Palliative-care: unparalleled humanity in the face of unbearable suffering

A version of this piece originally appeared in the Montreal Gazette

David Sherman

If you're looking for heroes for all seasons, they're here, gathered in a few hundred square feet of the fourth floor of the Hôpital Sacre Coeur. This is not a unique group. Similar souls can be found holding up palliative-care units throughout the world.

When we first began the nightly commute to the rooms lining the lilac-coloured corridor to help my father-in-law die, I could find no grace here. I could see only unrelenting misery in drab, claustrophobic, airless cells. It seemed a gulag, scented with fouled linen and overheated air, and, for the few still capable of digesting, cold, institutional mush that smells the same in every hospital, everywhere.

There is no privacy for the vanquished who spend their last days here. Through each doorway cadaverous, dwindling souls can be seen, fed minimally by tubes, evacuated by tubes. Outside the boundaries of palliative care others are hooked to masks and pipes and pumps and wires but here, where there is no hope, technology does not intrude.

I visit my father-in-law almost nightly, girded by deep breaths and the impotence of positive thinking. I tell myself I am here for my wife and this is not about me. I barely know Roger who, after only two weeks in the ward no one survives, no longer knows me.

I quickly learn to recognize signs. When a neighbour's room becomes crowded with friends and family, it means another victim is about to depart or has already made the trip. Each night brings whispered news of yet another death. In one night, two deaths, in the same room. Death here is a juggernaut and the turnover in rooms and beds is fierce. Gasping, groaning, mumbling stick figures disappear overnight, only to be replaced by slightly hardier souls who will follow the same path. The only uncertainty is when.

I expected torrents of tears but families of the ill begin to recognize each other and smile, a sign of sharing, of forbearance, of compassion. I am dazed. People so stricken with grief can find the strength to offer courage to strangers in similar straits. For a few days and nights a family of sufferance forms, its members changing with the vicissitudes of mortality.

I have no defined role to play here, really, so I marvel at the perseverance of the loved ones of the doomed. They are a constant. Some sleep in the corridor. Some in the room. Some pace. Some offer food and drink and a soft touch. Some sit by the bed quietly. Some yell, as if sheer will can break through to wherever the dying go in the days and hours and minutes before they succumb. My wife holds her unconscious father's hand for hours, strokes his head, applies moisturizer to his scalp and face. At these most tender and intimate moments, I need to weep but cannot. Instead I pace the corridor, trying to avoid witnessing the similar tragedies inside every other room. Or, I take refuge in a traditional Quebec greasy spoon on Gouin, across from the hospital. The windows are fogged from the steam of conversation, coffee pots and boiling oil. Each night I find comfort in the crispy French fries, gravy, flat burger and the soon-recognizable regular customers and waitresses who seem to know everyone. Here, life goes on.

The bravery of the families in the ward of the dying, of course, is matched by the courage of the caregivers. Every night, Sylvie Pelletier is there with appropriate medication, smiles, jokes and tutelage in the art of watching a loved one die. Palliative care legend has it many wait to be alone to pass away. Hanging on for days then slipping beyond as soon as they are abandoned for a visitor's bathroom or coffee break or a breath of non-superheated air.

Sylvie's energy is as relentless as the diseases that ravage her patients. Every shift for Sylvie brings only greater dissipation to the tenants of the tiny rooms, as if a hand in the night has carved more flesh from the advancing skeletons, scooped out the cheeks a touch more, quickened the breath. She no longer checks the vital signs as she did only a week or so ago. She needs no electronic gizmo to tell her they are increasingly less

vital.

We bring her cookies for Christmas, we tell her thank you. She asks ``for what?''

Dr. Patrick Bellemare, like almost everyone else who works the ward, is under 40. Perhaps after a time the 100- per-cent mortality rate here wears a body down, leaving only the younger to tend those whose days are numbered. But for now he patrols this corridor religiously. He has only morphine and sedatives to offer; his patients' pain is etched in his own face, their grief seems his. He cannot save, only soothe, yet his touch is feather-like, his voice a whisper. He seems humbled by the calamitous diseases that wither his patients, but he remains their faithful student.

And as far as heroes go, who is braver than those confronting their own demise, can trace its approach on the squares of a calendar? Once rolled into palliative care, they know they will never again touch the snow or feel the sun. Their time is three months or less. Often substantially less. My father-in-law remained polite and patient with the staff, stoic and co-operative despite the indignities the disease and the medical profession had visited upon him.

The last time I walked these halls I found only grace, only courage, only remarkable people in every little room. If it is a gulag, it is one of unparalleled humanity in the face of unbearable suffering.