Living with dying
Roller coaster feelings when you have a terminal illness
People often experience strong emotions when told that they have a life-threatening illness, or that their life is limited (see also 'Own reaction to hearing that life would be shorter than expected').
During subsequent weeks and months feelings may include denial, disbelief, guilt, anger, sadness, despair, resignation and calm acceptance. Some of the people we talked to described having been through different emotional 'stages'. But there is no clear pattern' several feelings may exist at the same time, some may not arise at all and fluctuations in people's feelings are common.
Talks about different emotional stages that people with terminal illness may go through.
Talks about different emotional stages that people with terminal illness may go through.
Can you tell me more, what you mean by, 'come to terms with the illness'?
Yeah, it isn't... I mean people go through... I can't remember them but there... they... it's said that there are five stages' One, that you disbelieve it, that you can't, that isn't, 'No they've mixed my diagnosis up with someone else's'. Then you become angry and say, 'No, no, no, no, I'm, I'm not ill, I'm not ill'. And then another one I think is that you grieve, not for yourself but for other people, relatives maybe. And then there's an acceptance which is I think probably where I've got to at the moment. And I've always had the feeling that material things are not that important. I don't get a buzz out of a big car or big house or anything. I think we don't come into the world with anything and we certainly don't go out with anything. We're just custodians while we're here. So that's where I get quite a lot of strength from, I think.
One man explained that he found denial was inevitable at first “It's not until it gets really, really bad, like it's getting now with me, do I realise it is really, really, happening”.
Many people felt angry, especially if their symptoms had not been taken seriously or if they suspected that they had not been given the most appropriate investigations or treatment.
She feels bitter that the consultant didn't recognise that there was something wrong and that she...
She feels bitter that the consultant didn't recognise that there was something wrong and that she...
So if you could go back in time and think about how the consultant reacted, what now do you think would have been a better way of treating and caring for you at that point?
I think if he had recognised that what I was saying wasn't just me making a fuss. If he had recognised that I had, had pain and that there was something there. I came away that I was nothing, that I was making a great fuss over nothing and that I should go home and get on with my life and forget all about it. I couldn't forget about it, I had pain there.
That's how I feel about it and I also wish that I had known that sarcoma was a possible side-effect of radiotherapy treatments. Yes it's rare, but nevertheless I would have liked to have known that that possibility was there and I would have dealt with what was happening to me in a much more positive way than I did.
Usually people expect that they will outlive their parents and will see their own children grow up. It can be very hard for people to accept that this 'natural order' has been broken.
Some thought that feeling 'low' or depressed was inevitable and had taken anti-depressant medication since they were diagnosed. A young woman who had chronic obstructive lung disease thought that depression was part of the 'grieving process'. She also said that it helped to write down bad feelings on paper, screw the paper up and then put it in the bin.
Explains that feeling low is inevitable.
Explains that feeling low is inevitable.
You will do, everybody does. It's only human nature. Even animals get depressed. You have to, it's part of the grieving process. It is the bereavement logic. It's the loss. If a person has a leg removed they still feel the leg. Just because it's gone doesn't mean to say it wasn't there. And that's how you have to look when somebody's got a life-threatening illness.
Yes, they're going to die, yes, we're going to die but we were there beforehand and you've got the memories to look back on.
The pain and debilitation of the disease and the side effects of treatments make some people feel terrible. A man with oesophageal cancer said that chemotherapy had so depressed him that at the time he considered ending his life. A woman who discovered that she would not get a transplant said that she had considered suicide as a way of gaining some control and 'not letting the illness decide when I was going to die'.
During chemotherapy he became depressed and had considered suicide.
During chemotherapy he became depressed and had considered suicide.
Emotionally not too bad, not bad, very weak physically. When we mention emotions, generally speaking, I've been able to cope with my emotions pretty well.
During the chemotherapy treatment, during the last three weeks of it, when I was very weakened, I did become quite depressed, even to the point of saying that if it was suggested that I have a fourth cycle of chemo, and bearing in mind I had three cycles, but I knew there was a possibility they might want to give me other cycles.
If they'd said to me, 'You're going to need a fourth cycle" I was so depressed that I'd probably have said "no way, I don't want it, I'm going to let the illness run its course." Now it didn't come to that, they were satisfied with three cycles. I didn't even have to discuss that with the oncologist.
Would you have discussed it with your wife and family?
I did. I discussed it with my wife and my eldest daughter. We're a very close-knit family, and my youngest daughter wasn't excluded, she just wasn't here. I knew that my eldest daughter and wife would discuss it with her. We've been very open about these things all along. I should say that at that stage I had thought about suicide, you know, I had contemplated how I would go about it if it came to it.
Others feel intense frustration and find it hard to accept that their life and horizons have changed. A woman regretted not having travelled and a man with multiple sclerosis expressed anger and frustration at his dependence on his wife. A man with testicular cancer and kidney disease said he felt sad and sometimes guilty that he was ill and now limited in what he could do for friends and family.
He expresses anger and frustration because he can't do things for himself.
He expresses anger and frustration because he can't do things for himself.
I feel guilty about that and I get very angry. I think to myself why the hell can't I do that? You know, I should be able to do that, but I know I can't because I'd be on the floor and that would make things much worse.
So anger is something that I think comes in the package but it's frustration as much as anger. Both perhaps.
When I said to the consultant that I was very angry, his answer was, 'Well I can understand that'. They all understand my anger but it doesn't help it.
A 32-year-old man with a brain tumour explained that it was hard to remain motivated' “You lose sight of life, you lose sight of why you're doing what you're doing and everything else”.
Several of the people we talked to were adamant that it was best to avoid bitterness and anger at the end of life (see 'Messages to others'). A man with a brain tumour explained how he would try to help others in his support group to come to terms with the shock.
Explains that he would like to help others in his support group to come to terms with the grim...
Explains that he would like to help others in his support group to come to terms with the grim...
But that's a big change, isn't it, to have to make?
Yes, it is a big change. You are going from one milestone to another. You want to crash, you want to... you do want to, you know... and I've learnt that doesn't work, you know, you've got to, it's nobody else's fault. You've just got to get on with it and be strong. There's no point in being angry.
But that's a big change to be able to make. That seems to me to be about what you believe about life, your philosophy of life. Is that the way you'd put it?
It is a philosophy but also it's the truth. I didn't ask for it there; nobody put it there. So, there's no point in getting angry with anybody because it's nobody else's fault. You just got to deal with it.
You know you said you started off being angry and then you started thinking like this - what happened to help you change from one attitude to another?
How life changed so quickly, in a short period of time. Yeah, you know, just watching the difference from one stage to another. When you get sick. When you sit down and you say, 'Oh I've been off work nine months', and you've got a lot of time to sit and think, and you look through what's happened and you realise that there's nobody to blame. It's nobody's fault. And if you don't get on with it, it's going to beat you, so, best thing to do is just try and do your best.
Don't be angry, because life's too short as it is, you know, yeah. It is too short, life is too short. No matter what way you look at it, and just enjoy it, because who knows' At the end of the day what I say now is what I'll be saying in the support group. And I'll try and help anybody I can, because this has come as much of a shock to me as it did to them guys, or lady, whatever. If I can help them, then I'll be happy.
A man with mesothelioma (lung cancer caused by exposure to asbestos) accepted that what had happened to him was a hazard of life. He found it easier to cope by accepting the situation and having positive thoughts instead of wasting time on anger.
Says he isn't angry and finds it easier to cope if he moves forward and thinks positively.
Says he isn't angry and finds it easier to cope if he moves forward and thinks positively.
When I was working with it, or I wasn't working with it, I was exposed to it, in the power station that I worked but at the time it seemed a small problem. Because we were, late 60s, early 70s in an old power station you were just exposed to so many other hazards. You know you could have choked on sulphur fumes. You could have given yourself nasty burns. We were, one of the things that we were really concerned with which was a major problem at the time was pneumoconiosis. Miners. We knew miners were suffering with that and we were working with very fine... we were working with coal dust, which was like talcum powder.
And I don't believe being angry with my employers is going to help me. You know, I've got the same employer now who, when I was exposed, but the company, the people who are in the company now weren't the people to blame. I could be angry with the government but it's a different government. Circumstances change and there is just no point in me being angry because it's just not going to help. What I've got, I've got... being angry is not going to get rid of it. The only way I can get rid of it is by treatment and by having lots of positive thoughts. So I just feel 'be positive and go forward' all the time, not just look for someone to blame and things like that.
Sometimes people live much longer than they were expected to - a woman who was once angry about her diagnosis, described herself as thankful, calm and at peace with the world. Others were philosophical about how life would go on without them.
She has found a sense of peace and calm.
She has found a sense of peace and calm.
Do you get comfort from your priest?
Yes I do, yes. He came to visit me in the hospice with a dozen red roses.
Ahh.
Which I thought was lovely.
Yes.
You see... when you're told you're gonna die you suddenly appreciate the small things. And here I am eight years on, which I've been told is an absolute miracle so I just thank... I'm just thankful for every day and I make sure that I enjoy it, I don't waste time.
She feels sad that she will not see her daughter grow up but recognises that anger is pointless.
She feels sad that she will not see her daughter grow up but recognises that anger is pointless.
And so I haven't really got angry. Again, my husband despairs at the things I say sometimes. I remember saying when I really did think that I perhaps didn't have very long, 'Well I'll find out what it's all about before most people I know, that'll be interesting because I've always liked new experiences'. I know, it's a strange thing to say but it's sort of trying again to make something positive out of something what's happening to you.
I've got... I think my emotions were more to do with being upset maybe. I'm sorry that I wouldn't be here when my daughter grew up and had her own babies or whatever and how much I'd miss that. But on the other hand, if I wasn't there, I wouldn't know I'd miss it, if you get what I mean? Sort of strange logic.
Those are the sort of things I could get very upset about but I wouldn't get angry about it. And yeah the medical profession should have helped me more and helped me sooner.
Last reviewed July 2017
Last updated March 2012.
Copyright © 2024 University of Oxford. All rights reserved.