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Winnipeg Free Press - PRINT EDITION

Death and life in a palliative care unit

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As I turn the corner from the elevator, I come face to face with the corridor leading to the palliative care ward on the eighth floor of St. Boniface General Hospital.

At first glance, it looks like any other ward in a hospital. The corridor is filled with dollies piled high with supplies, towels, food trays, TV monitors, tables with yellow gowns and antiseptic dispensers, and often a stretcher.

 

I bob and weave down the corridor. I pass the nursing station, glancing at the board to see which nurse will care for my family member on the current shift: Kirsten, Kristen, Neil, Dana, Gina, Chelsey, Brenda, or others. It really won't matter; they are all attentive, cheerful, gentle, never leaving the room without asking if he needs anything else.

His comfort, not a cure, is their goal. This is what makes the ward unique.

The attendant Paul is unusual. He is the resident roadrunner, always upbeat, darting in and out, putting on the brakes just in time to gently drop off or pick up what he needs to. You know he will not keep you waiting if he can help it.

As I pass the rooms, their curtains are always drawn sufficiently so I cannot see the patient. I just know someone is dying, and there is a family member, a relative or a friend quietly sitting there, perhaps reading a paper, perhaps thinking of pleasant memories or just staring into space.

After donning a gown and applying antiseptic to my hands, I will enter my family member's room. He is likely resting, his face lying to one side, sound asleep with his eyes half open, as well as his mouth. It is a look of exhaustion rather than peace. But not of pain or discomfort.

He does not stir for perhaps 30 minutes to an hour. What used to be a smile of recognition when he does awake is now replaced by eye recognition but little facial change. I just know he is glad for the presence.

We talk little. When I ask a question, there is a long, very long pause and eventually a quiet answer, often just a yes or no. When he sits up on the edge of the bed and looks at me I feel vulnerable; he seems to see right into my heart, my mind and thoughts.

I hope he sees my love.

Yesterday I got my answer. As I was leaving he squeezed my hand: "I think you could take me today," he said. I knew exactly what he meant.

When he was growing up, I always used to squeeze his hand and tell him he had to get on his knees and say "uncle." As he became a teen it was harder to get his cry for mercy.

I remember the day he promised: "You know one day you will be saying 'uncle' to me." Of course I was delighted when that time came. And now he was acknowledging that fun game we have played all his life.

My concerns have diminished. Now only the essentials matter. Is the pain level low? The nausea? I monitor his eating -- less and less, but he still likes a snack so I make sure the Monday afternoon cake treat and the Thursday afternoon snacks from volunteers are brought to him.

What about the stomach infection and the ever-filling bag? Did the bag burst in the night? In spite of multiple attempts to modify the procedure, the answer is often discouraging.

But what is more obvious is the resignation. There is no visible anger, no sense of frustration, no lashing out. Just acknowledgment of the reality. He is courageous, accepting, grateful. "Thank you" is probably his most frequent utterance.

Are his pillows comfortable? Is his laundry clean? Is his phone nearby? We have chosen his readings for his funeral, and so I find I read scripture to him less frequently. But when I ask him if he would like me to, he usually turns the question around: If you would like to!

Sheila arrives, stands beside him as he sleeps, and silently her rosary beads slip through her fingers. I weep as I pull a sheet up over him when he lies down, the only gesture of love I can express right now.

The team of doctors, often three, including two residents in training, arrive daily. They seem to change every two or three weeks. The charts are up to date, allowing a smooth transition. Currently, one resident is in advanced pregnancy -- a beautiful sign of new life in a ward where death is a daily reality.

They ask the patient about his treatments; they explain any proposed changes. Where possible they offer alternatives. It is a patient-oriented exercise, notably unhurried, calm, attentive. I feel free to ask any questions I want, even just for clarification.

Over a couple of days, I come to know the spouse, the daughter, the son, the grandchildren, aunts and uncles of the other patients. Those who can't come or don't come are known only to the intimates and the patient. The phone is an important communicator.

For some present, there is private grieving and they pass by with heads down.

For most, we exchange smiles and words of understanding encouragement. We talk briefly in the halls, at the coffee station or in the sunroom at the end of the hall. Some say they are praying for a miracle, others are resigned. Most of us simply don't understand the mystery of suffering and death. I pray for the peace that surpasses understanding.

I offer my family member a wheelchair ride to the sunroom. What used to be an automatic yes is now a rare agreement. We sit there looking out over downtown.

Like the patients, the buildings each have their own identity. The trains, like toys in the distance pass by in both directions. Most of all, we are captured by the junction of the two rivers. We watch skaters holding hands, we see youngsters developing their hockey prowess.

Then we watch the ice turn to water and the water rise as the spring melt makes its way into the rivers. The seasons are changing. More birds streak across the sky. Life is carrying on.

Further down the sunroom, a woman in her late 40s looks at her frail mother. Her smile is transparent, filled with love and concern for this mother who has obviously given her daughter so much of her own life. Right now she can do little for her mother, but she is in fact doing the most important thing.

In the evening back home, I write a note to family on my computer. Brief, inadequate, but a lifeline for those who cannot be here.

Death takes place very quietly. It is preceded by a larger number of family present, going in and out of the room, whispering in the corridor, brushing aside tears -- both men and women.

It is very private, intimate and not at all disruptive of others. Other patients don't even know.

Two days later an obituary appears in the paper, noting the courageous struggle that has gone on and invariably adding a word of well-deserved thanks to the doctors, nurses and staff of the palliative care unit.

 

Raymond F. Currie is the Dean Emeritus and Senior Scholar at the University of Manitoba. His latest book was his autobiography, Secure and Uncertain: A Father's Story. He is currently working on a novel.

Republished from the Winnipeg Free Press print edition April 21, 2012 j16

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