Working with death

Palliative care workers in London, Ont., find fulfillment.

Memento Mori: Remember your mortality

Nurse Virgie Concepcion says it is fulfilling to make people comfortable as they die. (Alexander Ballingall/Western)

The online series A Good Death is a CBC News co-production with students from the Graduate Program in Journalism at Western. | MORE

A new week breaks at the palliative care ward at St. Joseph's Health Care Parkwood Hospital in London, Ont., where Virgie Concepcion is performing the early rounds of an eight-hour shift.

Six people have died here over the past four days, so several of the unit’s beds lie vacant in the morning sun, waiting for new patients to fill them.

 "We go down to the morgue, pick up the cart, bring the body down," says Concepcion, a nurse on the ward for over 10 years, explaining what she does when a patient dies while she’s at work. "One time I had to go down there three times in one shift."

But Concepcion’s work doesn’t weigh her down. She says she finds fulfillment in taking care of people in the final days of their lives. "To me, it’s very rewarding to be able to give that time and keep people as comfortable as they can be on their way out," says Concepcion.
Hallway at St. Joseph's Health Care Parkwood Hosptial, London, Ont. Staff say they find personal fulfillment helping dying patients. (Adela Talbot/Western)

Many of her fellow end-of-life care professionals feel the same way. According to a 2007 study, 98 per cent of hospice and palliative care workers expressed "spiritual well-being," while nearly 80 per cent reported having "high job satisfaction."

Like any job, it has its sources of stress and difficulty, says long-time social worker Andrew Feron. But, he says, it can also be deeply rewarding and meaningful for the workers.

"You make a connection with people, and for a moment …you’re involved in a very intimate part of their lives," says Feron, who personally meets every patient who comes to the palliative ward. "It’s a real privilege to be a part of that."

According to another recently published study, palliative care and hospice workers "practice dying" on a regular basis. As a result, they are constantly reminded of their own mortality, and that affects their overall life perspective.

"Death and dying causes people to reflect deeply on what matters," says Shane Sinclair, author of the study. "These health care professionals could live vicariously through people who were dying at the end of life, but have the opportunity to change their own lives — if they want to — so it’s more aligned with meaning and purpose."

Pam McGrath, director of the International Program of Psychosocial Health at Australia's Queensland University, says working with the dying is a constant reminder of the preciousness of life. She likens it to having a deathbed realization about what’s really important in life, without being diagnosed with a terminal illness. 
Early morning at Parkwood Hospital in London, Ont. (Alexander Ballingall/Western)

"As soon as you get a diagnosis …you’re about: have I told my wife I love her? Have I spent time with my children?" says McGrath. "These palliative care people have that positive [outlook] without having that serious illness."

The work can be stressful

But, as McGrath and Sinclair point out, working in a hospice or palliative care unit isn’t for everybody. In these settings, workers try to alleviate the suffering of dying patients as visiting family members come to watch their loved ones fade away before their eyes. Many in the industry say the families are a major source of work-related stress.

For instance, Greg Manger, a veteran nurse who currently works on the Parkwood Hospital palliative care unit, says a lot of his stress on the job comes from the families of dying patients, rather than the patients themselves.

The dying process is highly individual for all involved — patients and their families.  According to Manger this means, "they’re all at different stages of dealing with the death."

Andrew Feron agrees. He says the death of a loved one brings familial tensions to the surface, sometimes leading to feuds in the palliative care ward. He describes seeing fist fights in the hospital parking lot. People have even gone out and slashed tires out of anger and frustration, he says.

"You’re walking into a sort of beehive of issues and problems," says Feron. "In extreme cases we’ve had to say ‘look, you’re on our turf.’" 

Palliative care units typically have "allied health" teams, which are made up of nurses, doctors, spiritual care providers, pharmacists and volunteer helpers. Many workers say this team atmosphere helps them deal with stress in the workplace. The unit at Parkwood is no different.

"Our staff tries to help each other as much as possible," says nurse Concepcion. "If I’m busy with one family and another family needs me, my co-worker will go and respond to them. It sure does help a lot with stress."

Another challenge for palliative care and hospice workers is losing a patient to whom they are emotionally attached.  There can be little time to grieve as empty beds are often filled quickly after a death on the ward. Parkwood can feel like a revolving door, says Feron, especially when the new patients stay only a few hours before they die.  "It can be a little overwhelming to say the least," he says. 

To help workers cope, the unit holds a "celebration of life" ceremony twice a year. Feron says it gives workers an opportunity to stop and remember the patients who have died under their care.

"It’s evolved into a really wonderful service," says Feron. "It’s an important piece in helping us care for ourselves."

For people like Feron, the enriching benefits of his work outweigh the challenges. Not only does he feel his work is meaningful, his work also helps put his own life in perspective.

"I’m not guaranteed tomorrow any more than the people we’re working with," Feron says. "It’s a constant reminder of the importance of living each day."