Lindqvist Olav, Rasmussen Birgit H, Widmark Anders, Hydén Lars-Christer
Department of Nursing, Umeå University, Umeå, Sweden.
J Pain Symptom Manage. 2008 Dec;36(6):648-56. doi: 10.1016/j.jpainsymman.2007.12.013. Epub 2008 May 27.
The disease trajectory of living with incurable cancer is characterized by increasing bodily deterioration and problems. In this paper, we have focused on the change in temporal awareness as manifested in the narrations of two men with hormone refractory prostate cancer and skeletal metastases as they approach death. The two men participated in in-depth research interviews during the last part of their lives, sharing a similar disease trajectory with increasing bodily change and decreasing physical function. Both died a lingering, cancer-related death. The first and last research interviews were analyzed using a discourse analytic method. Findings show that the temporal awareness in the interviews changes as the illness progresses and death approaches. In the last interviews, the present is flooded with bodily problems; the past and the future are hardly present except for the future beyond the men's own deaths. Pain, fatigue, nausea, and other symptoms figure largely in this change, and there is no time for much more than attending to bodily needs in a present that is dominated by problems. Here, the importance of alleviating bodily problems once again becomes paramount, and two questions are raised: Is the often reported withdrawal from life, when death is imminent, a physical necessity rather than a psychological one, and is it possible to free time from the time-consuming problems of the present by means of a more concentrated attempt to alleviate these problems?
身患无法治愈的癌症的疾病轨迹，其特点是身体机能不断恶化且问题日益增多。在本文中，我们聚焦于两位患有激素难治性前列腺癌并伴有骨转移的男性患者在临近死亡时的叙述中所体现出的时间意识的变化。这两位男性在生命的最后阶段参与了深入的研究访谈，他们有着相似的疾病轨迹，身体变化不断增加，身体机能不断下降。两人均因癌症缠绵病榻最终离世。我们运用话语分析方法对首次和末次研究访谈进行了分析。研究结果表明，访谈中的时间意识会随着病情进展和死亡临近而发生变化。在末次访谈中，当下充斥着身体问题；过去和未来几乎不存在，除了这两位男性自身死亡之后的未来。疼痛、疲劳、恶心及其他症状在这种变化中占据了很大比重，在一个被问题主导的当下，人们几乎无暇顾及其他，只能专注于身体需求。在此，缓解身体问题的重要性再次变得至关重要，由此引出两个问题：当死亡临近时，人们常说的对生活的疏离，是出于身体上的必要而非心理上的，以及是否有可能通过更集中地尝试缓解这些问题，将时间从当下耗时的问题中解放出来？
