What if palliative care was about living better?
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It's been really awesome to see people have never been more interested in our show, FrontBurner, than they are today. I'm Jamie Poisson, and FrontBurner is the daily news podcast that I host. We cover Canadian news and politics in, I think, a really clear way.

What topics? Oh, you know, Trump's threats to annihilate our economy with tariffs. Make us the 51st state. The chaos of a teetering federal government. A looming election. That kind of thing. So if you want to get a good sense of what's going on and why, please follow FrontBurner wherever you get your podcasts. This is a CBC Podcast. I'm Dr. Brian Goldman. This is White Coat Blackheart.

A few weeks back, we first met a physician in Hamilton, Ontario, who still does house calls. Hi, Brian. I'm Dr. Sammy Winemaker, otherwise known as Dr. Sammy, and I am a palliative care physician, and I work in people's homes, which is a really special and unique care setting. Treating patients where they live is a big part of what Dr. Sammy and her team provide. As a palliative care physician, she cares for patients with serious illnesses of all kinds, including cancer.

Palliative care is not only for people who are dying. It can improve quality of life, not just near the end of an incurable illness, but throughout. A few weeks back, we heard from the family of a patient who benefited from a years-long relationship with Dr. Sammy and her team. On this show, Dr. Sammy shows us the immense value in meeting up with patients and their families as soon as possible after they're diagnosed. Where are we heading right now? So we are going to a new consult.

I've never met this person before and we're going to his home and I think his family will be there. He has been referred to our palliative care outreach team. That's my daughter and she calls me lots. She knows not to call me unless there's an emergency but an emergency can be Aritzia is having a sale.

So, okay. So we are, yeah, we're meeting this gentleman with a, I would call this a new diagnosis. And when I'm looking through their consult notes on the computer, I'm really trying to pay attention to

What types of conversations have happened between the patient and the healthcare providers? Like, does it sound like in the notes that someone has had an open, honest, realistic discussion with this patient about what's going on and what to expect? Has there been any discussion about how things are going to unfold? Have treatments been described properly?

But has the option of not pursuing treatment been described? Has a prognosis been entertained? And so I'm trying to get a sense for, am I going to walk into a situation where people are already in the know about these things? Or are they going to be in the weeds of their illness?

So that's who we're meeting. And I'll just turn in here. When I drive to someone's home, I know this area quite well, like my geography. So I begin to get, you know, a vibe. Ready to go? - Either way. - Okay, here we go.

Dr. Sammy and her team only come when they're referred. We're showing what this kind of care looks like so we all know what to ask for if it's not offered right away. Sometimes I look at, you know, have the plants been watered? Has the walkway been shoveled? Sometimes there's notes on the door that tell a lot about

you know, guests not welcome, things like that. Hello. Hi, how are you? I'm Dr. Winemaker. I'm Kathy. Hi, Kathy. It's good to meet you. And this is Dr. Goldman. Hello. Hi. Can we come on in? Yeah, okay. Hello. Good morning. Good morning. I'm Brian. Do you want us to take our shoes off? Pleased to meet you. By the way, Dr. Sammy got permission of Ken and his family in advance for us to record this session. This is my daughter, Sue. Hi, Sue. Hi. I'm Dr. Winemaker. This is Dr. Goldman. Hi.

Hi, my name is Ken Hages and I'm 82 years old and I have been diagnosed with stage four prostate cancer. Hi, my name is Kathy Hages and I'm 81 and married to Ken and have three lovely daughters. Hi, my name is Sue Barker and I'm one of Ken and Kathy's daughters. It's really good to meet you.

Thank you. Yeah, I'm a part of a home visiting program. And I work with visiting nurses, and I work with the care coordinator from home care. And I work with your family doctor. And I work with the doctors at the cancer center. So we're all working together. I should probably ask you before we get started and for your family, if it's okay to speak openly.

Yes, that's the whole idea. Oh my goodness. Do you believe that some people say to me or sometimes I get someone come out the front door and say we don't want to talk about anything. So but not you? No, I don't think. Not me. Already you can see how Dr. Sammy operates. Framing the reason for the visit. Checking what everyone in the room knows. What they want to talk about. What they'd rather avoid.

She wants to begin a relationship that could last for years on the right foot. Okay, well, before I meet someone, I usually go digging into the records to get to know what the story's been before I come in. And what I appreciate is that this has been very recent. It's unfolded in the last couple of months, is my understanding. Exactly. Yeah. Are you still feeling like you're adjusting to this huge news?

I guess I am adjusting, but so far I'm just comfortable. That's all. Whatever happens is going to happen, and I'm willing to accept it. Okay. What do you mean by that? I'll do everything I can to prolong my life as long as possible, but you read in news clips and obituaries, after a long, courageous battle with cancer, so-and-so died. That's the way it is. Hmm.

So it sounds like you accept the fact that we live and we die, and having cancer might be the ticket for you. Everybody dies from something. Yeah. Yes, but everybody dies. Yeah. Even me. Yeah, even me. So can I share with you what I read this morning, or would you rather tell me your story? Oh, no. No.

I'll respond to what you say. It's funny, people always want me to do it. I don't know why. But in our medical training, we always are trained to ask the person to tell their own story. But I know that people sometimes get really tired going over it over and over again. So what I read, and correct me if I'm wrong, okay? Ken wasn't feeling well and lost some weight.

He had blood tests. His creatinine level was elevated, which meant his kidneys weren't functioning properly. He felt ill and had pain in his lower groin and went to the ER at St. Joseph's Healthcare in Hamilton. There, doctors found the cause for his kidney problems. Ken had blockages of both kidneys. The cause turned out to be prostate cancer, and the pain in his groin was caused by the cancer spreading to the pubic bone.

They called it metastasizing, I think. Yeah, that's right. That word means that the cancer has left the original site and found its way through whatever highway in the system and landed elsewhere. Dr. Sammy is good at translating scary words like metastasizing. Ken got radiation to treat the pain caused by the cancer metastasizing to the bone. When I had it,

I asked how many more of these will there be and they said well just this one. Do you know what the treatment was for? I don't think it was ever fully explained to me but... Well that was nice of you to take it. Okay typically when they give one dose like that they are usually doing it to manage pain.

Were you having pain in that area? I've had minor pain in this area, in this leg. Okay, so it's probably that they did it for pain management, but I'm not a radiation doctor, so I don't know exactly. But I want you to know that any time someone offers you some kind of treatment, that you can ask them, what is the treatment for? How will it benefit me?

And is there any risk to it? So they're really good at describing the risks, but sometimes people don't understand, well, why am I getting this anyway? So where were we? So we understand that the cancer is in different parts of the body. And when the cancer metastasize, like you said, it makes it stage four. Yeah, yeah.

Am I giving you too much detail? No. Okay. When it's stage four, sometimes people say to the doctor or the nurse, what does that mean? What does stage four mean? Can it be cured? Well, I've been made aware that it's not going to be cured. It might be controlled for as long as they can control it, but it can't be cured.

This moment goes by quickly, but it's really important. Ken knows his prostate cancer is not curable. An important detail Dr. Sammy won't have to explain. I think you saw a medical oncologist as well eventually. I know you were in the hospital twice. Yeah.

Dr. Ott, yeah. Dr. Sami explains that a medical oncologist is starting hormone treatments, also known as androgen deprivation therapy. It's usually recommended for advanced and metastatic prostate cancer. Do you remember any of that? I did, yes.

It didn't register. It didn't register? Okay. Understandably, you had a lot going on. Well, this is a big part of Dr. Sammy's job, to explain hormone treatments and anything else Ken and his wife Kathy didn't catch the first time around. Did anyone talk to you about the option of not having any kind of therapy for the cancer?

I don't believe anybody talked about that, but that wouldn't be my choice if there was options. Okay. Because it sounds like you have a will to live as long as possible. Exactly. Yeah. Yeah. Yeah. Okay. So it goes back to what you read in the obituaries about the courageous battle. Yeah. Yeah. Yeah. We'll be right back.

I'm Katie Boland. And I'm Emily Hampshire, who didn't want to be here. On our new podcast, The Whisper Network, we want to speak out loud about all the stuff that we usually just whisper about, like our bodies, our cycles, our sex lives. Basically everything I text to you, Katie. So this is like your intimate group chat with your friends. And we can't wait to bring you into The Whisper Network. This journey is a nightmare for me. I'm doing it for all of us. So you're welcome.

You're listening to White Coat Blackheart. This week, Ken Hagis is newly diagnosed with stage four prostate cancer. He, wife Kathy, and daughter Sue have allowed me to sit in as they meet with Dr. Samantha Weinmaker, Ken's palliative care physician, for the first time. Ken and his family have been thrown a barrage of clinical details. At this initial stage of getting to know one another, Dr. Sammy acts as interpreter. It's about making sure Ken and family understand his illness thus far.

But as we're about to find out, there's what you need to know and what you might or might not want to know. It's something Dr. Sammy is really skilled at teasing out. Can I ask you, sometimes when people get a new big diagnosis, they ask huge questions like, how long do I have?

Is that something that you asked? No. No? No. I'll ask that question later maybe, but right now it feels so good that it seems redundant. Okay. Okay. Fair enough. Yeah. How about you guys? Any questions so far? What I'm thinking is that it would be helpful to know about what time we do have with him, and that's important to me. Yeah. Yeah.

It sounds like you might be more ready for information about the future than maybe you are, Ken. Possibly. Yeah. I think that's true. Yeah. Matthew was asking me to join MyChart a month ago, and I thought to myself, I don't want to read that stuff. No? But now I've asked for the...

the code so that I can sign up. I really appreciate you guys being so open with where you're at in terms of readiness for information. And it isn't uncommon for us to meet a family and we're all over the board. Some people want to talk about the future, some people don't. A lot of what we do, do you know what kind of doctor I am? No.

It's nice of you to let me come. You're with the palliative care? Yes, that's right. One full hour into this consult, and with a touch of humor, Dr. Sammy utters the word palliative for the very first time, dispelling misconceptions, figuring out what Ken and his wife Kathy know. Do you know what that means? End-of-life care, I presume.

I think that's how we're marketed, but that's not all we do. But did you know that I was a palliative care doctor? That I am a palliative care doctor? I understood from the appointment that it was somebody from palliative care that was coming. And we have been battling with this word, palliative. I have been. It used to mean end-of-life care. And

Is it different now? Yes. Okay. Okay. Yeah. So that's the good news. Yeah. And then I'd like to know what it is now. You know what, as far as I'm concerned, palliative care is really just about helping you to be the best that you can be, given the circumstances. It is making sure that we balance hope,

with the reality of the situation making sure that you guys have all the information you need to navigate this journey it's making sure you're treated as humans and

Depending on where we meet people and how recent the diagnosis has been, we never know how ready people are going to be to talk about anything about the future, especially when you are in the middle of determining what is the current plan and you're feeling good right now and you want to ride that wave. Sure. Yeah.

It's not uncommon, though, for the people in the shadows over there on the couch to be more curious about craving information. I feel like sometimes it's really better to go on. I mean, we know the end, but my style is to ride the wave until the wind changes, and then you have to figure out how to ride the next one. Okay. Yeah.

When it comes to knowing the prognosis, Dr. Sammy now knows how much Ken wants to know. As often happens, what the family wants to know may be different. So given this is a family affair, and you're in the spotlight right now, but we have the best supporting actors over there, you all count. And your information needs count, even if they're all different. And today we don't have to go into any nitty-gritty.

But I do want you to know, and I tell you this from my experience and my heart, that the more information you have, the better illness journey you will have. For better or worse, people feel more grounded when they have information. Information is the best way to stay out of a crisis instead of just having to respond to it when the wind changes.

It is important to me to sort of have a plan. I will go along with whatever Ken says. I mean, he's the one that has the cancer. But I don't want to go over Ken's head or behind Ken. I respect him. Ken, is it okay if Kathy has questions about the big picture stuff and a need to have that information, even if you...

aren't interested yet? It is okay. I guess my concern is can Kathy handle the answers? That's a good point. Maybe you need a backup when you ask those questions. You'll be my backup? Okay. I certainly am willing to come and talk to you guys about anything.

I've done this many times. Yes, I'm sure. Yeah. You know, you will have an individual course through your prostate cancer journey. Yes. But I have a big picture idea of what the footprint is going to look like because I've cared for so many people with this illness. I have a roadmap.

in my own brain that I can share with you guys at any time, even though we don't know the actual details of how this will unfold. I think for mom and I, and maybe my sisters, I think it's better for coping if you know more information and you have time to digest it. Because the worst part is

this journey just for me personally has been the not knowing. Does that surprise you Ken? Are you learning something new about your family? They're strong. They're very strong. Are they stronger than you thought? Yeah. Yeah? Does it touch you?

Yeah, I see that. You're protecting your family. Right. Yeah. The other part of it is if somebody says, oh, you have six or seven months, then all of a sudden there's an end point. And I don't necessarily want to accept that that's the end point. Yeah, yeah, fair. It sounds like everybody's giving up at that point because that's what's going to happen. But...

And it may be true, but it may not be too. I have some good news for you. Good. Yeah. Okay. You still have some life in you. I know that. Yeah, I can tell. I'm an expert in this. And you're not going anywhere too quickly. Okay? That's what we want to hear. Yeah. Yeah. Yeah. Well, I feel that. Good. Yeah. Yeah.

And I have some other good news. A lot of people worry that as time goes on, that pain is going to enter into this storyline and build until it's a dramatic ending. Pain isn't necessarily going to be part of this story. You know how people think palliative care is end-of-life care? A lot of people think when you have cancer, it's automatically painful.

Or when you're in, you know, the last chapter of life that the end is going to be painful, let's just say. And that's not necessarily true at all. Okay? So you are not destined to have pain. We are really good at treating symptoms. And so the goal would be, again, to make you the best that you can be at any stage here. Okay? That's fair. Did you expect your palliative care visit to be...

To be worse than it is here? I wasn't sure what it was going to be like, but I'm very happy that you came today, both of you. Well, everybody said that you were a great person to be doing the job that you're doing. Were you speaking to my mom? And that's how I feel too.

keep asking. Okay. You got it? Yep. Okay. Thank you. Take care. Thank you, everyone. Thank you. Oh, Ken, are you a hugger? Oh, always. Okay. I hugged everyone in the family, but I didn't get to hug you. Take care. Okay. Bye-bye. Bye now. Have a good rest of the day. You too.

Back in Dr. Samy's car, her mobile office, I'm thinking about something she did that was subtle. Acknowledging and accepting that Ken doesn't want to know his prognosis while making the point that patients who know more do better. Folks that are in the know, that have information, can be more proactive. They can plan ahead. They can make informed decisions. They can use their time the way they want to as an individual.

They can feel more grounded, feel less scared. They can have hope. They can feel more confidence. People who don't have information often feel like everything happens suddenly.

I suddenly can't get out of bed. I suddenly am not eating anymore. I'm suddenly at the point where there's no more treatment. And then afterwards, they died suddenly. And you're saying that's not the case? There's barely anything that is sudden about this. You have said in your writings that you're often called in

at the 11th hour. And Ken is certainly not at the 11th hour. So that's a big shift, isn't it? Huge. I am delighted that I have been asked to come in. If this was a patient with a non-cancer diagnosis...

it's unlikely I would have been asked in. And I'm not saying that I am the solution or a palliative care specialist is the solution, but in the absence of all the other healthcare teams really understanding the importance of this approach and this philosophy of care, it's very lucky when we're invited in early.

But if this was a patient with COPD or, you know, I could name 15 other illnesses. Do you want me to? Heart failure. Okay. So dementia, all types of dementia, heart failure, COPD, pulmonary fibrosis, cirrhosis of the liver, advanced kidney disease, heart

ALS, multisystem atrophy, Parkinson's disease. I mean, I could go on and on and on. Those non-cancer diagnoses, those patients are at even higher risk of not fully understanding that their illness is not just chronic. They are also progressive patients.

you move through chapters in those illnesses, the beginning, the middle, and the end. But if we just treat them all like they're just good old chronic, then at some point the gig is up and we pull the carpet metaphorically from beneath them and suddenly say, there's nothing more we can do for you. We're going to get the Grim Reaper service in, the palliative care team, and

I would say that whoever is taking care of those patients should be providing that, not just me as a specialist. I think every cardiologist, respirologist, nephrologist, hepatologist, did I say neurologist, oncologist, family practice, all of us have a stake in the game and all of us need to be providing a palliative approach. But in the future,

Personally, I hope no one needs us because we've done such a good job integrating a palliative philosophy of care into all care providers' competence that we don't have to label it palliative care. It just becomes very amazing person-centered care delivered by everyone. It's going to happen, Brian. Yeah.

Dr. Samy uses knowledge not to take away hope, but to eliminate the false sense that bumps along the road happen suddenly. She says those bumps are largely predictable. That's the biggest thing I take from watching her in action. That and reminding people that if they aren't offered palliative care, they should ask for it. In the months since that first session with Dr. Samy, Ken Hagis continues to do well while receiving treatment at the local cancer center.

Wife Kathy and daughter Sue haven't yet asked for that follow-up chat, but Dr. Sammy will remind them that the invitation is always open. That's our show this week. Our email address is whitecoat at cbc.ca. White Coat Black Art was produced this week by Jennifer Warren with help from Stephanie Dubois and Samir Chhabra. Our web writer is Brandi Weichle. Our digital producer is Ruby Buisa. Our senior producer is Colleen Ross. That's medicine from my side of the gurney. I'm Brian Goldman. See you next week.

For more CBC Podcasts, go to cbc.ca slash podcasts.