Isolophobia:

In our ethics class we have covered the topic of life and death. We have covered the responsibility patients and their loved ones have with regards to deciding what happens when they die or are in a life or death situation. We covered a living will and how although it represents the patients wishes it is not legally binding and ultimately the family or loved ones are responsible for the life or death decisions. But where do we draw the line when it comes to the death of a patient so that we protect ourselves.

One of the most common fears that is written into the DNA of humans is the fear of isolation, like many mammals we are herd animals that survive better together than we do alone. Along with that fear of isolation comes the fear of dying alone. When it comes to healthcare, death is one of the worse sides if the job. As horrible as it is, it is unfortunately just a part of life but there are certain things that can be done to make people feel less afraid to die and the most important part is not leaving them to die alone.

When someone is determined to be terminal, depending on how much time they have left, their family is informed and given the opportunity to be with them. They either come to the hospital to sit with their dying loved one or the dying loved one is sent home and made comfortable surrounded by their loved ones. Thankfully I have not had to deal with the death of a patient very often, and until a few weeks ago I had never had to watch a patient die. In my mind, I just assumed that people in a hospital wouldn’t die alone, there are nurses there and the family is around often called in to spend the final moments with the patient.

In the singular instant that I watched one of my patients die, it broke my heart that he died alone. Although he was in the ICU and his death was not unexpected, it was still heartbreaking to see someone pass on all alone. His family had come in earlier that day to say goodbye and they were present when all the machines and medications were switched off and stopped. But the family didn’t stay long and by the time he actually passed on he was all alone. I had been working with the patient for 3 days and although he had been in a coma the whole time I still spoke to him incase he was aware of what was going on. Part of me thought I was sad because I was projecting my own fears onto him, or maybe I wish I could have spoken to him even just once. But it made me wonder what us, as healthcare professional, are expected to do when it comes to being there for patients when they die.

And if morally we are supposed sit there and hold there hand what kind of toll will that take on us.

For death and dying to become a normal part of our jobs is something difficult to comprehend and to be there for some as they pass on is not something I think I am able to do. It might depend on the persons personality but as someone who considers themselves a very empathetic person I think the death part of this job will weigh quite heavy on my heart. And knowing whether ethically it is expected of us to be there for the patient no matter the toll it takes on us, is something that would be helpful to manage the likelihood of developing compassion fatigue.

Compassion fatigue is emotional and physical exhaustion due to the deep personal interaction healthcare workers have with their patients. It is also referred to as Burnout, and is often a result of trying to deal with ones own emotions regarding patients, a heavy work load and expectations not being met. It can result in healthcare workers having difficulties communicating and connecting with their patients as a protection mechanism for their own struggles (Quinn-Lee, Olson-McBride, & Unterberger, 2014). Quinn-Lee, Olson-McBride & Unterberger 2014 proposed that burnout could be prevented by certain protective factors by having support groups or systems and by having a sense of humour and maintaining spiritual activities and journaling. They also stated “The concept of death anxiety is important because the way that hospice professionals view dying and death may significantly impact the quality of care they provide to clients, as well as the amount of stress they experience on the job” this was regarding how death anxiety might affect healthcare workers. Death anxiety includes: denial of death; fear of death for yourself or others and a reticence to interact with people who are dying or have a loved one who is dying. (Quinn-Lee, Olson-McBride, & Unterberger, 2014)

Whitehead 2012 stated that generally people react to the death in two ways, action or presence, action reaction is when the healthcare professional tries to do something to ease the passing through a procedure or medical intervention. Presence reaction is when the healthcare professional admits that there is nothing more than can be done and they merely remain present with the patient and keep them company while they die (Whitehead, 2012). While the death a of patient takes its toll on everyone, being present with a patient till the end seems like the much harder choice, accepting that there is nothing you can do is a very difficult thing to do (Whitehead, 2014).

Knowing that the emotions and thought I experienced are felt by others and being able to put a name to what I went through is helpful, as well as having techniques to possible help with this in the future is invaluable. It is important for us as healthcare professionals to ask for help when we need it. Even though it is our job to help other sometimes we are the ones who need help and that is ok. Ethically we need to do all we can for our patients but if you get to a point where your own health is at risk it is a good idea to take a step back, gain some perspective and ask for help if you need it. Asking for help is not a sign of weakness it is a sign of strength to be able to admit that you are not infallible.

References:

Whitehead, P. R. (2014). The lived experience of physicians dealing with patient death. BMJ Supportive & Palliative Care, 271-276.

Quinn-Lee, L., Olson-McBride, L., & Unterberger, A. (2014). Burnout and Death Anxiety in Hospice Social Workers. Journal of Social Work in End-Of-Life & Palliative Care, 219-239.