Bullets 2 Bedpans
EP:12 What it’s like to be on the other side: Hospice Care with Helen Bauer
Today we are conversing with Helen Bauer, an extraordinary hospice nurse with a rich and varied career. From her roots in hospital nursing to her calling in hospice care, Helen's story is a testament to the resilience, compassion and dedication inherent in this noble profession. Her understanding of death and end-of-life care, honed through years of comforting patients and their families in their most challenging times, offers an insightful perspective that cuts to the very heart of our human soul.
Get ready to view the world of nursing through a different lens as we navigate the complexities of hospice nursing with Helen Bauer.
Nurses and Medics: This is your platform! We want to hear your stories of the good, the bad and the ugly. Send us an email at cominghomewell@gmail.com
Do you know a health worker that needs a laugh?
B2B N.F.L.T.G. Certificate click here
Get the ammo you need to seize your day at Soldier Girl Coffee Use Code CHW10 for a 10% off at checkout!
Special Thanks to
Artwork: Joe Weber @joeweber_tattoos
Intro/Outro/Disclaimer Credits:
Pam Barragan Host of 2200TAPS Podcast
"Racer" by Infraction https://bit.ly/41HlWTk
Music promoted by Inaudio: ...
Today we are conversing with Helen Bauer, an extraordinary hospice nurse with a rich and varied career. From her roots in hospital nursing to her calling in hospice care, Helen's story is a testament to the resilience, compassion and dedication inherent in this noble profession. Her understanding of death and end-of-life care, honed through years of comforting patients and their families in their most challenging times, offers an insightful perspective that cuts to the very heart of our human soul.
Get ready to view the world of nursing through a different lens as we navigate the complexities of hospice nursing with Helen Bauer.
Nurses and Medics: This is your platform! We want to hear your stories of the good, the bad and the ugly. Send us an email at cominghomewell@gmail.com
Do you know a health worker that needs a laugh?
B2B N.F.L.T.G. Certificate click here
Get the ammo you need to seize your day at Soldier Girl Coffee Use Code CHW10 for a 10% off at checkout!
Special Thanks to
Artwork: Joe Weber @joeweber_tattoos
Intro/Outro/Disclaimer Credits:
Pam Barragan Host of 2200TAPS Podcast
"Racer" by Infraction https://bit.ly/41HlWTk
Music promoted by Inaudio: ...
people who would come home to their own homes and strip down in their garage.
Speaker 2:Yeah, I would not have any contact with their families.
Speaker 1:Yep, you know they slept in separate rooms, eight with utensils that were separate, that kind of thing.
Speaker 2:And that's a mental toll all by itself.
Speaker 1:I mean I don't think the public realized what we had to do to keep going.
Speaker 2:This is your co-host detox, and I am here usually with MZ, but MZ had to step out for a little bit. But in the meantime, we brought our other sassy friend back with us, leslie Yancey. Hey, leslie, hello. Hello. Leslie is a respiratory therapist by trade, but we bring her with us because she brings the sass and she has about 800 hilarious stories and she is just so much fun to be with. So we brought John today. Jump in with us because we're going to talk about something a little different. Right, leslie, absolutely. So we're going to be talking about well, we're about hospice, but we're not talking about hospice itself. We're talking about hospice nursing, because this whole show is geared for the medical professionals. Right, think of the break room talk, not getting your CEU conversation. Right, you know what kind of conversation that is, leslie, right? Absolutely, yep. So today we're going to bring on a fellow podcaster, helen Bauer. Hello, helen, how are you? Hello?
Speaker 1:I'm great.
Speaker 2:How are you? I'm good, I'm good and Helen, you are as wise as Leslie and I are. You're in that 30 year range in the medical community as a nurse.
Speaker 2:Yep, I've put my time in. You have, you're in a couple of t-shirts, correct? You got it, yes, and so Helen and I met through doing a promo of Whole Care Network and coming home. She is hilarious, has a huge background, and we just want to kind of get into your story and how you went from getting into nursing, staying in nursing this long commended and getting into hospice care. So how did all that transpire? Where'd you start? You know?
Speaker 1:I've. I've never had one of those stories that was, I felt, a calling or a mission Florence Nightingale type personality, if, if anybody was calling, I did not answer. I never. I never had that. I knew it would be a full time job there's longevity because there will always be sick people and so I just went into it with a very practical mindset. I've been in the. I worked in the hospital for two years, gained some skills there, and then I went into community based care doing home health for years 13, 14 years and doing home infusion and then very inadvertently stumbled into hospice. Had no idea what it was like to work with people at end of life. I had actually only seen one person die in the hospital and never any body dying at home in their own home. And so, 14 years later, I'm hooked. I love it. I will work out the rest of my career like this, in this field?
Speaker 2:What led you so? What did you do in the hospital for nursing? What was your does my surgery.
Speaker 1:I worked in a cardiac unit and because I was brand new brand new I did what they call floating. You know they pull you basically your low on low man, on the totem pole when it comes to seniority. So they pull you to all these different floors and I actually hated that because I never knew where I would be from shift to shift. But there's a lot of experience and a lot of exposure to be gained there. You get to see a lot of different stuff and you learn from all these other season nurses that are working and that part I really benefited from and when I when I had kids doing shift work like that was really difficult.
Speaker 1:So yeah, that's when I went into community care.
Speaker 2:Floating to me is the fastest way to ramp up your anxiety disorder.
Speaker 1:Oh, you know I think back on it. Now it's been 30 years. I could still feel the anxiety from yeah, you never know what you're going to end up with.
Speaker 4:Oh my gosh.
Speaker 1:And not everybody was welcoming to having a brand new nurse who didn't know the unit was constantly asking questions. So you have to choose, you know. Do I harm this patient, do I make a mistake, or do I ask a question of a co-worker who's a little on the cranky side? A little on the cranky side and doesn't want to respond because she's busy and doesn't have time to talk?
Speaker 2:Chet, who does you for doing float at a brand new nurse level, because that's the fastest way to your anxiety disorder, holy shit.
Speaker 1:Yeah, I wouldn't go back and relive that, nah, and I think it taught me a really good lesson about how the nursing profession works, because we're our own worst enemy, our bitchy when it comes to new nurses. We are so happy You're a nurse and then we're just going to be mean as hell to you. Yeah, the entire time, until we feel like somehow you've qualified by the time that you've worked.
Speaker 1:Yes, that you have to earn decent being treated decently. Really, we were the. And then we wonder why the industry is so short. Yeah, why we are so short staffed because we act like jerks to the people who are brand new coming in.
Speaker 2:We're the founders of hazing seriously.
Speaker 1:Exactly.
Speaker 2:It's a professional hazing, it is yeah, and they don't do anything about it.
Speaker 4:I mean, we that actually came up when we were doing the violence in the workplace.
Speaker 2:Oh yeah, I mean more.
Speaker 4:People said to me you need to be doing or addressing the conversation of. You know us eating our young.
Speaker 2:Oh, that's happening, we're going to aggression, aggression in the workplace.
Speaker 1:Yeah, yeah, absolutely.
Speaker 2:Yeah, it's insanity. It's funny, helen, you said that you didn't come in like, oh, I'm going to be a nurse and I'm going to save people. I was like, yeah, I'm all like, I want a job that I can travel with, make decent money, and I needed a way out that was secure and sure. Why not pick the hardest bachelor's degree? Why not? So off, I went and did it. I don't regret my choice. I mean, I I liked being a nurse, but I definitely was more pragmatic and hated that. That eating like, knock you down, you're not good enough. I have never understood that. So so when you did that and then you left and went into community care nursing, did you ever do anything like that? Do you do this respiratory therapy? Go out in the field?
Speaker 4:Yes, Actually, yeah, home health is big for respiratory because of BIPAP, cpap. Yeah, home ventilation oxygen. That's actually really big in the respiratory field.
Speaker 2:Did you go out? Have you ever done the community work? I?
Speaker 4:have. I think I may have done something during clinicals, yeah, but I that's not for me and I have several friends that do it now and absolutely love it, especially like home ventilators. When kids are going home on ventilators, yes, no joke.
Speaker 4:They will do the visits and they absolutely love it. Me personally going into someone's home, especially in the area that I live in. I it's not for me. I have been in those homes, yes, well, I mean, I live in Appalachia, so so that's just not something. I think that me, I think I would see so many situations that I would feel like I needed to do extra help in, just because the education isn't always there and what that patient needs isn't always available, and I think mentally that that would be extremely hard to do.
Speaker 1:Oh, it is. It is the moral fatigue that you experience. Yes, because you know we. We come in, especially with hospice, because it's holistic care mind, body, spirit. We do collaborate with people like respiratory therapists and dietitian and physical therapists, but for the most part almost all of the care is provided by that core team a doctor and nurse, a social worker and a chaplain. And we look at everything and we're like we got to fix this Right. If the patient's not safe, we fix it. If there are bed bugs, we figure out how to fix it.
Speaker 1:And when I first went into to hospice I remember coming home and telling my husband these people are sick in an obscene type of way. I had never seen disease so advanced cancer that was in five or six different sites in a body pain, you know, emaciated patients in stage Alzheimer's, patients that were bed bound and nonverbal. I had just never seen that kind of stuff. Because in home health it's all about we're going to be there for a very short period of time. Do the prescribed plan of care get you up on your feet, make you independent and send you off healthier than you were before? And in hospice that's not the goal, right? Yeah, so going into people's homes and being inserted not only into their living environment but into their family dynamics and all of their relational history and disease trajectory. You know they've lived a big life before we even got there, for the most part Right, unless you do.
Speaker 1:Pediatric hospice, that's a different type of care. But to be inserted inside someone's life like that, in a very personal way, there's a lot of autonomy. That's needed and I think working in the hospital got me ready for that. You know I got the skills that I needed. And then, working in home health and hospice, you learn to work by yourself. You learn how to reach out when you need to connect. But you have to be ready to have a work environment where you don't sit down because the furniture is filthy. When you get through at the end of the day you realize that you have some sort of I'm going to say water, some sort of liquid stain on the knees of your pants and you know you didn't kneel down on your own urine, so it was somebody else's, and you have to get used to that and have a certain tolerance of it. You have to be willing, you have to have the stomach. You have to be able to stomach some of the stuff.
Speaker 4:So I would assume, helen, when you go in, you probably have to learn to prioritize what the needs are at the time, because when you walk into a situation like that, I would think it would be overwhelming to say, oh my gosh, we have all of these factors that are interfering with this patient's wellness. What do I attack first, I mean, is that kind of the mindset that you have to have to go into that.
Speaker 1:Oh, absolutely Absolutely. So first thing you look at a patient is if they're in pain or they can't breathe. Right Right, you want to get those major symptoms because, first and foremost, so say, the house is filthy. If a patient can't breathe comfortably or their pain is not controlled, nobody cares about how dirty the house is.
Speaker 2:Air seems to be important.
Speaker 1:Absolutely. Yeah, you have to prioritize and the good thing is is working with an interdisciplinary team. We each bring these skills that are so necessary. If we have a patient with no clean running water, no air conditioning because I live in the South that's a huge thing. That's what your social worker is for. You need a family conference to talk about advanced care planning. Or you know there are horrible family dynamics. Your social worker and your chaplain. They deal with the psychosocial and the spiritual side. Patients been incarcerated or is disconnected from family that's your chaplain. You know to deal with guilt and regret and relational issues. Fortunately, the nurse doesn't have to do so much of that. You know all of it overlaps in a certain way. She's responsible for assessing pain, that kind of thing. But without the team the nurse would never make it through this.
Speaker 2:Yeah, that's heavy. It's a heavy load to do it all by yourself. Well, let me ask this Hospice itself even within the medical community, I think there's still some level of understanding. You stay hospice. You say you're going to die. Right, I mean, that's what everybody immediately says. But if you talk to hospice, one of the first things I will always hear them say is you know, palliative care doesn't always mean end of life. So will you clarify that first?
Speaker 1:So there's so much confusion around palliative care.
Speaker 2:Yes.
Speaker 1:Because palliative care is the new specialty on the block Right. It's been around for a little bit, but not as long as the other silos of healthcare, so this is the way I always explain it. So palliation is to comfort, right, to create comfort, to make a patient comfortable. So palliative care is always part of hospice. Right, we always want our patients to be comfortable. But not all palliative care is hospice. You can have palliative care without being at end of life, right, right, right Now, that's what they recommend. When you start out with a chronic illness or you receive cancer treatment, you have a serious illness or a life-limiting illness, you should be starting palliative care way early, before you get to hospice. But palliative care is incorporated into hospice care. It's just confusing.
Speaker 2:So palliative care in and of itself is just kind of getting life into the optimal level before there's any more decline. Would that be a fair assessment?
Speaker 1:Yes, and you can receive treatment Right. That's where it differs from hospice care you can receive aggressive treatment and have palliative care, whereas in hospice. You're receiving palliative care, but you're not pursuing aggressive treatment at that point.
Speaker 2:Because now we're at end of life. Now we're at end of life, right.
Speaker 1:Treatment's not effective, or you've maxed out on it, or you just don't want any more.
Speaker 2:Right, and you decide Okay, so, and you know, really, the goal is that you know, like bullets to bedpans is all geared towards our perspective, right? So I still like to clear up what hospice is Because, like I was saying earlier, you know, like hospice care is kind of like obstetrics, like in the medical community, they're like oh, that's that other medical stuff, like we don't, we don't do vaginas and we don't do that death thing, like sorry, yeah, like and the people that, the people that do, the people that do, are just not socially acceptable.
Speaker 2:Right yeah, there's like there's just always podcasts. Right here we are doing podcasts.
Speaker 1:And we talk about death is excessively. Oh my God.
Speaker 2:Let me tell you I, and being medical, I would, I would go a little sideways, or, but being medical, we already have a different perspective of death and life. Yeah, let me tell you, like I used to say and people thought I was crazy when I said this like when a labor and delivery nurse had a baby, they were just like actually surprised, like, oh, look, I get a baby to term, right, because there's so many miscarriages, like it's, it's more common, and we see that, right, we see more of that than any community would see that. So for us we're like, well, hot, damn, look at that, we made a baby and we made it all the way through. There you go, right. So we kind of have a little bit of that work sense of humor and the same side with death, right. And so I've been in scenarios and I'll have people you know, family and friends. You know. They're like, oh, she's a nurse, she must know. And I'm like, okay, and so I'll get these calls like, well, I, you know that it's that it's terminal and we don't know how much longer. And what do you think? Oh, I'll like I can't see them, I'm not there, it's not my special. Hey, I don't know, your guess is as good as mine at this point, right, Like I don't know. But there's certain things that you, you've, I've learned through my friends that are nurses, you know, like end of life stuff. When they start seeing what what is it called? When they start seeing family and friends that have passed already, visioning, visioning, yeah, and stuff like that.
Speaker 2:So a lead to the story is that I had somebody that had called me as a friend. Her mom was declining. She was very much older, 93 or so, had a good long life battling cancer, and she calls me up we talked about every week or so and I was checking to see how she was doing and my perspective was if you feel this is the end, then make it her best end, right, so play the music or the TV show or have the smells that she remembers, talk to her about her past, get those last memories in. You know all that stuff, right, celebrate it, don't be afraid of it, right, because it's going to happen, so let's do it in a good way.
Speaker 2:So she calls me up and she says, hey, so there's some brown fluid coming out of her and I was like, okay, where? Which orifice? Well underneath or at the bottom? I'm like, okay, is this arrectum? Do you think she? You know, because two different things did she have liquid poop or do we have urine and kidneys are failing? What are we? I'm not sure Might be urine.
Speaker 2:And so I started talking with them like okay, well, if it is, then you know this would be a time to let your hospice nurse because she was in hospice let them know what you're seeing, you know, I said, because if it is, I said then there is a chance that what will happen next is that she might slip into an unconsciousness, you know. And she's like what does that look like? And I said, well, you know, they just kind of look like they're sleeping and they're not really responding to you. And then she's like I think we're there. And I was like, okay, you should call your hospice team about now. So and I go into her family there and she says they're coming tomorrow morning. And I said, okay, that's good. And noon the next day I got a taxi, had passed away, so, and family was there, hospice was there, but I was giggling in a nurse medical way, all in appropriate humor, and I was gently giggling at her surprise, like I think we're there, like she identified that's pretty good assessment.
Speaker 1:You know you didn't get into is the baby crowning? Oh my God, I've done that one too.
Speaker 2:That's not as calm, let me tell you, like holy Lord. So so, from your perspective, as a nurse dealing, you've been in this what? 14 years and you said you want to keep going, which I by myself think that's impressive, because you are not just dealing with the person. If anything this is just my opinion Sometimes the patient's the easiest one to handle. Oh yeah, how is it from your perspective, when you are doing this day after day, like this is the grind, so to speak. Like how does how do you cope? What's your care? Maladaptive or adaptive?
Speaker 1:I've had some of both, so I'm not in the field anymore. I haven't been in the bedside at the bedside for several years, but I still speak the language. I work as a consultant, so I'm constantly reading, talking, interviewing. You know the podcast for seven years talking about death and dying and grief and bereavement and how we handle it as professionals and how we deal with patients and their families. And I had a social worker teach me early on about the dreaded FD. She called it and it was family dynamics which, holy crap people are. People are crazy, right.
Speaker 2:Amen.
Speaker 1:Sister, I'm telling you that's, that's my theory about human behavior. Forget Freud and all that other complicated, all those people. People are nuts that is what it comes down to.
Speaker 1:And that includes us too. That's how we cope. So I I found I had some personal rituals that worked really well for me, and they sort of developed naturally. Now, having had several years underneath my belt, I know more about myself and what I need as far as how to take care of myself. But I, at the end of the day, I would come home and for infection control purposes right, you've been in all these different houses and come home to my own house with my husband and my children, and I would strip down out of my scrubs and immediately take my shower. I like to it.
Speaker 2:It wasn't just that was pre COVID too, wasn't it?
Speaker 1:Yes, which I and I hear stories about friends during COVID. You know who would come home, because we were still seeing patients in the home. Wow, people who would come home to their own homes and stripped down in their garage.
Speaker 2:Yeah, I would not have any contact with their families.
Speaker 1:Yep, you know they slept in separate rooms, ate with utensils that were separate, that kind of thing.
Speaker 2:And that's a mental toll all by itself.
Speaker 1:I mean I don't think the public realized now what we had to do to keep going. The hospital is, and this enclosed, protected environment. It became encapsulated and protected, but when for community based care, especially for those who were dying, we, we stripped down the care. Unfortunately, chaplains and social workers did not go in. They weren't making face to face visits, but our clinicians are nursing clinicians still were. Our aides were still making visits in a lot of homes as well. So you learn these rituals to take care of yourself, and for me it was to get clean and it was a washing off of the day.
Speaker 1:Yeah right Getting out of that uniform, not just to change clothes, but to change my role and my identity. I'm back in my personal life and who I am.
Speaker 2:Yeah, I get it completely, Because that's what I did when I came home.
Speaker 1:I was like I need a shower, but I didn't realize it was a ritual until later on. You know it was a washing off of the day. It was a. It was a mental and a psychosocial, psycho psychological coping mechanism that I did for myself. I just didn't know it when I was doing it. I just wanted to be clean.
Speaker 4:Yeah, well, go ahead, helen that makes me think like what? How supportive was there is your spouse with, with your?
Speaker 1:role. You know my husband does not work in health care and he would listen to the stories. God help him. And you know, of course I didn't confide. I didn't tell my kids what I was doing. I think eventually they figured out. I worked with people who were dying. My husband has always been very, very tolerant because as a field clinician, I was going out in the middle of the night. He wouldn't know where I was. I would get phone calls. I had a pager way back when. You know that would be then wake us both up in the middle of the night. He's always been really, really tolerant, and he's also a very quiet person, so where I needed to talk, there was space for that, yeah. And one thing I did learn, though, was I was not comfortable sharing with him a lot of the things that I experienced because he couldn't relate.
Speaker 4:It wasn't relatable for him, right.
Speaker 1:He couldn't relate to it. And the other thing was it was sort of a contamination of my personal life. The things that really bothered me, that I saw that were upsetting. There was a lot of suffering or something like that. I didn't talk to my husband about that. He could not get it. It was. Sometimes it was horribly gross. You know, we see a lot of nasty stuff and you really have to have somebody who has seen those things. So you talk to your coworkers and your colleagues and you're saying you're not going to believe that SHIT, that I saw, that it was horrible. And this is a person who can relate. And they say tell me, you know, I saw this patient last week with you and they totally get it.
Speaker 4:Go ahead. One thing that I was I actually did a podcast years ago and it was the same thing. It was organic. I didn't know what was going to be asked of me. And one thing that he started off with is he had been a medic and he had done rotations with the respiratory therapist and one thing that stuck in his mind was RT's going in and terminally extubating patients.
Speaker 4:And when he said that to me you know I'd been a therapist at that point 20 years that never, I never registered that in my brain as being something that other professions didn't have to do. But that was something that was expected of me and I worked critical care was and it could have been a 16, 17 year old trauma patient. It could have been a child, it could have been and the nurse went in and told the family respiratory is going to come, they're going to remove that too. And then it was my responsibility to and this is where that grossness comes in. You know, I didn't want my patient gurgling. I didn't want my patient struggling, because at that point then my focus was on the family. I didn't want them to be traumatized, so I would have them step out. And then, as I've kind of went through this and and you sit back and you try to process those things and you think, wow, how abnormal is that. That.
Speaker 4:I am sticking, you know, a yonk hour up someone's nose, down the back of their throat, as far as I possibly could, so that the family isn't traumatized by liquids or gurgles or unnatural sounds. And you know I needed to make sure that that patient wasn't struggling. That's where your support with your nursing staff came in. Hey, let's bowl us this patient. I don't want that family and I sit back now and I think I've done that for so many years. And how abnormal is that that the general public has no understanding of what that's like.
Speaker 1:Yeah, that's 10 kinds of jacked up. I mean let's, let's be real, let's be real.
Speaker 1:There are things that we do in nursing and and health care. It totally is. It's true. If you could tell people OK, so here's the process we do. We do terminal extubation in the home as well. Yeah, sometimes we do it in the hospital. If a patient is is on hospice in the hospital because their care can't be managed at home, we do that and the hospice is, the whole hospice team is involved. But there is a huge process that goes into processing those events and setting them up. It takes a team. You've got your respiratory department, your nursing, all these different departments, that and clinicians that manage all this stuff. We couldn't do it without each other and we shouldn't do that each other. But after you get finished, if you look at what that event is, you have just helped someone die.
Speaker 4:Yes.
Speaker 1:Holy shit yeah.
Speaker 4:And respectfully so. That was another thing is you're wiping their face, you're combing their hair, you know, making sure that their eyes, you, you want them to be as presentable as possible during those last moments, and sometimes it's a complete shit show. You're going in, you're trying to hurry, you're trying to. There may be a very, very small window between that extubation and that death and you want that family to be able to come back in, to be there for those moments. So you know, and and to your point earlier talking about newbies, I don't know how many times I would have new nurses. They would be totally flabbergasted. Is that normal? What? What should we begin this? I'm like just bolus, just bolus.
Speaker 2:Try to stop the chain stokes breathing.
Speaker 4:Yeah, we do medication and then you get a new nurse who's just as shocked as the family is.
Speaker 1:Oh, yeah, yeah, You're going to you're going to medicate.
Speaker 4:You're going to medicate the patient Hell yeah.
Speaker 1:You're concerned. You can't medicate the family Right?
Speaker 2:Yes, my first time, my first death, I will never, ever forget. We had I was waiting to come in the military but a nurse a whole wop in two months, I think working at my hometown hospital, a little tiny thing. And a gentleman comes in there that has terminal brain cancer and we're on the. We're on the terminal, terminal end of it. Right, we're just managing him. And the doctor had written an order for milligram morphine IV every, increased by one milligram hourly PRN pain. Right, okay, we can do that, right, so I have, so you know, 12 hours shift. I wasn't every hour, but near the end I was up and I think by the time I left, if I'm not mistaken, he was somewhere near 10 milligrams. I mean, like, come on, well, anyways, come in the next day. Guess what he passed away.
Speaker 2:I was convinced that I killed this guy. Right, I was. I went home, I was upset. My mom is looking at me and I am tears and I'm like I killed him. How did you kill him? And I'm like morphine, and why were you giving it? My mom is looking at me like she already got it Right and I was not getting this, and she's like Donna and I said, yeah, was he gonna die anyway. Yes, I'm not processing it, I'm just beside my. I killed him, I could. And then, once I processed that, I was like, oh, wait a minute, I just let his body do what it was going to be doing. You know, without that struggle, right, without that horrible fight and, and you know, any of us seen chainstokes. You only need to see it once to remember what chainstokes breathing looks like. Right, that's the most horrific breathe. I saw it at nursing school. And and Guppy breathing, yeah, guppy breathing.
Speaker 2:Yeah, yeah. And I mean the lady like did that whole and I thought that was it Right. So I'm like all right, we're done Right. And and all of a sudden I was like holy shit, I didn't know what had happened. And I was. I was that nursing student that you're just looking at, like it's OK, this is normal, like yeah.
Speaker 1:But so that's the situation that families struggle with in the home-made hospice.
Speaker 1:We're going to teach you how to work, how to give these medications, oh, but guess what? We're not going to be here when you give it Right, because we don't stay here. That's one of the big myths about hospice care in the United States is, once somebody elects hospice, chooses hospice care, that a hospice person, a nurse, is going to be with you when things you know towards the end somebody will be there. No, it's hit or miss. We're going to teach you how to do all these things Correct, empower you, educate you. However, you're probably going to be scared, right. And once you get mom or dad or whoever comfortable, those body systems and those processes that are made to shut themselves down, naturally your body already knows how to die. They're going to get comfortable enough to do that, and so I've had families say you know, I gave him the morphine and he died an hour later. That's right.
Speaker 2:Right, you got him comfortable yeah. But there's a lot of fear around that.
Speaker 1:So here's a crazy story. My father-in-law was on hospice two years ago in the middle of the pandemic, and he had in stage Alzheimer's and was on hospice, had been on hospice, I guess, four months or so and was having all the trouble swallowing, you know, didn't recognize his family, who was pretty much nonverbal, and he had a stroke. He had a stroke which was a gift. So for anybody who understands Alzheimer's disease, the swallowing becomes an issue. Do you feed? Do you modify the feeding? You know, a lot of times, as they get closer to death, the body can't process the food and they don't want to eat. They lose weight even though they're getting insurer or supplements, and it's a very, very sticky time to figure out how to care for a patient. They aspirate Leslie will tell you there's aspiration. Pneumonia is a nasty thing for the treat.
Speaker 1:So my father-in-law we were blessed because he had a stroke that put him in the bed, unable to swallow, and precipitated his death Right. So he began to have some panting. He began to breathe. He was, you know, he would be at 38, 40 breaths a minute, which is a lot of laboring. It's unnecessary, but that was just how his body was shutting itself down. So we began using morphine, according to the instructions that the hospice nurse gave, and we had to up it and then we had to up it again and it was all within the parameters of what the doctor prescribed right.
Speaker 1:And how the hospice nurse, you know. But we, I came home and I remember thinking what if he dies after we up this dose?
Speaker 2:Yeah.
Speaker 1:What if he dies? Because I was supporting my husband and his mom and telling them you know, it's okay to up the dose. It's safe to do this. There's no threshold on morphine. It's okay to do this. It'll relax his breathing. You know it's a side effect of the morphine and that's how we use it. We're not using it so much for pain in this case, we're using it for his breathing. But I remember thinking what if we killed him with the morphine?
Speaker 2:Yeah, you can't help not think that, Cause that's how I felt it was, like I did that, and then you're like did you like? Can you really break that down? No, you relaxed the body so the body could do what it? Needed to do, and did we expedite that? Yes, we expedited it. If we didn't, we would watch a person struggle with pain, agonizing death and not be able to go peacefully Cause.
Speaker 1:Well, so really I don't think we expedite anything. No, I would use that words particularly we calm things so the processes could go forward and move.
Speaker 2:Well, that's fair enough. But if you're yeah, to me expedite means to speed things along, and I don't think the meds do that why I think that I guess my maybe I explain it's not the right word, maybe it's more, because I just think that if they're fighting this whole time I don't know you're right, maybe we're actually not expediting, because if they're fighting pain and they're wearing themselves out, maybe that makes it go quicker.
Speaker 1:I mean it could do that way too. It's just suffering while the process happens, and it's unnecessary. Right, right, right.
Speaker 4:Yeah, so one thing that I because I always work critical care so and I worked at a trauma hospital, of course there were tons of situations where deaths seemed very untimely or they were very young or there were different things and horrible situations that surrounded death and mentally how I had to, and I didn't figure this out until I was later in in my career that I to not carry that with me. I had to process the fact that I nothing I did sped up someone's time leaving this earth, that that was above that, that had nothing to do with me. I was used to take care of a patient and whether it be a mistake, whether it be should have, could have, would have I don't get to decide how long someone stays on this earth. I was just used to care for that person.
Speaker 4:Because I think that mentally, we carry so much of that responsibility and it's not ours to carry as caregivers, and that's really how I had to start looking at things and I had to encourage other caregivers because I think that we do, we have a bad call or we have a patient that we worked and we don't understand why they didn't make it and it is not our call ever. I think that we are put in situations and I and I don't know, helen, that how you process it, how you know other nurses that you've been around with have learned to process that. But how do you deal with with death or that person that says, oh, I gave that morphine and they died within 10 minutes? Like, how do you address those things?
Speaker 1:I'm like you. I think you have to realize that as a professional caregiver because that's what we are as nurses and therapists we are placed with a purpose at the bedside. Yes, I guess the extreme would be I intubate, I extubated a patient, a terminal extubation and that did precipitate in the patient's death. But when you look at all the mechanized, medicalized things that we put in the way of people's natural dying process, we realize that we bring our skills to the comfort and the palliation and the support of a patient and that, to me, is way bigger Right Is way bigger than the quote unquote part we played in a death. The death was coming anyway.
Speaker 1:I think that's a really good way of thinking about it. But when you're new to things and you haven't experienced it, donna, like what you were saying, when you went home that day and you told your mother I may have killed this patient, I think we all go through moments like that, even as seasoned professionals, because you have to look at this role. It's really a weird dichotomy for us, because you have to take it casually at some point. This is part of my job. I do this every day because otherwise nobody would ever do this work. Absolutely, it's crazy.
Speaker 2:Here's my question Do you think that nurses in our medical people because there's more than just nursing and hospice care but do you think they are a different breed and I'm comparing this to what we had talked about eating their own she's smiling already, she knows where I'm going Compared to this whole eat your own kind of personality, do you think nurses and medical people that get into hospice are a different breed?
Speaker 1:I would like to say we are. I would like to say we mentor better.
Speaker 2:Are you more welcoming, like new nurses coming in?
Speaker 1:I want to say yes, because hospice teams are so different. Hospice teams it's very much a work family and because it's kind of like the military, the brotherhood that's created by serving in these intense circumstances. Hospice culture is very much the same way. So, leslie, you and I could be caring for the same patient. We've experienced a trauma, a traumatic event, we've watched it and we carry a little bit of that as compassion, fatigue or secondary grief with us through each one. So I think the way we support each other is different and deeper.
Speaker 2:Nice sir.
Speaker 1:Yeah, I have to say yes because after doing this for 33 years, 34 years, I've never worked in a silo of healthcare, nursing, where I felt a connection and experience the kind of support that I experienced from my hospice team, hospice colleagues. It's really just different, at least in my opinion.
Speaker 2:You mentioned military and it's funny, because military we don't have hospice nursing. You get shot and you either get killed or we pick the bullet out of your butt and then we sew you up and then you get better and you go back to it. There's really no in between here, and if you do get to that place of terminal we have people that like cancer and stuff like that. Hospice care comes from the civilian side. We don't have military hospice. So it's a form. It's a little weird.
Speaker 2:Yeah, to think about that. Do you take care of a lot of veterans, have you taken?
Speaker 1:care of veterans. I have, so here's an interesting statistic. If you are nerdy and nerdy. I am a little statistic. Medicare is the major insurance, you know the major benefit for hospice care. In the United States One in four Medicare hospice patients is a US military veteran.
Speaker 2:Geez.
Speaker 1:One in four, 25% of the patients we care for that are Medicare hospice patients and that's the majority of our patients. They are military vets.
Speaker 2:But they're going to decline over it because now we just have the boomers. You know we're in this boomer Right. The silver tsunami? Yeah, silver tsunami, I like that yeah.
Speaker 1:Yeah, there's an influx of these folks, yeah. I'm on right on the cusp. I'm on the edge. I'm a year younger than the boomer. I'm on the boomer boundary. Geez, you don't look that old.
Speaker 2:Thank you, dang girl, that Ola Volay is working for you.
Speaker 1:I will take that compliment. But yeah, I've worked with a lot of veterans and of course they've changed through the years, because it used to be that we had the World War II, the World War I guys, right, right, and then the World War II veterans and we're almost out of those. Those are we are.
Speaker 2:Are they done? Yeah?
Speaker 1:I was on a team that honored a Pearl Harbor veteran. Wow, he very advanced age and this very revered service that he had had yeah, pearl Harbor, and being in the military. And we were actually. He was on our service when Pearl Harbor Day happened and several of the people went out. We have a program called we honor veterans that agencies can participate in and what they do is they get veterans from that same branch of the military to go as volunteers to visit the patient. They are in uniform, hopefully the uniform from that era. So there's recognition and connection. Yeah, and the military services honored and we were able to film this gentleman's. They did a little service that presented him with a flag and a pin from his branch of the service on Pearl Harbor Day. Oh, that's awesome.
Speaker 1:And then he died a few weeks later, and so it was this incredible meaning that we were able to make for his family and for the gentleman. It's amazing to work with veterans. For me, as a middle-aged white lady that has never been in the military and up until a few years ago had never had anybody in my family that was in the military, it can be hard to relate yes, it really can to their experiences. But I remember I had an older gentleman who had served in World War II. He was a character, very country guy, lived way out in the middle of nowhere with his daughter and son-in-law on a big ranch that had a cattle ranch very stereotypical Texas and he had been an ambulance driver and he was in the military. And he was so funny when he needed to go to the bathroom he would get up with his walker and he would say I'm going to go to the post office. I need to go to the post office, just me a long time.
Speaker 1:I asked his daughter. I said is he confused? Where is he going? She said, oh, that's his code for saying he needs to go to the bathroom. Because, he was an older gentleman, he was very polite. He didn't want to say I got to go to the bathroom I need to pee.
Speaker 1:You know I'm going to say that, yeah, the ambulance driving thing was a big deal because it became part of his reality. When he got closer to the end of his life he began to hallucinate. Some Didn't know where he was, was easily disoriented and at night, if there were car lights that would pass outside the window, he would say there's an ambulance, I got to go, I need to drive the ambulance. And he talked a lot about seeing dead children. Oh, I bet. His family said they didn't know a whole lot of details. He had been very, very close and private about his military service.
Speaker 2:Most of them were the ones that have seen. I had a great uncle. That was D-Day and so you all seen Save and Private Ryan when they show them climbing the cliffs. He was one of the cliff climbers. Yeah, and I didn't know for years. He was just the crazy old drunk uncle Joe. That's how he was always seen and, you know, come to find out he just had repressed all that and that's why he was, you know, drinking like a fiend and everything else. So, yeah, a lot of those guys were really quiet. And do you notice, when you're dealing with veteran end of life, is there anything significantly different than I don't know, civilian end of life, I mean, and how they are coming to the end of their life? Just curiosity.
Speaker 1:I think a lot of times they have stories that they haven't told.
Speaker 2:Storytelling is they want to tell? They want to tell yeah.
Speaker 1:They do. To a certain extent, it depends, I think, on the level of trauma and the intensity. Yeah, because so, for instance, vietnam vets, a lot of those guys came back and there was incredible shame. Yes, and shaming.
Speaker 1:you know there was a lot of rejection from the American public and so the stories and the trauma, the trauma that they experienced, they never shared it with anybody and they internalized it. You know a lot of addicted behaviors, a lot of alcoholism, drug use, that kind of thing, and at the end of life they might loosen and share something that I would have families tell me. I've never heard my dad say that before.
Speaker 4:Yeah.
Speaker 1:I never knew he did that.
Speaker 4:So, helen, I have a question how do you, since you don't have so in the hospital setting I have someone who relieves me, who takes my spot? How do you, as you're going in and doing the visits, how do you draw that line between I need to stay here and sit with this person, or share with this person and go back home? I mean, I'm sure that, like to me, that sounds like that would be a constant struggle as to when do I cut off the time here.
Speaker 1:Yeah, yeah. So this is what I'll say about that line it's very, very wide and it's very gray. Yeah, it's boundaries for people who work in community-based hospice. It's a real challenge. It is a real challenge because we get to know these people intimately. We are in their homes, we see pictures of their grandchildren, and people tell you stories In the hospital. Like Leslie, I'm looking behind you. I see things mounted on your wall diplomas or certificate, certification.
Speaker 2:She's missing her calendar, though, from the fireman she has to get that up.
Speaker 4:We're still waiting to get our fireman down.
Speaker 1:So when you're in someone's home, you get to see all these things and their pieces of their lives, and those are the conversations you have. It's not all about what's your blood pressure when it's the last time you pooped although it's a lot about when you pooped. I talk about poop a lot, but so in the hospital, you, you, you are a star of your identity.
Speaker 1:Yes, yes, when you're inserted into their lives and their environment and their family and their relationships the way we are, it is much harder to disconnect Right and let go of that. You have to learn that if you want to do it well and you want to do it for any length of time, you've got to disconnect and honor yourself as an individual. So how?
Speaker 2:do you do that? That's actually it was going to be my question, as we kind of start winding down. Is somebody that is curious about getting into hospice and they already struggle with boundaries nursing? Then what is it that? What advice do you give them on how to do something like this, where you have become part of their family and then they lose their family member, but you lost your patient, but it's a patient plus right. It's not the sterile environment. They come up and do the whole dressing of them that goes down in the morgue and that's that. You are in their house. Now how do you, as the nurse, handle all of that? What advice would you give to a nurse that's wanting to do hospice?
Speaker 1:You know we overuse that term, self-care so much. But I think self-care, after the pandemic has changed, we have an awareness. It's not vacations, it's not a manicure, it's not a massage, it's a minute to minute, hour to hour. You touch a doorknob to go in a patient's room, you take a deep breath and you say I'm here to do good, let me do no harm, let me leave them more comfortable than when I came in. So that kind of self-care, some self-awareness, trying to get that 10,000 foot view from above, which is really hard when you're thinking, oh, I could mow this patient's yard, I don't have anything going on this weekend. Yeah, that's a lack of a boundary. Yeah, that's a lack of a boundary.
Speaker 4:It's wonderful and benevolent, yeah, yeah.
Speaker 1:So I think, being self-aware and practicing great self-care, very robust, individualized self-care. But the other thing, I think, is to let ourselves grieve, because we grieve with our patients. We have anticipatory grief for every single damn patient we see, because almost every one of them is going to die in our care. That's the goal, but you still grieve it and you watch other people suffer, you watch that family suffer and if you're not changed by that, if you don't grieve over that a little bit, you need to be doing something else.
Speaker 4:I think that's something that we're really bad about, and when I do public speaking, I go through. I think there's like seven to ten different types of grief, and I think one thing that we don't own as caregivers is, just like you said, we don't allow ourselves. It's not my emergency, it's not my family member, it's not my death, so therefore I can't grieve it, and that's totally not true. So I think we go with all of these suppressed and unpacked emotions and year after year after year, and that's why we end up in such a bad spot mentally as healthcare workers, because we don't process these things and I don't know where we've gone wrong.
Speaker 4:As far as educating Like you know, you both were in nursing school I taught respiratory for seven years we never address the fact of that it's going to change who we are. We never address that?
Speaker 2:No, we just study Kubla Ross about the grieving process in relationship to our patients, not to us, Right?
Speaker 1:right, and all of that applies to us as we move along through this. I mean right. In nursing school, everybody goes through labor and delivery right.
Speaker 2:Oh, you have to have a labor and delivery class I hated it.
Speaker 1:So sorry.
Speaker 2:So not my thing, I would have had to slap somebody.
Speaker 1:Let me tell you that yelling.
Speaker 2:Labor and delivery is not my choice. There's a very short version of this. When I came in the military, I was I see you trauma, anything like that, until the commander comes and says, hey, I need one of you guys to go to obstetrics, and of course my head. I'm like fuck that. Until I couldn't get the words out because the girl next to me breaks down and cries and I'm like, oh, there starts my new obstetrics journey. There you go, thank you.
Speaker 1:You have to have. You have to do worse than crying pass out. So do something. But I get what you're saying, though I mean yeah, we all go through labor and delivery in nursing school. So not all of our patients are male, excuse me. Not all of our patients are female and not all of our patients are going to have babies. But every single patient, every single human we encounter is going to die. There is not a class on death and dying in hospice care.
Speaker 2:in right school we don't do it Medical school same way, yeah, but I thought medical started some of that. I know that they started like bedside manner kind of class.
Speaker 1:That's a work. That's a work in progress. Yeah, I'll just say that. But I think there's a dialogue. Why aren't we talking about? This why? Aren't we talking about its impact on the longevity and the quality of the careers that we have? Absolutely. I mean we have people leaving in droves. The silent resignation, the great resignation that hit nursing and hospice, was just as bad.
Speaker 2:They're saying, I think between 2025 and 2030, we're going to be a half million short on nurses alone, yeah, alone.
Speaker 1:So the statistics for LBNs licensed vocational nurses or LPNs licensed practical nurses. They lost 30% of the work, 36% of the workforce. And here's the impact of that Most of our long term care facilities, nursing homes, are staffed almost exclusively by LBNs.
Speaker 2:Because that all changed right when I was graduating, a long, long time ago. That I was the year that graduated and they said, oh, we're going to this team nursing thing, and that's where it started, where they wanted less. I was at BSN, right, so they wanted less of them and they wanted more LPNs and CNA, right, which is fine. I'm not knocking any of that their goals. I thought they were saving money. That didn't really turn out to be the case, but the team nursing survived and now 30% of the LBNs walk out. That's nurse. Like you said, nursing homes are majority LBNs, lpns and on your floors, guess who that foundation is? Because they built the teams and you got team nursing and so that RN is over 35 patients and has a team of two or three LBNs, like, if they're lucky, and some CNAs and whatnot, and so now your foundation just walked out, right Now. What medical community it's?
Speaker 1:funny. When I started in the hospital, I trained under the LBNs. I was a brand new GN, brand new graduate nurse waiting for my board results, things like that. Those LBNs trained me and these were the women with the white shoes, the white pantyhose, the white dress and the cap. Heck yeah, by the time I got to nursing school they had done away with the caps, right, Right. All of that traditional white stuff was gone and I have to say that was a welcome change, because white in nursing, white uniforms that's just so stupid.
Speaker 1:Yeah, it's crazy. Sure, let's do that. So here's the kicker when I went into hospice care 14 years ago, the first nurse I rode out with because you do the orientation stuff, you watch the films, do the videos and read the policy stuff that you have to do and then they send you to ride along in community-based care to make visits and shadow someone else it was an LBN. And that first day out in the field with an LBN, the first visit we made was to a patient that she had known and been taking care of for a while, and the patient died while we were there.
Speaker 2:Oh hell.
Speaker 1:It was incredible.
Speaker 2:You know I I have maintained this that if you take three nurses, take an LVN or LPN, take a, but they used to have ADNs. I think we've done away. There might be a couple left, but the three year degree doesn't exist anymore and then take a four year graduate and you all move them to the 10 year mark. You wouldn't be able to pick out who's who.
Speaker 1:That's true. I mean all solid ones. I worked for 28 years as an associate degree nurse. I got my bachelor's degree a few years ago. In my early 50s yeah, there were things that were close to me, but I was able to do everything I wanted to do up until that time, I used to tell when people would say you know, what should I do?
Speaker 2:Should I become, you know, should I do LPN, lvn, bsn? I said, well, you got to think about your future and that. So if you'd say, I just want to be a floor nurse, and that is it, I'm like, you get the time, like you can do an ADN, you can be an LPN, you know, and you will maintain yourself on a floor and that's it, I go, if you have any aspiration for anything above that, you have to get your bachelor's or your master's or whatever. So that's really the defining factors in that right. Right, but a sharp LPN that has studied and knows their clinical stuff can rock it out just as well as a four year RN. You know, absolutely.
Speaker 4:And I think we're missing that. I think that we are so pushing out at this point the BSN and the master's that everyone's they're skipping over those initial steps that you ladies took, that I took, where we started from the bottom and worked our way up and you had that experience line. Now you have these new grads who are well, I can't do floorwork, I have my BSN, or I have my master's, so I'm not doing floorwork. So you have these nurses with advanced degrees that have no experience whatsoever, it's true.
Speaker 4:And unfortunately, they are putting them into roles where they need experience and it's not there anymore and it's like healthcare. They've got it all backwards. Like you said, experience you can't replace experience with a degree. I mean, you just can't.
Speaker 2:You gotta get gritty first. You gotta get gritty first.
Speaker 4:You gotta get gritty first, absolutely.
Speaker 2:I mean you can't do it any other way, right, and on top of that, I mean it's gonna. I'm gonna bring it back to what we were talking about. Is that? How are you, in any leadership position, gonna relate to your staff that is now going through these micro or major traumas, you know, and trying to cope in either adaptive or maladaptive ways? How do you even pick up on that? Because you have no idea what they're going through, right?
Speaker 1:You can't value their perspective. So what you have is people who are nurse managers, but are they nurse leaders? A leader and a manager are two different things. Very much two different things A lot of leaders are also managers, but there are a lot of managers who are not leaders.
Speaker 2:Yeah, to be able to say I've been there, I've got that T-shirt too, goes a long way. Because, like you guys said in the very beginning, you don't tell your husband a lot of detail because why, he's not gonna understand it, it's what? And you're probably just gonna stress him out because he's like God, is she okay? Do you need some wine? What's going on when you could pop over to us and be like, oh my God, this happened and we'd be like, oh damn, or you need a hug or a glass of wine or a shot. Where are we at right now?
Speaker 4:And we're not trying to commit you, so our suggestions that were applicable to the situation.
Speaker 2:Oh yeah, the nice stuff too.
Speaker 1:They can't even do that. And then, when you get to the end of that conversation this is my belief and I do this for my friends you want that accountability. I would ask you. I would say okay, this has been rough. I hear what you're saying. What are you going to do to take care of yourself.
Speaker 2:What are you gonna do about it now? That's right.
Speaker 1:What are you going to do to take care of yourself?
Speaker 2:Yeah, there has to be, because you can't vent. I mean, I'll be a ear for anybody, but it can only go on for so long Like you can vent, but then you have to stop and go. Okay, like I got it all out and I'm looking at it Now. What do I do about it? What do I leave?
Speaker 1:And what?
Speaker 4:do I need to yeah, sit down.
Speaker 2:What do I need to process later, Whatever it is? What do I need to do now to move forward? Right, because you have to, because if you're just going to sit there and vent, then forever, then you're not getting anywhere.
Speaker 1:Well, I think venting becomes a gripe session which isn't productive emotionally. It doesn't get you anywhere.
Speaker 2:I couldn't stand it. One of the things that drove me bonkers is when people would always be excited to find me, when they wanted to tell me some dirt, and I'm like, can you come find me and say, hi, how are you? What are you up to? Was nice seeing your face today, you know. Like, why does it have to be? Like, gets a bit higher. I heard I was like I don't care.
Speaker 4:I think that's another coping mechanism, because you know like the hospitals are 100% like soap operas.
Speaker 2:Oh God yes.
Speaker 1:There is so much. It's a lot of drama.
Speaker 4:And there's so much unhealthy. I think that we do so many unhealthy things in the hospital systems to remove ourselves from what's actually going on.
Speaker 2:Yes, yeah, that to me is energy vampires.
Speaker 4:We could just go back to we're just all crazy. We're just all crazy to go with, we're all just too.
Speaker 1:My theory on human behavior. So you see how that's applicable to pretty much every situation. Try it, you just try it.
Speaker 4:You're right. Try it with anything, Helen. I'm just going to end everything with or? Everyone is just crazy. We're all just crazy. So we're all just crazy.
Speaker 2:We have a fellow podcaster, susie Landofi, right, she had I don't know if you've met her, helen, she was on the promo with us. She was the beautiful silverhead lady and she's a therapist. Yeah, she's a therapist and her podcast called Be Crazy. Well, because she's pretty much like look, we're all crazy, so let's just do it good, let's do it the most healthy way we can do it.
Speaker 1:It doesn't mean she's not meaning be as crazy as you can be, no, be crazy, well Be crazy and healthy at the same time.
Speaker 2:Exactly so I mean, I think that we're missing that in the medical community and in general, that we just need to own our hot messness in whatever fields we're in, right, and just be like, yeah, damn it, it's a mess, but I'm doing the best I can, and it sounds like to me the hospice world is probably should maybe put together some lessons, really honestly, now that I think about it, so we might have something here, because who better to teach about how to maintain yourself than the people that see the end of life and say let me tell you the 10 things you're going to regret and you're going to be telling me about when you're in hospice?
Speaker 1:Oh yeah, there are studies. There was a hospice nurse in Australia I can't remember her name now. She did this huge study where she interviewed all these people towards the end of their lives and she wrote a book called the Top 10 Regrets of the Dying. Oh, I need to get that book, oh yeah. And it's awesome. It's all the stuff that you would think. This is what needs to be important in my life.
Speaker 2:OK, so we need to hand out the books to all the nursing students and respiratory therapists and occupations and everybody, and be like we think your job goals.
Speaker 1:It's not in your top 10. You may think it is now because you're 22 years old.
Speaker 2:Consumed right.
Speaker 1:Yeah, yeah, you're your first million and when you get it, not in your top 10 regrets when you're 85.
Speaker 2:No, no no, no, just that you got to maybe retire a little earlier, but yeah otherwise Maybe so. Yeah, exactly. So all right, ladies, because I think we could talk forever and I always had good conversation. I was excited to get Helen on, so I said to our executive director I was like she's fun and so she goes. Oh boy, I'm like, yep, me and Leslie will have fun with her.
Speaker 4:We'll do it again and maybe do the topics. We could do the topics we should, Helen.
Speaker 2:That's the next one. We need to do another one. That's a great idea.
Speaker 4:Well, we have had the conversation that we don't really fit in anywhere.
Speaker 2:That's why we're friends, Leslie.
Speaker 4:And this is why that she and I are friends, Because we're all crazy. But I think health care workers it's a different kind of crazy. It's very difficult to fit in other societal groups because they just don't get your weirdness.
Speaker 2:And then slap the military on top of that, and then we're just all gone.
Speaker 1:When you go to a party and they say what do you do for a living? I'm a hospice nurse. I work with dying people.
Speaker 2:They're just like. I'm going to go refill my drink now.
Speaker 1:Yeah, I see somebody I know over here.
Speaker 2:I'm going to go talk to him.
Speaker 3:Oh my gosh, yeah, nobody ever asks me, even in my family.
Speaker 1:people don't ask me when I was in the field nursing, what did you do today? Oh, you don't want to know. It's almost like a huge buzzkill, absolutely, if they talk to you.
Speaker 2:You're kind of like the green reaper, Like if I talk to her it might happen.
Speaker 1:Yeah, it's true, it's true. And the bad thing is is we are exactly like that and if I have somebody who's actually interested and asks me, I will tell you stories about so and so died this afternoon, and this is what we did, and right, it's just weird.
Speaker 2:If it was appropriate. This is like way far, but we could have like a whole podcast on interesting end to death like scenarios, so that could be. You know, their eyes just lit up when I said that there are a lot of people that do that.
Speaker 1:There's a huge death positive movement. There are a lot of people. You guys ever heard of death cafes? Yes, yes.
Speaker 2:Is that starting like Oregon? It's like a pod right. Is that the same thing as the pod?
Speaker 1:I don't know. So death cafe, leslie, it's a movement that was started by a guy out in the UK originally, and it's just these. I think he was in the UK, may have been in the US, anyway. So a death cafe is simply a meeting where you have some coffee and a piece of cake and you talk about death. And it's not grief support, it's not for health care professionals or funeral care people, it's just for people that want to talk about death.
Speaker 2:And I'm intrigued. There you go, go have your mocha cappuccino and talk about your favorite casket, Exactly if that's your thing.
Speaker 2:Did you see? That's another one. See, this is horrible, we're going to rabbit hole this. But there's like this whole I can't remember where it's at, but they make caskets that are custom and they're all like but dazzled, or they got Elvis on or whatever it is you want, like they're wild ones. And I was like snap. I told my kids I'm like mom's going to be cremated, but like I'm going to have a wild urn. And they're like oh, mom, you're so stupid.
Speaker 1:That's cool. Well listen, I told my kids I wanted to do human composting, which?
Speaker 2:is a very new thing. What are those like the fermentation farms, or were they?
Speaker 1:It's, it's well, it's not like a body farm.
Speaker 2:There's one in they use. Oh it's different.
Speaker 1:No, no, it's actually a formulation that has been made and the body is placed in a container like a capsule type thing and it's mixed with alfalfa and I can't remember what else is it. There's a formula that they've determined is is conducive for that.
Speaker 2:You're going to end Betsy now. Great the cow.
Speaker 1:So that's actually not a bad thing. So so what it does? It turns into this composted soil and the family can either have part of it or some of it to scatter or use in a garden, or it's repurposed and put out into, I guess, like a national forest, where things have been I can't remember the word for it not reforested, but purposed to replenish the environment, the soil there.
Speaker 2:Hey, at the beginning of life I have had many people ask me for the placenta because they were going to go plant a tree with it.
Speaker 1:So I have to tell you that even as a house business, I'm 100 percent grossed out by that.
Speaker 4:Yeah, me too.
Speaker 2:Wow, I'm honored that I actually could get that response out of you. Yes, wow, that OK, then I'll one. I'll one up you that it I don't even like the word placenta. That's better than the soup that that some cultures make out of that. So there you go, and there is nothing more interesting than walking into the break room and there is a crock pot full of placental soup. So there you go. I wish I was like I can't.
Speaker 4:It is for countries where they're starving and they have no other option.
Speaker 2:OK, but I saw it here in the US. It's one of these days there's so wrong.
Speaker 1:One of these days I'm going to have selective shock therapy. You know how you have memory loss, but I want it to be selective things. That's going to be one of them, Wow.
Speaker 2:If you can grow us out of hospital, I think that's that's pretty, that's pretty good.
Speaker 1:One for today. I still like it. After 33 years of nursing, that I can still look at something like that's just disgusting yeah.
Speaker 2:Yeah, there is very few things that get me like I, and you know I used to have people say, oh, you're a labor delivery nurse and like this whole kumbaya, and I would just look at it like, let me just demystify you, we're very bitchy.
Speaker 1:Just like what. Listen as as a nurse, as a hospice nurse, you know we we're all about comfort. We try not to do injectable stuff.
Speaker 2:Yeah, that's, we're all about that, it's all stuff.
Speaker 1:Yeah, and the places you guys inject stuff. I'm like, that is not inject, plays, check.
Speaker 2:Yes, we, we have many, many, many stories.
Speaker 4:Well, you know, I'm respiratory, I only do the nipple line up.
Speaker 2:But you still see gross stuff though.
Speaker 4:Leslie, Absolutely, but I don't have my hands in it, I still yeah.
Speaker 1:Trach the first time a patient ever coughed through a trach and it you know it flew out on me.
Speaker 4:Yes, you just got to make sure you're not in line with the trait to stand to the side, I will deliver.
Speaker 1:I even asked her to cover it because I was. I deliver a thousand babies over trait that trait.
Speaker 4:Care God, that that's why there's respiratory and that's why we have you, Leslie.
Speaker 2:That's right. Respiratory therapist. All right, we should wrap this up. Cindy is probably like my gosh Don. I'm way over. All right, so any last words here. What do you got for me there, miss Helen?
Speaker 1:Self care, doesn't matter what type of nursing you're doing. Oh my gosh, care for yourself, care for the people around you.
Speaker 2:Very sound advice. Lastly, any words of advice here.
Speaker 4:I just want to tell Helen, thank you for sharing with us today and thank you for your 30 years of caring for the community. We, the world, runs off of people like you, so thank you very much for sharing with us today. Thank you, that's so sweet. I will always wait, but that was nice.
Speaker 1:I like it. Now, that's self awareness. There you go.
Speaker 2:This was concerned, like I had to laugh. I was like, ok, I'm so glad I talked with Helen before I listened to her podcast, because if I would have just listened to the podcast and her podcast is great, everybody I'm just going to tell you it's hard of hospice and it is a phenomenal podcast Everything to do with hospice care and it's very well, professionally done, unlike this podcast where we're just asking elbows just getting it out there, and so I was like, oh, I was like OK, helen, are you ready? So I got this and she, she definitely had this. So, helen, thank you so much for coming on and I'm glad you could come talk to us from your perspective, because that's really what we want.
Speaker 2:Everybody here is like we are the people behind the profession. Right, we put our profession first and we do it well, but there's people behind that and and we're figuring it out too, and I want the medical community, both on the military side, and civilians. I have to see that and be like, damn, they're just trying to figure out and get it done too. Yeah, we are Right, and and we're all doing it in the best way. We know how, and laughter and inappropriate humor and all that stuff is what gets us through the day, and so I thank you, helen, for coming in here and being a little raw and sassy with us, and I look forward to doing more podcasts, because I can think of two more right now that I'm like, oh, we got more to do in the future here. I love it, let's do it All right. Ok, everybody, from all of us here to all of you guys, we want to keep sassy and raw. Thank you for joining us on Bullets to Bedpans. Have a great week, peace out.