December 24, 2004


At this time of year, I can't help thinking about a couple of angels I have met. One was through a family, decimated by age, accidents and AIDS, leaving three generations of women without men sharing one household. And one of these women, having contracted AIDS from her husband, is slowly dying.


Her widowed sister is the sole income-earner, supporting them all -- ailing sister, plus the four teenagers they have between them, not to mention an aged mother.


Into this surreal scene, my patient stepped, fresh from taking the Community .Care Home Hospice training course, which was created in 1990 by Toronto's Metropolitan Community Church as part of their contribution to the AIDS Committee outreach of Toronto.


Since then, it has helped more than 1,000 men and women either live with

determination or die with dignity. Or both.


After rigorous training and a tough reference check, volunteers work four hours a week providing comfort and service to AIDS victims and their families.


My patient, too, has known tough times, fighting her way back from a depression that landed her in hospital and almost cost her job. Back then, she was encouraged to apply for a disability pension. She knew, as we all do, that such acceptance could mark her as a perpetual invalid. Seeing only years of drudgery ahead, she set her sights on recovering. As part of this process, she had signed on for the hospice course to fill her time and return some meaning into her life.


When the instructors called around for a reference check, they wanted to know her capacity to deal with difficult situations. Would she be up for it?


I supported her. After all, she had lost a 14-year-old niece to cancer a decade ago, so the churlishness of the teenaged girls in this household hardly fazes her. That said, she has never married, never had children, never mopped up vomit and diarrhea, never winced her way through cleaning scalded bums -- that is, until now.


But even I couldn't have foreseen what the task would eventually entail.


Now, she sits for hours at the bedside in an intensive-care ward as everyone in a family is prepared to "let go." She has kept a vigil that has seen her charge rally, then recover, then miraculously go home. There are nurses who come daily, there's family, but there are more than enough tasks to go around, including the most fundamental nursing care of all: gentle comforting, simply being.


The second angel is part of what to the casual observer may seem to be a strange threesome entering a local coffee shop.

The owner knows these three women and moves quickly to help them settle in. Two of them are rail-thin, clearly ill. The third, gargantuan by comparison, is coping with multiple sclerosis and is in a wheelchair. It's clearly a challenge for her friends with their the puny physical strength to push her up the street, and impossible for her to negotiate the small step into the coffee shop without help.


These three women are neighbours. They're able to check on each other simply by looking out the window, and that is how they fell in with each other. This and the fact that they are all seriously ill.


The "angel" is my patient and I've written about her before as a testament to her incredible AQ. (Adversity Quotient). She's a breast-cancer survivor, a long-term HIV/AIDS survivor and she has scraped through the drug treatment for hepatitis C that nearly killed her.


Having survived all this, who would have thought that she would find herself as an adviser, confidante, manager and caregiver?


But she's suddenly all these and more. The trio's coffee klatches have been expanded to organizing trips to cancer-treatment clinics for one of her friends. My patient can't help this woman care for her two babies at home. But she found a grandmother to take up these chores.


The unique contribution of my patient has been to create a sanctuary of sorts for the woman who has cancer and is slowly glimpsing the grim prospects for her and her young family. What she needs is a safe place away from the family to talk and cry. As this woman lost weight, my patient took her shopping for new clothes. As her hair fell away, my patient encouraged her to cut it off.


She remembered her own experience with chemotherapy, when she felt she had no control of any part of her body. Rather than waiting to go bald, she cut all her hair off. "Don't wait for it to cover the pillow and fill the tub," she advised. The hair went and her friend reported that she felt better for having done it.


And together, they went off to visit their third friend, now in hospital. She had fallen out of her wheelchair and broken her hip. As with many patients with MS, such an injury becomes a major assault on all her systems. And so when her friends arrived to visit her after her surgery, they found her restless, restrained and almost incoherent.


Once again, my patient stepped into the breach. She explained the effects of the drugs and the necessity for restraints and reminded her friend that her profound weakness was brought about by her profound stress. In a few days, things turned around and the bedridden woman was able to talk on the phone.


This was good, because her parents are very old and her mother has Alzheimer's, so getting to the hospital to visit their daughter is a challenge for the father. And so my patient keeps tabs on them as well.


I know that both of these angels will face even more demands than anyone reasonably has a duty to fulfill.


I know that caring for the dying is a wearing vigil that raises doubts in all of us about our capacity to endure sadness and loss, to find words of comfort that aren't prattle, to do the right thing by family and friends, and not to be worn into nothingness.


But these two women who need so much themselves are the very ones who share so much of their lives and offer so much love.


There is a line from Angels in America, the TV series adapted from Tony Kushner's marvellous play about AIDS in the eighties. The protagonist is in hospital with AIDS and he asks a favour of his Mormon visitor, a rigid icy woman who has been thrown together unwillingly with this terribly sick man.


"I've always trusted in the kindness of strangers," he tells her. Her clipped response is that relying on strangers is a foolish thing to do.


And yet it is the kindness of unlikely strangers, both in Angels in America and here in real life in Canada, that will see those most in need through this holiday season.

Dr. Jean



Doctor. Writer. Athlete.

Advocate. Adventurer.