The Art of Conversation in Cancer Care

"We use "mortal time" in our work to mean the experience of human beings confronting the prospect of death. This confrontation can stimulate intense feelings, a flurry of thoughts, and erratic or unusual behavior. In the broadest sense, mortal time is entered whenever death comes near, and that can happen either directly or vicariously. Hearing the words, "you have cancer," and signing a medical consent form where death is a possible medical "complication," are direct experiences of mortal time. Learning of a loved one's cancer diagnosis, losing a family member in an automobile accident, or reading about a missing child are vicarious experiences of mortal time. The power of tragedy in the theatre can brings us into the experience of mortality. King Lear's madness in the face of betrayal propels him toward an untimely death. The focus in this book is on the particular and powerful experience of entering mortal time when someone receives a diagnosis of cancer, a life-threatening illness. As we noted in our introduction to this second edition, the experience of mortal time in cancer medicine has changed with new treatments. A cancer diagnosis could mean an illness where rapid progression toward death is looming, or where there is only the distant possibility of death. Now there is a third option: the prospect of longer survival with metastatic disease due to the promise of additional therapies, facilitated by next generation genome sequencing. This means, a lengthier period of mortal time and uncertainty for many cancer patients. MORTAL TIME: HOW LONG DOES IT LAST? There are, of course, many instances in which people far exceed their statistically predicted life span. This holds true whether it be the prediction of a physician in the midst of treating an illness or the projected life span of an insurance life-expectancy table. In Part II we give an example of how misleading statistics can be when we discuss the idea of false hope. When mortal time looms with the diagnosis of cancer, it may stretch from days to years, with patients encountering both helpful treatments that lead to periods of remission and recurrences of disease requiring additional treatment. Some patients may never experience a time when it is apparent that they are dying until the last days. The interval between living and dying that we are concerned with here is not primarily chronological time, measured in days, weeks, and months. The hallmark of mortal time is the person's unique biological, psychological, social, and spiritual experience of the prospect and meaning of death, a prospect that confronts their caregivers as well. Mortal time is "kairos" time, the ancient Greek word meaning the time of decisions. When someone enters mortal time directly, their caregivers enter the same time zone vicariously. What they do together in mortal time, especially how they speak and listen to each other, affects the quality and meaning of life for all involved, in the moment and beyond"--

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Self-Help > Death, Grief, Bereavement, Psychotherapy, Psychiatry, Terminally ill, Psychology, Psychological aspects