“Sex was a taboo subject when I was growing up, just like death and dying, come to think of it. And since I never even came close to conforming to the ideal body image, I always had a hard time of it.”

Raymond is a 50-year-old social worker at a home health care agency. He is thinking about applying for a position in the agency’s hospice program, but he is not sure if he is ready for the responsibility. “I need to better understand my own feelings about death and dying before I can hope to assist anyone else,” he tells me– hoping I can help him do this. “If I’m going to do this work, I want to do it well.”

Raymond’s mother died of ovarian cancer when he was seven, but he never really processed the loss. Now his friend Joann is also dying of cancer. Her imminent death has opened the floodgates of his unresolved grief associated with his mother. “I’m both drawn to Joann and repulsed by her all at the same time, and she knows it,” Raymond says. He’s confused and disoriented, and he no longer recognizes himself.

At a recent visit to his doctor, Raymond learned he is at high risk for heart disease. He also is considerably overweight. “I guess I’ve pretty much let myself go to seed,” he says. “I’ve always been a big guy, big-boned, as my mother would say, but now I’m just fat with a capital ‘F’.” The heart disease news didn’t come as much of a surprise.

Three years ago, Raymond went through a very acrimonious divorce, and his life was shattered. His three children live with his ex-wife in another state. He gets to see them only on holidays and for a month during summer.

After the divorce, Raymond lost his will to live. His weight ballooned, gaining more than a hundred pounds in a matter of months. “Maybe that’s why I’m considering this hospice move, and why I’m so ambivalent about Joann,” Raymond says. “Maybe I need to recover a sense of meaning.”

It sounds to me like Raymond is avoiding more than just his mortality– but sex and intimacy, too.

Raymond has never been comfortable talking about sex, and he has replaced sex with overeating. Turning to food was a lot easier than facing his own problems.

“I never had much confidence that I was a good lover,” Raymond confides. “When my wife left me, I figured it was because I was lousy in bed.”

However, for Raymond, intimacy was entirely different– and often enjoyed at the dinner table. He considers himself good at the art, one he calls “a meeting of souls.”

Sex was a taboo subject for Raymond when he was a child, just like death and dying. “Since I never even came close to conforming to the ideal body image, I always had a hard time of it,” Raymond says. “When I was older, I still let that haunt me, because I never had any confidence about my role as a husband or lover, either.”

I tell him that he is on to something. Our culture is indeed plagued with mixed messages about sexuality and intimacy. We can easily become obsessed with the image of the perfect body, with youth and beauty– and all of this can get in the way of finding a comfortable place to express ourselves as intimate, sexual beings.

I ask Raymond how important sexuality is in his life.

“I know I’ve built up this wall of fat to keep people out, and I can see that this crazy defense mechanism of mine will most likely kill me if I don’t get a handle on it,” he says. “I don’t aspire to being the world’s greatest lover, but it would be nice to stop running for cover every time the subject comes up.”

It’s never too late to relearn new and healthy ways to address our sexuality. I suggest that Raymond read up on the topic of male sexuality, and once he is more comfortable– he could move on to a partner.

Because Raymond is so comfortable at a dinner table and finds intimacy comes naturally, I ask him to bring the intimacy of the dining room into the bedroom. That way he could combine something he knows how to do well with something he is starting to learn.

He could invite a partner for dinner in bed. Plan a menu of finger food and other things to feed one another. Sex, like eating, should not be work– and maybe when Raymond gets really good at eating in the bedroom, he could try sex in the dining room.

Raymond should then take a long walk with his partner. The exercise will do him good, and he will have a perfect opportunity to do some more talking. I suspect that sex, sexuality and sensuality continue to confuse him because he knows very little about any or all of these things. Talking broadens our life experiences.

Learning to communicate is key to having a happy and healthy life– and death. Positive sex– and end of life– experiences are not mysteries. They are wonderful miracles, and Raymond is ready to welcome them both.