At some point, all clinics deal with death. Our clients may have unresolved issues surrounding their own or someone else’s death; a person close to them may be dying or threatened with life; we lose colleagues and have to work through what that means for our professional lives.

And more often than we would like, our customers die themselves.

Dealing with the death of a client affects our personal, private and professional lives as well. So what do we do with sorrow we feel? Do we bring it into the office or keep it hidden?

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One of my clients is nearing death. He was healthy until his diagnosis, so he has two years to plan how he wants his life and death to unfold. To my surprise, he recently asked me how I am dealing with his impending passing, a question that was both touching and confusing. I was torn about how honest I wanted to be in my response—I could have given him a hollow answer, after all—but then decided there was nothing short of self-disclosure that would work.

So I shared some of the joys and frustrations I’ve experienced over the years working with this client. I talked about the real emotional experience of being his therapist when he was healthy, and the transition I had had to make after his diagnosis with a neurodegenerative disease. It was an interesting and profound experience to share this kind of intimacy with a customer.

Forged by fire

Being close to death and the process of dying is not new to me. I came of age as a therapist in Boston during the AIDS epidemic, where I myself, as a homosexual, was at the center, placed in situations—groups, workshops, individual work—where death was always in the room with me. Either you will like the work, or you won’t last. Fortunately, I did the former. AIDS taught me to embrace death as a subject and a process, and to make it part of my own formation as a therapist.

So I have never been afraid to approach the issue of death with my clients. What was new was that my client was curious about my reaction — to his death.

Emotional impact on the therapist

I have been impressed by some of the conversations I have shared with this client. Everyone reacts differently to a diagnosis like this, but I have felt that this client is a great model for coping. He talked to lawyers and he talked to his partner. He decided what to do with his property and money, and he ensured the well-being of his partner’s financial future. Then he planned his funeral and wrote his own obituary. He contacted the venue where he wanted his service, including the caterer who would provide the meal after the service. It was all quite moving.

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After he asked me about what I felt, I realized that the experience is not only about him dying, it is also my loss. I remembered that since he had shared his prognosis with me, I was saddened and in tears on several occasions, but I had been careful to keep it from him… and now what he needed and craved from me was an honest answer , and which I gave him. I talked about the joys and frustrations of working with him for many years, and what we’ve done together, and what my own challenges have been working with him. And then I spoke about the truth and the pain and the loss that I myself will also experience.

And it is not insignificant. This is someone I’ve worked with for a long time — he’s been a regular part of my life for years.

I shared with him that I will be available and solid. No matter what he wants, I’m there for him. But at the same time this is very painful for me. What we’ve agreed to do is to have many of these conversations as long as he’s here, to continue to explore what kind of life and what kind of death he needs, and to go into a deeper place of hypnosis or guided meditation to deal with the truth of life, to deal with the physical pain and to alleviate some of his symptoms, to make sense of everything that comes up and to allow this to be a process where the end of his life is something that is beautiful rather than just painful. And we agreed that I would also continue to share my feelings with him.

I have always known this, but he has reminded me that it is such a privilege for doctors to be a part of a client’s final management and with their last conversations with loved ones. it is a privilege to help clients review their lives and tie up loose ends.

Takeaways

There are many clear starting points from this situation. Of course, my own goal is to continue to have open and honest conversations with my client about his illness, death and the impact it has on others – including myself. I will continue with my treatment plan, which includes using hypnosis and guided meditation to help him deal with the physical and emotional aspects of his illness and impending death, and do what I can to help him ensure that his end of life becomes a beautiful process and not just a painful one.

But beyond that, I want other doctors to ask themselves the hard questions that I have asked myself. Is it okay for us to be human with our customers? How real and honest we want to be when we see them navigate fear and pain? Are we instilling hope, or are we just here to witness tragedy?

We’ve been taught to be formal and a little removed, and this experience has made me rework some of that. When a client is getting ready to die, I’m not sure that’s really the best and correct posture. Instead, when a client is grappling with death, we must be ready to be a part of that journey with them.

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