At the End of Life, the Holidays Can Be a Time for Meaningful Moments

By Jenifer Goodwin,

Thursday, December 18, 2014


The holiday season can be a particularly difficult time for people who are terminally ill and their loved ones. Yet there are ways to work with the experience to derive joy and meaning in the midst of fear or sadness.

From the marking of a new year to the ghosts of Christmas past, present, and future in A Christmas Carol, the holiday season brings the passing of time into sharp focus.

For people with late-stage cancer, that emphasis can make the holidays particularly difficult, says psychiatrist William Breitbart, Chair of Memorial Sloan Kettering’s Department of Psychiatry and Behavioral Sciences.

“For many people, the holidays are a time to be with family and loved ones,” Dr. Breitbart says. “People who are terminally ill may wonder if this will be their last holiday, and that can bring with it feelings of loss and despair.”

Despite the enormity of what they’re facing, people who are nearing the end of life may still be able to find meaning and joy in the holidays, he says. While there is certainly no one “prescription” for everyone, and each person will experience both cancer and the holidays differently, Dr. Breitbart and MSK clinical psychologist Wendy Lichtenthal offer this advice.

As much as you can, mark meaningful moments, not dates.

“The Greeks had two words for time,” Dr. Breitbart says. “The first is chronos, or sequential time, which is how we in modern society live. We think about how much time we have left, whether it’s years, months or weeks. Thinking about time in that way can evoke fear, anxiety, and a sense of loss.”

“The Greeks had another concept of time, kairos, which is not measured chronologically but by meaningful experiences that make life fulfilling,” he continues. “At the end of life, thinking about those meaningful moments can help people accept the life they’ve lived, and measure it not by how long they’ve lived or how much time they have left, but by knowing that they have lived a life full of meaningful experiences and that they can continue to have meaningful experiences.”

Whether you’re gathered with family, upholding a cherished tradition, visiting a house of worship, or doing something even simpler, like admiring a brightly lit Christmas tree, all are experiences that can hold meaning and value, he says.

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Accept that you may struggle to think like the ancient Greeks.

As much as you may try to focus on the richness of experiences past and present, there may be moments when you feel overwhelmed by feelings of grief and anxiety, Dr. Lichtenthal says.

“Give yourself permission to feel whatever range of emotions you may be feeling. These are likely to vary, even within a given day, and you may have feelings that seem at odds with one another, such as simultaneous joy and sadness. This is normal and very understandable.”

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Consider what is valuable to you, and try to make the holidays as much about those things as possible.

Family, friends, faith, tradition, music — each is an element of the holidays that may be important to you, and staying connected to those things may help you derive meaning or pleasure from the season, Dr. Lichtenthal says.

“Do you want those around you to keep traditions? Do you want to enjoy and be in the moment, or speak candidly and openly about the end of life with those close to you? Do you want to give them permission to feel whatever they’re feeling and help them think about their future?” she adds. “A word that often comes up is ‘legacy.’ The holidays can be a time to reflect on one’s legacy and how you would like things to be in the future, during the holidays and otherwise.”

If open discussion is a possibility, she says, talking about traditions that you’d like to see continue or letting your loved ones know that they can celebrate in future years however they choose, as long as they are taking care of their own needs, could be a great gift to give.

“Quite often, though, family members want to protect one another from discussing such difficult topics, and so they avoid them,” she adds. “Open communication can be very helpful in a family that generally gets along. In some families, however, these topics bring significant tension, and it might be important to get professional support to facilitate such conversations.”

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Cherish the significance you have in other people’s lives.

Despite physical limitations you may have, savor what you mean to people, and remember that your influence transcends your illness, Dr. Breitbart says.

You may also want to express your love, gratitude, or forgiveness in a conversation, a recording, or a letter, Dr. Lichtenthal says. “Whether the letter is ultimately shared or not is up to the individual,” she says. “But expressing oneself can help a person process and organize challenging thoughts and feelings and reflect on what is most meaningful.”

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Seek professional help.

“While there are opportunities for meaningful moments and powerful, beautiful experiences during these times, it’s important to acknowledge that for many people, thinking about the possibility of life ending is incredibly difficult and painful,” Dr. Lichtenthal says. If you need help coping, reach out for professional help. MSK social workers, psychologists, psychiatrists, and chaplains are here to help people with cancer and their families.

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I received a letter to donate to MSKCC. I went here for a second opinion and was treated as a number, not a person. The doctor was not prepared to discuss my type of cancer even though I provided disks, scans and reports of all testing in advance of my appt. I left with more questions. I will never go back to MSKCC and will not donate to a hospital that makes people feel insignificant. Please remove my name from the donation contributors, thank you.

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