Sherrie

Sherrie was 37 years old in November 2019 when she attended for her cervical cytology test at the Homeless Healthcare Team. The examination revealed invasive cancer and so a course of treatment began but it was soon evident that the advanced stage of Sherrie’s cervical cancer meant that there was no chance of a positive treatment outcome.

Together we began the journey into palliative care. Sherrie’s wishes about her care were explored, and her firm desire was to remain in the homeless hostel she had lived in for the last two years. In that place she felt she had friends and wonderful support from the staff. Estrangement from her child was a source of great distress, and although Sherrie nurtured a strong hope that she would see them again, she never regained enough strength so to do. Sherrie’s choices were honoured, and every attempt was made to help her live well for the time she had left.

The story of her palliative care and the example she offered those of us around her as she approached the end of her life will remain with us. Sherrie died at the hostel on 22^nd October 2020 in the loving care of friends and staff, less than a year after her diagnosis.

Peter

Peter was a reluctant recruit to Right By You, referred by his Cancer Nurse Specialist in August 2022, he had been sleeping rough in the forest for some years since the breakdown of his marriage and a troubled relationship with the remainder of his family. When I asked whether he would mind me accompanying him to his oncology appointment Peter expressed indifference, but I followed my instinct and went along to an appointment at which he was told that his cancer of the colon had spread to his liver. Over coffee after the appointment, Peter and I struck up an easy rapport, which was to last until he died.

Peter was 65 years of age at this point, and it was clear from our early discussions that he had experienced a great deal of trauma in his life. In addition, his own involvement in local gangs had estranged him from any social support. We met regularly, and despite the easy rapport, and the fact that Peter was quite the raconteur encouraging him to articulate his wishes around the end of his life proved difficult. He was disposed to move into accommodation, and as his age and the fact that he would likely be denied treatment without accommodation, it proved surprisingly easy to place him in an over 60’s block where he found he could store his beloved metal detectors.

Peter’s health began to deteriorate late December 2022, and it was in early January, in his studio flat that I was able to be with him when he died. Not alone, not in pain and free from the psychological distress that had dogged him for years. Safe and in his own space, he had finally come home.

Hannah

Having got to know Hannah in the last 13 years of my working life at Homeless Healthcare, I was devasted to accept her as my first referral in my Right By You role, as she had been diagnosed with terminal cancer of the cervix. For all those 13 years I had chipped away unsuccessfully at her reluctance to undergo a cervical cytology test. Many of her fears were grounded in the death from cancer of her adoptive parents and she herself described how their deaths drove her substance misuse, and led her to unwise choices in partners, some of whom were controlling and coercive.

Hannah had experienced a long period of homelessness and had no fixed abode when she was admitted to hospital with heavy bleeding which led to her diagnosis of cancer. Palliative treatment was initiated, and we began the process of planning how Hannah wished to live the time left to her. She was clear that the familiar environment of Patrick House hostel for people experiencing homelessness was where she felt comfortable and where she would like to live her last weeks and months and die. Hannah was able to make contact with her adoptive sister and brother who visited her and took part in the planning process. Negotiating with hostel staff around their concerns about how her life would end, managing her pain relief alongside the use of street drugs, and supporting her in the tasks of daily living as she became weaker, was pivotal to the balance between Hannah’s wishes and wellbeing and maintaining staff morale.

It was difficult for Hannah to come to terms with her diagnosis, and she frequently berated herself for her failure to attend the cytology test, magnanimously Hannah used her own situation for the good of others, appearing on local television encouraging women to attend their cytology screening to avoid a plight like her own. Just 2 days before her death she received messages from women who had seen her plea and had booked their tests. Hannah died on 9^th May 2022 in Mountbatten Hospice, her choice to move there for symptom control as pain and weakness became less tolerable. The staff at Patrick House remained involved to the end, and her bed there remained open for her should she have been able to return.

Mikey

Mikey was referred to my case load in the September of 2022, just after his 43^rd birthday. The apparent abscesses on his face and neck considered to be infective in nature, turned out to be metastatic lesions from an unknown primary cancer.

I had known Mikey for many years in my role as Nurse Consultant at the Homeless Healthcare Team, where Mikey remained registered. In late 2017 Mikey had cared for his father until he died of Cancer of the Oesophagus, Michael senior, who was also homeless, had been allocated a flat which they shared until Michael died, and Mikey had to leave, and was homeless again. This experience affected Mikey profoundly and I vividly remember the discussions around his grief and low mood, tempered by the pride he took in being with his father to the end. Now, in the midst of an unexpected diagnosis, Mikey was advised that his cancer was terminal, and that he had less than six months to live.

Armed with the DS1500 form which confirmed the terminal nature of Mikey’s illness, I set about seeking self-contained housing for Mikey, as he was clear that he did not wish to die in a hostel and wanted to leave the hospital where he had already been for a month. This did not prove to be easy; housing was at a premium in the city with many living in temporary accommodation. It was suggested that Mikey should move into B&B, but we resisted this option, at a time when palliative chemotherapy to alleviate symptoms would render him immunocompromised.

Eventually a studio flat was identified, and we visited and the property met with Mikey’s approval. Mikey had good friends who crowd funded some furniture and equipment to complement that which we had managed to arrange in his package from the charity SCRATCH. Mikey left hospital at the end of November, after more than three months on the ward. Unlike his father, there was no one to care for Mikey and a package of care was arranged and Fast Track Continuing Care applied for. In planning for Mikey to live well for the life he had left, his independence was really important to him but the rapidity of his decline saw my visits increase from twice weekly to daily until on 1^st February he messaged me to say he could not cope any more. I arranged an admission with his oncologist, and after ten days in hospital he was transferred to Mountbatten Hospice, where he died on 14^th February.

Mikey was incredibly sanguine about his lot, he was not given to complaining, we spent some time together on Christmas day in his flat but he did not rail against the fates that he was alone, on this the last yuletide of his very young life. His transient lifestyle inherited from his father and the loss of his mother seemed to diminish his expectations but never his persona.