(This entry was originally published at globeandmail.com on March 17, 2012. It accompanied stories by Globe and Mail writer Lisa Priest about hospice care in Ontario). The original piece can be found here with links to two image galleries.
The Globe and Mail was granted access to Kensington Hospice to observe care provided to those who come to die and to see how people live out their final days.
Why hospices? End of life care is an important health issue, one that given the aging population, will grow in importance. About 70 per cent of people die in hospital, even though most say they want to die at home. Hospices offer something between those two worlds: they provide a residential, home-like feel with doctors and nurses for those who can't die at home, but for whom a costly hospital bed isn't appropriate, either.
Mostly, they come to accept what we all must: death. Their willingness to allow journalists to document that journey is a gift.
– Lisa Priest
|Basia Hoffman hugs Kensington Hospice Social Worker Maxxine Rattner during a visit with her mother, Andree Hoffman, a few short hours before she passed away on Feb. 9, 2012.
There are few phrases more painful than “It is with a heavy heart.”
After the death of a loved one, these words most often mark the earliest stage in the grieving process – an intimate and emotional moment when family and friends are coming to grips with their loss.
For journalists, even though many have heard these words repeated several times throughout their careers, the emotional charge never seems to fade.
These emotions – pain, sadness, confusion, loss – make covering death and dying one of the most challenging assignments for writers and photographers.
The best way for a photojournalist to approach this kind of assignment is to draw on personal experience – to put yourself as much as you can in your subjects' shoes. This means trying to remember what it feels like to touch a loved one for the last time, to have them look upon you for the last time, and to desperately want more. To realize there is no way to fully prepare for that final moment.
For a recent story about hospice care, I found myself drawing on this personal experience, as well as the many stories I've covered in my career, where strangers have granted me the privilege of witnessing some of life's most intimate moments.
These experiences help when trying to approach people and families in the most unobtrusive manner possible.
And this is the point. You cannot, and must not, endeavour to work on stories about one of the most challenging times in anyone's life if your presence will in any way make those moments more difficult.
Before I introduce a camera into any sensitive situation I always try to introduce myself first. Meeting people in person allows me to better understand their situation, but it serves the more important purpose of helping them to understand who I am, my goals and my methods. These meetings might be brief, or may take hours, days or months depending on the subject, but for everyone involved they are critical.
At Kensington Hospice in Toronto my involvement started with a meeting. My goal was to build on the trust earned by my colleague, reporter Lisa Priest, to gain permission to come and go as the story required, and to establish rules so I could work in a manner that fell within their guidelines, and with constant consideration for all of its residents, not just those I was documenting. Lisa had already laid much of the groundwork for me, and so this meeting was very straightforward. The next step was meeting the families involved.
You never simply ask if you can take photographs of someone. To do so is risking immediate refusal. Photographers understand that visual storytelling requires a more sophisticated approach and I have yet to speak to an individual who does not appreciate the difference.
I have never worked on a story of this nature without believing that I can do justice to the story, and that I can do so honestly while preserving the dignity of everyone involved. This is what I try to convey in trying to secure someone's trust to participate in a story.
This is what I concentrated on during my initial conversations with members of two families with loved ones at the hospice. While I would always prefer not to rush into any story, time did not allow a leisurely approach to this one. While Marianne Kupina and her husband, Andrew McCarthy, weren't quite sure what to expect from me, they readily accepted what I proposed in terms of photography. There would be no posed portraits, but only real moments as they arose. Andrew, a handsome man, who, at 55 was dying of cancer, seemed all too aware that time was of the essence. After only a short conversation he simply looked at me, smiled, and said, “Well. Go get your cameras.”
|Marianne Kupina spends time with her husband, Andrew McCarthy, at Kensington Hospice in Toronto on Feb. 7, 2012. Mr. McCarthy passed away on Feb. 20, 2012.
This rapid progression from introduction to working is certainly not the norm, and yet it did repeat itself the following day. Basia Hoffman, who had travelled from California to be with her mother, Andrée Hoffman, during her final moments, did not hesitate to allow me to be present in their lives. I think she was pleased that I hoped to find beauty in some of the moments that would be so sad. Where there is sadness in death, there is also love and tenderness.
While both families agreed to the presence of me and Lisa, it was still critical to have a frank and honest conversation. Not every acceptance comes so readily, but regardless, the initial conversations are when you lay it all on the line. This is when you try to understand the comfort level of each individual, improve it if you can, or at least determine how their comfort level might change over time. I try to establish a starting point with an understanding that the rules might evolve.
I would never photograph, or use images from a moment, that in anyway betrays the trust that people grant me. Only by being present, aware, flexible and sensitive, are you able to make photographs of those tender moments that will enhance the readers' understanding of your subjects' true experience. It is this trust that you hope for, and this trust that will allow you to be present when it really matters.
But you also need to know when to draw the line. You need to know when to back off, when to get close, and when to stop shooting. There may be moments when you are unsure of how to proceed. Anticipate this and discuss the possibilities openly before they arise. I simply let people know that if ever they find a situation where my presence is too much they only need give me a “look,” and I'll understand. They need to trust that they are in control, that they are making the rules, and that their comfort level and their lives are most important. And you need to understand that it is not your story that is paramount, but their lives.
You need to judge which moments are needed to tell the story and when an image is perhaps not worth the discomfort it might cause. This is a constant challenge, but one of which to be keenly aware. It will challenge your sensitivity as a human being and your skills as a visual storyteller.
This method has never failed me. I have certainly missed some moments over the years, but I have never walked away from a story feeling that I did more harm than good.
Stories of this nature can be emotionally draining, but it helps, at least for me, if you can take away some of the positive from the experience.
Mrs. Hoffman passed away during the night, with her daughters, Basia and Tatiana at her side, only hours after I had the pleasure of first meeting them. During the evening I was able to photograph some beautiful moments and before I left for the night I whispered a few words to her in her native French that included goodnight and thank you.
Andrew McCarthy, who had been a resident at Kensington Hospice for nearly six months, passed away on the afternoon of Feb. 20, 2012 with Marianne at his side. He was only 55 years old. Theirs was a love story, and one that I was privileged to see. On a Sunday, a week before he died, Marianne poured Andrew and I each a wee dram of Irish whisky. I was the last to have a drink with him and feel honoured to have done so.