It is not hard to live through a day if you can live through a moment. What creates despair is the imagination, which pretends there is a future and insists on predicting millions of moments, thousands of days, and so drains you that you cannot live the moment at hand.
--André Dubus

The people I interviewed spoke often of the importance of living in the moment, of how they had learned to savor time with the people they loved and to seek out experiences that had meaning to them. Like them, you may have discovered that a focus on the present lends an intensity to life, permitting an appreciation and awareness of both inner and outer worlds. You may already be pursuing meditative and prayerful practices that help you to focus attention in the moment. You may also have begun to revise your goals to those which are short-term, and achievable, and to understand that worrying and regret represent unnecessary and painful trips to the future and past.

As medical sociologist Kathy Charmaz found in her study of people dealing with chronic illnesses, a moment-to-moment focus is related to the issue of control.

Living one day at a time is a strategy for managing chronic illness and structuring time. Moreover, it also provides a way of managing self while facing uncertainty. It gives a sense of control over one's actions and, by extension, a sense of control over self and situation.

Existential psychiatrist Irvin Yalom found that his patients, too, had evolved this method of coping, which he encouraged.

Many patients with cancer...realize that one can really live only in the present; in fact, one cannot outlive the present--it always keeps up with you. Even in the moment of looking back over one's life--even in the last moment--one is still there, experiencing, living. The present, not the future, is the eternal tense.

In discussing her perceptions of how cancer patients, including herself, could best come to terms with what was happening to them, Dr. Rachel Naomi Remen told Bill Moyers:

My sense is that the worst thing that happens in life is not death. The worst thing would be to miss it. A friend of mine, Angeles Arien, says all spiritual paths have four steps: show up, pay attention, tell the truth, and don't be attached to the results. I think the great danger in life is not showing up.

Many of the people interviewed for this book have come to this understanding on their own. For some, like Ellen Scheiner, the capacity for focusing in the moment came from a conscious cultivation of the meditative state, which she analyzed for its elements.

If there is awareness and concentration, there's a suspension of expectation because you're not anywhere else: you're here. In that way, it has helped me profoundly. The combination of awareness and concentration are extraordinarily helpful with life-threatening illness.

Others, like Barb Clabo, make this realization through the direct discovery that when they anchor their awareness in the present, their emotional distress becomes more manageable--at least as long as their "now" doesn't include a great deal of physical distress.

Staying in the moment is fairly easy for me to do. This is the only way I can survive. Thinking and dwelling on what the future might bring is too difficult and depressing, so I try not to let myself dwell on it. It helps when I am feeling well and working or doing things I enjoy. When I'm not feeling real well is when I tend to have bad days and think that I'll never feel good again.

Nancy Gilpatrick tells a story about her diagnosis that illustrates how a shift of focus into the present, combined with the companionship of people she loved, offered her relief in the midst of crisis:

As I drove home, I cried. Just let the tears flow. When I got home I didn't want to be alone, so I called my sister and told her. Even though I had prepared her by telling her of the appointment, she was stunned and cried. We cried together. I felt less alone talking to her. She immediately said she would be there for the surgery whenever I scheduled it. I was comforted knowing she would be with me.

When Terry arrived we talked about this potential cancer diagnosis (I had some residual denial in place) and about our plans for the evening. He wasn't sure I would want to go out. We had plans for dinner with people we didn't know well. I decided that there wasn't anything we could do staying home, and meeting someone new might be a good distraction. We also decided not to tell them. There would be no talk of breast cancer. The evening was wonderful and stands out to me vividly as a true gift from the universe: we laughed and laughed, belly laughs, laughing in a way I hadn't done in a long time. We played cards and just had a great time. I learned from that first night to laugh when I could, when any opportunity for fun arose to participate, and second, I learned the value of being in the moment.

Determination and self-trust also played an important role for Mary D'Angelo, as she learned to combine the uncertainties in her prognosis with a newfound and poignant pleasure in daily life.

I like to deal with one thing at a time, so I don't project into the future. I like the fact about my illness that even though there are statistics, my doctor doesn't really know what will happen with me. That makes me feel that I'm a partner with him in a way, that he helps me, but he doesn't have the answers. So why should I get worried, if there's no answer? If he were to say to me, "Well, you're going to die in three months," then I would get very worried--for a week, and then I would try to plan my death. So planning the death would be what would keep me from being overcome by sadness or anxiety. There's always something to do and to plan for.

I think life is so rich and so full, you only really understand that when it's threatened. It's a terrible thing to waste any time feeling depressed or anxious or anticipating outcomes that may never happen.

All people with metastatic breast cancer face a shortened life, and so time comes to seem precious to them. Many express concern about spending their remaining time engaged in meaningless activities or in states of fear and grief. Sue Tokuyama saw this as a preparation, whether or not her remission continued:

Suddenly, the pace of my life must be accelerated. Saving for retirement is an absurd idea. Waiting for anything important is a mistake. And rarely a day goes by that I don't think to myself: What has my life meant if I die today? I spend a good deal of what little alone time I have pondering what I want my life to mean. In the spirit of the idea that one is born alone, and one dies alone, I am trying to create the expression of me, that is not wife, mother, or friend. What am I in the universe? And I continue to try to find that perfect expression with words, and in clay, and even in the enthusiastic remodeling I am doing of our house. I am planting a garden. I am hungrily seeking wisdom, because I am not sure I have time to wait for it to find me.

Breast cancer has made me roll up my sleeves, and get my hands dirty in the business of living. If I live to be 90, I'll be richer for this experience. And if I die tomorrow, I hope I won't say that I'm unprepared.

Cancer patients and their families often dread the future, fearing debilitating treatments, pain and the indignity of dying. But these are really only fear-laden fantasies and memories--the reality, when it comes, is bound to be something else, something that can be planned for in practical terms, and then met and managed, moment to moment. The British writer CS Lewis, who chronicled the death of his wife, the American poet Joy Adamson, in A Grief Observed, articulated this clearly:

When the reality came, the name and the idea were in some degree disarmed. One never meets just Cancer, or War or Unhappiness (or Happiness). One only meets each hour or moment that comes. All manner of ups and downs. Many bad spots in our best times, many good ones in our worst. One never gets the total impact of what we call "the thing itself." But we call it wrongly. The thing itself is simply all these ups and downs: the rest is a name or an idea.

Pam Hiebert recalled a similar realization:

Last year I was having one of my long and valuable conversations with my father. I was going into much detail surrounding my thoughts and fears of death. At one point he interrupted me and said, "Pam! You are talking like this is a linear thing. You are talking like you see death as an end. Pam, don't you yet know--there is no death! There is no death, there is only life. Life is all there ever is!"

At that moment I felt a burst of insight. He was right! My concepts of trying to draw boundaries with each event were only adding to the tension in my life. These linear lines of perception I'd developed for greater certainty, were in fact setting up potential battle lines. In reality there is no boundary as such. I was planning a war because it served to boost my feelings of security. His statement reminded me that the world is actually a seamless coat of no boundaries. I was confusing my map of boundaries--drawn lines set between sickness and health--as the territory. And what I actually desire is to find my certainty in the security of the territory and not the boundaries that I imagine.

Glenn Clabo, advising the husband of a cancer patient who felt he was caught up in a nightmare of treatment and uncertainty, put it concisely:

Don't let the unsure future be the enemy of the now. We need only learn to enjoy now while it's here.