We’re taught from a young age to dream big, go after what we want, plan our work, work our plan. This culture-wide forward-thinking mindset has blossomed into achievements as diverse as iPhones, space flight, ultra-marathons and gene splicing. But it’s also helped create anxiety, depression, unrest and a feeling for many that, since our achievements aren’t as grand as our dreams, we’re living a meaningless life.
The moment of reckoning between the fantasy of our dreams and the reality of our lives often surfaces during critical illness. The door of future possibilities slams shut when the doctor says, ‘Cancer’; or when you’ve collapsed on the busy sidewalk and are suddenly unable to speak, feel your right side or understand what’s happening; or, when sitting in the quiet symphony hall, you feel a pain in your left arm, an elephant leaning into your chest, and hear yourself release a deep, ancient, pre-human moan. Up until these turning moments, we’re often able to struggle from one agenda item to the next and avoid the moment before us as we plan for moments to come. Whole lives are consumed this way.
These habits can even overwhelm our dying. We look for treatments we hope will delay our deaths, which is reasonable. But when our pursuit of hope becomes the pursuit of a miracle cure or the transcendence of death itself, it threatens to rob us of being present for the quality and meaning of our life in the here and now.
Our culture often lauds the individual who fights to the end. Obituary language is full of battle metaphors, where we honor those who have soldiered on, never given up, or accepted the advice of ‘experts.’ Less common is praise for those who’ve moved towards their death with acceptance, grace, equanimity and love. But it is these less noticed qualities that, in my experience, provide the foundation for a peaceful death.
Many patients have expressed to me that they don’t want to ‘give up.’ Sometimes they have very good reasons to push their declining bodies. I remember one young mother who chose to live with agonizing pain rather than allow morphine to rob her of the few clear-minded moments she had left with her daughters. Her desire to continue caring for her daughters over-rode even her instinct to avoid pain.
But mostly this urge to ‘not give up’ is motivated by habit: We’ve spent our lives avoiding being where we are, so when we are faced with pain, illness or death, we turn away from our present experience and flee to the future.
‘Giving up’ sounds like rolling onto our backs and accepting defeat. It’s based on the perception that the world is hostile and that we have to continue planning and fighting to keep the unwanted at bay. It believes that old age, illness, loss and death should not be part of our lives; that they represent failure and must be resisted. Many of our religious systems reinforce this belief and teach that if we continue to believe and hope and strive towards righteousness, we will be rewarded with an afterlife filled with pleasure and freed of the uncomfortable.
Patients have taught me that the wiser path is to live in the ever-shifting balance between hope and reality, or said another way, between acceptance of the present and care of the future. There are times when it is necessary to hope for a different future; there may be steps to take towards healing or resolution or the care of others. But that must be balanced by a clear-eyed acceptance of things as they are; by a willingness to look at the conditions of this moment and find peace right here. The cost of exclusively pursuing the future is to miss this moment. The cost of exclusively pursuing this moment is to fail to care for future moments.
The middle way between awareness of the present and care of the future shifts and flows with circumstance and can’t be captured or taught. It must be lived and discovered as life unfolds. Now, this moment requires attention to the present as we accept and allow our experience to be what it is and relinquish control. Then, the next moment invites us to extend that looking to the future and see what steps we can take to bring about a better outcome. Flowing like this, we can both allow and care, honoring this moment and the next, not turning away from either.
My hope is that our culture will find this balance between hope and reality. At the same time, I accept the reality that we are not currently there. I trust that by being mindful of my own life as it unfolds is the best preparation for the illness, decline and death that await me. By watering the seeds of awareness and acceptance within myself moment to moment, I am creating the conditions to accept my joy and happiness as well as accept my inevitable losses. And since society is the collective consciousness of its members, I trust that living this gift of my patients, which is to see the wisdom in the balance between present and future, will shift us all in ways I can’t measure or imagine.
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