We begin the second series of Our Voices with David, a psychotherapist who specialises in end-of-life care.
In his unique position of seeing people in their final moments, David reveals that he “can become something of a secular priest” to his patients. The main regret that is often expressed is that his patients were “deferring their lives”. The most heartening expressions he has heard from his patients before dying is that they have no regrets and that, being aware of their mortality, they did what they wanted to do while they could. Referring to Nietzschean philosophy, David talks about the Eternal Torture, the concept that you would live your life not just once but that you would return to it to relive it for eternity. In David’s words: “Living for a tomorrow which never came, that would be the ultimate torture.”
One of the hardest parts of David’s job is helping people accept the inevitability of death. He talks about a particular patient who was able to beat cancer ten years previously only for a different form of cancer to return. It was clear that the woman would not recover and her husband had begun to prepare himself for her death but he had not been able to prepare their children for one key reason: the woman herself had not accepted that she was dying. David’s role was to help her with this, although it was not a role that he found easy to play: “It’s not my place to tell her to come to terms with death…that’s nobody’s place.”
It was up to the patient to show that she was ready to accept the end and, until she showed that she was able to do this, David focused on creating a safe space for the two of them to interact. They contacted each other virtually due to the restrictions created by the pandemic. However, the benefit of this was that they could continue interacting even as the patient became very frail. They spoke of all manner of subjects except one, the one subject she was not ready to tackle.
Eventually, David was asked to contact the woman as her condition was becoming critical. He realised that this was the moment where the final topic had to be broached: “I said to her, OK, you’re dying, now what?” She replied: “Maybe I’m not dying, maybe I’ll recover.” “No,” David insisted, “this is it now.” At such directness, the woman was finally ready to accept the situation. She said she would speak to her family and call David back in 30 minutes. Upon calling David, she said that the final conversation had been had. Her husband and children had had a chance to say goodbye. The process of acceptance had been started. The woman thanked David for encouraging her to do what she had been so desperate to avoid but what had so desperately needed to be done. The woman would die a day later.
Reflecting on his work, David says: “I’m doing my dream job and don’t want to be anything else.” Reflecting on the woman he was able to help, he says: “She reaffirms that I’m living my life the way I want to live it, which is the most precious gift anyone can give.”
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