Wakil
Thank you all for being here with us today.
We're so honored to welcome our guest today, Yana Hanson.
Annalouiza
Yes, welcome. Yana.
Yanna
Thank you.
Annalouiza
Yana Hanson is a death doula and currently specializes as a volunteer with End-of-Life Washington. Helping terminal patients navigate the medical aid in dying process.
She is often present when they take the life-ending medications. Yana also helps educate clients about another life-ending choice, that of V-S-E-D, which is voluntarily stopping eating and drinking.
After raising her own five children, Yana became an RN, providing post-op care for pediatric patients, but she often felt called to hospice nursing.
When she retired, she became a hospice volunteer. Four years ago, she completed a death-doula training with Bodhi Be, and since then has been supporting patients through her association with the End-of-Life Washington.
Wakil
Again, thanks so much for joining us on this conversation. We're so glad to have a chance to talk to you.
Yanna
Thank you for inviting me, thank you..
Wakil
Yeah, thank you. We usually start with the question, So when did you first become aware of death?
Yanna
Well, when I was growing up, death was not something my family talked about. I had a grandmother who died when I was in elementary school.
We didn't talk about that. We went out for Chinese food that night that she died. We didn't look at it. That was what we did.
We went out for Chinese dinner and nobody talked about it. And then I had a little nephew who died.
We didn't talk about that either. I don't remember any kind of service. Maybe they thought I was too young to go.
I don't know, but it was just didn't talk about it. But then I think when I was busy raising my children, I was not thinking about death.
Fortunately, I didn't have to at that time. But then when I went to nursing school, I started caring for people who were elderly and dying.
And it kind of brought me face to face with, yes, we're going to die, we're going to die. And what do I, how do I feel about that?
And what do I know about that? I didn't know anything. And I just felt kind of afraid of this big unknown.
So at that time, I just started paying more attention to death and just thinking about it, what it meant.
And then, I became a hospice volunteer, but that didn't, that wasn't a good fit for me. It just didn't give me enough of what I was looking for. As a nurse, you get to have this intimate connection with people at a really hard time in their life, especially with children. and that's what I, what kind of work I wanted to do, something that was more intimate.
So I took Bodhi's training, which was wonderful. And when I left that training, I just, I didn't know what I was going to do with all that.
But then I ended up just kind of serendipitously being a volunteer with End-of-Life Washington. And that's just really gives me that intimacy and let's me share in people's lives in such a deep and a profound way that, and, and being a part of their death and their process of thinking about it.
It is just so awesome and such an honor.
Wakil
Really? Yeah. Yeah, I think we've talked, of course, many times about how it may be one of the more sacred moments in people's lives to be in their life during that time and with their community as well.
Annalouiza
So, Yana, you didn't have a foundation around talking about death, and now you are right in the middle of a lot of conversations.
Tell us what is, tell us more about your work and how it plays out on your day-to-day.
Yanna
Okay, well, I will learn about someone who wants more information or is trying to do the process. I will either get a referral from the main office End-of-Life Washington office. People can fill out a request for support online. I also get We'll get requests from doctors.
They will connect me with a patient who they've discussed that with. Sometimes the hospice nurses let us know someone wants some help.
So then I'll get that person's phone number.
We call them clients.
We don't call them patients because we're not medical people. So they are our clients. So I will call them and set up a time to meet with them.
It's really best to meet in person and they always want to. So I go to their house and we just talk.
We have a conversation. We talk about what they know about the process where they're at in their illness and in their dying process and just whatever they want to talk about.
And then after we do that, then we'll get down to the nuts and bolts of the actual process of having to see two doctors, having to turn in a written form.
And the prescription, it gets sent to the pharmacy. I don't know how much information, how much detail you want about that.
I kind of walk them through that process. And then maybe I'll stay in touch with them now and then, oh, how did it go?
I know you saw Dr. so-and-so did he sign off for you or now saw a call of pharmacy? Oh, did you get that prescription?
So I kind of keep tabs on the process. And then once that, once the prescription is at the pharmacy, depending on the person, for some people, they want those drugs right away.
And for some people, they just want to know that that prescription is there, ready for them to use if and when they want it.
And that gives people so much comfort and so much sense of control. So whether they use it or not, it's there.
And I think statistically it's about maybe two-thirds of people who get a prescription, fill it and use it and the other third don't.
So then I offer to attend their death to be there. I can't really say how many people choose that because there's a lot of people who do this process on their own without a volunteer helping them and to do it themselves.
But probably at least half the people I work with want me there. And I work with a partner, another volunteer here in Port Townsend.
So if they want us to come, we'll come and just be a calm experienced presence for them.
I usually mix up the meds.
People don't really want to do that themselves. and just guide them through doing this. And it's just, you know, people are so brave.
You know, you just, you just sit back and watch this and watch these people doing this in their lives, making that choice for themselves and having the people who love them support them in this.
Maybe they don't support it 100%, but they are there for their person.
Yanna
Yeah and so once the person has taken the meds and has died, then I will usually wait. Not always, until we call hospice, let them know.
We advise people to be on hospice. And they usually are. So we kind of help with that closing process, calling hospice, calling the funeral home.
Sometimes we'll wait and then sometimes we'll just go if they're okay. of judge how people are doing. How long is it going to take?
Wakil
Yeah, thank you. One thing I know from my own research is that this is not that. I mean, there are probably people on our call who aren't from the state of Washington.
And so I believe there are half a dozen states in the, or maybe a little more now in the country that have some form of death with dignity or physician-assisted dying.
And the rules are different in every state. And so I think our rules just changed or are going to change.
They just have passed some new legislation in the state of Washington that changed the rules so you need one doctor and one medical person that doesn't have to be a doctor to sign off on it.
And so some of the rules change. And I think the point of this is for anyone who's thinking about this to do the research in their own state and their own area and find out what's available and find somebody like Yanna who can help you know what's going on and help you with it.
And as you mentioned in the in your bio at the beginning when we're talking there are other options and I know hospice can help you with palliative care VSED or other options.
The voluntarily stopping eating and drinking that will accomplish the same thing possibly less comfortably. But yeah so I wonder if you wanted to talk about any of that do you know any more about any of other states or any other options?
Yanna
Well, I think there's about 10 states now that medical aid in dying is legal. VSED which is the voluntarily stopping eating and drinking, is never illegal.
It is a person's choice to do this. And there are no laws governing that. One thing, I don't know if this has anything to do with this question, it used to be called medical aid or it used to be called death with dignity.
That's how it started.
The thought being that people want to, people look at death, their own death and think, oh, I don't want to be writhing in pain.
I want to feel like I have some dignity as I'm going through this process. And the truth is, you can have a dignified death, whether you, however you choose.
And in my mind, I'd like to read. something about that. It's written by Stephen Jamieson. He wrote a book called Final Acts of Love, Families, Friends, and Assisted Dying.
And what he wrote, he says, the idea of a good death is not owned by any one approach or institution.
It doesn't only occur within hospital settings or with availability of hospice care. The idea of good is affected by the nature of the experience, wherever it occurs, and whatever model of dying is finally selected.
It evolves out of the experience itself by the opportunities that are taken by all participants. In this way, an attitude of awe and sacredness towards death doesn't necessarily depend on how or where one dies as much as on who one is and what one carries into the experience. Although death is managed in better ways, if we desire that a sense of awe, respect and sacredness be present, these must be brought to the experience by the participants themselves.
Wakil
Beautiful. We'll put a link to that book in the podcast notes.
Yanna
He wrote it in 1995. I think he was involved in the Hemlock Society. He was a thanatologist and he wrote this book and did research on dying.
Annalouiza
Thank you. Yes.
Wakil
Thank you. Yes, I've read some other things by him. Thank you, that's a great quote.
Yanna
So actually where I was kind of going with that was death with dignity is now called medical aid in dying.
That's really a better phrase for it. So we call it M.A.I.D, - M-A-I-D medical aid in dying. Because like we just heard, know, you can die in a beautiful way without taking medication or, you know.
So that's a real misnomer and so medical aid in dying, maid.
Annalouiza
I love that.
Wakil
Great, great. Thank you. That's important.
Annalouiza
It is. I just have a question about when you are supporting the client, do you also help support the family or friends who are witnessing or just supporting your clients?
How are they resourced?
Yanna
During this whole process. I think they are always, well, at least let's say the closest family members and friends are present during the initial conversations.
So I'm able to answer their questions and make myself available by phone or email. If anything comes up for them.
And then on the day of "ingestion", we call it. It's something we're all doing together. I think the best support for them is education of the process.
It's like, okay, now the person is going to take these pre-meds, or pre-meds that are taken to settle the person's stomach.
So we explain about that and we explain the timeframes. it's just preparing them to know what is gonna happen.
And. and possibilities of what could happen. I think knowledge can bring people comfort and peace. so I think that's the main way.
And then staying out of their way, this is their sacred time. And so it's something you really have to be sensitive to is how much to get involved and how much to withhold and stay back.
Annalouiza
I'm glad you said that education can bring comfort and peace, Yana, because that's what Wakil and I, why we started this podcast, because we do want to normalize these conversations around death and dying in all of its many facets, right?
So thank you for doing that heavy work, too.
Wakil
Again, it's important, yeah.
Yanna
It is privilege that really is.
Annalouiza
So what are your biggest challenges with this work?
Yanna
Yes, I thought about that question and I think my biggest challenge, I mean I have a lot of support in this, my partner supports what I do, I have a really good mentor within End of Life Washington and so she's always right there for me and so I feel really supported that way.
I think a challenge for me is to, and this may sound strange because I do this a lot, I don't want it to become rote for me, I want to be present with each person in the way they deserve and that just blesses everybody. So I think just taking the time to center myself and go to this person and not, you know, not have preconceived ideas or like, oh, well, I'm meeting this person out and I have to meet somebody else in half an hour.
You know, just, so that's kind of a challenge. And I think, I don't know, it's, to me, it sounds kind of funny.
It's like, it's such an awesome thing. And yet, when you do something a lot, it can become kind of taken for granted.
And I don't want to do that, ever.
Wakil
Yeah, beautiful. Thank you. That's so, so thoughtful of you to think to hold it in that way. That's such a compassionate way to think about it and hold it.
It's a beautiful, unique, new experience every single time.
Annalouiza
Every time.
Wakil
Yeah. Thank you. That's beautiful. So, what do you need in your life to be supported?
You said you have a partner that takes, that supports you, have mentor. What are other things you do to support yourself, like to resource yourself?
Yanna
I am being more committed to my own spiritual practice. I try to manage my life and my schedule so that I can be mindful and present when I need to talk to people.
I don't know.
Annalouiza
I mean, that's foundational for a lot of folks who do this work. You know, it's the spiritual practices that keeps us connected.
Wakil
Yeah. Yeah, I think one of my, one of my friends who we actually interviewed our very first interview is Ayah Shakur.
And I remember asking him when I first met him, how do you get yourself ready for each new conversation?
Cause he was a hospice, um, chaplain. And, um, and he said, well, I, you know, I take, I always stop before I go, even if it's just for a few minutes, you know, between people and just take time to, if possible, be in the forest, if possible, at least be with a tree or by some water or something and just take some breaths and give myself the permission to be fully present in that space with nature, if possible, or at least with my own breath.
And so I think, you know, as we're saying that that spiritual practice that reconnection or that noticing our connectedness is a great example of how, I think what you're talking about, just having that practice of being centered before you begin another time with people, because it's so important and such a grace to put yourself in that place of connectedness and go into a new situation, each new situation with that connection.
Yanna
Yeah, well I'd like to share a story, unless you have a really burning question to ask me.
Annalouiza
Go ahead, please tell your story.
Yanna
Well, this is a story, and it's a true story about a friend of mine. Her name was Abby, and she had cancer.
She went through treatment for over a year. And had mixed results with her treatment and finally she couldn't get any more treatments and she was dying and she had gone through the medical aid in dying process, got all her paperwork in order, had her prescription waiting and but she was just waiting to see if she would want to make that choice or not but towards the end she was suffering she was and she said no it's I'm ready I want to take these drugs and so she picked a day
And what she chose to do in the morning before she took the medications was she was the person who loved dogs and she didn't have a dog of her own but she befriended dogs all over town she knew all these dogs she knew their names their favorite cookies and so she wanted to have a dog parade she invited her favorite dogs to come walk one by one past her bedroom window so she could see them and I brought my dog, and she was so happy. I mean, here she was so close to death and she was radiant.
I mean, she just, and seeing her dogs that she loved. So then the dogs went home and then she invited about six of us to be there and we just, before she took the meds, we just sat on her bed and talked together and then we kind of one by one spent some time with her and she, so she took the meds and died very quickly and, and we just all sat there.
We sang and this is just such a beautiful example of how beautiful this presence can be. So by the time she died, it was kind of the end of the day and we hadn't called the funeral home yet.
We were still just waiting being with her and someone had brought some soup and so we put together a dinner and so we were all sitting at the table eating and there was Abby in her bed next to the table and it just felt so normal and it's so natural that we were still all there together and then the funeral home came and she ended up having a beautiful green burial. But it was just perfect, but again it doesn't have to be that way to be a good death.
Annalouiza
Yeah yeah but thank you for sharing that because yeah uh I think more of our community should know that that is a choice right in this culture we whisk everything away quickly and we sanitize and yet the real um the beginning of this journey for us who are left behind
To my mind is exactly like what you did, right? Have some soup and still have your friend here by. It's, it makes me so happy.
Wakil
Yeah.
Very, very beautiful story. Thank you. That's such a great, great sharing.
Appreciated it.
Yanna
She orchestrated it all.
Wakil
Yeah, that's the better. That's the beauty of it too, right?
It's like we have that opportunity. If we take it.
Yanna
Yeah. Mm-hmm.
Annalouiza
So. Are you afraid of the end of life, Yanna?
Yanna
Oh, you know, I'm, I could say I'm not afraid of death. I don't have a terminal diagnosis, so it's kind of removed from me, but I feel like I don't fear it.
I feel like I have enough confidence in the medical world to be able to keep me comfortable.
So I'm not really afraid of pain or suffering or not being able to breathe. I feel like those things are managed medically, usually pretty well.
I think for me, thinking about dying is letting go of my family. That's even now it brings tears to me because I want to be there with them.
And so I think the fear in that is that when I am dying, I want to have the grace to not fall apart for them.
And I know that's part of it is doing that, but yet I want to, I don't know, I just want to shine with love and not with sadness and emotion.
So I think that's my fear. But I also trust that when the time comes, it will probably be okay.
Annalouiza
Yanna, I just want to say I bear witness to the longing that you have to stay with your family.
And I also hold that, yeah, you, you radiate life and love and it'll be a blessing for your family as well.
Wakil
And we may all fall apart. In fact, we definitely will whether we want to or not.
Yanna
I know on other shows you talked about you're a crier and I'm a crier.
Annalouiza
And yeah.
Wakil
Yeah.
Annalouiza
And it's okay actually.
Wakil
It's okay. Yeah, crying is a good thing.
Annalouiza
And it's okay to have that longing too. I think that I actually have never heard anybody say that.
And so usually when I've been in hospice situations, they've always been, well, terminal, they had a terminal illness. And so they worry about physically being in pain in front of family.
I hope somebody listening out there has that similar yearning that you do. And it's okay. It's all part of our humanness and our human journey.
Wakil
Yeah.
Annalouiza
So thank you for sharing that. Yeah.
Wakil
And thanks for your tears. Those are always a blessing. Always a blessing. Well, we're getting close to the end.
Is there any questions or anything that you wish we'd have asked you or any other stories that you'd like to share with us?
Yanna
I don't have another story. I have kind of a question that I think about and some of my clients talk to me about and that is if you go the route of medical aid in dying, how does that affect your experience of death?
I'm thinking like Catherine Dowling Singh writes about the nearing death experience and how you can reach the highest levels of consciousness at that time.
If you're so deeply medicated, how does that work together? That's my question I'm thinking about and like I said some of my clients are concerned about, well I don't know if I want to take those drugs because I want to be there, experience it.
And so I don't know. I'm curious if Bodhi talked about that in the presentation he gave.
Wakil
Not really. I mean he may have in his class that he gave but he didn't talk about it with us.
And I know you know when my in my work with hospice there was always that trade-off of wanting not to be in pain but also wanting to be conscious right and so there was always this trade-off that people were balancing of having enough meds that they wouldn't be in pain but also not being so out of it that they weren't even present for the last part of their life.
So it's a really good question and one to consider. What has been your experience with that? I mean sounds like the actual medication for dying is a fairly quick process.
So there's not like a lingering or maybe there is but I guess it's a question I should ask. Is there a time of checking out that people don't get a chance to be present?
Yanna
Well, when they take the drugs, they will fall into a deep coma within probably about five minutes. So there is a time when, you know, they're going somewhere and then it can take the average time to death is a couple hours.
But who knows what's going on?
Wakil
Yeah.
Yanna
You know, it's again, it's such a mystery in so many ways. It is. So yeah. I don't know.
Wakil
Yeah, that's a really good question or a good thing to think about. I don't have a good answer, but then that's why it's a mystery.
So something for all of our readers and our, I mean, our listeners and our friends. to ponder and maybe they can write back to us and tell us their thoughts.
Annalouiza
Yeah.
Yanna
I think we have. Yeah. This has been great. Thank you.
Wakil
We appreciate the work you're doing. and your presence and who you are and what you bring to this work. in general, just your life and your five kids, I'd love to meet them sometime.
Yeah.
Annalouiza
Yes. Thank you, Yanna. I appreciate it.
Wakil
Okay. We usually end with the poem at the end. And so this week's poem is an excerpt from Song of Myself by Walt Whitman.
I wish I could translate the hints about the dead young men and women and the hints about old men and mothers and the offspring taken soon out of their laps.
What do you think has become of the young and old men? And what do you think has become of the women and children?
They are alive and well somewhere. The smallest sprout shows there is really no death. And if ever there was, it led forward life, and does not wait at the end to arrest it, and ceased the moment life appeared.
All goes onward and outward, nothing collapses. And to die is different from what anyone supposed, and luckier.
Annalouiza
Oh Walt. So aware, so prescient, what we know now, like nothing ever really goes away. Yeah,
Wakil
That was in an 1892 version of the song of myself. So beautiful, beautiful.
Annalouiza
Yeah, beautiful, beautiful.
Wakil
Well, thank you everyone for joining us, especially Yanna. Thank you so much. And we will have another episode coming in a couple of weeks.
In fact, in that episode, we’ll be meeting Jane Ellen Nickell who is a retired chaplain from Allegheny College. She lives in Meadville, Pennsylvania now with two feline companions. She is talking to us about how it was as a college chaplain, where she said death is a relatively rare occurrence, but when it happens it is often unexpected and involves losing someone at a young age. Also, of course, the job involves counseling students and faculty and people who have lost family members. So we’ll hear some really poignant stories from Jane Ellen Nickell in our next episode
Annalouiza
Yes, and we want to hear from all of you listeners, You might have some great stories or poignant experiences that you would like to share with us.
So you're welcome to email us at endoflifeconvo@gmail.com. Yay! Thank you, Yanna.
Wakil
Thank you, Yanna. See you later. Thank you.
Yanna
Thank you.