Thresholds

In any life-limiting illness, there are many thresholds we cross, some so small that we step over with ease, barely noticing, some harder, sharper edges, that take us on deep dives into tangled emotions.

I was first introduced to the concept of these threshold moments by Alexandra Derwen during our Journey with Death. There are boundary points, where we cross from one state, one way of being to another. Often it is only with himdsight that we realise the threshold has been crossed.

This was particularly true as I witnessed my mother’s dying. There was the last time she physically crossed our home threshold, it was some time later that I realised that she would never enter the house again, and would only leave it after her death. There were what turned out to be her last meal, her last hug, the last time she got out of bed, her last words, the last time she closed her eyes, her last breath. All poignant, many only traced back some time afterwards, searching for that moment, lost in an increasingly overwhelming tsunami of losses and lasts and never agains.

I have such gratitude for Alexandra for highlighting this, as it helped me to firstly notice these often subtle points. Also, to use them as navigation points on a grief wracked journey where I was often out of comfort zone – no, more than that- out of my skill set, my courage, energy and stamina.

Others were more conscious – the first time the words palliative care were used; the conversation that led to her deciding to stop medication; the terrifying bag of just in case meds arriving; the hospital bed replacing the one she had slept in for years. Each one of these cut deeply, a bitter reminder of what was coming, too fast and too soon to fully process.

Now, I am recognising these threshold moments in my own care. The impact of “palliative care” was less than I imagined, as it had lost some of its fearsome implications, given the time I spend with dying people. We fear the word, imagining the last days, the sedation, the full on pain meds, but palliative care is simply the switch from focusing on cure and focusing on symptom control, although this could involve slowing cancer’s spread.

But the last 6 weeks or so have been a roller coaster of three or four of these threshold moments. Firstly I was rushed into hospital with an infection in my arm, temperature soaring, the risk of sepsis beginning to be mentioned. It was the first time I had reached a point where the treatment induced immune supression could easily have led to very severe illness, life threatening illness. We drove to A&E, wondering if this was IT. The reality of my condition hit home, brutally hard. Hours of wait, panic setting in. As it turns out, all was easily treated by mega antibiotics. But the outcome does not detract from the impact, that a boundary had been reached and crossed.

Then, barely a week later, after lugging too-heavy-but-I-won’t-give-in furniture around, I was getting sharp, burning pain in my ribs. Back to hospital, back into a failing, overstretched NHS system and all that entails. More waiting, more anxiety. Scans, tests, more prodding and poking. This time, my cancer-weakened bone had fractured, from doing a task that would have been easy a while back. Another threshold, the first time I have had any symptoms from the cancer itself. Plenty from the treatment. But this felt different. Along with a tiny clot on my lung, also caused by the cancer, I had stepped into a new stage, albeit only minor in some ways.

Still reeling from these, the usual scanxiety at my routine 3 monthly CT had magnified intensely. And there another threshold and for me the hardest to work through. My previously dormant cancer has woken from slumber. Small progression, new mets in my precious, fragile skeleton. All of the reassurance and normality that both oncologist and nurses were giving me disappeared with that word – progression. It is what we all fear, us who live by this 3 month cycle of uncertainty. It’s taken a week of gently unpicking, questioning a very patient nursing team, learning and understanding, news slowly assimilating.

It isn’t awful news, it isn’t the start of the end by any means. It does mean shifting treatment plans, but that’s in hand. What I am trying to convey, is that each of these situations, to me are thresholds. They can be easily minimised, but particularly one after the other, are disorientating and disturbing.

Other people will of course, have their own boundary-crossings, their own ooofff moments. But by acknowledging them, honouring them, possibly creating ritual to mark the threshold, we can begin to recognise, honour and integrate them. We can hold the authenticity, the challenge, the sacredness of this journey.