Not all of them, and rarely right away. But Tim Hofman, a Dutch TV presenter, has heard it while making a show about young people who can’t be cured: their illness and their approaching death were the best thing that had ever happened to them. Why would anyone who is dying say that?
What Hofman heard
I came across his answer in a Dutch newspaper. In June 2024, NRC, a national daily in the Netherlands, interviewed Hofman about a book he had written about fear. By then he had been presenting Over mijn lijk, Dutch for Over My Dead Body, for six years. On that program from BNNVARA, a Dutch public broadcaster, young people who are incurably ill are followed over a long period. Hofman wanted to present it himself, he says, because every question you ask there is urgent.
The interviewer asked whether being around death all the time had made him less afraid of it. His answer, translated from the Dutch:
“Absolutely. I’ve seen people step into death full of confidence. I should add that a whole process of grieving comes first. But I’ve also heard people say that their illness and approaching death is the best thing that ever happened to them. Because of the turn their life took as a result, and because of the bullshit filter it is.”
Two reasons in one sentence
Hofman gives two reasons. The first is the turn. The Dutch word he used, afslag, is the word for an exit off the highway. After a diagnosis like theirs, people end up on a road they never planned. The second is the filter. With little time left, much of what used to fill their days no longer makes it through.
Both reasons are about what came after the diagnosis: the road their life took, and what they stopped putting up with. And Hofman is clear that the grieving comes before any of it.
Does only Tim Hofman hear this? A psychiatrist heard something close to it decades earlier.
What a psychiatrist saw
Irvin Yalom, an American psychiatrist and professor at Stanford University, spent ten years working closely with people who were dying of cancer. In 1977, he and a colleague wrote about a group they had led for four years. People whose cancer had spread met there to talk openly with each other about what they needed and what they feared.
In Staring at the Sun, a 2008 book about the fear of death, Yalom looks back on those years. Many of those patients, he writes, “rather than succumb to numbing despair, were positively and dramatically transformed.” They rearranged their priorities “by trivializing life’s trivia.” They claimed the power to say no to “the things that they really did not wish to do.” They talked more deeply with the people they loved and appreciated the changing seasons, the beauty of nature, the last Christmas or New Year more keenly. Many grew less afraid of other people, more willing to take risks and less worried about being rejected.
One patient told him it was a pity to have had to wait “till now, till my body was riddled with cancer, to learn how to live.”
Trivializing life’s trivia. Hofman’s filter, in Irvin Yalom’s words.
One question on the phone
Would many patients say something like this if you simply asked them? Researchers at Indiana University set out to learn just that. In the fall of 2014, they recruited patients at the university’s cancer center in Indianapolis, all with advanced cancer of the colon or rectum. In the end, they analyzed interviews with 23 of them. In 19, the cancer had already spread to other parts of the body.
A psychology graduate student phoned each patient for an interview of 45 minutes to an hour. At one point, the interviewer asked:
“Some people talk about positive changes that have taken place since dealing with the illness. Have you experienced any positive changes since your diagnosis?”
Twenty of the 23 named at least one. Most often, they had grown closer to family, friends and co-workers. Others appreciated life more, had grown in their faith, felt more for other people who were suffering, or saw their priorities more clearly. One woman put it this way:
“I think I’m a little more light-hearted. I don’t bog down too much on things. If something doesn’t go right I’m like, you know what? It’s not the end of the world and we’ll get through this.”
Three of the patients named nothing. For some people in the study, the illness was a bad experience from start to finish. And the question opened by saying that some people talk about positive changes. I suspect that made a yes a little easier to give.
What they let go of
So why do people who are dying call their diagnosis the best thing that ever happened to them? Put Hofman, Yalom and the patients in Indiana side by side, and the reasons are ordinary ones.
They let things go. Obligations they never wanted, small worries, much of the fear of what other people think. With little time left, that became easier. What they held on to was mostly people: a partner, family, friends. And for Hofman’s young people, a road none of them had planned.
Is the diagnosis a gift, then? None of them chose it, and Hofman says the grieving comes first. What they call good is what was left once the trivia fell away. That is why I would leave the word gift to them.
A turn of my own
My own life took a turn for medical reasons too. After ten years in the cockpit, my work as an airline pilot came to a halt, and only later did it become clear what that set in motion. Yalom’s patient wished they hadn’t had to wait for cancer to learn how to live. I built Last Hour Experience so you can ask that question sooner: about an hour alone, with headphones, in which you live through your own last hour. What would you let go of first?
Questions people ask. One of them is me.
Do terminally ill people mean it when they call their illness the best thing that happened to them?
Some clearly do. Tim Hofman, a Dutch TV presenter who spent years with young people who were incurably ill, heard it from some of them, and he adds that a whole process of grieving comes first. In a study in Indiana, 20 of 23 patients with advanced colon or rectal cancer named a positive change since their diagnosis, and 3 named none.
What does Tim Hofman mean by a bullshit filter?
Hofman, who presents a Dutch TV show about young people who are incurably ill, uses the phrase for what happens to a life after a fatal diagnosis: with little time left, much of what used to matter no longer makes it through. Irvin Yalom, an American psychiatrist who worked with people dying of cancer, described the same change as rearranging priorities “by trivializing life’s trivia.”
Is it okay to tell someone with cancer that their illness is a gift?
I wouldn’t. In the sources behind this article, the positive changes were named by the people living with the illness, in their own words. In a study in Indiana, 3 of 23 patients with advanced cancer named none, and for some people in the study the illness was a bad experience from start to finish. If a gift is part of their story, it is theirs to tell.
Does a terminal diagnosis change the people closest to the patient too?
Often it does. In a study in Indiana, the family members who cared for 23 patients with advanced cancer were asked the same question, and 17 of them named a positive change of their own. One partner said: “[I am] not worried about the yard anymore and what the neighbours think. It’s like, you know what? The grass grows and it’ll get cut eventually.” Six named none. One wife said: “I can’t think of anything positive in having to deal with cancer. I’m sorry. I wish I could.”
Sources
Tim Hofman: ‘Ik wil niet ja knikken tegen iemand die iets op me af wil vuren’, Dutch for “I don’t want to nod along to someone who wants to fire something at me,” the interview by journalist Anne Dohmen in NRC, a Dutch daily newspaper, published on June 5, 2024. Dagblad van het Noorden, a newspaper in the north of the Netherlands, reprinted it on July 7, 2024. Hofman’s answer about the bullshit filter, the program he presents and why he wanted to present it come from this interview. His words were translated from the Dutch.
Group therapy with the terminally ill, the 1977 article by Irvin Yalom and a colleague in the American Journal of Psychiatry, a medical journal for psychiatrists. The four years with the group and what its members talked about come from the summary published with the article.
Staring at the Sun: Overcoming the Terror of Death, the 2008 book by Irvin Yalom, listed at Open Library, an online catalog of books. The ten years with patients facing death from cancer, the changes he saw in many of them and the patient who wished they hadn’t had to wait come from this book.
Positive Changes among Patients with Advanced Colorectal Cancer and their Family Caregivers, the study by Catherine Mosher and colleagues at Indiana University, published in 2017 in Psychology & Health, a research journal. The phone interviews, the question, the numbers and the quotes from patients and family members come from the full text in PubMed Central, the online library of the U.S. National Institutes of Health.