Ava & George*
Ava, in her late 60’s came to me for an individual session. She shared that her husband George was dying from malignant melanoma (stage four). Through his courageous efforts, he was alive far longer than expected and Ava believed he had about six months to live. What she wanted was support for the two of them, beginning with her, in deepening their communication in this time of great frailty.
I found Ava to be intelligent and self-aware. It was clear that she deeply cared for George without idealizing him or the relationship. She was understandably distressed and my task was to listen and give comfort and gentle guidance. She and George discussed her session with me. She expressed her yearning to enter into the most authentic space possible with him in this next stage. They made an appointment for the following week.
When George walked in through the front door of my house, I gasped inwardly, knowing immediately that six months was out of the question. I could see his courage, dignity, and waning life force. My heart was completely open to him. As we three sat together, all that was Ava and George as individuals and their relatedness was palpably present. Their friendship and mutual caring was apparent. This was a conscious dying process writ large.
Ava wanted to have what would probably be their last vacation together on Cape Cod. All George wanted was to sit on the terrace of the beautiful home they had designed in the woods, and rest. It was clear that my role was to facilitate that conversation by helping them hear each other’s heart’s desires. As my own heart kept opening to them, I found words to echo the love and anguish that was present and the underlying reality that the end was in sight. Sitting on the terrace became the metaphor and significant resting place for that end.
As Ava heard George and saw him let go of his valiant struggle to stay alive and express his desire to just rest, an even more profound gentleness and love appeared between them. This was the assistance for which they had come. On this terrace they could share their last times together, she a poet with deep spiritual understanding and he an engineer with heart, integrity, and a burning purpose. By the time of the next session, only a week later, George had taken a turn for the worse. We had an abbreviated session on the phone. Less than twenty-four hours later George passed away.
The turning point for George came with giving himself permission to let go of his struggle and accept the reality of his situation. He was affirming a way to have precious time with Ava and be true to himself as a dying man. For Ava, she too was facing the reality of George’s fast approaching death, made more palpable by their feeling into the words they exchanged in session. Her caring for George and her struggle with letting go were vividly present.
I practiced the art of just being present. It became my turning point. I no longer needed to add any classical couple’s therapist interventions. Offering overt interpretation of the systemic dynamic between them would not have been in keeping with their invitation to enter their relationship at such a poignant moment. I needed to recognize what a rare privilege and honor it is to be with a couple in such circumstances. All that was necessary was my attunement to their process and for them to discover and express the truth of their hearts.
It’s now three years later. I have continued to see Ava. Our work together provides her with a container for the grieving of loss and a celebration of life.
*Not their actual names.
Commentary
George, my husband for 30 years, and I thought we were prepared for his death, but we were not ready for the quick changes we encountered. George had a rare form of melanoma, and he fought the disease for 20 years with extraordinary courage and openness.
He had decided years ago upon alternative treatment under the supervision of a fine physician. He also had three major surgeries at a renowned cancer center to remove tumors from his brain and abdomen. Despite George’s heroic efforts, the cancer progressed inexorably. We had lived with the reality of George’s impending death for a long time.
When I say we were prepared, I mean we had discussed powers of attorney, wills, our daughter’s suffering in losing her father, my making a new life after George’s death, and the progression and treatment of George’s disease. We even developed a touch of sustaining humor about cancer. In fact, we had to use some care in discussing our situation with friends who were not as intimate as we were with the process of death on emotional, biological and spiritual levels.
Suddenly George’s health failed quickly, and we knew his death was close at hand. I noticed a difference in our relationship. We started to talk around the edges of our feelings, not clearly and to the point. We became very careful in what we said to each other and, I think, to ourselves. The ineffable was apparent, and sadly, we distanced ourselves from each other. Not knowing how to cross the divide of life into death with my partner, I became more strained, more remote. Bill did the same.
A friend who was a recent widow reached out to me and told me about her work with Matthew, and I made an appointment with him. The first time we met I felt in a place of grace. He understood the chasm I faced and my sudden retreat into silence with my husband, rather than our ongoing openness.
Matthew was about my age and, I felt, a bit world weary in an engaging way, and very caring. He didn’t say too much or too little, but I do know that I was right where I was supposed to be.
When I was home again, I said to George, “We have to really talk.”
He said. “I know. I am dying.”
There it was! We had crossed an invisible line and were back together again, but we needed help in getting through the final weeks of George’s life. We made a joint appointment with Matthew.
When we arrived, George was weak and had trouble climbing the stairs to Matthew’s office. We sat in chairs side by side and talked to this man whose expertise went beyond textbooks and to the nub of life itself. I could tell that George felt in a place of trust and safety, and he reached out his hand to mine and didn’t let go. I was amazed at how fast we reached our turning point toward loving each other even more deeply than before, this time without any barriers.
I asked George how he would like to spend the rest of his life. Was there something special he wanted to do? Did he want to visit Cape Cod, the place where he grew up? Should our daughter come home from California where George had just visited her a few weeks ago?
My husband said, “I just want to sit on the patio with you and look at the trees and the pond and the house we built and talk about our life and memories.”
George’s strength deteriorated. We scheduled another appointment with Matthew, but I went alone. George participated by phone in part of the session but then had to hang up. After this, George experienced a few very good times with friends, and we sat quietly holding hands on the deck and on the patio. With his permission, I contacted Hospice, and George called our daughter and said it was time for her to come home.
With our dear friend Ray at his side, George asked me for morphine to quiet the pain in his leg caused by an aneurism. I gave him one spoonful.
He said, “More,” and I gave him another.
George died at home in our bed. I held him in my arms until his body grew cold. Then with anguish, I released myself from his journey into the unknown.
My grief was profound. It is still present three years later in subtle ways. However, I am grateful that I embraced the loss of my beloved at the time of his death. Now with the help of my friends and the ongoing skill of my therapist, I embrace life.
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