Johanne de Montigny on suffering, inspiration, and the joy within. Canada's first psychologist in palliative care shares her insights from 29 years of providing psychological support to the dying and to their families
"The atmosphere and the inspiration of the work are unbelievable and I knew I wanted to be here for sure. I wanted to be in palliative care."
By Devon Phillips. Johanne de Montigny is sad to retire but expresses no regrets. She has big plans for her future, continuing her work as a psychotherapist in private practice as well as a published author. Mme de Montigny’s achievements to date are impressive: she has provided 29 years of care and wisdom as a palliative care psychologist first at the RVH (Royal Victoria Hospital), then at the MGH (Montreal General Hospital), has served on multiple Québec governmental panels on health care at the end of life, authored three books, appeared on innumerable TV and radio shows, and most recently, she won the 2014 MUHC Multidisciplinary Council Award of Excellence in Professional Service. I met with Mme de Montigny in her office at the Montreal General Hospital.
Q: What drew you to palliative care?
A: I suffered a life-changing, tragic experience prior to my interest in palliative care. I survived an airplane crash in 1979, when I was 29 years old working for a government minister in Québec City. Several months after assuming this position, I was flying back to Montreal. We crashed near the Québec city airport not long after take-off. We were 24 aboard the plane, including the crew members and 17 people died. I was seriously injured and suffered for 5 years from the impact of the crash. I had to go to rehab and could not walk. I had to recover physically and psychologically. During my recovery I discovered the generosity of professional caregivers. I was amazed that these kinds of people existed – their goodness, their values, their human touch – I had never experienced that. I was too injured to return to my job. I could no longer travel so I went back to university and studied psychology as a second career. I wanted to work with survivors of catastrophes because of my positive experience during my recovery from this trauma.
Q: How did this tragic plane crash serve as a bridge to a new career as a psychologist?
A: The gentleman who sat beside me on the plane died. It is likely that he died from a heart attack when we began to experience problems before the crash occurred. The man left me with a very precious memory. Although I felt bad and guilty that he died and I survived, I wished I had comforted him more than I had done. In other words, I wish I had done more than just sat beside him and held his hand while he died. This memory has stayed with me. Now I wonder for all of us: is it true that if we have time to prepare for our death, we die well because we know in advance? Do we die in a very painful way when no one notices? As a result, I thought I could work with the dying by going into a hospital and accompanying them on their journey. In my heart I felt it would be a tribute to those who died in the plane.
My work with Dr. Balfour Mount at the RVH was my first job after my survival, and for me it was like a going from a plane crash to a safe landing in palliative care. I came to palliative care only with a desire to give back what I had received.
Q: You are clearly very passionate about your work and very inspired. Where does this inspiration to work with people at the end of life come from?
A: I have to tell you that I am inspired by those who died in the plane crash...I often think of them. Especially when I give a talk, they inspire me. I am honouring them, making a tribute to them. I live and they are with me somehow and I will always remember our last journey together.
I think it’s a blessing to feel profound joy even though you are sad. The image that helps to inspire me is of me swimming in a tranquil lake and I look up at the blue sky in awe. This is heaven. But then suffering is different; in my situation, I had to plunge deep down inside and discover new potentials. That image would be that of deep-sea diving, and swimming back to shore with a starfish in the palm of my hand. I had found something precious to hold: a promising turning point.
Q: You speak about suffering as though it has benefits. Can you share your thoughts on this.
A: As a psychologist, I am not worshipping suffering. However, suffering is the only way to bring you close to your strengths and to your hidden potential, skills that happiness alone will never trigger. It is nice to be happy but this is not where we discover the profound self. When you have to go deep down and experience the dependency, humility, when you cannot wash yourself or go to the toilet yourself for a year, this is a lesson of humility. It takes courage to let people help you. I did not want this help at first, but when you let yourself be helped, you abandon yourself in the hands of good care, and their attitude of respect gives you back a sense of dignity.
Q: How did you join the team at the RVH?
A: So now we are in 1988, after my internship ended, when I got a call from the Royal Victoria Hospital. Dr. Balfour Mount and his colleagues said that a family left a significant donation for psychological services to be provided in palliative care. I was asked, would you want to come back for a one-year full time contract or three days a week for two years, and so I went back three days a week. My position was the result of a family’s generosity. After this two-year contract, they said we will try to find money from the hospital foundation and we will try to keep you. The funds were secured and this enabled me to stay all these years providing service. I was blessed.
Q: There were no footsteps for you to follow as you were the first palliative care psychologist. When you started at the RVH, what was your approach?
A: First, I went to get some supervision from Dr. Pierre Grégoire, a psychologist, who was able to guide me with my new responsibilities, and then, Dr. Mount told me to just explore the psychological needs of the patients, the families, the staff, everywhere I could see where psychological services could be supportive and helpful. At the time, patients would be there for much longer than they are now at our unit at the MGH. Often they were there for 2-3 months so we had time to establish contact. At present, patients are kept at home longer so now it’s an average of 7-14 days until death, so the challenge is how to establish profound and real contact in only maybe one meeting. With experience we learned it is feasible. Furthermore, families can count on our bereavement follow-up which helps prolong and enriches the initial contact I had made with their significant other.
Q: Did you feel a part of the team at the RVH? How many years have you worked in palliative care?
A: From 1986 to 2015 – so including my internship, it will be 29 years next spring. I have to say it again: it has been a blessing to be involved in a team with such great values and a humanistic approach. This convinced me that I could not work elsewhere. The RVH was the first place to have palliative care services in North America. Dr. Mount really created the palliative care format in a hospital environment, which remains an amazing feat. Since then, palliative care services have spread around the world and the McGill experience remains a teaching model for many.
Q: When you joined the palliative care team in 1986, were you aware at the time what an important period in history this was?
A: Yes, because I had read about palliative care and how it was created by this visionary, Dr. Mount, who would become my mentor. It was exciting to embark on his developing project. I was a pioneer/apprentice in becoming a psychologist when I started my internship at the RVH in 1986. Since then, I come to work grateful to have survived my accident and been given the fabulous opportunity to plunge into such a rewarding career.
In that regard, the perspective of retiring next spring triggers mixed feelings; mainly sadness. However, the time has come to pass the torch on to psychologists who will not only bring new perspectives, but who will benefit from the exceptional groundwork and examples that have been left for them. Further on, the move to the Glen Site [June 2015] is a promising adventure, a new chapter for palliative care.
Q: You started at the RVH, which then merged with the Montreal General Hospital in 2003. Tell me about your team and your patient population now.
A: Here at the MGH we now have a team of psychologists. Our clientele is adults, although some are young, in their 20s and 30s. Often people admitted at the end of life are in their 50s. When I started working in palliative care I was 36. I came close to death in the air plane crash but I survived and from then on I felt far from death; now I look at the names of people dying and their ages: 52, 56, 62, 65... it feels much closer to my age and so I identify more.
I have also trained many psychologists and psychology interns. I have supervised about 20 trainees who are now working in different palliative care settings across Canada and in Europe. They come here to do their internship and at least four have come from Europe. They have introduced our techniques and protocols to their colleagues. Many are now working with patients and families at bedside using a proactive approach to treating the sick and applying psychological concepts in a very specialized context: death and dying.
Q: You radiate happiness. How is this possible in the face of loss on an every day basis.
A: It’s the patients and the families that give me energy. In my case, I am so grateful to have survived that when I come here, it helps me to help them. You know they are sad and I see and hear terrible stories every day. Sometimes we go through one box of Kleenex a day. I am lucky to be a joyful person. I think this is a gift to know that joy for me is just as important as sadness and I think that the joy I have within me gives me the capacity to handle the sadness. I don’t think I could do this if I was depressed because it’s very difficult, but the joy sustains me. It is also important to trust people’s capacity to cope with difficult changes; their courage is aroused in the face of adversity and hope takes on different meanings even when one’s life takes a turn for the worst.
Q: Does your work cross over to your personal life? How do you manage that?
A: When I go on holidays, my brother says, “Please do not bring a book on bereavement.” One time we were going to Florida and he gave me a novel and he didn’t know but it was a book on someone who had lost a loved one (laughter!). But it’s not morbid what I read, because I am interested in knowing more.
I have to say that I am more sad as the years go by because you cannot be totally unaffected. I am aware of that sadness, but it’s not depression or demoralization, it’s just that I have accumulated more tears over the years. I have a reservoir of stories within me. When I go outside and I breathe deeply I see and feel the beauty of this world, but I also know the world can be cruel. I see both sides, it’s sad and joyful, full of great surprises both good and bad. I know that “bad things happen to good people.” Life is a mixture of so many things and I can handle that. I am impressed by how people manage with the ordeals they face, and I always admire people who are able to bounce back. That inspires me to write about hidden potential in the midst of a psychological storm.
Q: What are your plans for the future? What does retirement look like?
A: My plans will be to continue my private psychotherapy practice. I will be 65 and this is my second career. And I have projects. I wrote three books and I want to continue to write during my retirement. It will be around palliative care and grief, including a chapter on the benefits of human interdependency. I realized when I was sick that there is a kind of dependency that is valuable because we are all here to help each other and one day, it’s going to be me again. If we try to distance ourselves from our collective interdependency, as many in our society seem to want, we are making a mistake. There is a healthy dependency in our society and I think that we are lucky to have dedicated professional caregivers, as well as generous volunteers all determined to give their very best.
Q: Can you tell me more about the role of volunteers in palliative care?
A: In the future, volunteers will be needed even more because a lot of people are alone, especially the elderly who have lost many members of their family and friends. In the tragedy I went through I met a lot of people I had never known in my life. They were all strangers. That person is a stranger for two minutes and then they become your soul mate who helps you. I discovered that we can do so much for each other and this is why for me working in palliative care makes so much sense. Just to be there and help the dying face the inevitability of death, this is extraordinary because having faced death I realise how precious life is, in spite of its sometimes short duration. At the end of life, the only thing that really matters is the human being beside you. The most important thing we can offer one another is comfort, dignity and respect. Being too individualistic and isolated in our own world will never replace the human touch we all need at the most difficult of times.
Q: What message would you like to give moving forward?
A: I would like to stress the essence of psychology in the context of palliative care. Listening, observing, assessing, intervening, accompanying and planning for the best services for the dying requires flexible and adaptive clinicians. The complexity of the human experience, and for many, the tragic life experiences, resurface at the end of life. Psychologists should develop their ability to work together with their colleagues (doctors, nurses, social workers, pastoral care…) in the vast area of death and grief matters. Most psychologists were trained to work individually, but the health care domain allows us the possibility to interact in a team approach that utilises the sum of interdisciplinary abilities. This assists in planning and provision of care. The exceptional input of our immediate directors consolidates our actions and clearly helps to make good decisions.
Supporting families and friends will have a positive outcome on the patients’ journey. This is the reason why families are included in our care planning if patients agree to include them. At the end of life, meaningful relationships will sustain those who are confronted by uncertainty. Not only techniques but also the calmness of the psychologist will help reduce death anxiety that most patients experience in their final days.
Finally, the lasting impressions and experiences that leave one deeply moved, gradually transform the psychologist not only as a professional but also as a person in her/his own life. The last messages that are left with us at the very end of life will often times induce a deeper engagement with life. I have the privilege to facilitate a weekly staff meeting called “Sharing and Support Rounds” and we take the opportunity to reflect over the latest experiences on the palliative care unit. This space helps us to marshal our empathy towards patients and families, but also helps us to reconfigure our ways of living and caring for our close ones.
The experience of working in palliative care is an opportunity to capture the importance of living with mindfulness, insightfulness, and kindness to others. What a privilege this has been!
Published February 4, 2015