes'

A light touch, it seems to me, lets me think in a both/and kind of way: I can both desire to live and be willing to let go when the time comes.

Supporting the patient's treatment choices

How can the support person continue offering full-hearted support to a patient who contemplates a course of medical or alternative treatment that seems wrong-headed? Ken has a balanced response to this:

'If the person decides to do the treatment then shelve your scepticism and get behind them 100%'

What I was still learning, and still learning the hard way, was just how to be a good support person. My lesson here: if you are genuinely sceptical about a particular treatment, voice that scepticism during the period that the person is trying to decide whether or not to do the treatment. That's being honest and helpful. But if the person decides to do the treatment then shelve your scepticism and get behind them 100%. At that point your scepticism is cruel and unfair and undermining.

Meditating on the world's suffering

Treya finds a meditation practice that helps her to transcend her individual suffering. Having practised Hinayana Tibetan Buddhist meditation (in which you simply pay attention and witness whatever is going on, externally and internally, without judging it, avoiding it or desiring it) she takes up the Tibetan Buddhist Mahayana ttonglen teachings which stress the enlightenment of all beings and which are practices for developing compassion in the mind and heart. Ken describes how to approach ttonglen:

'Hold that suffering in your heart. Then, on the outbreath, take all of your peace, freedom, health, goodness, and virtue, and send it out'

In meditation, picture or visualise someone you know and love who is going through much suffering - an illness, a loss, depression, pain, anxiety, fear. As you breathe in, imagine all of that person's suffering - in the form of dark, black, smokelike, tarlike, thick, and heavy clouds - entering your nostrils and travelling down into your heart. Hold that suffering in your heart. Then, on the outbreath, take all of your peace, freedom, health, goodness, and virtue, and send it out to the person in the form of healing, liberating light. Imagine they take it all in, and feel completely free, released, and happy. Do that for several breaths. Then imagine the town that person is in, and, on the in-breath, take in all of the suffering of that town, and send back all of your health and happiness to everyone in it. Then do that for the entire state, then the entire country, the entire planet, the universe. You are taking in all the suffering of beings everywhere and sending them back health and happiness and virtue.

Grace and grit

When a final brain tumour operation seems to have failed, Treya tells Ken that she will try to hang on one more week, just in case her condition improves. Ken writes:

Treya kept her word, and for one week pushed through the extreme and rapidly growing, even alarming, agony - and stayed right with her programme, every single exhausting detail of it. And refused morphine so she could be mindful and aware and present. She held her head high, and she smiled often - and she wasn't faking it. For her it was 'Walk on!' And in doing so, I can say without the least exaggeration, she demonstrated a courage and an enlightened equanimity that I have never, ever, seen equalled, and doubt I ever will.

The evening that the week ended, she said softly, 'I'm going.'

At this particular point, all I said was 'OK,' and I picked her Up to carry her upstairs.

'Wait, sweetheart, I want to write something in my journal.'

'I got her journal, and a pen, and in clear bold words she wrote: "It takes grace, yes - and grit!" '

I got her journal, and a pen, and in clear bold words she wrote: 'It takes grace, yes - and grit!'

The noble Goethe had a beautiful line: 'All things ripe want to die.' Treya was ripe, and she wanted to die. As I watched her write that entry, what I was thinking, what I didn't have to say, was: That summarises her entire life. Grace and grit. Being and doing. Equanimity and passion. Surrender and will. Total acceptance and fierce determination. Those two sides of her soul, the two sides she had wrestled with all her life, the two sides that she had finally brought together into one harmonious whole - that was the last message she wanted to leave. I had seen her bring those two sides together; I had seen that balanced harmony pervade all aspects of her life; I had seen that passionate equanimity come to define her very soul. Her one, major, overriding life goal, she had accomplished, and that accomplishment had been brutally tested in circumstances that would simply shatter a lesser realisation. She had done that; she was ripe with that wisdom; and she wanted to die.

And 48 hours later:

About 3:3o that morning, Treya awoke abruptly. The atmosphere was almost hallucinogenic. I awoke immediately, and asked how she was. 'Is it morphine time?' she said with a smile. In her entire ordeal with cancer, except for surgery, Treya had taken a sum total of four morphine tablets. 'Sure, sweetie, whatever you want.' I gave her a morphine tablet and a mild sleeping pill, and we had our last conversation.

'Sweetie, I think it's time to go,' she began. 'I'm here, honey.'

'I'm so happy.' Long pause. 'This world is so weird. It's just so weird. But I'm going. ' Her mood was one of joy, and humour, and determination.

'Phrases that she had wanted me to remind her of right up to the end, phrases she had carried with her on her flash cards'

I began repeating several of the 'pith phrases' from the religious traditions that she considered so important, phrases that she had wanted me to remind her of right up to the end, phrases she had carried with her on her flash cards.

'Relax with the presence of what is,' I began. 'Allow the self to uncoil in the vast expanse of all space. Your own primordial mind is unborn and undying; it was not born with this body and it will not die with this body. Recognise your own mind as eternally one with Spirit.'

Her face relaxed, and she looked at me very clearly and directly.

'You'll find me?'

'I promise.'

'Then it's time to go.'

'The room seemed to me to become entirely luminous, which was strange, given how utterly dark it was'

There was a very long pause, and the room seemed to me to become entirely luminous, which was strange, given how utterly dark it was. It was the most sacred moment, the most direct moment, the simplest moment I have ever known. I did not know what to do. I was simply present for Treya.

She moved toward me, trying to gesture, trying to say something, something she wanted me to understand, the last thing she told me. 'You're the greatest man I've ever known,' she whispered. 'You're the greatest man I've ever known. My champion ...' She kept repeating it: 'My champion.' I leaned forward to tell her that she was the only really enlightened person I had ever known. That enlightenment made sense to me because of her. That a universe that had produced Treya was a sacred universe. That God existed because of her. All these things went through my mind. All these things I wanted to say. I knew she was aware how I felt, but my throat had closed in on itself; I couldn't speak; I wasn't crying, I just couldn't speak. I croaked out only, 'I'll find you, honey, I will ...'

Treya closed her eyes, and for all purposes, she never opened them again.

'Practice the wound of love'

My heart broke. Da Free ]ohn's phrase kept running through my mind: 'Practice the wound of love ... practice the wound of love.' Real love hurts; real love makes you totally vulnerable and open; real love will take you far beyond yourself; and therefore real love will devastate you. I kept thinking, if love does not shatter you, you do not know love. We had both been practising the wound of love, and I was shattered. Looking back on it, it seems to me that in that simple and direct moment, we both died.

 
 
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