Magazine article American Nurse Today

The Will to Live-And Living Well

Magazine article American Nurse Today

The Will to Live-And Living Well

Article excerpt

Grucho Marx said, "Marriage is the chief cause of divorce." When we mentioned this to a friend of ours, he retorted, "Yes--and life is the chief cause of death!"

In writing this reflection, we revisited the existential question: What is life? More specifically, what do we do with life at the end of life? How do we define the intangible or compare one life to another without knowing the passions that move each person to make certain decisions?

The term patient-centered care reminds us to be sensitive to each person's uniqueness and respond accordingly. Cultural influences may shape a person's life; but what accounts for variations in individuals' perceptions of the meaning of life and living? What distinguishes the will to live (to go on) from the desire to live well (to recalibrate life)? How can we best support patients as they navigate these questions, given that we all define life and living differently?

The choices patients make

Consider two patients with a diagnosis of incurable cancer who've each been told they have a year to live. Patient A chooses to surround himself with family and friends, experiencing all that life has to offer. He decides to spend his savings, travel the world, host dinners, see shows, and so on (to the extent that his illness allows). Now and then, he visits the emergency department to treat a cancer-related crisis--but with a smile on his face and the optimism that once he regains his strength, he will continue his adventure to live well until the end. He takes no steps to preserve tangible items for the future, instead making the best of the "here and now."

Patient B chooses a different path. From the day he learns of his "sentence," he decides to use his remaining time to provide for his family, to make sure they'll be secure after he's gone. He goes back to work. He puts all of his energies into finishing his dream home (again, to the extent his illness permits) and imagines his children living there. He plans his remaining year to ensure he will continue to have a physical presence in his family even after death.

Despite their similar prognoses, these two patients are living in radically different ways. Determined to live well, Patient A is "unpacking" his life by enjoying his remaining time. Patient B, on the other hand, is demonstrating the will to live while preparing for the ultimate departure.

How can nurses determine what life means for patients? Nurses in hospice and palliative care settings deal with such issues regularly, but for nurses in other settings, addressing life-and-death issues can throw off the routine workflow. Imagine having deep existential discussions with patients and families between the 9 AM and 12 noon med passes! Those conversations could cause considerable moral distress as we strive to heal our patients. Here we offer a brief reflection on how nurses can assess their patients' will to live and their desire to live well.

Nurturing the will to live and the desire to live well

After physician-writer Oliver Sacks learned he had metastatic cancer secondary to ocular melanoma, he wrote in The New York Times, "I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts." His published end-of-life reflections have the calm eloquence of a lover writing to his beloved: life.

We imagine that nurses, too, can see life from a perspective different from that of other healthcare providers. Meaningful nursing takes existential issues into account. …

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