End-of-Life Sherpa

An under-the-radar Canadian woman: a brief profile of Catherine (Kit) Martin, RN CHPCN(C)

Her hair was tied into a thick braid, draped over the front of her left shoulder and reaching her waist. The silver colour of it contrasted against her black turtleneck. She had a PowerPoint presentation; the projector aimed at the wall.

None of us expected that a collection of slides and a few hours would forever change us.

“Will someone let me know when we get to our break time?” she asked. “I tend to go over the time that’s given me,” she explained. Several said yes. They didn’t.

Her name is Kit (Catherine) Martin, a Palliative Care Nurse Consultant and Educator. She was there to talk about family dynamics around palliative, end-of-life care.

When she left the room two hours later, many of us wrestled with new concepts she slipped into the folds of our brain: a comfortable death; that there is no such thing as closure; and the strange, sad and wonderful things that families do when one of their own is dying.

She told us of a woman who demanded that her mother be allowed out of bed to sit in the lobby for a while. Although moving the mother from a bed to a wheelchair risked breaking bones, Kit supported the woman’s desire. “How can we do this?” she asked the woman. Tension. It seemed there wasn’t a solution. Then came the idea to move the bed with the mother in it. A happy moment.

During the break many of us, feeling moved and somehow changed, shared our impressions about the impact of Kit’s session. If you ask her, she’ll deflect, saying she didn’t do anything special, that she was just teaching people what they need to know.

Palliative care is all about “living a good life until your very last breath, allowing you to live fully until you die,” says Kit. Her entire career has been a mix of caring for the dying and teaching others how to think about and care for them as well.

Kit graduated from Toronto’s Women’s College Hospital nursing school in 1963, back when it was illegal to sit with a patient, back when she was threatened with disciplinary action for ‘conduct unbecoming’ for giving a dying patient a hug. The patient, about Kit’s age, had just been told there was nothing more to be done and he should go home to put his affairs in order. Kit was in the room. Her first mistake was to sit on the bed. Her second was to open her arms to hold him. Conduct unbecoming: she beat the charge.

As a student, she witnessed a physician at Women’s College Hospital model end-of-life care: “She was the only doctor I saw who sat with the patient, asking: What can I do for you today? What do you want? What’s most important to you today? That has stayed with me. I just adored her. Years later, I looked her up and took her to lunch to tell her how important she was to me. She just smiled and said, “People are important, aren’t they?”

Kit’s teaching about palliative and end-of-life care started one evening at dinner. “I grumbled that the health care system didn’t know how to care for people who were dying and what needed to be done. My son said, so do something about it.”

And she did. She developed a course and program for health professionals and care providers and delivered it to staff in long-term care facilities where it’s keenly needed. People tell her, “I was in your class” or “I attended your talk and I’ve tried a few of the things you suggested. I want you to know that it’s helping.”

Along the way, she launched the Palliative Care unit at Toronto’s Baycrest Centre and helped create the designation exam for Certified Hospice Palliative Care Nurse in Canada.

Kit says “Patients have told me, taught me what they need so that I can teach others. That’s the gift they give: a greater understanding of living until we die and of ourself along the way.”

Written by Frances Share

Edited by Lucinda Atwood

Published by Catherine Brindley

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“Open your hearts and love everyone”

Barb Todd’s advice to Canadian women is “open your hearts and love everyone” – not so hard to follow as it relates to your neighbours or colleagues, but what about loving the marginalized and stigmatized members of Canadian society? What about loving sex trade workers?

Barb Todd moved back to her hometown of Toronto a few years ago, stepped into All Saints Church and immediately felt a strong connection. All Saints Church is located at the corner of Dundas and Sherbourne, a notoriously dangerous area of downtown Toronto. In 2009, a study by the Toronto Star reported Dundas and Sherbourne as the most dangerous area of Toronto, topping the list in street robberies, assault-related offences, shootings, stabbings and sex attacks.

Because of its location or maybe in response to it, All Saints Church has a drop-in centre four days a week. People from off the street are welcome to come in, sit, talk, use the internet, have a coffee, and be surrounded by extraordinary volunteers.

However, as Todd pointed out to me, as we sat in All Saints Church, 90% of the people that come in off the street are male, a statistic that is true for most services in the Toronto downtown core. The few women that do attend the drop-in are by and large sex-trade workers, ranging in age from 20-55. According to Todd, “these women are in the low track sex-trade meaning that they are not [working] in a massage parlour. They are not in an escort service – they are in the sex trade in order to feed their drug addiction”.

The women that Todd saw at the drop-in were in downward free fall – oftentimes coming in battered and bruised. And while Todd estimates that 100% of women in the sex-trade have experienced abuse, only approximately 2% of them report it to the police. A police officer once told Todd that even if a sex trade worker does report violence, they really have nowhere to take her other than jail or the ER. What makes the situation even more unfortunate for these women is that it is illegal in Canada to rent living spaces to women in the sex trade. All of the women that Todd sees live in stairwells or “couch surf” because there are not enough safe beds for women in Toronto.

Todd remarked that “these women are the ones that broke my heart…so I decided to do this measly little thing. I opened the doors [of All Saints Church] one Friday afternoon [for sex-trade workers]”. While Todd may modestly call this act “measly”, it certainly was anything but. Todd visited every agency in Toronto that dealt with women in the sex trade and when she told them about her idea of having a drop-in centre just for women in the sex trade she was “flabbergasted” at the response. “I would go meet with people at different agencies and they would say this idea was amazing! They were all jumping on board. Now we have too many volunteers that we need to make a schedule!”

However, as one might imagine, not everyone was pleased with the sex-trade worker drop-in concept. As Todd noted, “Society has a violent attitude towards these women. We have neighbours in the area who will say, “how dare you harbor those maggots, they’re garbage”.

When it comes to women in the sex-trade, an overwhelming consensus from society is to blame these women – as if they are somehow responsible for their situation. Most of the time, these women have drug addictions coupled with mental health issues. Because they are stigmatized, they tend to fall through every crack and don’t receive the help that they need. Todd refers to them as the “invisible population – all the issues are thrown in and then people say, ‘we don’t know what to do with them’”.

Despite the complaints from their neighbours, the drop-in has become the successful product of a collective of women. Every Friday morning, Todd and other volunteers do outreach in the neighbourhood stairwells providing crack kits and inviting women who would not normally think about entering a church to join them for a hot breakfast, crafts, and a safe space.

“There is something about bringing a group of women together. I’ve seen it in the different places I’ve lived, like the Arctic and Nova Scotia – women get together, the elders and moms – well, so do women in the sex trade”.

Another important aspect of the all-women drop-in is to provide women with services that they might not be as willing to receive at other drop-ins. For example, there is a nurse at the All Saints drop-in centre every Tuesday; however, Todd noted that in her five years at All Saints, no women in the sex trade have come in to be seen by the nurse. Todd acknowledges that the lack of privacy at the Tuesday drop-ins may be a deterring factor for these women. So Todd has arranged for a nurse to come in on Fridays and “even if they aren’t doing any nursing, I just want them to be there so the women can be like, ‘oh yeah, I know so-and-so, she’s cool and I can ask her something’”. Todd is also doing the same thing with police. Once a month she arranges for a policewoman from the Special Victims Unit to attend the drop-in, because if a woman wants to report abuse, she might feel more comfortable with someone she has already met.

Todd recognizes that this is only the first step in helping sex-trade workers in Toronto. She is working on bringing together agencies all around Toronto that work with sex-trade workers and facilitate communication between these agencies to provide support for the women.

Todd also acknowledges that while four hours a week may offer the women a temporary escape, it is certainly not enough to keep them healthy and safe the other 164 hours. The WISH Drop-In Centre in Vancouver (http://www.wish-vancouver.net/) is a drop-in centre for female sex workers that is open from 6:00 pm until 11:00 pm, 7 days a week. WISH provides meals, hot showers and other services. Using the WISH model, Todd would like to start a 24/7 drop-in in Toronto.

Todd emphasized that the biggest part of the drop-in is just getting to know the names of the women and sit with them and chat and show them that someone cares. “We all just want to be loved; no matter who we are”. And so, Barb Todd’s advice to me and my fellow girls and women is to open our hearts and love everyone.

Written by Jaclyn Cappell

Edited by Lucinda Atwood

Published by Catherine Brindley