How Then Shall I Live?

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I was terrified, anguished, and grieving.

In December 2009, I was promoted to Director, Patients and Families First & Government Relations for the Saskatchewan Union of Nurses.

In February 2010, I met an extraordinary woman, and plunged into a wonderful romance.

In August 2010, I received my diagnosis and prognosis: very aggressive prostate cancer and a 50/50 chance of surviving 3 to 5 years.

I had a career that I loved.

My sweetheart and I were planning a fantastic present and future.

Cancer shattered all that.

I chose aggressive treatments. I faced continuing bad news with as much courage and optimism as I could summon. All around me were stories of new treatment options coming soon, or other cancer patients who were in remission.

But after surgery, hormone therapy, radiation and months of chemotherapy, my health care team is describing my treatment as palliative–not curative. My cancer has now progressed to several places in my skeleton and my lymphatic system. It is terminal.

How do I balance the need to face my early expiry date, while not allowing despair to engulf what is left of my life?

How then shall I live?

Thankfully, I stumbled upon Dr. Balfour Mount’s work in palliative care. Dr. Mount is a retired cancer surgeon, cancer patient, and Professor Emeritus of Oncology and Palliative Medicine at McGill University.

Here’s what has provided me with so much comfort and peace. (The following merges text and concepts borrowed directly from Dr. Mount, and my translation of these into my own life).

“We are geared toward healing–living, not dying. Healing happens in the present moment, just like love, awe, ecstasy, celebration, and requires leaving behind fears for the future. Diving, not falling. Let go of egoism and defence mechanisms, reach for forgiveness of ourselves and others. That permits us to access the healing connections that provide meaning, hope, and a sense of inner peace.

The basic principle is ‘healing’, not physical healing, but a shift away from suffering and anguish toward an experience of integrity, wholeness and inner peace. The goal of this healing is to enable us to be of greater service to others, and to the global village.”

Dr. Mount noticed that palliative care patients who managed to find some peace while facing their death enjoyed what he described as healing connections. (He contrasts these with wounding connections and relationships.)

He says those healing connections happen at four levels:

  1. a sense of connection to self
  2. connection to others
  3. connection to the world perceived through our senses (as with music, or the grandeur of nature)
  4. connection to ultimate meaning of life or spirituality, however perceived

When I discovered Dr. Mount’s four levels of healing connection for palliative patients, my immediate thought was, we should all live this way, even if we are perfectly healthy!

It seems to me there is a perfect fit between the concept of the definition of health as not just the absence of illness, but the emotional, physical and mental fitness to live the life we wish to live, no matter how serious our illness or disability, or prognosis may be.

Despite our illness, how do we patients maximize our health, our reach toward life, not death; our reach toward hope, not despair; toward sunshine, not darkness; toward caring, integrity and love, not anger and selfishness?

Here’s how I’ve translated the concept of healing connections into my own care plan.

1. Connection to self.
For me, this means self-awareness and exploration. Reading, writing, learning, discussions. My best reflective time has been exercising, walking, listening to documentary radio broadcasts. Over and over, it has allowed me to climb down off the bridges of despair, fear, conflict.

I am trying to understand and manage fear, anger, blame, anguish and the other basic emotions that dominate our existence. I am reading and writing about basic emotions and trying to implement strategies to help ‘rational me’ lead ‘emotional me’ more of the time.

2. Connectedness to others.
Relationships are everything now. I am nurturing open and direct connections with loved ones, friends, family, and strangers. Casual conversations, minor courtesies or offers of assistance are now leading to new and very rewarding friendships. My circle of friends and ‘positive energy people’ has expanded.

3. Connection to the world perceived through our senses.
My strategy is to reach deeper into music, learning, reading, photography, food, nature, art, cooking, dance, history, writing, drawing, movies, comedy, news and politics, sensuality and sexuality. (Bruce Cockburn calls it that compact universe of skin, breath and hair.) Every sunrise reminds me I have another day to experience all the richness of basic life we humans take for granted.

4. Connection to meaning and purpose of life or spirituality.
Although I can’t summon up a religious connection, facing death really does force us to imagine our life had a purpose. I want to believe I have contributed to making the world a better place, by supporting the sunny side, not the dark side, with integrity, honesty, and a commitment to the greater good. In other words, staying on the healing side, the constructive, collaborative side, not the wounding, selfish, blaming side.

How then shall I live? How do I make these last couple of years the best years of my life?

Dr. Mount says, instead of being preoccupied with all that has been lost, he needs to focus on clearer recognition of the potential that remains. Brilliant.

I also need to stick to my personalized care plan, keep finding the courage to face whatever comes, and focus on the potential that remains, nurtured by these connections.

That way, I get to write the last chapter of my life.

A happy ending is improbable.

But I will be grateful for a peaceful and graceful ending.

23 Responses to “How Then Shall I Live?”

  1. dan
    December 27, 2013 at 6:38 am #

    i want to write but dont know what to say, your blog has made me feel better about my own journey, i could give u a long story about how i got here but thats in the past, i was dx with aggresive p cancer, 7.8 on the gleason scale, think that is the name, by the time the prostate came out it had already escaped so the prognosis was not good 3-5 7-10, i am at the seven year mark and going for a mri for some pain in the pelvic region, hope its arthritis lol, my biggest beef about the whole process is the idea of fighting the desease as opposed to living with it and going with the flow, i have heard all the well meaning ideas and helpfull hints and it drives me nuts, cayane peper and lemon juice comes to mind, thanks for the outlet, i have been writting but only to myself, alot of people i talk to are not comfortable talking about my condition and i think maybe its me just whining, well i better get ready for my bloodwork and then off to work on a project, thanks for the blog i know im not alone in this struggle but it sure seems that way ohoh whining again:) i have to be honest i noticed the last reply was in oct and thought is he still with us but it dosent matter because he helped me today, hope that came out right

    • Lawrence LeMoal
      Lawrence LeMoal
      December 28, 2013 at 3:25 am #

      Hello Robert Charles! To connect with a relative who has been so reflective about life and death is very inspiring. I do have a childhood memory of meeting Emile, and later Charlie. Emile’s family lived just across the river from us. I am pulling together family photos/letters/cards into binders to pass on to my children, and creating electronic copies I am happy to share.
      Last night I was watching a documentary about happiness and to what extent it is dependent on being motivated by intrinsic goals of connecting with community, family and striving to make the world a better place. Fascinating. Thanks so much for sharing your knowledge with others. Let’s connect. Regards, Lawrence

    • Lawrence LeMoal
      Lawrence LeMoal
      December 28, 2013 at 3:42 am #

      Good morning Dan, I am up in the middle of the night responding to recent posts, and posted my response to a relative here by mistake! Oh well, you and I are related too it seems in our struggle! I am so grateful you took the time to write. I would encourage you to connect with the prostate cancer support groups, where you will find other patients who are sharing your experience. I found it enormously helpful to connect and share with fellow patients. Just check with the Cancer Clinic nearest you for a contact person.
      My new post-chemo drug has started producing some positive results so I expect to be able to keep writing! Your reply, along with others, fuels my determination. Thank you!! I hope your treatment buys you some more time too! Let’s keep in touch! Regards, Lawrence

  2. Robert Charles LeMoal
    December 26, 2013 at 5:09 pm #

    Hi Larry (Lawrence) . . .
    I have heard your name and your father’s name frequently throughout the years, but we have actually never met. Emile was my grandfather. Dr. Mount was right in what he said — firstly the connection with SELF is key — then you are able to have all these other connections. All these connections in your life happen for a reason and will help to meet your fate, as you say . . . with grace & peace. Life is not always roses and sunshine, but with positive thoughts and connections, you can surely see the light and appreciate the beauty of a blooming flower in spring.
    I wish for you exactly as you do and your situation has been brought forward to teach others how to find that positive energy and connect with themselves. Many put this off their entire lives and are never self aware or awakened. I find Eckhart Tolle to be very inspirational in all of life’s situations. But I am sure you have already read much of his inspirational thoughts and writings.http://spiritlibrary.com/eckhart-tolle/the-inner-body

    So glad you have found your great love to be by your side.

    “To love is to recognize yourself in another.”
    ― Eckhart Tolle

    🙂

    • Lawrence LeMoal
      Lawrence LeMoal
      December 28, 2013 at 3:26 am #

      Hello Robert Charles! To connect with a relative who has been so reflective about life and death is very inspiring. I do have a childhood memory of meeting Emile, and later Charlie. Emile’s family lived just across the river from us. I am pulling together family photos/letters/cards into binders to pass on to my children, and creating electronic copies I am happy to share.
      Last night I was watching a documentary about happiness and to what extent it is dependent on being motivated by intrinsic goals of connecting with community, family and striving to make the world a better place. Fascinating. Thanks so much for sharing your knowledge with others. Let’s connect. Regards, Lawrence

  3. Bill Eberts
    October 19, 2013 at 8:36 am #

    Hi Larry,

    Stumbled upon this blog and so glad I did. Your ‘connections’ are something one should do even without a life-threatening situation. I am a very ‘goal-orientated’ person and finish one project and then on to the next one, but don’t take the time to do these things. Your words have made me think more.

    All the best,
    Bill

    • Lawrence LeMoal
      Lawrence LeMoal
      October 19, 2013 at 10:33 pm #

      Hi Bill,
      Great to hear from you, and thank you for the comments about the value of connections. It’s certainly true that illness highlights how valuable connections really are, but I keep stumbling across more and move evidence about how critical connections are to our success and development and happiness at every stage of our lives, no matter what our circumunstances. I’ve noticed many other cultures are better at connections than us gringos. Too soon old and too late smart as the old saying goes. Thanks again, and let’s stay in touch! Regards, Lawrence

  4. Murray Hill
    July 18, 2013 at 4:51 pm #

    Thank you for posting this. It’s moving, uplifting and incredibly depressing all at the same time. Your strength is an inspiration to anyone who reads this! I had my prostate out nearly three months ago and although my prognosis is different from yours at this point at least, I would really appreciate an opportunity to link to this site through the blogs I’m going to be writing about my experiences along this journey. If you could E-mail me I’d like to tell you what it’s about, where it will be available and what my project involves. I’d very much like your story to be a part of my project.

    • Lawrence LeMoal
      Lawrence LeMoal
      July 19, 2013 at 5:20 am #

      Hello Murray, great to hear from you. I would be grateful if you shared the blog. This site has great potential patient/provider/policy maker interactions. I suggest you also look at Heather Thiessen’s. She has a great patient perspective. She inspired and supported me to get started posting. I will email you directly and we can figure out how to best to coordinate. Thanks for you work on behalf of patients! Regards, Lawrence

  5. Milica
    July 14, 2013 at 5:20 am #

    Hi Lawrence,

    You don’t know me but I know your sweetheart 🙂 And she was right, you really are a great man, because to have such clarity and wisdom at the darkest of moments is remarkable. What you share is inspiring for all, people fighting an illness and those just fighting for happiness. I wish you many, many wonderful sunrises in the arms of the loved ones.

    • Lawrence LeMoal
      Lawrence LeMoal
      July 16, 2013 at 7:07 am #

      Hello Milica. Thank you very much for such a warm and generous reply. I can tell you are part of the ‘positive energy people’ tribe. I hope we get a chance to meet in person some day. There was a beautiful sunrise this morning, and my sweetheart arrives today. I am a very lucky man. Wishing you all the best.
      Regards,
      Lawrence

  6. Pat Stuart
    July 6, 2013 at 12:46 pm #

    Thank you so much for these blogs. Some of the lessons I have learned from profound loss leads me to celebrate each day and find at least one daily opportunity for gratitude. Today, that opportunity for gratitude was found in the reading your insightful blogs. I know that you are a very powerful presence here on earth, and I appreciate you sharing some of the most intimate parts of your journey with us. May you continue on your path of connectedness with self and others.
    Pat

    • Lawrence LeMoal
      Lawrence LeMoal
      July 7, 2013 at 6:48 pm #

      Hello Pat, and thank your very much for sharing your experience and understanding about this issue of daily gratitude. Last night I stayed up really late to hear my son play guitar and sing with friends at a small performance venue, and this afternoon hung out with him while he sorted out an issue with his radio/sound system in his truck. Big moments and small moments all seem so precious when your priorities shift to relationships, don’t they? I suspect your contribution to nursing and health care is another window that has opened this perspective about gratitude for you? Let’s stay in touch.
      Regards,
      Lawrence

  7. alison
    July 5, 2013 at 10:15 am #

    Yes, we should all live this way.
    I’m gonna live this way today.
    I love you, Lawrence.

    • Lawrence LeMoal
      Lawrence LeMoal
      July 5, 2013 at 7:47 pm #

      Hi Alison,
      Over decades, I’ve met and watched families and friends that were very close, and have been jealous of the warmth, community and mutual support I saw. Your love and encouragement feels just like that for me. Thanks so much.
      Regards,
      Lawrence

  8. Anne Winograd
    July 4, 2013 at 11:25 am #

    Lawrence…..when I think about you……my head tells me that I should feel sad but my heart tells me to feel happy……I think knowing you has turned me into one of the new”positive energy” people you have chosen to surround yourself with…..I hope so because it looks like it’s working!!
    Take care and keep writing.

    • Lawrence LeMoal
      Lawrence LeMoal
      July 5, 2013 at 7:37 pm #

      Hello Anne,
      Your encouragement and positive support is wonderful. I don’t manage to stay on the sunny side all the time. Visiting the dark side is inevitable and probably essential for our growth. But these links with positive people doing positive things keep bringing me back.
      I hope your recovery is going well. Looking forward to future discussions, Regards, Lawrence

  9. Heather Thiessen
    July 3, 2013 at 9:11 am #

    Lawrence. Wonderful words you are sharing again.

    You are right we should all live this way. In a sense we are all battling something and will all face death at some point. Some unfortunately sooner than others.

    I love the last quote from Dr. Mount who tells not to be preoccupied of what is lost but what is remaining. You have chosen to do incredible things with what time you have left.

    I too think I know I cannot chance what has happened in the past to me but I am going to darn well make sure I will help future patients not to experience what I have in the past.

    Thank you for inspiring me to keep up my journey and fight!!

    . I am so thrilled to read your posts and know by you speaking up truthfully you are teaching as well and changing how we should all view our lives.

    Take care Lawrence. Good for you!!!!

    • Lawrence LeMoal
      Lawrence LeMoal
      July 3, 2013 at 7:17 pm #

      Hello Heather and thank you and Dr. Mount!
      Dr. Mount’s connections framework is based on research with palliative patients, so I am doubly impressed. It literally saved the rest of my life. I am reminded of the roadrunner cartoon, where the coyote can run off a cliff in pursuit of the roadrunner, and is just fine unless and until he looks down, and realizes he is above a chasm, and zoom, down he goes. It feels like the reverse to me, where realization of mortality suspends me and us. Thank you for your contribution on behalf of patients and families and your support. Regards, Lawrence

  10. Maura Davies
    July 3, 2013 at 9:05 am #

    Larry, thank you for another profound life lesson. Gives me much to think about.

    • Lawrence LeMoal
      Lawrence LeMoal
      July 3, 2013 at 7:17 pm #

      Thank you Maura!
      I am beginning to understand we humans have evolved to deny or ignore our expiry dates. That serves us well to fulfill our ambitions, goals, even caring for others. But, it doesn’t prepare us well for facing the inevitable. An interesting paradox!
      Regards,
      Lawrence 

  11. Dennis Kendel
    July 3, 2013 at 8:45 am #

    Thanks one again for a very profound and inspiring perspective on living the days we to the fullest. This is sage philosophy for all of us as we all are “terminal”. Some of us just have less certainty about the days, months or years of life we may enjoy.

    • Lawrence LeMoal
      Lawrence LeMoal
      July 3, 2013 at 7:12 pm #

      Hello Dennis,
      I know how fortunate I am to have this ‘slow motion’ progression to death and the chance to write Chapter 3. Yesterday I met a woman whose husband was killed by a drunk driver. She came upon the scene before the emergency vehicles. She is still wrestling with court, estate, insurance, and of course the grief and anger. My planned exit is a gift, although the wrapping is complex!
      Thank you for your commentary. Much appreciated.
      Regards,
      Lawrence

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