LW you are depressed as many have pointed out. You feel lonely. You feel your life is worthless. Why not change these things? Treat your depression and then change your life.

If I knew how old you are and what your other circumstances are, I might be able to better tailor my suggestions but it doesn’t so here are some general ideas that should apply to anyone in your position:

1. Volunteer for charity work, not only will you be doing good, you will enviably make new friends. Giving money to charity is great and you should continue to do this but being involved is even better.

2. Find a new job. Why do you think you need to stay at a job you hate? It sounds like the only one you are supporting financially is yourself so if you would enjoy working in another field that perhaps pays less, do it. If you need to go back to school to enter that field, do it. I went back to school to become an engineer. I did this while working and supporting my children. It was hard but now I’m done and I am making more money than I could have ever earned without a degree and I am doing interesting and rewarding work. It was hard but it did it. You have fewer impediments than I; you can do it. Even if you already have a degree or are a senior citizen this still applies. Plenty of people with degrees go back to school to earn another degree or simply work in a field that does not apply to their degree at all and seniors are going back to school in record numbers.

3. Examine yourself. Clearly you are at a place in your life where you do not want to be. How did you get there? It may be that you are just depressed and after medication your life will be rosy. However, if after being treated, you still feel that you are lonely you might want to examine why. Human beings are complicated and we often do things that are not in our best interests without ever realizing that we are doing these things. A counselor could help you or maybe even a good self-help book (anyone know some good books that help people learn social skills?).

4. Take care of yourself. Have you “let yourself go?” You don’t have to be a beauty to take pride in yourself. Taking care of your body and overall appearance can help us feel better. Exercise, eat better, get a make over, spruce up your wardrobe, etc. It’s not about giving in to pressure from a society obsessed with beauty. If you look “well put together” you will feel better and people will respond to you more positively—it’s a biological fact. More importantly, you will be healthier.

LW I am no Pollyanna. I have been depressed and I have contemplated suicide—many times. Life is tough and no matter what we do, sometimes bad things will happen to us and even if they don’t we may still fine ourselves wondering if our one little life really matters. I have decided mine does and I hope that you come to that conclusion as well.

This story does not parallel yours, LW, but perhaps you'll find something in it.

When my wife was terminally ill, she felt tremendously conflicted between her desire not to cling to a life that truly was not, at the end, worth living, and her desire for our children — who were still living at home — to know that she would never, ever leave them voluntarily. She agonized deeply over how she would know when it was time to go, and a good friend of ours, a priest (although we are not Catholic), was able to say to her, "You'll know. When that time is really upon you, you'll know."

And she did. When that time came, she was certain and serene. She knew that the balance had tipped.

I would say to you, then, that if you can't yet say, "It's time," it may not be. That doesn't mean it won't ever be, and I, for one, won't judge you when you decide it is. There is grace to be had in that moment. But be aware that it may not be a moment of not being able to go on, but a moment of finally being able to go forward. That may not make sense to you now; some day soon it may.

To those who say the cancer is not particularly relevant, I would disagree. Inevitability is a gift; it's much more wrenching to turn down help when so many are urging you to accept it. It's a different choice now, and in many ways a harder one.

I wish you peace, LW. It's your decision, and I will admit it's hell to watch.

You wanted to die, and so you attracted the cancer, you are where you are supposed to be right now. Ride the wave, ride it out into the open ocean. And read the Tibetan Book of the Dead before you go.

I work in a psychiatric emergency room. I see hundreds of people a month who want to die, or have tried to kill themselves in every conceivable way.

Some are angry that they are still alive, some are relieved that it didn't work. Some are dying quickly from fatal illness, some are dying slowly from alcohol. Because of my vantage point, I tend to think more about what can be done to change this thinking. [Given that a successful suicide is irreversible, and most suicidal thinking is episodic]

While each case is individual, they tend to fall in a few groups (always with exceptions).

1. Those who use suicidal thought and action as a means to calm their out-of-control emotions. They get emotionally triggered by an event and cannot tolerate their emotions, so their best coping skill is to tell a close relative that they want to die, or overdosing on pills in front of someone. This creates a crisis, and therefore the person doesn't have to feel their emotions at the moment. (Thus inherently is rewarding). The downside is this action: a)sometimes fatal b) wears out family, treaters, etc... c)never really solves the underlying problem of the intense uncontrollable emotion. Usually, the treatment of choice involves finding a good therapist and getting some DBT or other such mechanism to find more effective coping strategies to intense emotion. When the person who is suffering is willing to change their behavior patterns, they usually get healthier and find more adaptive coping strategies.

2. People who usually are doing well, but fall into a deep pit of depression. The psychic pain is so tough to endure that they feel death is the only escape. Usually in this case, the person is incapable of remembering not feeling this depressed and states they have "always felt this way" despite all evidence to the contrary. (One of the less helpful things our brains do is selectively remember all of the bad times in life when depressed). Usually, through a combination of medications, therapy and sometimes social interventions, these people can slowly get out of the pit. And usually in several months feel much better and regret their suicide attempt.

3. People who base their life in their accomplishments and tend towards the self-absorbed spectrum who suddenly lose that which makes them special (loss of a job, loss of power, loss of a critical relationship). They cannot envision a future without this item, therefore become suicidal. Most of the work here can be in rebuilding a life and building in supports.

Given the sheer number of people who attempt near lethal suicide attempts and really end up finding ways to enjoy their life after doing some work. I would rather err on the side of trying to help (even if the help at that moment is unwanted).

Also, having seen the family members and children of those people who have died and the irrevocable scar that it leaves in their psyche, I must say that I think of suicide as an angry aggressive murder of the self, which causes serious harm to people who love them.

One last thought... I'm leaving out the concept of end-of-life care, because I think that it merits an even more nuanced discussion, and is not the case here.

I don't know which category (if any) the letter writer fits under, but I think a good psychiatrist or therapist would be able to help in these regards and help reduce the suffering in the moment so that the cancer can be thoughtfully dealt with).