Posts Tagged ‘hospice’

Late last year I did an interview with Dr. Karen Wyatt, a hospice physician, speaker, author, and founder of End of Life University – a series of interviews with key figures in what has been called a movement to reclaim death and dying. The interview was great fun, as we shared our common passion for end of life care. I felt like I was having a conversation with a close friend (though we have never met!), so connected are we to improving end of life care in our two countries, and throughout the world.

Have a listen, and let me know what you think! Please feel free to share with your colleagues, friends, and fellow hospice volunteers.



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When I was doing research for my book “I don’t have time for this!” I created a number of google alerts on death and dying, palliative care, medical aid in dying, and elderly parents. I’ve kept those alerts active and, as a result, I receive a daily digest of all the relevant Canadian media items on these topics. I realize this probably makes me seem even weirder than I probably already did, but it’s given me access to articles and news stories I would not otherwise have seen.

The link above is one such story – a fulsome and thoughtful article about the impact our culture’s fear and denial of death is having on the institutions (hospitals, long term care homes etc.) and families in society – and the crisis it will create in the not-too-distant future. I urge you to read it – and to consider the impact that those of us who are involved in hospice care are having in breaking the silence around death and dying.

On another note, I’d like to welcome all the new followers to this blog, many of whom hail from countries where the fear of death is not so prominent. I would love to hear from followers new and not so new, about your own experiences of death and dying. Feel free to comment here – if  you have something more lengthy that you might wish to contribute, please send it my way so that I can consider including it on this blog.

If you’ve just happened upon this blog for the first time, please consider following it – there should be a button near the bottom right corner where you can click. I promise I will not be flooding your inbox. Also, feel free to scroll through the archive of postings and respond to topics from the past.


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I wrote the blog post below six years ago, as I faced the month of Christmas cheer (and excess) with which we are inundated, regardless of our religious faith or lack thereof. Each year, I find myself re-reading this post, as I remind myself that many many people find this time of year difficult. The loss of a loved one, an illness, an estrangement, painful memories, or longing for the memories of years gone by. And for many of us, the memories co-exist with the happy times and new traditions we have with grandchildren, friends, companions, and colleagues.

This piece is a reminder to all of us to think about those for whom this season is a challenging one.


You can’t miss the fact that we are approaching Christmas, even if you tried to. Elevators and malls pump out Christmas tunes, newspapers and flyers are full of ads for the newest toys, gadgets, and must-haves. ‘Tis the season to be jolly, we are repeatedly reminded, in case we had forgotten.

But what about those people for whom Christmas is not a season of joy? Many of us set aside food and sundries for homeless shelters, buy toys for underprivileged children, send an extra donation to our favourite charities. It’s great that Christmas provides an opportunity for generosity and gratitude and I have no doubt that these actions do make a different, however small, in people’s lives. Today, though, I am thinking about a largely invisible population – people for whom Christmas has lost some of its magic, whether because of serious illness, a painful separation, or the death of someone they love. Where in this season is the place for these people amidst the shopping and celebration and feasting?

I grew up in a family where Christmas was a “big deal.” Though the gift giving would pale in comparison to the extravagances many people engage in today, still our annual rituals of new vinyl records, a new dressing gown (with a crisp new $5 bill in the pocket), a silver dollar in our stockings, the obligatory item or two of clothing, and a few “special gifts” for each of us. I can still remember the amazing service station complete with car elevator that I received when I was 10. The fact that my not very handy father had spent half the night trying to put it together made the gift all that more special. I’m certain that my sisters have equally vivid memories of their favourite gifts.

When grandchildren arrived, my mother got the chance to embrace Christmas full force. She loved buying special fancy clothing for her four granddaughters, and to “spoil” my daughters with elaborate toys I couldn’t afford. She was in her element filling stockings with trinkets she had found throughout the year – and expensive necessities (a roll of stamps, a pack of subway tokens, bookstore gift certificates).

All that changed when my mother suffered a brain aneurysm in 1991. Though she survived the aneurysm, she was left with considerable brain damage, and could no longer walk, speak clearly, or care for herself. Shopping for Christmas was clearly out of the question. Without our mother’s zest for Christmas, something was missing in “family Christmas.” It wasn’t about the presents – it was about how much my mother loved giving them. She took so much joy in being able to surprise us, to help us, to make us happy.

When my sister Carol died in 1997, “family Christmas” seemed to end.  Carol was that person in your life who always knew exactly what you needed, even though you didn’t know it until the you opened up the present. A set of dinosaur rubber stamps for my older daughter who loved dinosaurs and writing stories. A kit to make beads from wrapping paper. A beautiful sweater suitable for work for me (no one but Carol ever dared to buy me clothing). As with my mother, it wasn’t the gifts themselves that mattered. It was the fact that she knew us SO well.

It’s not that Christmas stopped after my mother became ill and my sister died. But that particular carefree (for me!), joyful, special family Christmas did.

Strangely, it’s through volunteering in hospice that Christmas was transformed yet again. Each year, the hospice asks people to take on extra shifts, as regular volunteers fly off for family gatherings or stay home to cook and be with their own families. The year I graduated from the hospice course (2001) I eagerly signed up for extra shifts. I expected the hospice to be a sad and dreary place, as families celebrated their last Christmas together, or their prepared for their first Christmas without Mom (or Dad).

When I walked into the residence that year, I could hear singing coming out of Room 4. Jingle Bells. Joy to the World.

“Who’s being so inappropriate as to sing Christmas carols,” I wondered. I soon discovered my answer. Room four was filled with family, bearing gifts, shaking Christmas bells, trimming the tiny tree placed on the nightstand. And sitting up in the hospital bed was the queen of the day, wearing a Santa cap jauntily placed on her head, and joining in the festivities.

“You folks sure know how to celebrate,” I remarked.

“Oh yes. That’s the kind of family we are. Since she can’t come home for Christmas, we brought Christmas to her!”

I have never forgotten that image, though it’s been 11 years. Joy in the midst of dying. Celebration of life.

I learned that year that many patients “hold on” until Christmas, dying shortly after. My own mother waited so she could be with her family one last time. It is indeed a special time – not because of the presents, or the turkey, or even the beautiful music. It is special because it is a celebration of life – new life – and life well lived. And so, as I approach this holiday month, I’ll remember those faces in Room 4 that day, their joy and cheer and love. And hold all of this in my heart.


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When I first saw the headline for this NPR story, I thought it was a good news story! One in five patients being discharged from hospice! That’s amazing!

But when I dug into the article, I realized how wrong I was. You see, in the US, most hospice operate on a for-profit basis. They are looking for ways to improve the bottom line by moving out patients who might need costly medical procedures – re-admitting them after they’ve been treated. As well, there’s evidence to suggest that they may be over-admitting patients who might not be within 6 months of death, thereby insuring that they fill all their beds. This doesn’t sound like good news to me!

Hospices in the United States began much like those in Canada – through the pioneering efforts of people following the example of Dame Cicely Saunders, founder of St. Christopher’s Hospice in London.  Once Medicare began to pay for the “hospice benefit,” for-profit enterprises (including venture capitalists) began purchasing and establishing hospices. The result of this is described in the attached article.

We are not perfect here in Canada – hospices are not adequately funded by Medicare and millions of dollars must be raised by each not-for-profit hospice just to survive. Costs are kept down by the use of thousands upon thousands of volunteers – providing enormous savings in staff salaries and invaluable services of all kind. As many people have noted, volunteers are the heart and soul of hospice and the benefits we provide are immeasurable.

Volunteers are essential to American hospices as well, of course. In fact, to receive funding through the hospice benefit program, at least 5% of staffing costs must be provided by volunteers. That’s a huge incentive to organizations to attract and retain volunteers.

Not all hospices in the U.S. operate on a for-profit basis. And I’m sure that some of the for-profit hospices provide excellent, caring services for people at the end of their lives. Nonetheless, I’m glad that in Canada, so far, we’ve maintained the non-profit basis for hospice services established by the founders of the hospice palliative care movement.




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I have a very difficult time dealing with people who are exhibiting signs of serious confusion or dementia. Perhaps it’s because I’m what I often describe as “pathologically honest” –  the result, no doubt, of being a judge’s daughter.  So when someone asks me a question that seems to come from way out in left field, I have a hard time not responding with what I see as “the truth.” Whether or not that’s the right thing to do, however, remains an open question.

I’ll give you a couple of examples.

One of the first times I faced this challenge in hospice was with Margaret. She was a woman in her 80s with a large, loving family who surrounded her with music and laughter, grandchildren and treats. One morning, when I approached her bed to ask if she wanted anything, she beckoned me closer.

“The air is changing. Can you feel it?” she whispered.

I was at a loss as to how to respond. I certainly couldn’t perceive any change in the air.

“No, I can’t,” I began.

“Well, you should be able to. It’s going to be in the Toronto Star.”

Before I could ask her precisely what the air felt like, she began talking about a complex machine she’d been asked to work on. She described gears and levers and a fantastical operating system that she seemed to understand perfectly.

“That’s amazing!” I said, in all honesty.

A few minutes later, I found myself chatting with her adult children who were relaxing in the hospice sun room. I mentioned Margaret’s comments to me and they smiled knowingly.

“Yes,” her son said. “It’s hard to know what to make of it.”

“Some people might say it’s the result of the medications she’s on. Or a lack of oxygen in blood stream. But somehow it doesn’t feel like that to me. Any way, I’m not about to ‘correct’ her,” I said.

“Neither are we,” a daughter chimed in. “And you know what? The workings of that machine she’s talking about are far too detailed to be the result of confusion. Mom never had any interest whatsoever in anything mechanical, and now she’s talking about complex mechanisms she has no business understanding.”

We settled on it being part of the mystery and left it at that.

All these years later, I can still see Margaret, sitting up straight in her bed, pointing towards the gardens and the river beyond.


On the weekend before she died, my sister Carol had a clarity and drive we had not seen in months. That’s part of why I was so taken aback when she seemed so disoriented when I arrived at her house on Monday.

“What are you doing here?” she asked.

“Umm, I’m here to visit you,” I said, more than a bit unnerved.

“Katherine’s come to spend time with you,” her caregiver B. offered. “Just like she always does.”

The sound of my name seemed to jolt her back to the present. We chatted a bit about what I’d been doing and how she was feeling and things seemed back to normal.

Then, out of the blue, she asked if I still had her piano.

“Your piano?” I asked. “Of course I don’t have your piano. It’s right upstairs where it belongs.”

I’m sure she could tell by my expression that I was freaking out.

“Not that piano! My tape of the soundtrack from The Piano!”

“Yes, I still have it,” I said a little sheepishly. “Do you need it back?”

She shook her head, laughing. She always loved to tease me!

It would be the last time. The next day, we were faced with a medical crisis. And by Friday morning, she was dead.


I could provide many more examples of hospice patients who have exhibited everything from mild confusion to profound dementia. Some will ask the same question  over and over again, trying to make sense of their surroundings. “How did I get here?” “Why am I here?” “Where’s my husband?”

There is no simple answer to those questions, and I’m no longer sure that pathological honesty works in all circumstances. What use is it to tell someone who suffers from profound dementia that they are in a hospice, or that they are dying, or that their husband has preceded them in death? The greater likelihood is that they will repeat their question every five minutes, regardless of whether we provide an answer.

So what are we to do? I come back to the place where I always try to begin. Be with them. Simply be with the person as they are, with their confusion, with their suffering, with their sadness. It is by no means easy. But I believe it is a way to honour their humanity, in all its complexity and mystery.


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Last weekend I had the privilege of accompanying my aunt on the final days of her life. Long burdened with Alzheimer’s disease,  Aunt Ruth turned 94 on Friday, accompanied by a staff member who had stayed late Thursday night so she could be the first to wish her a happy birthday. On Saturday night at 11 p.m. she took her last breath, with another staff member by her side.

One of the longest residents of Fenelon Court, the long term care residence where she spent the final years of her life, Ruth was loved by the staff, who called her Ruthie, her childhood name I had only heard in family stories. She was the youngest of my father’s five siblings and the last to leave. She was spunky, spirited, outspoken, generous, and loving.

When we arrived from Ottawa on Friday, she was somnolent, no longer responding to visitors or staff. I had brought my ukulele with me on the trip, and knowing that hearing is the last sense to leave, I set myself up by her bedside and began to play. Whether she could hear me I’ll never know, but I like to think that the music of Leonard Cohen (Hallelujah) and the gentle words of The Water is Wide provided her with comfort on her journey.

As I played, staff came in and out of the room to check on Ruth, and to offer drinks or food to me. Each time they entered, I was struck by their gentle caring and familiarity with “Ruthie.”

“She’ll do it in her own time,” one nurse commented. “You always have, haven’t you Ruthie.”

On Saturday we spent much of the day with Ruth, giving my eldest sister a much-needed respite from the long days she had been spending by her side. Once again, I sang, shared birthday cards and stories with Ruth, reminders of the love that surrounded her. When we finally went back to our hotel at 9, one of the nurses reassured us that she would sit with Ruth. She remained at her side until she died.

The next morning we returned with my sister Judy to begin cleaning our Ruth’s room. Ruth’s body was still there, and I was glad for my years of hospice volunteering that helped it seemed perfectly natural. As I remarked on the volume of clothes in her closet, I couldn’t help but notice their beautiful condition – another tribute to the careful attention of the staff.

As we prepared to walk out with the people from the funeral home, a staff member lay a quilt over her body, and as we walked slowly to the front door, staff members throughout the building lined the halls, a gesture of respect I recognized from my own hospice.

Though I am writing this post to honour Aunt Ruth, I am also honouring the amazing staff at Fenelon Court. When I knew she was in a long term care facility, I had an image of hallways filled with patients sleeping slumped over in wheelchairs, a certain smell permeating the building. I had witnessed these scenes in other long term care facilities, and I was dreading seeing my aunt in such a place.

Fenelon Court could not have been farther from those expectations! The building is bright and clean, the patients engaged in activities where possible, and attended to with care in every encounter I witness. “We are their family,” one nurse told me. “Often they have a son or daughter who rarely visits. We are here every day and we love them. They’re our family too.”

Perhaps it’s because the facility has only 67 residents – and it is designed in pods so each area is relatively small and contained. Perhaps it’s because it is located opposite an elementary school and children often visit the centre, sharing drawings, Easter activities, and joy with the residents. Perhaps it’s because it’s located in a small town, a place where community really matters. But I think there’s something more – something I can’t quite put into words – beyond respect, dignity, caring, and love. That’s what I experienced with my aunt last weekend. And for that I am enormously grateful.

Fenelon Court



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Today is March 8th, International Women’s Day. So it seems appropriate to share this article about Dame Cicely Saunders, the founder of St. Christopher’s House in London and a pioneer in the modern hospice movement. Many people involved in hospice palliative care work in Canada and elsewhere were inspired by her work and her life. Dr. Balfour Mount (the Montreal physician who established the first palliative care unit and coined the term palliative care) and Dr. John Seely (a champion of palliative care in Ottawa and friend and colleague of Dr. Mount) both visited Cicely Saunders in London and saw first hand the importance of her work.

So today, I am grateful for Dame Cicely Saunders and the many many women who came before us, who paged the way for our work today, and shone a light on the possibilities of the future.




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