Death & Loss: Cancer’s Five Shocks (3 of 8)


Typically, a person diagnosed with cancer must face five major shocks. 1) The shock of the diagnosis itself; suddenly you have to confront your own mortality 2) The shock of the treatments; realising they are long and arduous 3) The shock of recurrence or metastasis; feeling like you’re on a slippery slope 4) The shock of ‘no hope’; recognising the end is coming 5) The shock of the actual death and its aftermath.

First Shock – Diagnosis

Diagnosis - the first shock
Diagnosis – the first shock

The first shock occurs with the diagnosis itself. As soon as you hear the words ‘you have cancer,’ your mind immediately associates these words with impending death and your cosy expectations of longevity and continuity are shaken. Suddenly, the boundaries shrink and you are confronted with a new reality, one that you are entirely unprepared for.

Second Shock – Treatments

Expenses - the second shock
Expenses – the second shock

The second shock occurs with the realization that cancer treatments are difficult, painful and expensive. You run around from clinic to laboratory, undergoing a battery of tests. Hospitalisation, surgery and post-surgical recovery are extremely disorienting.

Follow-up treatments like chemotherapy and radiotherapy can last for months, affecting you physically, psychologically and financially. You feel powerless and lose your sense of identity as a whole person; you become a unidimensional cancer patient.

If you are lucky (like I was), your treatment will be successful, you will find yourself in remission and most importantly, you will only have to endure the first and second shocks. The prospect of death is still real but somewhat distant.

Third Shock – Recurrence or Metastasis

Recurrence - the third shock
Recurrence – the third shock

The third shock occurs if your cancer recurs, continues to grow or spreads to another part of your body. You realise that all the time, effort and money you poured into your treatments have not really produced the desired result. You feel as if you are on a slippery slope and your view of the future narrows even further.

At this stage, you, your family and your doctors will most likely roll up your sleeves and fight the good fight, using all the resources that you and they can collectively command.

The doctor might say something like:

“We are doing all we can and we hope for the best. If the treatments work, well and good. But if not, the statistics say that you have somewhere between ‘x’ months in the worst-case scenario and ‘y’ months to live, if things aren’t too bad.”

At this stage, the prospect of death is real and it is part of your peripheral vision at all times.

Shifting focus from ‘Quantity of life’ to ‘Quality of life’

In all three cases, the focus somehow turns to the quantity of life – how much time a person has to live. Everyone gets caught up with this. The doctors are trying their best to extend the duration of life and the family is desperate for this to happen because the prospect of death triggers pain and fear in them.

With this preoccupation, you can easily miss the more significant aspect: the quality of life. The questions that should matter to you at this point are:

How am I going to live my life? No matter how long I have, what are my real priorities now?”

We have seen time and again that shifting your priority from the quantity to the quality of life is extremely profound and empowering. Instead of focusing on an approaching event, you feel motivated to do something here and now, to act on the really important things that bring both fulfillment and in some cases, the necessary closure.

This shift is so important that we believe the process of healing takes root when two things occur:

  • When an individual commits to placing the quality of life above the quantity
  • When that individual begins to make tangible changes to his life.

The work of practitioners like Carl Simonton and Lawrence LeShan shows that when individuals start taking charge and actively pursue the quality of life, it has a remarkably positive impact on quantity as well. What a bonus!

Fourth Shock – No hope

No hope - the fourth shock
It spread too much – the fourth shock

The fourth shock occurs when all options have been tried and nothing is working; in fact, your condition is deteriorating and you are diagnosed as a terminal or palliative case. You feel hopeless and powerless. You might feel like there is so much to do but so little time. And you hope against hope that you could live longer.

The doctor may say something like:

“We have done everything we possibly could and we have nothing left to try. The cancer is just too aggressive or too widespread. It is best that you go home and be as comfortable and free of pain as possible. Enjoy the company of your loved ones and come to terms with the fact that you will not live much longer.”

In this situation, death now looms large and is therefore the focus of everyone’s attention.

Even at this stage, it is crucial not to lose focus on the quality of life; perhaps it becomes even more significant now. Keeping the person comfortable and free of pain is the minimum that is required. Beyond this, palliative care involves bringing about a sense of reconciliation and closure by settling unfinished matters, be they personal (healing family estrangements for example) or professional/financial concerns.

Fifth Shock – Death

The Dying Process - the fifth shock
The Dying Process – the fifth shock

The fifth shock occurs during the last days or hours of life, when the body actually starts shutting down. Organs and systems don’t function anymore and the person may slip in and out of cognition and even consciousness.

When the finality of death is only moments away, some people (and families) feel this shock very intensely and they experience a great sense of futility, despair and loss, looking back at all the opportunities lost or missed.

However, other people (and their families) who are more prepared, don’t experience this shock so intensely because they have been able to make peace with themselves, their loved ones and with life in general.


  • In your own cancer journey, do you recognise one or more of these five shocks? What impact did they have … how did you cope?
  • Whichever shock you are facing now, what steps can you take to manage it better? Where can you get help?
  • How important is ‘quality of life’ for you, compared to ‘quantity of life’? What changes can you make to refocus on quality over quantity?

More from this series

Title About the article
Part 1: Death Unites Us All Traditional societies were closely connected with nature’s continuous cycles of birth-growth-decay-death, and marked these rites of passage with specific and well-established rituals and sacraments. Modern society seems to have lost this close contact with these natural cycles.
Part 2: Five Stages of Grieving Dr Elizabeth Kubler-Ross, one of the world’s foremost authorities on the subject of death, describes the four stages of Denial, Anger, Bargaining and Depression that people pass through when coping with any severe loss, including their own death.
Part 3: Cancer’s Five Shocks With cancer, there are five major ‘shocks’ that a person/ his family has to deal with.
Part 4: What Actually Happens at the Time of Death Caring for a dying person, especially at home can be difficult and daunting.
Part 5: Top Five Regrets of the Dying Every single patient found their peace before they departed though, every one of them. When questioned about any regrets they had or anything they would do differently, common themes surfaced again and again. Here are the most common five.
Part 6: How to Die Before You Die Perhaps the most exciting and empowering aspect of death is that it resets your clock to zero. By sharply ending what has gone before, it creates space for a new beginning – a rebirth of sorts.
Part 7: Quotes We share some quotations (compiled by Arun Wakhlu) on the subject of Death
Part 7: Video (When I Die) How do we approach death whilst embracing life? How can we change the conversation around death and palliative care for the terminally ill?



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