On… Mortality #2

An Interview with a Covid Doctor

Two weeks ago my eighteen and half year old cat, Mackie, passed away.

Mackie was born in my Grandma’s lap, just a few days before she died, and I was given him as a pet to help me with the grief.

My family experienced an unusually large number of bereavements throughout my childhood. From the age of six to eighteen, there was barely a year when someone I loved was not either approaching death, or the rest of the people I loved weren’t grieving that death.

I partly attribute those experiences to my interest in climate change; for a small child, it did feel like the end of the whole world. So as an adult, working on climate change has been a way of revisiting and finding some meaning in those experiences (more on that in next week’s post).

But, despite so many bereavements, watching my cat die was the first time I had ever been present as a being breathed their last. I sat next to Mackie on my bedroom floor as he peacefully slipped away.

This was a profound experience for me because in witnessing Mackie’s death, I was able to understand more deeply what had happened to my other family members who had died many years ago. It filled in what had happened when they disappeared from my life, and in doing so death lost for me a little of its mystery, and with it a little of the fear it holds over me.

The last time I wrote about death, On… Mortality #1, was when I had a health scare a month or so ago. In that post I shared my belief that facing death is an essential part of facing up to the reality of climate change, because if we find death so difficult to talk about we are surely going to find the prospect of climate change even more of a challenge.

I wrote of my fears about the upcoming medical test, which I was truly dreading;

‘That squirmy, heart-racing, deep-breaths-don’t-even-help sort of vulnerability is exactly the kind of fear I also get when I think about runaway climate change. It’s the fear of loss, of suffering, and ultimately of death.

We’re not familiar with talking about death and we’re often not quite sure what to do with it when we are required to. But if we can feel more confident to have those conversations we might find it easier to face what’s happening to our planet and to do something more about it.’

The question, of course, is in the how.

Marie is a foundation year two doctor working on the covid geriatric wards.

As part of my research into how to build greater emotional resilience in responding to the climate emergency this week I interviewed my doctor friend, Marie, to find out what we can learn about navigating the planet’s grim prognosis from her experiences supporting people through the final stages of their lives.

Marie has been on the geriatric covid wards looking after those hospitalised with the virus, and many of those who have lost their lives to it. Before that she had also worked at a hospice, and before that in care homes for the elderly.

Marie’s in her twenties but she knows more about death and dying than most people will learn in their lifetime.

So I have summarised below my interview with Marie where she shared her wisdom and experience about how to approach death as healthily as possible.

You’ll find some recurring themes about facing mortality which include;

• Talking about it

• Doing what we can to prepare for it

• Being with each other through the experience

• Looking for ways to find meaning in it

The biggest take away from everything Marie said was, for me, the transformational power of presence.

Things become toughest when presence is not possible but the capacity to be present to ourselves and to each other in what we are going through can bring immense healing.

And I have a sense that there could be a great deal of insight for us in that as we face the challenges of climate change ahead.

Marie’s approach to death draws on the tradition and wisdom of palliative care which is as old as the existence of humanity, and I hope that you will find it as inspiring, helpful and challenging as I did.

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Tell me a bit about what drew you to medicine in the first place?

I come from a healthcare family so from a young age I saw what a difference you can make to someone by helping them through sickness, and eventually death, and I thought, ‘that’s what I want to do.’

I guess I ended up in palliative care in many ways because of the pandemic.

But being with someone in the final stage of their life and supporting their family through that too, is such a privilege. Every day I have the ability to bring comfort and dignity to someone in a very difficult situation.  

There are ups and downs, of course. Some days I come home and just cry because I want to do a better job, other days I know I’ve done well. I never quite know which of those it’s going to be when I turn up to work in the morning, but I feel so lucky that I get to say that overall I really do love my job.  

Through my work I’ve learned that death is a natural process and we need to talk about it more. My profession still has some way to go in understanding that medicine isn’t always about making people well. Sometimes it’s about helping people to die well too.

Death is a natural process, as natural as life itself.

There’s so much we can do to make death as comfortable as possible but for that we need to be able to talk to each other about it, and make preparations wherever possible.

And death can actually bring healing, though we don’t often think of it in that way. In those final moments people are often able to find closure, they’re freed up to say things to each other that have needed to be said, or it helps sharpen a sense of priorities.

I get to be there for that and help facilitate that, which it is just an amazing privilege.  

Can you tell us a bit about your experience on the frontline during the pandemic?

It’s been a really rough time, to be honest.

Most of the people working in our profession have never seen death on this kind of scale. We’ve all worked extra hours, done two peoples’ jobs and seen some awful things.

I think the mental health backlash is going to be huge because we’ve not emotionally recovered from the first wave, and now we’re back in a similar situation again. I had four people on my ward die in one morning, and it’s just so difficult. That was probably my worst day.

We’re working with resource scarcity on a whole new level too, and in a way that I think was incomprehensible to many of us just a year ago. Those of us on the frontline are getting a sense of the tough decisions that those working on a more strategic level have been having to make about the NHS for a while.

And it’s so surreal being on a covid ward but then leaving work to see life going on relatively normally outside.

There are so many people who don’t understand the situation still, which makes me angry. Not so much at them but at the way information is shared and how much misinformation there has been.

But probably the most difficult thing is that these are not normal deaths because the families cannot be there for that final stage.

I am often the person delivering devastating news over the phone or holding the laptop for a final skype call to say goodbye, and it’s so hard knowing that the family and friends can’t be there in person.

It’s an enormous loss and makes the whole thing so much more difficult.

I think it’s really made us value even more just how important those very human and emotional aspects of dying are, now that we can’t have them at the moment.

The pandemic has helped the healthcare profession value even more just how important those very human and emotional aspects of dying are.

How have you kept on going through it all?

Like most of the people in my profession, it’s the job satisfaction of knowing the difference you make, and it’s the teams we work in together. The National Health Service really does run on goodwill and I feel so grateful to be a part of that.

But outside of work, I try to live as normal a life as possible. My husband worked as an A & E doctor during the first wave so we could share our experiences with each other, and I have a lot of friends I can talk to about it too.

I think it’s also sharpened my sense of how important it is to get on and live our lives here and now, so I’ve tried to do more of that. With the future so uncertain I don’t want to hang around, and I want to focus on the things that really matter to me.

My husband and I have decided to work towards reducing our hours to part-time because with something like this pandemic going we’ve realised money really isn’t the most important thing to us. We want to prioritise other things and we want to have a good work/life balance where possible.

Another thing was the clap for the NHS. I know it’s only a gesture but it was lovely and it meant so much to us to be appreciated and recognised in that way.

The pandemic has shown us just how much the NHS runs on goodwill.

I also decided to take up wild swimming, which has made a huge difference to me. Its mid-November but I still swim in lakes etc. most weeks and it helps me so much.

I work in such an artificial environment, we cannot even allow flowers into wards because of infection control, so I try to get outdoors as much as possible by cycling to work each day, and the wild swimming too.

Marie’s book recommendation is ‘Blue Mind’ by Wallace J. Nichols.

Nature is so incredibly healing, I am sure people would recover faster in wards if they had more access to nature.

I actually wanted to make a book recommendation which is ‘Blue Mind’ by Wallace L. Nichols. It’s all about how nature, and especially water, is essential for our survival in terms of our mental health and I would really recommend it for anyone interested in the links between self-care and planet care.

What do your experiences teach you about how to approach death?

I think somewhere along the line we lost the humanity in healthcare a bit.

We forgot that birth, life, and death are natural processes. Coming into hospital is a life-changing experience for many people. For some, it can be horrendous but that’s exactly why we need to talk about it more, so people can be prepared.

I have seen a lot of people dying in hospital this year who did not have Advanced Care Plans in place and I think at least some of them would have preferred to have had their final days at home. An Advanced Care Plan allows you to decide with your GP what you want your future care to look like, and what you want to prioritise in healthcare.

So if those conversations and preparations had been in place for those people, things could have been different and perhaps those people could have died at home with their families.

That’s also why it’s so important for us as professionals to be as upfront with patients as possible, and to spend time answering their questions. Often the information patients need is relatively simple, like ‘what does dying look like for me?’

Having the opportunity to explore that together usually makes a huge difference.

As a society, we tend to fear death, and we certainly avoid talking about it. But every one of us is touched by death, it’s as natural as being born and I want people to know what death can look like, and that good can come out of it.

The sooner we can acknowledge that, the sooner we can live our lives better.

Going through something like this pandemic is horrendous, but we have the opportunity to make something out of it. If we can talk about it, and share our experiences with each other, we can learn something from it.

We owe it to ourselves to do that.

About Me I’m Jo,

formerly the founder Director of national climate change charity, Hope for the Future. I am currently researching eco-anxiety and how we can build emotional resilience in our response to the climate emergency.

Welcome to Climate.Emergence- a place to emotionally process what on earth is happening to us and our planet