COVER

On the front lines with death

Palliative care comforts the hopeless

JENNIFER HUNTER March 9 1998
COVER

On the front lines with death

Palliative care comforts the hopeless

JENNIFER HUNTER March 9 1998

On the front lines with death

COVER

Palliative care comforts the hopeless

Doris De Groot helps people die. A palliative care physician in Vancouver, De Groot works with patients in their last weeks or months of life, making them as comfortable and pain-free as she can. "To do what I do,” says the doctor, “you have to be able to walk into a situation where there is a lot of emotion, a lot of grief, and feel that you can create something positive out of it.” Her job is not just to help a patient deal with pain. ‘You’re helping them and their family come to terms with death,” says De Groot.

Palliative care workers—doctors, nurses, social workers, ministers—often step in when there is no other medical solution for patients. Most have cancer or AIDS, but some are dying from heart or lung problems or other causes. Yet De Groot finds her job much more spiritually uplifting than psychologically draining. Death, says the 42-year-old physician, is part of living, an experience emotionally akin to birth. “With the right support,” she affirms, “a family can experience growth and healing in the dying process.”

De Groot is part of a team working for the health board of Vancouver and neighboring Richmond. Her day typically starts with a rash of phone calls and pager beeps demanding immediate response. A home-care nurse’s patient is not coping well with pain; a family doctor is not sure what medication to prescribe; a despondent cancer sufferer is contemplating suicide. “Sometimes,” she says, “a family doctor will phone and say ‘I’m over my head, can you come and help?’ ” Family physicians do not always know how to alleviate a

dying person’s symptoms. Nurses cannot write prescriptions and do not always know how to negotiate their way through the medical system. So De Groot finds the equipment a patient needs. She frequently phones pharmacists and arranges for taxis to pick up prescriptions. She decides whether pain medication should be changed from oral dosages to a subcutaneous drip, and if the dosage should be increased.

The support teams also include the patient’s family doctor, a clinical nurse specialist, a social worker and a volunteer coordinator who sends non-paid, sympathetic “listeners” to the patients’ homes to spell off tired relatives or run errands. Volunteers also co-ordinate a team that stays in touch with relatives by telephone for a year after a patient dies.

De Groot spends at least an hour with new patients, determining how they are coping with the prospect of imminent death. She has them set goals for themselves—figure out what they want to do during their last days. “For most people it is overwhelming,” she says. ‘You need to help them find ways to overcome the emotional impact.” Yet her patients touch her, too, often in profound ways. ‘You learn from them and you are inspired by them,” she says. She recalls a couple in their mid60s who died within 24 hours of each other of cancer. Just before the wife took her last breath, the husband—succumbing to the last stages of a brain tumor and seemingly in a coma—reached over and took her hand. “That one act spoke volumes about the relationship between those two people,” says De Groot. “It transformed their 30-year-old daughter’s understanding of the experience of death.”

Thinking of a week when she visited three patients who were born the same year she was, De Groot concedes: “Sometimes my work hits pretty close to home.” She sometimes has to talk firmly to patients, such as a man in his mid-40s who tried twice to commit suicide. ‘Your nine-year-old son is watching how you manage your death,” she reminded him. “He will always remember how you died.” That, De Groot says, snapped the man out of his despair and allowed him to seize his last moments of life.

Up to a third of patients will experience deep melancholy, De Groot says, a problem that is usually alleviated with antidepressants. “Often people who are considering suicide are those who feel overwhelmed by their pain or symptoms or feel abandoned and despairing.” One of her jobs is to recognize a patient’s inclination to become depressed and step in with medication if necessary.

De Groot says she cannot condone doctor-assisted suicide but she respects a patient’s decision to end his or her life. “As a physician there are two questions to consider,” she says. “Do I think patients have a right to choice? Yes. But do I personally feel I have the right to take another’s life? No. It’s not for me to decide when you’ll die.” However, she will not try to revive a dying patient who has taken an overdose, nor will she resuscitate a patient who experiences cardiac arrest, unless he or she requested it beforehand. “We shouldn’t prolong life at any cost,” De Groot says. “For most of our patients, it’s medically futile since they are already so close to death.”

JENNIFER HUNTER