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An existential journey of a palliative care physician.
The Covid era revealed modern civilization’s paralyzing fear of death.
Tolstoy “The Death of Ivan Illich”.
As a young child, I remember vividly lying in my bed at night contemplating death. Specifically, what happens to me, my essence or life force, when I die? Of course, I didn’t have any real understanding of consciousness or spirit at the time. Yet, somewhere inside of my 8 year old body I knew I, as the awareness or being, was something far more than just this biology. I had no real connection to any conceptualizations of a creator as the larger questions of life were not a dinner table topic with my hard working labourer blue collar parents. They knew of the grind of life, by and large, with moments of shear loving bliss intertwined when the grind briefly halted, on weekends mostly. Death terrified me so deeply that it caused me severe physical abdominal pain. A child’s worries and fears often emerge in the still and quiet at bed time. I would wake my mom up night after night because of the pain but would never let her know my innermost thoughts and fears, the root cause. I would lie still in the dark wondering what not being here meant or would be like. I would imagine my loved ones when they die and were no longer in existence. I couldn’t imagine eternal nothingness after this profound experience of living in all its variables. The ultimate fear of non-existence is felt in the gut. I couldn’t imagine a life without my mom to hug. My heart felt like it was in the pit of my stomach, my chest hurt, and I was gripped by the force of fearing my own nothingness, my own mortality. My thoughts were shaped from a cultural and societal environment devoid of connection to God or anything other than a physical existence. My mom was, and is, amazing; she would give me warm water bottles, rub my tummy, lie with me for hours, and when nothing helped, she took me to the doctor to assess these severe pains. Of course, nothing was ever found physically. And, Of course not, given the source of my pain was existential. My pain was metaphysical. Eventually, after a couple of years of this, I seemed to have suppressed it enough that it didn’t bother me the same way. In other words, I learned how to “cope” and escape the burning need to understand more deeply my full spiritual incarnation as well as the physical experience of being in this world. I never dealt with this ubiquitous fear because it was too uncomfortable and I didn’t have the skills to do so at that time. I was embarrassed to say anything to anyone for fear of dismissal or judgement. These fears were sourced from external influences beyond just family and friends. Our entire western culture was almost completely out of touch with the connection to spirit.
As the years went by, I revisited these same thoughts many times but had no new path to holistic understanding of all parts of myself and again became too uncomfortable to face them and my own limitations. Deeper these neuronal networks got buried and then engrained into my implicit memory, given the repetitive processing of the same thoughts; which, remained unexplored and unreconciled at that time.
As a medical student, my first and only clinical experience with a patient knowingly facing her imminent death was even more uncomfortable and I turned away from this again.
Not until I was independently practicing medicine as a hospitalist did I truly begin to think differently and deeply about death and, consequently, living for that matter. This path lead me back to the larger questions in life; like, what is the purpose of life, are we anything more than just physical beings with thoughts and emotions, what are thoughts and emotions, who actually experiences them, and again what happens when we die? A pivotal moment in which I chose a different lens through which to seek answers from arose and I finally chose to observe through it.
Spirituality and my higher self or essence were elusive threads I began contemplating and reaching for at various times in my tapestry while searching to understand true value and to finding meaning. This journey became essential when I acknowledged and accepted burn out, extreme stress and dissatisfaction in life as there was no meaningful connections other than with my patients and their families. It left me exhausted and unable to engage in my own relationships and I withdrew. A pinnacle moment came when I thought I was making effective changes and moving toward more balance by shifting to community based work from almost exclusively hospital based with call. Yet, I remained superficial in exploration and additional stressors and events occurred that just seemed to pile upon me at a time when I couldn’t handle any more external squeezing of my life force. I won’t go into the details, but taking over a retiring doctor’s practice was not without massive inherent baggage and issues. I tried to reach out for help or support to my local community but my cries (quite literal) went unsupported, for whatever reasons. I found a couple of my colleagues had recently gone through burn out and a contemplative spiritual awakening of some kind and to some level. They shared a couple books, resources and offerings of support. It was the first time that it felt ok to be me just as I was. I pursued this self actualization and spiritual path deeply and came to many profound realizations of why I was feeling the way I was. A lot of it related to my inner values and not setting boundaries to uphold those values. I began making decisions that honoured my values and boundaries and practicing this, and the art of saying no, until it was a more natural response. No practice is perfect and I am fallible, which I internalized for myself as ok. I recall one palliative patient who I had had an existential or spiritual discussion with as his family reported he is “hanging on for some reason”. After this conversation, I felt quite good about how it went and how it was received. The next morning his family was at his bedside and he was now unconscious, actively dying. They reported to me he had mentioned our talk and that “dr. Luchkiw wished me dead”! They laughed. I was wholly mortified. They told me this was his sense of humour and he appreciated our discussion deeply. His essence lives on even though he was biologically gone in the stories we share and our mythos.
The way we approach or relive traumas or the big life questions we grapple with determines the response we have to it. Our culture has evolved to a largely emotional reaction to everything instead of responses based on deep introspection and contemplation. If we continue to respond out of a lack of metaphysical exploration and in fear we continue to experience life and existence in the same fearful manner. For many people, the fear of death inhibits living life. No one escapes or beats death. It took understanding existence - awareness and consciousness - to know what non-existence may be closest to. It wasn’t until I accepted this truth, as it was, that I began my own restorative inner work. While helping others navigate their end of life journey, I began to focus on the person’s quality of living and individual value of being. Consequently, this catapulted my own transformation in quality of being. Understanding the value patterns of people who are leaving this world, intimately expressed as “wishes” were, in fact, basic human needs. And, striking similarities emerged from most of the answers I received from all of my patients when inquiring about what’s most important to them. Spoiler alert, each and every time close loving human contact and connection were a necessity in their death process and listed as their regrets for not having prioritized it while alive.
My work required me to grapple with death in many new ways. There was simply no other option and I was ultimately forced to sit with the discomfort of these challenging moments of human life and find answers in new places. Simply put, I needed to search for meaning in death and dying. Having the most difficult and sobering discussions as often as I did, revealed to me the inherent value in understanding and appreciating the fragility and sanctity of life. Being a palliative physician allowed me to practice thinking qualitatively far more often and hone a skill in truly compassionately and honest exchanges. It allowed me to observe the effects of sincere compassionate care unto human suffering. Meaning in life comes from our most intimate and basic needs, loving human contact and connection. It doesn’t matter what age you are, these are essentials of quality living and in dignity while dying. We are hardwired to exchange tender touches, exchange laughter and smiles, and wrap ourselves in enormous hugs. For what is life without these wondrous experiences? As a physician, these are also the places I found meaning in existence and began to focus more on my own quality relationships. Which meant I had to choose to be completely honest with myself and the choices I had made. I had to face secrets, which are just lies we tell ourselves and keep from others, as they contradict who we know ourselves to truly be or who we know we want to be. That is tough stuff. And, I’ve made mistakes, big ones, just like everyone has. I’m forever a better person for having been so honoured to foster my own growth and development from such private, intimate human connections with my patients and their families. Last remaining moments of life became such beautiful manifestations of palpable and visible love and meaning. And, similar to the grinch’s heart that grew two sizes when shown love and generosity, my default mode neural network fearing death shifted and my awareness and acceptance expanded. This is where major transformations are possible; within the choice for radical self honesty and accepting the responsibility of what is.
Many times, imminently dying patients would express their will to live for a specific moment or purpose. Almost every time, if genuine and unwavering, my patient met that moment and very shortly after left this world peacefully. My patients manifested their reality with their conscious being, not because of their physical body. Two standout examples come to mind: 1/ a woman was dying of cancer in the hospital, she had mere hours to days left to live. Her son was in prison and the institution was to arrange for him to be brought to visit her. It took days, but she saw and hugged her son one last time, and passed on right after he left her room. 2/ a middle aged woman had terminal cancer and suffered a complete bowel obstruction for which she could not receive any nutrition and nothing worked to help open up even a bit of her bowel. She and her husband had already planned to renew their wedding vows, which over 2 months away. She remained in hospital up until that time, renewed her vows and transitioned the next morning. I have countless stories just like these. Inextricably, such patterns of the Epi-physical nature of free will and self determination in my patients showed me that there is most certainly more to human existence than just the biological or physical organization. Like an onion, we have many layers to peel back and unfold before we can begin to appreciate the complexity that we are as creative manifestations.
Simultaneous deep exploration of my own essence was being reinforced by my professional approach and reciprocally compassionate experiences with my patients. Choosing to focus my awareness on the epi-physical, human consciousness, opened my map of living with new routes for exploration, curiosity and personal growth. And, these pathways resonated physically within my body. Finding meaning in our everyday experiences in sincerely benevolent human exchange builds the scaffolding for the ways in which we can access new default or trigger responses. Nothing good ever comes easily. Yet, the growth and absolute value is always in the effort put forth and in the struggle itself. Invaluable lessons emerge from these times of bravely persisting the struggle. Once overcome, the fruits of your labour will be enjoyed. Think of every “under-dog”story, movie, or situation; the common threads of being against all odds but never giving up is the experience of ordinary human existence.
Practicing medicine, to me, is truly experiencing reciprocity in action as a profound source of meaning. At least that is what my broad and cumulative perspective determines. In exchange for serving others in need, I gain the most incredibly valuable knowledge to be used to expand my own Self and tools for understanding the great mysteries. Most of our lives we try to simplify and compartmentalize complex information for easier understanding. However, then the intrinsic divinely infinite complexities and mysteries can never be fully understood by our own limited capacities. Surrendering to this and acknowledging a higher authority than man is a primordial quest. It is most certainly one for our current times.
It’s inexplicably difficult to accept being stripped from my art, losing that which organically helped shape my transformative growth as a human being and physician. Particularly, at a time in my professional career when I felt I was serving others to a higher standard than ever before. However, I’m beyond humbled and grateful to have been fortunate enough to find such beauty, grace, and meaning in life, for which death is a part of the whole. Being relentlessly persecuted and abused by a “care” system has taught me countless other lessons and challenged my own inner strength of moral character. Whether or not I return to medicine cannot define or undermine what it has meant to me and what my experiences have taught.
As I transitioned to my community family practice, I brought with me this expansive toolkit that shaped and maintained my clear respect for each individual being. My patients trust me because they know they will be seen, heard, and understood. They trust me because they know that I value each person equally to myself and all others. They know that their existence is sacred to me. Patients trust me because they know sincerity and authenticity of experiences. My patients trust me quite simply because I earned their trust, and that I show I trust them.
Just as the bonded coherence within a diverse fabric quilt creates its structural integrity, so to is the necessity of our human relationships. The quality of coherent and orderly (respectful) interactions with all others we come into contact with determines the integrity of society and institutions. For this reason, medicine is always an applied art form. We are dealing in human life and it’s infinitely variable condition, which cannot be sequestered or reduced to sameness nor to mere quantification
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