Terminal Diagnosis and the Question of Prognosis

Lorraine Kember
 


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As intelligent human beings, we know and understand that we can not live forever, we are not strangers to suffering and death, however as long as we are healthy, we do not think of the inevitability of our own death, and even if we do, we prefer to believe that it will not happen until our dotage. After all, there are so many things we want to do in our lives and we have many plans for the future.

There is nothing that can prepare us for the shock and devastation of a terminal diagnosis and the knowledge that we can no longer take our lives, or the life we share with our loved ones for granted. Terminal diagnosis usually comes with a prognosis (Estimated time of survival) and this intensifies our turmoil. It is one thing to accept that your life is limited it is another to be given a time in which it is expected to end.

Once given a prognosis, it is impossible not to begin counting down the days remaining. Furthermore, the beginning of each new month is seen as bringing you ever closer to the expected time of demise, causing feelings of fear and dread. This has a huge impact on the quality of day-to-day life.

The irony is, that prognosis is only an estimate of other people’s experiences and as such is often incorrect. No one can accurately predict how long a person may survive-because every one of us is unique. Each terminal patient though on the same journey, may not travel at the same speed, take the same turns in the road, or reach the end of the road at the same time as those who have traveled before them. We may lose our fight for life at some time prior to prognosis or we may live far longer than predicted. Why point the bone? I sincerely believe that many patients die at or around the time of prediction simply because they were told to.

My husband, upon his terminal cancer diagnosis was given a prognosis of three to nine months, we wondered if he would be granted 90 days, 270 days, or somewhere in between. With no idea of how or when he would die, we feared that he might die at any time.

When after nine months my husband was still very much alive, he said to me, “Well, I have proven them wrong, I am still alive and feel much better now that I have surpassed their prognosis. " The change in him was remarkable; without an expected time of demise hanging over his head, there was no dread and he was able to accept and enjoy each day as it came. He survived for two years, during which he remained active and alert, drove his car for eighteen months and continued to go fishing which was the passion of his life.

Many people may wish to be given a prognosis so that they can put their affairs in order but I suspect there are many who do not. I believe that unless a prognosis is requested, it should not be given. Life, no matter what its duration, is precious, each day should be enjoyed for the gift that it is and every tomorrow should be anticipated.

Article written by: Lorraine Kember – Author of “Lean on Me" Cancer through a Carer’s Eyes. Lorraine’s book is written from her experience of caring for her dying husband in the hope of helping others. It includes insight and discussion on: Anticipatory Grief, Understanding and identifying pain, Pain Management and Symptom Control, Chemotherapy, Palliative Care, Quality of Life and Dying at home. It also features excerpts and poems from her personal diary. Highly recommended by the Cancer Council. “Lean on Me" is not available in bookstores - For detailed information, Doctor’s recommendations, Reviews, Book Excerpts and Ordering Facility - visit her website http://www.cancerthroughacarerseyes.jkwh.com

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