Dying art of caring: lessons from 34 years in a Hospice

“Some day, we will all die, Snoopy,” is the declaration of Charlie Brown in the Peanuts cartoon by Charles Schulz. “True, but on all the other days, we will not,” is Snoopy’s famous, gentle retort. It’s this cartoon that palliative nurse Janice Malkinson carries with her as a reminder of the deeper philosophy behind her work, which spanned 34 years at St Francis Hospice in Port Elizabeth until her recent retirement.

Looking back on a career that started with training at Groote Schuur Hospital in Cape Town at the age of 17, Malkinson says she hopes to have made “whatever path the patient was on that little bit lighter or easier”.

It’s a humble reflection for a medical professional who has received international recognition for her humanitarian work by being awarded a Paul Harris Fellow through the Rotary Foundation. She also served as a past chair of the Port Elizabeth Union of Jewish Women and on the committee of the city’s Jewish Benevolent Fund.

Born in Pretoria shortly after World War II, Malkinson grew up in the small Western Cape towns of Mossel Bay and Worcester. As a child, she says nursing “was the only thing I ever thought of doing”.

In those days, student nurses immediately began working as part of their studies. She recalls feeling “overwhelmed” the first time she entered Groote Schuur Hospital.

“I couldn’t even find the ward where I needed to go. It was the surgical ward, C Ward, on the third floor, and I remember I was late because I got a bit lost. I walked in, and the sister asked me who I was. When I replied, she said, ‘G-d, een bliksem se Jood [one damn Jew] in the whole lot of student nurses, and I had to get her!’

“At the end of my three months with her, she said to me, ‘Ek wil net een ding sê: as ek hoer al ooit daar is nog ’n Jood, ek sal sê, Ek wil haar hê!’ (I want to say just one thing: if I ever hear there is another Jew, I will say, I want her!).”

When Malkinson graduated, she was still so young that she couldn’t get her epaulettes until she turned 21. By then, she was training to be a midwife in London, first at the Chelsea Hospital for Women in South Kensington and later in the countryside in Ealing, replete with her very own “Call the Midwife” bicycle.

She recalled a time that it was pouring with rain, and she was pushing her bicycle because it had a puncture. “A big truck driver stopped, and I thought, ‘Oh boy! He wants to put my bike on the back and offer me a lift!’ Instead, he stuck his head out the window, and asked if I could give him directions – everyone knew the nurses knew the area. So I gave him directions, and he left me standing in the pouring rain, still pushing my bike!

“It was great fun!” she says with a laugh. “It was about bringing life into the world.”

In the interim, she returned to South Africa and settled in Port Elizabeth, where she got married and had three children. She also studied to be a paramedic and volunteered in the field, later teaching the course to first-year-university pharmacy students.

In 1978, a friend told her about meetings that were being held at a local hospital on palliative care. Malkinson went along to a meeting, and soon started working as a volunteer. When St Francis Hospice was later formally established, she first volunteered and then later became a full-time staff member.

Her first patient was a young mother who had a brain tumour. “Her children were the age of my youngest child.”

The night before Malkinson was to visit, she remembers getting so nervous that she lost her voice. She had to be coaxed by Port Elizabeth’s Hospice founder, Lesley Lawson, to go, and it was with this gentle nudge that she began her true calling.

From that first visit onwards, she took steps to place herself in the right frame of mind to care for the terminally ill.

“Generally, I walk quickly and work quickly. I remember on that first visit, parking my car, and jumping out – and then stopping, thinking, this patient is in bed, she can hardly move. I need to slow down.”

It’s a practice she adopted over the next decades of work.

“Before each patient, I would take a moment to be aware of where I was and the patient’s circumstances.”

Malkinson worked both in the in-patient unit of Hospice when it was in operation and travelled door-to-door across the length and breadth of Port Elizabeth communities attending to patients at their bedsides.

“My job became the opposite of paramedic work. I couldn’t save or cure them. It was about making them have a life, day-by-day, as they were, and where they were. It was to make each day for them as kind and as good as it could be, to help alleviate symptoms and to listen.

“Especially in the early years, the families of patients couldn’t bear to hear the reality of their experience. People kept telling them, ‘It’s going to be okay; you’ll see, you’ll be better’. It was so hard for the patients. They needed them to acknowledge the reality, to have them say, ‘I hear what you say.’”

Malkinson has seen society grow tremendously in its ability to cope with these difficulties. However, she laughs wryly that mentioning she’s a Hospice nurse is still a definite conversation killer at dinner parties!

Yet, the truth is that the work isn’t just the doom and gloom people imagine. “There is such warmth, because in these circumstances, life is so real and kind. There are still happy times around the table as families gather. You see families grow together and come nearer. You see people take in other people who haven’t got a place to stay. I remember there was one woman who heard about a school friend she had last seen when she was 15. Her friend was now ill and not being cared for properly. She went to fetch her friend, and brought her to her home. You hear of incredible women who take back the man they divorced and care for them in their days of need.”

Overall, says Malkinson, “the work has given me much more than I’ve given”.

Nevertheless, according to her colleagues, Malkinson’s legacy is profound.

Lawson says Malkinson’s gifts lie in both her head – in her extraordinary expertise and knowledge – as well as her heart. “She is just fully present to her patients.”

Trevor Wiblin, the director of Hospice who retired alongside Malkinson after nearly two decades of service, says he has received countless letters from the families of patients in gratitude for the work she did.

He jokes that she had to often be “reigned in”, so unconditional was her sense of service and dedication.

Hospice’s Dr Niel Malan said her work could be described only in superlatives, recalling times when she went into dangerous areas and even after experiencing problems with this, still “went back because they needed her”.

He said she was, in fact, the first Jewish person with whom he had ever had close contact. “My goodness, what an example of humanity, of kindness, of sincerity!” Malan says. “She has taught me so much.”