(127) Matters of the Heart

Matters of the Heart

In “Matters of the Heart”, it is about the big themes that have to do with your heart.

Like the theme of the great loves in your life, not just your soul mates or your loved ones but especially to yourself. Or the theme of the great losses, not only the death of your soul mates and loved ones but, also the loss of that fantastic job you had or, the suffering from a terminal illness. And following on from that, the theme of learning how to deal with grief and the possible consequences of ignoring it, avoiding it or being afraid to ask for help. Or like the theme of the possible illnesses of the heart when you do not listen to your heart, not so much the medical but the emotional consequences.

The common thread running through these themes is that consequences in “matters of the heart” prove to be fundamental. These are (enormous) changes on your life’s path. Whether you want to or not, you had better learn to deal with it and try to approach it from a positive, the sunny side … however difficult that may be … so that you can get everything that is possible for you out of your life.

The great losses

The great losses in my life are the death of my soul mates, my daughter Anne Birgit and my wife Mary-Anne.

Just before her death, Anne Birgit told me that she had been looking for information on how to support children who were about to die, and how their parents could cope with that. However, she had been unable to find anything suitable. Her last wish was I would guide parents who lost a child … because she had seen what I can do.

My wife Mary-Anne received a card from a woman who worked in one of my teams, one of my Golden Teams. She knew the woman and had me read the card. The woman wrote that she found me a light on her life’s path because of the way I knew how to motivate and coach her and her team members … making the impossible … possible.

During the weekend, Mary-Anne said that she recognised the compliment and that she thought that this should be more my future path. On that path I would be able to be completely myself … who I am in my core. It would also help to fulfil the last wish of our daughter.

The symbol of a heart wearing a headset.
Listen to your heart

Two days later, my soul mate Mary-Anne died.

However, it took a few years before I even had the courage to fulfil that promise. It meant a life’s change … a completely different path in life. Suddenly it happened to me … I had forgotten to listen to my heart.

Open-heart surgery

Six years ago, I had two open-heart operations in quick succession. Two because the first time, when the aortic valve was replaced during the operation, it turned out that even more needed to be renewed. Altogether, it wasn’t so much that these operations were aggravating, but it was the enormous impact they had on my life. An impact that changed my life’s path.

A compass.
Change of my life’s path

Prior to the open-heart operations, I had registered for a European assignment through a colleague. As the client had ranked me second, I missed the contract… too bad, better luck next time. But after those operations, my colleague told me that the client wanted to hire the first three people on the list and he at once asked when I could come for the intake interview. Only … the bizarre thing was that when I heard that … I didn’t want to do this kind of work anymore. Make no mistake, I always found the work awesome. Stimulate people within my teams to enjoy doing the work … each time making the “impossible” come true. They became my Golden Teams. Fantastic jobs they were … I always enjoyed them!

After those open-heart operations it was over … it was just all over. I still don’t know how that was possible, but I had no desire to do what I used to do. I changed my career path and went to work in the land of loss and grief as a grief counsellor. In this way I’m fulfilling the last wishes of my two soul mates, my daughter Anne Birgit and my wife Mary-Anne.

Cardiac arrest
A line on a monitor with the rhythm of a beating heart. The line ends in a flat line towards the Light.
And then … it was quiet … and there was peace

Recently, I suffered two cardiac arrests. It happened in the ambulance after I had fainted during a walk in the dunes. I was not afraid for a moment. Only afterwards I did realise that I had been on the brink of death and the question arose… “Why weren’t you afraid? Even a friend who was with me experienced the peace around us. She was aware that incomprehensible forces were at work to protect us and support me. During the moments when my heart was stopped … I was very aware of the peace and tranquillity around me and felt very Alive. No, I was not afraid! I had an unshakeable confidence that there was something around me that would ensure that I would not die and that all would be well.

It was not the intention I would die at that moment. I already knew that working as a grief counsellor was the right path in life for me … but now I know without any doubt that this is my mission. A mission that I will not shy away from in the Land of Light. And it is precisely this that has made such an impression … in the same order as after those open-heart surgeries. However, this time not only on a deeper level, but also giving more direction.

As a grief counsellor, I am going to specialize in counselling parents who have lost a child … or will lose a child. I have also become aware that I must do something (to others) about the impact that the Near-Death Experience can have on a life. I don’t know yet how to do this, but I have blind faith that I’ll find the answers in my future.

Blind trust

You might think this sounds arrogant, but I have a blind faith that I can deal with what comes my way … and that I may and can guide the people I am going to meet. It is a very deep confidence. In retrospect, I consider those two times that my heart stopped as a Great Gift … as a gift from God! What happened then, I was allowed to Know and experience … I would never have wanted to miss the Near-Death Experience. I feel gifted, blessed, humble … and one with utter Consciousness! Something like that … but on a much deeper level.

True love
A heart in the Light.
True Love

When I look at the way I am now in life, I can say that I was never afraid to live. At the same time, I was never afraid to Be after my death in that other Universe to which we all eventually go.

On the other hand, I was afraid of the run-up to my death and the transition to that other Universe. I clearly had an opinion about that. But since those two times when my heart stopped and what I then experienced … that fear has also disappeared. What I also realise now is that the loss and mourning of both my soul mates has reached a point where I miss them … and will always do so … but now I can move onward with confidence with a new partner in my life. I am now fully aware that about that “ability”, I have been lacking in the past years to enter a new relationship.

Message
Spring. Budding branches.
A new beginning

The message I want to give you as a reader of the blog “matters of the heart” … no matter what happens … most of the time there’s a way to cope with the situation at hand … “a new beginning.” It helps by being really positive in your life. It can just be a new beginning where you start doing completely different things in your life.

Dear Reader, I fully realise that being positive in your life can be difficult from time to time … I know from experience … but for matters of the heart it is more than worth it. Whether it is the loss of a child … medical matters relating to your heart … a cardiac arrest and the deeper insights you may receive at that time … or the love for your partner, your soul mate … these are all matters of the heart that make life worth living!

(117) Hans … 20 years later

I hope I can provide a handle so that you too can learn to deal with your loss and mourning whatever may be the cause.

Hans … 20 years later

20 years later? What happened in those 20 years? Most of the blogs I have written are about the period after the death of my daughter, Anne Birgit, in 2000 and of my wife, Mary-Anne, in 2011. Now I don’t want to write about that previous period. This time I want to share with you how I look at my life today … what I am going to do with the lessons I was allowed to learn during that period … how I want to proceed with my life … in a nutshell, how do I see the future today and am I happy with that now.

I hope I can provide a handle with this so that you too can learn to deal with your loss and mourning … whatever the cause may be.

The way I look at it now

The way I look at it today, I am pretty happy with my life. Satisfied in the sense that I have learned to deal with my loss. The raw grief of the past has turned into the gentle pain of mourning. Both Anne Birgit and Mary-Anne are no longer in my mind every day … but we are connected from heart to heart in a different way. As if we know each other when we think about each other. And when a feeling of sadness comes up, it’s like they’re just sitting next to me.

However, there are still times I suddenly go back in time … when Anne Birgit and Mary-Anne were still alive. I still don’t understand how that can happen… maybe because of a smell, a colour, a voice, an image … but in those moments it’s like it’s all real again. Like the way you watch a movie … including all the emotions and feelings that were present at the time. It is true that these kinds of moments have become less frequent in recent years. But when it happens, it is still exactly as it used to be.

The way I look at it, there is immediately a positive thought for every negative thought. As if these are the two sides of the same coin. What strikes me is that in recent years that positive thought has come more often and is stronger than that negative one. That feeling … that positive feeling makes me a happy person. But I should remark that the joy in me goes much lighter and emotionally much deeper than before … more subdued.

I am very sure I would not have been on the path of life I’m walking now, if Anne Birgit and Mary-Anne would still be alive. Paradoxical as it may sound… on the one hand I would like to have both around me again… on the other hand the path I am on now gives me a fantastic but at the same time also an ambivalent feeling. Presumably that feeling will always stay that way.

What do I do with the lessons from that period

The biggest lesson from that period is that I’ve become an experience expert in dealing with loss and grief. People around me are amazed at this. Because for them dealing with loss and grief is about how you deal with it? Isn’t that completed? Time heals all wounds … right? Yes, you have lost a child… that’s like a rollercoaster … we know that. You have now finished your mourning? When I answer that it’s not about that at all, but that it is about guiding others in coping with their loss and their grief … they become silent … then they slowly start to understand. And at the same time, they also indicate that that would never be their choice. But that aside.

In my previous professional life in industry, organizational consultancy and IT, I have learned to look at processes … at people how they use those processes … how possibly could done this better, more convenient, more user-friendly. In this way, I’ve also observed those past 20 years at how I dealt with coping with my grief and my loss. I used that knowledge to write my blogs.

In the meantime, I have started the training “dealing with loss” at the Dutch organization “Land van Rouw.” The amazing thing about this is that the knowledge I have gained from my experience can often be found in the literature used in the course. Does that mean that my training is wasted energy and money? No, that’s not it! It gives me insight from different angles, perhaps other disciplines. With the help of that training, I can even become a professional experience expert, where I can combine theoretical and practical knowledge of others with that of my own.

How I look to the future now

As I look to the future, I envision a path where, in addition to completing training courses, I use my knowledge and experience to assist people in coping with their loss and their grief in the broadest sense. You also should imagine that people become aware that they are in a narcissistic relationship and that they eventually decide to do something about it… no matter how difficult that can be. Or, people who lose their jobs, are terminally ill, or divorce…

I don’t walk that path alone. Together with others I want to guide people with the aim that grief and loss in any form is the most normal thing in the world and that we can talk about it without taboo. I would love that.

As I now look to the future, I also see that I am also moving the common thread of groundbreaking work from my previous profession into this field. For now, I’m just translating it into the form of giving presentations about mourning and loss in any form, writing articles and writing books.

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As I now look to the future, it will end for me eventually sooner than later … I am currently 72 years old. In the coming years I also want to enjoy myself and have fun. Somehow, I feel like I’m going to accomplish that. And what I would love is for others to continue my work in their own way.

In this blog I wanted to show how I eventually “can” deal with my loss and grief. Yes, “can” … because there are times when I can’t. It is what it is. I wanted to show you that it can be a long stretch, but in the end, there is light at the end of that process.

I hope I have been able to provide you with a handle so that you can also learn to deal with your loss and grief… whatever the cause may be.

(110) Don’t leave me alone

Two people who each have their own point of view, their own opinion and no matter how you look at it, both are right. That is allowed and there is nothing wrong with that. But when with one of the two violent emotions play a major role, like sadness, fear or pain, then it’s important that both are willing to understand the other’s point of view. Understanding, so that the bond between the two is not severed but strengthened!

Introduction

The current blog, “don’t leave me alone,” is about two people with the fictitious names Kathy and Tanya. Both have a different even opposite view of the same situation. That is possible and should be okay. But when intense emotions play a major role at Kathy … then it is important that both can talk to each other … and … can understand each other’s opinion. “And then what,” you may think. “Can’t you have a difference of opinion?” Yes, you can. But it becomes a different story when intense grief or a serious illness play a role with Kathy. Relationships can sever or even end; as with Kathy who is afraid of being left alone. Whatever you think, it happens in daily life and it “hurts people.” Nobody wants that, right?

Kathy

Kathy has no shortage of friends and, just like my daughter Anne Birgit, she’s a beautiful young woman. However, on the outside, you can’t see she’s seriously ill. And Kathy too had to cope with the necessary blows in her life with the result that the brilliant light she really is, rarely comes out.

Kathy has undergone a whole range of chemo treatments and radiation treatments. During the last consultation with the specialist, he indicated that the treatments will continue to work in her body for months before something can be said about the result.

It is already the second time for Kathy in her life that she has undergone such a series of treatments. She can still clearly remember the first series. How relieved and happy she was after she was told that she was free of tumours … that she could celebrate life again.

The results of the second series will take months to come. Until then, Kathy is not really in a party mood, let alone to celebrate life because the treatments have been completed. She can still remember the enormous disappointment and especially her anger when the tumours returned for the second time. Until then, Kathy is full of hope that the treatments have achieved the intended effect. On the other hand, she is so afraid of being disappointed again because she realizes what that will mean for her sooner rather than later.

Tanya

Like Kathy, Tanya is a beautiful young woman who is full of energy and who is always ready to throw a party as soon as there is anything to celebrate.

Tanya also had the necessary setbacks in her life … yes, who didn’t. But when you don’t know it or don’t look deep into her eyes, everything indicates that life seems to be one big party for Tanya, and she enjoys it to the fullest.

Tanya and Kathy are close friends. The treatments Kathy had to undergo for almost a year took a great toll. She was more often in bed than not and too tired to do anything. Tanya made sure that at least Kathy was eating … that is if she could keep in that little bit, she was able to eat … and … take care of herself.

When Kathy returned after all those intense treatments from the last consultation, it was just natural for Tanya that this should be celebrated. That’s what you do … it makes sense … you have completed a phase … you can go on with life, right?

Don’t leave me alone

Kathy had a different opinion. She still remembered the conversation with the specialist, the uncertainties expressed in it and Kathy also remembered the result of that first series of treatments. The enormous relief and joy she felt at the time when they told her that she was free of cancer, and a few years later the intense sadness, the anger and the fear that the tumours had returned. Now Kathy is afraid, so afraid of being disappointed again.

“What do you mean, party? There’s nothing to celebrate” Kathy says to Tanya who doesn’t agree with her. For Tanya there definitely something is to celebrate. The treatments are completed, aren’t they? And with this difference in thinking … this difference in opinion … a difference in point of view that is so logical and obvious for each of them … that it’s impossible for them to understand each other’s point of view.

don't leave me alone, sad, afraid, disappointed
Don’t leave me alone!

And at this point the relationship between Tanya and Kathy starts to wane and Kathy’s cry for help, “don’t leave me alone,” becomes a reality eventually.

But on the other hand, maybe Kathy’s fear has made Tanya as frightened as she is. Or … there is something that Tanya has been touched by or afraid of … which dilutes the relationship. Or … maybe … yes, you can think of and accept anything, but it’s not something you can get along with it.

How to proceed from here

For me it is crystal clear that Kathy and Tanya should discuss this with each other … and … keep talking to each other so Kathy doesn’t feel left alone. Yes, it’s clear to me, but do they think so too?

In my opinion, it is necessary that Kathy and Tanya sit together at the table and each tells her story about … what is felt … missed … should be celebrated … or not … or what they might be even afraid of.

It would also be beneficial to do this together with a “mediator” so that, in addition to helping in expressing each other’s words to the other, at the same time he or she can foster the understanding that both look at the same situation in their own unique way.

Both have a point, but it is important that they can understand each other’s point of view … so that the relationship between Kathy and Tanya does not gets diluted … but instead … becomes stronger.

Conclusion

It’s my experience that people start from their own opinion, or their own view they have of the another. That’s obvious, you might think, but in my opinion, it will be something completely different when that image is based on a series of assumptions. The reality regarding others is usually different and much more complex than we initially thought or assumed. That is why it is wise to keep talking to them in order to get a better understanding for each other. The same applies to people we think we know very well or for a long time.

You could also assume that everyone is correct. To illustrate this, imagine you are standing in a mountain landscape. The image that you see is determined from where you look at it. When you let everyone tell you what that landscape looks like, you will hear different stories depending on where these people were standing … in that same landscape.

In communicating with the other person, it is important that we are prepared to adjust our own opinions about the other person if that should prove so during the conversation. And there is often another bottleneck because not everyone can just do this or want to do this.

Epilogue

The core of the case used in “don’t leave me alone” is not unique. There are countless examples in which communication between people is the cause that they do not understand each other … with all possible consequences … like the one in “Farewell“.

Like in the used case of this blog in which two people each have their own point of view or their own opinion. No matter how you look at it, both are correct. That is allowed and there is nothing wrong with that. But when one of the two experiences violent emotions, such as sadness, fear or pain, then it is important that everyone can understand the other’s point of view, so that one of them doesn’t feel left alone in the end!

(108) An overwhelming loss

An overwhelming loss just happened to you. At that moment you are in deep pain and don’t know what to do, but in the end, you get it resolved somehow. Be aware that it can often be a long and arduous journey, a journey in the unknown, with love and joy at the end of that journey. However, never again it will be the same as before … there will always be some pain left.

Suddenly there it was … an overwhelming loss

Recently you suffered an overwhelming loss that has a huge impact on you. It seems as if you have fallen into a deep hole, that your world stopped turning, that you are so stunned you don’t know what to do anymore.

Preferably you would want to put the clock back to the time, which might not be perfect, but in which you were happy. To the time you had the job of your life and didn’t realize that the company you worked for would eventually go bankrupt. Or perhaps to the time when that loved one was with you, who was always there for you, who always supported you, and gave you courage, who was the one your world revolved around, but who is deceased now. Or maybe to the time when you felt good and healthy and had no suspicion that you were seriously ill. After many intensive treatments the doctor informed you eventually that there wasn’t any other existing follow-up or trial treatment available for you to help.

An overwhelming loss results into grief and mourning.

The enormous emotional impact of the loss can raise questions like “does my life still makes sense” or “how do I proceed with my life from here” or “what is (still) the purpose of my life?” These questions will certainly not reduce the impact of the loss, on the contrary.

Your overwhelming loss and the ensuing grief and mourning can also be intensified by the opinions and attitudes of the people around you. People who, like you, are involved with the same loss but are trying to process this in a different way within their own realities. People who may not realize that everyone is mourning in their own way.

They are custom examples, or so you wish cases, which have happened to me and my family. When you happen to recognize yourself in one of these, I hope that this blog can help you.

It starts with the acceptance that what happened … did happen

Mourning or processing grief is a process that lasts as long as it takes, and which runs differently for everyone. Before the process of mourning can begin, however, you first must be able to acknowledge that this great loss that has happened is irreversible. That you accept that there is no way back because the company for which you worked is bankrupt or … that your loved one has died or … that your illness is terminal … and that what others think of your loss and your mourning is rather a mirror for themselves than that you have to do something with that.

Your acceptance of your loss does not mean that the processing of your grief is going “smoothly.” There may be times when at one point it seems you have accepted your loss while at a different moment it seems that it is not nearly the case. You may not even be aware of that but changing the acceptance of your loss from one moment to the next may generate the necessary additional emotions in you. Emotions that can translate into reactions in your body and also in your behaviour towards others. The same applies to the people in your immediate environment who are processing their grief too. It does not make it any easier.

And that was just the beginning. Yes, mourning requires a lot of energy. Jung said it back then, mourning, or processing your grief, is hard work.

Then come the questions, the life questions, on which answers are needed

Answers to life questions such as “does my life still make sense” or “how do I continue with my life” or “what is the purpose of my life” help in accepting the reality of the loss. In my blog I cannot give answers to such questions because the answers are influenced by who you are, by your background and culture, and how you were formed during your life.

“Mmmmm …” I can hear you think … “but how can I, as a reader, get answers to these, although basic, but for me personally … important questions?”

In my opinion, it is important that you do not end up in a negative energy spiral, because the longer it takes the harder it will be to reverse it again. But not everyone recognizes or acknowledges that to themselves.

It is also important to adopt a positive attitude, so that problems become opportunities, lessons become obstacles, and your worries are just a part of your life.

My point of view is also that people can change … you too can change … using your heart and all the unconditional love that is available in our universe.

Easy to say but doing and continuing to do so is quite something else. It takes a lot of energy and above all perseverance. But not everyone is willing to devote that.

How do you tackle that … dealing with loss?

It reliefs when you are distracted from that overwhelming loss. For example, you have children who need your care, time and attention. Or you have people in your immediate environment who depend on your help. Or you have a job. But not everyone has that.

It is easier when you do away old things. When you are open to other ideas, other signals, other observations. But not everyone can do that.

It reliefs when you start recognizing that your fear has to do with your thoughts that tell you that something is not possible, but that when you can think in opportunities and challenges you can develop further and create new opportunities. But not everyone wants that.

It helps when you dare to leave the trodden path, and while you struggle over the path that is unknown to you, you eventually discover a new path with new and more possibilities than you ever were able to dream about. Opportunities that become a new reality for you. But not everyone dares.

It reliefs when you ignore what others think you should do, but that you listen to what your heart tells you … that you listen to your feelings. But not everyone has the courage to do so.

A perspective…

To provide you with some support while processing an overwhelming loss, I can offer you some perspectives from my own experience.

When you at length go through your mourning with falling and getting up again, you discover at a certain moment that the raw grief you experienced in the beginning has changed into the soft pain of sorrow. That the pain has become a viable and essential part of you … it has made you who you are at that moment.

It may even be the case that you have changed so much that people around you wonder how that happened, while you wonder why you did not start the activities you are currently engaged in much earlier in your life.

In retrospect, you may consider that the great loss you have experienced was necessary to put you on the path of life you are currently walking on … that you can be proud of yourself on who you have become … on what you do now in and with your life. What another thinks of that is like a mirror for the other and not relevant to you.

In retrospect you may still vaguely remember any negative aspects and moments before and during that great grief, but later you remember mostly the beautiful things in your life. It gives freedom in your head, in your mind … it relieves.

Looking back in time…

An overwhelming loss just happened to you. At that moment you are in deep pain and don’t know what to do, but in the end, you get it resolved somehow. Be aware that it can often be a long and arduous journey, a journey in the unknown, with love and joy at the end of that journey. However, never again it will be the same as before … there will always be some pain left.

For that job of your life you’ve lost, eventually another occupation came in its place that gives much more satisfaction. For the loved one you lost and of whom you are missing the intimacy from human to human … maybe it even still hurts deeply … you are somehow still connected with the other from heart to heart. And because of that (terminal) disease you eventually learned to live and enjoy moment by moment.

Dear reader, I have learned to approach life in a positive way. That did not happen by itself. Two intense mourning processes contributed to this. It was hard work and there were times when I no longer knew how to continue in life or how I could find the answers to my life’s questions. But when someone asks me now, “if you would have the choice with the knowledge you possess now, to completely relive your life? What is your answer?” then I would answer wholeheartedly with … Yes!

I hope this blog is useful in helping you while processing your grief.

(106) The shadow side of mourning

The loss of a dear one

The shadow side of mourning? Is there a light one then? Everything is relative, you could see it as the difference between dusk with a brilliant sunset and the oncoming night as the shadow side.

The mourning process about the loss of a loved one can become complicated, without talking though about complex mourning. No, about a form where many things play a role in the periphery of mourning. That I call the shadow side of mourning. A form that can lead you to deferred mourning and everything in between.

Mourning, imaged as a sunset

When you consider a sunset as an image for a mourning process, then mourning is limited to the processing of the loss of a loved one by you and by you only.

The image of the sunset is not just about the (sometimes) difficult moments in your life … but also including those great moments that you shared together. It’s about a life, that when someone asks you if you would be willing to live that life all over again … including all those sad and great moments … your answer would be an immediate yes!

It maybe is a meagre consolation, but the deeper the grief the greater the love that existed between you. At the moment of realization, it doesn’t console you though … because the other one isn’t there anymore and you can’t give him or her a hug or a kiss.

The shadow side of mourning

The shadow side of mourning is about a loss that can become an even greater one by aspects that play a role in the periphery of the grieving person.

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Besides the loss of your loved one, you will also have to deal with aspects that are the result of how others manage the same loss. A disagreement between family members during the preparations for the memorial service could cause this … or just after that. Or the handling of the inheritance became an issue … and consequently, family ties could be lost. The so-called “glass door” effect for mourners results to the loss of friends. After the memorial service of your dear one, almost everyone promises to invite you. Only a handful honour their promise though.

The loss of a dear one might even lead to anger. Anger because you are so sorry that your last words didn’t reflect not even close what you felt for the other. You may feel abandoned because you now must deal with all those things and issues your loved one always did. You may find out secrets about your dear one that were hidden from you all the time. It could be even that your anger turns into hatred.

You may feel compelled or even forced to take over the position in the company of your loved one. A position you never wanted to have because you don’t have the knowledge or skills. But now you should do so.

When the shadow side plays an important role in your loss, then mourning becomes convoluted. It’s clear though, like everyone else, that only you can process your mourning. But that is not to say that a helping hand can’t be offered … a helping hand in the form of support or guidance.

Finding support … but how?

Support and guidance should primarily be directed to raise awareness and the understanding of what is happening to you (in other words, to understand the parts of your puzzle) at that moment; and what parts are important to you; and what could be done to resolve those parts of your puzzle.

Secondly, you should find out what parts of your puzzle could be resolved by yourself or by somebody else. And, not to forget, why and for which items of your puzzle support or guidance would be required. As normally would be the case knowledge and experience are important factors, but with grief or bereavement trust is the most important factor. The rule of thumb that should be used is: “When in doubt, out!”

Personally, I find it important that the grieving person should become self supporting as soon as possible. That means that all assistance or guidance provided is only of (very) short term nature!

Afterword

Mourning is not just about the loss of a loved one. Parallels could also drawn for mourning as a result of a treatable but incurable disease up to and including a malignant terminal disease.