'For 25 years, I've helped people dying in palliative care. Here's what it has taught me.'

This post deals with suicide and might be triggering for some readers.

Maryan Bova has worked as a registered nurse (RN) with palliative care for over 25 years in the community, helping people die at home with dignity.

She knows what it is like to witness people in the final stages of their life. People of all walks of life, ages and genders, experiencing the same thing - being given a terminal diagnosis and trying to come to terms with it. 

For some, they have struggled to cope, reckoning with the idea they don't have much time left. Others have managed to come to peace with what's in store for them, and use the time left to build stronger relationships with their loved ones. But regardless of where the patient is on the path to palliative care, Maryan aims to support them no matter what. 

Last year, Maryan experienced a "full circle moment". Her mum Helen was diagnosed with brain cancer, leaving Maryan to do a job she knows so well - but this time around, it was on a much deeper intimate level. It was someone she loved. 

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As an RN working in palliative care, Maryan's role included a range of things - monitoring symptoms and adverse effects, providing treatments, education and support.

"You become a pivotal member of that person's community," Maryan said to Mamamia. "Hopefully, you have the opportunity to develop a relationship over that period of time, with the patient getting to know yourself and the service. You also play a key liaison role with the person's GP and the wider palliative care team."

In 1997, Maryan first started working in the palliative care space. And throughout her career, she's seen some really horrible experiences, and also some beautiful ones too.

"The experiences that stand out for me are always the ones that best reflect your own circumstances. I'm a mum of three girls, so seeing anyone in my own age bracket, mums or young kids dying, it obviously touches a nerve. Especially when the patients are so young, you can see they've just been thrust into a world that is beyond what the average child experiences - their parents may live to a ripe old age, but their child won't. Your heart goes out to them," Maryan said.

"The more negative things I've witnessed often come down to that person feeling pain - both emotional and physical. When that person is wracked with horrible pain, it leaves them in a bad state. No one wants that for a person. And it doesn't just affect that one person, it affects everyone around them witnessing their pain too."

Maryan continued - "Sometimes it's the people that feel 'ripped off' that struggle the most. And it's understandable. They're the ones that have looked after themselves their whole life, for example the yoga teacher who runs retreats and has probably never eaten anything that wasn't organic and green in their life. And yet they've been smacked down with a horrible diagnosis. It can feel like a slap in the face."

RN Maryan Bova. Image: Supplied.

Amid the good and the bad, Maryan says that what underpins them all is often the person's ability to accept the situation and their mortality, along with the amount of support and care they receive. 

There's one experience that sticks in her mind particularly. 

She was working with a family - mum, dad and their four children - helping the terminally ill mum with at-home palliative care. As Maryan went to visit the mum one weekend, the house was abuzz. People were outside the home in the rain cutting pavers, fixing bits and pieces around the house. Others were in the kitchen preparing food and fresh juices, others distracting the children. 

"I was talking to the woman's husband, and I said to him 'wow this is quite a beautiful thing to see so many people coming to help and support.' He turned to me and said 'I really wish this wasn't the circumstance, but had we not been in this situation I would never truly know what love is.' What he said stuck with me - even though they were devastated, it was a way for them to come together and grieve as a unit," Maryan reflected.

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Understandably, working in this field can be emotionally draining for some - having to juggle supporting your patient while also not becoming too emotionally attached. 

It brings a whole new level of appreciation to healthcare workers and those in this sector. But for Maryan, she sees it as a privilege. To try to make sure someone's final days are spent as pain-free as possible, receiving care and compassion. Because not everyone gets that. 

Considering how suddenly a person can die - often without the opportunity to say goodbye - it's clear we don't have total control over our mortality. But we as a society have control over how best we look after those who are dying. 

"There's been some traumatic things that have happened. There are instances that you know a person should have received far better care than what they were given, sometimes leading that person to suicide because it became all too much for them. Those experiences do rock you - we're human after all," Maryan said to Mamamia.

In 2021, Maryan found herself in a position she hadn't anticipated. Her mum Helen had been diagnosed with grade four Glioblastoma, an aggressive brain cancer. Maryan nursed her mum through it until her death in May that year.

Maryan knew what to expect given her experience. Her siblings did not.

"I knew what it would all end up looking like, but I also knew how to orchestrate the help that was needed for her to die at home in a space she was comfortable in. It was a gift to have that time to talk openly, have important conversations and bond as a family. It was like mum became childlike again, a full-circle moment," Maryan said.

Maryan nursing her mum Helen. Image: Supplied.

Given that Maryan has essentially been surrounded by death for so much of her life, it's nice to hear the positive outlook she has and the 'life lessons' she has learned along the way. And a lot of it comes down to preparation.

"We prepare for births, a marriage, buying a house, divorcing, a big birthday celebration - why is it we don't prepare for our death? I think there's merit and value in not ignoring death," she said. "It's also great to have age-appropriate conversations with kids about death too - there are lots of resources out there. Each and every one of us is going to have trauma land on our doorstep. It's a fact of life. The consolation is that you can know you're not alone."

This week marks National Palliative Care Week, Australia’s largest annual awareness-raising initiative held to increase understanding of the many benefits of palliative care. It's also a time to spark important conversations among family and friends. Because we're all going to pass at some point - and it's important to ensure we all have access to care.

"When you help these people, they're so grateful. I know that one day, I'll probably need a palliative care nurse, and I'm hoping I will be given the same amount of compassion that I've given to others. And the empowerment to choose what best works for me in those end stages," Maryan said. 

"Everyone's grief is different - and that's okay. What nursing has ultimately taught me is what the human condition looks like - our vulnerabilities, innate strength, our desire for human connection, and our capacity to find humour in the most difficult times."

To hear more of Maryan's story or about her work as a certified mindset and results coach, you can visit her website here.

If you think you may be experiencing depression or another mental health problem, please contact your general practitioner. If you're based in Australia, 24-hour support is available through Lifeline on 13 11 14 or beyondblue on 1300 22 4636.

Feature Image: Supplied.