It is a shock to hear the news that you or a loved one has cancer. You work with it - fight it. Many, many patients survive the battle. To them, the joy is indescribable. But to some, the enemy is just too strong. It is devastating to hear from a caregiver that hope is gone. Especially for the loved ones, this news can be the most traumatic to hear.

A patient goes through three phases: 1 – Anxiety, disbelief, shock, anger, denial, guilt, humour, hope, despair and bargaining.
2 – Depression.
3 – Acceptance.
- But loved ones suffer in a very different way. To see the suffering - but not feel it, you tend to go through phase 1 with a patient, but then seem to get stuck on ‘hope’. Hope is a wonderful, positive attitude to have, and no doubt, very helpful for a cancer patient to be surrounded with. But sometimes, when the devastating news comes – your focus should shift. This is the final phase of your beloved’s life, and should be made beautiful, memorable and of the greatest quality.

Your first tool is your ears - listen. Stop playing down the fears of a patient. Discuss them, and find simple solutions. Grant him/her their wishes. This is of utmost importance. Discuss the treatments for the final days – pain management, nutrition, sedatives, CPR. This is called ‘advance directive’. Ask the caregiver what choices there are, discuss them with your loved one, and finalise them. Whatever the wishes of the patient, it is their right (even to change them later). To have all wishes decided on and in the open, is very helpful and less stressful for all involved towards the end.

What to do/expect: Pain – 1. The caregiver will prescribe acetaminophen, NSAIDs (non steroidal anti-inflammatory drugs), which can be used over longer periods.
Good for bone and soft tissue pain.
2/3. Weak opioids followed by strong opioids (e.g. Morphine)
For severe pain – use often enough in large enough doses.
Delirium – Caused by pain, drugs, water retention, dehydration, underfeeding or infection.
Decide before the time whether or not to intervene with sedatives.
Nausea – Due to drugs or large meals.
Dyspnea - Laboured breathing.
If not due to bronchitis or pneumonia, this could be stress related.
Small meals - Give smaller meals, and eliminate dietary restrictions.
Take turns - Where possible, let loved ones take turns, assuring always having someone by the patients’ side.

Funeral plans should also be attended to. I see a persons’ funeral, as their last party – I repeat - THEIR party. To know that you are going to host this persons’ most eventful day is an honour. Discuss all his/her wishes. Talk about the wonder of their lives, all the memorable moments, the joy and tears – everything. Put everything in a journal for them, or suggest they do it themselves. Take many pictures. This is very, very difficult – but don’t tiptoe around the subject. Some people will be too shy to ask for your help, or might not want to hurt you by mentioning the word ‘funeral’. Be brave and humane, and do it for them. This will most definitely also be healing for YOU.

The spiritual preparation for death is great for all involved. Get your hands on as much reading material concerning this. Hospitals and hospices also have people qualified for this important task. Before birth, most women go to ante-natal classes. Why? Because this (mom-and)-baby will be entering a ‘new world’. (You and) your loved one are also entering a new world. Dying is a normal process of living, but we also need some ‘classes’. And remember these important words by Pierre Teilhard de Chardin: “We are not human beings on a spiritual journey. We are spiritual beings on a human journey.”

Lastly – although you feel like your heart is breaking, most patients are waiting for their loved ones to give them ‘permission’ to die. Be brave, and do this because you love this person dearly. There are many support groups for relatives and friends – a good one is www.caringbridge.org

You are in many people's prayers!