From the past three decades of working in health care, in general and palliative care in particular, the author has recognised that the discussion around death and dying often provokes uncomfortable professional conversations. The author's experience indicates that such conversations are not only delicate or sensitive, but can elicit death anxiety in some people and overt avoidance of the topic in others. Death comes to every person at some point. Therefore, avoidance is not a rational option. For health professionals working with dying patients, every death might be a painful reminder of how fragile their own life is, and that they are thus forced to face their impending mortality.
The anxiety that this might induce in a person is a prolonged disabling state of worry, not necessarily because of death itself but what death means and its impact. The state of anxiety, if left unmanaged, can be demoralising and paralysing and, with no real progress made to resolving it, can also be disabling. Different cultures react to death in different ways: some welcome death as bringing an end to life on earth and any suffering associated with it, while others may view death as interrupting life and preventing the accomplishment of important goals (careers, family, etc.). As health professionals with our own culture, the challenge may be that we struggle to place our own cultural beliefs in check while we tend to the beliefs of the patients we care for. In other words, we struggle to see how our cultural values fit with the self (us), others and the world at large. The point is that, first, we need to be aware and comfortable with our own perspectives and beliefs about death and dying in order to be effective in supporting patients who are dying. For example, if we accept death as part of life, we may be better prepared to fully focus on living life and its joys and do those things that are important to us while we can. The opposite can only hold us back and result in frustration when death threatens to cut life short. The Dalai Lama (2002: 39) emphasised this point, saying ‘It is crucial to be mindful of death, to contemplate that you will not remain long in this life. If you are not aware of death, you will fail to take advantage of this special human life that you have already attained.'
Another aspect is that, very often, when patients and families we care for grieve for their loss, they remind us of our own loss (past or to come) and that can hamper our ability to support them. Worden (2002) reminded us about another uncomfortable occurrence-existential anxiety-which is our own personal awareness of death provoked by stories that we hear from patients; the most uncomfortable existential anxiety experienced is when the dying patient has similar characteristics as us or a close relative (age, gender, ethnicity). This realisation can either liberate us, as we recognise that life is ephemeral and, therefore, live life to the full, or restrict us, as we worry about something we cannot change or control.
In end-of-life care, it is still possible to help patients enjoy every remaining moment of their life. It is possible to support patients and families to share those last moments together. It is even more important in the current climate, in the COVID-19 pandemic, where proximity and sharing intimacy are so restricted that we become creative and find other ways that families can remain emotionally close to each other. The use of smart technology is one affordable and easy way. Furthermore, implementing all the measures recommended to prevent the spread of the virus (wearing a mask, washing hands, social distancing, personal protective equipment for staff and getting tested) will help facilitate meetings between dying patients and families. We can still make dying a positive experience for all despite the challenges.
These experiences shared here and elsewhere in published literature can help health professionals become more aware of themselves and their views on death and dying as they support patients at the end of life. We can then guarantee dignity in dying and ‘smooth’ bereavement for relatives.