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Dr Jeyanthi Kathiresan, Palliative Medicine Staff Specialist at Nepean Hospital 

Palliative care in the time of COVID-19

25 May 2020

 

In 2020, National Palliative Care Week will be held from 24 May – 30 May. Palliative care can help people with life-limiting illnesses to live as well as possible, for as long as possible.

During the COVID-19 pandemic, Supportive and Palliative Care has become an essential component of Nepean Blue Mountains Local Health District’s frontline response with staff working to provide the best possible care for those who are suffering from this virus and those who will sadly succumb to the disease.

Dr Jeyanthi Kathiresan, a Staff Specialist in Palliative Medicine at Nepean Hospital, has been on the frontline, supporting COVID-19 positive patients. She says COVID-19 has presented significant challenges for palliative care workers providing end-of-life care.

“It has been challenging to deliver holistic palliative care to our patients in isolation because of COVID-19. Caring for these patients without families at their bedside is very different to how we would usually provide care,” says Dr Kathiresan.

Dr Kathiresan explains, “Our approach to palliative care is holistic and includes the whole family working closely with us to address the patient’s physical, spiritual, emotional and psychosocial needs.”

Most often, this approach includes face-to-face consultations with family members and the regular or ongoing presence of families at a patient’s bedside.

Overcoming the physical distance between isolated COVID-19 patients and their families has been paramount for the palliative care team.

“We have put in extra to do what we can to keep families connected. Personal connection is incredibly important at the end of life. Grief is very complicated. If families haven’t said goodbye, if they haven’t been able to speak with their loved one, it doesn’t give them any closure once that person has passed,” says Dr Kathiresan.

“It is also important for the patient to have their loved ones with them. We know that seeing or touching a family member or hearing their voice can help the patient to have a more peaceful death.”

To overcome COVID-19 visitation restrictions and isolation requirements, the palliative care team has worked hard to keep families connected with special arrangements made for visits where possible and regular video calls using smart phones or iPads when they are not.

Dr Kathiresan assures that though COVID-19 patients must be physically separate from their families, they are not alone as they receive their end-of-life care.

“Their families cannot see them, cannot touch them, and so we must be the eyes and ears for the families. We speak with the families and we work hard to find out what the patient’s needs are and what they might like while they receive our care. For example, we’ll play a particular type of music or hymns in their room, we can make arrangements for pastoral support or we change the lighting in the room depending on how they might like it.”

“The families cannot be there to do these things in person, so we do this on their behalf, to bring comfort to the patient and their family. During this time, we have also put in extra to help families to come to terms with what’s going on. It is very difficult for them to be apart from their loved one and so we work hard to keep them informed,” says Dr Kathiresan.

“Even with patients who are unresponsive, we have seen that when their family are saying their goodbyes on the phone or a video call, there are signs that the patient is aware of their voices. We often see that these patients die very peacefully after their families have said goodbye, and for us, that validates what we have done.”

For example, the family of one patient who received care for COVID-19 at Nepean Hospital were able to say their goodbyes over the phone shortly before her passing. Her family spoke with her one last time as a nurse held the phone to her ear. The patient was able to squeeze the nurse’s hand and this was then relayed to the family member on the other end of the phone.

Dr Kathiresan says the palliative care team caring for COVID-19 patients feel and understand the community’s deep sadness for these people and their families.

“We have really, really tried our best to do whatever we can for these patients. It has been a very tough time but it has also been very rewarding helping to keep these families as connected as possible. The families know you have done something invaluable for their loved one and they carry that with them,” says Dr Kathiresan.