With the End in Mind summary

The general pattern of dying presents us with a fairly rosy picture of what happens in the final days of a terminal illness. But there are some darker exceptions to the pattern. 

Sometimes, a terminally ill patient follows it for most of her illness – but then, right before she dies, she experiences one last surge of energy. That might sound like a good thing, but it can be a mixed blessing, as the story of Holly illustrates. 

When we’re forced to confront a challenge, we often discover that we’re stronger than we thought. That’s especially true of a terminal illness, arguably the ultimate challenge that life can throw our way. 

Even in the face of the most terrible diseases, people find themselves surprised by their own resilience. Consider the case of Eric. He was a strong-willed school principal looking forward to his retirement when he developed Motor Neurone Disease (MND) – also known as Amyotrophic Lateral Sclerosis (ALS). The disease is always fatal. It destroys the neurons that control the body’s voluntary muscles, leaving a person increasingly paralyzed, until they’re unable to do anything for themselves. 

When it comes to coping with a terminal illness, there’s no one-size-fits-all solution. Different coping strategies work for different people with different personalities. Unflinching realism might be right for one person, but wrong for another. And then there’s the opposite strategy – denial. 

Generally speaking, this is one of the simplest and most effective ways we deal with the emotional effects of difficult situations. After all, if we don’t believe a problem is real, we don’t have to deal with the emotional response it would otherwise trigger. 

Terminally ill patients cope with their illnesses in a variety of ways. There's a single powerful tool that can unlock these coping mechanisms – cognitive behavioral therapy, or CBT. 

CBT is a modern approach to psychotherapy that is all about getting a patient to identify and change her patterns of thoughts, emotions and behaviors. In 1993, Dr. Mannix added CBT training to her repertoire, and became a pioneer in bringing it to the field of end-of-life care. 

In the previous blink, we saw how CBT helped a terminally ill patient reverse a vicious cycle that led to suffering. In this blink, we’re going to look at the opposite dynamic – how CBT helped a patient embrace a virtuous cycle that led to happiness. 

It was the late 1980s, and a woman named Louisa was looking forward to her daughter Penny’s big day. They were at an upscale clothing store, looking for a wedding dress. All of a sudden, Louisa’s hip bone broke. 

Death has become a taboo subject in modern times. Indeed, our discomfort with talking about it can run so deep that we often end up engaging in conspiracies of silence, and avoid the topic altogether. 

Unfortunately, these conspiracies of silence can lead to serious communication problems, which can hamper health care decisions. Take this common scenario, for instance. An older person wants to talk to his children about practicalities surrounding his death. But they rebuff him every time he tries, saying it’s too morbid. 

People with terminal illnesses aren’t just dying from those illnesses. They’re also living through them. That’s how we can learn from the desires, emotions and struggles in the stories we’ve been exploring.

Dying is a part of life – not just because it’s an unavoidable aspect of existence, but also because it forms a distinct phase in most of our lives. Some people die sudden deaths, but for most of us, there are whole weeks, months or years in which we live through the chapter of our lives called “dying.” It might be the final chapter, but it’s as much a part of our life story as any other. Indeed, the finality of it makes it all the more precious. It’s our last chance to do the things we want to do.