Working With End of Life Requires Self Care

QUESTION: Talk about self care for professionals who work in end of life.

No matter our chosen career taking care of ourselves is important but working with end of life presents additional challenges. I have often said I can teach anyone how to take care of someone at the end of their life but I can’t give them what they need in their heart to do the work well and not “burn out”.

What do these health care professionals need that I can’t give them to work with end of life? Of paramount importance is a belief that death is natural, that everyone will do it. It is not the enemy, it is not a failure of the medical profession and it helps to believe that just because you can provide a medical procedure doesn’t mean you should do it.

Working with end of life doesn’t require a belief in God or an after life. It does help to know what you do believe when death happens or at least are comfortable with yourself in your uncertainty.

It helps to be comfortable with touch, being touched and touching others. To be comfortable with other’s emotions and tears, to be comfortable with silence. Knowing that touch and silence can often convey more than any words you could say.

Because dying is not a medical event but a social communal occurrence it is the people skills, skills of the heart, that make hospice care what I think needs to be the quality standard for all medical care.

Using our heart can open the door to taking on, as our own, the patient and/or family’s experience and challenges. It is a trap easily fallen into when we identify with other’s misfortunes. Taking another’s “pain” or challenge home with us, dwelling on it, worrying about it, is nonproductive. It actually makes us less effective.

Every life is filled with challenges. It is the name of the game we call life. I have challenges, you have challenges, patients have challenges. Our job as healthcare workers is to support, guide and instruct with the knowledge of our profession. It is not to become entangled in the emotion or physical experiences of our patients.

We, in healthcare, are great at telling others how to take care of themselves. We know nutrition guidelines, when exercise is appropriate and when it is not, that a good night’s sleep makes for a better next day. We know all about balancing work with recreation. We teach these principles all the time BUT we often don’t apply any of these principles in our own lives. In essence, we know how to take care of ourselves, that is part of what we teach others, but way too often we don’t practice what we preach.

I’ll add to the list of taking care of yourself something that is unique with hospice/end of life workers: Finding balance and mental health following the death of a patient. We tend to go from one patient to the next, one is gone only to be replaced by another, and so the cycle goes. I have found that some sort of ritualistic closure following the death of a patient is helpful in releasing them from our heart and making room for those that will follow. My closure ritual was attending the wake/visitation which gave me the opportunity to say goodbye to the body and the family--my closure.

Hospices and often nursing facilities have monthly memorial services honoring the patients who have died during the month. Attendance at that service is also a way of having closure.

Acknowledging that a person has touched our life and our heart, mentally saying goodbye, gives us closure which gives us balance in our work. It is bringing the human element into our professionalism, that in itself can keep us healthy.

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