Suzanne met with her radiation oncologist for the last time just a week before her collapse. The radiation she was getting was itself purely palliative – aimed at managing her symptoms and providing some quality of life in her final months. But the referral was refused because Suzanne’s radiation oncologist was still caring for her.
Suzanne’s medical oncologist referred her to see a palliative care physician six months before she died. What she wanted and needed was to talk to a palliative care physician about the end stage of her disease, the situations she was likely to encounter and the decisions she (and I) would likely have to make.Īs a practical matter what we found was that it was impossible to get assigned to a palliative care physician while she was still under active treatment. In Suzanne’s case she did get an assessment by a social worker about five months before her death, but it concerned her physical needs while she remained at home, which were minimal. However, according to the Canadian Cancer Society, about 40 percent of cancer patients in the province do not receive any palliative assessment in the last year of their lives.
Officially in Ontario, palliative care can begin at any point in the progress of the disease. In Suzanne’s case this would have meant roughly two and a half years before she died. The American Society of Clinical Oncology recommends that patients with advanced cancer receive palliative care soon after diagnosis. But she had not been allowed by the health system to meet with a palliative care physician who could prepare us for her final days.
#If its alright id like to kick it with you all night how to
She had made a new will, shown me how to cook the spaghetti sauce our son Alex consumes by the litre, picked her cemetery plot and chosen the engraving for her own tombstone. Suzanne had done everything she could to prepare for her death. But we had never been allowed to meet with a palliative care physician until that hurried consultation in Emergency the previous day. Why was I so surprised? I later learned that this situation is not unusual for cancer patients in the final days. I had never imagined that in her final days, she would not be given the most rudimentary stuff of life that I would have to stand and watch that happen. The moment that Suzanne told me she had found a lump in her breast the moment it was diagnosed as cancer the moment sixteen months later we learned that it had metastasized all of these moments are indelibly etched in me with grief and shock.īut having attended every doctor’s appointment, waited outside the surgical theatre, sat through each chemotherapy session, gone to the radiation appointments, sat many times by Suzanne’s bedside in Emergency – and walked with her, travelled with her, laughed with her, swum with her and talked with her for many long hours during it all – the news that she would be cut off from food and drink came with a glance at a chart. When I asked the nurse about it, she checked the chart and said simply that the doctor had not ordered it. I immediately noticed that she was no longer being hydrated.
That came in the evening of the next day, when I returned from an excursion home to feed the kids and found Suzanne had been moved to the cancer ward. The doctor told me that at this stage in the disease, it would only “feed the cancer.” When I replied that this must mean Suzanne was close to death, the doctor answered – rather implausibly, I thought – that hunger strikers often survived for many weeks.īut this wasn’t the moment of greatest shock. And yet, it was only the next morning in Emergency that she and I met for the first time with a palliative care physician – someone specifically trained to attend to the needs of the dying.īy this point, Suzanne had not eaten in a day and a half, and I asked the doctor out of Suzanne’s hearing whether they would be feeding her intravenously. It had been clear for at least six months that Suzanne, whose cancer had metastasized to her skull and was pressing on her brain, had entered the closing stage of her terminal illness. She was obviously quite thirsty and when I asked one of the Emergency physicians to start hydrating her intravenously, he quickly arranged for that to happen. By the time the ambulance got her to Emergency, she was largely immobile and had great difficulty speaking. Suzanne had collapsed at home after having prepared her breakfast but finding herself unable to eat.
In the four years I accompanied my wife Suzanne as she endured the diagnoses and treatment for breast cancer, the most shocking moment came just five days before she died.
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