It’s a time of crisis for most – a loved one has died, suddenly and/or from unknown causes. Now they have to deal with the news that a post mortem will be carried out and there’s a possibility that they won’t get all the organs back in time for the funeral.
“It can be difficult and traumatic for them and my job is to make sure they have all the information and support they need,” says Celine.
Celine is one of the 29-strong social work team in Dublin’s busy Beaumont hospital who every year work with thousands of patients and their families dealing with the impact of hospitalisation, illness and, in some cases, bereavement.
Celine’s clinical work – carried out as part of a team comprising the mortuary manager and the hospital’s bereavement/end-of-life coordinator – has been focused for the past 15 years on guiding bereaved families through the post mortem process, from the initial contact through to the return of organs months later or subsequent bereavement support.
She’s also on the hospital’s active End of Life steering committee which runs a strong bereavement service and is committed to making end-of-life care a key part of the hospital’s service plan.
The committee runs the awareness-raising programme, Final Journeys, at the hospital once a month inviting staff from all parts of the hospital to attend.
“That would include catering staff, porters, doctors, nurses – we believe strongly that end of life belongs to everyone in the hospital, everybody can make a patient’s end of life journey better,” says Celine.
The social worker says she has seen a change in attitudes towards death in the hospital over the years.
“There is a greater awareness of the place of death in a hospital. A lot of people come here to get well, but we have 900 people every year who die here. And staff are now much more aware of the importance of end-of-life care,” she says.
The ideal, she says, would be that every person who dies would die in a private room surrounded by their families – but that’s not always possible. The challenge and the aim is to bring the principles of the hospice into an acute hospital.
The hospital tries to do that by making end-of-life care an important part of everybody’s work, recognising that the person who makes the tea or the porter who wheels the patient around may very well be the person with whom the patient or family are more likely to talk.
Another significant area in which Celine and others involved in the Irish Childhood Bereavement Network would like to see improvements is in attitudes towards children whose parent or other family member is seriously ill or dying.
Traditionally, children have been excluded from the bedsides of the dying in adult hospitals and from funerals.
But there is now a move towards involving children, allowing them visit dying relatives and attend funerals to the extent that they are able to do so.
“What all staff now try to do is to prepare and explain to children before they visit about the machines they will see, that the person is very unwell, that the person might be unconscious. What children imagine is often a lot worse than the reality,” she says.
If children want to visit the deceased person in the mortuary, someone will discuss with them in advance what they will see and what they can expect.
The mortuary is a part of the hospital that Celine would encourage all staff to visit so that they can answer bereaved families’ questions about where their loved ones are being taken and what it’s like.
“In Beaumont, we were very fortunate to get funding through the Design and Dignity programme, an initiative of The Irish Hospice Foundation, and we had our mortuary completely upgraded. It was a huge project and it’s now a space that is welcoming,” she says.
There is a family room where, for example, Celine can meet a family when organs are being returned – if that’s what the family wants – long after the funeral has taken place.
A number of different programmes and supports are offered for families who are bereaved, all of whom would be contacted by someone in the social work department. Bereavement information is provided by social workers to the families of everyone who dies.
“The majority of people who experience a loss can manage with information and the support of a loving family and community, however a small minority need additional support and counselling,” says Celine.
There is a public lecture on bereavement every year to which families who have lost a loved one during the previous 12 months are invited. There is also a programme for parents who have lost children where one-to-one counselling is offered.
A typical day for Celine would entail finding out what post mortems are taking place and the circumstances in which they are being held, establishing who the contact person for the bereaved family is and then talking to them to explain what is happening.
“I’m a support and advocate for them, I bring them through the process. I’m the liaison person between the pathology department and the families. I may go to their homes or they come to me. We let them know the post mortem is required, let them know why, tell them about the procedures. They know I am going to call them as soon as the post mortem is over. There is a lot of practical information they need, “ she says.
Following the initial contact in the time immediately after the death, Celine will keep up communication with the family. When the time comes for retained organs to be returned – around six months after the initial post mortem – Celine will make the arrangements with the family which may involve having the organs interred in a plot in the hospital cemetery or returned to the family’s undertaker.
Her day might also involve meetings about end-of-life planning, education programmes and various activities and events that take place during the year.
Celine says that although her work involves dealing with people at a very difficult time for them, she enjoys it.
“I like working with families at a crisis time in their lives. It is a very short time and if you can make that journey a little bit more bearable, it’s very rewarding,” she says.
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