The existential moment.

From earliest times, sages have advised us to become comfortable with transience, more than that, to be at peace with our approaching death and to keep it in constant view. Whatever the benefits of such a perspective, they must surely be harvested in abundance by those working in Palliative Care! An ongoing personal cost0benefit analysis of our daily confrontation with death is for many a legacy of the trade. “Why” questions are our persistent companions. They have colored my recent days as I holiday with my family in a cottage on Lac Massawippi in Quebec. Stop time! I just heard the news. Phil died a few hours ago. It was expected, really. Responding to his questions, I had told myself, told Phil, and those who love him, what to expect, how it would be. I tried to accompany them, suggested how best to manage his unresolved symptoms and how to support loved ones exhausted by the struggle involved in pushing water up hill for too long, while “learning to fall” ~Simmons, 2002!. Dead? Yes, Phil’s death was expected. But thinking about death and actually experiencing its finality are two different things. Suddenly I have feelings that are unexpected—waves of sorrow too deep to express; waves of pleasure that engulf the f lood plains of memory. Memories of Phil. I oscillate between grief and joy, born in the simultaneous experience of both loss and potential that accompanies all endings and the beginnings that they thrust upon us. I struggle to integrate the new realities inherent in a Phil-less world. Philip Simmons was 45. A.L.S. had been ladling life out of him, and insight in, “one teaspoon at a time” for a decade ~Simmons, 2002!. In a life-long friendship, he had been my colleague, my mentor, my fellow-performer, my friend. As I give thanks for his wisdom, love, and many gifts, the news of his death brings to mind another existential moment, one that I shared with a young companion just 2 days ago. We were walking along a path through the woods on a humid, sun-drenched summer afternoon, absent mindedly sharing freshly picked raspberries—pick two; give him one. My powerfully built companion was half my age. Every fiber of his being was focused in questioning, a seeking charged with the muscular urgency of youth. Suddenly, with eyes brimming, he blurted out, “I don’t want to die! I don’t want to die!” Not that he was more actively dying than we all are, even sick. Instead, he had suddenly been struck by the reality of his eventual fate. We all have had such experiences. To our dismay, a crack appears in our carefully crafted concept of reality. These existential moments wrench us into a new way of perceiving. How to describe them? They Corresponding author: Balfour M. Mount, Eric M. Flanders Professor of Palliative Medicine, Department of Oncology, McGill University, 546 Pine Ave. West, Montreal, QC, H2W 1S6, Canada. E-mail: [email protected] Palliative and Supportive Care ~2003!, 1, 93–96. Printed in the USA. Copyright © 2003 Cambridge University Press 1478-9515003 $16.00 DOI: 10.10170S1478951503030025