Among the gifts that Dr. Tom Watterson has offered during his thirty-year tenure as a physician at The Bloom Group’s May’s Place hospice, his insights and perspective in the hospice movement and palliative medicine, all grounded in the growth of May’s Place, stand out.
On the eve of Tom’s retirement, The Bloom Group’s Executive Director Jonathan Oldman sat down with Tom to discuss what May’s Place, the first free-standing hospice west of Toronto, has taught him about respectful and dignified end-of-life care for all; a summary of their conversation follows.
Jonathan: How long have you been one of the physicians at May’s Place?
Tom: I have been at May’s Place since its inception nearly 30 years ago. I actually interned and then was one of the physicians at the Downtown Clinic when it first opened on Cordova Street next door to Victory House. It was there that I met May Gutteridge. She worked as head of the St. James Community Services Society [the former name of The Bloom Group]. A friend of mine who ran the Downtown Clinic went to Victoria with the idea of starting a hospice but got nowhere. I talked to May about it.
At the time hospice was really not a common phenomenon. There was one in Toronto, and the sort-of-leader of the hospice movement was Doctor Cicely Saunders in England, so I took a course there and came back to Vancouver and approached May again about getting a hospice.
You could have opened a hospice anywhere, but why the Downtown Eastside? What was the impact?
It was the place I knew. I’ve always been drawn to the Downtown Eastside because it’s a village in a way where everybody begins to know everybody.
I think it gave some relief and knowledge that people could come here without dying in a hospital. Everyone else would die in a hospital at that time. Dying in a hospital at that time typically meant a room on most wards where people were left.
Initially, it was six beds with typically elderly men with COPD (chronic obstructive pulmonary disease) or lung cancer.
The elderly guys with COPD were the old-school Downtown Eastside population, those guys in the SRO and who worked in the resource industries, right?
Yes, and alcohol and heroin were the drugs of choice. The hotels are full of ex-loggers who had bad backs. That’s all changed now.
Then the AIDS epidemic hit. Many of the patients at May’s Place were infected IV drug users. It hit pretty hard in the Downtown Eastside because DTES was an IV heroin place and instead of snorting crack, people started shooting crack and cocaine. Very rapidly, the hospice became six beds, three of them were typically filled with AIDS patients. They were incredibly difficult cases, often with many terrible symptoms.
Today it’s a different mixture of things, trending more towards difficult patients – psychiatrically and addiction-wise. It sort of evolves over time.
Many people from the outside of this community see all of the services and believe some things not working. How do you see all these things coming together?
Well, May’s is a perfect example where two things are happening. You know, people have quite serious psychiatric disorders with an end-stage malignancy. I think that’s somewhat unusual combination that quite often gets steer cleared of outside of the Downtown Eastside.
How close or far away are we from everyone in this community having access to end-of-life care?
It’s pretty good, actually. The trouble is the difficulty with providing it. I went on a house call yesterday to a guy who has carcinoma on his lung. He is not psychotic but is a very isolated guy who has lived in a local SRO hotel for 10 years. We have found a beautiful place with extra support he needs in South Vancouver, and we can’t get him to go there. He won’t go. He sleeps on the floor. He drinks a bit but doesn’t really use drugs or abuse alcohol. He is just this isolated guy, but actually has a lot of care: we come to see him, home care comes to see him, and he has wound care at Powell Clinic.
Some patients pop up really at end-stage because they don’t seek help right away. We see that at May’s Place when people who have really end-stage malignancies go to hospital, are untreatable and are sent to us sometimes.
This is one place that people know and are quite thankful that it’s here
With all of the changes, what does May’s Place mean to the Downtown Eastside today?
This is one place that people know and are quite thankful that it’s here – especially the care providers who know that there’s a place for terminally ill people.
As I think you know, many of the residents here don’t have future plans in mind. It’s often quite difficult to get them into hospice, difficult to get them to understand that there is a need for them to be cared for now, so that quite often makes it difficult.
And while supportive housing or long-term care facilities offer end-of-life services, you still need to the hospices to deal with those complicated cases.
Yes. Though the ideal is dying at home, many people can’t because they don’t have support. To die at home, you actually need a family. So many people here don’t have family members. It’s the vast majority. Today at May’s Place, we have five patients and only one has family supporting them.
What will you miss most about May’s Place?
The staff is great, the atmosphere is good. I like the challenge of symptom management. And that is the best part of medicine in many ways. In many ways, we began to think of medicine as a curative thing, but quite often the best medicine is symptom management.
One last question; after 30 years of experience, what do you think makes a good palliative physician?
One with patience and a sense of humor. I think all chronic diseases need a sense of humor. Even when there is no hope, everybody wants hope.
The Bloom Group is deeply grateful to Dr. Tom Watterson for his gifts to May’s Place hospice and the Downtown Eastside community.