We All Want Impossible Things

The novel’s setting is a long-term hospice care center for patients dealing with terminal illness who cannot—or do not wish to—spend the final stages of their illness at home. Typically, hospice is a solution for people who are not expected to live more than six months. Palliative care is the term for specialty services dedicated specifically to patients suffering with serious, debilitating, and often terminal illnesses.

There are benefits and drawbacks of hospice care. The benefits of dealing with a terminal illness in the comfort of one’s own home are rather obvious: familiarity, comfort, close proximity to family, friends, or pets, having one’s own possessions close at hand. The benefits of entering hospice care, however, can sometimes outweigh the creature comforts of home.

Hospice and palliative care can often provide specialty medical care unavailable in a home setting, especially in regard to pain management, which is often required in instances of terminal illness and is often the only medical intervention possible in the final stages of such illnesses. In the novel, Edi has incurable ovarian cancer, and enters hospice care in order to manage her deteriorating physical state as her organs begin to shut down and she loses the ability to care for herself and experiences increasing levels of pain and discomfort. The doctor in the novel reiterates that his job is to ensure that she is on the proper medications and pain relievers, and not to try and reverse the natural progression of her illness.

For hospice centers, the objective is to provide the greatest possible quality of life for patients in their final weeks or months. Chaplains and mental health professionals are typically available to help patients navigate anxieties about death and the grief that accompanies terminal illness. No therapist or counselor makes an appearance in the novel, but Ash does encounter the hospice chaplain, who helps her accept the reality of her friend’s impending death. While the story is fictional and only loosely based on real events, the depiction of hospice living and palliative care is true to life and representative of the best instance of such a situation. The care at Shapely is depicted as top-tier, conscientious, and flexible, providing a positive image of an important social and medical institution that often goes unrecognized.