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Can any marriage survive a terminal illness?

Dr B. J. Miller, a specialist in palliative care

When most people think about the impact of a terminal illness on a loving relationship, they imagine the strain – a heavy weight that squashes the tenderness between two people. But, in fact, 20 years of working as a palliative care doctor have taught me that the opposite can be true.

One patient who had advanced stomach cancer told me that he and his wife were closer than ever when his cancer returned, their marriage ‘reawakened’.

As his wife put it: ‘It’s easier when we’re dealing with the illness because we feel like we’re doing something together.’

I’ve seen sickness rescue marriages, divorced couples brought back together at the end of a life, and estranged partners happily adopting caring duties.

Last week, I told of how, amid the heartache, it is possible to reach a stress-free and peaceful death, and I provided 30 practical tips to help you achieve it.

This week, I’ll look at how relationships at this stage of life can be both challenging – and rewarding.

It can be an incredibly tender time between two people, full of forgiveness and showing people how much you love them.

REMEMBER WHY YOU FELL IN LOVE

When you’ve been handed a terminal diagnosis, one of the biggest shocks is adjusting to the daily activities and tasks that you can no longer do.

Similarly, partners have to come to terms with their new-found role of carer or nurse. This can make the relationship feel alien, compromising intimacy.

Here are some ideas that will protect yourself from feeling as if too much of you is being given away.

1. DON’T FORGET EACH OTHER

Pick a night every week and do something that isn’t about illness. It should be something you both enjoy – maybe as simple as playing a game of cards – either as partners or as a whole family.

And think about why you fell for each other in the first place: the old jokes you shared, the books you read, the photographs you took, the restaurants where you ate. Even if those things aren’t practically accessible now, just remembering them can be powerful enough to provoke an emotional connection.

Think about why you fell for each other in the first place: the old jokes you shared, the books you read, the photographs you took, the restaurants where you ate (stock image)

Think about why you fell for each other in the first place: the old jokes you shared, the books you read, the photographs you took, the restaurants where you ate (stock image)

2. PASS ON YOUR KNOWLEDGE

Maybe you deal with the bills and your partner cooks, or you’re the calendar-keeper and they are the laundry-monitor. But what happens when one person is consumed by illness or no longer around?

It’s painful to imagine but it’s kind – for both of you – to tackle these tasks. Take on two tasks of each other’s roles each week.

3. FIND LITTLE STABS OF HAPPINESS

The new, weird reality of hospital visits and medication reminders can feel odd at first, but you can make it yours by choosing new, pleasurable rituals.

Stop at a park or ice-cream shop after every appointment. Share a sip of sherry at medication time, or try one kiss per tablet.

Coping with illness means you can forget to remind your partner that how they feel matters too. If they feel taken for granted, give them a small sign of appreciation – a squeeze of the hand or a flattering comment.

NO SEX ISN’T THE END TO INTIMACY

When you’re sick, one of the first things that may become neglected is your physical relationship.

Then there’s the emotional turmoil of a changing body – surgical scars, the loss of body hair and weight gain hardly function as aphrodisiacs, after all.

It may feel extravagant or even dangerous to afford your body any pleasure. But I have patients who have kept active until the very end – one actually died in hospital during a moment of sexual intimacy (just to be clear, it was his cancer, not that act, that killed him).

It may feel extravagant or even dangerous to afford your body any pleasure. But I have patients who have kept active until the very end (stock image)

 It may feel extravagant or even dangerous to afford your body any pleasure. But I have patients who have kept active until the very end (stock image) 

1. CAN I EVEN HAVE SEX?

Sex after treatment may feel different – you may feel numb, or extra-sensitive. Alternatively, your confidence, limits and energy may have shifted. A frank conversation with a doctor or nurse is a good start. If you’re worried about safety, this has to be delivered point-blank: ‘Is it safe for me to…’

2. DON’T FEAR THE HOSPITAL BED

… But breaking bad news isn’t easy

There is no simple way to tell your loved ones about a life-limiting diagnosis. But first, make sure everyone is comfortable – if necessary, take a dose of painkillers before entering into the difficult conversation so that the pain doesn’t cloud your ability to think clearly.

Prepare people by saying: ‘I’ve got some difficult news to share.’

Be direct with what you need from your loved ones and how you’re feeling. It might just be a confession such as: ‘I don’t know what I need – just sit here with me!’

With children, consider the pecking order, as who you call first can matter a lot. Convening a family meeting or conference call may work better instead.

With employers, come prepared with a plan – what will your illness require of you and are there any strategies that could cover your work?

If you feel the news led to discriminatory action, talk to your HR department or seek independent legal advice.

And for the people responding, don’t be afraid to hold a little silence, even for a few seconds. It allows room for deeper emotions.

Don’t tell people to ‘think positive’, and don’t compare their suffering to someone else’s or project on them your religious views.

Know that just being there is the real balm.

Medical equipment might create physical barriers that suggest you shouldn’t be touching. But don’t let the tubes, needles or hospital beds get in your way.

It is perfectly legal to get in bed next to someone you love. Those side rails are retractable, after all.

3. IT’S NOT JUST ABOUT INTERCOURSE

I had one patient who was left impotent thanks to medication, and was scared his wife would leave him if he told her. Her response? She was relieved.

Studies show that holding a hug for a few minutes helps calm the nervous system. There is a lot of body beyond the groin, and any part can become erogenous. Find a patch that doesn’t hurt and start there.

… BUT DON’T BE SCARED TO SPLIT UP

Yes, some people do break up at the end of life. It’s not necessarily as devastating as you’d imagine.

It can feel cathartic to let go of a relationship that’s sucking up precious air. But before you do, consider practical details, such as getting to and from appointments, and make sure you have another avenue of support.

A doctor, nurse or counsellor can signpost you to local services.

And if you are reliant on a spouse for financial support, a split – providing it is amicable – doesn’t always mean you are cut off.

One of my patients asked her ex-partner if she could remain on his insurance plan until she finished her treatment. He said yes, and things remained that way until she secured her own plan a year later.

People strike deals like this all the time, so don’t let it stop you pursuing true happiness.

  • A Beginner’s Guide To The End: How To Live Life To The Full And Die A Good Death, by B. J. Miller and Shoshana Berger, is published by Quercus, priced £20.

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