From the Editor

2020; Volume 22, No 1, January

One Letter May Have Made a Difference

By Alison Ramsey
IAHPC Newsletter Editor

The French have an evocative expression: cri de coeur. Literally, it means a “cry from the heart.”

More than a year ago, I wrote a letter—my cri de coeur—to the long-term residence where my mother endured an excruciating last few weeks of life. I gave a short description of her experience and, in a flight of hopeful fancy, dared to submit recommendations based on details of her treatment.

Mom, clever with her hands, made our old-style dresses and even the bonnets for our church’s 150th anniversary in 1970. Photo used with permission.

The nurses and personal care attendants were excellent, and the occasional doctor’s visits seemed useful, but we were all hampered by imperfect communication.

Despite her age (95), her physical condition (deteriorating badly), and level of pain (high, and becoming intractable), “comfort care” (their term for palliative care at the end of life) was not named, and was therefore denied.

This past summer, having heard nothing, I telephoned to follow up. The administrator had changed; I resent the letter, expecting nothing.

Then, just before Christmas, she called to report back. Nurses, including new hires, would take a 15-hour course on palliative care prepared by the provincial institute of nursing training. All personal care attendants would have additional training in palliative care, especially relating to symptoms (70% had already been trained). Nurses were given increased power to adjust and administer doses of painkillers. Patients would be fully evaluated at least twice a year, if their condition was stable, and more often if not; discussions about comfort care would be routinely enacted.

All this, despite COVID and the heavy toll the pandemic had taken, and was still taking, on long-term care residents and caregivers in Quebec.

It was the nicest shock I had all year.

My letter may have landed at the right time, with the right person, or had arrived as one request among many of a similar nature. I don’t know. But I do know that it gives me hope that one heartfelt effort can effect a positive change. Which is a wonderful feeling to have, especially at the beginning of a new year.


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