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The main focus of therapeutic approach in palliative care is the person in need and their family. The suffering of the person who endures an incurable and progressive disease is considered global, because it integrates their physical, social, psychological, emotional, and spiritual dimensions.

Every single interdisciplinary therapeutic intervention is based on the key elements that support this type of care: symptomatic control, communication, family’s support, teamwork, and support in the grieve. The team that attends in this area must be prepared and able to cover all the dimensions of a person’s suffering. This preparation will allow a know-how and know-be interrelated with the spiritual experiences individually, and as a therapeutic team, strengthening each individual person, which will be reflected in the care provided.

In the interdisciplinary team of the palliative care unit at Casa de Saúde da Idanha (CSI), from Sisters Hospitallers in Portugal, pastoral in healthcare and the promotion of the spiritual care are integrated through some elements in the Pastoral Healthcare; these being the chaplain and the spiritual assistant. In our daily life, we feel that the identity of the Institution belonging to the Catholic Church shapes the pastoral action, making the mission of Jesus towards the sick present.

This distinguishing feature is an essential part of the Hospitaller Care Project to the assisted person, welcoming everyone without discriminating because of race, religion, ideology, or social status. As people who care for the sick and accompany them in a meaningful stage of their lives, it is urgent to offer the opportunity to take care of the team, support them in their loss, anger, dreams, and last wishes… to embrace the dignity of the person we care for. Interdisciplinary teamwork makes it easier to offer an integral and holistic care.

Spiritual Dimension

The spiritual dimension in the palliative care team is lived in two complementary directions. On the one hand, we are all involved in the care for the sick person’s spiritual needs; this is, to feel valued as a person, to be accepted and welcomed, to forgive and be forgiven, to make peace with oneself, with the rest, with life, to find the meaning of life and of suffering, in an individualised system. On the other hand, the needs for self care in the team are also clear through their emotions, their experiences with loss, promoting hope, being a silent presence for the patient and their family.

Sometimes, a space in a team meeting where professionals can talk about how they feel about death, how to deal with frustrations, uncertainty, is a relief for the team’s own suffering. Other times, an informal conversation with the Chaplain where we feel comfortable to express our vulnerability regarding death, believes, and God Himself.

We have the privilege of accompanying spiritual and religious moments that are important for the sick person, such as; baptism, the wish to go to Fatima’s sanctuary, the wish to leave a legacy to the kids, reunions among family… Those are moments that promote, among us professionals, a deeper reflection and acceptance of death, giving sense and mission to the hard work of the palliative care team. The depth of these moments transforms us daily, acting as a spiritual and human experience… learning how to care beyond what’s visible!

Although the service we provide daily forces us to face our own finitude, living situations of huge stress and suffering, it promotes the humanised and mutual care, and the recognition of the dignity of every single patient that passes through our unit.

A day in the Palliative Care Unit

I’d like to illustrate what it is to be a professional in the Palliative Care Unit, and how spirituality is the harmony felt in so many moments, for the good done and promoted through small gestures.

A.G. had been a patient with us for a month. But that day, she was nervous… she was very anxious, and her eyes were full of tears. After dinner, a colleague and I were taking care of her when she suddenly said:

“My God, help me, I’m tired of suffering!”. She held my hands and continued: “God, forgive me for all my sins, take care of my family…”. She looked at me in the eyes while adding: “Help me, My God, to get out from this suffering”.

I kept my eyes in hers and told her: “Dear, God is listening to you, and He knows you are a special person. He will help you find the light… now try to take some rest, I’ll stay here with you”. I took her hand in mine while she was crying, and I couldn’t hold my tears back until she fell asleep.

Some days later, A.G.’s sons came to visit her at the unit with me, and she said: “Dears, I am very tired. I love you, but forgive me, I have come to my end”. They didn’t know how to react. I looked at them and said: “tell her what you are feeling, tell her you love her. Forgive her and thank her for being your mum”. And I left.

From that day, A.G. only opened her eyes again when María arrived, a cousin of hers from France that she was waiting for.

Next day, Fr Chaplain came to the unit, not in the afternoons as usual but in the morning. He had a beautiful connection with A.G. They shared many moments of prayer and reflection, which undoubtedly helped her find the ‘new sense’ of life. He came into my office and asked me if I needed something. I paused for a second, thinking, and then said: “maybe a prayer with A.G.”. So we went together to her room, where her husband and cousin were.

“A.G., can we share a prayer with you?”, asked the Chaplain. As she nodded, we all held hands around her bed and started praying.

Hail Holy Queen was one of A.G.’s favourite prayers. The Chaplain started singing it, while A.G. was following in a whisper… until we couldn’t hear her whisper anymore. I looked at her, she was gone.

The four of us kept singing, holding each other’s hand. When we finished, we were all crying. A.G. had the opportunity to prepare for farewell. Her life was so special, that she chose with dignity the meaning of death!

Written by Maria de Fátima D. Oliveira, Nurse in charge of the Palliative Care Unit at Casa de Saúde da Idanha of Sisters Hospitallers in Portugal.