December 6, 2003


My patient looked out her window in the early autumn evening thinking that life was not only good, but couldn't be better.


She had just come through her treatment for breast cancer and was given an all-clear at her first annual visit. Her daughter was safely ensconced at university and, given the girl's special-education needs, achieving this goal was both a consolation and a culmination. And finally, her great love of gardening had been realized -- she could see the fruits of her labours from where she was sitting.


"Good things come in threes," she thought.


A niggling doubt arose in her mind, born of many years struggling through black despair and bedrock aloneness: "Don't ever let down your guard."


The call came less than a minute later. Her mother had been gripped with terrible pain, and needed her help. Fast. The outcome of their race to the hospital was the discovery of an unknown cancer in her mother's bones. Chemotherapy was instantly begun, and the family was quickly dispatched to arrange for the kind of home care that would be beyond their slender resources. As my patient quipped later, they needed one daughter to care for her mother physically; one to do all the research about her illness and one to provide money for all the extras.


What kind of extras, beyond ensuring that one of the adult daughters would be with their mother at all times?


None of them lived with her, and only one lived in the same city. While mom was proud of the independent life she had crafted after their father died, the daughters were alarmed.


Clearly, she could never be left alone now, so it fell to my patient to divide her time between her home and her mother's, between work and caring, juggling times, places and jobs.


She had only one question: "Where will I find the strength?"


She was terrified that all her added stress would activate her old depressive patterns, and she would soon sink into frenzied anxiety. Anticipating an inexorable slide into withdrawal and despair was as alarming as watching her mother's swift physical decline.


I assured her that her old depression was safely under the lock and key of Prozac, that her hard work in therapy had given her a different way to ward off the black thoughts, and that her mother may indeed be afforded one more act through her treatments.


For another patient, returning to work after a year of maternity leave was the trigger for a checkup. But it quickly became clear that she needed more than a physical.


Now with two small children, she had come to a painful realization: Her semblance of marital accord was a sham, and her year of trying to resolve the issues with her husband had been a waste. She is withdrawn, increasingly isolated, fearful her old depression will return. She used to exercise a lot, but can't muster the effort to get to the gym. In fact, her checkup was the first thing she had done for herself in a long time. An only child, she lost both her parents to cancer a few years back, and she'd hoped her little family would protect her from the profound loneliness she had experienced after that loss.


She has decided, though, that the "for worse" part of her marriage vows isn't enough to keep her in a relationship that has failed to nurture either her children or her own needs. Shouldering the responsibility for everyone's happiness is beyond her. Where is her help? she pleads with me, as she prepares to start anew, with two very young children.


She doesn't drive, so she'll walk her kids to the babysitter. But getting them there and home between work is a formidable task. Still, as all her woes spilled out, she was also preparing to reach out for help. Her company offers an excellent Employee Assistance Program, and she's open to therapy herself (though her husband is refusing to join her, she hopes her actual leaving may bring them together, or at least into a counsellor's office). If she's like many of my other patients in the same straits, she'll reach out more and more each day, to friends, asking for their help.


Getting back to work is part of that process, and she'll draw enormous support from Day One with her colleagues. Despite her ambivalence about going back to work, her job offers a haven and a way to reconnect with old friends and her old identity.


If your question is, "How will I find the strength?" a new kind of help is on the way -- at least for compassionate care.


As of the New Year, Ottawa will offer employment benefits for compassionate leave. This will be a boon to employees who have to take a leave of absence from work in order to care for a critically ill relative.


It's valid for up to six weeks; it's transferable, in that more than one family member can access the benefit (though not at the same time).


What determines eligibility? A serious likelihood that your relative will die within 26 weeks. The new program is meant to acknowledge that lost time from work to take care of sick family members costs Canadian business $3-billion a year, that 70 per cent of Canadian families are dual-income, and that the vast majority of home care is done by the family.


For my first patient, the next round of critical care for her dying mother will likely be eligible for some income protection. Her mom just has to hang on until January.

Dr. Jean



Doctor. Writer. Athlete.

Advocate. Adventurer.