Episode Summary
This meaningful conversation between Kath Murray and Mahoganie Hines—a clinical nurse specialist, educator, and passionate advocate for equitable palliative care—explores what it truly means to take a palliative approach, from diagnosis through bereavement. Together, they discuss the importance of honoring the whole person and their family throughout the care journey. Mahoganie shares powerful stories, including a resident’s final wish to attend her son’s wedding, and reflects on the small, compassionate acts that uphold dignity and affirm personhood at the end of life. They delve into the concept of “total pain,” the value of holistic and equitable care, and the profound beauty of being present for others during life’s most vulnerable moments—the very heart of palliative care.
Episode Guest
Mahoganie is a Clinical Nurse Specialist at St. Peter’s Hospital in Hamilton and professor for Georgian College, with extensive experience as an educator and palliative care consultant. She has worked as a PSW, bedside nurse, consultant, professor and educator. She has volunteered with the RNAO and CPCNA, holding various leadership roles including, currently, the role of President for both. She has a Master’s degree in Bioethics and has contributed to various RNAO Best Practice Guidelines. A corner stone of her practice is advocating for equity and accessibility in palliative care for all those who would benefit from it. She has received several awards for her work. Outside work, she plays baseball, volleyball and referees for the Niagara Roller Derby League.
Additional Resources
Canadian Palliative Care Nursing Association
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Transcript
00:00:10 (Kath Murray): Hello, Mahoganie Hines.
00:00:13 (Mahoganie Hines): Hi Kath.
00:00:14 (Kath): Welcome to the Hospice Palliative Care Ontario Palliative Talks podcast series.
00:00:21 (Mahoganie): Thank you.
00:00:22 (Kath): I’d like to start by introducing you, so everyone will know you. Now, we could do this over a long time. And we could, in fact, just for those who don’t know Mahoganie, might know that we could do this on a roller derby…Is it a team? Or is it a rink? Or what is it that you do?
00:00:39 (Mahoganie): Probably like a rink, yeah.
00:00:40 (Kath): But we could do this, and we could just interview you as you were refereeing or skating around the rink, and that would be kind of fun.
00:00:50 (Mahoganie): It would be something.
00:00:50 (Kath): So Mahoganie is a clinical nurse specialist at Hamilton Health Sciences and a professor for Georgian College. She has extensive experience as an educator and a palliative care consultant. She’s volunteered with RNAO, and in that capacity she has contributed to several best practice guidelines. And with the Canadian Palliative Care Nursing Association, she has helped in many capacities, including as President. And I know that CPCNA has just loved having her.
For any of the nurses listening who maybe don’t know about CPCNA, then that would be something you’d want to find out about.
She has a master’s degree in Bioethics. A cornerstone of her practice is advocating for equity and accessibility in palliative care for those- for all those who would benefit from it. She’s received several awards for her work, and I have known Mahoganie for a number of years, and I’m just proud to be one of her many fans.
My name is Kath Murray. I’m a hospice palliative care nurse, educator and author, and co-founder of Life and Death Matters, a Canadian palliative care education and resource company. So Mahoganie, good to see you today.
00:02:05 (Mahoganie): It’s great to see you, Kath.
00:02:07 (Kath): I want to talk to you about, a palliative approach to care and wonder if you could start by defining. How do you see that? How do you express and define that to people?
00:02:20 (Mahoganie): Yeah, I’d love to. So, a palliative approach to care is it really should start from the time of a life limiting diagnosis. And when we talk about life limiting diagnosis, the first one that normally comes to mind, I think, is cancer for most people. But life limiting diagnosis, there are multiple of them, and many people often have many. So some of them might include things like, congestive heart failure or COPD, which is an umbrella term that encapsulates multiple respiratory illnesses. It might be liver failure. So any of your organ failures.
One of the most common ones that we see – most commonly in long term care – is dementia, which is also an umbrella term that encapsulates multiple different, cognitive impairments. So all of these are life limiting diagnoses.
And really it should start from the time of diagnosis or soon after, and all the way into bereavement. Now, I just always try and ask people to consider, like, when do you think people start grieving in that process? And oftentimes people will say like, oh, when somebody dies, I think that grief happens. But in my experience, grief actually happens every time we experience, a loss. And whenever we experience that loss, that’s grief. And part of the palliative care approach is also tending to that grief for not only the person, but whoever they identify as family. So it’s a holistic approach to care because we don’t just exist as physical beings.
We exist in multi-facets. And that’s the beautiful part of caring for humans. And the beautiful part about that is- is it’s really not just about whoever the person is, but whoever they identify as family, whether that’s given or a chosen family. And it’s really wraparound care to tend to what we often call the domains of care. And we can explore that a little bit more as we talk.
00:04:16 (Kath): So can you give an example of how you suggest, or just a memory or an example of integrating a palliative approach in care?
00:04:24 (Mahoganie): Yeah, I mean, I have quite a few examples that come to mind. One of the ones that comes to mind from long term care. I worked with long term care homes for many years as a palliative pain and symptom management consultant. And in that role, I would often go out to long term care and I would get consultations. Sometimes for pain, sometimes it was because families were having a difficult- difficult time coping with the diagnosis or somebody was transitioning into end of life. And in those cases, the things that we think as health care providers might not be actually the priority for the patient or for the family.
So the case that always kind of comes to my mind as one of the opportunities that we really exemplified, excellent palliative approach to care was when we had a patient who was nearing end of life, she was entering kind of those end of life phases. Her goals of care had changed from curative measures to comfort measures, really focusing on that. But one of the things that was causing her a great deal of distress and pain was the fact that her son was to get married in a few months, and she knew that she wasn’t going to be alive to see that and experience that. And it was incredibly important to her to be the mother of the groom. And in the long term care home, like, we were trying to address her pain physically, but it wasn’t physical pain. It was what we often refer to in palliative care as total pain. So it was this emotional dimension.
It was a practical dimension. It was psychological. And it was her social needs. And there was a lot of loss and a lot of grief for all involved. And when we kind of extrapolated that and pulled it apart and got to the root of what was going on. When she told us that, we actually spoke with her team, and spoke with her family, and we asked her son if there was any possibility of coming in and having a wedding, and they were all for it. They actually lived out of province. So they came in, him and his future bride to be. They got dressed up, they set a date, she got her hair done. The staff got to do her hair and her makeup for her, she got to pick out her outfit. And she got to have that experience that was so incredibly important to her, and helped with her grief, and helped with the total pain she was experiencing. It didn’t require medication. It required presence, and it really required getting to know that patient really, really well. And they were able, the whole team, I really had little to do with, in all honesty.
I was there to just kind of help figure out what was the issue. And then the team ran with it and the PSWs helped, and the nurses helped, and the – the social worker helped. They had a chaplain come in, and they had a ceremony. And like, that’s the beauty of what palliative care really ought to be, is getting to know people and meeting them where they’re at, and really tending to all of the facets of who they are as a person to live really well until you die.
00:07:44 (Kath): You have identified a most beautiful story, a classic story about somebody who the staff was able to do something so beautiful to plan and to implement and orchestrate this wedding. But I think about the beautiful care that people do on a daily basis when people are grieving. Whether that’s the inability to get up to see a family member, whether that’s the inability to eat, or to enjoy eating, or, or or or or- so many things that one can grieve. And- and again, you came back to the word – the word beautiful. And, you know, it’s not the first story that I’ve heard of a wedding in long term care that has been done to address- address that desire. And it’s- it’s one of those big stories. And yet so often it’s the little things. So let’s go. You’ve just talked about something big, big, big huge. Talk to me about some of the little things, the tiny things, as Philip Larkin said, that make such a difference.
00:08:48 (Mahoganie): Yeah, there’s- I mean, I think every day anybody who works in health care, we get these little opportunities or little gifts along the way to be able to do those little things that make such a profound difference in somebody’s life without even acknowledging that we’re doing something. So it could be something as little as giving them the option between what they would like to eat. Right? Giving them the option between what they would like to wear. And then if they want to get their makeup done, or if they want to have their beard trimmed, like if they want to look a certain way. And giving people choice is one of the biggest ways, in such a very small minute way, that we can really recognize and acknowledge somebody’s personhood.
And I think we have such an opportunity, and it’s really such a gift to watch people step into who they are, even through the illness journey. Because I think sometimes as somebody is sick or progressing in their illness and- and getting close to the dying phases or the end of their life, sometimes they struggle with like, who am I? What kind of legacy am I leaving? And we have such beautiful opportunities to acknowledge their personhood at each of those transitions. And we- many health care providers that I work with, I work with nurses daily, I work with social workers, I work with chaplains. You know, I work with doctors. I work with really amazing health care providers. And they all do this every single day. And most of them don’t acknowledge that they’re making a difference, without even acknowledging that they’re making a difference. They’re sometimes just doing their job and showing up.
00:10:35 (Kath): Is- is there anywhere that it- it’s harder. And in what ways is it easier? What ways is it harder? What ways is it easier to integrate a palliative approach?
00:10:46 (Mahoganie): I think it’s harder when people don’t understand what a palliative approach to care is. I think that’s one of the biggest barriers that we experience. I’ve worked in palliative care my whole nursing career, and I often hear people say “oh, now the person’s palliative” or “oh, there’s nothing more we can do for you. Here’s some palliative care.” And that’s actually not at all true. It’s a failure of our system when we say, like “oh, here’s some palliative care because there’s nothing more we can do for you.” Anybody who provides palliative care, which arguably is everyone, you know, like, we all are doing it. We just don’t call it that.
And I think that it’s a really unfortunate thing when people don’t understand what palliative care is and what it brings to the table. And they sometimes see it as like giving up. But it’s not about giving up. I think when we flip the perspective and we start thinking about like, who is this person? And how do I get to know them? And how do I show up for them? And how do I provide the best care I mean, I often go back to an ethical approach. I often respond really well to like ethics of care models and ethics of care actually pushes back on some of the generalized norms where we talk about not just caregiving, but care receiving, being the recipient of care. All of us are going to receive care at some point. We’re all going to be care receivers. We may not all be caregivers, but there’s like a reciprocity that happens between the two. There’s like this reciprocal nature where we go back and forth. And I think that’s a gift, it’s really beautiful.
00:12:38 (Kath): It is beautiful. There’s your word “beautiful” again.
00:12:41 (Mahoganie): I’m biased. I’m very biased. I will be the first to admit.
00:12:45 (Kath): So, just- let’s just take a minute. When you – when you use that word beautiful and when you say you’re biased, could you just expand for another minute on that?
00:12:55 (Mahoganie): Yeah. And I think Kath you kind of you started to speak to it a little bit. You said something that I often say. For me, part of the reason I came into palliative care, and that’s why I’ve worked there my whole career. This was a second career for me. This wasn’t my initial career. And I came into nursing knowing I wanted to work in palliative care. And part of the reason for that was every time I learned what nursing was supposed to be or ought to be, or healthcare was supposed to be, and ought to be, and then I learned about what palliative care was, about person centred care, really about integrating not only the person, but whoever they identify as family, and really getting to know people in all the facets, the weird and the wonderful, and everything in between.
It really is the essence of what nursing ought to be for me. Like, it really deeply speaks to the true nature of what we, I think aspire to be as nurses is people who show up and support you through really challenging times. And by proxy of that, we get to continue to learn and grow. And I think that’s such a gift. And – and for that, that’s – that’s where I often find the beauty. You get to see the full spectrum of humanity. You get to see people at their very best, and sometimes at their very worst, and everything in between. And I think that’s such a gift because I don’t think it’s afforded to everyone.
00:14:24 (Kath): We are so fortunate in giving professions, and I think we could say that for every giving health care provider. But boy, I think you and I both love being nurses. And and some of the hard things, though, is about how do we do this with the restrictions that are on us? Can you- can you address that like you’re coming in from the outside as a consultant. But- but let me- let’s talk for a minute about how does one do that, and keep that loving of their role when- when time and rules and regulations just seem to govern?
00:15:09 (Mahoganie): Yeah. I think, those are not foreign boundaries for me. Even when I was working in a consulting role, even when I’m working in like my clinical practice, because oftentimes I’m very fortunate, I get invited to many of the policy and procedures tables. So I have an opportunity to sometimes change policy or influence policy and give a bit of a front line perspective. Even though I’m kind of removed from the front line, I interact with front line providers every single day. So I get the opportunity to be able to bring forward some of those concerns.
But that’s not to negate the fact that there never is enough time. There seemingly is never enough time. People have more complex disease processes. We’re seeing people with very great complexity of disease. We’re seeing a lot of ratio challenges where we just don’t have enough care providers for the people that need to receive care. And it can make it really challenging because you often feel like you don’t even have time to decompress before you see your next patient or resident.
And I think in those cases, one of the things that we sometimes talk about is trying to be mindful, but also taking like a moment for yourself. There are a lot of like grounding techniques and opportunities that you can use that might be beneficial in just bringing you back to yourself. Bring yourself back into your body. Let go of, kind of what had just happened in the previous room, or with the previous resident, or your previous colleague or what have you, or maybe a family member, and just taking a couple of seconds to kind of reorient yourself to be like, “okay, I’m here, this is who I am. This is how I’m going to proceed with care to the best of my ability.”
00:17:15 (Kath): I think about those things, whether it’s just a touch, whether it’s a wink, whether it’s just a tone of voice. And some of those things don’t take a lot of time. Conversations are such an important thing. Then we’ve got this wonderful term that we’ve been using for the last decade or two, and goals of care, conversations and- and trying to figure out what especially does someone want and what’s my role as a nurse, or as a volunteer, or as a recreation aide, or as a PSW in those, can you I know you love- I know you love conversation. And so sometimes people will say, “oh, you know, these are difficult conversations, but let’s find a way to make them easier.” I think you go in and you go, “oh, I love these conversations. Let’s just dig in. Come on. Let’s go.” Can you give us some ideas about conversations, goals of care conversations and planning?
00:18:12 (Mahoganie): It’s more than conversations. It’s really understanding like, what do people value? And what are their goals? What are their- their beliefs? What are the things that guide them? Do they have like religious, or spiritual, or cultural beliefs that are really important to them, that guide the way that they make decisions, that guide the way that they interact with people, that guide the way that they want to be cared for. I think some of those are pieces that are really important.
And I always look to my PSWs, or my health care aides, because they often are the ones that really get to know people. You have an opportunity to get to know people in their most intimate moments. And in those intimate moments, in my experience, people are more willing to open up and share to you. They already feel vulnerable. So I think the vulnerability barrier has kind of come down in the sense that “I already feel vulnerable, I might as well kind of put it on the table,” and they often will tell you things that they might not tell the doctor, or they might not tell the nurse, or they might not tell the social worker.
So it’s really important for you to be able to communicate that to the rest of the team, because you have a role in those goals of care conversations and those goals of care, those values, those beliefs, those wishes they help to guide when we’re making suggestions as health care providers, what we’re offering. Because we often offer within what’s called the standard of care. So these are the things we can offer you. This is what we can do. And these are the ones that you’ve identified would align with your goals of care. Some of the things we might just exclude automatically, because we know that that’s not something that you would value in any way. So it helps us to kind of streamline into what’s most important. So that way when we do have those really short periods of time, we can focus on what’s most important to have conversations about.
00:20:20 (Kath): Palliative care- one of the principles of palliative care is that it’s to be provided – It is provided by team. What’s some advice you have for – for all of us as we strive to work with team.
00:20:33 (Mahoganie) Yeah I think this one is really important. And it’s sometimes taken for granted or overlooked or maybe not valued as highly or prioritized as highly as maybe it ought to be. But doing excellent palliative care requires a team. It’s a team sport. I requires all of the members of the team to come together and shine the light on the person from their own lens and their own scope of practice. So sometimes the things that a PSW sees are not things that I maybe perceive.
Maybe the social worker or the occupational therapist or the physician, We all have a bit of a different lens at which we look at the situation from, and bringing it all together and coming together helps us to see those multi-facets of who that person is. So it really helps us to show up for them in ways that are are important. And the team as a whole is a really important piece because each of us brings something different within our scopes of practice.
You know, physicians and nurses will often bring like the medications and the treatments, maybe the interventions. Therapeutic rec. brings, you know, sometimes legacy work, which like, therapeutic recreationists really don’t get the credit that they deserve. Dietary brings like their favourite meals, and make sure that the texture’s not terrible for them. Right? Maybe it’s speech language pathology talking about how do we communicate in a way that’s really meaningful to them, so that way they can communicate and have the autonomy of we can go to them and ask them questions instead of having to go to the family member. So I think it’s really important that we all fit together. And for every person and every care plan, the compliment might look a little bit different. But at the end of the day, we all have a role in it.
00:22:29 (Kath): When we’ve talked over the years, we’ve talked about how it begins with us, and how we need to do our own care, our own conversations- not our own care, how we need to do or have our own conversations, so that we’re more prepared to have conversations with with residents, with family.
00:22:54 (Mahoganie): Yeah.
00:22:551 (Kath): So true, eh? Another- another phrase that you’ve used over the years, I’ve heard you talk about that we always need to be teachable, that we always need to be learning.
00:23:08 (Mahoganie): Yeah. I think there’s a certain level of humility that we need to have. I have expertise in palliative care. I’m always leery of calling myself an expert because I’ve not died yet. So, I’m not an expert in dying, I’m an expert in caring for people who are dying, but I haven’t done it yet.And I think that it’s a really great opportunity for us to to really be humbled by the fact that we may be the care provider, but the person as the person who’s going through this, and we have lots to learn from them, and we have lots to learn from all of the members of the team, because sometimes I think we get very focused and stuck in our lanes or from our personal lens. It was part of the reason I did a master’s in bioethics and not a master’s of nursing was because I wanted a different lens than than the nursing lens.
00:24:04 (Kath): Mahoganie, I’m going to go away from our conversation today with a different word than I had anticipated going away with. I am taking with me the word “beautiful” and the word “beauty.” And I am just going to take away and consider the incredible beauty in the work I do. And- and that’s not something new to me, but it’s something that I think, again, as we’ve had this conversation, and you mentioned earlier about how sometimes people say there’s “nothing more we can do for you” and, and that what they’re really saying is “there’s nothing more we can do to prolong your life, or modify your disease.” But that’s when I say, and hospice palliative care says, “we’ve only just begun.” You know, we- we’ve only just begun, that there is so much we can do. This isn’t about no care. This is about beautiful care. And this is about the most beautiful care that- and that it integrates so well with the principles of gerontology and the beauties of caring for someone with dementia or caring for someone in a whole different field. But that beautiful care, that team care, that being- that being receptive, that learning, that putting somebody there in their person centred care, putting them in the centre. Thank you. Thank you for meeting with us and and sharing just some thoughts on some stories. Really appreciate it.
00:25:37 (Mahoganie): I’m really grateful to be able to share just a little snippet into the beauty that is palliative care.
00:25:45 (Kath): So true. So this podcast, as you know, Mahoganie, is part of Hospice Palliative Care Ontario’s education programming. Please go to HPCO.ca for a full range of education opportunities and resources and continue to join us for the podcast series Palliative Talks. Thank you.
00:26:07 (Mahoganie): Thank you.
00:26:09 (Kath): You have a beautiful day.
