February 12, 2016
This past Easter my mother died. She was 75 years old and was active until the last month of her life. She was troubled by Rheumatoid Arthritis for 15 years and had constant joint pain and deformity yet managed to get around and see friends and family. She had few other health problems; she was a smoker. In her last weeks she had significantly worse joint pain and decreased mobility. As is common, she fell in her home, couldn't get up and came to the hospital via EHS. Her initial evaluation showed tumour in her hip but no fracture and a chest x-ray showed probable lung cancer. A subsequent CT-scan demonstrated extensive rib, spine, pelvic and liver metastasis.
She remained at the Halifax Infirmary. Staff and family met and attempted to arrange for care at home; difficulties arose because of her lack of mobility, intensity of nursing care and pain control issues. After a week of excellent care, she continued to fail. In the last days of her life she was surrounded by family and friends in a busy hospital setting. Every effort was made to accommodate the dying process; hospitals are busy, staff have multiple priorities, people and patients come and go. My mother had a good death, in a highly clinical environment, occupying a hospital bed that was in high demand.
This past Christmas my wife's sister died. She was 65 years old and was active until the last week of life. She was troubled by osteoarthritis for many years and had numerous joint surgeries. She had a few other health problems. She had breast cancer 12 years before, was a smoker and was diagnosed with lung cancer 2 years ago. She fell at home and was brought to hospital by ambulance with decreased level of consciousness. Her initial evaluations showed extensive spine, pelvic and brain metastasis.
She was transferred to McNally House Hospice in Niagara West. She was visited by friends and her extensive family in a community hospice setting. She received excellent end-of-life care, had very good pain control and nursing care. Her family was able to use the garden and kitchen, talk to other families and reflect about life, and death. She died surrounded by family, her favourite blanket over her bed, in quiet and peace.
There has been extensive debate in Canada these past two years about physician assisted-death. This debate is important, timely and controversial. It has occupied the resources of many medical, legal and advocacy groups. But this debate will only affect a handful of Canadians each year. It's not to diminish the importance of the issue, but rather to remind us that the vast majority of Canadians will not be directly affected by it. Most Canadians at the end-of-life have cancer, heart disease, dementia...common diseases and processes that claim our lives. Some early, some late. But, with crushing and unrelenting certainty, we all will die. To my knowledge there are no hospice beds in Nova Scotia and there are only a handful of formal palliative care beds. Many Nova Scotians will die in a hospital bed, will receive their end-of-life care in an acute care setting. For many, there just isn't another option.
There are organizations that wish to create a place where people and their families can go to receive end-of-life care that is person and family-focused, non-hospital, and accessible. These organizations deserve the support of our communities.
On paying it forward and why it makes a difference
My wife's sister and her husband were small business owners in Grimby, Ontario. Both Newfoundlanders, they constantly gave back to their community. They were approached several years ago for donations to a local charity. They donated enough to equip a kitchen and dining room. Their photo, and a plaque, are in the kitchen in McNally House.
They would never have known that this would be where she would die, surrounded by family. That her family could rest, have a meal and take time to reflect in that very kitchen.
Odd how the circle of life works, and what is important.
David Milne, MD, FRCP(C)
Doctors Nova Scotia