Thank you to the Canadian Medical Association and Macleans Magazine

Across the country, Canadians were given a forum to discuss end-of-life care,  thanks to the Canadian Medical Association (CMA) and Macleans. The Town Hall style meetings were an inspired idea. I attended the meeting in Mississauga and was pleased to see the combination of structure and informality in the program. Participants could come away with a common vocabulary, a sense of having been heard, an appreciation of other points of view, and direction for personal action. All of this in a two hour period.  Within a month of the last town hall, the CMA has released its report, End of Life Care: A National Dialogue. It is essential reading for all families.

Perhaps the best feature of these Town Hall meetings is that the hot-button issues of euthanasia and physician-assisted dying were set into the much larger context of end of life care. That context includes discussion of  end-of- life wishes, the preparation of advance care directives, the art of communication and the science of symptom management.

As someone who gave much thought to end of life care in the course of writing Autumn’s Grace, and who continues to worry about palliative care in rural Canada, I was delighted to see that the CMA’s conclusions included the following items:

  • A national palliative care strategy should be developed
  • All Canadians should have access to appropriate palliative care services.
  • Funding for palliative and hospice care services should be increased.
  • More education about palliative approaches and as well as how to initiate discussions about advance care planning is required for medical students, residents and practicing physicians. (The CMA was addressing its own discipline, but I would add to the list: nursing students, practicing nurses, pharmacy students and practicing pharmacists, etc.) 

Thank you to Dr. Louis Hugo Francescutti, the panelists and Macleans for initiating a national dialogue that I hope will result in changes to practice, policy and funding for palliative care…in my lifetime.



We Can Do Better

Chapters Display

“Forget about planning your funeral; begin planning your end of life!”  That was the first response to my question, “What was your ‘takeaway’ from reading Autumn’s Grace?” as a recent discussion with The Neighbours’ Book Club was winding down.

There were nods around the room. The speaker continued, “I have started talking with the people I love about how I want my last days to be, and I ask them what they would like for theirs.”  It was a reaction that I did not anticipate as I was writing Autumn’s Grace.  At most, I had hoped that readers would vicariously, through the eyes and ears of Max, Marge, Jessie, Jane and Ethan, feel more informed about the challenges of diagnosis, treatment and care-taking. Maclean’s cross country conversations on  End of Life Care: A National Dialogue  have, I suspect, accelerated the interest in considering the issues, and for these fora I am grateful.

If individuals, couples, families and communities prepared for end-of-life as well as we do for pregnancy, childbirth and infant/child-development we might enter our last stage of life’s journey with less fear and more informed support.

The second response to my query was, “We can do better.”  This speaker was not suggesting that people (family members, health care professionals) and organizations (hospitals, community health) were mal-intended. She thought that perhaps individuals and organizations did not stop to examine recurring negative patterns, and adjust accordingly. Without being prescriptive, Autumn’s Grace shines a light on some opportunities for improvement.

Both responses resonated with me. In 2013, the Faculty of Nursing at University of Toronto dared alumnae to dream of better endings.*  Dr. Sioban Nelson, then Dean, noted that “until we see death and dying as part of the continuum of care, Canada will remain a poor place to die.” I agree. We can do better. Simply put, that was my motivation for writing Autumn’s Grace.


* See: Dare to Dream Of Better EndingsPulse Spring/Summer 2013, Volume 6, Number 1. Pulse  is the magazine for Alumnae of The Bloomberg School of Nursing.



Rants and Rabbit Holes

Once again I find myself in the midst of writing a story about something that incites my passion. This time it is elder care. But before I know it’s happening, I have ranted my way down a rabbit hole, and find myself figuratively peering up, saying, “How do I get out of here?”

Writing about the topics that fuel my conscience is a challenge. At best I find myself ranting; at worst, I preach. Neither makes for satisfactory reading. I know it; my husband confirms it.

On Friday when I finished with the manuscript for the day I thought a major re-write was in order. The result was that on Monday, this week, I could not muster the courage to open the file. Yesterday, I tried a tack that I used in Autumn’s Grace—I gave all my characters permission to speak. They had observations that surprised me and they shared pieces of their history that I had not yet discovered. It was a happy 2,200 word day!

Perhaps my learning here is that controlling the narrative is analogous to digging a hole and then sitting at the bottom—alone. Giving my characters their voices, conversely, feels like being in a meadow—open,  full of colour, life and possibility. I prefer the latter, and that means learning how to let go.

Bonnie Lendrum is the author of Autumn’s Grace, a story about one family’s journey through palliative care.