People and Places

Palliative Powers

Mel did anything and everything he could not to die. At 70, he was often taken for a 50-something — he took care of his health the way he took care of his cars, never missing an appointment for either.

But it was a peculiar case, his cancer rare and aggressive. Though he looked as if he had just come off the golf course, we were told that the prognosis was not great long-term. Because he was still vital and strong, they would throw the full gamut of treatments at him: hormone injections, radiation, and chemotherapy. “Fill your boots” was always Mel’s response. He wanted more time, and he was prepared to do whatever it took. I was prepared to support my husband and best friend of 35 years in whatever he wanted to do.

The treatments did not go well, and palliative care was soon the focus of our meetings. In Ontario, 40 per cent of cancer patients do not receive palliative care — that is, assistance focused on the comfort and quality of life for people with chronic and terminal illnesses — in their last year of life. Fortunately, we had read about the benefits of early palliative care and knew that one can have it both while trying to live and in the last hours of life. We knew about the evidence that suggested earlier integration of palliative care can improve treatment outcomes and add years to a life. And Mel wanted more time.

At first, Dr. Christine Whetter at the Ottawa Hospital’s Cancer Centre helped us manage symptoms, allowing him to stay connected to the activities he cared about. Mel loved cars and he loved to drive. As pain medication became stronger, I questioned whether he could or should still drive. The response from the doctor was measured and sensitive: give it a few days to see how the new medication worked. She understood what it meant to him to lose one more pleasure.

Dying is an ongoing process of losses. While Mel was realistic about his prognosis, he never lost hope. He hoped that a new treatment might extend life. He hoped that he might start to feel a bit better. He hoped that he might go for that one more road trip, however short.

But palliative care meant more than just medical care. It meant that we were guided to discuss end-of-life options. We talked about medically assisted dying, about dying at home or at hospice. These conversations were difficult but eventually brought us some peace. Dr. Whetter was always candid with us. She told us that she did not think Mel would qualify for medically assisted dying because he would probably not be conscious when death was near. She helped us decide when it was time to call our daughter Emma home from her job in Germany. Better to have time when she could do things with her father. That advice gave her a precious month with him. It gave us time to have a special birthday party and another trip to the cottage.

Good palliative care helped us weigh the value of trying something else — a new treatment or a trial drug — and when it was time to stop. This meant a team approach: we would meet with both the medical oncologist (the doctor who was trying to slow the cancer) and the palliative doctor (the one trying to keep Mel as comfortable as possible). We trusted them, and it was never hard to reach a consensus.

Eventually, Mel left the hospital, which meant we transitioned to community palliative care. It was a scary feeling to leave the structure and support of the Ottawa Cancer Centre, but I was reassured that I could call at any time. Fortunately, the transition was smooth. Within a few days, a community-based palliative doctor visited us at home.

But then things happened fast, and his health declined with a sudden ferocity. Mel was so weak that he could no longer walk; he was restless and in pain. We were visited immediately by an excellent community palliative doctor who supported us throughout a traumatic weekend. Soon the referral was made to move him to May Court Hospice.

The minute Mel went through the doors of May Court, he relaxed. There was a palpable sense of relief and comfort for us all. I was embraced and was finally able to abandon the role of caregiver and return to being his wife. At May Court, I witnessed end-of-life palliative care at its best. The nurses, personal support workers, staff, and volunteers treated my family with such respect and gentleness. It was a privilege to share this most intimate time in such a special place.

Mel died on October 5 at May Court Hospice, just as we had hoped and planned. It was a long, difficult, and sad journey, but palliative care — both early and end-of-life — made it better. As Dr. Whetter put it, “When done well, palliative care is the perfect marriage of the art and science of medicine.”

Dianne Wing was Mel LaFloor’s best friend and wife for over 35 years. She was publisher of Ottawa Magazine for 13.