Marisa is no stranger to death. "I took care of my father (tycoon Geny Lopez) when he was dying. While he had hospice care in the US, we took care of him here. And he enjoyed his last weeks on earth. I went diving with him in Palawan until he couldn’t anymore. I won’t forget that because the whole family was together for the last time."
Dropping everything to be with her father, Marisa adds with a beatific smile: "My father signed a waiver saying that we’re not going to use any heroic measures or life support systems on him. He allowed himself to die peacefully – in his home, in his bed. It was a beautiful transition from living to dying, compared to people in the ICU who are attached to a machine with so many tubes stuck to their bodies."
"We had time to prepare for his death," she speaks, as though staring death in the face. "The minute he decided he wanted hospice care and the minute he said he didn’t want any medication anymore, he spoke to each of us, one at a time. We also told him that if he wanted to go, it was all right. I think that some dying people don’t want to die because they know their loved ones don’t want them to die, so they hold on. At some point, my father was already saying he wanted to go home – and I think he meant home to heaven, not home to the Philippines. So it was a beautiful death; it allowed nature to take its course in the sense that when he couldn’t eat anymore, we didn’t tube-feed him. Because when you can’t eat anymore, it’s actually a sign from your body – it’s telling you that your body doesn’t want to eat anymore, and to respect its normal signs."
It was another blessing, says Marisa, that even if her father was only on 5 milligrams at most of morphine, he was not in excruciating pain.
Marisa confesses she was not really a daddy’s girl. "In fact, I was very kontrabida with my father. Ayokong sumipsip because I felt the whole world was already making sipsip to him. It used to turn me off – it still turns me off – how people make sipsip to people who are in power. But before he passed away, I was able to tell him that I regretted that, I wish I had loved him more instead of fought with him so much."
On June 28, 1999, Geny Lopez died of cancer of the lungs that metastasized, according to Marisa.
Marisa lost her father but gained a newfound perspective on life – and death. Taking care of other relatives like her grandmother, Marisa had enough experience with the terminally ill to last her a lifetime. But still, she chose to undergo training with a doctor on palliative care.
"A doctor’s orientation is to prolong life, to make you live, but there are doctors who are now open enough to what their patients or their families feel," Marisa says with a sigh of relief. "Palliative care is already part of the medical curriculum in some universities. Hospitals have a palliative care department and interns have to undergo training in that department. There are palliative doctors who are trained in pain management, treating the symptoms of dying – they’ll make their patients as comfortable as possible, give them quality of life at the end of their lives."
Marisa went to Singapore and England to observe and learn more about hospice care. When she got back, she gathered some friends and members of her family. Last July, Marisa put up her own foundation aptly called Hospice with a Heart. So now, these former ladies who lunch only talk about their insatiable desire to reach out to other people over pasta at Grassi’s. Among them is Rosario "Bonet" Ugarte, who’s been Marisa’s friend since they were 11. Bonet went to Australia and Marisa went to the US. "Many years later, we saw each other again and it was like we were never apart," says Bonet.
They’re fated to be together. "We’re both Rosarios – my real name is Maria Rosario," says Marisa.
Over lunch, we share some stories – and a lot of laughter – with Marisa and Bonet, who are really like a couple of giggly schoolgirls.
But shouldn’t we be dead serious – after all, we’re talking about death, we remind ourselves. But Marisa reminds us, "Death is a celebration of life."
She’s quick to add: "I think there’s a need to change the way people perceive death especially in this country because despite the fact that we all say we’re Catholic and we believe in life after death, we treat death as something so morbid, so terrible – a lot of us do. Many people treat death like it’s the end of the world, they dramatize it. When actually, if you really love the person who’s dying, you should know he’s going to a better place. In the end, if you can detach yourself and not think so much about yourself, death can be a joyful time, when you rejoice for the dying."
Our morbid perception of death, says Marisa, is one of the things we have to change. "The other is our preoccupation with prolonging life. In the end, you should respect the dying person’s wishes. If he wants to keep prolonging his life, that’s up to him. His family shouldn’t impose that decision on him. You hear about so many people who are brain-dead but are kept alive by a machine. Like this man I met who had renal cancer and had to undergo a very painful dialysis treatment. He didn’t want it anymore because he was in so much pain and he knew he was going to die, but he was doing it for his family. That’s so sad. That poor soul probably wants to go, don’t you think? If you think about it, it would be so much more compassionate to let life take its natural course. You should listen to the dying person."
Bonet thought her first home visit to a terminally ill patient would be morbid. "On the contrary, it was a wonderful experience," Bonet beams. "We tried to make this lola laugh. We held her hand and prayed with her. It wasn’t as bad as I thought, I actually felt good."
Even as the terminally ill grandma hovered between life and death, she was surrounded by the warmth of home and the love of her family.
Bonet observes, "There’s a coldness, something about going to a hospital that doesn’t make you feel good and relaxed. Just the smell of antiseptics already institutionalizes you. Whereas if you see the dying at home, there’s no stigma of hospitals. You don’t even think or feel death because it’s home."
"If you ask people where they want to die, more and more are saying they want to die at home," says Marissa. "Which is why the hospice gives support to families taking care of their sick loved ones at home."
Happily, caring for family, in good or ill health, is second nature to Filipinos. "We’re a caring, loving people," says Marisa. "Filipinos have a strong support system. I see hospice care as thriving here."
Hospice, Marisa clarifies, is not really a place. "It’s a way to die – a way to die with dignity." She declares: "We believe people should die at home. But if people have no one to care for them at home, I will take care of them. Our calling is outward bound, to have as many volunteers as we can to visit people in their homes."
That lovely Wednesday, we would have met two real nice ladies who are putting up real hospices – with rooms, says Marisa, but they must have been very busy visiting the sick and attending funerals.
I’m here at the funeral of a 19-year-old boy who died in a motorcycle accident," Mae Heredia of Our Lady of Mercy Hospice tells us on the cellphone.
Mae didn’t know the word hospice until she took care of her sick mother, Greg Morelos Heredia, and helped her to die. She put up the Our Lady of Mercy Hospice to celebrate her mom’s birthday on Nov. 18 last year. She trained at the University of Navarre, Pamplona to bring hospice care to the Philippines.
"Did you know that Dr. Josefina Magno, a Filipina, is the mother of hospice in the US," she shares. "Now, it’s all over the US."
Currently, there are 45 people training under Mae. "They’re all volunteers who visit the terminally ill once a week, at a fixed time and day. They’re men and women who come from varied professions – there are lawyers, businessmen, and architects (like Mae). As long as you have commitment."
The other lady who wears her heart on her sleeves is Rosie de Ocampo who picks up where Mae has left off. "Love and Care takes up from Our Lady of Mercy Hospice," says Rosie, who was Mae’s classmate in gradeschool. "The Philippine Medical Women’s Association and the Veterans Memorial Medical Center have banded together to put up a training center."
Rosie’s mom, Dr. Pilar de Ocampo, is the president of the Philippine Medical Women’s Foundation while her dad, Col. (Ret.) Emmanuel de Ocampo, a World War II veteran, is president of the Veterans Federation of the Philippines.
Says Rosie, "I’m involving myself in this work because I want to be able to do the same thing for my parents while they’re still strong and alive. I live only two blocks away from my parents’ house and every morning, I join them for breakfast before going to work."
According to Rosie, Love and Care is training Filipinos who can go abroad and be caregivers instead of domestic helpers.
Full of life and dreams, Marisa says with a glow in her eyes, "Eventually, I want to put up my own center. I am a smaller hospice because I’m a Zen hospice, one that is spiritually and not medically based. I’d take in people who maybe don’t have family members and require a minimal amount of medical care. It will be run by volunteers, people who have a spiritual background. It’s very non-invasive, non-intrusive – you could be Moslem, Buddhist, Catholic or Protestant. We just believe in the soul and spirit."
Hospice care, says Marisa, comes at the last stage, when the patient has come to terms with death. "I believe in the end, you know inside yourself when you’re going to go," she tells us. "We prepare the dying for death. If they’ve accepted they’re dying, we ask them what are the things they want to take care of before they die – if there are things they want to settle with their family or other people. Maybe a lot of times, these people want to make peace and iron out the kinks in their lives. I always try to stress the spiritual aspect. If the spiritual is a significant part of your life, death becomes natural. It’s not an end, you can even look at it as a beginning. I’ve seen people die angry. Up to the last minute, they fight with their family, the people taking care of them. It’s very sad to see people dying that way."
Marisa used to think she’d like to die suddenly. "Now, I think I like to have time to prepare for death as long as I’m not in pain, to say goodbye to my children, say my last few words to them. It’s important that you can say your goodbyes."
Bonet wants to go pretty much the same way. "I don’t fear death. It’s all part of life’s journey. I’m just going to the next part of my journey. I want to go happy and surrounded by my friends. I don’t want a sad funeral, I want people playing music, partying, having a celebration."
Right now, Marisa has two full-time "patients." The work is taking much of Marisa’s time because she doesn’t have an organizational setup yet. Good thing husband Beat Grassi is busy in the kitchen of Grassi’s and hasn’t really complained. Their four-year-old son Joshua is exposed to his mom’s work. One-year-old Beata is too young to care.
Joshua once went Mommy when she visited Rolando Lindayag, 35, who’s suffering from cancer. "Exposing children helps, as long as it’s not too mabigat," says Marisa. "Death does not become such a foreign thing to kids. So Joshua was sitting there, but after a few minutes, he said, ‘Mom, can I go to the car?’"
Marisa tells the story of a dying man with a three-year-old kid. "They put his bed in the living room so he could be part of the family activity, instead of being in his room. They don’t know how much this three-year-old really absorbed but for sure, it must have made a positive mark on her. There are ways to deal with death which are not morbid or sad. There are hospices in the States that have beauty parlors, aromatherapy rooms; patients go on day trips, they have as normal a life as they possibly can. You can say these are my last days so I wanna be crazy, I’ll go out and do all the things I’ve never done."
Probably like what Marisa’s other patient did. For the first time in years, he went out to the garden to breathe fresh air, breathe new life, so his wife tells Marisa in a text message. The wife jokes that her husband’s fine and he can get by without Viagra.
Marisa wants to put up a scholarship fund for Rolando Lindayag’s six children. Rolando had to quit work because of his illness. His wife Imelda took over running their little stall in the market. "I’d like to appeal to people for monetary help," she pleads.
Marisa heaves a long sigh and smiles, "As much as I give, I receive and maybe more. It changes your outlook in life when you’re exposed to people. Like this man who’s completely paralyzed that I’m visiting. He can’t even talk but when I’m with him I’m so happy. His family is so kind, there’s a closeness to God. When I go there, parang I’m the one who receives. It tells me how transient this life is. We make such a big deal of those little things in our everyday life. We magnify them so much when all this is nothing in the end. Like what happened with the World Trade Center. It’s so foolish to base all our hopes and concerns on this life. For me, living with the dying has made me value what is really important in my life – my family, people I love. And in my everyday dealings with people, I’ve learned to treat each person kindly, compassionately. There’s not much more that I can do."
We share more stories and more jokes. Really, we could die laughing!