Healthscope’s own Tracey Moroney recently shared her thoughts and professional expertise on the challenge of conversations around death and dying for ‘Dying to Know Day’, a topic close to her heart as the Cancer Support Coordinator at Ringwood Private for the last 12 years. In this role she has provided counselling to oncology patients and their families. Tracey has over 25 years’ experience in oncology nursing. She has a Master’s in Counselling and Psychotherapy and has undertaken additional training in Trauma, Loss and Grief. Tracey has also held the role of People Representative during the COVID crisis and is available for peer support. Her contact details can be found on the Healthscope Intranet.

The month of August encompasses Dying to Know Day, a national campaign which aims to encourage discussions around death, dying and bereavement. Through conversations, one can build a greater understanding of death and the fear associated with the topic can diminish. The campaign is based on the notion that to die well is to live well.

In the context of COVID-19, Dying to Know Day takes on a whole new meaning for all. We’ve been proud to see healthcare workers demonstrating a capacity to make room for the way the pandemic is impacting their own life, offering compassionate care to their patients confronted by the realities of this terrible virus.

Irvin Yalom, the renowned psychiatrist and researcher in the field of existential psychotherapy, postulates two basic propositions regarding death and dying:

1. “Life and death are interdependent; they exist simultaneously, not consecutively, death whirs continuously beneath the membrane of life and exerts a vast influence upon experience and conduct”
2. “Death is a primordial source of anxiety and, as such is the primary fount of psychopathology”.

Yalom suggests that death anxiety is inversely proportional to life satisfaction and that the sense of having lived well, can mitigate against the fear of death. Death reminds us that existence cannot be postponed. By keeping death in mind, we are more open to experiencing gratitude for that which gives our life meaning. We may not be able to control death, but as Viktor Frankl reminds us, we do have the freedom to control our attitude towards it.

For those of us who work in healthcare, we have an obligation to consider the meaning death has for us, so we can be open to these discussions with our patients. We need to be willing to hold space for them, where their fears and hopes can be heard with an empathic acceptance. Common fears around dying lie around the process itself, symptom management, losing control, concern for family, the fear of the unknown, the afterlife, and a sense of unfinished busines. It is often thought that initiating such discussions can add additional angst for patients, but generally the opposite is true. To have such fears validated and processed, assists in the myriad of ways patients attempt to come to terms with the inevitability of their situation.

Caring for the dying in the current climate brings with it its own unique challenges and is unlike anything Australian healthcare workers have seen before. However it is important to remember that despite the resilience, courage and dedication displayed by healthcare workers, it is not a sign of weakness for them to acknowledge the impact this once in a lifetime event is having on their psychological wellbeing. Studies suggest that normalising the anxiety around stressful situations encourages a stronger culture of self-care and help-seeking behaviour.

Self-Care Strategies: These can include maintaining a healthy diet, scheduling regular exercise, practicing good sleep hygiene, debriefing with colleagues, practicing mindfulness skills, and continuing to engage in activities that bring meaning and pleasure.

Seek Support: There is a wide range of supports currently available for healthcare workers, however it is recognised that there is a reluctance to ask for it. Just because one is medically trained, does not mean they are immune to the mental health impacts of the pandemic. Programs include:

• Healthscope’s Employee Assistance Program and other support programs promoted through HINT
• DRS4DRS: An independent program that provides confidential support to doctors and medical students across Australia
• Nurse & Midwife Support: A 24/7 national support service for nurses and midwives that provide access to confidential advice and referral
• Beyond Blue and the Black Dog have resources specifically for health care workers
• Australian Psychological Society has a rage of articles relevant to health professionals and COVID-19

In summary, COVID-19 has been a catalyst to encourage dialogue around death, dying and bereavement. Talking about death brings attention back to life. From the writings of Stephen Levine and his book Who Dies? “There is no other preparation for death except opening to the present. If you are here now, you’ll be there then” p.33.