Dr Anushka Aubeelack, Clinical Fellow in Obstetric Anaesthesia and Intensive Care Medicine, has been supporting our Intensive Care Unit (ICU) during Covid-19. Anushka is passionate about advance life planning and good quality end of life care and writes below how her experiences caring for critically unwell patients during the pandemic has highlighted the importance of having open conversations about dying:
Returning to my normal day job is going to be bittersweet.
I am one of the anaesthetic fellows sub-specialising in obstetric anaesthetics. As well as overseeing the emergency anaesthetic care for women giving birth at our obstetric unit, part of my role has been working with the Maternity Education team on our education programme.
I also like to keep up-to-date with current critical care practice by regularly working on our intensive care unit (ICU). This turned out to be useful over the last few months with the arrival of Covid-19. All of the anaesthetic fellows were redeployed to ICU to help bolster the numbers of medical staff working there.
It has been a strange and challenging time to be working in ICU. Groups of staff from different specialities and different levels of experience coming to work together in a high-stress area for the first time; it could have been a disaster.
There were times when the numbers of desperately unwell ICU patients felt overwhelming. However, we were not overwhelmed and I believe that it was the astounding teamwork and leadership that got us through those difficult months.
Whilst Covid-19 itself has been truly awful for our patients, their families and our staff, there were also some positives. I am grateful for the support provided by our clinical psychologists at exactly the right time. I was reminded of the joys of working with a consistent team (shout out to Team 3!) and hope that this is something not lost moving forwards.
It was also inspiring to see how quickly we can make changes happen when given the resources. This is definitely going to be an experience that stays with me and there are some aspects I will miss once surrounded by screaming babies again.
Working in ICU on and off throughout the years attending calls for the critically unwell, I have seen many deaths; some of those ‘good’ and some less so. I have noticed the thing 'good' deaths have in common is some form of planning. Because of this, I developed a keen interest in advance life planning and good quality end of life care (the irony of my specialist interest being obstetric anaesthesia is not lost on me!)
On hearing a talk I gave on the subject last year, the charity Compassion in Dying (CID) got in touch and I became their clinical ambassador.
The charity aims to empower people to prepare for the end of life through talking about it, planning for it and recording decisions for example through an advance statement or directive. We produced a series of online videos which were released at the beginning of this year. During Covid-19, I have participated in several webinars for the charity as well as contributed to articles and media pieces.
There appears to be an increased need to talk about advance planning. At CID, at the height of Covid-19, they noticed the number of living wills completed via their website was up by 160 per cent and advance statements up by 226 per cent.
I believe it is important all healthcare professionals have the skills to broach the subject of advance planning comfortably. When patients tell us what is important to them, it allows us to do our best for them.
As with any skill, I believe education is the key to improving these conversations. Eventually I would like to see refresher training throughout our careers on communicating sensitively and honestly about death and how to talk about realistic expectations for a patient's health.
That said, death and end of life planning should not be something only spoken about in healthcare circles. As a society, we need to be better about talking about it and the pandemic has begun to change that because it has made death everyone's business.