Ascension can mean letting go of the constraints and gravity of the physical world. Image courtesy Shutterstock photo 1907435317/KieferPix
EDITOR'S NOTE: Timothy Tate says the names of the individuals in this story have been changed to protect their anonymity but the following column is based on real people.
by Timothy Tate
One of the beauties of having a long-term psychotherapy practice in the same mountain town for 38 years is that a significant portion of an individual’s life can be known, witnessed, and held. So it was with “David,” a man who entered my practice two years after it opened.
Trusting another with one’s deepest secrets, being vulnerable, is the confidential alliance forged in a therapeutic relationship formed over time.
Until only recently, mental health was not talked about much publicly and people who needed help sorting things out often were thought of as sick and troubled and stigmatized. It’s hard to navigate our modern world and the only anomalies I know of are those who perceive that they have faced no reckoning of loss, grief, pain, struggle or unexpected adversity. In other words, there are no anomalies. No one escapes the above.
Growth in our development as human beings is most potent in the realm of dealing with inner challenges—and we all have them. In many mountain towns we come here believing we can flee from our traumas by escaping into nature, putting miles between us and our past, or keeping distracted by improving our physical fitness in external settings, but we cannot run away from ourselves.
Think of the relationship we seek in understanding ourselves and the role therapy can serve as a longitudinal study of one’s life encouraged to be realized—and lived—deliberately with more awareness.
I am musing here of the route of instinct and self-discovery, as hinted by Henry David Thoreau: “I went to the woods because I wished to live deliberately, to confront only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived.”
I am musing here of the route of instinct and self-discovery, as hinted by Henry David Thoreau: 'I went to the woods because I wished to live deliberately, to confront only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived.'"
Should there exist a shared span of age, worldview and geographic origin in childhood between client and therapist, the context of stories can be imbued with richer meaning in the layers they accrue. At the same time, most of the issues are universal, in that others before us struggled and those coming after us will struggle with the truth that we are not immortal.
So it was for me with "David" as demographic contemporaries. We came from the same place and had interests in common: Raised in the Chicago suburbs, a love of literature and philosophy, both reaching our mid 70s and the abiding experience of living in mountain valleys and the communities of people they foster; he in Paradise Valley and me with my home and practice in Gallatin Valley, Montana.
The course of therapy is affected by the journey of a person’s life which adheres to distinct phases.
When David was diagnosed with Stage Four pancreatic cancer several years ago, our intermittent connection restarted. Although he now lived in Washington, was madly in love with “Kelly," his younger wife with whom he shared the last 15 years of his life and who supported him unconditionally, he wanted counsel on how to attain a deliberate death.
Facing a terminal diagnosis is one of life’s darkest mirrors that may illuminate hidden depths. We all know how this life ends but we can make believe we have adequate time to plan until our departure. Of course, sometimes we don’t.
The medical field and insurance companies can generally predict how much time a person has to live based on risk factors and the nature of a diagnosed disease, the relative health of the patient, and the efficacy of the agreed-upon treatment strategy. Doctors and preparers of actuarial tables see patterns.
“Tell me, Doc, how much time do I have left,” has become a cliche yet when a patient sits behind a closed door with his physician that question grips the nervous system like little else. The year that David was given, as a length of time he could expect to remain in this world, became a test of both his character and the integrity of his relationship with wife Kelly.
Reconciling our life—or more precisely coming to terms with things we did or still aspired to do while we have the emotional and mental fortitude to make such an honest assessment—is a task that requires courage. It is reserved especially for people who do not shy away from truth.
We all have a tendency to embellish our life with a version convenient to our private mythology. This self-perception, when dealing with a terminal diagnosis, can often elicit an iterative response of a “poor me” victim story, or be housed in a hard won realism, or can be a vacillating creative act strung out between protagonist and other players in their story.
There does come a time, however, when all bets are off in having options for how to approach an end, when fate simply happens unexpectedly.
Facing that dealt hand can be made more bearable by the type of love shared with another. Yes, there are throngs of folk left to fend alone or be at the mercy of the kindness of others, such as those among us who do not have close meaningful relationships or are alienated from families or origin. These are ordinary people who do not have a safety net and are surprised by another unknown person giving them a moment of time, of conversation, of connection.
This was not the case with David. He was loved as deeply as he loved. This does not happen magically. It comes through encounters with others built across time or by being open to experiences with others that one does not see coming; when deeper connections are made they appear before us as clear and beautiful as a summer sunrise on a cloudless morning.
David had suffered through an adversarial, challenging relationship with the mother of his two sons. We talked through the sharp edges of his divorce. We talked through the challenges of his oldest son. We talked through his son’s suicide.
We talked through the enigma of his younger son’s way of “being a man.” We talked through his falling in love with a feisty Montana woman 26 years younger. We talked about his change of career from master woodworker to his interest and work with and installation of wall beds. We talked through his shock when his first wife died in a car accident on a rural gravel road. We talked through his choice to leave Paradise Valley—his long term home— and his new wife’s local habitat. We talked through their move to a remote spread in north-central Montana where he hung the ranch sign with pride: Go Away Ranch. We talked through their decision to leave the bitter cold winters and move to Squim, Washington.
And then we talked our way through his pancreatic cancer story.
This story was couched in his reserved Scandinavian manner, fueled by a loving heart that mixed together with his “no patience for fools” attitude that added up to a sometimes terse, matter of fact, no nonsense approach to life. Although a man of means he preferred working with his hands, his beloved draft horses, and the land. He spent time and money wisely. And he loved Kelly with gratitude, wonder and ease. Long before disease had arrived, he had been healed of other tribulations and wounds of self-doubt by having new love in his life
The stage was set for his and their relationship’s final act.
The rigors of chemotherapy, its gut wrenching after effects, the loss of intestines and bowels, the willingness to submit to another round of chemotherapy in order to appease those who wanted him to resist fate were all shared with Kelly and every three weeks with me.
Often, medical attempts to heal terminal cases are harder to cope with for the patient and loved ones around them than the implications of the disease itself. Whereas treatments aimed at physical ailments are often in vain, attention paid to the psyche can actually lead to a healing for all involved.
“Every day of our relationship I said yes. We knew we had a finite amount of time. Arguments did not enter our relationship; petty spats were resolved quickly because we both knew our time was limited. With this knowledge, when David received his terminal cancer diagnosis, we didn't have any regrets because we had been living every day to its fullest from the beginning." —David's wife, Kelly
We approached his last act together, not knowing how it would play out but knowing that we had to scour every hidden shadow if there was to be, for him, a dignified death. He truly was interested in the search to know his own state of being.
As part of his coming to terms, the process included applying for and receiving consent to end his own life with medical supervision. He had his own austere, accepting nature about this impossible choice. Know here, reader, that I am neither promoting nor judging euthanasia. David did not see it as giving up or capitulation; much of what he did in our sessions was exploring how to better live and coming to terms with his end was part of that.
Kelly shared her perception of their relationship basis in an email. Her summary expressed her belief that the essence of a good relationship is based on an appreciation of the brilliance of each day lived with presence.
She wrote: “Every day of our relationship I said yes. We knew we had a finite amount of time. Arguments did not enter our relationship; petty spats were resolved quickly because we both knew our time was limited. With this knowledge, when David received his terminal cancer diagnosis, we didn't have any regrets because we had been living every day to its fullest from the beginning. We grew closer after the diagnosis because there were no walls built up over the first 15 years together.”
David had a last request for me. He wanted to talk to me on the phone after he took the lethal pill. He was to swallow the pill which might take up to hours to actually have its effect, though he would be in a sedate state before its final effect.
His plan was that he would take the pill, we would talk, and then he would lie down with his beloved, slipping away, held in her arms.
He did not set an exact time. I was not able to take his call. I was in session when he made it but the voicemail he left was so gut wrenching, so loving, so resolved, and so sad that I have kept it to this day. Kelly was there and lay together with David as he died.
For David this was his way of bringing a natural conclusion to his own well-considered life and it was not an event imposed upon the living. Even though we don’t always know the time, place and circumstances of our departure we do know there is no fixed destination in the desire to derive meaning. And meaning is one thing we can pass along to others.
About Timothy Tate
Community Psyche columnist Timothy J. Tate, who lives in Bozeman, Montana, has been a practicing professional psychotherapist for more than 30 years. For decades, he had an office on Main Street behind The Blue Door. He still works with clients downtown.
