Borderline

If you have borderline personality disorder, please try really hard not to get an aggressive cancer.  The combination of the love/hate, push/pull personality doesn't do well with the rapid changes that come from say, ovarian cancer or pancreas cancer.

I recently took care of a woman in this situation. She'd opted not to pursue chemotherapy for her advanced cancer, but also seemed determined to feel good despite not wanting any medications.  Our daily conversations went something like this:

"Ms. Fraz, how are you this morning?"

"Miserable. Horrible. Awful", she’d say with her disheveled hair, eyes half open, and wrinkles cemented on her face from constant frowning.

"Oh?" Feigning surprise, though this was the 4th day in a row she'd said this, "What specifically is bothering you?"

"I'm vomiting, I'm in pain, and I'm so tired" were her general complaints.

To this I reminded her, "You know, Ms. Fraz, you haven't allowed us to give you any medication to help"

Her reply in full whine now, "But I don't like how medicine makes me feel" pause, "What are you going to do to fix me?"

And this is the crux of such a personality. She wanted someone else to fix her and to bare responsibility for her misfortune.

What makes borderline’s even more difficult in terminal illness is that they usually don’t have a lot of healthy relational support. 

Ms. Fraz, in fact, had only one single person as her friend. No family…no other human relation. More tragic, the one friend she did have, Bill, was adamantly apposed to her decision not to pursue chemotherapy.  He would tell her daily that she would be going to Hell for not trying to cure herself. “It’s like suicide to not try for a cure”.  He’d badger and bemoan her and she’d cry and get distressed. She’d demand he leave, and then call him back for more.

She was aware that when she lost the ability to make decisions herself, he would be in charge. She had given him that power legally, even acknowledging that he would probably choose things she didn’t want.

And so she spent her time dying of cancer, wanting to feel better, but refusing the help we offered. It was in this pitiful state of inertia that she continued to pull Bill in, to listen to his rants about her mistakes and damnation until finally she weakened and he won. Back to the hospital she went from hospice, to spend her last days hooked up to machines and IV’s, getting poked and prodded, pushed and pulled.  A perfect borderline personality metaphor; dying in the same way she lived.