What Was Life Like Before? (Death and Terminal Illness Aren’t the Only Things We Deny)

In the television program Virgin River, Melinda Monroe (“Mel”) has left her Nurse Practitioner position in Los Angeles and moved into the wilds of California’s Northstate (very like the communities I served for over two decades). Mel’s decision follows the death of her husband Mark, and others around her and in his family especially demonstrate the kinds of behaviors chaplains, counselors, social workers, and other hospice staff members refer to kindly as “family dynamics.”

 But in the midst of varying layers of drama, at one point she’s questioned about her perspective on their marriage and its challenges. Wanting Mel to return "the family's" wedding ring, her sister-in-law asks, “If Mark were still alive, do you think you’d be still married?"

 True, those around the bereaved can often be horribly insensitive. But this scene (in Episode 5 of Season 2) reminds me, too, of how often our patients’ loved ones fall prey to pretending that everything in the patient’s relationships were uncomplicated by conflict, or that somehow being gravely ill results in some new sense of nobility, respect, or at least stability in the life of the patient.

 As we’ve seen frequently in recent months, though, even as our patients face their impending end-of-life, they are still who they have been. We work with families where relationships have been damaged by substance abuse, abandonment, disagreements, religious conflicts, and many other factors. The questions raised by these realities sometimes needs to be asked:

 “If your loved one wasn’t dying, would you let them live with you?”

 “If your loved one wasn’t dying, would you have taken an interest in their religious beliefs?”

 “If your loved one wasn’t dying, would you have stopped the divorce proceedings?”

 “If your loved one wasn’t dying, would you…?”

You cannot resolve what you will not address. Ask the questions.