Maria is sixty-two years old and has metastatic gastric carcinoma (stomach cancer). She has a developmental delay and does not speak English; still, she is able to communicate verbally in Portuguese with her family and understands her condition is terminal.
Over twenty years ago Maria came to Canada from Portugal to live with her family. In Portugal she had lived predominately in her aunt’s house, where she worked as a domestic while also fulfilling the role of a companion. After her aunt’s passing, Maria came to Canada to live with her father, performing somewhat the same role as she did with her aunt. Since her father’s passing ten years ago, she has lived with her brother Vitor.
Maria was first diagnosed with gastric cancer in March of 2016 and immediately began weekly chemotherapy treatments. In December 2016 she was admitted to Toronto General Hospital’s (TGH) emergency room with a shortness of breath, caused by a pleural effusion on her left lung. The condition, which involves an unusual amount of fluid around the lungs, has many possible causes but in Maria’s case it was due to the spread of her gastric cancer.
After her pleural effusion was drained, a magnetic resonance imaging scan (MRI) indicated that any further chemotherapy treatment would not help Maria. The health care team at TGH was also concerned that in her frail condition continuing chemotherapy treatment would impair her quality of life in the short term and would only prolong her illness in the longer term.
Maria with her family discussed her options. Maria couldn’t return home to live with her brother Vitor — and continue with her chemotherapy treatments — unless she felt stronger. Even if that happened, however, going home would still be very difficult, since it would be hard for Maria to navigate the tight hallways with her walker. Stairs would also be a problem, as would bathroom accessibility.
Maria decided she didn’t feel well enough to return home; as for chemotherapy, she felt that if it was not going to help then she would choose to no longer receive treatments. Maria decided she should be in palliative care. She was admitted to the palliative care unit at The Salvation Army Toronto Grace Health Centre (TGHC) in January 2017.
Maria feels she is receiving excellent support and is in a very caring environment at the TGHC. The nurses, she says, continuously check in with her to see if she has eaten or if she needs help with any activities of daily living. While it is true that the nurses do help her to the shower, she is still fairly independent and is able to wash and bathe herself. Maria is also still able to walk unaided short distances. She uses a walker for longer distances and a wheelchair is provided when she is escorted to recreational therapy.
Everyday Maria looks forward to participating in one of the many programs in recreational therapy. She attends Craft Corner, making sympathy and Christmas cards; the On the Move exercise program, which involves body stretching; Sitting and Dancing; baking class; and bingo. She also likes to go to chapel services on Sundays. She says that all the support she receives at the TGHC, along with the care, the recreational activities, and chapel services give her some hope. These activities, she says, help to keep her active and allow her to not think or dwell on her illness, for which she is grateful.
Maria misses Portugal; she misses her friends, the smells, the food and the way of life. However, she is glad she is here with her brother Vitor, who she says loves her very much and takes good care of her.
Maria wishes she didn’t have cancer but she says, “It happened to me so what can I do?” Then she adds, “There’s no point in getting sad, because it won’t change anything.”
Maria passed away on the evening of April 6, 2017.