Just today, I received seven emails asking me this question. I have no previous knowledge of or history with any of the writers who were asking me such a daunting question.
But they each have loved ones, of different ages, with different types of metastatic disease (lung, liver, bone, brain, or multiple sites). And all of them want to know how much time remains for them to enjoy this person who is staring the Grim Reaper in the eye.
Sometimes people ask me this question because they are trying to decide whether to take time off from work to be with their loved one until she dies. Others are trying to determine the proper time to tell the children that Mommy isn't going to be able to beat it this time. Still others may be seeking to gain some sense of control over their own futures.
I have no ready-made answers for them and probably neither do their oncologists. If the doctor has recommended stopping treatment and has said that all treatment options have been exhausted, then this gives me an inkling that the patient is at the end of life and that death will come in the next days to weeks.
If, however, the patient is in active treatment and is physically active, she may live well and in harmony with this chronic disease like someone who lives for many more years with controlled diabetes. Everyone else falls somewhere in between. Their longevity will depend heavily on how well they respond to treatment.
Fighting a metastatic disease is a complicated process and no two patients are alike. How hard a patient wants to fight is a factor. Perhaps a specific goal - like the impending birth of a grandchild in the spring - may help her to hold on.
None of us knows our future, but I'm a firm believer that everyone, no matter what the situation - even those of us who hope to have beat this disease for good - needs to have certain things in order. These include advanced directives stating our wishes for medical care at the end of life; a will; discussions with family members about our final wishes; and information about the location of important documents like life insurance policies and bank account statements.
And, because quality of life is the key, the person must be allowed to spend her remaining time just as she wishes. Honesty and openness are also imperative. These are precious times, not because she knows that one day she will die but rather because she now has a better sense than most of us of when and from what.
Interestingly, many women with metastatic disease have told me that the best part of their life was the one that began after recovering from the shock of knowing they had this medical crisis.
Perhaps their priorities suddenly become crystal clear and they no longer are sweating the small stuff. They have quit their job. They are savoring their time with grandchildren. They are enjoying every sunset.
