Ahead of her February 19, 2025 lecture entitled 鈥淢y experience of accompaniment, death and bereavement: 29 years of psychological services at the heart of the MUHC team (1986-2015)鈥�, part of Palliative Care 不良研究所鈥檚 National Grand Rounds, Johanne de Montigny shared her thoughts with Program Director and palliative care physician, Dr. 厂迟茅蹿补苍颈别 Gingras.听
Dr. 厂迟茅蹿补苍颈别 Gingras (SG): How did you first become interested in the field of palliative care?听
Johanne de Montigny (JdM): It was a very profound and sudden experience where I almost died that guided me in this choice. I survived a plane crash in which 17 people (out of 24) died. After this event, I asked myself what I was going to do with my life. For me, that meant choosing a meaningful profession. After returning to school to study psychology, I chose to become a palliative care psychologist. Because of my confrontation with sudden death, I wanted to understand how people reacted when they learned that they were going to die, that they still had time, and how to live with it. This meant doing something positive, which gave a lot of meaning to what had happened to me.听
Before becoming a psychologist at the Royal Victoria Hospital, I spent a long time preparing for this听line of work听to make sure I didn't confuse my own story of death with that of another person. It was against this backdrop that I met with Dr. Balfour Mount to propose the introduction of psychological services in palliative care, which did not exist when I was officially hired in 1988. We agreed to set up a pilot course to identify the types of services that would be most beneficial for three target groups: patients, families and nursing staff. By the end of the course, we had concretely and clinically initiated accompaniment services for patients and loved ones, and support services for caregivers. 听
We ensured that the care we provided embodied the fundamental values of the palliative approach, values that I espoused as a humanistic psychologist and that I wished to offer to those who were suffering. Symbolically, I aspired to restore meaning to the death of the people with me on the plane. I thought a lot, and still think today, about their families. I wondered: how does one go through sudden mourning? And so, the question of grief was born.听
SG: Thank you.鈥��That's very, very interesting.鈥疌an you elaborate on those three groups? 听
JdM: With the patients, I was able to objectively see the impact of the fundamental values surrounding the psychology of mourning and dying: Welcome, presence, listening, benevolence. It may sound simple, but the power of interpersonal skills fosters openness to difference, to the perception of others, to the specificities of their stories.听 听
In the early '90s, patients stayed with us for around three months, a timespan that facilitated my work of accompanying patients and supporting their families.听 The length of stay went from three months to 7 to 14 days. My great challenge with patients was to know how to offer a professional quality of listening and intervention that made a difference in such a short space of time. In these moments, I remembered that before I died - because I thought I was going to die - the young flight attendant who, in the space of a minute before the crash, had managed to help us contain the shock and give us some hope. She told us, 鈥淲hatever happens, we're together and we're going to get through this together.鈥� That one minute of relationship made all the difference. It enabled us, I believe, to survive psychically before dying physically. She was my first carer just before she died.听
It's with this in mind that I've continued to accompany patients, reminding myself that when the body deteriorates, the expansion of the psyche enables a quality of encounter hitherto unhoped-for. The psychologist takes into account the intact part of the patient at the end of life, that is, the part of him or her that has not been shattered by the cancer, the hard core at the center of being. 听
As for the family, what was most striking for me was the realization that the end of life is a time of unparalleled intimacy. In palliative care, you're somewhere else. It's a soul-to-soul encounter, if you will. And there's something intimidating about being at a loss for words, facing up to your own powerlessness even as a caregiver, and accompanying families who are also searching for the right words because they are the last ones. 听
To overcome the feeling of powerlessness in the face of death and the distress of families, I have come to understand that a word is never prefabricated, i.e. that the intervention formulated the day before will not necessarily be useful for another person. Words cannot be invented; they are created on the spot by the quality of the contact. What I've learned is to trust our baggage: the notions we've acquired, the colleagues who help us think, our life experiences...听
The integration of my experience has opened the way. Now it's a question of using it well. And if we return to our core values, which are invaluable tools in our profession, this means being present to the other person, being fully with him or her. In psychology, we refer to this metaphorical image: 鈥淚 learn to disappear gently so that the other can fully appear鈥�. This delicacy of the encounter enables a bond to be forged even in a short space of time. 听
Because of what happened to me in 1 minute 48, when I experienced the worst [in the plane crash], thinking it had lasted 2 hours, I know how much we can achieve as caregivers, even in 1 minute. We can make a difference with a kind look, attentive listening and pure presence. What Balfour Mount so aptly called a radical presence. Dr. Mount was my mentor and he inspired me with this concept.听
For me, these words mean the emergence of a word that rises from the depths and of a right proximity in end-of-life contexts. We need to gauge the psychological state of the person present, respect them, adapt to their needs, and draw on our own goodness to soften suffering. Thus, the best intervention may simply be to breathe together with the patient, closing her eyes until she falls asleep. Not running away is part of the intervention. In other cases, it's about building a bridge and taking on the role of messenger between a mother and daughter who have never been able to say 鈥淚 love you鈥� to each other. Intervention: What would you like to say to her that you've never said before?听
As far as the caregivers were concerned, it wasn't a question of offering formal psychological services, but rather meetings where, as a psychologist, I could clearly grasp through their testimonies the stresses, fatigues, issues and apprehensions they were experiencing.听 My aim was to free up what might have been difficult for them, so as to arrive 鈥渇resh and clear鈥� in front of a patient in dire need of a stable, empathetic and reassuring person. Hence the importance of holding feedback and sharing meetings with the team of caregivers during a difficult or particularly touching death, to help the group release tensions before returning to the bedside.听
SG: In your work, you're totally involved in caring for and accompanying patients, the bereaved, and sometimes caregivers. How do you take care of yourself?听 听
JdM: I've always known that my choice of profession was the right one, that it gave meaning to my personal and professional life. For a long time, I drew inspiration from my patients, from the depth of their stories. Often, they had come through the worst with remarkable resilience. I was filled with gratitude for what they continued to teach me. They reinforced my zest for life. I felt like a deep ocean, where all my patients could pour out their tears. 听
You never come out of the nursing profession completely intact. There's a price to pay when everything stops.听 While I was preparing for retirement, I felt flayed, submerged under a flood of tears. So I cried a lot, for months after leaving my job, my tears mixed up with theirs. In time, it passed. I internalized a phrase I'd read: 鈥淭here's nothing to fear, the ocean never drowns鈥�. This quote from Christiane Singer helped me a lot. I've also managed not to fight the contradictory feelings that sometimes coexist within me; in other words, my sensitivity and vulnerability rub shoulders with my strength.听
SG: Where would you like to see the field of palliative care in the coming decades? 听
JdM: I'd like to see palliative care promoted and accessible in other healthcare settings (new hospices, seniors' residences, as well as at home). That the palliative care approach (accompanying patients and families) exists not only during the end-of-life process, but also afterwards with bereaved families. Even in the context of medical aid in dying, loved ones need bereavement support. In short, in general, we need to recreate a mobile 鈥渞elational home鈥�, ensuring that we preserve the quality of a human approach as an antidote to existential suffering.听
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