PORTRAITS IN PALLIATIVE CARE
Patient Attendant Nelia Victoria on the Challenges and Rewards of Providing Basic Care to End-of-Life Patients
“This is not an office job, the patient is not a piece of paper but a human being, so when we work together in all aspects, it can mean washing and feeding the patient together... We all have to observe the patient and communicate well. You have to see the patient as a human being. That’s what I like about palliative care, it makes me feel human again.”
By Devon Phillips. According to Patient Attendant Nelia Victoria at the Lachine Hospital, being a patient attendant or “PAB”, is a tough but rewarding job which requires dedication, teamwork and the ability to slow down to match the rhythm of the patient. After 10 years of providing basic care to patients at the end of life including working throughout the COVID-19 pandemic, Nelia recommends that end-of-life care should be regulated by a public healthcare system.
Q: Tell me about your job at Lachine Hospital.
A: Well I am, in French, “préposé aux bénéficiaires” or “PAB”, which translates to a patient attendant. I take care of the basic care of patients, including the feeding, washing, changing of briefs, all that needs to be done. I don’t take care of the medication, that is done by the nurses. I am part of the medicine surgery ward and the palliative care unit which is on two floors at Lachine Hospital. But I work a lot of time in palliative care.
Q: What is it like working in palliative care compared to the surgical medical ward?
A: In palliative care it is a more challenging because you are dealing with people at the end of their life and you are dealing with families, so there is emotion and a lot of anxiety. It’s not the same as being on the floor of medicine where you are dealing with for example, an elderly person who has fallen and has to be hospitalized.
The care is different. In palliative care you have to go at the rhythm of the patient compared to medicine where you say, “it’s morning, let’s go, we are going to get washed and we are going to get breakfast”. We tend to let palliative care patients sleep more because if that’s what they need, then that’s what they get. And it’s not a quick wash, it’s more intimate. We’re washing, we are putting lotion on them, our approach is more delicate. It’s a certain rhythm because they are at the end of life.
And if they are still able to talk when I am washing them, I ask them what they did in their lives work-wise, have they travelled, do they have kids, what were their hobbies? This distracts them and takes away from the distress and it’s nice to talk about what they’ve done in life. If they’re at the point where they are not talking, it still feels good to be washed, right? We wash them, change their position and feed them if they can still eat. I also feel that the family has to be taken care of too so I’ll ask them about their children too and what they’ve done, because they want to talk about their lives. I enjoy the slower pace of palliative care.
Q: What brought you to palliative care?
A: I lost my Dad at the age of 36. He passed away in May 2009 and at the beginning of the same year I had lost my job. So I had a change of direction. I went back to school at the age of 36 in October and finished the course in May 2010. I sent my CV in on Tuesday after I finished my course, got a call back of Wednesday, and was hired the following Monday. I didn’t even have a week off! I feel it was my Dad who helped me. This was the last lesson he taught me, that I could do something else with my life. I went from being an office worker to an orderly!
Q: Going from working in an office to being a PAB in a hospital is a big career change. After 10 years on the job, how do you feel about this choice?
A: The pandemic has shown that this is not just a job, it’s an important job. We are certainly the eyes and the ears. We are the ones who are mostly with the patients. The nurses have a lot of patients to deal with and they have to make sure they are giving the right medication to the right patient, but we are seeing the patient from one day to the next so we see any changes in the patient. We are there with the patient longer than anybody else. To me, it’s all about a team working together. When the team works together it’s great. The doctor is a doctor, the nurse is the nurse, and I am a PAB and I know my role. I am not going to tell the doctor or nurse what to do, but I tell them what I observe about the patients.
Q: You are saying that the team is important. Tell me about that.
A: At Lachine, we have a team and it works because if we all do our job right, then the patient benefits. The team also benefits because when we work together, it is more pleasant and you want to go into work. When you have the attitude that this is not my job, that does not work because looking after a patient is everyone’s job. This is not an office job, the patient is not a piece of paper but a human being, so when we work together in all aspects, it can mean washing and feeding the patient together. And the medication may have to be adjusted, maybe they are too sleepy, or, maybe they are too agitated and this is where a good team works together. We all have to observe the patient and communicate well. You have to see the patient as a human being. That’s what I like about palliative care, it makes me feel human again.
Q: What is it about palliative are that makes you feel human?
A: On the non-palliative care floors, we have so many patients that it’s like a car wash; you have to keep them going. But in palliative care, you have to slow down and remember that they are human beings. They are many patients who touch me. I will never forget this one woman, far too young to be dying, and she approached her illness with such courage and dignity. When she died, I cried, and it was a family member who consoled me. I thank her for making me feel human. It’s not just another body. You have to remember that body was a person.
And I’m not going to tell you they all affect me because if they all did, I couldn’t do my job. You have to separate yourself a little bit too because while that person died, in room 412 there’s a person who needs you so you can’t be so distraught that you can’t help another patient who is still living.
When I started this job at age 36, I did not think about aging. But I lost my father and that was a reality check and then this job opened my eyes – we are not invincible. We need to enjoy life. When you see a 30-year-old person dying, it’s hard not to be affected.
Q: You are in the trenches right there close to people. Is the end-of-life experience different for each person?
A: Yes, it’s very different. For some people the last breath is hard and for others, it’s peaceful. And sometimes we go into a room and the patient has passed away and no one was there. Some people don’t have family with them for one reason or another and that’s sad. And some people have a hard time dying. There was this one lady I could not believe how long she lasted and I said to her, “why are your holding on so strongly?” and she said, “it’s for my son”. And I said, “your son has just turned 50 and it is time to let go”. Sometimes it’s just holding their hands and telling them they can let go if they cannot die on their own.
Q; It sounds like your job requires a lot of courage in order to be close to people.
A: It does. When I first got into this I thought more about the physical demands but I didn’t realize how emotional it is, but then again, you are dealing with human beings so how can it not be? This pandemic has shown that there is a lack of people to do my job. When I saw the pamphlet about being a PAB, it shows a cute elderly woman and the PAB by her side, and it all looks so nice. But the reality is that not everybody is nice. I have been slapped, I have been verbally abused but that’s a given, I came close to being punched but thank god my reflexes are good because I would have seen stars if that man had succeeded. This happens for different reasons - sometimes it’s the illness, and some people don’t want to be helped. Some people are very confused so when a total stranger removes their briefs, they do not understand what is happening. This is not an easy job by any means, but it is a rewarding job.
Q: Do you receive appreciation for the work you do?
A: Yes, and sometimes just at the right moment. On a bad day, just as you ask yourself why you left that cushy office job, a patient will say, “you have a nice smile and you look like you enjoy your job”, and you know what, I do enjoy it! Just three days ago, the wife of a patient in palliative care drew a picture of an angel and said, “that’s you”. It doesn’t get better than that!
I feel most appreciated in palliative care. We are a small group; palliative is great and it’s so nice at Lachine. What my Dad received when he was dying compared to what we offer, there is no comparison. I would have loved for my Dad to be here at Lachine and that knowledge helps me to do this job to help someone else. Isn’t that what it’s all about? The news about the world is so depressing and you just need to feel that you are part of a community, part of something bigger than yourself. This is what this job brings me.
Q: And what about the response from the healthcare system? Are you and your fellow PABs appreciated in the way you should be?
A: No, and the pandemic has shown this. The government is scrambling; they say that we are lacking PABs so Mr. Legault says we are going to hire 10,000 people. How much are they going to pay these people? $49,000 a year or $26 an hour. And here I am. I have done the course, and I have celebrated 10 years at Lachine and I am paid $22.35 an hour, so what’s going on?
So do I feel appreciated by the healthcare system? Not really. They keep putting more pressure on us. We have more patients and former Health Minister Mr. Barrette says the patients do not feel the cuts. This is BS. I cannot tell you how many times patients push the buzzer and say to us, “I have been waiting 20 minutes.” I apologize but I have 10, 11 patients I can’t be with them all at the same time.
If you do this job just because of the $22 an hour, you are going to be miserable. It takes a lot out of you but it also is rewarding. You can see the difference in the care provided between a patient attendant who enjoys the job compared to someone who doesn’t. At the end of the day I want to say that I’ve done my best.
Q: What do you think about the program being implemented in Quebec to fast track the training and recruitment of PABs?
A: I think it’s too fast. My course took 7 months and we needed all that time. There’s more to it than just washing a patient. You have to know the signs when a patient is thirsty or the blood sugar is too low. I don’t diagnose but I need to be aware of signs and changes, and the program I took gave me this training. Can they teach this in this in 3-month program? I am not sure they can.
Q: Looking to the future, what would you like to see for your profession? After all, you are an essential worker.
A: We are definitely essential workers and this pandemic has shown this. I’d like the government to hire more people. Money wise, $22 or $24 an hour is not great but it’s okay because compared to the private sector, people are being paid $13 or $14 an hour for the same work. In the private institutions, they are hiring people who have no training. They are just taking people who need a job and then paying them very little. I’d like to see a public system for everyone. I would like to see more people hired so that we are not overwhelmed.