Grażyna Hanaf: – You work in a hospice with people who are dying of cancer. When patients arrive at the place where they will die, how do they react?
Agnieszka Czochara: – They react in very different ways. Some people strongly deny what is happening in their lives; they do not want to say the word hospice at all, do not accept that they are staying in this hospice, that their illness is terminal and that they are not being treated, but only having their painful symptoms alleviated. They remain in this denial until the end. Their death, although I do not know whether this is always the case, was accompanied by great fear. But there were also people who knew that they had come here to die, that this was the disease they had. Their inner negotiations concerned more whether it would happen consciously or without pain. In the hospice, patients see one another and form an idea of what their final days will be like.
Are there any specific mechanisms at work when we learn that we have a fatal illness?
One might say that a person goes through successive phases of coming to terms with and accepting it. These phases begin with denial, but this always happens differently for each person. On the one hand, this mechanism prevents us from confronting reality as it is—the reality of approaching death—but on the other hand, it protects us so that this does not happen too quickly, so that this reality does not come crashing down on us too soon.
What exactly does this mechanism of denial look like? What does it involve? Does the patient say, “I am healthy”?
The patient does not say that they are ill. They supposedly know it, but they cannot bring themselves to say it, and neither can their family. They might say, for example, “It’s just a tumor; they found something there.” They do not say directly that it is cancer, or, despite the progressing symptoms, they select information in such a way as to believe that things will get better and that this is only a temporary breakdown.
What happens when the patient begins to confront reality?
Then anger, defiance and fury appear. A sense of anger sometimes directed at fate or doctors. Sometimes there is a sense of guilt for not having undergone examinations or for discovering the cancer too late. The next stage is sadness and depression: the patient begins to see that the illness is bringing them closer to death, that they will be saying goodbye to something.
What makes it easier to come to terms with fate, illness and death?
It depends on what kind of person they are, what relationships they have with those close to them, the quality of their emotional relationships and how fulfilled they are in life. News of approaching death is easier to accept for people who have fulfilled themselves, whether in their family or professional life. They can say that they have experienced and accomplished something in this life. Faith also helps. The denomination is not important. What matters is that this faith is experienced inwardly and deeply. Then it is easier to come to terms with fate and accept one’s situation.
Does accepting the illness help us prepare for death?
A fatal, terminal illness places us face to face with existential problems—problems we had not encountered before. Generally, our lives proceed in such a way that we do not confront our fear of death and passing away. Of course, this depends on the individual abilities of a given person and whether they are capable of such self-reflection. Very often, people in this situation undergo a spiritual transformation, as we might call it. As a result, people appreciate family ties, closeness to another person and the things that build us as human beings, rather than mere superficiality.
Have you met someone in your work who had come to terms with their own death?
Yes. At the beginning of my work in the hospice, I met an elderly woman, and I feel that I learned a great deal about dying from her. She had previously lost her children and her husband. And just as she had once been unable to come to terms with their deaths, looking back on her own life, she came to terms with her own. When she took stock of her life, she thought about the children she had raised, what she had done and what she had accomplished. She knew exactly that she was at such a stage of her life that she could die. I remember her with great respect.
(interviewed by Grażyna Hanaf)