"I'm only 20 years old, still in school, and was told I have cancer. But I was also told it's very treatable and I can expect to live a long life. I wonder, though, how my friends will treat me or if they'll be afraid for me? Everyone will be thinking the same thing I am thinking – Am I going to die?"

"I was just told that I have cancer and I'm only 31 with 2 small kids. The doctors say it can be more dangerous to have this type of cancer when I'm so young, but that it was caught early. I am so afraid I will not be here long enough to raise my kids, and the first thought that came to me was – Am I going to die?"

"I'm 45 years old and have been living with cancer as a chronic disease for 6 years. I will never be cured of this cancer, but there is a chance I can live a long time. Off and on I need different types of treatment to control the cancer, and I occasionally have days when I just don't feel well. Then I find myself asking – Am I going to die?"

"I just celebrated my 57th birthday, and the nurses at the clinic sang "happy birthday" to me right before I had my chemotherapy. The cancer came back after 3 years and spread to other parts of my body. So now I am being treated for metastatic disease. Every day I wonder – Am I going to die?"

"At 62, I'm considered a long-term survivor since I was originally treated for cancer over 30 years ago. Now I have heart damage from my earlier treatments and I must have surgery. Although I have no signs of cancer, I'm still afraid of this surgery and what they might find, and I wonder  – Am I going to die?"

"I feel so thankful that I made it to 70. Fifteen years ago I was successfully treated for cancer, but I was just diagnosed with another entirely different type of cancer and have to undergo more chemotherapy. The doctors say I can't have anymore radiation as this new cancer may have happened because of my past treatments. Again, I ask – This time, am I going to die?"

"I will soon be 84 years old and was just diagnosed with cancer. It is a type of cancer that grows slowly. My life has been good and I still have some adventures left in me. So I have decided to not have any treatment, feel as well as I can for as long as I can, and let nature take its course. My question is not –Am I going to die? But when and how?"

[Narrator]

Seasons of Survival, an article by Dr. Fitzhugh Mullan, the co-founder of National Coalition for Cancer Survivorship, describes the acute, extended and permanent stages of survival. These stages cover 1) the time around diagnosis and treatment; 2) the immediate months and years after the initial treatment is completed; and 3) longer-term survival that can extend into years and decades. But many feel we need to add the experience of dying to these stages of survival, as death can happen during any one of these time frames.  Our challenge, then, is to learn how to live fully while we are alive, and to continue to live as fully as possible as we are nearing death. 

Many of us accept the fact we will die – we hope with dignity and grace. Others do everything in their power to not think about it or to fight it every step of the way. No matter how we deal with dying, a diagnosis of cancer seems to stare us right in the face. It quickly puts life into perspective whether we want it to or not. The issue of will we die from the disease is usually one of our first and last questions. Other questions include: When will I die and how? Will I be in pain? Will someone be with me? Can I be at home, or will I die in a hospital or nursing home? When will I be ready for hospice? Will my doctors give up on me if I am ready to die? Who refers me to hospice and when? Will I be afraid? What lies beyond? Or, our thoughts may be more practical and turn to finances and wills and powers of attorney. Will our loved ones be OK after we die? Are there good and bad ways to grieve? Are there people and resources to help me and my family both during and after my death? Who can help me find these resources?

Although death is an inevitable part of life, few of us know just what to do or say, or how to find the support we need when we are nearing the end of our lives and saying our final good-byes. Also, some of us are better at dealing with death than others.

A good example of someone who has spent time confronting the challenges of dying is Amy Harwell, a cancer survivor who was not supposed to be around long enough to write a book. Meanwhile, she's written two books and is still going strong. In her second book, Ready to Live – Prepared to Die, Amy shared a story where a neighbor, who was also dealing with cancer, noted that Amy seemed at peace with her serious diagnosis, and asked what was her secret to be able feel this way? Her secret was simply this: "I had worked through my dying to go on with my living. I believe that once we have prepared to die, we are really freed to live in whatever time we have left." While Amy is determined to live her life joyfully and in the present moment, she is also realistic about the challenges and difficulties that accompany one's dying. Her writings describe many of the lessons she learned in putting her life in order so she could feel free to savor each and every moment of the rest of her life.

In Dying to Know: Straight Talk About Death and Dying,  Tani Bahti, a long-time hospice nurse, writes:  "Intellectually you've always known that one day you will die, but somehow, it comes as a surprise. You just didn't expect it…yet. There is rarely a good time to die. Since living forever is not an option, let's talk about the choices you do have."

We hope that you find this module of the Cancer Survival Toolbox® informative, supportive, and maybe even reassuring, as you learn more about your choices, resources, and what to expect during this last stage of survival.