July 05
Published on: April 30, 2014 | Last Updated: April 30, 2014 4:59 PM EDT
Since Ken Owen heard the crushing news in October that there was nothing doctors could do to prevent him from dying, one physician  — palliative care doctor Darren Cargill — has really done a lot.
Cargill’s regular house calls, usually accompanied by a nurse, have helped Owen live without pain, discomfort and fear, until he dies.
“If I’ve got to go — I’d rather stick around, but if I have to go — then they’re going to allow me to with my dignity and they’re going to be there for me,” the retired Windsor social worker says in a video produced by the Ontario Medical Association for Thursday’s Doctors’ Day. It’s meant to showcase the kind of end-of-life care the OMA believes everyone in the province deserves.
Owen, 68, was diagnosed two years ago with esophageal cancer that has since spread to his chest and brain. In an accompanying thank you letter to Cargill, sent to The Star, he writes that palliative care is about making the fear go away when you know you are dying. He said that the idea that his beloved wife Madeline would have to watch him suffer as he died scared him more than anything.
“What Dr. Cargill has done for me, and for my wife, is make that fear go away.”
Cargill said the gratitude shown to him by patients and family really motivates him in this specialty he loves. “When someone has a lot of symptoms and pain, and I can do something to help that, and usually fairly quickly, that’s something that’s very gratifying for me as a practitioner,” he said.
People may think palliative care is doom and gloom, but it’s not, he said. “What palliative care is trying to achieve is providing the best possible quality of life for the time the patient has left,” said Cargill, the medical director of Hospice of Windsor and Essex County. He makes house calls to 90 per cent of his patients, helping them manage pain and other symptoms such as shortness of breath, nausea and the side effects from taking powerful pain medication.
“It’s almost like old-fashioned medicine where the doctor used to come out to the home,” said Cargill, who moved to Windsor in 2006, after doing a rotation here as a resident under the wing of the city’s only palliative care doctor at that time, Dr. Charmaine Jones. Jones retired shortly after Cargill arrived, leaving him as the sole specialist in this growing field.  Now there are three full-time and four part-time palliative care doctors. The resources here for palliative care — a team of social workers, nurses and other health professionals pitch in — means Windsor has it better than the rest of the country, where only 30 per cent of people have access to good quality palliative care where they need it and when they need it, according to Cargill.
Nationally, 70 per cent of palliative patients end up dying in hospital, whereas 70 per cent of them say if they had the choice, they would prefer to die at home. Doctors want to improve the 30 per cent number of people dying at home, Cargill said. In Windsor, the home death rate is about 70 per cent, he said.
A 70 per cent home death rate is very good, he said, since some patients will always need the high care levels only a hospital can provide. Hospice sees about 1,700 patients annually, 170 of whom use its residential unit with the rest seen at home or seen when they visit for out-patient programs.
A way for a doctor to decide if a patient is palliative is to ask the question: Would you be surprised if this person dies in the next year? If the answer is no, the patient would benefit from palliative care, said Cargill, who said doctors want to expand people’s thinking about palliative care.
“We want to make sure this kind of care is introduced earlier and earlier, because it’s not giving up,” he said, explaining that people can still receive palliative care while also getting treatment such as chemotherapy. “It’s making sure that we’re focused on what the patient needs, what the family needs.”
Many diseases are not curable, he said. “And we want to make sure we’re not ignoring these patients, that just because we can’t cure you we can still provide great care for you.”
When the video featuring Cargill and his patient Owen was shown on the weekend to the OMA’s governing council, it resonated with every physician in the room, said OMA president Dr. Ved Tandan, a Hamilton cancer surgeon.
“That’s the kind of care they would like to see for their patients and for their loved ones, and right now, people die in a hospital with advanced disease who would prefer to be home.”
The OMA expects to roll out its plan for end-of-life care at the end of May, and will use the Cargill/Owen video to showcase the need for improved access to palliative care services. The video was shot in March. Owen was not feeling well enough Wednesday to speak with The Star.
Tandan said he sees patients like Owen every day in his practice. “And he was very fortunate to have the kind of care he received from Dr. Cargill. It’s the kind of care every patient deserves.”
Ken Owen, a retired Windsor social worker dying of cancer, wrote this thank you to his palliative care doctor Darren Cargill:
One of the worst things a person can hear is that he is going to die, and that there is nothing his doctor can do. I learned that lesson two summers ago, when I was diagnosed with esophageal cancer. The treatment failed, and the cancer spread to my chest and brain. That’s when I got the word – I am going to die, quite soon, and there is nothing anybody can do. It was a very painful lesson. But I have learned another, far less painful one since then. That is, even when there is nothing doctors can do, there is actually a great deal that doctors can do.
In my case, I was lucky enough to meet Dr. Cargill at the Windsor Hospice. The hospice provides palliative, or end-of-life care, the kind of care you need when you’re never going to get better. It’s the kind of care nobody wants to need, but what Dr. Cargill has taught me is that it is one of the most important kinds of care there is. I am writing this story so that on Doctors’ Day in Ontario, people will know about what a good doctor can do to make a sad ending better.
Dying makes certain things very clear. You find out what really scares you. For me, I was very scared of dying in pain. And even more afraid of having my wife watch it happen. Bad enough to know that instead of spending our retirement years travelling and being together, she’ll have to go on alone. The idea that she might have to start that journey by watching me suffer in death scares me more than anything. What Dr. Cargill has done for me, and for my wife, is make that fear go away.
That’s really what palliative care is. It is making the fear go away. I can’t change the fact that I’m dying, but I know everybody dies. How you go matters enormously. And thanks to Dr. Cargill and his team, I am comfortable. And they are going to keep me comfortable and pain-free until I die. And so what little time I have remaining, I don’t have to spend afraid. Instead, I can spend it with my wife, loving her, and treasuring the moments we have instead of suffering through them. That is a gift beyond imagining.
We look to doctors to perform miracles, and sometimes they can. Other times, when they can’t, they do something almost as amazing. They make it possible to come to grips with dying, to know that it is simply part of life, and you can do it in comfort, with dignity, and without fear. That’s what Dr. Cargill has done for me, and on this Doctors’ Day, I just wanted to say thank you.
tags: hospice, hospice of windsor and essex county, palliative care, ken owen, darren cargill