“As caregivers, I don’t think we get to stop or take a break during the process.”
Amy Tsai, a Richmond secondary graduate, was her father's main caregiver after he was diagnosed in 2019 with stage four prostate cancer – a stage when treatment was no longer a viable option.
From the day of his diagnosis to the day her dad requested and passed away by Medical Assistance in Dying (MAiD), she had to put away her feelings and emotions “in order to get things done.”
MAiD refers to a doctor or nurse practitioner helping an eligible person, at the patient’s “capable, voluntary, and explicit request” to end their life, according to Vancouver Coastal Health.
The controversial program was legalized in June 2016 with specific eligibility requirements, safeguards and assessment process reviews added in 2021.
“It is difficult. You don’t have time to grieve. You have people around you who can listen to you, question how you could let him go this way," said Tsai. "But no one can really understand what you go through as the caregiver of the sick."
To illustrate the challenges MAiD caregivers go through, Tsai teamed up with other film industry professionals who grew up in Richmond and created a short film titled The Last Flight. This was her debut as a director.
The film is based on the experience of caring for her dad, and was created with the help of co-director and cinematographer Brian Cheung, post-producer and editor Cindy Au Yeung, associate producer Alisha Weng, and music composer Caleb Chan.
The film follows the journey of Lily who has to find the strength to honour her father's last request to pursue a medically assisted death.
As her father's caregiver leading up to his final day, Lily is also confronted and criticized by her family about her dad’s decision.
"Every step of the way, we're focused on how it's like for the caregiver," Tsai said.
The film shows only a thin layer of what caregivers of MAiD patients deal with, not only during the journey, but also the mental health after-effects on them after their loved ones’ death.
Making the film was a more "digestible way" to give the perspective of caregivers, given the heavy and controversial topic.
“When we get to see and experience a perspective through someone else’s lens, it allows us to understand it or learn from it without actually having to go through it,” she said.
“It allows us a chance, without sacrifice, to make better decisions for our own lives.”
Caregiver’s struggle
Tsai described her dad as a person who valued his independence and freedom, a man who was strong and stern on the outside and gentle, kind and stubborn on the inside.
The cancer had stripped her dad of his independence and he was “very well aware how his condition was affecting my life,” she explained.
“He didn’t want to be a burden. I don’t think any parent or anyone would want to ever feel like they are a burden.”
As a caregiver, Tsai wanted to do everything in her power to find ways to help him.
But as a daughter, she couldn't bear to see her dad screaming in pain from needles and treatment every day.
The idea of MAiD was suggested to her dad by Tsai, a topic she struggled to bring up.
“How do you support something like this? By supporting them, it means they will no longer be living.
“I didn't have a lot of time to sit on it, but I just knew, in my gut feeling, that the moment I brought it up as an option, (my dad) is going to say he wants this.”
She told the Richmond News that she had always been reluctant to talk about her dad's medically assisted death to avoid the “pity” and “disapproving awkward eyes” from people.
In the average Asian household, speaking about death was and still is taboo, which made talking about it even more difficult.
“I never felt safe and brave enough. I always went with ‘my dad had cancer’ and ‘he died from cancer.’
“I thought that without bringing up the part of MAiD, it would make me feel protected, where I didn’t have to deal with the judgment and opinions from others.”
Community support during grief and healing
When dealing with end-of-life and death in general, most caregivers don't think about self-care until the person is gone.
Many caregivers have no time to think about themselves, Tsai explained, and what they need to do to make sure they are physically and mentally well during the period of time leading up to "the date."
"You're so focused on what the task at hand is at the moment, like trying to fight for your loved one, to give them the best care they can get and trying to figure out treatments for them.
"What remains after the person is gone, whether it's the mess, the estate, the burial, the funeral services, or whatever it is, everything has to be dealt with by the people that remain, too. And this is something they don't tell you."
When Tsai's dad passed away, she found herself pushing herself non-stop to get everything arranged.
"After he left, there was something empty, something was gone."
She questioned what she was supposed to do and had to be reminded she did have things she liked to do, and that she had a job and other activities.
"I had to remember, I was a person before I took on the role of taking care of my dad. And I found myself that was the time I needed support the most."
Tsai found help with Bridge C-14, a MAiD peer-to-peer networking and connection group, where caregivers needing support through the stages of MAiD can speak with someone.
After six years, Tsai is still an active participant in the community group. She also volunteers her time to help other caregivers going through the same experience she did including giving one-on-one support to Mandarin-speaking caregivers as well.
"I want caregivers to know it's okay to not be okay. If you feel like shit, it's fine.
"It almost feels like you're so alone, and I want to say to them that you're not alone and there is support here for you."
The Last Flight debuted at the 2024 Mighty Asian Moviemaking Marathon and was then shown at the 2024 Vancouver Asian Film Festival.
Tsai and her team are working on an extended cut of the film, which will be submitted to festivals around the world starting this year.
Meanwhile, the team is also working on their next project with Telus Storyhive to tell other people's MAiD stories from the perspective of both patients and caregivers.
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