The first word that comes to my mind when I think of Inta Gerhardi, the head of care at Hospiss LV, is peace. It is in her voice, in her being and in her actions. Although I have met Inta only a few times so far, after every conversation, after every meeting, I am left with a peaceful and warm feeling. I believe that colleagues, dying people, their relatives and other people who come into contact with Inta experience something similar.

Inta, why did you choose to work in hospice care?

This field came to me on its own - my father had oncology and I went through the palliative care process and saw how and what was happening. Shortly after that, the volunteer movement started in Latvia and I got involved. I felt like I knew the right thing to do, where the problems were and how to fix them (Inta's voice is slightly ironic). I have seen people in hospital palliative wards whose relatives do not know what to do; people who are very lonely, with no one to visit them; people who are abandoned by their spouse or family.

Why is this happening?

I don't know. While volunteering, I met a woman who had breast cancer and had been abandoned by her husband. It hurt her very much, such betrayal at such a difficult time. Later it turned out that this happens very often, it is not uncommon. Wives do not usually leave their husbands at such times, but men leave their wives. Not all of them, of course, but it happens all too often. It seems to me to be a double betrayal.

Where do people in need of palliative care end up in Latvia?

Palliative care units exist in several hospitals in Latvia, for example in Liepāja and Daugavpils. Two hospitals in Riga have such units: the Riga East Clinical University Hospital (RAKUS) in Bikernieki with 25 beds and the Pauls Stradins Clinical University Hospital with 17 beds. The main problem is that patients are paid to stay in these wards for 7-10 days. If you don't die in that time and are unable to pay for the rest of your stay, go home and do as you please.

Three years ago, as a volunteer, I visited a woman in the palliative care unit who had water in her lungs, was connected to medical equipment and could not be moved. She left me money to pay at the cash desk when she died. I did so, but this should not be the case.

How does the team of carers you are responsible for currently work?

We started Hospiss LV with the idea of creating a hospice house - a place where people could spend the rest of their lives with dignity, where they would be physically and spiritually cared for. We thought, "Is there really a house with 12 rooms all over Riga? It didn't. We had a talk with the Minister of Welfare, Gatis Eglitis, and he understood us very quickly. We decided that we had to start something, and we started home care for dying people. This is possible thanks to the funding granted by the Ministry of Welfare for a pilot project. We now have 12 carers looking after 16 patients (15, one died this morning, Inta). Most of them we care for 8 hours a day, some for 4 hours, because the family is able to be with the patient the rest of the time. Some are assisted with technical aids and medical manipulations. This funding is until 31 December this year and we do not know what will happen after that. Nor can we ask our current care recipients to die before the end of the year. We very much hope that the pilot project will be evaluated, found to be a success and that this service will continue to be available to people in the future. 

Why is the birth of a child celebrated here, but the dead are often neglected?

We dance through life from birth to death, these starting and ending points have much in common - the condition is helpless, the physical needs are similar. I think we have avoided talking about death for years. We ignore it with ostrich politics, we brush it under the carpet. Of course, the associations with death are not pleasant; to see the agony, the process of dying - it may be beautiful in a spiritual sense, but not physically (like childbirth).  

Is it also a cultural issue?

Yes, definitely. In Asia in general, it is common for all the relatives, near and far, to come to the deceased, and the mourning is also done together. In Germany, in France, people consider it a great blessing to be able to be with the deceased, to have the whole family together, standing by, holding the hand - that is important to them.

I remember an incident from my early days as a volunteer. I wanted to go to a patient in the ward, but the nurse called out - don't go in there, they are dying! Why not? That's absurd! Maybe this person needs to have his lips wiped, maybe he needs someone to sit next to him because he is afraid. Imagine a situation where somebody says, 'That's where you give birth, don't go there'.

Or our reality of three or four people in a room in a palliative care unit, each with their own complex condition. It happens that someone dies and they are simply separated by a screen for a while. Should the other people, who are on the verge of death themselves, watch this process? To continue with the birth analogy, it would be like a woman expecting a baby lying in an operating theatre next to other women who are already in the process of giving birth.

How would you like to die? What is the ideal death?

I would like to know a little in advance that I am going to die, so that I can make my last wishes to my children, my husband and say goodbye to everyone (I have to get things sorted in time at the notary). Yes, I would like to have a small phase and then go peacefully. As Professor Dace Baltina said, one cannot die cured, one can die healed. That seems to me to be essential.

One friend's godmother died like this - the previous evening she celebrated her birthday (over 80 years), where all her relatives got together. Then she washed the dishes, went to bed and didn't get up in the morning. It seems like a pretty ideal death.

What do people who are about to die usually want to do before they leave this world?

What matters is the age at which a person leaves. One young woman said a month before she died that she really wanted a family, children. Another woman had a family quarrel and we managed to call her father and brother, who came to the hospital to talk to her. I was not standing next to them, but you could feel from the atmosphere that there was reconciliation, everyone was crying.

A young woman wrote to me this morning that if she had a chance to live, she would like to walk along the Gauja, to be in Italy and catch a fyling, to create a healing place where people connect with love and nature. (At the time of publication, the woman is already dead).

When you are well on in years, when you have done everything, you don't want to do much anymore. Old people want to say goodbye to their children, they are waiting for them to come back from England.

How much influence do you have on dying to wait for your children to come back from England?

I don't know, there must be something going on at a subconscious level. But it doesn't always work - there are situations when someone comes and the person has just died. We don't know much, we can only imagine - both about dying and about what happens afterwards. Different faiths have different interpretations, but we don't know what it's really like. In general, people of faith find it easier to die, they have hope for something afterwards.

There is a story from the book "Consolation". A priest meets a woman on the subway who is crying because her son has died. The priest comforts the woman, telling her that her son was a good man and is now with God, looking down on her. At first the woman sobs, then starts crying again, saying, "I wonder if looking to God is the best thing a person in his 20s can do."

What is the most valuable thing a volunteer can give to a dying person?

The most precious thing is the presence and warmth of the heart, the feeling of security that one has not been abandoned, that one has not been forgotten by society. He was still working, with everyone, but now he is alone in his bed, in his pamper, his family is far away - they call, they come to see him once in a while. For such people, a volunteer can be a friend who lives with what is happening in their lives. The best situations are not when everyone is like Timorese run off, do something and leave, but those where you manage to pick up a string of the other's soul that matches your own, where you develop a close contact, a friendship. What should help practically? See that the person is clean and well cared for, that they have adequate food. Everyone has their own wants and needs.

I remember that we used to have a box in the palliative care unit where patients could throw their wishes. The first gentleman whose note we read wrote that he wanted warm food once a day, a dry bottom, and there was something else. But these wishes were so low, so minimal. The gentleman then literally blossomed when our girls started taking care of him and lived for another four months. He admitted that he had never felt so pampered and dusted in his life. Another man sleeping at home wanted to hear the violin playing we arranged, another wanted to celebrate his birthday with his girlfriend - we arranged a garden party, another wants to eat some more oysters. 

If you were given a miracle clue to create the ideal hospice care in Latvia, what would it be?

We don't need to invent a new bicycle, but to adapt existing systems to Latvian conditions. For example, there are 28 hospices in Poland, Lithuania and Estonia. I have already mentioned the problems in hospital palliative wards - the limited number of days and having several people in one room - but everything else is good there: the doctors are professional, the medical care is up to scratch.

The real pit, or as Latvian radio journalist Evija Unāma says, "the despair zone", begins when a patient who has left the hospital returns home. We have actually seen situations where a man is brought home from a palliative care ward on the day before Christmas and his wife has absolutely no idea what to do. We travelled with Valentina, the carer, and showed her how to care for this man. He also needed a whole list of medicines, but the GP had already gone on holiday, so there was no one to prescribe them. At the moment, no thought has been given to the various details that can cause a complete nervous breakdown for the relatives. Yes, there are written instructions, but if a person has never done this, he does not know how to turn a person properly, how to care for him. How can he look after a relative if he has never heard words like 'bag', 'probe', 'tracheostomy'? And, you have to take into account that the loved ones have to learn these things under enormous emotional stress because their loved one is dying.

Ideally, there should be a close collaboration (slowly developing) between palliative care doctors and hospice care specialists. Then a doctor, a nurse, a carer would come to the patient's home - show and tell everything, see how the care is going for the loved one and adjust if necessary. They would tell you everything several times and slowly. Many relatives damage their health, especially their backs, because they do not look after the person properly, they strain them. A lot can be done easily if you know how to do it. Then the carer would keep coming during the day so that the relatives can go to work or school. Everything would be under control, looked after. If the patient needed special medical manipulation, he could come back to the hospital again. And at the very end, a hospice would be the ideal place.

What should a hospice be?

My ideal vision is: a hospice house would be a place where individual rooms are available for dying people, where relatives can stay overnight (hospitals cannot). The room would have an extra sofa to sleep on, coffee to brew. They could also push the sick person and his bed outside to lie in the sun and feel the nature around them.

The most important thing is that such a place would have 24/7 access to medical professionals who could be called on if needed. Not all loved ones are prepared to be with the moment of death, with the agony of death one-on-one; many need someone else to be there to monitor the situation. At such moments, the ambulance is often called and, as a result, instead of dying peacefully with their loved ones, the person dies in stress on the way to the hospital or in the hospital.

Such a hospice could also have a day centre, where palliative patients could be brought for special hairdressing, manicures, water treatments and massages. The hospice would also be a place for home visiting carers to work. And there would be a mobile team with a doctor on duty who could go to palliative patients when needed.

Of course, ideally, hospices would also have their own specialisation, as oncology patients require different types of medical manipulation than, for example, AIDS or multiple sclerosis patients.

What books on the subject of death would you recommend?

In this field, Elizabeth Kübler Ross's "Leaving" and "Consolation" are classics, and "Being Mortal" and "On the Brink of Death" are also very valuable (you can read more about these books in the "Library" section of the website "hospiss.lv"). In his youth, Albert Schweitzer's book "Letters from Lambaréné" made a deep impression, in which the author describes his experiences as a doctor working with the locals. Fyodor Dostoyevsky's works also have everything necessary for life inside.

What have dying people taught you?

Connecting with people who have passed away helps me not to live under the illusion that I am eternal. It is hard to separate from my self and accept that I will not be. This is so evident in working with dying people - it is clear that I will not be. That life is to be lived worthily, that it is a privilege after all: I am 60 years old - I am still living, breathing and enjoying life. Priorities are changing - it doesn't seem terribly crazy if a chair is too hard or a sofa too soft or the soup doesn't have enough salt, the little things bother me much less. I get up in the morning - the sun is shining, I say thank you, I appreciate the good days. I connect more consciously to life.

How will you celebrate your 60th birthday?

The children told me: "Mummy, take the 11th, 12th and 13th of April off". I know that my husband and the children also have these days free and nothing more, the invitation will follow on the evening of 10 April. Very good, no more rasola cutting!

What else would you like to say to our readers?

I would encourage everyone to think about the second half of life and to do it in good time, not to be afraid and not to exclude death from life. To remember that we are mortal.