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Introduction - Putting On The Boxing Gloves
Ernest H. Rosenbaum, MD and Isadora A. Rosenbaum, MA

All people, not just the critically ill, face grave moments in their lives. We have all, at one time or another, been tempted to give up and not continue. During these tumultuous times, it's often easy to miss the opportunities for what could be very rewarding achievements.

Consider a story about Niccolo Paganini, one of the great violinists of the eighteenth and nineteenth centuries. He was giving a concert when one of his strings suddenly snapped. Although the audience gasped, he continued playing. A second string broke, and, without missing a note, he continued playing. When the third string gave way with a sharp crack. the violinist momentarily stopped playing, but he then continued with persistence and confidence. He raised his Stradivarius above his head and announced, "one string...and Paganini." Then, with tremendous skill and discipline, the gifted artist finished the selection on a single string with such perfection that he received a standing ovation.

Like Paganini, we need courage. dignity, and optimism to meet our challenges in life with hope that we can overcome whatever obstacles are present.

Indeed, life-changing obstacles often become catalysts that awaken or deepen our will to live. Illness or other crises frequently force people to step back from their day-to-day lives and ponder the meaning of their very existence, wondering, about the purpose of their lives, contemplating why they want to survive, and then firming their resolve to do so.

We are always impressed by the spirit and grace with which people cope with chronic disease, disability, and the threat of death. We have seen again and again how they refuse to let debility or discomfort affect their enjoyment of family and friends or prevent them from going to work or pursuing outside interests. Inspired by their fortitude, we asked them how they were able to transcend their problems, what made them want to live.

The answers we received at first seemed simple and obvious: My children, they said. Or, my grandchildren. My wife. My husband. My dog.

But there was more to it than that. As we listened to their stories, we realized that the will to live means that they really wanted to live, whether afraid to die or not. They wanted to enjoy life, they wanted to get more out of life, they believed their life was not meant to be over, and they were willing to do whatever they could to squeeze more out of it. After a period of feeling devastated, they simply decided to assess their new reality and make the most of each day. When it came right down to it, they simply loved life and all it has to offer.

The threat of death often renews our appreciation of both the importance and transiency of life, love, friendship, and all there is to enjoy and learn. We open up to new possibilities and begin taking risks we didn't have the courage to take before.

Many of our patients tell us that facing the uncertainties of living with an illness makes life more meaningful. The smallest pleasures - eating dinner by the fire, walking the dog, the smell of fresh-cut grass - are intensified. Much of the hypocrisy in life is eliminated. When bitterness and anger begin to dissipate, there is an even stronger capacity for joy.

One patient wrote, "I love living. I love nature: being outdoors, feeling the sun on my skin or the wind blowing against my body, hearing birds sing, breathing in the spray of the ocean."

Yet another said, "I, like many others who are ill, went through a period of anguish and decided, yes, life is still beautiful, still precious and -- until the last breath -- worth fighting for. I have learned to truly value life, to cherish it, to enjoy it and appreciate its bittersweet brevity. When you make the momentous decision to live, you suddenly find that you never knew how to live life fully until you faced the reality of losing it."

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First appeared April 18, 2008; updated June 10, 2009