Once Homeless, Now Dying - Part 1
Not too long ago, I was working as a community palliative care nurse in Toronto. I was visiting people who were dying in their homes, and my role was to make sure these people had everything they needed, and may potentially need, to die peacefully and with dignity. But of course, there are always some cases that will forever stay with you. Their journey through the healthcare system and the amount of suffering I have seen will leave you intrigued, chilled and confused.
On that note:
Welcome to the series of palliative patient stories!
On a cool summer morning, I was sent a referral to visit a young woman in her fifties. She lived in a Toronto Community Housing apartment building, and the fact that this client lived in a community housing building, I knew right away that her resources and supports are likely to be pretty low. Not once has this prevented me from doing my job though. It just meant that I had to be creative, and think outside the box.
The moment I arrived and entered her apartment later that morning, it was like nothing I've ever seen before. It was clean, but so incredibly bare, like someone moved out. As I stepped inside, the kitchen and living room had nothing but a plastic chair and a small couch, an empty spare bedroom to the left, and the last bedroom was where my client was resting. She was on a hospital bed with the head all the way up, an oxygen tank, a box of nursing supplies and a commode. Beside the bed on her side table, a plastic cup and a spoon and some yogourt. As a safety concern, I went back to the kitchen and checked her fridge - also bare, except for a small pack of yogourt.
I kid you not - this was all this woman had in her possession.
So I go back to meet my new admitted client in her bedroom. When our eyes met, the very first glance I knew this woman did not have long to live. I knew she had terminal lung cancer with a large mass on the right side of her neck from reading her referral...but little did I know about its' size. This tumor was massively round, pressing in her neck and against her jugular. Her veins were so protruded that I could visibly see her pulse against the mass - pounding dangerously fast. Her skin was discoloured, a redish-purple colour and her hands and feet were cold. Her circulation was limited, and her airway was obstructed. This was not going to be good, I thought to myself. Not good at all. My adrenaline started to kick in, and I began to work on her case.
Before I began to refer an entire team of dedicated workers at her footstep, I needed to know a bit more about her. I needed to know what kind of tools I had accessible. She could hardly speak because the mass was pressing against her vocal cords, but she was able to whisper. And her words were earth shattering.
A bit over 2 weeks from that moment, she told me about her lifestyle. She was homeless, and lived in a park a few minutes away. She's been homeless for the past 2 years of her life, anxiously waiting to be next on the extremely long, 7 year Community Housing waiting list so she can finally get off the streets.
A gentleman suddenly walked in and interrupted the interview, but she explained to me that this was her boyfriend, and that they had found each other in the homeless community. They looked after each other. They were family. He eventually joined us, and talked about their previous life together.
A little over 2 weeks from then, Martha* was feeling short of breath, and decided to go to the emergency room to get it checked. The hospital admitted her, and placed her up at the Palliative Care Unit for a few days. Martha was told that she has a life-threatening diagnosis of lung cancer, and she only had a few weeks, maybe days, left to live. She made all the staff aware that she did not wish to die there, but she wanted to have a home to die in. And by some miracle, her name was bumped at the top of the Community Housing list, and by God, she got herself an apartment.
The very apartment that we're having this conversation.
Neither one of them had any other family around other than each other. They shared with me how they got around, and how they managed to survive on the streets. They shared with me how they had 'a guy' for some resources like gum or toothbrushes. Supplies were scarce, and the money for Martha's pain medicine was getting difficult to afford. Her boyfriend would be out all day, asking strangers for money. Sometimes Martha would actually stop taking her medicine to make it last longer, or because she didn't want people to think she was a drug addict...There was so much pain, suffering, and sadness in her life. Her experience was something I never could have ever imagined..
That was my sign that her ultimate wish was to die in this apartment. After all this woman has gone through, helping her get to that wish was the very least thing that I could do - and I planned to do just that.
I began by conducting my usual nursing assessment to see what kind of care she would need. I was offering her everything and anything that I could get for her. Daily nursing, personal support workers 4 times a day, meals on wheels for each meal, cleaning supplies, toiletries....everything I could think of. I wanted to make sure the last few days of her life were as comfortable as possible.
By the time I left her apartment, my heart sunk and broke. I suddenly realized just how fortunate I was to have the life I live today. A roof over my head, the essentials of living, a healthy body, a good job... I honestly couldn't believe the case I just opened, or that people in Canada suffered this way...
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Martha*: Name was changed for privacy protection
