People often look at those living with a chronic, terminal illness and call them strong. Brave. Inspirational. And they are. But not because they choose to be heroes every day. They’re strong because they have no other choice. Metastatic cancer, and many terminal illnesses like it, is not a disease someone recovers from. It doesn’t end in remission parties or five-year survivor ribbons. You don’t get to ring a bell and leave with an applaud. It ends in death. That’s the truth that rarely makes it into polite conversation. Until that day comes, life becomes an endless series of treatments, scans, and decisions. There’s always a new medication, a new side effect, a new tumor to deal with. Weeks fill up with appointments: surgeries, radiation, chemotherapy, palliative care, cardiology, and countless other specialists whose names become all too familiar. People living with terminal illnesses don’t just fight disease. They fight systems. Insurance companies, hospital scheduling, drug approvals, paperwork. The phone becomes an extension of their hand as they try, often in tears, to make sure they get what they need to stay alive. Every day demands the kind of energy reserves most people can’t fathom. Yet on the outside, many appear “normal.” Smiling. Chatting. Picking up kids from school. Posting photos that look like life is rolling on. But underneath, there’s exhaustion that goes beyond physical fatigue. Treatments meant to prolong life slowly damage the body in other ways. Hormone-driven cancers are stripped of hormones, plunging patients into medically induced menopause with symptoms that can leave a person feeling like a stranger in their own skin. Bone pain, memory lapses, insomnia, emotional volatility…it all comes along for the ride. None of this is designed for young people. Or young parents. Or anyone trying to juggle a family, friendships, careers, and some remnant of a personal life. And the emotional burden grows heavier because talking about it, even with the people closest to you, is often impossibly hard. Loved ones may care deeply, but they’re not living it. They don’t feel the daily toll. They don’t really know. And so many people keep the darkest parts to themselves, carrying the weight in silence because they don’t want to scare, burden, or alienate those they love.
Then there’s the financial reality, especially for younger patients. How do you keep a job when your life is ruled by scans, treatments, sudden progression, and crippling side effects? Physical pain, fatigue, and brain fog can make even part-time work impossible. Yet life costs money. House payments. Food. Medical bills that insurance doesn’t fully cover. Raising children. Trying to hold on to some piece of a future. Social Security Disability is often the only option. But when you’re young, the payments are barely enough to cover the basics, let alone support a family. And for some, especially younger patients, there’s an even harsher truth: they might not have worked enough years, or paid into the system long enough to qualify for Social Security Disability at all. Many spent years raising families instead of earning a steady paycheck, believing there would be time to build careers later. But when illness strikes, they’re left without the safety net people assume exists. Even when benefits do come through, they’re often far too small to live on, especially for those trying to support children. It leaves people trapped between impossible choices: stay alive, but lose financial security. Keep fighting, but risk everything else.
And whether someone is living with a terminal illness for years, facing it as a lifelong battle, or even if they’ve had earlier-stage cancer and finished treatment with no evidence of disease…there’s trauma. Because for many, even when cancer seems gone, the fear never fully leaves. Trauma from surgeries, scans, endless hospital stays, and the terror of waiting for results. Trauma from watching your body change, from pain, from treatments that save your life but also wound it in other ways. It leaves scars that don’t always show on the outside, and trauma responses that linger long after the doctors say you’re stable. It’s real. And it’s a part of this story too, even though it’s so often left out of the conversation.
Because metastatic cancer and many other terminal illnesses are often invisible, people don’t always understand. They look at someone who “seems fine” and wonder why they’re not working. Why they’re canceling plans. Why they can’t just push through. But these illnesses are hidden monsters. They live in the bones, the organs, the spaces in between. They’re relentless. And they steal more than health. They steal stability, certainty, and sometimes even dignity. People living this life aren’t avoiding loved ones because they don’t care. They’re not flaking out because they’re unreliable. They’re simply trying to survive the day. And then, if there’s a flicker of energy left, they’re pouring it into moments that matter; a bedtime story, a family dinner, a quiet hug on the couch. They’re not looking for pity. They’re not trying to say “poor me.” They’re simply hoping people might understand. Because the truth is, terminal illness wears you down. A day, a week, a month, a year. It’s relentless. And it’s lonely, because the world often doesn’t see it, or doesn’t want to. Until it happens to you. And God willing, it never will. But if it does, or if it happens to someone you love, may you remember this: Strength doesn’t mean the pain is gone. Positivity doesn’t mean it’s easy. And sometimes, just surviving the day is the bravest thing a person can do.
For all of us living this truth,
Crystal
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Letters To Life 