Cancer, Death and Finding the Words to Say Goodbye

Cancer has a way of forcing us to consider the inevitable notion of our own passing, and whether you want to think about that or not, I want to suggest that it need not be dramatic or discomforting if we choose to simply observe the phenomenon as something both mysterious and certain.

When a lifelong friend told me she had terminal, inoperable cancer I searched long and hard for the genuine and unpretentious words to say, knowing I had only one shot at getting it right. I'll call her by her first name, Laura.

I hired Laura to work for me in an entertainment agency I started in California back in 1978. We were both in our late 20s. She was talented and fun and did a great comedy routine as "Mae West." We lost touch over the years, but she reappeared again when my wife was diagnosed with advanced ovarian cancer, since they had both been good friends. She checked in often as I did my best to be a supportive and loving caregiver for my wife who, despite our best efforts, died at the age of 47 in 1997.

Those of us with a cancer diagnosis, no matter the stage or grade, know all too well that people die from our disease. The end of a life is something we experience with increased frequency as we get older, and also as we come to know more and more people like us with varying degrees of cancer. Of course, many of us live long and fulfilling lives.

I want to share some of the actual words Laura and I exchanged by letter in her final days with some short excerpts, not simply to show the remarkable courage and insight she expressed, but to act as a visible example of how a conversation with a dying friend might evolve. I recall the distress I felt at having to say goodbye in my letter, knowing it would be the last exchange I'd have with her.

I wanted very badly to avoid being trite or patronizing, but most of all, I wanted to be open and honest and to find the words to express the sadness I felt to lose her, along with the joy of living my life while knowing her. Laura wrote:

"I found out today that my cancer has now grown significantly in my liver, along with other areas. At this point my oncologist said that he did not know of any other options for me as far as treatment, and I most likely have three months to live. He has taken me off the chemo I was on and has now written an order for Hospice. I am sorry to give you this news."

I sat with this news for a day before writing back to her:

"I received the news that your cancer has advanced beyond the treatable stage and I'm writing to tell you that I love you and that no matter where you are in the universe, you are now and always will be in my thoughts, memories and in my heart. I know from my past experience with my wife, that many who know and love you are muted by grief and there is a great difficulty to find words for such things."

I reminded her of a few incidents from our past working as entertainers — things we had laughed over long ago. I spoke briefly about our philosophical views of death and dying.

"My own cancer experience, along with my wife's, has forever altered how I view life and death, and though I feel a tremendous sadness that you may soon be in another place where perhaps we can no longer be in touch, those feelings are tempered by my unshakable belief that life — just as it is – is absolute perfection. I know from our conversations that in having a complete trust in life's ultimate plan and purpose as we both do, there is a comfort we feel in this mystery that lies ahead for you and me and all of us. Of course, it's those we leave behind who suffer - perhaps the most - but life, at least from my perspective, is always about growth, even though it hurts like hell at times.

And finally, though we both had accepted that there was no turning back, I wanted her to know that she would not be forgotten.

"Being human, I have that familiar ferocious desire to hold on to all we love. I know I can't hold on to you my friend, but I can always keep you close to my heart. There is a place there just for you. And I will never let that go. I promise."

Stephen Murphy-Shigematsu is a psychologist in the Stanford University School of Medicine. He said, "Saying goodbye is learning what to hold onto and what to let go of. I firmly believe that by embracing our mortality with full awareness we can learn to experience life in a deeper and more passionate way. But the internal work of saying goodbye means finding a way to acknowledge that people come and go in our lives, leaving permanent imprints in our character; we inherit traits from everybody who crosses our paths or touches our hearts."

Laura died five weeks after we exchanged our letters. Others in my life will die, too. And then one day of course, it will be my turn. And the only thing I know with any certainty is that these goodbyes are sure to repeat time and time again, until one day, that last goodbye will be the one reserved for me.

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