Can You Go Home Again? Returning to One's Country of Origin in the Setting of Terminal Illness

Abstract

important issues. One approach to dealing with these issues is mindfulnessdquality of mind that notices what is present, without judgment and without interference. Mr. G was a 70-year-old man with widely metastatic small bowel carcinoma. His illness was associated with terrible suffering, including pathologic fractures and major depression. Mr. G had three sisters who were deeply concerned about his condition; however, his unresolved anger at his own predicament strained their relationships. Mr. G expressed significant spiritual suffering, making statements such as ‘‘God is not listening,’’ ‘‘Satan is trying to hold me down,’’ and ‘‘I should have lived better.’’ As his diseased progressed, staff attempts to assess and address his suffering were mostly met with Mr. G expressing hopelessness, hostility, or contempt. He made statements such as ‘‘they can’t do anything for me,’’ ‘‘that medicine won’t do any good’’ and ‘‘no one can help me.’’ He exhibited paranoia and delusional thinking, accusing the staff of trying to perform experiments on him and stating that influenza or HIV had caused his cancer. Many staff privately shared that any visit with Mr. G was an experience they wished to avoid. In caring for this difficult patient, we attempted several mindfulness-based practices, such as identifying our feelings of guilt and defensiveness, recognizing our discomfort and habitual patterns, and letting go of control and being open to the possibilities of our interactions with Mr. G. In retrospect, we found that this approach enhanced our own feelings of efficacy and our ability to cope with Mr. G’s anger and depression. It also enabled us to identify helpful interventions.