By 
“Jonathan, what do you think about this clinical trial?
Have you heard about this treatment before?
Do you think that I should go to Israel?
Who do you think I should contact?”
Diana’s flood of questions was not anything new.
I was used to being peppered with them each time we met, this was simply who she was.
I liked her.
She intrigued me from the moment we met. It wasn’t because she had a fascination with the subcontinent or found Indians mysterious, no. It was because she was prepared to ask bold questions, she was a truth seeker and she had an eccentric personality and dress sense to match.
And it seemed that when she was focused on her mind unto something, stopping her train of thought was impossible. However, we talked about this clinical trial only a few months ago. I wondered if she’d forgotten or if something new had stirred her attention.
Diana had found an obscure Israeli news report from 2018 about an experimental therapy for her particular type of cancer that was being trialled in the Middle East and in America.
I had told her that this medication wasn’t available in Australia and it looked from my literature search that the trial had been discontinued and terminated at both sites due to the mounting side effects and a lack of funding.
And even so, flying to the Middle-east in the midst of a global pandemic with advanced cancer was not a good idea.
However Diana persisted, but it all came to an abrupt halt as she arrived at this poignant thought.
“I know it’s a long shot and I know that I probably can’t do it, but Jonathan, I’m not ready to die just yet. I feel so alive!”
I’d met Diana six months before when she was referred urgently to our service. Her Oncologist was worried because she was deteriorating at a rapid pace. To her and many others, the dreaded Palliative Care referral meant that end was near.
However, through a combination of social and psychological support and expert symptom management, Diana felt her spirits lift as the side effects of her treatment and symptoms of cancer at war within her body, simmered down.
She was even able to tolerate a few more rounds of chemotherapy and Cyberknife Radiotherapy before the dose was reduced as her symptoms returned. She discontinued all forms of therapy not long after. This certainly wasn’t a setback because her energy soon returned and all her other troublesome symptoms seem to dissipate and become manageable with our measures.
And suddenly Diana’s world looked quite different. Her mind became less occupied with getting through the minutes and hours of debilitating symptoms to now looking with hope towards the weeks and months ahead, even years she told me.
We’d talked too about that one question that almost every one of my Palliative Care patients asks,
“So, how long do you think I have to live?”
With all the information that we had available at the time and the way Diana was physically progressing, it looked like long months but certainly not a year.
But today, the Diana sitting in front of me was different from the one I had met three months earlier — she was brimming with energy.
I could see too that her statement, “I feel so alive” stemmed from the new meaning she was experiencing in her life as she started to seize each day with vigour and vitality, and a clear idea about what she wanted.
It also came from a lingering thought and question as to whether or not she would continue to live like this, and if she could, she’d do anything to keep living.
However, I could stop thinking about her statement,
”I feel so alive!”.
It confronted me with a truth that I had seen play out in many of my patients. But not simply in the lives of my patients, but in the lives of my friends, colleagues and myself too.
At times when we are confronted with our mortality or the end of our lives or a significant change in our world, we suddenly realise that,
We are not ready to die or experience significant change because we can see that we aren’t living fully now!
We’ve been “dead” up until now.
Dead to the possibilities that existed in plain sight.
Dead in the face of crippling fear and self-doubt about taking the next step in our careers, towards our passion and in love.
Dead within ourselves from the opinions of others and our own insecurities.
But then, a dire diagnosis or significant life event forces us to consider the number of days we have “left” and this stark realisation provides clarity for us to start truly living.
Truly living.
And what does it mean to truly live?
Truly living — alive and not dead
To truly live is to have a sense of our own mortality and of our short time here on earth and seek wisdom to live our lives accordingly.
Whether you like it or not, our days are numbered.
The Psalmist suggests that our lifetimes are short, gone like a breath of wind, here today and gone tomorrow.
“He knew that we were made from mere dust — frail, fragile, and short-lived, here today and gone tomorrow”
Oliver Burkeman’s insightful book “4000 weeks — Time and how to use it”, suggests that we all have 4000 weeks of life to live on average if we live to 76 years.
And as I reflect on my Palliative care practice, I do not think he is wrong. Our latest data show the average age of patients admitted to our service is 78 years old!
This isn’t a pessimistic way to live but rather living with the end in mind and knowing that we have a short time here on earth to make difference, establish connections, leave a legacy and enjoy this wonderful world.
To truly live is to savour and taste what all life has to offer in your world, being mindful and joyfully expectant about each new day and awe-struck by the rich simplicity and beauty around us.
Truly living is when we are alive and present — experiencing the full range of emotions, in touch with who we are and doing what we want, taking hold of the wheel and writing our own story.
Because, if we were, to be honest, there are many of us who are going through the motions of life, with little care about our numbered days and the purpose and meaning of our time here on earth. To these people, life is happening to them.
The drudgery of days and the monotony of weeks pass so easily that the years slip by like the mist described in the wisdom book of Ecclesiastes.
We let our allocated number of days slip by in a haze of information and emotional overload and the numbness caused by life’s little and big traumas.
We may work hard but perhaps not on the things that matter when we are faced with our mortality.
Peppered through these years are perhaps milestone experiences, the seasons of life, and maybe even good fortune and easy days.
But are we truly alive?
Our lives may be full, but possibly not of the things we want.
On the outside we may be successful, ticking off the boxes of career and life success, the accumulation of assets and rising to prominence and obtaining a high position.
But inside there may be deep unrest that our lives have not been meaningful and that there are aspects of our being that have never been explored.
Our lives of hurry, distraction, tiredness, insecurity, anxiety, misaligned dreams, unprocessed emotion, mounting regrets and a lack of joy slowly slip away leading us to an empty existence.
A death.
Death of the person who we wanted to be.
Death of the person who we initially saw ourselves becoming.
Death of the person who we could have become.
Diana living fully
With her symptoms under control and her mind able to wander into the far reaches of the future, Diana’s question about the clinical trial was really a question about how long she had to live this way, feeling truly free and truly alive in her body.
A crooked smile crept over her face. It has been left paralysed by an earlier neurological complication. But that couldn’t hide her energy beaming through her eyes. She had make-up on and I thought she was wearing her best to see me and her Oncologist. But no, she had a lunch date. Diana was now a woman with a schedule to keep.
I could clearly see how much it meant to her to live and to squeeze every ounce of joy, exhilaration, breath-taking awe, and meaning out of the life she had remaining.
Diana was only checking in only because she was on the cusp of a trip around Australia (reduced only to Western Australia due to COVID-19 border restrictions), something she’d wanted to do for many years.
She’d also sold her consulting business and started working outdoors a few days a week in a nursery that was happy to have her when her energy served her well.
Again it was something that she had wanted to do for many years but never did — working with living things outdoors instead of being stuck on a computer. She’d also put her affairs in order and kicked the man who accompanied her on our first visit, out of her life. “I couldn’t stand him anymore Jonathan!”, she chuckled as I told her to spare me the details.
But in serious reflection on this moment and as much as she felt better, Diana could feel life in her body wane with each day. Suddenly each sunrise signalled an opportunity for Diana to make her mark in this world — she knew now what it meant to be truly alive.
To dead to live and too alive to die
The reason why her words resonated with me was that I’d read Byung-Chul-Han’s quote in a book that I was reading about eliminating hurry from our lives.
In talking about burnout and people in the Western World, Philosopher Byung-Chul Han said in his book The Burnout Society,
“They are too alive to die and too dead to live”
“Too dead to live?”
I read that line over and over again.
It captured my attention for weeks.
I highlighted it and wrote it down in my journal — this was something I needed to get to the bottom of.
As I reflected on my interaction with Diana and this quote (who I was told was on her way to Broome), I realised that I had written something similar a few years ago.
In a reflection on the biggest lesson that caring for the dying had taught me, I concluded,
Don’t live with regret, when you have the opportunity available to live your life fully now!
The thesis of my article was that our days were numbered on this earth and therefore the only way to live was to learn from our regrets and past mistakes and use them to help shape our lives now.
We know this, but how many of us are actually living in this way?
This is because when your days are few, you’ll know that you’ve wasted your life chasing after things that didn’t matter and not living in the fullness that you could have had.
And whilst Diana was seizing her days now and had an agenda to achieve, I’d seen many of my patients that hadn’t lived in this way. Their diagnosis was an existential slap too late.
Learning that you only have weeks or months to live when you planned your life with years and decades in mind is a stark realisation. As I have seen it, death often arrives too soon. It is an unwelcome intruder to most and only a welcomed acquaintance to a few.
The reality of numbered days is the realisation that we may have wasted our life chasing after things that didn’t matter, caring about the opinions of others and living out the wrong story.
A life of regrets not analysed and thus a life not realigned.
A life of kindness not given and forgiveness not granted.
A life of emotions not processed and therefore a heart unhealed.
A life numbed by digital distraction and over-desire for good things which now rule our lives.
A life of choosing comfort and choosing not to deal with important questions.
The regret in my patients is palpable.
And this leads many to experience significant distress at the end of their lives which contributes to their total pain and torturous last days.
This is regret seen in unforgiveness, unrealised dreams, wasted potential and unfinished business.
And the greatest of all is not being able to truly express your love to those closest to you or to the one you loved most.
So what can we do?
How does this relate to being alive but dead?
And how do our lives arrive at this point?
Living in a state of numbness
Psychologist and author Dr Lori Gottlieb provides insight into how this can happen.
It all relates to living in a general state of numbness — a state of unprocessed emotion and thought.
This is an excerpt of Dr Gottlieb talking to Lewis Howes about this state of numbness and being alive but dead.
“Numbness isn’t a state of NOT having any feelings.
Numbness is the state of being overwhelmed by too many feelings.
Being in a numb state means that you mute out other feelings too.
If you mute the pain to protect yourself, you also then mute out the joy in your life.
And then we find ourselves living in a state where we don’t get to feel the range of feelings that make us human.
And this state is called “dead”.
“Because it is possible to be alive and but not living”
— Dr Lorri Gottlieb
And this is what can happen to people — where they are alive and going through the motions but they are not really living their lives.”
Dr Gottlieb is talking about the consequence of living a life of unprocessed emotion and thought — a numbness to life.
Alive but not living.
Our emotions hold the key
Nothing holds a mirror as to what is more important to us than our emotions.
Our emotions are the gateway to our hearts. They reveal our core values — the bottom line of our life, our loves and joys in this life and also our pain points. These are the areas in which we are struggling and the secrets that we wish no one to find out.
One way to see our emotions at work is to reflect on the last time we were angry. Adam Grant suggests that the things that make our blood boil reveal what is important to us — our core values that are being threatened.
Our emotions are beautiful pieces of feedback for us about the issues that we are facing and they deserve our attention. This is because one of the most loving things we can do for ourselves is to examine our emotions and seek to understand why we are feeling this way.
But here is the problem. Examining our emotions and our thoughts, especially grief and sadness and even anger, can be painful. So it is much easier to drown them out, expel them from our consciousness and avoid processing this “pain”.
However, living a life of unprocessed emotion and thought that we actively suppress, eventually leads to numbness — being alive but not living.
And this numbness is harmful. It manifests adversely in all the dimensions of our lives — in the physical, spiritual and psychological aspects of our being.
Ignoring our emotions can worsen our physical pain and emotional suppression has been shown to increase the likelihood of disease and death.
But most importantly living a life of unprocessed emotion and the numbness that follows it eventually leads to a life devoid of joy and the sinking feeling that our life has not found its ultimate meaning.
In his insightful book, ‘The ruthless elimination of hurry”, John Mark Comer lists several symptoms which are clear signs that we may be living a life of numbness, caused by our hurry and unprocessed emotion.
Symptoms of hurry and numbness of life
Irritability
Hypersensitivity
Restlessness
Workaholism
Out-of-order priorities
Lack of physical self-care
Escapist behaviours — distracting ourselves into oblivion with food, pornography, binge-watching Netflix, scrolling mindlessly through social media and any cultural narcotic
Loss of connection to our spirituality — the essence of who we are
Isolation and loneliness
-Ruthless elimination of hurry — John Mark Comer
This is a diagram I created to illustrate the consequences of living a life of unprocessed emotion and presented at a recent medical conference.
Reference — School of life: Unprocessed emotion.
The antidote to numbness
Diana died 3 months after her trip around Western Australia. She was surrounded by her friends at home and from our death review, it was peaceful.
As I reflected on her life, I was grateful to have met her because she taught me something profound.
A life of numbness can be prevented.
A life of being alive but not living is a choice.
And facing your death and realising you could have lived much differently, is the default setting of the world that we are living in today.
Truly living is an intentional decision.
And the anti-dote numbness is self-awareness.
Cultivating a sense of self-awareness is the antidote to slipping into a life of numbness.
And self-awareness is the cornerstone of practising emotional self-care.
When we choose self-awareness we choose to live a life that provides for the silence to reflect, the solitude to examine and the space to let our minds wander and bodies rest — these are foundations of self-awareness.
It is clear to us all that our lives, no matter how isolated we are, are running at a faster pace than at the turn of the century. Our progress has brought innovation and with it technological revolution — global connectedness, rapid dissemination of news and exponential growth in information.
Creating space for self-awareness in this time period is not easy and not common and therefore essential!
It is ultimately easy to be swept up in life’s little and big issues and the pressing urgency of the now. We are digitally overconnected and slaves to the device in our hands. There is noise coming in at a relentless speed from our social media feeds, our inbox and calendar and more information that we have any need for!
David Brooks suggests in The Road of Character,
“The noise of fast and shallow communication makes it harder to hear the quieter sounds that emanate from the depths”
It is no wonder that silent retreats and wellness holidays are so popular. Our souls are begging for rest and silence and our hearts are trying to keep up with our now “normal” relentless pace. It is ridiculous to think that we are paying a premium to find silence, solitude and space for self-awareness.
It is ridiculous because this is available to us right now.
Hurry and busy are the drivers that lead us to not consider self-awareness as a helpful tool. We’ve been conditioned to find fast answers and easy solutions.
And as result, the deep and meaningful go largely unexplored for the convenience of the here and now.
Self-awareness requires us to reduce our pace, disconnect from a perpetually connected world and stay silent long enough to hear our minds think, allow our hearts to feel and our souls to connect to a higher meaning.
And perhaps what seals our fate of dying when we feel so alive is the fear of dealing with our most pressing thoughts and underlying emotions.
It is the fear of shining a light on the story that we’ve been writing with our lives.
It is the fear of finding out that we may have been chasing the wrong purpose, choosing outward success in favour of a wise heart and deep soul.
This false and a lie.
I am here to tell you that shining the light on your life in self-awareness is the most loving thing you can do for yourself.
Numbing your emotions and not creating the space for self-awareness does nothing but lead you further along towards being dead whilst very much alive.
Scrolling, consuming, workaholism and numbing ourselves are easy.
Creating silence, solitude and space for self-awareness is the cost of being truly alive.
Dealing with your hurt, observing and unpacking your emotions, confronting false ideas, asking for forgiveness, confronting and feeling your pain and having the courage to start writing a new story — this is love. It is the greatest loving act you can choose for your one, wild and most precious life.
The key is to living a life where you are truly alive is self-awareness.
Self-awareness prevents us from waking up and realising that we’ve been following the wrong path, living out the wrong story and moving further and further away from those who we once loved with unresolved anger and unforgiveness.
Too many of us are numb as this is the easiest path to take. It also doesn’t help that our world has evolved in this way. There are countless ways to check out, suppress our pain and numb our emotions and seek pleasure and comfort instead.
The uncommon path is self-awareness — examining our emotions, observing our thoughts and shining a light on the story that we have been writing.
My encouragement to you is to find silence and solitude and create space to examine what is bothering you.
This will allow rest and healing for your heart and care for your soul that is starving for meaning and depth.
Emotional self-care — self-awareness in action
It is clear that in Diana’s life she found instant clarity when she was given a terminal diagnosis. Learning that she has months to live woke her up from the numbness that had enveloped her life. The way that Diana shook off her numbness and moved forward with intention is a lesson for us all.
For those of us in the land of the well, I am not talking about instant radical change but intentionally creating space in your life for self-awareness.
This is because,
Our hearts need space to feel and process our emotions.
Our bodies need time to replenish and heal.
Our minds need time to wander and be at their creative best.
And our souls need time to catch up and reconnect to what brings meaning.
In the reality outside this article, I recognise that we all have our own burdens, baggage and complexities to navigate.
However, if you seek a life beyond numbness, here are a few thoughts to cultivate self-awareness as you practice emotional self-care.
Pay attention — Observe and acknowledge your pain
Be mindful of your self-esteem — Monitor and protect it as your self-esteem is your emotional immune system. It helps to buffer the threats and tests that you face
Disrupt — Stop those negative thought spirals before they take hold
Deal with grief — Grief is a sad reality of life and whether you are dealing with a major piece of grief of several tiny pieces of disappointment, grief does take its toll. Dr Naomi Remen suggests that grief that turns into burnout is grief with no place to go.
Heal — Learn which activities help you to process your emotion.
“Too alive to die and too dead to live” can be arrested.
One of the greatest lies and assumptions in the world today is that “you have time — don’t rush”.
This is evil and it ruins many into thinking that tomorrow will come and be their saviour and they have ample time to change.
My practice of self-awareness in emotional self-care
It is clear to me as a Palliative Care doctor that our days are all numbered. We need to learn to interpret our lives correctly. Numbness is what it means to be alive but dead. Self-awareness is our key and gateway to a life that is truly life.
For me personally, I found a life that is truly life through my faith. My faith in Jesus Christ is the bottom line of my life, it is where I place my hope and where my joy and meaning in life come from.
However, being a Christian does not make me immune from the disease of numbness, it certainly does not!
But rather as I draw close to God and create space for self-awareness in silence and solitude, I am realigned to the rhythms of grace and mercy that God has abundantly given to me.
And as a dad to three boys, a husband who wants to love Kylie till our last day and a doctor with a mission, creating space for self-awareness has been tough but the single most life-giving and powerful move that I have undertaken in the last few years.
My days start early in silence and solitude. They involve a journal and quiet words to God and always a cup of black coffee. In this space, I observe my emotions and I am honest about what is troubling me. I lay each concern down in prayer and connect to the God who loves me.
From this space, I’ve been prompted to say sorry and ask for forgiveness from those I’ve wronged. It is also given me the strength to have difficult conversations with those close to me. This space too has held me accountable for my less-than-ideal behaviour. But most importantly my time in self-awareness reconnects me to my eternal purpose and allows me to be kind to myself.
There is hope to overcome the numbness
Creating space to care for your emotions and cultivate self-awareness will look different for everyone. Some of us may choose to practise self-compassion as we examine our thoughts and emotions. A few may select a skilled therapist to help unpick their wounds and swirling thoughts. This is helpful, especially for those who feel stuck — I have been here too. Others may have a trusted friend or family member who helps them to talk through their emotion. And others like me have had mentors and coaches who have held a space for them to be accountable for the story that they are writing with their life.
The life of unprocessed emotion and hurry are the precursors of being alive but not truly living.
Creating the space for silence, solitude and rest is the foundation for self-awareness in emotional self-care.
This is the wisdom of life because it is honesty with yourself.
Do not let a terminal diagnosis or significant life event be your wake-up call.
There is peace and rest are available to you now.
Live intentionally.
Love relentlessly.
And enjoy your health — your one, wild and precious life.
Dr. Jonathan Ramachenderan
@drjonathanrama
The healthy GP 