In Memorium

Patricia Anne Haidenger Clifford died at Calgary, Alberta on August 12, 2008. She was a survivor of ovarian cancer for over 6 years, and received over 80 chemotherapy treatments. She published a book of poetry on life with cancer, Embracing Brings You Back. She spoke to doctors and medical students on the experience of being a cancer patient.

Although a fierce patient advocate for ovarian cancer, Pat did not wish final memories of her to be that of an ovarian cancer patient. It is her past as an educator, writer, and good friend that was of most importance to her. Here is her obituary:

"Pat Clifford died at Calgary, Alberta on August 12, 2008. She lived her life well, as a teacher, educator and writer. She filled her life with family, friends and colleagues, and in turn filled their hearts. She leaves a gift to us in her teaching, scholarly writing, poetry and stories. As a teacher, Pat was steadfast in her belief that each child had the right to succeed brilliantly, and brought to them her own love of literature, writing and history. As a daughter, she supported her mother with laughter, empathy, and a kind listening ear at all times. As a sister and aunt, she was certain in her love. As a friend, she was loyal, up for great conversation, and a good time. In her flamingo shirt and red shoes, she entered a room with presence, wit, and a good story to tell. She still fills that room with her energy, even though her body can no longer support the life she lived."

A memorial service was held at the University of Calgary, Rozsa Centre on Friday, August 15, 2008. It can be heard at this site .

At Pat's request, donations should be made to the Patricia Clifford Scholarship Endowment Fund at the Banff Centre, Banff, Alberta.

Coming Undone

Part of the world as I know it has come undone. Pat died on Tuesday, August 12, 2008. It was unexpected; until the last few hours before her death, she had been busy with writing, entertaining friends, and telling a good story to all who cared to listen. That she did it from a hospital bed was of no matter to her.

She did not wish to die. A few weeks prior she had whispered to me in a small moment of fear, "I don't want to die. I love my life too much". She had been counseled to learn to let go; to accept that she was dying. This was never an issue for my sister; she knew that she was dying and had made all the suitable preparations. She was, quite simply, raging against the untimely nature of these events when she had much left to do. She saw no point to acceptance; it was a weak alternative to demanding her right to live.

In the last few days I spent with Pat, I came to realize how much of her now-presence was devoted to the telling of a good story. A small event during the day would be shaped, enlarged, and changed to make a marvelous story for all who would listen. In doing so, she followed in the footsteps of our mother and our Scottish aunts, all of whom loved nothing more than to tell a good story, always to be in the long version and never the short.

For everyone who knew Pat, I would invite you to tell your own story about her, the more outrageous the better. There are few things Pat loved more than a tale well told.

Catch a Falling Star

Catch a falling star and put it in your pocket

Never let it fade away

The palliative care unit at the Foothills Hospital is not what you might expect. It is as much about living as it is about dying.

Few of us consider how best to live the rest of our lives. But this question is part of the fabric of Unit 47. It intensely, personally, and completely about the wishes of the patient.

It was Alison, one of the palliative docs, who brought this question sharply into focus for Pat. We were discussing what was most important to her for the remainder of her life. Pat's response was quality of life. “And what is quality of life to you, Pat?” “Well, I have a lot of writing I want to finish. I have this article I'm working on for Harvard Review, and I have some other pieces I'm working on.”

If you have ever worn glasses, you will remember that moment, as a child, you carefully put on your first pair of spectacles and the blurry world became focused. So this is what the world looks like! So too with Pat's answer. We understood the yardstick against which decisions could be measured. Will this make writing easier, or harder? Will this take energy, or conserve energy?

It has become the focus for all of us now. Four hours in the morning have been set aside for writing. And with the ferocious intensity that is both Pat and part of all good writers, it has become her space, her time, when there is nothing but life. The Harvard article has been submitted. And tales yet to be told are taking shape.

To catch a falling star is to capture a dream. And Unit 47 was the first to spread the net across the galaxy of Pat's dreams. A star is now safely tucked into Pat's pocket and with each written word, will never fade away.

Baxter

Pat has acquired a faithful retainer who follows her everywhere, ever vigilant, never sleeping. His name is Baxter. Baxter is the machine that meters out her TPN (Total Parenteral Nutrition). Pat calmly announces his name to me. I am mildly concerned that Pat has taken to humanizing a machine. “Why Baxter? “ “Well, because that’s what written on the machine.” Sure enough, in bold letters in the top left-hand corner, Baxter announces his name to all who can read.

Baxter the Butler is how I think of him. Dinner, m’dam? Highly nutritious, if slightly on the bland side. “I would kill for a cappuccino”, mutters Pat. One of Pat’s docs is within earshot. “Well, you can probably have one if you want. It just gets sucked back up the gastric tube.” And just like magic, doctor’s orders are written for cappuccinos.

Petra, who cherishes her own cappuccinos, has been mourning their loss for Pat. We feel that she should do the honour – and the next morning, Petra appears with two in hand. Cautiously, Pat sips on the cappuccino (double sugar). She savors the taste on her tongue, like a fine wine, and then swallows. A quarter cup later, no disasters have occurred. And with morbid curiosity, we watch the gastric tube for evidence of exhumed cappuccino.

Pat is ecstatic. The taste of food, the act of swallowing. The doc suggests she try a popsicle next. Sharon fetches a popsicle from the hospital fridge (Baxter refusing to leave Pat’s side, even for a moment). A grape popsicle. Pat cautiously sucks on the popsicle, carefully navigating its tip around her gastric tube. She gives a huge grin, and we realize that the popsicle has turned her teeth and tongue purple. So we agree that perhaps not grape the next time.

We learn the rules – if the food is liquid enough to pass through the gastric tube (which is about the circumference of a large straw), then it can go into Pat’s mouth and down the throat. Gravy from stew is next on the menu. Broth is requested. The possibilities begin to unfold.

Pat tells me that doctor’s orders have been written allowing her two glasses of wine a day. I think we will have someone other than Baxter make the wine choice.....

Sisters

Each of us knows a different part of Pat; very few know the sum total. Certainly I don't. But I can share parts of her past that are known to a very few.

Pat and I were born seven years apart. Pat was the blessing; I was the surprise. Our mother had had a partial hysterectomy, with no expectation of further children. Raised at a time when children meant poverty, she was likely happy with one. But there we were. Patsy and Pamela.

When Pat was 14, I was seven. I was the skinny, asthmatic kid with allergies and a drippy nose, who hung around my older sister, irritating her with my mere presence. “Mum, can’t you make her stop sniffling?” But I was busy trying to figure out what it meant to be a real teenager. I was infatuated with her red pumps and crinoline skirts. I would put on her hoop crinoline, left for washing in the basement, and twirl on tiptoes on an imaginary dance floor. I read her pamphlet “On Becoming a Woman”, try to discern the mysteries of Kotex pads and menstrual cycles, and how to speak to boys (or, as the pamphlet suggested, how to listen carefully).

When Pat was 17, I was ten. She had a boyfriend, a dashing young man who knew how to ballroom dance. And Pat loved to dance with him, gliding across the floor in waltzes and two steps. She was an accomplished actress, part of a bright, shining group that captivated my world with Shakespeare and Moliere. I would sit entranced, listening to her careful elocution and measured tones, even then bringing language to life.

When Pat was 20, I was 13. Now in university, she was working for the summer in the North Battleford Psychiatric Centre as a ward aid. A mental institution, as it was known then. A place of dark secrets. She learned to smoke and swear, and in turn taught others how to use tampons (Rule #1 -- remove the cardboard applicator after insertion!). I was busy trying to figure out nylon stockings and garter belts.

When Pat was 22, I was 15. In fourth year university, Honors English, she was an intellect. Surrounded by dark young men debating Camus, she drank beers with her professors at the Park Town, typing papers late into the night, due the next day.

And then Pat was gone, a married woman living in Ontario.

Over time, seven years has shrunk from a canyon into a crack in the sidewalk, easily stepped over in shiny red pumps and sensible walking shoes. We had planned to grow old together, sitting on a front porch, clutching plastic purses and calling out to the young men walking by. Living in a house by the sea filled with art, music, ideas, and friends. For now, we will turn back time and grow young together.

And now from the sister...

Today you get to hear from me, the sister, masquerading as Pat. Not that it is much of a masquerade. I am a lawyer, and words are the stuff of contracts and other legal documents. I love the orderly flow of words, the precise communication of complicated concept and thought. But today I enter Pat’s world, to tell you more of her story from a space of love.

Pat is currently under hospital care for a bowel obstruction. Having very little understanding of bowel obstructions, I asked her doctor for an explanation. Our organs are surrounded by the peritoneum, a smooth, slippery surface. With ovarian cancer, tumors seed on the peritoneum, like sand thrown against its surface. The bowels have motility, and slide over the peritoneum. With the presence of tumors, the bowel gets “stuck” on some of these tumors. These tumors can press upon the wall of the bowel, causing it to collapse, or can cause the bowel to twist or loop on itself, narrowing or even closing the opening in the bowel. Our bowels sustain us by processing our food and delivering to the body what it needs; when the bowels are obstructed, the body is without sustenance.

Obstructions can, in the words of the doctor, wax and wane. They can resolve with rest and medication; they can remain stubbornly and obstinately in place. And while such obstructions are present, nutrition and hydration presents its difficulties. Pat is currently receiving TPN, which is a totally balanced nutritional supplement delivered intravenously, and beginning to regain her strength.

This has been an intense week of reflection for the two of us. Many decisions have been made, both medical and metaphysical. And now is the time for defining absolute priorities.
For Pat, an absolute priority is her writing. She has much left to say, and it is writing that sustains her as much as the TPN that feeds into her veins.

For all who are close to Pat, we would ask that you focus on all that is required to allow her write with passion, beauty, and from a place of strength. For that reason, I have offered to take over her blog, so as to free her for the writing that is now of greatest importance to her. For that reason, we would ask that if you write to Pat by email, you are not disappointed if you do not receive an answer. She holds all of you in her heart.

We would also invite you to participate together in this experience by posting comments, rather than sending email. As we all care for Pat, the journey is worth taking together.
Pam

Contemplating Beijing

I’m still in hospital doing the food tray typing. Today the network is down, but I am determined to get a message out, so I’m going through the back door as it were—composing the old fashioned way in Word then moving it over to the blog, hopefully without incident.

I am feeling way stronger than a few days ago. They have me back on that artificial feeding routine from my previous hospitalization. The dietician says I am getting a perfectly balanced diet. That’d be a first in my life. This time they had to resort to drip and suck, so I have a tube down my nose to drain excess gastric fluid. One of life’s lesser joys, I would say. For several days I wasn’t able to take in anything by mouth, but yesterday, oh joy of joys, the doc suggested I could try a latte if I wanted—more for the taste than anything, since it ends up being sucked up into the tube. What an amazing treat. Good coffee, my mouth smiled—and I will never take a sip of coffee for granted again!

Alas, there has been no talk of barbequed salmon or steak. Too bad.

So things have gone significantly sideways in terms of this obstruction. I was admitted to the palliative ward of the Tom Baker Cancer Center, in part because my palliative doc was doing a home visit assessing what was happening, when I threw up all over her. She said she had been wondering whether another obstruction was developing—and she got her answer in a big way. As a rule, I would say no projectile vomiting over your doctor, but it sure put things into motion! She actually had to continue her day wearing a pair of my trousers, while I got whisked directly in, do not pass Go.


I have a very lovely big room with floor to ceiling windows, Totally unlike being on the surgical ward. I am also getting a sense of what it means to be a palliative patient, and have palliative docs. I like them very much. In this I have always been lucky, because I adore my oncologist as well, so I feel like I am being well held, and becoming well known to a new set of people who care for me equally well, but somewhat differently.

And here’s a surprising thing. Many of you know that I have had a meditation practice of sorts for many years. I have certainly been working on my spiritual journey, and on pain control. One of the palliative docs is amazed at how little pain I actually experience. She says the only other people she sees with this degree of comfort in what should be a pretty hard situation are elite athletes!

Now if you had to place me with fellow travelers, would it be with athletes? I’m thinking we might be in trouble in Beijing.