Facing Death, Living Life – Dr. Joan Borysenko – HPP 112

SPEAKERS

Dr. Joan Borysenko, Keith Kurlander, Dr. Will Van Derveer

 

Keith Kurlander  00:06

Thank you for joining us for the Higher Practice Podcast. I’m Keith Kurlander with Dr. Will Van Derveer. And this is the Podcast where we explore what it takes to achieve optimal mental health. Hey, welcome back. So this episode is titled facing death, living life. And it’s a challenge to fully embrace our lives and find joy, meaning and purpose and every day, stay stable, consistent and loving and open hearted. That’s obviously a challenge for all of us to take on and an amazing practice. And it’s something that probably many people who are listening to this podcast, strive to engage in that fulfillment of life. And then there’s another aspect of life which is facing death. And this episode is all about when we face death, obviously, with either you know, coming to the end of our life, or a medical illness, or something else that’s happened earlier in life. We are confronted by many different things depending on the individual, but there are different themes that many people face when they’re confronted with death and facing death. And living longer than we thought we would live is an event that typically is transformative for a human being, to where value shift and life has new direction and meaning for many people. So this episode is a dive into facing death and living life with our dear friend and colleague, Dr. Joan Borysenko. She’s been on the podcast a number of times before. She’s a very close friend of both myself and Will. We love her dearly. Her work has been instrumental in the entire movement of integrative medicine and mind body healing. Joan is a distinguished pioneer in integrative medicine and is a world-renowned expert  in the mind body connection. Her work has been foundational in the international healthcare revolution that recognizes the role of meaning and the spiritual dimensions of life as an integral part of health and healing. After graduating magna cum laude from Bryn Mawr College in 1967, Dr. Borysenko earned her doctorate in Medical Sciences from the Harvard Medical School, where she completed postdoctoral training in cancer cell biology. But after the death of her father from cancer, she became more interested in the person with the illness than in the disease itself, and returned to Harvard Medical School and completed a second fellowship in the field of behavioral medicine. In the early 80’s Dr. Borysenko co-founded the mind-body clinic with Dr. Benson and Dr. Kutz became licensed as a psychologist and was employed as an instructor of medicine at Harvard medical school. Her years of clinical experience and research culminated in the 1987 publication of the New York Times bestseller, Minding the body, mending the mind which sold over 400,000 copies. And she is the author or co-author of over 16 other books. So let’s welcome Dr. Joan Borysenko to the show. She is going to dive into a very personal story of what was facing death in her mind and what came through that process for her.

 

Dr. Joan Borysenko  03:50

Hi, there you two. It’s always just a joy to be with you and be with everybody who’s listening in.

 

Keith Kurlander  03:58

Yeah. Connect with you. And today, you know, discuss talking about the big process you’ve been through recently and the near death experience and talking about the topic of death and dying and illness and medicine. And so we’re just kind of, you know, we’re gonna play together here in this field of what you went through and see where it takes us. So maybe just start us off with where you want to start around the process you’ve just been through.

 

Dr. Joan Borysenko  04:30

I can tell you how happy I am, that both my husband and I are alive and well. And on the opposite side of each of us having a kind of mortality, risking experience. We just came back from a five day hiking trip in the wilderness of Colorado, and it was great. That was a sense of oh my god, here we are again. We’re grounded. We’re so grateful to be here. So in a nutshell, what happened was that in the spring, my husband Gordon had a heart attack. And I’m a cancer cell biologist by training. And I’ve always been more afraid of cancer that a heart attack, but the heart attack was really scary, because it’s sudden, it’s a totally different thing than facing some more lengthy or chronic problem that may still be impacting you in terms of you think, well, this is it this point I’m gonna die from, but being with him, as I saw, Oh, my God, I hope the ambulance gets here in time was a truly frightening experience, both for me as his wife, and in a way less for him. I think until you face mortality, you really don’t know what you’re going to experience, you may think you do, but you don’t. And for him, he had a sense of great peace, and a sense of, if this is my moment, I’m ready to go. I don’t have any regrets. I accept my life for what it is I’ve loved, as best I can. And I think all of us look back and we wish like, Oh, I wish I’d been more skillful in this way or that. But at the moment of death, if you can accept all of that, it’s a great thing. So he was fortunate as No, well, we live royally. And it takes about 25 minutes for an ambulance to arrive. And then there were COVID precautions when I got to the hospital, so nobody could sit with me, neighbors had followed the ambulance and came with me and they had to go. And I ended up alone for about three hours in the ICU waiting room. No, the hospital was quiet. It seemed deserted. But meanwhile, wonderful things happened in the cath lab, he got three stents. And when he came back to his room, this was now by about 11. At night, he was so clear, he was like a little Buddha state. And I thought to myself, either has done really well with death, or give me some of those drugs. This guy is like a very pure present state. And that was really remarkable, and made us both grateful for modern medicine that the stents could come in. And now there was, you know, a period of course of recovery, he finished cardiac rehab, just recently about so this was about a four month process. And I don’t think that you’re ever the same. There are just so many more moments of looking at each other of whatever’s going up to the other when you know how it is you’re busy in a house, you’re there together, but you’re not together, you’re passing through your you have to return your email, whatever, but of simply stopping and looking at each other and just having a hug, because the gratitude is so great. And one of the things for sure that I used to hear my own patients tell me when I was running a mind body clinic, I have plenty of people who had heart attacks, cancer, AIDS, you name it, is how they became more aware of how life is precious, and particularly with their loved ones took the time to be more loving took the time to be more present. So that turns out to be a great gift of the experience. Then flash forward two months, and by that time, he was pretty well recovered. And I found, as you know, a honey do size melon tumor in my abdomen and went to see a gynecologic oncologist who jumped to the conclusion that it was ovarian cancer, which statistically it should have been. I’m older, the chance of having ovarian cancer increases as you age, but she never gave me any alternatives. Like could it be anything else? And I think one of the things that makes such a difference for people who are facing aging who are facing chronic illness or who are facing acute illness from which they think well, this is this could be at the physician who treats them of course the relationship you have with them and how they present things makes an enormous difference to a person is not only peace of mind, but perspective on the illness. And this was a cautionary tale, when I gave a lecture for you guys on presence. If I do that, again, I’ll incorporate what happened, because going into a waiting room of a place that’s like a cancer mill, and people are running around with their IVs. And my first thought is, okay, take a few deep breaths, and give yourself a break, it’s going to take time to accept, this is where you are right now. This is your peer group. This is what’s happening to you. And mind you. I didn’t have any information yet. I had just come from the CT scan. And after about a two hour wait, I saw a physician’s assistant with my husband and we sat there. And she never saw much or said, Hello, how are you? I know this is a difficult time for you. And let me tell you where we are so far. She just said sit down, she sat across a big desk, she started to read the report from the CT scan. And it reads terribly. She said, Well, the tumors are huge. It’s the size of a honeydew melon, it’s almost 20 centimeters. And she said, Oh, there are large lymph nodes, and there’s a spot on your liver. And then her beeper goes off, and she runs out. And she’s gone for 10 minutes, she comes back without so much as a sorry to leave you like a mid death sentence. And she starts to read the remainder of the report, which is scary. Then finally the doctor sees us. And by the time I went in there, we were so sure that it was ovarian cancer that the first question I asked the doctor was, Do you think I’ll be able to live out the yearre? That was my question. So clearly, something was already wrong, because the diagnosis had been implied. When I said to the PA, what do you think it is? She said, Well looks like ovarian cancer. And that was exactly what the doctor said. Her first words were, you’re in big trouble. This is not exactly a great way to greet your patient. And after saying, Okay, I want to get you into surgery immediately. She said, But there is really good news. We’re about to start a fabulous, interesting clinical trial that involves immunotherapy. Sort of, and fortunately, you know, because I was a cancer cell biologist for years, because I’m a scientist because I understand clinical trials. I said to her, have your clinical trials manager send me the protocol. And as you know, that happened, and it was a horrendous trial, it turned out to be a phase one toxicity trial. Although it was also a phase one two trial because there was a placebo arm to it. But it involves basically being put in a cage like a rat, and having your parent Nim kept and walking around like that for months. And after each chemotherapy, they would sample what was happening in the peritoneal cavity and all that. And I thought, Oh, my God, that would be the end of quality of life. I’d rather do nothing, rather have palliative care than that. And so fortunately, I knew what the trial was, and I turned it down. But it was deeply upsetting to me. Because the idea that first of all, they’d scare you to death, and then try to sell you on a clinical trial. Within literally five minutes. I thought, Oh, my God, what about all the people who don’t just happen to be trained scientists? And who would say Thank God, I have hope. And that was actually very deeply upsetting to me. As part of the process. I was fortunate enough to find a great doctor. About a week later, these two doctors were such a study. The second one, you know, sat with me and she said, Would you like to see the slides from the CT scan? And she explained them beautifully, especially because my husband has no medical background. He was able to understand everything she said, and from her way understood. It could even be something benign there. You know, let’s not jump to conclusions. I was lucky. That’s a strange beast called borderline tumor, there’s a lot of mitosis. But the kind I have, fortunately, is not invasive. I didn’t need any chemotherapy for it, I have a very good prognosis. But it led to, you know, a real consideration of death and dying, particularly for a period of about two weeks. That was about two weeks between the time that we thought this thing was a huge ovarian cancer and the time of surgery, when we recognized it wasn’t two weeks. It is shown

 

Keith Kurlander  15:39

if you prior to this, bringing it more to an aging conversation, like do you contemplate death and dying often? Is that just something you don’t think about a lot? Like I’m curious, like, how was the process prior to that moment? And then leading into that moment?

 

Dr. Joan Borysenko  15:56

Yes, if we have both thought a great deal about death and dying, I think, maybe more than the average person because I ran a cancer clinic, I ran an AIDS clinic, I watched people dying. But of course, you never do think that it’s going to happen to you. There’s a line in the Bhagavad Gita, like, what is the most amazing thing about human life? I mean, this is such a Loose paraphrase, but you think of it like all the wonders of the world, and the wonder that you’re talking about is that you can watch your family and friends die all around you and never quite get that this applies to you that your time will also come. Of course, yeah, the older people do die, you begin to see more of that. But because I’d seen so much of it. And because I had had what’s called an empathic or shared death experience, many years ago, 31 wouldn’t have been, it would have been about 35 years ago, when my own mother died, I had thought a great deal about what is death and what is dying. And of course, there are two very different things. I think most of my patients said to me, I’m not so afraid of death, I’m afraid of suffering during the process of dying, and I’m afraid of leaving my children, leaving my loved ones, leaving my you know, my spouse or whatever. And that’s the kind of suffering. And what Gordy and I were thinking of moving Gordy, in terms of facing his own death, was in a really good place, he was ready to go. And I was also in a good place, I feel like, okay, I’ve spent a long time trying to integrate the experiences of my life, the difficult ones that have led to growth, the times when I’ve really messed up and fallen flat on my face, and then tried to make amends to other people as best I could and done the forgiveness myself. These are all things we need to do, not only in preparation of death, but in celebration of life that we can truly be more present than loving in this lifetime. So we’ve both been working on that for a long time. And both very interested in the question of, are we just our bodies? Or are we something more than consciousness surviving death. And for me, I think I’m so fortunate because having been in the AIDS years with so many people who are dying, I’ve got lots of experiences to draw on. You know, one of them. For example, when a patient was about 50. And he was a mountain climber. He was in great shape, and he had liver cancer. And he was getting chemo, he had a pack that he wanted his belt and it was dropping chemo right on to his liver, literally, and still climbing mountains. And he did not want to die. And he was terribly afraid of death and thinking, it’s completely the end. There’s nothing there. And he died. And a couple of weeks after his death, his wife called and said, Can I come in and see you? And I think this is very important because when someone’s dying, it’s not just about them. It’s about everybody who loves them. And she said David was very afraid of dying, as you know, and was really in denial and he had a terrible death. It was painful. He was screaming. He was frightened. It was a terribly traumatic experience for her. And then she said, I came back from the hospital after he passed. And I was sitting outside in a rocking chair. And he appeared to me in a full three dimensional vision. And he said, I’m so sorry that I’ve frightened you. And he said, death is beautiful. And I’m in a beautiful place. And he had a very meaningful exchange. And then he said, I want you to go and make an appointment and go see Joe, and tell her this experience so that she can share it with other people, and they won’t be afraid to die. And what can I say that’s a grace. And these experiences was a paper written in 1926, about a variety of shared death experiences. It’s not that unusual that people know that a loved one has died, even though they haven’t heard and, you know, they’re nowhere around they know, or a vision comes to them or a feeling comes to them. Or, you know, they have like I had with my mother and my son and I both Hatter’s, you know, what Raymond Moody calls an empathic death experience, where you go into the light, and have almost like a near death experience, except you’re not dying, your loved one is dying. So in those two weeks, when I thought, like, oh, ovarian cancer, this is not good, this is not going to be good. I was not afraid of dying. But I was definitely fearful of the process that would happen, you know, of treatment or relapse of all the kinds of things that happen with that diagnosis. And yet, also hopeful, you know, they still remember Bernie Siegel, Bernie Siegel, had founded e cap exceptional cancer patients, and I have a friend with ovarian cancer. And she said, look, he kept all these fascinating case histories. And if anybody can be an exceptional patient, it’s you. But in the process of this new to all kinds of stuff came up, you know, sometimes Great piece, sometimes great fear, after it was all over. And I had a good prognosis, the whole process had been so intense. And what Gordon and I had done was, like, go deeply into meditative processes. Years ago, I used to do Tibetan Dream Yoga, and had gotten to the point where I could wake up in the dream state pretty easily, pretty often, and then hadn’t done it for 20 years or so. So we started the practice of Tibetan Dream Yoga again. And then in a strange way, was an anti climax to realize, oh, not dying over here. This is resting. And after, you know, a couple of days of great celebratory relief, like a depression and I thought, okay, having gone through this, what is this experience to me? How do I hold it? How do I not go back to life as usual too quickly because standing on the precipice of death is kind of a shamanic initiation. I mean, you know, I was I had a major surgery, you know, I have an incision that goes up from my pubis to up over my belly button, and like, everything inside, basically was removed. So that’s a shamanic experience of dismemberment. And I’m still in deep reflection. What does this mean to me? What am I called to do in this part of my life, other than the most obvious thing, which is love the one in front of you to get out of your own way. Now, I think part of my calling is really working with people who are older as we are because I’m almost 76 and Gordie is almost 78. And our friends are getting sick. Many of our friends have died or are dying. It’s been a kind of big year of transition. And there’s not much of an opportunity for people to talk about death and dying in our society. It’s just because we’re not a society that dwells on that, and we’re not a society that understands how to breathe, because I find that even in the aging process, especially in the aging process, there’s a lot to grieve things that you just have to adapt to, in the process, things that you can’t do that you used to do the loss of certain facilities. And there’s a tremendous gain and gift in other ways. But I think often we focus more on the loss than on the gifts. So there’s a lot there to unpack. I hope I didn’t go on in.

 

Dr. Will Van Derveer  25:41

No, not at all. I wanted to share with you, Joanie, that when we got the news, and thank you for sharing with us on what I imagined was a shorter list of people that you shared the news about the diagnosis, it was obviously just a kick in the stomach of Oh, my goodness, and where’s this going? And our beloved friend, and how can we support and I’m sharing this partly because of the other facet of, you know, when you started talking about your husband, Gordon and his keys, and then the people who love Him are having a different experience from that peaceful experience. I mean, I was having an unpeaceful experience over here. And there was this kind of panic about how do I support you? And what is the, quote unquote, right way to be with someone who has this because the first email was, this is a Varian cancer, and I had all the things that from my medical training experience of being on the gynaec service and seeing difficult situation after difficult situation, and, you know, the barbaric attempts, you know, brutal attempts to try to advance the science and, and so there was this kind of conundrum of wanting to kind of tell you, it was okay, that we wouldn’t see you on the teaching stage, because of what you were dealing with. And yet at the same time, there was this wondering about whether sort of releasing you from that agreement together could actually have a negative impact on your experience. And so I just wanted to share that because it’s such a delicate dance as a friend with someone who’s gotten terrible news. And the helpful thing that you think you’re doing, you know, could have the opposite effect. It’s very difficult, especially from a distance.

 

Dr. Joan Borysenko  27:33

Yes, it is. It is. I remember, during the years that my practice was real, it was all people who had acute or chronic illness, or sometimes just stress related illness that would go away, which was great. But a very big part of it was family members like doing, trying to help the person who was ill. And what the literature has to say about that is help as little as you possibly can. If you over help you disempower the person, and that it’s a tough line, even if you’re there in the same house, let alone in different cities, as we are to say, am I helping this person? Or am I hindering them? Am I saying you’re helpless who can’t do this? Or on my saying, take your time to heal? And, you know, we’ll do what we can. It is a very, very delicate, delicate thing. And it was hard for me, because I got, as you know, a lot of joy out of teaching and sharing. And I thought this is going to be a great loss for me if I can’t do this anymore. And yet, I don’t know what’s happened to me. I’ve got this thank God. Now premature diagnosis of ovarian cancer. I’m going to have surgery, maybe I’ll be in chemo. I can’t tell these guys that I’m going to teach because what if I’m, like, busy with my head in the toilets rolling up or?

 

Dr. Will Van Derveer  29:15

Yeah, yeah. I mean, first of all, we are so delighted that that first diagnosis was wrong. I’m so relieved. 

 

Dr. Joan Borysenko  29:29

So really this is like me, I had cut my hair off and anticipated chemotherapy. And so that I wouldn’t have to deal with a bunch of long hair. So you know, this is still growing in chemo. The aborted chemo cut. It was such a strange thing to be prematurely erroneously diagnosed. It really was and I’m still really thinking at some point. Soon I’ll write about it, having an experience of facing death for two weeks, and then saying, Oh, it was nothing. But years ago, by the way, when I was still living in Boulder, I had a misdiagnosis of a heart condition from an excellent cardiology department, that Jewish Hospital in Denver, and they told me, I was in heart failure. They told me in our head, first of all, they said, I had an open foramen, oh, volley. And also I was in heart failure. And I thought, how could that be? I live at almost 9000 feet, and I hike around, it just doesn’t. I don’t feel like somebody in heart failure. And I walked around for two years with that diagnosis, before they finally said, oh, a mistake, you’re fine.

 

Dr. Will Van Derveer  31:09

So this isn’t your first rodeo, so to speak. Wow. During those two weeks, Joan, was there any part of you that was questioning this ovarian cancer diagnosis? Or were you pretty?

 

Dr. Joan Borysenko  31:24

Absolutely, I was totally convinced, I was completely convinced. There was, to me, no question about it, because I had been reading the riot act from the CT scan, and then the doctor. I mean, it was to be greeted with while you’re in big trouble. And then literally, the whole in a five minute appointment by the end of it, trying to be brought into a clinical trial does not leave you in a hopeful stage.

 

Keith Kurlander  31:55

Were you assuming you are basically in a dying process that was not very far away?

 

Dr. Joan Borysenko  32:00

That was time. And that was why my first question to her was, Do you think I’ll live out a year?

 

Keith Kurlander  32:06

I’m curious, during those two weeks, what did you do in your dying process like that? You thought you were in How did you start engaging with family, like how are you acting on your dying process?

 

Dr. Joan Borysenko  32:20

Well, it was first I let the immediate family know, which was really difficult, especially for my children and the older grandchildren. So, you know, see this to understand what it was. And that was really difficult, but also really wonderful, because they were also supportive. And it’s a wonderful thing, knowing that you’re held. And you guys just were wonderful. Everybody was wonderful. But what I did to know what to do when you’re facing death is the same way you cope when you’re facing life or any challenge, I sprung into action. So as you know, I reached out to you and I said, who’s a good guy, not a person. And I reached out to friends of mine, a radiation oncologist friend on the west coast at City of Hope, and someone on the East Coast, at Dana Farber and arranged that I could, but I’d have to go in person to either of these places. And I thought about quality of life. Do I really want to leave my house, leave my friends and go to a strange place for treatment? I mean, these are the kinds of questions to ask. But then on the other hand, it’s your life that’s at stake. And then I realized, look at any of the big cancer centers, there’s no magic bullet waiting out there. I just have to make sure I have got a really good surgeon. So it took me two or three days. I was on the phone on the internet, looking for the best doctor. And I was fortunate that I found an absolutely exquisitely remarkable physician. Right here in the middle of nowhere. When I lived in Santa Fe, I found someone an hour away in Albuquerque, who actually has office hours in Santa Fe once a week. I thought how fantastic this could be. And I have to say the minute I met her, I could feel my whole energy shift. And it was like thank God, I am with the right person. That was great. So to answer your question, a lot of that was how am I going to manage this immediate thing? And then, because I was going into a very big surgery, I thought, well, you know, you gotta get your affairs in order.

 

Keith Kurlander  35:00

So it was really a management process for you.

 

Dr. Joan Borysenko  35:04

We were already getting our will in order when Gordon had his heart attack. We weren’t finished. We were in process. And you know, it’s like, I’d let it go for a while I’d get back to it. Because I’m the one who tends to manage. You know, in every marriage, somebody usually takes the lead in different areas. I’m a financial person. So I’m, I like getting well done. I called the lawyer and I said, what is in the hospital? He just had a heart attack, we have to finish the will we have to finish it now. And so it’s like he gets out of the hospital in three days . We are in her office signing the will. And this was not so good. Because as time went on, I thought, you know, we didn’t do this right. And I called her up. I said, back to the drawing board, “ My prefrontal cortex was offline after Gordy’s heart attack, and I didn’t pay close enough attention. She said not to worry. And so then I called her up again, I said, Jackie, but it looks like I’m dying. Now, we have.

 

Keith Kurlander  36:17

Again, just like, speaks to the such the realities of life that come crashing in our face when we’re facing leaving the world like, that’s for all we got to get all the practicalities done before we can relax into this process.

 

Dr. Joan Borysenko  36:35

Yeah, well, that’s exactly right. And then I was fortunate because my business partner sprang into action. And she said, we have to organize our whole support system. So she organized everybody to take care of me to make meals to do whatever was necessary. She made plans to come here for a week after surgery, she created a caringbridge site for me. So this was, in a way, a great distraction. And then when we weren’t doing that, I was watching videos of Tibetan Buddhist lamas. I had a stack of books about the afterlife. So great book, by the way, called after by Bruce Grayson, who’s a psychiatrist who’s been interested, really in consciousness. And does that continue after the death of the body? He’s a great scientist and a great person. And after, there’s a wonderful book, I think, for anybody to take a look at. Certainly, you know, for anybody who takes care of people who are ill, or has simply a lot of aging people in their practice. It’s really good. Really good to have a look at, well, what is this whole field of death, dying, and shared death experience, which is just beginning, there was just an article on unfortunately, I was telling you before we started, I just got it yesterday, haven’t read, it can’t remember the journal it’s in. But it’s about the shared death experience. And how is it that psychiatry for the most part, doesn’t know about these experiences and can’t help people who are alive, integrate what happened when someone died? Or help a person who has an experience like a near death experience and comes back? Can’t help them integrate it. It’s something that’s just ignored in the training.

 

Dr. Will Van Derveer  38:50

Yeah, I mean, it’s definitely not something that we learn as psychiatrists how to be with people in a dying process. It’s interesting, I’m glad you brought that up. But it’s not a rotation that you do as a psychiatry training or medical training. There’s so much emphasis on this kind of crusade against illness and the fight against illness. And the mystery and the beauty and the presence of being with someone who is transitioning is generally speaking completely off the reservation in terms of medical training. And it’s considered almost psychologically, like a failure to, you know, inside the mind of a medical provider to acknowledge death, because then you’re putting your sword and your shield away and you’re doing something else. It’s sad. It’s a missed opportunity. I’m happy that the palliative and hospice care movement has become much more mainstream than it ever was over the past many years. And there are alternatives for people now that didn’t exist before in terms of the kind of violent deaths that happen in the hospitals.

 

Dr. Joan Borysenko  39:54

And you know, this was very important to me . Just before gordi His heart attack literally two weeks before, one of our best friends of physician who had been a hospice doc from Boulder died. And it was in part due to him that the death dignity law had been passed, he worked very, very hard on that. And actually, that’s how he exited with his whole family around him, when, after a very, very long set of illnesses, the time had finally come to put down that sword and shield. And what I discovered was that finally in New Mexico, we had recently passed a Death with Dignity bill here, that gave me a tremendous amount of peace of mind that, if it got to the point where there was just suffering going on, that was too much, I could make that decision. That was wonderful. It also led to some very interesting discussions with friends about some of them saying, Well, I would never make that decision for myself. And my saying, Well, I want to know that when the time comes, I simply have a choice. Because I know, until you’re faced with whatever the situation is, you really cannot say what you will do. You can really believe with your whole heart, you would or wouldn’t do something. And then at the moment I know, what emerges is something very, very different.

 

Keith Kurlander  41:33

Yeah, it’s such a complex matter of life, how long do we fight for it for the person dying? How do we yield it ourselves and know when it’s time to say I’m going to yield into the process and stop fighting? And then on the other side of that is the medical profession of like, is it okay to not hold the stance that you’re supposed to fight? Or is it okay to just support the person’s wishes the whole way through? Even if there’s a fight that they would most likely win? Like, it’s just this whole complicated piece of our psychology around life and death? And when do we yield into death? If it comes slowly? When do we yield into it versus fight to stay longer?

 

Dr. Joan Borysenko  42:17

Well, exactly. That’s so important. I have a very dear friend, who is right now, according to all her doctors, she’s dying. And she’s had cancer for a good 25 years, and has really thought and managed and grown and helped others. She’s such an exceptional person. And they finally said, Look, we can’t do anything else. There’s nothing else left stuck in time for hospice. And she was able to convince a doctor that she needed one more, just one more round of chemo. One more try. And there’s that too. It’s like, sometimes, sometimes the doctor says there’s nothing left and the patient wants to fight. It’s not an easy thing. It’s important, I think, to just talk about it, because there’s all kinds of individual instances. I remember having a patient who had melanoma, this was 30 years ago at a time that it was definitely a death sentence. And he had just had a recurrence, and it was in his brain that was all over and the guy was an electrical engineer, and he tried to electrocute himself and failed. So this was for me. Hmm. What do you do when your patient with cancer tries to commit suicide? How do you hold that? How do you help them hold that and fail? So I went and got supervision, there was at that time at the Mass General of psychiatrists, thank God Who was this was his business was death and dying, that what I realized right away is this brilliant electrical engineer must not really have wanted to die because he failed in his attempt. It was a half hearted attempt. And it was very, very interesting to sit with him and his fiancee and talk about this, because he hadn’t talked to her. And it was for her would have been a really difficult thing. And, you know, for me, my own father jumped out a window when he had cancer, because there was no one to talk to and in his case, he had CLL and the treatment for that involved high dose steroids. And he developed a manic psychosis and there was no one to Talk about with that. That was like, from my mother. My father was this gentle man who actually hit her in a shopping mall because he wanted to go into the store and buy a piece of really, kind of crummy jewelry. My mother had beautiful jewelry, but he was in a manic state. She said no, and he actually hit her. Something he would never do. You couldn’t talk to him. Now just a constant flight of ideas and what it’s like. And finally he got taken off those steroids to have a splenectomy. What was really very interesting, I remember, the night before he killed himself, he called on the phone. And it was the first real conversation I’ve had with him for over a year because he wasn’t manic. He was so peaceful, and I thought to myself preternaturally peaceful, why is he so peaceful? In retrospect, it was peaceful, because he made up his mind that he was going to jump out the window. And it was that goodbye, call. But I thought to myself, then it’s like we know so little. Now at least, you’ve got consultation, liaison services, back then there was nothing that I could think about the suffering that our family went through because of that, and how my mother then suffered. It’s like, why wasn’t I up at three in the morning to prevent him jumping out a window. As you know, she was a helicopter wife, just like she was our mother. The survivor’s guilt that happened after that was really difficult. And you guys know this story? Well, because I told you about it when I was teaching you. But for me, the survivor guilt was so great, because I was a cancer cell biologist. And I thought, why couldn’t I have been more helpful? Why was there nothing that I could do? Why did I let him jump out a window on my watch, we all took it personally, like we could have done something differently. And my way of dealing with that was retraining, you know, getting licensed as a psychologist, and immediately going to work in this area of stress or chronic illness and acute illness, with the hope that maybe one more family would have a better outcome than our family did. These death and dying experiences are powerful, they are vivid, they are deeply emotional, so that they’re fertile ground, on the one hand, for falling apart, never recovered, my mother became a hermit for 13 years, till her own death, she wouldn’t even see anyone that can be the outcome. Or, for me, it led to a total transformation of who I was and what I wanted to do in the world. So there fertile ground for something to happen for good or for ill, and in working with clients, to be able to listen and to be present, and to be able to help people to see the possibilities, to see these things in a certain way, as an initiatory experience, into some new way of being is just so important. And we really aren’t trained to do this. Right.

 

Keith Kurlander  48:55

I think that’s a really good place to start closing. I guess I’ll just ask you, you know, is there any last thing you want to say to the listeners about all of this taping you want to get across?

 

Dr. Joan Borysenko  49:12

Well, first of all, I want to thank you too, because what you’re doing is so important. Your programs are so fantastic. And I want to say thank you to both of you personally for supporting me through this program, because it’s like being full circle. Just what I’ve been through used to be my business. That’s what I do for years and years. And then it’s humbling, I think for all of us. Here we are, we are so concerned about people’s physical and mental health. And eventually the moment will come for each one of us when we’re going through this ourselves. And we can look back and say, What did I learn? What did I learn from my patients, what did I learn from friends from family, who have faced illness or faced mortality? And I would say we’re all very fortunate because we can call on all these things, but in the end I would say, we don’t go through this alone. And the degree to which we have people around us, who love us, who listen to us, who are there for us, is the greatest grace in the world. So thank you.

 

Keith Kurlander  50:41

We look forward to connecting with you again on the next episode of the higher practice Podcast where we explore what it takes to achieve optimal mental health.