Last summer, we thought Kathy would die. She had been admitted to the palliative care unit after suffering a fall, and losing her ability to speak and walk. She had been diagnosed with breast cancer a couple of years earlier, and this complication was considered to be a likely result of metastasis to the brain. But Kathy didn't want to die and she didn't want to die in hospital, so she amazed everyone when she regained her speech and enough strength to go home. It wasn't going to be easy to manage at home, however. Kathy lived alone. But with the help of community nurses and personal support workers provided by the Community Care Access Centre, Kathy was determined to make it work.

Kathy did something else to ensure that she was safe and comfortable at home. She reached out to her friends and family. Kathy's sister, niece and friends stepped up and organized their visits so that Kathy was not alone. They even stayed overnight. They wanted to take care of their friend until her death. But they gradually realized that Kathy had no intention of dying right away. They were happy and relieved that Kathy had stabilized and was clearly going to enjoy life for a while longer, but were becoming weary with their intense level of caregiving and were in need of some reinforcement. One of Kathy's friends, a VON Hospice Volunteer, suggested that Kathy consider requesting support from the VON Volunteer Hospice Service. Kathy agreed so I went to meet with her in February.

I was immediately taken in by Kathy's positive and realistic outlook and infectious laugh. She was very open with me about her situation and what she hoped we could do for her. Based on her easy-going, warm personality, I knew she would be easy to match. So by the next week, we had a VON Hospice Volunteer, Mary, spending a couple of hours with Kathy three times a week over the lunch hour, making sure that she was not alone while negotiating her way around the kitchen. Mary and Kathy enjoyed each other's company and the two became friends. They could chat for hours about any and everything, including Kathy's health, fears and wishes. Kathy had always been able to maintain a healthy balance of hope and realism about her situation. She knew that hope and palliative care are not mutually exclusive. Palliative care is all about comfort; comfort for the mind, body and spirit. This is just as important for those that hope for a cure as it is for those who hope for a good quality of life until a peaceful death. While Kathy knew that she would die from her disease, she maintained many hopes for the time remaining: quality time with family and friends, independence for as long as possible, and a plan to attend a few events of importance to her. One of Kathy's goals was reached in July when she was able to participate in the Cancer Society's Relay for Life fundraiser.

Along with these hopes, Kathy made careful plans about her expected death and made sure that her family, friends and caregivers were well aware of her wishes so that there would be no confusion as her disease progressed. Kathy did not want any life-prolonging measures other than comfort measures and when her heart stopped beating, she did not want any resuscitation interventions. Kathy wanted to live as long as she could while still able to enjoy life, but once her body began to shut down, she did not want to prolong the process in any invasive way. There are many ways that medical interventions may work to extend life but unfortunately, these efforts sometimes only prolong a quality of life that no one would anticipate or choose. By making sure that all of her caregivers knew of her feelings, and by completing a power of attorney for personal care, Kathy was confident that her wishes would be followed. Having made these decisions did not prevent Kathy from hoping for continued life, but it did allow her to make the most of every day, knowing that as her disease progressed, her care would continue as she had determined, even if she lost the capacity to make any further decisions.

Another of Kathy's hopes was to die at home but unfortunately, this was not possible. In early July, Kathy became too weak to manage on her own, even with the help her many caregivers, friends and family, so when her Care Coordinator advised her that she needed to be admitted to the palliative care ward, she graciously agreed. Terminal illness often involves reevaluation of one's hopes and expectations and Kathy accepted this fact with grace, never missing an opportunity to thank her nurses and other caregivers for their continued help.

Mary continued to support Kathy in hospital, and we involved a few more VON Hospice Volunteers as Kathy weakened, knowing that she loved having someone with her to chat, help her with a meal or hold her hand. Kathy died peacefully on a Sunday afternoon in September, surrounded by the love of her family and friends.

Karen would have been sixty years old this December.

– VON Algoma, Sault Ste. Marie