When Tomorrow Isn’t Promised: Lessons From Sitting With the Dying

There are parts of my work that feel clinical, parts that feel logistical, and then there is this other part—the part that feels undeniably sacred.

I sit with people who have cancer. With people whose bodies have betrayed them through chronic illness. With people who are staring straight at the thing most of us spend our lives trying not to see: the reality that tomorrow is not promised. If I can admit to anything, it’s that I believe less in karma now than ever.

Because the people I sit with are often the good ones. The mindful ones. The ones who watched what they ate, moved their bodies, recycled, did yoga, loved deeply, were kind to animals and showed up for others. And still—here they are. Randomly selected, in excruciating pain. No lesson. No cosmic trade‑off. No “everything happens for a reason.”  There is a felt sense of injustice that lives in my chest when I do this work. A quiet, ongoing protest. A knowing that fairness has very little to do with who gets sick and who doesn’t.

What I witness, over and over again, is how people choose to spend their last years… months… weeks. And I can tell you with absolute certainty: it is never about material items. 

It is always about people. Human connection. Real, deep, meaningful relationships.

The relationships they invested in. The ones they wish they had invested in more. The conversations they wish they’d had sooner. The moments they will miss—weddings, births, graduations, ordinary Tuesday mornings that suddenly feel impossibly precious.

I sit with mothers who will never watch their daughters walk down the aisle. Parents who won’t meet the babies their children may someday have. And there is no intellectualizing that kind of grief. It is gut‑wrenching in a way that bypasses language entirely.

We talk about the unknowing of the afterlife. About fear. About hope. About the unbearable question of “What happens when I’m no longer here?” When clients leave my office, the sadness doesn’t clock out with them.

I carry it.

I metabolize it the only way I know how—through gratitude, through empathy, through a kind of quiet alchemy. Sometimes with my own private tears. I take their truth and let it rearrange my priorities. I let it sharpen my attention. I let it remind me to make my moments with my people count. With my loved ones. With this one, imperfect, fleeting life.

Watching cancer, disease, and chronic illness slowly take the life force—the chi, the spirit, the soul—from someone who is very much still alive is a special kind of graceful hell. One I still cannot fully hold the weight of, no matter how long I’ve been doing this.

I ask clients how they want their last moments on earth to feel. Who they want around them. What their memorial would be like. What they hope people will remember.

The answers are rarely dramatic. They are tender. Simple. Human. Painfully beautiful.

If sitting with the edges of people facing their own mortalities has taught me anything, it’s this: the meaning of our lives is not found in what we accumulate, but in how deeply we let ourselves love while we’re still here. I am profoundly grateful for the clients who trust me with their time, knowing how finite it truly is. And that feels worth paying attention to.

Gratefully at the edges of life and death,

Mandy