My mother is dying -- how will I bear it?

Dear Cary,

I'm writing because I love your advice and follow your column avidly. I don't have the time or focus to make this pithy. I've always envisioned writing you a clever and insightful letter someday, and this ain't it.

In a nutshell: I just learned my mother has a deadly cancer, her second round in two years. Despite what doctors are saying right now, I have a gut feeling that this is it: My mother is going to die young. She's not even 60. I'm not even 40. She won't meet my future children. She may not even be alive to see me get married to the love of my life. He and I had planned to get married next summer.

I am the only daughter, and anticipate being in the role of primary caretaker. My father and brother try their best, but I have always known it will be me who will help my mother die (or get well if there is some miracle). In fact, I have been preparing for this in therapy for over a year: trying to overcome my phobic fear of death, hospitals, illness, and least helpful of all: vomiting (people getting chemo vomit -- a lot). I've made some progress, but I am still terrified and panicked that my fears will get in the way of being helpful or comforting.

She gets her first chemotherapy treatment next week, and I will be there (she lives in a city three hours away).

I'm beyond "why me, why her." I know we all must deal with the death of our parents someday. Here is my question: How do people bear it? What can I do to overcome my fears and terror, and to offer my mother -- who I love fiercely -- solace and even meaning in the face of death? Is it even my role to offer this? How do I hold hope and death at the same time? She has been a wonderful mother -- and devoted so much of her life to caring for me. How do I return the favor?

Heartbroken and Afraid

Dear Heartbroken and Afraid,

Much has been said to malign death, but little is said in its defense. Thus we fear it inordinately. But there is much about death that is wonderful. One thing that is wonderful about death is how little it requires of us, and how much we can count on it. Unlike a lover or a deliveryman, death will surely come, eventually, every time, to all of us. It will come whether we want it to or not, whether we are home when it arrives or not, whether we schedule it or not. The certainty of its arrival is frightening in a way -- we might not be ready when it arrives! -- but it is also reassuring. For once we do not have to choose. We bear no responsibility at all. If we do not make a selection, a selection will be made for us. When death arrives, it will not require payment or any form of reciprocity. It will not turn down the bed and then stand at the door waiting for a tip. Death, for the dying, need not be feared.

All death requires of us is that we bury our dead.

This is not to say that you are a silly and weak earthling caught up in weak and silly fears. I am not trying to pass myself off as some cold, imperious guru, impervious to fear of death. Far from it. I too fear death and dread the passing of those around me. I only suggest you try to make peace with death itself, in your own heart, to the extent possible, in order to lighten your burden, so that you can then move on to the issue before you with less dread and anxiety. You have probably made ample progress, perhaps more than you realize, by concentrating on this issue over the last year in your sessions with a therapist. You have been preparing. You cannot cure yourself, of course, or eliminate your natural responses to these future events. But you can prepare for them, and you have been doing so.

So take heart knowing that you are well prepared for the difficulties ahead. And take heart knowing that there will be many, many people around you who will care for you and help you when you need it. Your immediate family may disappoint you, but when illness comes, others rise to the occasion; wise caregivers and unexpected allies who were only on the periphery seem to step up and become central. Be alert to the people in your mother's life who will now come forward. Look to them for the support you will need. That is how people bear such things.

It's gruesome and terrible and frightening, I know, when the body is in the process of dying. But we do get used to certain tasks, however much we think we could never endure them. And death itself, once accomplished, is serene and quiet.

While you are taking care of these tasks, think of the immense procession you have joined -- consider, as you empty bedpans, that you are taking your place on the great wheel, that we all go, every one of us, eventually, no matter what we believe, no matter what we have accomplished or destroyed, no matter how we have failed: We all go, and likely there will be someone emptying our bedpans, and someone emptying theirs, and someone emptying theirs. In this cycle of care and decay we are united. Your mother will go, and you will follow. My parents will go, and I will follow. Or perhaps I will go first and they will follow. We do not control the order of our going. Of this we can be sure.

I am not saying something as clichéd as that all this is happening for a reason. I don't know that. But I do know that death comes to all of us eventually, and so to deny it when it is coming is, well, futile, yes, but also undignified. Without giving up -- we must do what we can to live -- we also need to embrace death, recognize its power, its omnipotence. Give it its due.

Perhaps some of our unease has to do with our guilt that we are not the ones who are dying. But really, unless we believe in a literal hell -- and I don't -- what could be so bad about being on the other side? Why should we pity those who leave a little before us? For a time, some of us will be on one side, and some on the other. For a time, our friends are inside the nightclub and we are behind the rope. But before too long, we'll all be over there on that side. True, the difference between the living and the dead is profound and fundamental, as is the difference between those inside the club and those behind the rope. But still, as Tom Waits sings, "We're all gonna be just dirt in the ground."

So I suggest you take responsibility for the things under your control, try to make the proper medical and financial decisions in a timely way, comfort your mother, tell her whatever you need to tell her before she goes, but give some measure of honor to death itself, as well. It is all of our fate. It is our inheritance. We will all be joined there eventually.