A FAREWELL WITH FAMILY
ABOVE: Dennis Wagner expressed gratitude for his care as he prepared for end-of-life.
How patients and doctors partner to make best medical decisions during end-of-life Dennis Wagner knew he had pancreatic cancer. He also knew it was inoperable and would eventually claim his life. However, as he lay in bed at Royal Columbian Hospital following new complications from his cancer, the 80-yearold Coquitlam man realized, with the help of hospitalist Dr. Joelle Bradley, how advanced the disease had become. Their discussion gradually turned to end-of-life. “Dr. Bradley came and saw me and more or less laid out the cards,” Dennis said from his hospital bed, with his wife Marleine by his side, two days before he passed away. He agreed to share his story out of gratitude for the care he received. “She (Dr. Bradley) laid it out very matter of fact,” Dennis
explained. “It sort of took a load off of my mind. Now I know where I am at.” With a shared understanding of his illness, she then asked him to consider what’s most important to him now. For Dr. Bradley, it’s important to understand her patients’ health priorities and goals. “I always have conversations with my patients, ‘if things were to go sideways and you weren’t recovering, do you have any guidance, anything you want me to know?’” she says. “I ask about goals. I ask about fears. I ask about what gives you strength, whether it might be spiritual faith or family.”
at Royal Columbian. Dr. Shawn MacKenzie, a hepato-pancreaticobiliary surgeon, bypassed a perforated bowel, which restored Dennis’s nutrition and helped keep up his strength. Later, gastroenterologist Dr. Ken Atkinson performed an urgent procedure, using a special powder that was invented for battlefield trauma, to stop a life-threatening internal bleed after Dennis turned up in the ER in near collapse. But with his cancer having advanced to a stage where medical options were ever more limited, Dennis told Dr. Bradley what was most important was to go peacefully. “I don’t want to be in pain and suffering and prolong it,” he said. Dr. Bradley then worked out a plan with Dennis that would allow him to remain comfortable while his family travelled to his bedside from Vancouver Island, Quebec, and England to say goodbye. Dr. Bradley finds her work very meaningful. She wants all patients to know, “Should you ever be in the situation where a physician is asking you about your goals and preferences and what the end of life might look like, it’s because they deeply care. If we can courageously enter this conversation together, we can make the end-of-life phase the best it can be.” LEFT: Hospitalist Dr. Joelle Bradley.
Finding comfort In the few months since being diagnosed with cancer, Dennis had ended up twice ROYAL COLUMBIAN HOSPITAL FOUNDATION I YOUR HEALTH MATTERS
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