In Angers, a mobile palliative care team offers personalized support to patients

It's only after shaking hands with Dr. Hélène Schmets and nurse Laurence Lardy and having accepted a coffee in their office that I realize that I am not in a palliative care unit. In the strict sense, of course. “You are in the conventional hospitalization unit of the Western Cancer Institute (ICO) in Angers,” explains Hélène. However, she and Laurence are indeed specialists in palliative care. Their tandem constitutes the ICO’s “mobile” palliative care unit. Mobile, because they move around a lot, within the establishment and among patients.

By agreeing that we follow them for a day, Hélène and Laurence show us that palliative care goes well beyond the units dedicated to this discipline. It is possible to spread this culture with small structures, like theirs. “We devote a third of our missions to training caregivers in palliative care,” confirms Hélène.

Ease the emotional burden

An example: every week, caregivers have gotten into the habit of meeting to discuss complicated cases. To also lighten the emotional burden. “It shouldn’t just be a discussion group, or an information meeting. It’s somewhere in between,” analyzes Jean-Marie Commer, ICO doctor. The team can spend thirty minutes on a case. That day, the caregivers wondered how to prevent a drug-addicted and unstable patient from ripping off his bandage. And can his partner spend the night with him? No, thinks Jean-Marie: “There is a security risk in the hospital. And she already spends a lot of time with him during the day. » The caregivers point out that this woman stresses the patient; arguments are not uncommon. “Ah, I didn’t know,” said Jean-Marie. This confirms our choice. » A nurse warns against the prejudices she observed towards this man: “We must take care of him as well as a UN ambassador. »

Hélène asks Laurence if she wants to come and meet with us a 41-year-old terminally ill patient. The nurse hesitates. ” I do not think so. I'm afraid it will be too many people in the same room. » We recognize the palliative expert by these delicacies.

The patient, Marie-Claire, exudes an impressive serenity. She only has one worry: that they won't put a drain in her in time to spend her last days at home, with her husband and her 6-year-old daughter. Without this drain, she has to go to the hospital for punctures every two days. The drain can only be placed by an anesthesiologist and a surgeon. However, their schedule is proving too busy at the moment, Hélène apologizes, her hand delicately placed on Marie-Claire's leg. “I can’t fit in their hallway? » the latter half jokes. Against all expectations, the eternal lack of means bursts into the room.

Marie-Claire is full of praise for the kindness of the ICO caregivers. And their intelligence. Faced with the sick, the caregivers here avoid major philosophical flights of fancy. “Everything has to start with the patient. We should not suggest anything to them,” explains Marie Guerin, a nurse. Patients are invited to express their desires, to find meaning in what could be their last months of life. Caregivers do their best to make their dreams come true. Like this man who wanted to go to Spain for six weeks in a campervan with his family: he succeeded. “We did the consultations by videoconference,” says Hélène. It was a bit rock and roll at the end. »

Suddenly, a young woman faints. This is a novice pharmacy technician. Hélène rushes towards her. She orders him to stay lying down; especially not to apologize. Immersing yourself in a cancer department is not easy. The service experiences 120 deaths per year. How not to break down? “By never forgetting to say to myself: what is my role alongside the patient,” believes Hélène. I could break down crying with some of them. Would this bring them a more peaceful life? Not necessarily. » If she's not feeling well, she avoids having several difficult discussions in a day. Or pass the baton to a colleague.

Knowing how to question yourself

Jean-Marie Commer has seen authoritarian colleagues pass by. This created tensions. “To make a palliative, we must accept that others question our decisions,” he judges. Those who don't like it don't do it for long. » “We cannot do palliative alone,” adds Hélène. Caregivers, for example, see and hear things that we miss when washing. Their look is always precious. » The profile of the all-powerful doctor tends to fade. “It’s changed a lot,” says Myriam Breau, a social worker at the ICO for thirty years. When I arrived, there was no psychologist here, because the director was wary of this profession…” For her, the shift took place during the 1998 States General on patients' rights.

Here, a nurse can remind the doctor that a scan creates fear of the result in a patient. We must be sure that this act will be useful. Marie Guerin has already suggested to the doctor to avoid further chemotherapy for a patient who she felt was very tired. “He prescribed hormone therapy. He listened to me,” Marie appreciates.