Since Canada's assisted dying law passed one year ago, there has been only one confirmed case of a medically assisted death on the tiny province of Prince Edward Island.
It was Paul Couvrette's.
But before he embarked on his "new adventure," Paul asked his beloved wife, Liana, to share the story of their love and how he chose to die with dignity, completely on his own terms.
Now, Liana is keeping her promise.
As medical assistance in dying was coming into existence one year ago, my husband Paul was awaiting surgery to remove the cancerous tumour in his right lung.
We lived on Prince Edward Island, so my husband was being sent away to have this procedure performed in Halifax. It meant travelling a great distance. We would be separated from one another for a week to 10 days. I wouldn’t be able to be there to support my husband, who was the love of my life, in a situation that he would find very stressful. There would be additional expenses we had not anticipated. As someone who’s physically handicapped, I would be left alone to manage our household and care for our dogs. It was a challenging time for us, but we pulled together and worked our way through the many challenges we faced over the weeks that followed. Our family was far away, but we had wonderful friends and neighbours who helped us.
That was in July.
By early September, Paul had follow-up meetings with the surgeon in Halifax and the oncologist in Charlottetown. We were so excited to hear that Paul’s cancer was in remission. He was cancer-free.
We settled back to enjoy our dream, a life by the sea. Paul and I had spent many years supporting and caring for family members. When our responsibilities ended, we had chosen to fulfil our fantasy of living in the Canadian Maritimes. It had all happened so quickly. Our house in Ontario sold in days, then we found our magical home by the sea, and moved to P.E.I. in less than a month. Now, one year later, we could relax and enjoy the renovations we had just completed to our century-old farm house. Our summer and fall were filled with wonderful memories of visits from our children and grandchildren. As Paul recovered from his surgery, we enjoyed an idyllic time celebrating our life together.
Three months later in the last week of November, after a routine, follow-up CT scan ordered by the surgeon, our life was shattered. This cancer was deemed very aggressive. Not only was it back, but it was spreading. Our worst nightmare had materialised.
When Paul and I moved to Prince Edward Island, we were fortunate to be assigned a doctor within six months of our arrival. It was at our first meet-and-greet appointment that the doctor noticed Paul’s cough and ordered a chest X-ray. The X-ray showed something on Paul’s right lung and so he was referred to a pulmonologist in Summerside, P.E.I. The specialist requested further tests and confirmed that Paul had a potentially cancerous tumour. A biopsy was ordered, but just before his appointment in Charlottetown, Paul slipped on the ice and fell, severely injuring his right arm and shoulder. Due to his injury, the medical staff were unable to position him to get a clear CT scan and perform the biopsy on the tumour. After further discussion with the pulmonologist, Paul was given several options for treatment. He chose to have the tumour removed.
It’s important to note that Paul had very definite ideas about cancer treatment. His focus was always on quality of life. To that end, his decisions leaned in favour of treatments that offered the least intrusive or physically damaging alternatives to the body. There were factors from his childhood and personal history that made chemo and radiation unpalatable as treatments for him. Paul did keep an open mind and we asked many questions when chemo and radiation were offered. We did many hours of research and worked through a cost-benefits analysis, before he made the choices he did. Nothing was done without careful consideration, long discussions and much soul searching. We had met late in life and adored one another. The last thing we wanted was to end our wonderful life together by the sea.
It was always Paul and Liana's dream to live by the sea. Their joyous final days were spent here, at their dream home in Maximeville, Prince Edward Island.
When the cancer returned and we had met with several specialists, Paul and I sat down with our family physician to discuss his options. Paul knew that I would always have his back and advocate on his behalf when it was necessary. I respected his right to choose his own path in life. As his devoted and loving wife, I felt my job was simply to help him weigh all his options and make the best, most informed, decision he could. It was his life, his body, his illness, his choice, his decision. I would support whatever he wanted to do. The nature of our partnership and marriage demanded no less of me.
Paul was very clear about his wishes. He had been told by the radiation-oncologists, that even with aggressive treatment, his potential survival rate was very small. Paul chose quality of life over quantity. At age 72, he believed he had lived a full and rich life. He wanted to spend what time remained in the comfort of his own home with the wife he loved. Our goal was to reduce any stress in his life and live quietly in our rural community on the Northumberland Strait. Paul and I loved to cook meals together in our big country kitchen overlooking the sea.
Paul’s doctor arranged for him to enter the palliative care program. The staff and services were all we could have hoped for. They kept in close touch and we had emergency access 24 hours a day. Hospice also offered support in the form of a volunteer who was our neighbour. She has become a dear friend over these past months: someone who’s always there to help and support. There were many forms and documents to fill out. Paul stated his end-of-life wishes in writing and put a “Do Not Resuscitate” order in place. I was appointed as his medical proxy. He had already written a new will and appointed me as both his Executrix and Power of Attorney.
The terrible suffering that Liana's mother, Ruth (centre), experienced at the end of her life influenced Paul (right) to choose dying with dignity.
At that same appointment, Paul also reiterated his request for MAID. He was not ready to move forward at that time, but he wanted everyone to know his wishes. Things were in place. Our family was fully informed and kept in close touch. They were all so supportive of Paul’s choices. As the snow and powerful sea winds whirled around us, we were snuggled comfortably in our cozy home, far from the chaos and world of cancer. We consciously celebrated every moment of every day we were given.
Paul never had any symptoms associated with his lung cancer. However, by February, Paul was experiencing serious problems with his balance, coordination, walking and speech. Our family doctor ordered another CT scan of his head, chest and abdomen. From the tests, we learned that the cancer had spread to his brain. He had a large aortic aneurism and his prostate was enlarged. There was no question: his condition was deteriorating.
Unfortunately, it was necessary for us to change doctors at that critical point in Paul’s journey. It took a couple of weeks for that transition to occur. The palliative care team coordinated the change and kept in close touch, monitoring Paul’s condition regularly. In that time, his symptoms worsened significantly. The tumour in his brain was causing swelling, which in turn caused blinding headaches, nausea and vomiting, as well as difficulty in both walking and communicating. He fell several times and injured himself. Some of our children and grandchildren came from Ontario during March Break to be with us and help as best they could. Paul slept through most of their visit, although we did have some wonderful family dinners filled with love and laughter.
Shortly after our family returned home, a new doctor agreed to take us both on as patients. The doctor started Paul on a steroid to bring down the swelling in his brain. Paul was one of the lucky ones. It was like a miracle drug and within 30 minutes of the first dose, I had my husband back. Paul was acting like his old self again. This amazing medication provided Paul with a much higher quality of life during the weeks that followed. Life drifted into a gentle rhythm and for the next month or so, Paul and I went back to enjoying the life we had known before the symptoms of early March.
Window of opportunity
Those last weeks were a gift I will always treasure. In the evening, we would often turn off the TV, snuggle up with our dogs and just talk for hours. Paul allowed me to be a witness to his journey. He spoke of his life: the people he had known, the relationships he had experienced, the things he’d done, what he’d learned. Sometimes we just cried and held each other. We knew that the steroid was just masking his true condition. The time we were being given was just an illusion. We knew that the medication would only be effective for a short period. We had a window of opportunity and we made the most of every moment we stole from Paul’s voracious cancer. We created an oasis filled with so much love, laughter and great meals. We prepared our little feasts together and celebrated our wonderful relationship. It was pure bliss. We knew the sand was slipping through the hour glass of our time with each other, but we just pulled closer together, in gratitude for what we had been given.
Patches and Buttons giving Paul puppy love.
During one of those long discussions, Paul decided that he was ready to move forward and request MAID. The level of the steroid medication had been increased several times. We knew its efficacy was limited. When it wore off, Paul would no longer be capable of giving the written consent necessary to have assistance with dying. Even though, he had written his express wishes down and appointed me as his medical proxy, this was not sufficient to satisfy the current legislation. To wait longer would be a gamble he did not wish to take. Paul chose to die with dignity, on his own terms, at the time of his choosing. He didn’t want to go back to the suffering he had experienced before the steroid, knowing it would get much worse than it had been. Paul also didn’t want me to remember him struggling and unable to function. He wanted me to remember him as the happy, loving husband he had been all those years.
He called the doctor and made an appointment to begin the process necessary to qualify for MAID. We met with two different doctors, on two different days, and went through the extensive questionnaires and interviews. Both doctors were very compassionate and thorough. Then we went through the 10-day waiting period as required by law. Once it had passed, Paul gave the doctor notice of the date he wished to transition to his new life and the doctor proceeded to set the details in motion. The doctor and nurse were both people Paul knew well. He liked and trusted them implicitly. Paul knew that at any point, he could withdraw his consent and just end the procedure. He was in control.
Paul felt very empowered by his decision. I once heard him say, “The cancer didn’t get me. I got it!” When one of the doctors asked Paul what he expected would happen to him after he died, Paul replied that he had no idea, but he was sure it would be a great adventure and he couldn’t wait to find out. That was the attitude that he embodied in those last few weeks. He was happy, carefree and filled with joy. He tired easily and slept often. I knew this was his body, mind and spirit’s way of preparing for the transition he was about to make to his new life. He appreciated my understanding support and thanked me often. I cried many times and he comforted me. I was so happy that he would not suffer and that his transition would be so calm, stress free and gentle, but I was heartbroken to lose my best friend, my lover, my darling husband. He knew and offered me such loving support. I went through a lot of boxes of tissues, but he just kept bringing me more.
Paul was unsure what day to choose for his MAID. We discussed it and I made a suggestion, which he readily agreed to, once I had explained my rationale.
Love at first sight
Paul and I met through an online dating service when we were in our fifties. After several emails, we decided to meet in person and have lunch in Kanata, Ontario. Paul was living in Quebec and I was living out in the Ottawa Valley. Paul had to come into the city for a business appointment and I was coming in to buy frames for some paintings that I was going to be exhibiting. So, we set May 10th as the date for our luncheon rendezvous. He said, that for him, it was love at first sight. He knew from the moment I walked through the door that he loved me and I was the one for him.
Paul and Liana: "He was perfect for me."
My parents were devoted to each other. When I was 16, I had asked my mother how I would know when I met the right one. She just smiled and told me that I would just know. Halfway through lunch, as I sat wrapped in his melodic voice recounting stories, I remembered what my mother had said and I just knew. He was the one for me. Yes, as corny and trite as it may sound, it was love at first sight for both of us.
Ours was a whirlwind courtship. We felt, that at our age, we had the maturity to know what we wanted and didn’t want to waste time. Seven months later, at the base of a waterfall, during an eclipse of the moon, he asked me to marry him and I happily agreed. Three years later, we eloped. Once again, we chose May 10th as the day to mark this momentous occasion. During our wedding vows, we promised that we would love one another forever plus three days. We were married at a couples-only spa resort and honeymooned in our own private luxury cabin. It was such a romantic occasion and one we would celebrate every year with great joy.
Although life threw many challenges our way over the next 14 years, they just pulled us closer together. Our love grew, with each passing anniversary, and we knew how blessed we were. Every day we were together, he told me how much he loved me and how grateful he was that we had met. I replied in kind. I knew how rare a gift we shared.
When Paul was looking for a date for his MAID, in the second week of May, I asked him to please pick May 10th. I explained that, in the future, I would never look back on that day with sorrow. That, for me, May 10th would always be a reminder of the 14 fabulous years we shared. It would remind me of all our many adventures and happy times. He agreed, and so he chose May 10th for the transition to his new life.
'A new adventure'
Paul didn’t want a wake or a funeral. He wanted to spend that last week of his life with family and friends celebrating life, sharing memories, good food and laughter. His daughter in Montana kept in close touch and spoke to her father often. My three children — Paul's stepchildren — came from Ontario and brought our 17-year-old granddaughter to be with us. They all had an opportunity to spend time alone with him that last day. I made a big pot of seafood chowder and homemade biscuits. We invited the doctor and nurse to join us for a very light, casual dinner.
Paul reads a goodbye letter from his youngest granddaughter on the day of his passing.
We sat around the big table in our country kitchen, looking out at the sea, laughing, enjoying each other’s company for one last time. After dinner, Paul announced that he was ready to begin his new adventure. The children took our two sweet dogs down to our beach for a long walk. Paul made a special request of the doctor and me. He asked that we use his name and medical history to help educate the medical community and the public at large about dying with dignity and the MAID procedure. He asked me specifically to share our story. We both agreed to his last request.
He wanted his death to have meaning. His story will be part of the legacy he leaves for all of us. Paul thanked the doctor and nurse for supporting him through this transition to his new life. He told me that he had loved me since the first moment he saw me and that he would love me forever plus three days. Then he slipped quietly and peacefully into his new adventure, his new life. I held his hand and talked softly to him, as he had requested. I was grateful that he was at peace and would never suffer again. I wept softly, but I knew he understood.
Paul knew that a doctor-assisted death was not for everyone. He understood that religious, moral, ethical and cultural considerations might negate this procedure for some. However, it was the right choice for him. He wanted everyone to know that — if they qualified — they, too, could have that option, if they wished. We are so fortunate in Canada to have legislation in place that will allow people to die with dignity, on their own terms.
So, on this first anniversary of Canada’s assisted dying law, I hope that everyone will embrace Paul’s story and open their minds to all the possibilities. Death is not the end. It is simply a transition to a new beginning.
Dying With Dignity Canada is deeply grateful to Liana Brittain for giving us a glimpse into the love story she shared with her beloved Paul. We are beyond honoured to help share Paul's empowering choice and journey. Thank you.