You're faced with end-of-life care decisions. How do you cope with emotional exhaustion in the process?

Conheço histórias de pessoas que venceram os últimos dias, desenvolvendo a clareza sobre as coisas pelas quais estão passando. O entendimento de que somos responsáveis por nossos comportamentos e escolhas, se bem trabalhado, pode nos dar o poder de autocuidado Quanto mais nós sentimos vítimas do acaso, ou os que nos escutam, nos permitem ou nos colocam neste lugar, mas refém ficamos da situação e isso certamente não contribui para um estado de paz, o que na morte, acredito eu, se torna até menos dolosa para quem fica, além da probabilidade de prover um sobrevida à quem a desenvolve.

Having an excellent professional support group that meets to discuss clients and share issues that are draining you is incredibly helpful. One can’t be isolated dealing with difficult client issues. Others can help normalize your feelings.

Palliative care and geriatrics are typically multidisciplinary care teams to address many needs holistically. Challenges include physical symptoms, psychological stress, caregiver burnout, legal ramifications, and financial changes. Seeking support for all of this should involve social work, transition services, and lawyers. From a position of emotional distress, share with everyone involved that this is expected and to proactively find support before they feel like they need it (or reach crisis).

Seria importante que o apoio emocional e psicológico no processo de envelhecimento/ doença terminal fossem reais em Portugal. Na verdade, a maioria das instituições de cuidados continuados, lares, cuidados paliativos não tem nas suas equipas profissionais formados em saúde mental que possam auxiliar os pacientes/ clientes/ idosos na sua fase final e inclusive estes profissionais são relevantes para os próprios cuidadores e famílias, que sentem sempre até ao último momento que irão ser capazes de superar aquela perda ou que estão preparados para a perda, o que culmina, em alguns casos, com processos de luto patológico.

Todo processo de ir para a vida, de se movimentar para algo, envolverá um gasto energético para sustentar a autodeterminação rumo ao sucesso desejado. Fazer pausas para reabastecer é importante. Os aportes para dar suporte a caminhada, inclusive para superar as pedras do caminho. Uma reflexão sobre os valores e pilares da vida vai ajudar. Seja cuidados com alimentação, fé, meditação para respiração consciente, atividades físicas, uma caminhada, amigos para dar risada e claro, não tenha medo de pedir ajuda profissional.

The modern concept of grief comes from the work of Dr. Elizabeth Kubler-Ross, but interestingly, this research was based on chronic disease in general - not necessarily end of life. As we lose our physical and psychological capacities, we grieve each stepwise decline. One excellent resource is the book "It's OK that You're Not OK" by Megan Devine.

Self-care can take many formats from routines - this can be mindful eating, mindful walking, mindful toothbrushing - to formal therapy. We should consider both somatic (body-based or bottom-up) and cognitive (mind-based or top-down) forms of regulating the nervous system and stress levels. My book The Modern Trauma Toolkit has 40 activities that can be tried, including examples of both. Some to try include (1) creative expression, perhaps it's journaling gratitude or recording historical moments, (2) music playlists that match our nervous system state (active or calm), (3) finding time to connect - in nature, with others (pets matter too), with spirituality, (4) creating a path to legacy, to leave behind traces of what matters most to you.

One of the best concepts related to chronic illness was created by a community member who has experienced it directly - Spoon Theory is a bit like the metaphor of a battery or a gas tank. For those who are at end-of-life, they are beginning the day with less energy supply. So they have to spend it wisely. Boundaries are one of the ways we can do this. When you need to pace yourself, you cannot move the same way. When you have little energy, you have to manage relational expectations differently. When you have finite time with multiple competing priorities, you have to deeply consider what matters most.

Many palliative care teams will include a counsellor or therapist. They will specialize in the kinds of issues faced at end of life. It's best to engage with them before a crisis intervention is necessary. We should normalize seeking support.