Episode 69 - Covid Death-Moral Injury and Burnout
Covid Death-Moral Injury and Burnout
SUMMARY KEYWORDS
social worker, podcast, story, people, hospital, Covid death, reverse memory making, health workers, patient, moral injury, burnout, memory making, professional grief.
Justin Stech
0:02
Welcome to Social Work stories, a podcast exploring social work practice through stories and critical reflection. This podcast is recorded on Aboriginal country lands which were never seated. We acknowledge the traditional custodians and cultural knowledge holders of these lands, and pay our respects to Aboriginal elders past, present and emerging. We offer a warm welcome to any indigenous listeners who are part of our podcast community around the world. If you have thoughts or feedback for our team, or just want to find our whole back catalogue of episodes, check out our website Socialworkstories.com. But for now, on with the Episode.
MF
Mim Fox
0:54
Hello, everyone. Welcome to the Social Work Stories Podcast. I'm Mim Fox, and I'm here with my lovely friend Lis Murphy.
LM
Lis Murphy
1:02
Good evening, everyone. You've got a bit of a croaky voice, what's going on, a bit of karaoke on the weekend?
MF
Mim Fox
1:08
Oh Lis I wish so much that was the excuse I could give you. But no, I, like so many other people in Australia at the moment, are completely down with flu like symptoms, right? So influenza is on the rise. Thank you COVID for putting it off for a couple of years. But actually, influenza is seriously on the rise. So I haven't had the flu. But I have had all of the symptoms and feeling alright, to be able to do this now, but like to say it's a bit crazy to me Lis how many people are so sick right now. You know, like, I don't know about you, but every second person I'm speaking to is unwell in some way.
LM
Lis Murphy
1:54
I'm starting to just gently freak out here thinking I'm in an enclosed space with you, Dr. Fox. You know, usually we're zooming it now I'm suddenly sharing space with you and you're sharing with me that you're unwell.
MF
Mim Fox
2:06
Well let's milk crate this for a second. Okay, because actually, look, my mum's a GP. When COVID first started, she said to me, maybe people will now learn to stop shaking hands and wiping their face touching their faces when they're sick and in close contact, right? But we haven't learnt, everybody has actually gone, okay, if I've got COVID I should wear a mask, I should keep some distance. But if I have every other symptom under the sun, I shouldn't. So I have done my best about keeping distance from people. But it is amazing to me that I don't think it is a bit of a health promotion moment. But I've just I just feel like as a society. Have we learned anything from this pandemic? Is that too big a question to ask on this evening?
LM
Lis Murphy
2:55
Look, quite possibly, quite possibly. But I want to tell you that I ran an all day workshop yesterday. Yeah. And there were 14 health workers. And that was an all day simulation exercise.
MF
Mim Fox
3:09
We're talking a lot in a enclosed space.
LM
Lis Murphy
3:11
We were all masked up.
MF
Mim Fox
3:14
That's also though on health premises. Yeah. Yeah. New South Wales Health premises. So that's mandated.
LM
Lis Murphy
3:20
We have little pockets of it. We have little pockets. But I think I think it's a timely public health warning that you've given us?
MF
Mim Fox
3:27
Yeh, because in the university context, no one's masked. Right. So and if you're in the streets now, if you're in the supermarket, wherever you are, no one's masked. So, you know, I do think there's just something that we all just need to be a bit aware of that maybe just take some of those lessons forward. Is it too much to ask? I don't know.
LM
Lis Murphy
3:50
Not for you, Dr. Fox, I am going to next time I go to the grocery store. I'm gonna mask up with you in mind.
MF
Mim Fox
3:57
Yeah, yeah. Well,
LM
Lis Murphy
4:00
anyway,
MF
Mim Fox
4:01
and now that we've got to change the government, maybe we'll start hearing some different messaging about how we should be behaving around contracting illness. It's too much to ask probably, it's too much to ask. I think our listeners are sitting there going, come on Mim, you know, that's not going to happen
LM
Lis Murphy
4:15
And look to what I'm going to segue that statement or that theme right into this story, because when you said to me that comment about health just then yeah, I felt like my soul shriveled up thinking where where do we where do we begin? Where do we begin listeners? How would we improve the Australian Health System? But let's not go there because I think I think we'll we'll focus on this Health social worker. And this is a COVID story. And there's so much to this that I am really keen to unpack with you and Virtually are beautiful listeners. Yeah, but just a little intro. This is a social worker who's working in a very busy Sydney hospital. And she's actually working in a designated COVID Ward. And she's actually telling a story about an older person who ended up dying of COVID. It's a really sad story. It's a really sad story. So that's a little warning for people. But she actually talks about some interesting practices that came in to support this man in the end stage of his life. And I just, I also want to get people to listen to the way in which she describes the practice around it, and how it is shifted in the various waves of COVID. She talks about the approach and the first wave, the second wave, and goodness, I think she even mentioned, the current third wave.
MF
Mim Fox
6:01
I think this is a timely story, Lis, I'm glad we're doing it. Now.
LM
Lis Murphy
6:04
I am too.
SW
Social Worker
6:11
So a little bit about me. And my experience as a social worker, in the COVID-19 space, that has been the last couple of years, I've been a social worker for just over 10 years now, which is slightly terrifying how quickly that time goes from being a new graduate to a, I'd say now seasoned veteran of the social space. And like most social workers, the past two years of that has been during the COVID 19 pandemic. I've been involved in the COVID-19 space, across the multiple settings, including in the community, working with the public health units of health districts, and also, as an inpatient COVID-19 ward social worker.
The way that social workers responded to COVID-19 has really changed as climate around COVID-19 has changed. You know, now that we're at year two, I look back and think how social worker responded at first is so different to how it is now. In the community role, I found a lot of my my work was quite authoritarian, in that it was dealing with matters of restricting people's liberty temporarily, for the greater good of society. In terms of keeping everyone safe, we're all trying to contain the outbreak. And a lot of that was about managing people who needed public health orders and putting people into kind of isolation or combination and making sure that they kind of stayed put, making sure there are okay. And as we've gone along the timeline, the role of the social work now in the COVID-19, space has just changed so dramatically, I guess, you know, in preparation for this podcast, I am looking back at definitive moments along the way. And I'm, I'm really still quite, quite touched or affected by a particular case on the COVID ward.
Many, many, many, many months ago, I think over a year now. It was the story of a older gentleman who came into hospital for generally kind of miscellaneous health issue, nothing particularly complex, nothing particularly frightening. Really, you know, when I look back on it, something that could have been reasonably followed up with at a GP practice. And unfortunately, when they came into hospital, they were found to be COVID positive and at the time, the practice and policy around that from the Ministry and for health was people needed to be isolated. So, remained in hospital for that period of time. Prior to this, this was an older gentleman happily married for many, many moons. Very, very lovely partner. A wealth of children, grandchildren, great grandchildren. For all accounts lived quite an active and healthy lifestyle and from what I, you know, came to know there's a lot of joy in and day to day life and a lot of life to be lived.
So this this gentleman, contracted COVID-19 Somewhere along their journey and went out in hospital with it. And unfortunately, as we've seen, you know, a pre existing health issue or two, they became quite unwell deteriorated quite suddenly, all of a sudden, I was we were faced with a gentleman who we thought would just need to kind of sit it out for a couple of days. And then choof on back home was now facing end of life. This was particularly more challenging because at the time, the rules were strict, stay at home isolation orders. In their very large and loving family unit were all separated, isolating in their own properties. We had a very elderly spouse, isolating by themselves, with limited technological capabilities to be able to utilize and things such as FaceTime that we were able to facilitate for other people.
Unfortunately, this gentleman deteriorated quite quickly and rapidly approach the end of their life. And it was crisis Social Work intervention that was required, our role was facilitating and ensuring that medical updates were filtering through to the family members, and that everyone understood the gravity of the situation. Due to the fact that we weren't able to utilize our FaceTime technology here, a lot of my role was around reverse memory making in that, as opposed to taking something from the patient and giving it to the family, we were asking the family members to give us something that we could then provide to the patient.
So what we were able to do was get these family members to send on over to the social worker, myself, some personal sort of stories or messages for this patient that we then got sent up to our COVID Ward, which was then handwritten, so kindly by the staff up on the board, who then gave it to this patient who was very, very, very labored in their breathing and not having a good good time, at all, by any means. And these were read out to him and he was able to die holding these letters. Overall, that experience, I found was quite distressing for everyone involved in that we have multiple people who were completely vulnerable, and had to surrender to being powerless in, in their experience. And that was, you know, I'm sure how the staff were feeling as well, that that's how I felt we, it was very difficult to sit with, watching, you know, multiple decades long marriage unfold, and wrap up really in a matter of, you know, a matter of hours that no one was expecting or anticipating or planning for and that they were kept separate. And that we will also holding the concern for the well being of the spouse and the family members. You know, unfortunately, there wasn't a lot of time to prepare.
And it was quite a dramatic climax, really, that was it was quite distressing for everyone involved. I often think back to how much emotional energy I gave that case, and how emotionally and personally, I became involved in it, which traditionally, you know, is not how I operate. As a social worker, I can't quite firm boundaries, in order to have some longevity in the curry. But this one particularly affected me on a personal level. And I think that it's because at the time COVID-19 was impacting everyone. It wasn't something that really affected our patients, it was affecting day to day life, we were in a lockdown and life was hard and everyone was tired. One thing I take away from that experience was how beautifully everyone collaborated, hospital system can be quite hierarchical. That's how you know things get done. But this really saw everyone, you know, rolling up their proverbial sleeves here and kind of chipping in with you know, one of them or seeing your doctor's handwriting the notes and giving them to the patient, you know, the beautiful bedside nurse holding their hand, multiple people contacting the family to make sure they're okay ever and really did unify. And that was quite, quite beautiful to see.
I look back on that case now. You know, more than a year later, and what sits with me is that if I'm being frank, if I would have that situation again. I don't know if I could provide the level of support I did at that time because I think we're all just so exhausted. You know, it's up to the third wave at the moment and it's been a it's taken a massive toll understanding it in the healthcare system and ever everyone is really really feeling that and that that fatigue, that that mental fatigue? Even being faced with the prospect of that situation? Again, it's it's almost unfathomable. I think, again, I think I haven't had to respond to a situation like that in a little while and and part of me queries if I've subconsciously. In short, that I haven't had to as a social work practitioner just because you know, the, the cup is empty as it is as it is for everyone, at the moment. You know unfortunately, at the time that that scenario happened, it was the start of the second wave where we all were optimistic that that first wave was over, and then life was resuming normality. And we hadn't the Omicron variant, that it ramped up again. And I guess we're kind of back right now in that situation where we've got things returning to a new normal, and
SW
Social Worker
16:02
I speak for myself as a social worker, there's that underlying fear that this might be an intermission between another period of chaos, and it's a time to reflect do we, you know, as social workers working in healthcare setting, Do we have another one in us?
So I guess that's been a lot of what I've been thinking about, when I've reflected on the role of social work and in the COVID-19 space, you know, initially, two years ago, you know, everyone would have done anything and everything they could, and we did. And we still want to, I guess, it's just, what what, what, what do we have left to give, as, as practitioners in in that space? In that regards, and I'm sure, you know, I realized I'm speaking generally, on behalf of everyone. But it and I'm sharing my experience, but I feel like it's it's a universal experience across not just the social work profession as well.
But you know, everyone has been involved, I suppose what I think of what I've gained from it, it's been a beautiful time for collaboration. Everyone, you know, I find that one of the greatest things about working in hospital system is that it is quite, it's quite a good community. You know, everyone comes together, and you really kind of saw that unification. When when push came to shove, I really got to see, you know, the kindness of everyone willing to do anything they could to help. But now, I guess I say that the consequences of that prolonged giving, and then that's just a level of kind of compassion, fatigue, and burnout. And I think that that's definitely changed the landscape of the healthcare system.
And I guess, you know, social work within that healthcare system of, I guess it comes back down to providing support, and kind of extent of which we can do that ongoing in light of the last couple of years and everything that we've all been through as not only kind of citizens of a global pandemic, but also healthcare professionals responding to that and providing a service within that context.
LM
Lis Murphy
18:24
So I did warn you, I did warn you everyone, it was a sad one wasn't it?
MF
Mim Fox
18:28
Yeah I'm glad that you did actually Lis.
LM
Lis Murphy
18:34
Yeah, look at let's kick off with the commentary from the social worker about the different styles of, of, I guess, working with people with COVID that she's witnessed. So I think she mentioned, you know, when we first started, I can really relate to working in the first wave where it was a far more authoritarian approach in relation to you know, who could see patients who could work in certain spaces, what you had to wear, and there was certainly a high level of anxiety and, and stress and unknowingness in that space by both the staff and also obviously the patients and their and their families.
Then there's been this shift that she talked about, in terms of being a little bit more accommodating. But I guess, if we now focus on this story, there was something I mean, something about this story that just made me feel very heavy hearted Mim. I don't know if that was how you feel. But I felt incredibly saddened for the way in which this person died without someone who loved them with them. But I also felt incredibly touched by the lengths that the team, including the social worker went to, to enable his death to be, to have some connection with the family and for them to be as present as possible, through I've never heard never heard of reverse memory making.
MF
Mim Fox
20:14
Yeah, that was an interesting phrase we've talked about memory making on the podcast before, Lis, I wonder if you can just remind our listeners about what memory making is. And then what reverse memory making is?
LM
Lis Murphy
20:25
Yeah, yeah. So people might remember that some of the memory making stories that we've had on the podcast have included, either babies or children or adults who have generally died suddenly, in the context of, of, let's say, a hospital. And memory making might include things like taking hand /footprints, lockets of hair, photos. I think at our last or two episodes ago, the social workers talked about wanting to take photos of hands have become quite a popular photo that families are wanting fingerprints that are then being tattooed onto, onto family members. So so that's what we would call memory making.
But the reverse memory making has been something that sounds like it's become quite common in COVID, when families haven't been able to be present. So in this case, you would have heard that, you know, families were able to have letters transcribed and read to the gentleman in the last stages of his life, and I think it was quite moving. I think she talked about one of the specialists writing one of the letters. But I look, I'm just, what baffles me Mim, is that, I betcha we could have the same story being told by social workers around the world where a different practice might have taken place, i.e. that the family were able to get in there at least one, because I'm just thinking now about some of the things that I've seen in my hospital, where families have been able to be there when someone's died, and they've got they've moved heaven and earth to get that person there.
MF
Mim Fox
22:13
Yeah, I think there's a couple of different realities that we're dealing with here, around that situation about whether or not family members have been allowed into hospitals when people are dying. One of the realities is that, like you said, there have been these different waves of COVID, right. And because we're learning as we go, each wave is producing new knowledge and new information and the health services are having to play catch up all the time, right, the amount, the speed of which new policies are getting put out there is incredible and health workers then having to respond almost to on a daily basis to a change of circumstance and change your practice effectively. But the second thing that I've seen, because I work with social workers in different hospitals in different local health districts across Sydney, and I have definitely seen that there's different practice happening at different sites. So where your loved one ends up getting treated, will change, whether you're able to be there at their end of life or not. And the impact of that is huge for families, for loved ones for the dying person as we can see, right.
But there's an impact as well for health workers on that, I think, and if you remember a number up fairly early on in the podcast, but we did revisit it in at a later point as well. There was a beautiful episode that was about professional grief. You remember that episode or two into the most listened to episodes. And that episode was actually talking about the grief that social workers carry, when they work with people who are dying, right? That the worker holds, not that a loved one holds, but that the worker holds the impact of another human being on them as the social worker. And I think this story has an element of that to it. When you talk about the impact of work, that the social work ahead of working with this man and the family, I think there's a professional grief she's carrying.
LM
Lis Murphy
24:23
Oh yeah. And Mim, awesome observation, by the way, because that helps me understand the heaviness that I was picking up in the way in which this social worker told her story. It felt like something. She was both exhausted, but it felt like she was numb too.
MF
Mim Fox
24:44
Yeah and so I think it's the professional grief. I do also think though, the exhaustion is because and she says it, working through the different COVID waves and not knowing what's coming next. And having to be, you're on this merry go round that working in healthcare has been right, over the last couple of years, has exhausted the entire workforce, like we've had record strikes in the last two years from health care workers in this country, right? We have had the clearest messaging about exhaustion and overwork from that sector, in my memory. And I actually think it's about taking it seriously, this is about seeing the impact, not just on the people who are actually in the hospitals who actually receiving the health services, it's about the impact on our staff.
LM
Lis Murphy
25:40
Totally and I had to, I kept on pondering if this social worker was in my department, what could be some of the things that could be offered to her or the rest of the department is what you're, you're saying, in relation to this fatigue? How do we support our workers? What needs to be done now?
MF
Mim Fox
26:02
Yeah,and so I think that's right, I think it takes us into that realm. But do you know, at the moment, my brain is divided in half, half of it wants to talk about self care. Half of it really doesn't want me to.
LM
Lis Murphy
26:18
Ya know, if you go there, if you go there, I swear to God, I'll be throwing this microphone!
MF
Mim Fox
26:22
That's what I mean Lis, that's what I mean, we have self cared to death. Right. And as I know, and we've talked on this podcast, numerous times, we've had episodes devoted to us and our stress journeys, and our, you know, approach to self care, etc, etc, etc. And I feel like, That's all very well and good. But this couple of years has taken our healthcare staff to a totally different level, a totally different place. And if there's one thing that the work we've done in this space Lis has taught us is that it cannot be the responsibility of that healthcare worker alone. Because this person, they need to not be repeatedly living a Groundhog Day of COVID work. They just can't.
LM
Lis Murphy
27:09
That's what I was thinking about, like, where is it around staff rotation? Is it around providing longer leave? Is it looking at some options in relation to coming back and working in a different clinical area, working part time doing a combination of, you know, some non clinical work with clinical because you and I both know, in our research that we found that variety helped that, but like I feel like I want to, like organize for the best massage in the world. And a, I don't know, let's go shoot for the stars. a six months holiday lying on a beach in Bali for this person.
MF
Mim Fox
27:52
Yeah. But I think it goes bigger than that Lis. Like I actually, for me, that feels even even though that feels enormous. It feels like a band aid. I actually think there's structural issues within the healthcare services that are happening.
LM
Lis Murphy
Now we know that Mim! I
MF
Mim Fox
I know we know it, but it has to be said like, I think you're right. I think variety in the work, I think rotation, I think extra staff, I think there's a whole range of stuff that has to happen there. But I also think we need to be embedding this way more clearly, in our supervision structures. We need it to be part of the everyday discussion.
LM
Lis Murphy
28:26
Well, it is interesting, you should bring up supervision because I would be really curious to ask this social worker, why this story has stuck so much.
MF
Mim Fox
28:36
I wonder that too Lis, because on the surface, this story is a pretty straightforward story. Right? You know, like, it's not, we've had some really complex stories on this podcast. This is pretty straightforward. But the impact of it is huge. It was carefully chosen, right?
LM
Lis Murphy
28:56
So I mean, you know, yes, if, if this person was in supervision with us, I'm sure that would be one of the questions that would be asked, because I think you're right about the professional grief. And I think it is soul destroying when you see a person dying without their loved ones. And I think she mentioned that this gentleman had been married for 40 years. Yeah, had a very loving family who would have been bereft not being able to get there. And sometimes it is a social worker, that is that middle person that has to be actually the conduit, and explaining to families the reasons why they can't get in. And that's it. That is a horrible position to be in. And then the flip side, talking with the person who has COVID the patient about the fact that their partner, their kids can't be by their bedside flies in the face of what our social worker two episodes ago was talking about. A good death in a hospital.
MF
Mim Fox
29:51
Yes, yes, it flies in the face of everything we know, actually, about strong good bereavement support.
LM
Lis Murphy
29:58
And so I would imagine that would be part of the reason as a social worker to not be able to support that a good death to happen.
MF
Mim Fox
30:06
Yeah, there's a real sadness in that isn't there that you know that it could have been done better? Yeah, yeah. Look, I am, can we move out of the analysis for a second and just debrief this conversation between us as you would in any supervision session? Because I have to say that this is a catharsis for me to be able to even have this conversation with you. Because I think that some of our listeners might be going, Wow, they're sounding really passionate. Wow, that was an intense conversation, right? Because we've talked about this coming from different angles at different points in time. But I think the reason why we're both really passionate in this moment, is because there's a catharsis, we're tired just like everyone else is, right. And we’re working in this space, talking with social workers all the time. We know what this is like, and what it has been like.
LM
Lis Murphy
31:05
I know, I feel incredibly protective of my social work friends and colleagues. And I think that's what's also happening for me, someone who's been burnt out who has been damaged by the system. I can see it in others. And it just breaks my heart, and I think that it's interesting that this is a COVID story, because I think that has been the added layer to our social work colleagues that has just made the burden so much heavier. And it does break my heart because, you know, I think that social workers, like would have done absolutely everything in their power to have made that death as good as possible.
MF
Mim Fox
31:52
Yeah,yeah. There's a real vulnerability to this story. Yes. And I want to, I want to really thank the social worker for that. I think it's hard, it's hard to be vulnerable. It's hard to share, when it doesn't go how we want it to go. And when we know that this isn't how it should be. But there's a there's a truth to that, right. Like, we have to share these stories. Because if we don't share them, the risk is that we don't aim for the stars in our practice, right. Like, that's what we need to be doing all the time anyway. So we've we've got to sit with the vulnerable, that hard moments just as much.
LM
Lis Murphy
32:32
Absolutely. Well said, and know that the impact of our work is incredibly powerful. And often we shine the light on these very, very positive stories, but it does, like you say, takes its toll.
MF
Mim Fox
32:48
Yeah, yeah. So just to finish this conversation, then Lis, like I really want to send out that message to our listeners, that if you're sitting there working in this headspace, if you've been really feeling like this has been a tough couple of years, and that actually, it's hard to keep going. But you're not alone in that, that this is actually a global experience in our profession now. And, and we need to come together in a position of strength, I think and keeping that, keeping that vision in front of us of what does what does best practice really look like for us in our contexts, and for the people that we work with.
LM
Lis Murphy
33:27
Yeah, again, I can’t add to that.
MF
Mim Fox
33:33
Thank you for this wonderful conversation, as per usual. It is say glad to be recording back in the same space with you, Lis.
LM
Lis Murphy
33:41
If I get your flu Mim, I swear.
MF
Mim Fox
33:44
Yeah, I know. I realized well, and truly how, how much I will go down for that. So on that note, in case you don't hear from me again, listeners, this has been a lovely journey. But you know, otherwise, we'll, we'll speak to you again next month. Thanks, everyone. Take care of yourselves out there.
LM
Lis Murphy
33:59
Yeah, please take care. Thank you. Bye.
JS
J S
34:04
Thanks for listening to the Social Work stories podcast. All of the stories we share are de identified to respect and protect the people involved. We create this podcast because we're passionate about building the Global Social Work community, and strengthening our practice no matter the context. If you want to help us grow the podcast tribe, and continue the work that we do, we would love it if you can subscribe or follow the podcast in your favourite podcast app. That way, you'll be sure to get every episode as soon as it's released. While you're in your podcast app. If you can leave us a five-star rating and a review it would mean so much to us. You can connect with us on Instagram, Twitter, Facebook, and LinkedIn where you can share our posts with your friends to help spread the word. And you can always find us at our home on the web, socialworkstories.com.
The Social Work Stories podcast is made by Justin Stech, Lis Murphy and Dr. Mim Fox.
Thanks so much for listening.
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