At first I was scared.
I had been trained to heal, to accompany, to give time and relief, but not to put an end to this precious and fragile gift that is life. I have always thought that palliative care was enough or should be enough to provide a dignified and painless end.
I interfered in the meetings of the managers of the application of the law on medical assistance in dying (MAID) as a dilettante, as a spy, to make sure that it was not a drift euthanasia. I was surprised and reassured to find tags there, so much so that I said to myself that I would never have the courage to embark on this paperwork myself, not to mention the tearing of the image of the doctor that I had made myself.
Then, over time, one of my patients asked me to accompany him to the end. He’d drank chemo cocktails for months and watched his illness demolish every boundary anyone tried to impose on him. I convinced him to try palliative care first, because I strongly believe that palliative care should always come first, but also because I was scared. Afraid to launch myself and to commit myself in the act. But he came back to the charge after two weeks of palliative care to ask me to offer him this ultimate care. As I had a few days of vacation ahead of me, I dived. We determined together a date, a time.
And that time has come. I was shaking. So much so that I screwed my first syringe on the tubing too much and my hands were too sweaty to unscrew it. The nurse present had to help me. My patient looked at me gently and accompanied me, when it was his moment. He was telling me it was okay, it was his deliverance, his choice. So I pushed on the plungers of the syringes, my heart pounding, while my patient’s was dwindling in beats, until it quieted down forever. I filled out the paperwork, and took days off to recover from my emotions. I didn’t cry right away, but afterwards yes. And I wrote a lot, because it’s my catharsis.
Subsequently, I had the privilege of meeting several times as a second opinion doctor. I have sometimes issued a negative opinion, halting the process and offering other healing options, but most of the time I have recognized the thoughtful wish of these beings for directed relief. I also responded to specific requests to accompany a few of my other patients through to the end, and each of these moments remains etched in my heart forever.
I don’t regret anything, but I always question myself. I don’t always have a vacation to recover from the gesture, but I try never to return to work the same day. Because this gesture remains and must remain solemn, immense, heavy.
Trap
I was the subject of an investigation by the Commission on End-of-Life Care. I was initially insulted and worried about it, then I understood that it was part of the process, of the guidelines. And tags are important. Now that the Act seems to want to relax and broaden the eligibility criteria for this form of care (recommendations are to be tabled by a committee of experts in the spring of 2022), my fears are coming back.
How to respond to legitimate suffering without slipping into a trap? Shouldn’t we solidify the offers of help upstream of this request? Palliative care at home or in a palliative care home, access to mental health services (read here: easy and supported access), real support for staying at home, support for natural caregivers, improvement of care in CHSLDs and RPAs… So many needs to be met before expanding access to MAID. This act should never become a free pass to a failing system, which struggles to meet the basic needs of a society.
And how to find doctors who will agree to dispense MAID, already so meaningful in itself, if it no longer makes sense to them? This act charged with emotions, requiring time and energy on the part of the doctor, does not fit with the requirements of a saturated network, which demands ever greater efficiency and productivity. Should there be caregivers directly trained and supported for this intervention of last resort?
In an already rickety healthcare system, tongue-tied after two years of a never-ending pandemic, how can we find ways to meet the demands of these broken beings without risking missing out on solutions? just as legit?
At first I was scared. And today, I am still afraid. My fear is beneficial, because it keeps me on my guard, protects me from excesses. But this fear should not paralyze us, prevent us from thinking and discussing together.
The medical profession is on the verge of a nervous breakdown, exhausted, washed, rinsed. But the suffering of each patient is real and cannot wait. How can these two distresses be secured without sinking with them? Social debate is useful and necessary. MAID is a precious treatment; let’s make sure it’s never overused. Let us dare to name these discomforts in the hope of finding a way there.