David Di Fonzo is a second year internal medicine resident at McGill University.
I remember the feeling when I awoke to the phone ringing. Something was wrong. Later that morning, I arrived at the hospital to find my grandmother lying intubated. My family and I were informed that her stroke would prove fatal. I had not anticipated that my final semester of high school would coincide with this unexpected loss. A palliative care nurse named Mary was assigned to look after our grandmother.
I cannot recall specifically what Mary did, but rather how she did it. She performed each task with a calmness that revealed how well acquainted she was with suffering and grief. Through her gentle presence, we felt assured that my grandmother was receiving the utmost care and attention. This peace of mind allowed us to simply sit together as we talked, sang, prayed, and accompanied my grandmother as she left this world. When Mary informed us that my grandmother’s heart had stopped, it concluded an experience which, while tragic and grief-laden, had also been transformed into something beautiful. While I grieved my grandmother’s death, I found gratitude in the peace and comfort that were present during that time.
My mother often told me that death and dying can be beautiful. But I didn’t believe her. I was certain that these processes consisted solely of suffering and pain as we all eventually succumb to our own mortality. After my grandmother’s death, I realized that my mother was right. Mary had enabled my family and me to witness a beautiful death. More than the framing of death itself, it was her healing of the living that was especially needed.
In sickness, a cure may not be possible, yet healing is always possible. Palliative care fosters this in various ways: in its attenuation of physical suffering by pain management or optimal feeding methods, for example, but also in alleviating the emotional and spiritual suffering experienced by patients, their families, and their community. While bearing witness to death and dying, many of those involved become internally wounded by the tragedy. The palliative care team responds to this internal suffering, with their presence and service, to provide love to those who suffer. My family and I experienced such healing through Mary; we received care and service without stipulation or conditions. This is rare in a world where giving frequently exacts something in return. We had each been loved unconditionally by Mary and her healing was what gave us the courage to seek meaning amidst our suffering.
Viktor Frankl wrote about a universal human need to find meaning amidst suffering. Whether it be the patient, the family, the community, or the healthcare team, all those who encounter death and dying will experience some form of suffering which, devoid of meaning, may cause despair. However, if one can discover meaning in the midst of such suffering, one might experience hope rather than despair. But it might take time to find meaning. For me, recognizing one aspect of meaning took 9 years.
Nine years after my grandmother’s death, I was a medical clerk in a palliative care team, looking after a patient who had advanced cancer. In the week that followed her admission to the hospice, I checked in on Antonia and her family daily. I knew how it felt to be in their position; therefore, I attempted to conduct myself as Mary had. For instance, I made a point of always speaking to Antonia as if she could understand me even when she was no longer responsive. I wished to treat her with the same dignity I had seen Mary offer my grandmother. Just as I had experienced the beauty in Mary’s approach to palliative care, I sought to offer the same to those I was now serving. In so doing, I began to understand that the physician also receives when giving palliative care. For, in giving to others, we too receive joy at witnessing the healing power of our presence and actions. This joy offers great consolation to physicians as they see the potential for light amidst darkness.
I have been privileged both to witness and assist in offering palliative care and I have experienced its benefits from two perspectives. I have come to see how palliative care transcends the difficulties brought on by death and dying. To transcend suggests rising above something rather than resisting or defeating it. Mary’s care did not cure my grandmother’s stroke nor prevent her death. Mary was not seeking to beat death, but rather to heal, beautify and offer meaning in a dark time. I hope I did the same in my brief service to Antonia and her family.
Editors’ note: Details of the patient and family have been omitted and all names have been changed.
Bravo. Thank you for a personal blog showing us your transformation from receiver of care to giver of care. Not everyone manages to cognitively connect the dots as you have , well done.
I am privileged to call you a colleague