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CANADA: Woman writes deathbed letter about dying on her own terms

Assisted death 'too rarely spoken of and not well understood' writes terminally-ill woman the day before medically-assisted death
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2019-07-08 AssistDying JO-001
Keven Ferry holds a wedding photo of himself and his wife Gail Evans. Evans elected to die by medically assisted death on June 5. Jessica Owen/CollingwoodToday

COLLINGWOOD - On the deathbed of her choosing, a woman with terminal cancer used one of her last days to reach out to the world, and her nation, and tell her story. 

"I am writing this letter knowing with certainty I have one day remaining until I die," wrote Gail Evans in a letter explaining her choice to have a medically-assisted death and her gratitude it was an option for her. 

On the evening before her death, Evans’ husband prepared a lobster feast.

“We had wanted to do a lobster dinner, because Gail loved lobster,” said Keven Ferry, Gail’s husband, this week in an interview with CollingwoodToday.

On June 5, Evans, a Collingwood resident since 2005, opted to die through medical assistance in dying, or MAID.

The couple had planned a bucket-list trip to Halifax in September. Since they could no longer go, Ferry brought Halifax to her that night.

“I made a lobster dinner for us here and then I took it over to Campbell House (Hospice Georgian Triangle),” he said. “Normally, if you buy lobster tails here, they’re large and come out of the Caribbean.

"I searched high and low to find east-coast, Nova Scotia lobster. They’re smaller and they’re supposed to be more tasty.”

His search may have been in vain.

“As she’s eating the lobster tail and she’s smiling and she said, ‘I think I like the other lobster tails better',” Ferry recounted with a laugh.

Ferry said he and Evans met in 1981, when he purchased a triplex in Toronto to renovate. Evans came through the door looking to rent.

Ferry said he knew right away that she was special.

“It was magical. It was one of those rare occasions,” he said. “We had a special relationship. People always say their wife or their husband is the greatest thing that ever happened to them. We had people even six months ago stopping us to ask if we were newlyweds, because of the way we loved each other.

"She was my world, and I was hers.”

Ferry and Evans lived in Toronto for most of their lives together. They also spent some time living in Kelowna, B.C., in the 1990s.

“Gail was into theatre in a big way. She loved being on stage. She loved acting. She eventually became a really phenomenal director,” said Ferry.

Ferry said he and Evans always talked about having a summer getaway place. In 2005, they bought a waterfront cottage in Collingwood. Over the years, the duo worked hard together to build and renovate the cottage into their dream home.

“Gail did all the designing and the decorating side of it. She had a flair for how things should look. She was extremely talented,” said Ferry.

When Ferry described Evans, his eyes light up.

“She was an interesting character. She knew her own mind. She had a wonderful sense of humour, which I really cherished,” he said. “She was always very even-keeled with people. She calmed me, and would bring me back into focus.

"She was the centre of my universe.”

Ferry said Evans struggled with her health for many years. She was diagnosed with heat allergies and sarcoidosis, a disease involving abnormal collections of inflammatory cells that form lumps known as granulomas.

“At the time when she was diagnosed, it wasn’t active in her system, so the doctor just told her so she would know,” said Ferry. “It was never really bothersome.”

Due to the sarcoidosis, doctors didn’t think anything was unusual when Evans made a visit to the hospital in late 2018 complaining of general weakness and difficulty breathing.

“She was in bed from September 2018 on,” said Ferry, adding she was treated for the sarcadosis at the time.

In February 2019, a problem with her lungs led Ferry to rush Evans to the hospital. It was during this hospital visit that Ferry said she first noticed a small lump on her abdomen.

“It was about the size of her thumbnail. She was very thin at that point,” said Ferry.

After a few weeks of the lump remaining, Evans went to see her doctor again who ordered tests. The diagnosis came back the same day that Evans had stage 3 ovarian cancer.

“It had been growing in the background and nobody knew it,” said Ferry.

Ferry’s voice cracked when talking about the moment of diagnosis.

“She started to cry and said, ‘I don’t want to leave you.’ I said, ‘I don’t want you to leave me, either,'” said Ferry.

It took until April for Evans to get into an oncologist in Barrie, and another 21 days to get the results of a biopsy.

“This little thing we found in February, by the time we got in to get a biopsy it was the size of your fist,” he said.

The prognosis from the oncologist was that Evans’ cancer was incurable. Evans went through a round of chemotherapy, but was told by the doctor it was palliative only. When she saw the oncologist in April, she was told if the cancer went untreated she would have about six months to live.

In mid-May, Evans’ doctor told her she had to accept the reality of her health situation, that the cancer was simply unstoppable.

“She went from total denial to total acceptance that day,” said Ferry.

Ferry recalls when he first met Evans, they had conversations about how they wanted to live out their lives.

“She said back then, if anything ever happened to her, she didn’t want to be languishing away in some home somewhere. I always thought it was a little strange, because she was a young woman, but she always had this clear vision as to where she was going to go,” he said.

“I watched her suffer for many years with things the average person doesn’t deal with. That evening in May, she turned to me and said, ‘I want you to be prepared for this because this is what I want to do',” said Ferry. She decided to request medical assistance to die.

“I looked at her and I said, ‘Sweetheart, it’s your life'.”

In June 2016, federal legislation (called Bill C-14) was passed that allowed eligible Canadian adults to request medical assistance in dying.

In order to be eligible for MAID, you must be eligible for federally funded health services, be at least 18 years old and mentally competent, have a grievous and impossible-to-cure medical condition, make a voluntary request that is not the result of outside pressure or influence, and give informed consent.

Evans went through the process to apply. She received word the first day she would be eligible to go through the procedure was June 5.

“I was a little shocked by that, because all of a sudden it went from being a conversation to reality,” said Ferry. “According to the legislation, you have to be 100 per cent coherent, and the challenge with the cancer is it was progressing. There was a fear it would eventually start affecting her mind. So we accepted the first day of June 5.”

On that Wednesday morning, Evans was transported from Campbell House to her home.

“We had about an hour together. I bought a nice bottle of champagne and we opened it and toasted to her life and our lives together and how special it had been,” said Ferry. “One of the only positives of the last eight or nine months is we had time to say goodbye to each other. We had a chance to basically say everything we needed to say to each other.”

Looking back, while Ferry said he knows Evans was always certain that this was the route she wanted to take, he does believe she wavered at first on the choice to go public.

“I don’t think Gail wanted the stigma of saying she committed suicide. But then, it changed. The more she talked to people and the more she realized that not only was this acceptable in the public’s eye, that this was something she could get behind,” said Ferry. “She wanted an opportunity (to express) her gratitude. To live in a country that allowed this kind of morality, the ability to have a conscience that says when you reach a certain stage in your life, to end it on your terms.

Ferry relates to feeling a variety of emotions around Evans’ death.

“There’s a whole cornucopia of emotions that go along with it. It’s an enormous loss. I look around at the life we created here for ourselves, and it’s all different,” said Ferry.

“I have enough positive memories to last me a lifetime. I know she’s finally at peace," he said.  "When the doctor gave her the anaesthesia, she looked at me and said, ‘Thank you for everything. I’ll love you forever,’ and she closed her eyes.”

*************************

As the federal legislation does not force any person to provide or help to provide medical assistance in dying, Hospice Georgian Triangle opted to not provide the service at their facility when the legislation was approved.

“We had to look at whether or not that was a service Hospice Georgian Triangle would be able to provide, and we felt that that message was a different message than the one we want to give people, which is we want to support you to live the best that you can,” said Linda MacLeod, chair of the board of directors of Hospice Georgian Triangle.

“If a patient chooses that, we will facilitate discussions with their physician where that could happen. Most often it happens at home... and we would facilitate that as they choose. We tell people that before they come in,” said MacLeod.

Evans spent weeks at Hospice Georgian Triangle leading up to her death at home, so hospice staff was familiar with Evans’ story, her health struggles and her choice to end her life.

“I believe she’s the first ever (case) that we’ve had,” said MacLeod. “The legislation has only been around for a little while. We have people that occasionally explore the idea and decide against it. Many people might have that discussion with their physician and choose to have it at home and we may not have seen them.”

MacLeod acknowledges that there can be complex emotions that factor into many people’s beliefs surrounding medically assisted dying.

“There are some long-standing feelings people may have [about MAID]. Some are religious, some are from a moral background, some are maybe what your parents said when you were a child. People have a lot of emotions around death anyway,” she said. “We’re not seeing it from a stigma point so much as a patient figuring out what’s best for them. That’s very individual and very different.”

Gail’s letter

(On June 4, the day prior to her death, Gail Evans dictated a letter concerning her decision to end her life. The letter has been forwarded to government agencies and non-profits such as Dying with Dignity Canada as per her request.)

To All Whom It May Concern (and it does concern us all!):

I am writing this letter knowing with certainty I have one day remaining until I die.

My first purpose in writing is to express my gratitude to the country and people of Canada for embracing and legalizing Medical Assistance In Dying (MAID). My second purpose is to relate to people who are living with a terminal illness who may feel there is nowhere to turn and who are living afraid as I was, that there is an approved, legalized process in Canada that can alleviate much of the fear and bring a sense of peace.

This is my story.

I was not born in Canada; however, I have lived the majority of my life here and thankfully so. I have been ill for much of my life albeit I have also been extremely busy and active in the realm of theatre. I never really focused on death — it always seemed a long way off and again thankfully it was.

At the age of 70 I began to feel exceedingly ill. I was initially misdiagnosed and received treatment accordingly; however, my condition got worse and worse. By the end of September 2018, I was bedridden — too weak to hold my own body weight. During this time I sensed a voice inside exclaiming “this is going to kill you and if doesn’t happen soon you’ve got to find a way to make it happen”. MAID wasn’t on my radar. No one I’d known had needed or wanted it.

In February of 2019 a CT Scan revealed that I had Stage 3 ovarian cancer that had metastasized. I knew what that meant. The earlier treatment was immediately halted and I moved on to oncology. Ovarian cancer is nasty. By the time it rears its ugly head it’s almost too late to be treated. I am extremely grateful for the Canadian Health Care System. However, the length of time it takes for tests and assessments is lengthier than desirable and I have to say in some respects, borders on cruel. By the time I saw the oncologist I was very weak and the conclusion she came to was for me to move to hospice.

I had one round of chemo that did provide some relief and I rallied temporarily. That allowed some to hope that I’d return home; however, I knew that wasn’t going to happen.

And so, it was on to Campbell House, the residential facility of Hospice Georgian Triangle in Collingwood. And what a slice of heaven that has turned out to be — one of the biggest gifts of my life. The staff is beyond superb — kind, caring, compassionate and highly competent — I have totally trusted them with my welfare. Beyond their professional abilities, they are not doing this work simply to earn a living; they each go about their roles exuding a sense of mission, a sense of calling. Additionally, the many volunteers without whom the hospice model could not function, offered beautiful support to my husband and I. One of them, a registered wedding celebrant, even created and conducted a ceremony for us to renew our wedding vows.

Meanwhile, I continued to be ill and miserable and withering away — dying exactly the way I did not want to die. There were those who felt I should have another round of chemo. Deep in my heart, deep in my soul I knew that was futile; however, a part of me has always been a good girl so I listened respectfully and hung on. But, I wasn’t being honest and life has taught me that any time I’m not being authentic (i.e.: maintaining a stiff upper lip) I suffer — and I was continuing to suffer.

So, my doctor visited one day a couple of weeks ago and asked how I was doing — the floodgates opened. I told her I was miserable and we talked about the fact that the disease was going to kill me. I asked to be more deeply sedated so I wouldn’t have to experience the constant discomfort. She called a colleague who examined my chart from beginning to end which illuminated the cold, hard facts. Then, in one of the biggest aha moments of my life, I recalled that back when I was healthy I had seen a documentary on assisted suicide from Holland or Switzerland and I had concluded then that’s how I wanted to die. I had had many animals in my life that eventually I had to have euthanized at the end of theirs. I had always found it to be exceedingly humane, loving and peaceful and a mirror of what I wanted for myself. And then I remembered Canada had passed legislation that made that a possibility for me.

My doctor confirmed that I was definitely eligible for Medical Assistance In Dying (MAID) and we began and completed the cautionary process established by the legislation that includes:

  • Making a written request, witnessed by two independent adults
  • Providing informed consent
  • Obtaining the written opinion of your medical practitioner and a confirming opinion from a second medical practitioner
  • Waiting 10 days before the final step
  • Maintaining the right to not proceed up to the moment of the final step

While that might sound daunting, it was very simple and straightforward — I only had to complete a form and the doctors did the rest.

It concerns me that MAID is still too rarely spoken of and not well understood in our communities — perhaps because people are afraid or they’re simply unaware or for religious reasons. There are many of us who are eligible for this peaceful, loving death.

When you’re extremely ill it’s as if your life is taken away before you die. There are so many things over which you no longer have a choice. Having made the choice for MAID, I have chosen to free myself and to free up the world around me. I have been able to reclaim my personal agency. I’ve been able to choose when and where and in whose company I’m going to die. I’ll be leaving hospice and returning to our home for the final step where I’ll be only with my husband Keven and the required medical support individuals. I’ve chosen the music that will be playing, the flowers and scents that will be in the room, even my final meal — lobster tails! I’m filled with a sense of joy and peace and relief. I’m choosing not to suffer any further. I also believe that knowing I’ve gone peacefully is a gift for others who care for and love me.

Since my decision, my dying has changed dramatically. The anxiety about the practical, objective, procedural issues is gone. I can sleep restfully at night. I can enjoy the company of friends who stop by. Even my appetite has come back.

I can’t say I have no anxiety. However, that is moderated significantly by my certainty of knowing what the next steps will be and if necessary some mild sedation.

I’m having the kind of dying I want to have under the circumstances that my death is an immanent certainty. I’m grateful to this country of Canada for making this peaceful process possible. And of course, I’m grateful to all those who have cared for me and loved me — none more than my husband of 34 years, Keven.

Yours truly,

Gail Evans




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Jessica Owen

About the Author: Jessica Owen

Jessica Owen brings nine years of experience to her role as regional reporter for Village Media, primarily covering county matters, court, Collingwood and Barrie matters
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