Dr. Shelley F. Diamond: A Psychologist Facing Her Death

Okay, hi Shelley. We're just going to have an improv conversation. Uh, I've told you how much I appreciate it, how both professionally and when we've talked personally, you've faced and actually laid out some kind of blueprints, I think, for, for anybody, but for healthcare providers. And particularly, you're a psychologist, I'm a psychologist. How do we deal with facing end of life with our clients professionally? But also, how, how do we, how do we, or how do you— everybody does it differently— how do we face this big thing that Zen, my Zen friends call the great mystery? Of knowing that you have a terminal diagnosis besides the usual terminal diagnosis of being alive. And this is quite a day to do it. I'm sure you know of Thich Nhat Hanh. Yeah, a couple days ago who died and has wonderful things to— in his writings that have helped many people. So maybe Would it be okay to start with just saying what— how it happened that you found out that you had a terminal diagnosis?

Okay. So, um, I always tell people, feel free to ask me any questions. You know, I told all my patients, feel free to ask me any questions, because— and a number of people did want to know, how did you find out? Because I think that is an existential issue for all human beings is that idea of how will I know. And so I think people are always very curious about how you find out. So basically, I had gotten my second COVID shot, the vaccine. And the next day after I got the vaccine, I started to feel pain. And so I just assumed it was because of the vaccine. And I just assumed, oh, it will go away. But the pain never stopped. And so, you know, after a month, I decided I better talk to my doctor. And my doctor at first thought, oh, it's probably heartburn. I said, "No, I've actually had heartburn before. I know what that feels like. This does not feel like that." And she said, "Well, take some Prilosec for a week." And so I did that and the pain was getting worse. And so that's when she said, "Well, let's do some tests." So there was a series of tests. They tested my urine, they tested my blood. My blood. And then those tests determined that I needed an ultrasound. And the ultrasound test determined that I needed, you know, a biopsy. And so it just kept escalating. And so finally, when they did the— I believe it was the biopsy is where they they told me that I have pancreatic cancer. So each step of the way, there was a sense of, "Oh, this is worse than what was originally thought." At first, they thought, "Oh, maybe you have a gallbladder problem. Maybe you have gallstones. Maybe you have—" People were supposing different possibilities, but it kept escalating where, "No, this is more serious." Then it became clear that they could confirm that I had pancreatic cancer.

And they gave you a stage at that point, or did that come later?

It was a very long process. They could not give me a stage right away. I've had so many different incremental pieces of information. It was very difficult to actually get information. Again, it's during COVID so you're not meeting with anyone in person. You're doing everything over the internet. It was very much of an intrusion in the whole process where going into the— I had to go to the hospital to get this biopsy and they wouldn't allow anyone in with me and I had to wait by myself alone in a room for 3 hours. It really made it worse to have to have this happen during the time of COVID And everybody you talk to says, "Well, that's not my particular specialty. You have to wait and talk to this doctor." I had to talk to 6, 7 doctors for each individual thing. So it was, it was really a difficult medical journey to actually find out that I have less than 6 months to live. It took, you know, it took at least 2 months to actually, from the time. So it took like a month to figure out, okay, there's something seriously wrong. And then it took like another 2 months to figure out, okay, I actually have less than 6 months to live. So that's how that happened. So, so that, that part was very disturbing, of course, medically and existentially. I think the— what it triggered for me was, okay, once I got that clear information, like, okay, I have many, many decisions to make. So I had, you know, my, my, my first thought is, oh my God, I have all my patients. Um, um, and my first thought was, I can't deal with my personal issues until I deal with what am I going to do about all my patients first.

So you've been a psychologist in private practice for how many years?

Since July 1st, 2006. Yeah. So it was about 16 years, something like that. So I've had 750 patients over the course of my practice and at any one time I have about 50 patients coming in and out. I have a full 7-day week practice. So really, I had to deal with all the patients that were currently scheduled. And so I said, I have to focus on my patients that are currently on my calendar and deal with whoever ends up calling for an appointment. I'll have to deal with them when that they call. So I realized I have to come up with something I'm going to tell my patients. How am I going to tell them this? And so I had to really think about— obviously each person is different. So I realized certain patients do everything over email, arranging appointments and things like that. And we I often communicate over email. So I realized, okay, certain people I can tell over email, but some people don't do email. And I realized I'm going to have to tell them over the phone. And I realized, you know, this is going to be causing people harm to just get this information over the phone. And I, in my life, I've had— I've been told people are dying over the phone, you know, loved ones of mine. So I know that is a horrible way to hear this information. So I was very aware of thinking, okay, how will each of these people need to hear this? And You know, I have people that they just do texting. It was like texting is out. Um, you know, it really required juggling all these different communication methods. Um, and it— I mean, we could spend 2 hours talking about that. But anyway, what I realized is most of my people, um, I realized the best way was to compose an email message that I send them the day before our session, our scheduled session. And so, you know, I can, you know, I actually, in preparation to talk to you, I printed out a few of the messages that I sent to people so you get an idea of what I said. And so I had like a template that I sent each person based some of the original the first paragraph the same, and then I customized it for each person, part of it. Okay, so most of the people, the first part of the message, so the subject line says "Bad News," okay? Because I know they need to have a heads up, okay? Because I know most of my patients who use email, if it said something like "Bad News," they would either not read it or they would be prepared, like, before I open this, at least I know what it is. So I knew that would be helpful to a lot of my people, to prepare them to open the message. So the subject line says "Bad News," and then I just said, you know, start out with their name, you know, whatever their name is, Joe or whatever. I have some bad news to tell you. I've been diagnosed with pancreatic cancer, and I only have a short time to live. And, you know, I— you know, each of them I said something slightly different. But it says— a lot of them I said, Please accept my apologies for this abrupt change in our relationship. Wow. It hurts me to have to share this bad news. I wish this wasn't happening. So that seemed a good way to go through it.

Kind of a beautiful way. That touched me just then. Just, yeah. Yeah.

So I knew that I needed to connect with them in a human way because anyone would know this is a horrible thing to have to tell someone. And so then the third paragraph is something like, the only good thing is that I know you have learned a lot in the short time that we've been talking together. And we can still have our session scheduled for tomorrow. But that will probably have to be our last session. Okay. And I said in this, in the last session, we'll review the progress you've made because I don't want you to forget what you've learned. So what I learned in doing this, because I had to do this for like 40 patients, that there was a couple of people that I thought, you know, this— certain people, they're, they're going to need more than one session. Okay, that's what I thought. Um, so a few of them, I said, listen, if you need more— I said, if you need more time, we can have another one next time, but let's see what we can talk about tomorrow, or whatever. But every single per— no one wanted more than one session. Oh, I think it was too painful for everyone. They that the, the one last session was so intense that it was like they, they couldn't open up again in another session. Yeah, they all expressed— I would say, you know, there was only one or two people that— there was one person that basically freaked out and couldn't respond at all and just didn't— can't— just didn't show up for the last session and just couldn't handle it. And I sent them a message saying, "I understand this was probably too much to deal with, but I know how you feel. I know you long enough to know how you feel, and it's okay." So I needed to— and then there was nothing else from that person. And I knew he needed me to acknowledge that because I do know how he feels. I mean, I have a number of patients that I've been seeing for years, and so I know he was the kind of person that expressed very frequently, oh, I'm so grateful for our work together. He didn't need to repeat that. So I know how he feels. So each person, I had a different relationship with each of them. So some of them needed to say things in the last session, and some of them didn't. You know, one woman was, you know, inappropriate in that she, you know, she had boundary issues where she was, you know, her response was something like, "I looked up your home address on the internet and I want to come over and feed you soup and I want to bring you, you know, take care of you." And, you know, she had a, you know, much more, you know, the opposite kind of a I'm gonna smother you with love kind of, you know, uh, response. And so I had to, you know, put boundaries on her and say, you know, that's, you know, I appreciate your intentions, but, you know, that's just not appropriate at this time. And, you know, that— and so, um, you know, with her and with a lot of people, I had to, you know, connect them to another therapist. That was the other challenge I have is is getting them referrals. Because like someone like this woman, I was like, she needs to transfer immediately to someone else. Luckily with her, I was able to identify someone else I thought would be good. And she did connect with that person right away. And so I was able to say, talk to your new therapist about how you're feeling. I said, I know you're grieving. And this is, you know, your way of trying to stay connected to me. But I know this is part of the grieving process. And it's You know, this is reminding you of all the people in your life who have died, um, and that you've lost connection with. So I know there's a lot to talk about, and this will be a good way to connect to your new therapist, you know. So some people I had to really kind of help facilitate them taking their emotions and using that to be with someone else. That I can't do that anymore. So that's why I thought I would use this opportunity to say a little bit about what I did do, because I think obviously when it happened to me, I was like, I have no idea what to do. They're not really, there needs to be a graduate school session, not a session, but a whole course on dealing with this. And I think, you know, I did feel I had to reinvent the wheel The only good thing was that I was very aware of like, I have to do this, I have to figure this out. And so I just, you know, had this intense feeling of urgency. So I did, and I just used what I felt with my patients to guide me in what does each person need from me in this moment. And so, you know, things like For people that I saw many, many years, I was able to talk about, I know you're in a stronger place now than you were when we first connected. And I know you have the resilience now to deal with the ongoing challenges in your life. I needed to reinforce some of the things that I really did know that I know they had grown over time. You know, I said, you know, it's— I know you have more confidence in dealing with the challenges in your life. It's made me happy to see you grow and change for the better over time. Um, you know, I, you know, I, I've seen you, um, you know, I've seen you so many years, it feels bizarre that I won't ever see you again. You know, just being able to validate the feelings that I knew that they would have. You know, I'm glad I was able to be there for you during your long divorce process. I'm glad I was a witness to your changes in emotional maturity over time. I know you're capable of commitment, and I hope you can find someone else who's capable of that. And that's why I thought email was good, because it's a document that they can come back to. So I made sure that I wrote things to people that I knew who use written materials. In the last sessions, a number of them said, "Oh, I'm going to keep this by my bedside so I can read it again when I get discouraged." You know, and so we talked about— that's why I sent them these things the day before and then in the last session reinforced this again and to say, "Let's talk about your progress and how we can make sure that this doesn't become a relapse into your old, you know, unhealthy ways of coping with things." You know, I said, "The only good thing is I know you've made great progress and it's been a pleasure to watch you free yourself from all the old patterns in your life." to say that, things like that. What I did hear people say is, I've never talked to anybody about death before like this. I've never— like that we would talk. I asked them, who have you known that was dying or died? What did happen? And so I would say 99% said, we never talked about it. It was just something that you just didn't talk about. It was just always something to avoid as a terrible thing. And so, you know, one thing I do want to mention is that when I put my original notice to the San Francisco Psychological Association, you know, with the subject line, you know, I think it was Telling My Patients I'm Dying. That I received an outpouring of support and messages from my colleagues, other psychologists, which was wonderful. And people were very kind and, and, you know, and one of the people who responded was our colleague Eileen Serlin. And one thing she said, which was very important, was that She talked about how she had talked to patients about cancer and that she said, I know that it's scary to talk about it, but she said, I think I've had some very good conversations and it was important to talk about it and it was helpful to them. That's what she said. Something about that it was helpful to them. Okay. That got me. I think she said something like, we've had some profound conversations or something like that. And so her saying that really helped me bring more consciousness to what these last sessions. And I realized, you know, this is, this is a therapeutic issue for them. And I need to, you know, really think about how this is helping them to talk about it. Because before that, I was thinking, oh my God, I'm causing them harm by having to tell them this. And that's the opportunity. Yeah. So it's like, I knew I needed to be thoughtful about not causing them harm. But she also awakened me to the possibility that this could actually be a very profound therapeutic gift to give them. And so what was amazing was that really, that is exactly what happened, that every single Not every single— again, one failed to show up. One just was not able to respond appropriately. But I would say 98% of the people had just an amazing therapeutic session where they opened up about how talking about this is something they've never done. And all of the men were sobbing. I've never had the men cry. I was very aware of most of these men are macho kind of guys. And they were all crying. And it really— they were saying things like, I could never talk to my mother like this when she was dying. Or my grandmother. They were saying, this is— I wish my mother had been able to talk about this when she died. Various people in their lives who they didn't get that opportunity. And so they were able to really talk about our relationship and what they had gotten out of being in therapy. With me and the individual feeling they had about me, but they were able to expand it to the idea of death in general, how we don't talk about this and that they were really glad that we talked about it and that they said, I'm going to live a better life because of this. You're helping me realize I can't take each day for granted. That I have to appreciate everything more. You know, they were really, you could tell they were saying, this is now because this happened, I reached out to my family and said, I need your support. People, you know, they were each like reaching out to other people in their lives for, and they said, now I feel more connected to, "My support people, because you've given me the courage to talk about this, so I'm going to talk about it more with them. And you're helping my whole family." I mean, it's just people were very effusive. And it wasn't like they're just saying these things because it's the right thing to say.

No, it was real. It was very real.

It was very heartfelt. I mean, everybody was sobbing. You know, the only people that didn't really sob were like people from an Asian ancestry who, you know, clearly were taught, you know, you don't do that. But I could tell they were feeling it. And, you know, just, you know, just, you just could tell that everybody really was profoundly touched. And, and, you know, and I had people saying, thank you for being so honest about what's happening. You know, I had people say, you know, I had people who died but they just disappeared and I didn't even know what happened, or, you know, why they died, or, you know, there was no way to, um, have any— get any questions answered. So it was, you know, it was a good thing they told me the few options that I had, and I, you know, explored whatever the options were, but I didn't want to do any of the things that they had to offer. Um, I did, I, I did explore it. I talked, you know, there's something called Whipple surgery, and I talked to someone who had Whipple surgery, and I definitely did not want to do that. I, you know, I've seen many people in my family go through chemotherapy. I did not want to do that. I explored, you know, radiation. I didn't want to do that. I there's something called a nerve block. I explored that. I didn't want to do that. So I'm aware that— what I've really been aware of, it is now 5 months since my start of the pain that happened. And it's been like 2 months since they finally told me that I have pancreatic cancer. It's been almost 3 months, but at any rate, and I'm just not taking anything for the pain. I have a very long medical history. You know, I was— when I was born, I have severe atopic dermatitis, which is, you know, my entire body and, you know, allergies, asthma. I'm one of those people who will die if I eat nuts. I've almost died many, many times from that.

Anaphylactic.

Anaphylaxis, yeah. So, um, so I have a very, very long history of medical trauma from, you know, all kinds of treatments and failures of treatment and And so, and I also apparently have some sort of problem with taking opioids. They, like, just for the last— I just tried another experiment the last week of using Dilaudid, which had zero effect. Zero. I tried 2 milligrams, zero effect. 4 milligrams, zero effect. 6 milligrams, zero effect. 8 milligrams, zero effect. So now the doctors are saying, well, we're going to have to try something else. But I've mostly had a terrible reaction to opioids where I just have extreme nausea, even though I'm taking anti-nausea medications. I just have a very long history of problems. With that. But my whole life I've been in extreme physical discomfort because of my skin conditions. And so, you know, where you have constant itch. So, you know, if you— most people, I try to give them a reference point of poison ivy. If you've ever had poison ivy, that's like a short-term experience of itching. Okay? So I had itching like poison ivy for 60 years, every— all the time. My entire life was itch all the time. It doesn't go away. And so the only reason I've had any relief is in the last— when I was 60, they finally, you know, allowed me to be on prednisone every day. So I take a low dose of prednisone, 5 milligrams every day. And that's the only thing that has ever removed the itch. But my whole life, they always said, "You should not take it every day. You can't take it every day." So I've only really lived a normal life for the last 5 years. So before that, I had no idea what it's like to not be itching 24/7. I didn't know. That you could actually not feel that. I just thought— I didn't know what it would be like. Because of that history, I was always drawn to, you know, learning coping mechanisms psychologically because I tried everything physical and nothing works. So I was fortunate to, you know, learn psychological things And, you know, various, you know, obviously there's a zillion psychological things, but what happened to help me the most is a technique called focusing by Eugene Gendlin. And he wrote his book back in the 1970s. And if anyone's not familiar with it, it's a very short book, but it was based on the idea of something called the felt sense. And the felt sense is something that he identified during research on why does therapy help some people and not others. And it was— what he came up with was this idea of some people would use language that was like, "It felt right," or "It didn't feel right." And he realized there's certain kinds of people, they have a a felt sense when something is right for them or something is not right. And so I really resonated with that because that's how I lived my life, is by sensing what feels right for me and what does not feel right to me. And so, um, you know, uh, so I was intrigued by that premise. And so and the idea that this is a body-oriented technique where you really— to me, he didn't use this word, but it's the word interoception. So interoception is your ability to perceive your internal sensations. You know, like we usually use that in terms of, I feel hungry, or I feel thirsty, or I feel, you know, I have to poop or whatever, your internal sensations. But for me, it also refers to all of the internal sensations of, you know, I feel angry, I feel frustrated.

Emotion as well as— yes, emotional.

Yes. So to me, these are integrated. My body and my emotions are very integrated. I have a very strong body-mind connection of, and I'm really aware of what is my body and what's my emotions and what's my mental thoughts. So I have a, because I've had to really tune in to what am I feeling? Is this itch or am I just frustrated with something? Is it, am I itchy and I need to physically do something for the itch or am I just like, anxious because I have something I have to do tonight and I'm worried about it. Like, I've always had to sort of clarify, am I feeling a physical sensation or is it something else psychological, or is it a mixture of both? Okay, so a lot of times it's a mixture of both. And so I would use the analogy of like a ball of yarn. I have to untangle, I have to pull out, well, this piece is this and this piece is that is this necessary suffering or unnecessary suffering? You know, the judgment is the unnecessary suffering. So part of me learning to work with my body-mind experiences is getting clarity on, is this actual physical necessary suffering, or is it an unnecessary adding to what I'm feeling by some sort of interpretation or some sort of secondary reaction, overreaction. So my past experiences made it very clear what's necessary suffering and what is unnecessary suffering. It's much easier to live with the necessary suffering if you can clear away the unnecessary suffering that you can recognize of, oh, that's just an adding on, that's a mental or emotional reaction or interpretation. So just remove it. So I have a feeling of sweeping it away. So that's really how I've been dealing with the pain, is to just be accepting. And really, it's even beyond accepting, it's a welcoming of it. So it's an embracing of it in like a very— it's a way of being interested, curious, and open to what is it. Okay. And what does it have to tell me? What does it want? What does it need? Does it just want me to keep it company? The language I tend to use is that The pain doesn't want to be alone. It wants me to keep it company. It wants me to be present with it. That part of the necessary suffering is this feeling of solitude. And that if you can keep the pain company, it feels less— it reduces the pain. It's like a harm reduction technique. Where you— because part of the pain is also body memories from previous pain. Okay, so you— it's, it's really, um, you, you can't— it's— you can't always sort out what is my current pain from what is my body's— is it triggering body memories of old pain? So sometimes it's an That's what focusing does. It helps you realize that, oh, this pain is reminding me of an old pain from some other time. So the reason it's so intense right now is it's an echo from past. It's sensing, okay, what is this pain? Is it just something that needs to vent? It just needs to have a surge of expression right now. It's, it's, it needs to express itself. Um, and does it, does it just need my attention and acknowledging that I hear you, I feel you, I see you? Yeah, you needed someone to confirm that you exist. You're there. You, you want someone to acknowledge you, confirm you exist. And so once you get that acknowledgement, you can sort of settle down. You know, when I was a child, I, um, was reading a lot of, um, uh, spiritual things. And, you know, my— you know, I was a fan of Gandhi. And, um, you know, I would read about bodhisattva. And I remember as a child feeling like, oh yes, that, you know, you know, I, I don't want to I will live as long as other people are suffering. I want to share that suffering with other people. And that's the right way to be. And I remember that, you know, I would sleep on the floor because, you know, I would tell my mother, you know, well, other people have to sleep on the floor, so I should share that with them. And my mother was very angry because she's like, you know how hard I work to give you a nice bed? What are you crazy? You're sleeping on the floor? What's wrong with you? What have I done wrong? You know, this kind of thing. She couldn't understand these concepts. But, you know, this is— I had this ever since I was a child to share people's suffering. I had a very zigzag path here, but, you know, that was always, you know, sort of— I was called for that, you know. And, you know, when my dad died of cancer, I wanted to take on his pain. And I remember saying, just give it to me. Just give it to me. I wanted him to be free of his pain. And I said, I'm stronger, I can take it, give it to me. He was like, I wish I could. I've almost died many times from eating nuts. So I've always felt that I wasn't really afraid to die simply because I'd come so close to it before, and, um, it was always an experience of just letting go and surrendering to the process. And because what I learned from that is don't fight it, um, and that, um, just relax. The, the, the best thing always in that situation for me was when I realized, uh-oh, I'm having anaphylaxis, and so I might die right now, is to just really relax and be as completely physically relaxed as possible and sort of go into a trance. That's really what helped me is to— so I would go into what I would call a hypnagogic state where I would be I'm conscious, but I've always had this— I really use that time, like, as I'm falling asleep, or as I'm waking up to be— I can hold on to that hypnagogic state where I'm— it's an altered state, but it's a very peaceful state. And so, I always associate that with a dying experience because it feels like it's between worlds. Yes. It's a— there's a tenuous connection to the ego. It's tenuous. It's very— it's kind of dissociated. It's like an emotionally distant thing. It's like, yeah, I know that person. I, I have some— I'm familiar with that person, but you're not— you're, you're just— you feel more connected to like everything. So it's sort of like, um, having a string that, you know, a very long string that you know is attached to something, but you're really floating out. You have an anchor that's very, very light, a very, very you know, loose tether. Okay, but you're really out and you're floating and it feels good. It feels very good. And you're just able to process experience on every level, like intellectual, emotional, and you have a philosophical awareness that's very, very large. I would say when I've used psychedelics when I was young, it didn't feel— it felt more like on psychedelics, it felt too overwhelming. It felt like no boundaries at all. And it was more— it was that big connection, but it felt chaotic. And very, um, like too much. There was something about it, and it felt like I needed to figure out how do I, you know, um, have some safety in that. It didn't, it didn't feel as good as like my hypnagogic states feel very good. They feel again like a safe container. It feels like there's a container, but it's very, very large. When I was a kid, I remember my first— one of my early experiences existentially was being— I guess we were on a camping trip with my family, and we were outside at night under the stars, and I remember I was with my father, and we were looking up at the sky and it was, you know, one of those places where there was no light, so you really could see more stars than, you know, you could at my suburban home. Um, and so I, I remember looking up the sky, and my dad's— I think— oh, I know what it was. At that time, they had this TV show called Ben Casey, and, um, MD. Yeah. And, and one of the— and, um, Dr. Zorba in the beginning would write, you know, man, woman, and he would say infinity, okay, the sign for infinity, would write on a blackboard, man, woman, earth, infinity, or something like that. And I remember saying to my dad, Dad, what's really infinity? And he, he just said, look up at the stars, that's infinity. And I looked up And in that moment, he said something like, "It's that it goes on forever," or something like that. And he said something very, very simple like that. But I looked up at the stars and I felt this, like, I grokked, like, the idea of infinity. You know, it was like that whole, um, just, uh, like Helen Keller with the learning water. You know, it's like infinity, the cosmos. And it— I felt this such an— I must have been about 8 years old, and I just remember this amazing intense awareness of, um, the immensity of the universe. And it was like for a second I felt this, like I felt it, um, and then the next second I was like 'Oh my God, that's too intense.' And then I, I said— and then I shut it down. But I always remembered that second that I did let it in. I could let it in. And it really, um— and so I've always gone to planetariums. And, you know, because now that I'm older and more mature, I can go to a planetarium and feel it, you know, in a way I couldn't feel it for an extended period of time when I was a little girl. But now I love to go to the planetarium and be absorbed into that, um, immensity. So to me, that's what death is, is that you get absorbed into that infinity, that immense infinity that our human brains, I believe, are too small to comprehend the totality of the cosmos. So my beliefs is that humans are too, um, you know, too fragile to like hold the voltage of that infinity experience. And so we have to kind of shut it down, um, to some degree, because when you really think about how vast it is, it's just— it's, it's beyond our capacities, you know. We, we're gonna blow fuses. So I accept, you know, what you say, the great mystery. I've always said it's a mystery of what the, you know, what the true cosmos is. I, I don't believe we are capable of comprehending it. I think Every human finds some way of explaining it for themselves, whether it's religion or a faith or a philosophy. I just think of it as all philosophy, that of what helps them tolerate this ongoing uncertainty that we'll never know. We cannot know. And so, but we need to know. That's what being a human is, is we want to know, we need to know, we need an explanation. So I've always said, well, I hope someday I get a debriefing after this, and we'll see. But, you know, I truly— I believe, you know, what I have— but what those are all theoretical ideas. My recent experience has been sort of a building on that foundation in that my experiential reality since I've been given this diagnosis is that I have a felt sense that of my molecules, like preparing to disperse. And so that's what it— that is my felt sense. It's very hard to put into words, but I feel my— that's the only way I could say it. My molecules are preparing to disperse into the cosmos. There's like some, some, it feels almost physiological, but it's clearly a psychophysiological experience of, it feels like my molecules are sort of slightly expanded. They're like preparing to continue to expand. There's a sense of that something is expanding and opening, like every single cell in my body is, is, is starting a journey. And so it's very subtle, you know. I think most people wouldn't be aware of this, but I have such a clarity about my felt sense that I can perceive this on a very, like, atomic level or something. I know it sounds crazy, but—

No, it doesn't at all sound crazy. I really—

It's a very subtle thing. And so I feel like slight changes in every level, my body, my thoughts, my emotions. I had to really go through a process of understanding what's happening to me. So I've been writing in my journals. Oh. And that's been very good. And I've been— so I've had to sort of, in these hypnagogic states, I've been trying to process, like, how do I conceive of this? You know, like, the— I've always been prepared to die, but, you know, what's changed for me is that for so many years I was really suffering a lot, and I was often in most of my life thinking, I'll be so glad when I can die and just be done with all this suffering. And so I was always expecting to be like, have no problem, like, just jettisoning everything. But because I've been feeling so good physically these last 5 years, I'm actually having a different, another level of it where it's like, but I'm feeling good now. Now I don't want— now I'm like, oh no, I see why people don't want to die. It's like a— I'm having a very mixed feeling where I'm aware of like, oh, I just figured out how to feel good now. And now I have to go. So, and the other level of it is being aware of my sense of time is very changed. I'm aware that I now live in a time reference point that other people don't have. Like, I talk to you or other people and I'm aware you're living in a time structure that I used to live in, and I'm not in that anymore. Like, I'm aware I'm in a different group now because, like, I'm aware that, like, in the last 5 years, like, whatever happened, like, okay, yeah, well, I'll, I'll do that, you know, someday, at some point. Well, I'll get around to that, or If it doesn't happen this week, ah, it's okay. It'll happen some— at some point soon. I can't use any of those reference points. And it's so— it's— I'm very glad I have had those experiences now because I know I'm so much better prepared for what I'm going through than someone who's never had that. And I can tell from talking to other people who the way they are imagining what this would be like is so different. Like, it's just been interesting to talk to people. Like, some people who would— who say things like, so now that you have this, you know, you know, you know you're going to live less than 6 months, do you have a bucket list? Are you going to just go and have fun and do whatever you, you know, never got a chance to do? It's like No, I was like, number one, I lived my whole life as that I did everything I always wanted to do because I knew I may never live very long. So I've always done everything I wanted to do. I was never waiting for some retirement to do fun things. That would never have occurred to me, number one. Number two, I have so many things I have to do right now. I don't have time to go have fun or something like, you know, I'm just grateful that I actually am not going through any medical procedures because I am— the only suffering I have is this pain. Other than that, I feel fine. I can do everything I want to do. My mind is sharp. I'm in charge of everything that's happening. I'm juggling like 10 different things. I'm juggling attorneys and and accountants and doctors and who's going to deal with helping with my patient files and who's going to take this in my house and who— how do I organize my end-of-life medications and how do I, you know, I mean, I'm juggling like 20 different projects, um, that I probably wouldn't be able to do if I was like sedated or, or going through some sort of you know, medical procedures.

4 hours infusion. Yeah, yeah.

And so, um, I'm re— I— one of the things I really feel grateful for, and I spend a lot of time writing about what I'm grateful for, is that, um, I got that— I— that I— that I am mentally fine right now still, uh, that I— I didn't add more medical problems to my— my suffering, um, that I actually have had a certain amount of time. I'm really grateful that I, you know, um, you know, some people get this diagnosis and they're dead in a week or 2 weeks or something, a very short time. So I'm really grateful I've had months, um, you know, because when I first got it, I thought, I better act as if I'm dying next week. You better just zoom, get into gear, overdrive because you may be dead in a week. You have no idea how much time you have. And so I've been really very, very active in as much as I possibly could from the day I got this diagnosis. So I'm grateful I have the time. I'm grateful I've had, you know, that I lived as long as I did. I'm really grateful, you know, because I really thought I was going to be dead before I was 20. So I'm shocked that, you know, my father died when he was 60. And at the time, I thought he was an old man. And, you know, you know, I was 19 when he died. And, you know, at the time, I was like, 60, you know, you're an old man. And I remember people saying, oh, your father, it's such a shame he's dying at 60. I was like, what's he gonna do after he's 60? I mean, I remember thinking that that was I didn't understand why people thought that was a short time to live. If you don't mind, I will read a poem. Oh, okay. So before I start the poem, I will say there's an organization called You're Going to Die, and You're Going to Die does public, um, gatherings where people talk about death and they tell stories, they sing songs, they read poems, they share whatever they need to talk about in terms of that— an awareness of you're going to die. Okay, and I think they're a beautiful organization. They're here in San Francisco Bay Area. I think now during COVID they're doing it over the internet, but they did do them in person. And so they have a little thing they give out. On one side, it says, "You're going to die." Okay. And on the other side, it says, "You're not dead yet." Okay. So the whole point of it is to raise your consciousness to be aware that, yes, you're going to die and we need to be able to talk about the the pain of knowing that is going to happen, but we want you to be aware of you're not dead yet. You need to have both so that you can be present in the moment in a more helpful way. There's also something called Death Cafe that I've attended those as well in the past. So, I'll just end with a poem. That I think I've shared with some people and they said they thought it was helpful to them. So, the author is a man named Geoff Foster. He's a poet in England. So, I heard about this from some comment in the New York Times. So, I looked it up. Anyway, it's called You Will Lose Everything. By Jeff Foster. You will lose everything. Your money, your power, your fame, your success, perhaps even your memories. Your looks will go. Loved ones will die. Your body will fall apart. Everything that seems permanent is impermanent and will be smashed. Experience will gradually, or not so gradually, strip away everything that it can strip away. Waking up means facing this reality with open eyes and no longer turning away. But Right now, we stand on sacred and holy ground, for that which will be lost has not yet been lost. And realizing this is the key to unspeakable joy. Whoever or whatever is in your life right now has not yet been taken away from you. This may sound trivial, obvious, like nothing, but really it is the key to everything. The why and how and wherefore of existence. Impermanence has already rendered everything and everyone around you so deeply holy and significant and worthy of your heartbreaking gratitude. Loss has already transfigured your life into an altar. So, so thank you.

Thank you for that. And the one big word that is present with me right now after the poem, but after our whole time together right now, dear Shelley, the word love. Another infinite— infinity. Thank you so much for sharing. This is going to be so helpful to so many people. I know it's helpful to me. And namaste.

Yeah, thank you, thank you. Okay, so I just say to people, goodbye for now. I hope to encounter your spirit again.