Saying goodbye in the time of coronavirus

As we progress through this pandemic, many of us are thinking about the possibility of coronavirus affecting ourselves or our loved ones.

*Content warning: This article discusses grief and anxiety relating to COVID-19*

We are thinking about what might happen if someone gets ill with coronavirus and we can't be with them. You may have even considered talking about this with family and close friends in order to feel prepared in the event of illness, but haven't known how to approach it.
Although it may feel awkward, raising these topics of illness, death and dying are important to be able to talk about it openly. If we ensure we have these conversations while we are well, it can give us the opportunity to communicate what is important to us in our lives, and what sort of interventions are acceptable to us, if we were to become critically ill. 

This Marie Curie guide can help you prepare to open up conversations and talk through these complexities with loved ones.

What if someone is terminally ill?

In the case of a relative who is terminally ill with coronavirus, not being able to be with your loved one can be distressing and isolating. What other options exist, when being there in person isn’t possible?

• Is there anything your loved one needs?  It may be easier to ask nursing staff if your loved one is breathless and finding talking difficult. Ask for a list of anything you can drop in.
• Find out how your loved one feels about the situation and talk to the nursing team about contact. Perhaps steps can be taken to enable visits with limited contact, such as behind glass or with PPE, for example.
• Think through the medical advice you have been given and how isolation may be the best for your loved one.  
• Keep updated with advice from the specialist team. Having an understanding of the illness can be useful, but try to accept that having an illness is never an exact science and health care professionals won’t have exact answers or timelines sometimes.
• Depending on their medical needs and your loved one's wishes, consider whether you can provide a different setting for your loved one and discuss this with them. Think also about how this might impact their comfort and quality of life. 
• Can you share visits or time in hospital? Will this give you time to rest in isolation at home if you can't always physically visit your loved one?  What is the best way for this to happen with large groups; phone calls, video conferences, Facetime, Whatsapp? 
• Connect with yourself and write your feelings down. What is it you want to say? Is there something you know they would like to hear? Collect favourite memories, poems or readings.
• You could send a letter, gift, cards or depending on where your loved one is, flowers.  Flowers can carry bacteria so it’s worth asking the nursing staff first. They are not normally permitted in intensive treatment units (ITU).
• Phone calls and video calls still provide connection. The sound of your voice will mean so much, even if they are tired and unable to hold a conversation. 
• Playlists can express what words can’t sometimes. Ask the nursing team to do this for your loved one if they’re able to.
• Make a video of photos they can watch. A collection of memories you want to share will help you communicate your feelings. A picture really does tell a thousand words.
• Communicate and tell them what you want them to know. Even if your loved one is unconscious, they may still hear and understand you and will gain comfort from your voice.

Experiencing anticipatory grief

During a difficult time, such as this, it is common to experience anticipatory grief. This is defined as the grief that occurs before death or other significant loss, in contrast to conventional grief following on from death. Anticipatory grief can include many losses, such as the loss of a companion, changing roles within a family, fear of financial change and the loss of dreams of what might have been.

It can be a way of processing a confirmed future bereavement and can involve more anger, more loss of emotional control. It is common to vacillate between mourning the inevitable and wanting to stay strong and present. This can be confusing and exhausting. You may experience anxiety, insomnia, loss of appetite, fatigue - so it is important to remember to take care of yourself in basic ways. 

But this process can also present an opportunity to prepare to say goodbye. Your loved one will be going through a grieving process for many relationships and for life itself too. Keep in mind that there is no right or wrong way to express the changeable feelings they may face. 

Clinical hypnotherapy can enable you to find an outlet for your grief by helping you organise your thoughts and feelings and better communicate with your loved one and others. At a time when your life has become externally-focused, it allows some self-compassion.

The hypnosis techniques of body and mind relaxation can also help you feel more rested, supported and better able to cope physically. In the case of anticipatory grief, it can help you better sustain the trajectory of your loved one’s protracted illness. 

Since hypnotherapy can be provided remotely via screen just as effectively as face-to-face, it can also benefit patients in isolation with coronavirus. It is effective in reducing anxiety and enhancing analgesic effects and can help with processing, coping and acceptance.

It offers a spiritual approach that is tailored to the individual which can be introduced early on or at any time, and delivered in conjunction with other therapies since it doesn’t post any side effects.

Importantly, it is in-keeping with palliative care principles:

• Can enhance relief from pain and other distressing symptoms.
• Affirms life and regards dying as a normal process.
• Intends neither to hasten or postpone death.
• Integrates the psychological and spiritual aspects of patient care.
• Offers a support system to help patients live as actively as possible until death.
• Offers a support system to help the family cope during the patient’s illness and in their own bereavement.
• Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated.
• Will enhance quality of life and may also positively influence the course of illness.

It's important to talk to someone about grief or bereavement if you feel you need some support. For some, speaking with an outsider can offer more reassurance without the pressure and worries surrounding opening up to loved ones.

Below are some free helplines offering a confidential service: 

Bereavement Advice Centre
A free helpline and web-based information service. They welcome calls from bereaved people and the professionals and volunteers who support them. 
Tel. 0800 634 9494

Cruse Bereavement Care
The Cruse Bereavement Care Freephone National Helpline is staffed by trained bereavement volunteers, who offer emotional support to anyone affected by bereavement.
helpline@cruse.org.uk
Tel. 0808 808 1677

The Bereavement Trust
Trained volunteers offer comfort, support and practical advice to the bereaved.
info@bereavement-trust.org.uk
Tel. 0800 435 455

Marie Curie
A free support line to talk through terminal ill issues with nurses or trained staff.
Tel. 0800 090 2309  

Counselling Directory
You may want to consider private counselling. Speaking to a professional counsellor can offer you continued support if you need it. Many therapists are trained in bereavement counselling and are now offering online and telephone support to their clients during this time.