Seven Ladies Laughing: A Meaningful Encounter in Palliative CareNatalie deQuillfeldt, MD, MA Oct 3, 2023
During my first week in Palliative Care, my team of four female providers was consulted to meet with the family of Gayle, an elderly woman of African descent with dementia who had broken her hip during a fall, requiring surgery. We planned to discuss how her dementia was affecting her quality of life and may impact her recovery. Almost instinctively, as I thought of what a tragic situation this was and what a mournful conversation it would be, the words of Jane Austen entered my mind - “Prepare yourself for something very dreadful.” I could not have been more wrong.
From the moment we entered the room, Gayle, her daughter and her niece radiated joy and love. While Gayle drifted off to sleep, her loved ones told us about her amazing life. She had been raised in a home in which the homeless were welcome on Thanksgiving, bathed and fed by her own mother. She had married a military man and raised three children in New York. Her family described her as bubbly and fun, the rock of the family. Despite being in her eighties, she still enjoyed dancing, music, art, and good food.
“She even sang Bob Marley on the way here in the ambulance!” her daughter shared. She is a rare individual indeed who, in the words of her niece, “never suffered from anxiety, depression, or anything! Some people with dementia seem to get stuck in a time of their life. But I think she’s so happy because it doesn’t matter what year she could get stuck in since she lived such a wonderful life!”
Gayle had been an accomplished lady in her youth. Her work even led her to a position in Washington DC where she trained executive secretaries. Though she and her husband separated, they remained close throughout their lives and even came close to remarrying. “My dad even bought a ring and everything! But she said no. She was enjoying her freedom!” Gayle’s daughter joked before sharing a funny story about how she had found out her parents were divorced as a child from her Sunday school teacher. The room rang with their bright, clear laughter. And with ours.
The conversation shifted to how Gayle had come to live under the care of her daughter and niece. There was pain and hurt in their eyes as they related how she had been staying at an assisted living facility in New York where some of her belongings were stolen. Yet they looked at her move to Colorado as “not being a burden at all.” In fact, these three women leaned on each other for support. Gayle’s niece regularly took care of the elderly as a live-in nurse and admired her great aunt’s resiliency and ability to perform her activities of daily living independently. They were able to care for her 24/7 while also maintaining the ability to continue to working part time and traveling several times a year.
The provider leading the conversation smiled at the rest of the team and said, “We’re not used to having families who are this…equipped to take care of their loved one.” I think that encompassed the gist of my thoughts during this conversation. I was given the opportunity to admire the courage, vitality, and generosity of a respected elder, and I was also in awe of the two strong women caring for her! Their positive outlook allowed them to find hope even in the situation of her hospitalization. They concerned themselves with the maintenance of Gayle’s dignity and independence while also respecting their own boundaries, limitations, and self-care.
I could not help but think of my own mother, who first became ill from a stroke when I was an undergraduate student, and how my time as one of her primary caregivers was honestly one of exhaustion and anguish. I thought of how I might have another chance to care for her in the way modeled by this lovely family. Most of us will have to help take care of a loved one at some point, and most of us will not find it as easy or bear caregiving with such grace. We may not work with patients who have lived such remarkable lives or families who are able to see the beauty even in a life well-lived. Yet, if we as providers can celebrate who our patients are as individuals, I think we’ll find that there’s a lot more to laugh about in Palliative Care.