The Realities of Dying in Quebec
Ten years ago as a nursing student, my desire to work with elderly patients was deferred after a heart-breaking stage on a geriatric floor in a major Montreal hospital. My general impression back then was that as Louise McDevitt stated in her letter of the day last week “older people are being patronized, institutionalized and marginalized.” I knew after the stage was over that there was no way I could have a long career in geriatrics because I would have been in a constant battle with the system for better care for my patients, and there would have been no way I’d have had the strength to carry on such a battle for years and years.
Now, after ten years as a nurse, and with Bill 52 very close to becoming a reality, I feel privileged to have had experiences with dying patients, most of whom were children, as those experiences have taught me a great deal about the value of life. It was after one recent death of a teenaged boy just this past winter that I came to discover that in ten years, not much has changed. Society still appears to value the young over the aged especially when it comes to dealing with death, hence the need for a bill to legalize euthanasia.
The primary architect of Bill 52 Veronique Hivon and current Health Minister Gaetan Barrette have both said that it would only be open to persons 18 and over, the question then is: why? I have the answer: palliative care is far more available to patients under 18 years of age than it is for adults, particularly the elderly, because society would not stand for the kind of treatment the elderly go through when they are dying if that treatment was given to a dying child.
I was exposed to this harsh reality a few months ago when I took on a second job after my teenaged patient – who had palliative care – died. He died pain free, and even with me being able to provide him and his family with the one on one care that they needed for the entire day until he passed away, I still felt very empty afterwards. Later that night, I went to an adult off-island hospital for my second job, and one of my 12 patients was dying and was expected to pass-away within 24-48 hours. When I went to check on him early in the shift, I was horrified. The 88 year old was alone, with no palliative care available and with only regular morphine prescribed to him to be given every four hours. Despite my desires to stay with and comfort him in some way, and ensure he was medicated properly through-out the night until he died, I was told this was impossible due to a lack of nurses and resources. My other 11 patients also needed quite a bit of care needing iv’s, naso-gastric tubes, and extra fluids to keep their blood-pressures up, so I didn’t have time to devote to my dying patient. The other few nurses on the unit offered no support and seemed to take this all in stride as if it happened every night. I over-heard one of them say during shift change, “Il va mourir bientot”, as if it meant nothing. After the shift, as I drove home mortified, I couldn’t help but think, “perhaps this is why some people are in favor of Bill 52. I don’t want to die like that.” Feeling awful, with a terrible bout of insomnia after the seemingly sub-standard care that if felt like I was forced to give, 48 hours later I went to another adult hospital searching for hope. To my horror, nearly the same circumstances arose. 13 patients on the night-shift including a dying patient with no palliative care, not enough nurses, not enough time, I became a nothing but a morphine pusher and it felt like I was no longer even a nurse.
Children are not treated this way when they are dying so why are the elderly? In my experience, palliative care works but the reality is that because our society does not seem to hold our elderly in high regard, only roughly 1 in three have access to palliative care. Who then would not want to die quickly by being euthanized when faced with a death of suffering at the hands of care-givers who are turned into heartless drug pushers on a night shift? Our elderly are not stupid and I believe they know what is going on out there. Instead of backing a bill that seems to be a facile solution to a lack of resources and an ignorance of reality, perhaps Hivon and Barrette should go to hospitals across the province tonight and see how many dying patients are not getting the care they deserve.