Learn how to live, choose how to die

Brenda Hartman was 32 and a strong, healthy graduate student working on two PhDs when she got the news – she had cancer. And not just any cancer: stage IV ovarian cancer, one of the worst kinds. She was given a 5 percent chance of living 24 months. Her doctor told her to prepare to die. 

She did prepare, but she did not die. 

Now, 30 years later, she’s using the “twisted gift” that cancer gave her to counsel others facing terminal illness and death. A key message in her clinical therapy practice is “listen to your body.” 

“I’m thinking and feeling my body from the inside out,” Hartman says. “You learn to scan your body – how’s it doing, how’s it feeling?” 

Many patients or survivors get caught in a “cancer loop”: “Any ache or pain, our first thought is, ‘Is this cancer?,'” which leads to persistent fear and worry that needs to be managed. 

A beautiful death

Hartman was awarded a Bush Foundation Fellowship this year to pursue her desire to change the end-of-life narrative from fear and denial to the healing process. She will study practices from different cultures, religions and spiritual traditions, and teach health care professionals how to have conversations with patients about end-of-life planning and death. 

“I’ve helped people die,” she says. “I believe death can be a beautiful and healing experience.” 

Health care providers “need to guide people to that peaceful place,” but their medical training is focused on treatment, recovery and even cure, not dying. 

She likens the process to throwing clay on a pottery wheel, with hands inside and out shaping and smoothing a pot. The patient is working the inside of the body with nutrition, spirituality and self-care. The doctors work the outside. “[They] need to work together to heal this crack.” 

“Healing” is not synonymous with “cure,” Hartman points out. “What healing means for me is that from the moment I was born, I was working on healing, and when I’m healed, I leave my body. Some people call that death.” 

She tells clients, “Pray for 95 percent healing so you have a reason to be here.” 

Different paths to the end

Her mantra is, “I’m alive. I’m well. I’m healing until further notice.” She goes on: “I have looked at my death and I know I’m going to die. Not everyone has that” with their cancer experience, because better treatment options have changed the expectation of survival. 

Hartman loves metaphors, and she compares life to walking a path with others. Everyone’s path is slightly different – different footfalls, strides and place in space – and everyone’s path forks at some point. “When I am at my fork, I want to know I’m there,” she says. The fork between conscious living and conscious dying is a personal place – deciding whether chemotherapy, for example, is helping to gain or is taking energy, or whether it’s time for palliative or hospice care. “When you’re at your fork, what is your body saying?” 

She counsels families to react with grace and understanding when a family member talks about wanting to stop treatment. Choosing to stop is not giving up or failing, she says; it’s listening to what the body needs. 

How we approach death and how we die is our last conscious and unconscious act of teaching,” Hartman explains. “Everyone has a ‘this is how I want to die’ based on what I know and heard about.” A friend or family member’s death experience shapes their ideas of what it means to die.

Hartman tells clients to read at least five stories about people in similar situations “so they realize there isn’t one path. How does your body respond, what feels right for you? Because I can’t [tell them].” 

People want to know what she did so they can do the same. But, Hartman says, “what I did would not work for them, because it worked for me.” 

It’s a bit like parenthood, she notes. Expectant parents may plan to do everything perfectly and by the book (or like their friends), but they don’t know the baby’s temperament, sleeping patterns, etc. “You can’t possibly know until you’re there and you can’t go back. It’s a one-way street.” 

It’s a matter of trying to understand a new normal, Hartman says. After her diagnosis, “I had to grieve the life I had, and grieve the dreams that I had, so that I could get healing” and look at what was next: death or living. 

It’s like aging: Looking back, there are things our teenage selves did that we wouldn’t expect to be able to do in our thirties and beyond,” she explains. We can look at the results of illness the same way. 

“I would never give up my cancer experience,” Hartman says. “It taught me important things. I appreciate my body. I’m really happy to be alive to experience [things like] chemotherapy and aging. 

“I do the best that I can and offer the most that I can to the people I interact with,” she says. “It’s a good life.”