Emotions as you near the end of life
This is written for the person with advanced cancer, but it can be helpful to the people who care for, love, and support this person, too.
Sharon, age 42, with advanced cancer: “I still can’t believe it’s going to happen. I’m tired, but I don’t feel that bad. I just feel like such a burden on my family. And I’m so worried about my children.”
Sharon is expressing many normal emotions that occur near the end of life. She’s feeling the shock of how final death is and the guilt of being a burden on her family. She’s also concerned about leaving her children.
Knowing that death is coming soon takes an emotional toll on the person with cancer and their loved ones. This is an emotional time, and though it’s hard to talk about them, these issues must be addressed. Knowing these feelings are normal and expected may help you cope with what’s happening. Some of the emotions you can expect to have include:
People are often afraid to die, but pinpointing what part of death they’re afraid of can be helpful. Are they afraid of dying alone? Are they afraid of suffering or pain? Are they afraid they’ll die and there will be nothing beyond earthly life? Is there a fear that their lives had no purpose or meaning? These are some of the more common reasons that people fear death.
Trying to figure out what you fear can help you face it and manage it. It will also help others support and care for you better. For example, if you’re afraid of being alone, share this with your family and loved ones so they can try to always have someone with you. Sharing with loved ones and your health care team gives them a chance to help you find ways to cope with and ease some of your fears. It gives them a chance to correct any wrong ideas you may have, too. It can also give you a chance to look at and deal with some of your fears in new ways.
Anger is sometimes hard to identify. Very few people actually feel ready to die. It’s perfectly normal to feel angry about your life ending – maybe earlier than you expected. It’s unfair and you have a right to be mad! Unfortunately, anger often gets directed at those closest to us, the ones we love the most. We feel safest with these people and know they’ll probably accept our anger and forgive us for it. But it might help to try to direct your anger at the disease and not your loved ones. Also, you can try to channel your anger as a source of energy to help you take action where it’s needed. You can use it as fuel to solve problems, to become assertive, or to get your needs met. Try to re-channel your anger to do meaningful, positive things.
Guilt and regret
Sharon mentioned that she feels guilty about being a burden on her family. She also feels guilty that she’ll be leaving her children without a mother.
In the last few months of life, a person might regret or feel guilty about many things. We feel regret when we think that we should have done something differently. Or maybe there’s something we wish we had not done at all. We may feel guilty when we don’t meet our own or think we don’t meet someone else’s expectations. But how does it help anyone if you hold onto guilt or regret? Worrying endlessly about these things won’t make you feel better about them. It won’t improve your relationships with family members. It won’t ease the burden they’re carrying. It won’t make you feel better. It won’t make you live longer. It will only make you feel bad.
Sometimes the best thing to do is to decide to “let yourself off the hook” and spend your last days and months not feeling guilty about things that are out of your control. Simply let it go. You can’t change the past, but there are things you might be able to do today. Apologize for the things you regret and ask for forgiveness. Be willing to forgive others and yourself. Fix what can be fixed and try to let go of the things that can’t be changed.
This is a good time to talk with your children about the important things you want them to know. It’s also good to talk to them about how to handle their feelings and the loss they will soon go through. You may want to write letters to the people you love, record messages for them, or make videos they can watch – give them things they can keep to remember their time with you. Tell your kids who they can talk with when you’re gone and encourage them to be open when they’re hurting. Spend your time focusing on your children’s future, not feeling guilty about the past. Strengthen your relationships with loved ones. Live the best life you can, and use your time for what’s most important to you.
It’s natural to feel intense grief during the last months of your life. You’re grieving the loss of the life you planned and expected. You can no longer look ahead to a seemingly “endless” future. And you may have lost many things already, such as the strength to walk or get around like you used to, or the interest in eating the things you enjoy, or maybe the ability to get together with friends. You may feel distanced from friends who cannot handle the fact you are going to die soon. This is another loss that can cause sadness and grief. Many physical and emotional losses come before the loss of life itself.
The people you love are grieving too. They know they’re about to lose you. How can you and those who love you find meaning in what’s happening? Try to talk to your loved ones about the grief and loss of dreams you’re all going through. Being able to rise above the grief and connect spiritually to something greater than one’s self might help your loved ones heal after you are gone.
Talking with someone about these feelings – a partner, a dear friend, a spiritual advisor, someone you trust – can help you process these feelings so that they no longer weigh you down. It may take many tries, but once you’ve done this you’ll feel a burden has been lifted and you can move on to the other physical and emotional tasks that are part of the end of life. There are many important tasks at the end of life, but coming to terms with the losses is one of the most painful.
Anxiety and depression
What does anxiety feel like? Anxiety has been described as having a nervous stomach, a shaky feeling all over, being short-tempered, a sense of dread or worry, or a fear of the unknown. It can be quite unpleasant.
Some anxiety is expected, but if it’s severe it may need to be treated through counseling or with medicine. The goal is to make you more comfortable and help you better cope with the changes that are taking place. Anti-anxiety medicines or even anti-depressants can help. Counseling can be especially helpful in changing how you think about things so that you can focus on the present and not worry about tomorrow. Breaking problems into smaller, easier-to-manage pieces can be a good way to handle some kinds of anxiety.
Depression is more than just feeling sad. Depression includes feeling hopeless or helpless, feeling useless, feeling sad for weeks at a time, and having no joy in any activity. These feelings are not normal, not even when life is ending. Depression can sometimes be helped with anti-depressants, counseling, or a combination of both. Managing anxiety and depression well can make a big difference in how much joy or pleasure you can find in your last few months of life.
When someone knows for sure they’re facing their last months of life, there can be a loneliness that’s different from any other. It’s a loneliness of the heart, even when you have people around you. Frankly, there may be very few people who can really talk with you in a way that helps you feel less lonely. Some of them may be experts who are comfortable talking with people at the end of life, such as hospice social workers, nurses, or other end-of-life caregivers. They may have that special gift for silence or listening when you need it. Finding a few people that you can truly connect with is critical to ease this sense of intense loneliness. Your health care team may end up being one of your greatest resources in this area.
Almost everyone wants to feel their life had purpose – that there was some reason for their being on earth. Some people find meaning in their work. Others find that raising a family has brought them the greatest sense of joy and accomplishment. It’s helpful to go through a process of reviewing your life and figuring out for yourself what your purpose in life has been. What was your special contribution to the world? What have you done to make the world a better place? How would you like the world or your children, family, and friends to remember you? What were the things that you thought were really important and want your children to know about for their future? It doesn’t have to be something huge or earth-shaking – look for those things that have been important to you and those around you. The end of life experience is full of meaning that can be uncovered using personal reflection. Sharing your thoughts, experiences, and wisdom is a gift that your friends and family can cherish for years to come.
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Coyle N and Ferrell BR. Textbook of Palliative Nursing. New York: New York, Oxford University Press. 2001.
Glass AP, Nahapetyan L. Discussions by elders and adult children about end-of-life preparation and preferences. Prev Chronic Dis. 2008;5(1):A08.
Last Medical Review: 04/29/2016
Last Revised: 06/08/2016