Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 7.8 Story of Continuity (Patient Case Study)

Sister Antonine's Final - Great - Adventure

Angoon is a village of 600 residents on Admiralty Island in Alaska; there are more bears than humans on the island, which also boasts more than 9 million acres of a national wildlife preserve. Angoon was the vacation destination chosen by Sister Antonine, OSF, a 76-year-old Roman Catholic nun of the Franciscan Sisters of Baltimore, in July 1996. She had been a nun for almost 60 years and had spent most of her life teaching in poor urban communities on the East Coast. Recent years had been difficult for her - the Mother Superior of her convent was brutally murdered in 1992, her brother died in 1991, and her two sisters died soon after, one in 1993 and one in 1994. Sister Antonine had been with her sister Anna, who suffered a massive heart attack at home, was resuscitated by a rescue squad, and endured invasive hospital procedures before dying a few hours later.

Subsequent years continued to be a struggle: in 1995 and 1996, she suffered a series of strokes and had been hospitalized with a broken hip and fractured arm. In the 1950s, she had undergone open-heart surgery, and in the late 1980s, she underwent surgery to replace a heart valve. She was a tiny, frail woman. She was determined, however, that she would visit Alaska, and when a distant young cousin who taught in Angoon invited her to visit, she immediately accepted. At first, her Mother Superior did not believe Sister Antonine was well enough to travel; however, Sister Antonine enlisted Sister Mary Margaret, a "young" nun of 74, to accompany her. Despite her doctor's advice and warnings of blood clots, the two nuns took off for Angoon in July 1996.

They enjoyed three days of fantastic nature, travel adventures, bear sightings, halibut fishing, and dinners with the Tlingit Indians who live in Angoon. Then, on July 24, as they returned to a small apartment after dinner, Sister Antonine suffered another stroke, this one massive (she said to Mary Margaret, "I just don't feel well"). It was almost midnight, in the midst of a storm. Sister Mary called Sister Antonine's cousin, who contacted the local nurse, who radioed to Juno for help in evacuating Sister from the island. Eventually, a Coast Guard helicopter arrived to medevac her to a hospital. At first, the medics were reluctant to allow Sister Mary to come with them. When she insisted, they relented, gave her a helmet, and raced through the storm to the chopper, which took them to Sitka, a larger city on a nearby island.

There, she was hospitalized in a former naval station hospital, Mt. Edgecumbe. As the pilot left, he gave Sister Mary Margaret his phone number and told her to call if she needed help. That night, Sister Antonine was placed on a ventilator, for a brief trial to evaluate whether her condition was likely to improve. A nurse made up a bed for Mary Margaret, brought her a warm drink, and comforted her.

By the following morning, Sitka's Catholics had mobilized to help the two nuns - people visited the hospital, brought food, prayed with Sister Mary Margaret, and took her into the town. The local priest gave her his car to use and offered her the rectory.

Throughout the ordeal, people remained with Sister Mary Margaret, who was often at Antonine's side, praying. The two women had been friends for more than 40 years. When studies showed the extensive brain damage caused by the stroke, the hospital doctor consulted the Mother Superior, who agreed that Sister Antonine's ventilator should be removed and that she should be allowed to die peacefully and naturally. Less than 12 hours later, she died. The Mother Superior flew to Juno, where Sister Antonine's body was taken and cremated.

Sister Mary Margaret recalls the generosity of the town, the hospital and its staff, and the Coast Guard pilots - and she laughs when she says, "I promised to bring her home, and I did." Incredibly, this remote Alaskan community had created a care system that showed remarkable continuity, comprehensiveness, and competence.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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