4: The Death of Her

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Speaker 1: I'm just a fool, way Fearenschange's welcome to death, grief and other shit we don't discuss. I'm Kyle McMahon. I was completely numb. It felt like nothing was real, that this wasn't really happening. My mom had just been given her last rites. How is this happening? How is this possible? It's hard to explain, but it felt like I was watching a movie of my life rather than living it. It's almost like I was detached from what was going on, from what was really happening. Maybe it was my brain's way of helping me to survive. I'm not sure. I went to my parents every day, sometimes twice a day, just to sit with Mom. Most of the time she was just sleeping. I laid on the bed next to her, just watching her and trying to muffle the sound of my crying, waiting for her to wake up. I'd obsessively look over at her chest, just to make sure that she was still breathing. Here was my superwoman now fighting for every moment. She'd wake up, moaning in pain, and I'd hug her and tell her how much I love her. She'd tell me how much she loves me. Too and fall back asleep. She was suffering, and it was killing me. After an hour or so, I'd have to leave because it was just too much for me to witness her in pain. I don't know how Dad was able to, but I'm so thankful that he is. I'd go back home to my bubble for a few hours, or go to the studio and work on my show, and then i'd go back to my parents and do it all again. At night, I'd go to Shells and watch a scary movie with her Nadan. I was simply existing. I was simply going through movements and motions just to pass time, just to get through. The anxiety was intense, but the emotional pain was far worse. Now. It was just a couple of days after the priest had come and I had no idea how long we'd have Mom, but I knew it wouldn't be long. I went to the studio and did an interview from my show and then went to my parents. Mom's good friend, Diane, their neighbor, was there with her. Her and my mom had been friends for decades, and her husband Wayne had been friends with my dad for decades. They were the perfect neighbors. I walked in the room and Mom was talking to her, and she saw me and told me she loved me, and then soon after quickly drifted off to sleep. Diane was crying. I was crying. Mom had just told Diane to make sure she looked after me and Dad, And while I was crying, I just had to chuckle still at the fact that Mom's concern wasn't herself, it was me and Dad. And of course Diane had assured Mom that she would always look after us and she didn't have to worry about that at all. You know, just like Mom had lived her entire life here at the end of hers she's more worried about me and Dad than herself. At some point, Diane had gone back home and I sat with Mom and she woke up. She once again told me how much she loved me, and I told her how much I loved her. She said, I miss you, and that confused me. Mom, I'm right here, she said, I missed the way things used to be. Mom, I missed that too, but you're right here, and I'm right here right now. I knew exactly what she meant. She meant she missed our life before pancreatic cancer had come and destroyed it. She missed the times I'd come and stay for hours for dinner. Were the times I'd come and just say hi? Or are the times I'd run in and be looking for a shirt I had left at my parents? She missed the times before her life had turned into a series of anxiety producing medical treatments. And the truth is, so did I. I missed those times too. But Mom's heart was still here. Her body was still here as well, although it was failing her now more quickly than ever. But her giant heart was right here in front of me, and I wanted to hold onto that forever, even though I knew it wouldn't be fair to her. My brain, though, would take over, and reality would set back in that it truly wasn't fair to her. We talked about great memories. We talked about how much she loves me and how much I love her. As I laid on the bed next to her, her body was bone thin and covered up in her blankets, but she was still here for now. I told her what an amazing mom she is and has been my higher life. I told her how I literally couldn't have picked a better mom if I was able to design one myself, and I meant every word. Mom couldn't have been a more perfect mom to me. She's been my rock, my comfort, my strength. She had supported me through everything, through thick and thin. She was always there for me, no questions asked, twenty four seven, day or night. She always put me first, and I was about to lose that. I was about to lose her. We talked about how amazing Dad is, and she told me how lucky she is to have married him. She said how good of a man he is, and how good he's been to her. I agreed with her. She said, I married a good man. I replied, yes, you did. Mom. I asked her how they were able to work it all out. They had all the odds against them, and they made it through it all successfully. She said, compromise, understanding, and love. But Mom, you guys have been through so much, things that have torn most marriages apart. You guys have been through that and you're still here and you're happy too. She nodded her head in agreement. We always work everything out. It's not always easy, but we work it out. She started getting the bad stomach pains again, which meant she'd soon start moaning in pain, and I could never handle that, and I could tell she was exhausted. I love you so much, Mom. I love you too, Kyle. You were my whole world and you always have been, she said, And you've been mine, mom, and you've been mine. With that, I gave her a big kiss on the head, told her I'd be back tomorrow after my meeting, and then I went back home to my bubble to try and just survive the night. I knew time was getting really, really short. I knew she wouldn't be here for much longer. I didn't know if that meant seconds or minutes, or hours or days, but I knew it wouldn't be long. And that terrified me, and that saddened me. Even at home, I was worried that something may happen when I was away from my parents house. Should I go back there, Should I spend the night there. I could sleep in my old room, or I could even sleep on the floor of my parents room. I didn't know what was the right thing to do. I didn't know what was the wrong thing to do. I didn't know what to do. I texted Dad to see how she was doing throughout the night, and Dad said she was mostly sleeping. Of course, then immediately my what if thoughts would start seeping right back in and I would struggle with going back over there or not. But ultimately I decided I mentally couldn't handle hearing or wake up in pain all night. It just hurt me too much to hear her in such pain, and I just couldn't do it. And what good would I be if I'm there crying hysterically the entire time from hearing mom and pain. It would just make her more upset. It would just make me more upset. That would make it harder for Dad. I'm just not strong enough. Thankfully Dad is. He had texted me later on in the evening and said, you don't need to come. She's going to manage through the night and you can come in the morning after your meetings. Of course, Dad would never tell me I couldn't come see my mom or couldn't come to my parents' house. What he was really saying was it's okay, Kyle, It's okay. He knew what I was going through internally, and that gave me permission to take that decision off of my plate altogether. So now my goal was just to make it through the night myself so I could wake up and see Mom again. The next morning, Tuesday, I woke up and got showered and dressed. Of course, texted Mom good morning, and then I went to a client meeting. It took everything I had to just jump into my work and focus on it so intensely so I could stand and for that hour or so I was mostly able to get through. Back when Mom was getting chemo, we watched The Unbreakable Kimmy Schmidt on Netflix for some much needed laughs. In one of the episodes, the lead character Kimmy said, quote, I learned a long time ago that a person can stand just about anything for ten seconds. Then you just start on a new ten seconds. All you have to do is take it ten seconds at a time. End quote. That had become a mantra for me and Mom throughout her cancer journey, and I was certainly using it now in my meeting. When reality started to seep in again, I'd say in my head, just get through the next ten seconds, Just get through the next ten seconds. Just get through the next ten seconds, and then I'd be able to go back to hyper focusing on the task in front of me. Hey, we do what we have to do in order to get through right, even if it is quoting characters from Netflix comedies. After the meeting wrapped up, I headed back to my parents' house. Her longtime friend Patty was there. Patty was a nurse and was simultaneously comforting Mom while also helping to take care of her. Mom and I began to talk. She wasn't speaking as much today, and when she did speak, her actual speech had seriously declined. Even from yesterday, it was hard for her to form words now. Patty sat in the chair next to my parents bed, and I laid on the bed next to Mom. Mom was able to ask to hold my hand, so of course I held her hand, but it had become so thin, so fragile. These hands that had raised me, sometimes working two jobs as a single mom early on just to put me through private school were now simply flesh and bone. I laid my head on her shoulder, and she mustered the strength to slowly move her arm to my head, where she stroked my hair for a few minutes. I love you so much, Kyle. I love you too, Mom, so much more than anything. The tears were streaming down my face and patties. I got up for a moment and went to my old room and just started crying hysterically into my pillow. In less than twenty four hours, I could see the decline. This was it, she would soon be gone and there's nothing I can do. After a few minutes, I collected myself and went back in and laid on the bed again. Mom woke up, and Patty asked if I wanted time alone with her to say anything. I held Mom's hand and I was able to proudly say, We've said everything we've needed to say, and that was the truth. There was no doubt about our love for each other. There was no doubt that Mom and I were the definition of the unbreakable bond between a mother and her son. Mom was somehow able to work up a smile to my reply. The rest of the time I was there, Mom was mostly sleeping. I couldn't stop the stream of tears coming down my face. I knew, I knew that this was the end. I knew that this could very well be the last time I saw Mom ever again. After a Mom started getting pains again. Patty had gone out for a moment to let me say goodbye. I gave Mom a hug with the love from every single fiber of my being, and I told her how much I love her. It had been more than an hour now since Mom had said a word. It was just too much for her. Took too much strength to talk, and she was losing strength by the second. I touched her face with my hand and we looked each other in the eyes, and she smiled, and out of nowhere, I started singing the song that she had sung to me since I was a baby, all throughout my life, and somehow Mom was able to come up with the strength to sing along with me. You are miss Unshy, my only son Shy. You make me happy when skies are great. You'll never know, dear how much fellow, Please don't take my son Shine away. Does hospice always mean death? What is the difference between hospice and pallity of care? And how our healthcare workers and either of these specialties able to do this day in and day out. I couldn't imagine being able to go into someone's home and take care of them for months or weeks knowing that they may soon pass. It just seems so overwhelming, so sad, heartbreaking, depressing, I spoke with doctor John Goodill, chief of Christiana Care's hospice and Palliative care, to discuss hospice and palliative care and what it does for patients and their loved ones. Doctor Goodill started the pain management and palliative care program at Christiana Care in two thousand and four and now participates on an interdisciplinary team that provides consultations for hospital patients who are in the advanced stages of diseases such as cancer, renal failure, heart failure, and dementia. He was willing to sit down with me and discuss at all, no holds barred, So to start with, what is palliative care? Doctor Goodill explains, So, palliative is a word that comes from the Latin pallieri, which means to shield, and it really is a specialty that started back in the mid nineties after a large study done in five big flagship institutions around this country looked at the experience of patients trying to live with serious illness in the hospital in these institutions and ask how well we addressed their symptoms, how well we knew what their wishes were, how well we knew them really as people. It was a pretty negative study in terms of we were treating diseases and not people. We weren't paying attention to their experience trying to live with serious illness, and we needed to get back to focus more on that. So healight of care is really focused on helping people live their life well with serious illness, maximize their quality of life, address their symptoms, try to meet other needs they might have as they try to live their life with serious illness. And it's a service or a care that's given right along with regular medical treatment of their illness, and it's interdisciplinary and some of it is focused on people near the end of their life. Actually, hospice care is a subset of paliitive care. Paliative care is a bigger umbrella involving people further upstream when they're living with serious illness, but hospices focus more on closer to the end of life, helping people kind of live that final phase of their life as well as they can until they die. But there is some acceptance that we all die. You know, Medicine before that had looked at death as a adversary is something that when it happens, we've failed. But it's really not that we've kind of tried to recalibrate in order to provide benefit to patients and families. So hospice is actually a subset of palliative care. Exactly does hospice necessarily mean death? Well, the way hospice has grown up in the in the US is as a Medicare reimbursement benefit, and there are criteria for that benefit to be had, and the major criteria is a prognosis of six months or less. So there are people that get on hospice and live longer. In fact, there are studies that show that people who are trying to live their life with serious illness and it's advanced and progressive, they actually live longer on with hospice support than similar people who don't have hospice support. But the general public has kind of gotten this picture of hospice as when you sign up for you're near the end of your life and you're dying, so they put it off longer than they should, and when they finally do sign up for it, they are very near the end of their life, and so it's sort of a self fulfilling proposite. So palliative is more in a broader sense, is a general care taking of somebody who has an illness may or may not be terminal. Yes, yes, it has a serious illness, and people can recover from serious illness. A good example of that is a severe injury from a car accident. People can be very sick and near death and actually recover from that, often if they're young, but they may They and their family may need a lot of support during that time of treatment and recovery. But also a lot of people have serious, progressive, non curative illness that may be treatable, but it will progress over time. That's the natural history of it, and palliative can be helpful to people and families. The unit of care and palliative care is the patient and their caregivers or their family, and they can be helpful in helping them live the best life they can with hospice. I know when we started talking about hospice with my mom, immediate anxiety for me. As soon as somebody said hospice, I'm like, what, shut up, I need to like go sit down. With palliative care. I was a little bit more confused because I wasn't I had to like google it because I wasn't sure from what I'm hearing from you. You don't need to have instant anxiety when you hear palliative care. Now, there's actually a study done probably two years ago now, a survey of the general public of what did they understand about advanced directives, palliative care, and hospice, And what they found was that everybody knew what advanced directives were, but very few people build them out and did them. People really didn't know what palliative care was, but when you told them what it was, they all wanted it because it's a good thing. Hospice everyone knew what that was, and nobody wanted it because they associated with dying. It's really interesting and that kind of lines up with exactly how I was feeling. Yeah, and then ironically, Delaware Hospice does palliative care, which I didn't realize. So when they were talking about bringing Delaware Hospice in for my mom, they were only talking about when she got out of the hospital, to get her strong enough to go back to treatment. When I heard they're bringing hospice in, I'm like, what, Like, what are you talking about? And I'm like, having you know, a alpotation, yeah, crisis, And then I'm looking through the paperwork and well, yes it's called Delaware Hospice, but the palliative care team was the one that was kind of in charge of the direct tips for the team that comes out to my mom to get you know what I mean. There was a lot of confusion on my end. Palliative care is really just good medical care. But when someone is trying to live their life with serious illness, they don't just need the physical treatment of their disease. They need psychological support, they need emotional support, they need some practical stuff to support them, they need spiritual support, and so palliative and hospice have the same holistic approach to that, but in palliative you can get disease specific treatment at the same time you're getting that holistic support. Unfortunately, the way we've developed hospice in this country, once you get hospice the benefit that Medicare hospice benefit, you have to stop a lot of disease specific treatment because it's it's too expensive, the hospices can't afford to provide it, and they really provide a package deal once a person and signs up for auspice, So there is a transition period that is difficult in that way. They have to let go of stuff. Usually it's stuff that's not helping anymore and it's time to let go of it. But it feels like they have to change treatment teams, so it feels like abandonment. Sometimes they have to let go of treatment that they're used to, and that feels like maybe I shouldn't be letting go of this because I've been doing it for so long and I should continue. I mean, one perfect example is hemodialysis patients who are on hemodialysis but are dying of cancer. In order to get hospice services, they have to have a sort of a target day to stop their hemodialysis, and that really means that they're going to die within several weeks, and it's a hard transition, and again most people don't want to do that until they really have to. And in order to get the benefit of that kind of treatment, that holistic care, palliative care is kind of all and the hospices recognize that they're trying to reach more people for their upstream and so they develop a palliative care program on top of what they're doing in hospice. What is a typical day like for you. I mean, I'm sure there is no typical, but what you know, what is generally a day for you. So most palliative care programs started in the hospital and then we call them hospital based and that's how I started the program at Christianic Care and so I still work on the impatient consult service for palliative care. So I'm a palliative care specialist, and I see very sick people in the hospital, some of who are near the end of their life. Others who have a chance to get treatment and have that treatment be successful and go on with their life. But you know, I'll see a lot of people who are near the end of their life and I have to help them come to some understanding of that, if possible, some acceptance of that, and the people that love them and care for them all of that. That's a very stressful situation when you're finding out finding out for the first time that you've got metastatic cancer that's going to probably take your life, and finding out when that might be and what your life looks like for the rest of the time and how much maybe time that is. It's a pretty stressful thing and at the same time undergo being sick and looking at undergoing treatments that can be pretty burdensome also, so we have an inter disciplinary team that has social workers and a chaplain and advanced practice clinicians like nurse practitioners and physicians. We also have an outpatient team based at the Cancer Centate, and we have a community based team that sees patients with our Advanced Heart Failure team in their clinic with our Transition clinic, which is younger people living with lifelong serious illnesses that are difficult to live with like muscular distrophe, cistic fibrosis. And they also make home business for people who are it's very difficult for them to even get out of their house because of how sick they are. So we've developed those those branches over time and we now have a pretty full spectrum availability of palliative care in this community. That is I think very valuable to patients and families. Yeah, I mean it sounds like it is a attacks it from every angle, if you will. Yeah, for you, what have you seen in regards to the way this is trended. I didn't realize that this was as a relatively new discipline in medicine, you know, I thought I had just never heard of it until my mom got diagnosed with cancer. Are you seeing this grow more throughout the world, throughout the country, Like, what are you seeing trend wise with palliative care. Well, the US has been a leader in it, and it is more prevalent in the US than in a lot of other countries, although Europe is pretty good too, but the developing countries are somewhat behind, just because of the resources that it takes. I think the adoption of it is not unlike the adoption of any other innovation. You know, if you look at the adoption curve for smartphones, you know, there was a time in the seventies when nobody had a smartphone. Now everybody has a smartphone. The shape of that curve is something like an S curve, and you reach a tipping point where enough people have them that then everybody needs that, and so palid of care is sort of at that tipping point. It is available in most hospitals with over three hundred beds, and it's certainly available in all cutting edge hospitals, teaching hospitals, even hospices now have palliative care programs that they have developed and utilized to reach patients before they're ready to go on hospice. So's it's pretty available. I mean, it's more available in the northeast, midwest, west coast than it is in the south, but still it's pretty available. And is this is it something that you have to request or is it something that just happens that's variable? And I think part of the work of adopting it has been to educate our colleagues about its value for their patients. And so that's still an ongoing process and some people, some providers, healthcare providers are much more attuned to the value of it than others. I think if patients and families aren't getting in and they think they should, they should definitely ask. Okay, so if I'm a person that's been diagnosed with something that would be helped by palliative care, what exactly can I expect when I start that process? Yeah, I mean, I think the thing I would emphasize again is that it's not just end of life care. And so if you have a serious illness and you're stressed or challenged by things that come up with that illness, whether it be symptoms or difficulty, you know, psychological and emotional distress, or your families having difficulty, you can expect that those things can be addressed and improved upon so that your quality of life is better. And they also will help with this whole process of advanced care planning about thinking about the future and who you might want to speak for you if you get so sick you can't speak for yourself, and what medical treatments you might want to go through or not. That's something that again more of us need to do and revisit actually as time goes on, because people change their minds, so it has to be a flexible process, but you need often support and guidance to go through it, and a palliative care provider or team can help with that. When somebody gets a diagnosis that is difficult, whether it's a long term thing or a terminal thing or whatever, what have you found is the best? And I hate to use absolute terms like that. What are some healthy ways to deal with that news? Do you take? Do you create a list and take action from there of steps you need to take? Do you take time to decompres like what is between everybody's a little different, but people need support when they get that kind of news because it's scared, it's overwhelming. It's emotionally draining. You talked with doctor Masters about delivering bad news. There's a good way to do that, in a bad way to do that, And when providers do it in a bad way, it makes it ten times worse. Because if you're in the hospital and you're sick and you're very vulnerable and then doctor walks in and says you got three months to live and then walks out, that's pretty detrimental to me. That's almost malpractice. So there is a way to set up the situations so that people are supported with their loved ones, and you give them information in ways that they can understand it, and you wait and you respond to their emotional reaction to that, and you help them think about what the next step will be. Those are the things that can help people come to grips with it. But it still is overwhelming. I mean, if someone told me I have three months to live, Wow, that would pretty much upturn my life, right anyone's life. But I usually encourage people to take one step at a time and that sometimes things turn out better than they look at first glance, and then I continue to offer support and a plan going forward to deal with it. So do you think that a plan, no matter what good news is, a plan is, would you agree is probably the most important first step. I think all the steps are important. Listening to patients about what's important to them, responding to their their emotional reaction, making sure that they've gathered the important people around them that can offer support, because you know, again, if you're just meeting this person in that kind of a situation, you don't have a relationship to fall back on. They don't you don't know you that well. You want to do things that help build confidence and trust in a relationship that you can then move forward together with and deal with the situation. And how about on the other side, as so, I'm getting this news, what is important for me to do next? After receiving this news, I think sort of just sit with it and and you know, writing things down can be helpful, talking to the people that are important in your life can be helpful. No one should have to go through this kind of a thing alone, and unfortunately a lot of people do. But it can be overwhelming. I mean, none of us live forever, and we all are going to face the end of our life at some point. But having helped to do that I think can make it a little easier when we come back. Doctor Goodwill discusses how personal choices play a role in palliots of care and when you pass from cancer, what exactly is it that kills you? We dive further into these uncomfortable questions when we return. It's no secret that palliative care drastically improves the quality of life for patients, their loved ones, and their caregivers. Yet worldwide, only fourteen percent of people who would benefit from palliative care receive it. Seventy eight percent of the estimated forty million people a year who need palliative care live in low and middle income countries. According to the World Health Organization, one of the biggest barriers to palliative care is simply educating policymakers, healthcare professionals, and the general public about what palliative care is. As I spoke with doctor Goodill, I realize that even though Mom used palliative care, I still had so many questions about it, and that was mostly due to me not exactly being emotionally able to just jump right into the situation, particularly since Dad was handling it with Mom. Thankfully, doctor Goodill was willing to have these conversations with me, and these are conversations that most people, myself included before this, just don't want to have. Like how big of a role does the patient have in their own choices regarding palliative care. Doctor Goodill shed some light. There's always choices, Okay. One way to conceptualize this is to think of those five stages of death at Googler Ross talked about, because they also are sort of five stages of grief, and we're talking here about anticipatory grief a lot, but there's a lot of denial in the front end of it. There's anger, there's bargaining that goes on, there's depression, all that you know, before there's some acceptance and they don't always happen the same way for everyone, and they don't go in order necessarily, but all of those reactions are possible, and you know, recognizing what's going on and supporting someone through that and bringing the resources to bear that will be helpful. I mean, somebody is particularly religious or spiritual than a chaplain may be the key person on the team to spend time with that person and help them sort it out. They're sitting there, you know, in their hospital room thinking why is God doing this to me or something like this that I'm not probably the best person to answer that. So that's where the interdisciplinary team can be very helpful. Who is kind of your point person in a palliative care environment because it seems like there's a lot going on. You know, you have your medical oncologist, your physician, you're the psychologist, Like, who is kind of the point person that is like, Okay, this is a spiritual person we need to bring in at or whatever. Yeah. So the way our console service works is we're very busy. People who are in the hospital these days are sicker than people who used to be in the hospital back when I started my career, and so time moves pretty quickly. In the hospital. Things happen quickly, so you really have to get a handle on it quickly. And one of the things that we do in the hospital setting is we do a lot of coordination of care. So there might be four or five specialists involved in a particular case, and we spend a lot of time making sure that the right person is doing the right thing at the right time, and that we need a specialist input at a certain time or in a conversation with a patient family that we got it, and that takes time and effort to do. But usually the way we do it is when a new console comes in, either one of our physicians or one of our nurse practitioners or PA's will do the initial consult and that is part of that as an assessment about what other needs there are. So we have less social workers and chaplains on our team, so we use them sparingly and when they're really needed in a case, then that the initial point person will will make that clear and they'll be added to the list for the social worker or the chaplain. You know, you mentioned that palliative care is kind of at that tipping point. Is this something that we can expect in ten years? Is just going to be an accepted and expected part of practice everywhere south north around the world. Yes, that's the short answer. Okay, yeah, I mean in the state of Delaware. I you know, I started the first palliative care program here at Christianic Care and we've had it going for like eighteen years. But Delaware has a pretty good rating in terms of availability of palliative care and a lot of the hospice is that work in the Delawares area have palliative care programs attached to them. As we talked about, Wow, so it's pretty available and people should certainly ask for it and expect to be able to get it when they need it. This is kind of theorizing, but it almost seems like it's the future of medicine in general that you would want a multi disciplinary team for your regular health, you know what I mean. Yeah, paliative care is really about good medical care, and we've gotten back to it to embracing that aspect of it that we had forgotten about for a while back in the eighties and early nineties. We were so involved with diagnosis and treatment we forgot about the person when we're treating. For you, what is the most important takeaway that someone should know when they get a diagnosed that is not what they were expecting. So if you could tell every patient in the world or future patient it was listening to this right now, what would you say to them? I guess I would say that there is a way to live your life with serious illness in the best way, and pif care cannot help you do that. I mean, we can't cure a lot of diseases and people have to live with serious illness sometimes, but ollitif care can help them do that, And none of us are going to live forever, and it's often better to think about where things are going, and as scary as that might be, prepare as best you can because that makes it better in the end. What happens when we physically die. Yeah, you know, when Hyron asked me about this, I had to smile because I had just listened to a podcasts from the American College of Physicians, a podcast called Bedside Rounds. The episode was called Last Breath, and it was all about how we have diagnosed death over these centuries. And you know, before we had stethoscopes, how did you know somebody was dead? And there was some really bizarre stuff that used to happen. I mean, people used to cut up bodies to make sure they were dead, which is kind of weird. But you know, once we once we had the stethoscope, the basic diagnosis of the death included no pulse, no heart tones, no breath tones, person's unresponsive, and then they're pretty much dead. But there are phenomena that have been recognized over over the years, especially as since we've had CPR and resuscitation. You know, when you when you do a resuscitation on person, you do CPR to augment their blood flow when their heart's not working, and you inject their body with a lot of drugs to try and stimulate their heart back to working again. But that those drugs don't get circulated around, they may not get to the heart right away, and so they may do a resuscitation and get no immediate initial response, stop the resuscitation, and ten minutes later the body all of a sudden wakes up and starts working again, and it's a phenomena called auto resuscitation. Happens again in the situation of a resuscitation, not a natural death. So in that situation you probably ought to weight a little bit before you actually declare someone dead, whereas a person with a natural death, the time that you need to wait is probably shorter. I'll be on the order of two or five minutes. And that's what's used when we do organ procurement from people who have died. We don't want to take organs from somebody who's alive, so we really are pretty careful about making sure that we can declare them dead before we take their organs and that timeframe for a natural death is about five minutes. So the organs, even though the body has died, are still usable for a period after Yeah, they're recoverable. I mean, that's that's what the whole thing about organ donation is. Those organs can be taken out of a dead body and given to put in a live body and they actually work. And how long is that? Well, they degrade over time, so the time you know, again you don't want to wait too long, but you want to make sure the person's dead. So I think that the timeframe they used for organ donation after cardiac death is about five minutes. Okay, So I am, you know a body, and I have cancer or whatever. What is it that actually kills me? Explain that if you. I mean, obviously, depending on what is killing your your death will look a little different. So if somebody dies of a sudden cardiac arrest, their heart's going to stop. They'll stop profusing their other organs and those will eventually shut down. Somebody who's dying of cancer, it's usually a more slow, prolonged process of slowly whatever wherever the cancer goes in their body, it's gonna cause malfunction. So they may get metastasies to their brain, and their brain will start to malfunction. Brain controls a lot of things in the body, and it can cause malfunction in other other areas of the body. A person may get an infection and on top of their cancer, and then all of a sudden, their blood pressure will drop. Their body will have an inadequate response to the infection. Once their blood pressure drops, they'll they'll have inadequate profusion of their kidneys and their and their brain and their and the rest of their body, and they'll eventually die. Or if they don't get an infection, they may slowly become weaker, they will be less functional. They often become bedbound. They often will sleep more, eat less, and eventually, you know, their heart will stop and they'll and they'll die. Is there a process or I should say, what is the process? Like what happens you know, when they whisk away the body, whether it's at the hospital or at you know, to a funeral home or whatever. What happens to the body is it is the brain price unreally stupid? What are what's going on? So I don't usually accompany the body after it's dead wherever it goes I mean in the hospital, it normally goes to the basement, to the morgue, and then the funeral home comes and picks it up and they prepare it, so to speak. But immediately after a person dies, all of the tissues begin to break down through this process almost immediately, almost immediately through this process called autolysis, and that's where cell man brains dissolve, enzymes get released, and just accelerate that process. Several minutes to maybe half an hour, the body develops this thing called rigor mortis, which is stiffening of the muscles and the joints, and so you know, the body is really you can't really move it around very easily, whereas immediately after death it's pretty reliable. And then you know that stays in place for usually until the funeral home gets it and then they deal with it in some way. I don't really I'm not that familiar with how they embalm a body, but I don't know where the soul goes right right how long? Like I've heard that there is brain activity or something that can happen afterwards, but some some I guess, there's other schools of thought that say it's like more gases or something like being. Is there a consensus on this. Does the brain just cease afterwards immediately or you know, I that's a good question. I'm not sure. I'm I'm really an expert on that either. I do know that there can be some reflex even breaths taken immediately after death for a period of time, But I don't think there is consciousness. You know, these maybe sort of last gasp of function of particular cells in the body as they go through the dying process. But I don't think a person is conscious in any way, shape or form for this entire the entire process of you know, palliative care and end of life decisions and that sort of thing. What is the one thing that you think is most important for somebody that is facing end of life to know? There are two sort of facts that I deal with on a daily basis. One is that most people don't want to go before they have to. And the second thing is there's a lot of uncertainty about when that is for any individual person. So the trick is you don't want to hang on too long, but you don't want to let go too soon. Yeah, And that's that's the effect of life. Really. Yeah, yeah, and that's I would love for you to have an answer, but I think nobody has an answer for that. It's all individual, I guess no. I mean, I am an afficionado of Stoic philosophy, and the Stoics felt that that was an important thing, is to not not hang on too long, to live your life as fully as you as you can, and uh, and not hang on too long. Well. And it's interesting because that's kind of that homeostasis, you know, that exactly that we're trying to find throughout our entire lives yang right, which could and should really apply to our deaths as well. Palliative care and hospice are too related but separate functions that both aim to ultimately improve the quality of life of patience battling serious illness. Due to palliative care, Mom was able to be in my parents home in her final weeks, where she was able to pass in the bed she shared with Dad for nearly forty years, and that was one of her three wishes before she passed. Number one, she wanted to make sure that Dad and myself and her loved ones would be okay. Number two, she wanted to pass at home and number three, she wanted to be in her own bed. She didn't want to be in a hospital bed, and thanks to the incredible palliative care team that she had, Mom got two of those wishes granted right there. While we know the value and importance of hospice and increasingly palliative care, there's a whole another aspect of death care that has been around for centuries, but in the last ten years or so is becoming increasingly visible. It's called a death dula, and there's all types of different names for it. It might be referred to as a sole midwife, or a death midwife, a transition guide, or even an end of life coach. Essentially, a death dula's goal is to have their patients have a good death. Karen Karnatz has been a funeral professional for over twenty five years. In the last few years, she's branched out and become an end of life dula. So what exactly is an end of life dula? Karen explains, So, if you are going to hire an end of life dula, what you would be hiring is a non medical professional that is a support and a caregiver to either the dying and or their families as they navigate that end of life transition. So it is somebody, if I'm understanding correctly, it's somebody on the non medical side who was there to support in whatever that person needs on the death side rather than the birth side. Is that well sure? And so the easiest way for us to talk about end of life dulas is to correlate it to birth dula's just because people are so even though those aren't I'm learning now there are still people who don't understand what that is. It's an easy way for us to discuss it. So, just like adula is someone you go to support your birthing experience that you have with a medical professional, So either a midwife or a doctor, you would get that DULA to help support the mom as she is navigating that transition and then the partner allowing them to be involved in that birth space without having to be the person who's managing the situation. So the dula's kind of the manager for you and the voice to express what your needs and wishes are that you had already worked to put together right, so they hope gather information for what your ultimate experience might be, and then they try to help you have that experience and being an educational peace bringing that educational piece to the process. So an end of life dula work similar where they understand the process. They understand the varying feelings that are happening in one moment for all the different parties involved, and they're helping you to navigate and to feel free to express those feelings too. We don't always in this culture feel safe to express whatever it is that we're going through because we're going to be judged or because we are judged various reasons. So an end of life dula is trained to just listen. Sometimes sometimes it's as easy as that, just and to say easy listening is not easy. It's simple, it's simple, not easy, allowing someone just to express wherever they are at. So this seems to be kind of like a multidisciplinary thing in regards to seems you kind of have to be organized, you have to have compassion and empathy understanding. I'm sure patients. Is there a program or something that makes somebody a death dula or you know, how does that happen? That's a great question. So death dula's the name is new, but it's something that we've been doing for each other forever, for as old as time, there has been someone in your community or in your culture that you look to for these big life events, and they don't have to have a title. That could just be the grandma that you know is the one that is the one that you can look to and just naturally steps into that place. So I find that these are people that have a natural gift and talent to serve others, but also, for whatever read then don't have the same anxieties around death at other people might have, so they're able to bring their life experience and their heart and their soul and their talents to assisting others in moments where they really need the support of their community. So a title is a title, right, and that's It's great that there are organizations out there where you can get certifications, so that would be what I did. I attended the University of Vermont to get my professional end of Life do a certificate. But this is actually not federally regulated, so you could call yourself one and not be when and maybe even be you know, more qualified than someone who took the course. Right, So it really the people who have the heart for it, the people who are care in this way, they seem to now be drawn to it. And what's interesting for me, as someone who is primarily a funeral director, I'm seeing people who maybe once we're now samigating to funeral homes to start helping in that capacity, see this other thing that's available to them, and it is drawing those people also, So we're kind of we're seeing people choose because it is difficult to do both. And what's interesting is, like you said, it could be you know, the auntie down the street that's everybody's favorite auntie, that is just that compassionate person that everybody's grandma, you know what I mean, that person on the block or whatever, that everybody you know, you know, which is pretty special and comforting to know that the title, as you said, as a title, and it doesn't necessarily you don't have to necessarily go in search for death dula if you already have somebody like that in your life that you might already feel close to m And I will say, and at least in my experience in my class, I think I was surprised that more people weren't trying to make it a career. It was really a lot of people who had had a death experience, or maybe we're volunteers for hospice and they really wanted to get more skills so they could provide this service just as a community member, just or just for their family, or just know more about it. So the people that are going to get these certifications sometimes they're just people who just want to know more and be just get a little more education, a little more structure around what they're learning. But ultimately, you know, marry that with what they're already just know how to do intrinsically. And how were you drawn to this industry in general? You know, obviously you're you are primarily involved with funeral homes, but how did you get here? Rather than I want to be a you know, dentist or something. So that's funny. I hate it. I'm so mean to my dentist, Like people always say that to me, like you know, I could never you do, And I'm like, I could never be a dentist or a dental pygenist. So God bless dentists, thank you. No for me, I really liked science, and so I came to be in my I came to this career just picking anatomy in high school and from there I went directly from high school to mortuary college, which we have to. All states are different, but in California, if you're going to be an embalmer or you have to go to mortuary college. So I did that right out after high school, got a job with a funeral home, apprenticing as an embalmer, learning how to be a funeral director, and I've just like kept going and also learning. So different people do different things. I can just say for me personally, I became an embalmber, a funeral director. I learned how to operate crematories. I learned how to manage cemeteries. I just want I want to learn all of it because I want to be able to say that I know how everything works and give that knowledge back to the people that I am grateful to serve. So for me, it was important to just learn as much as I can about everything. It just so happens. The thing that I am most naturally gifted is being an efficient actually and being a celebrate what we call and that marries very well with the End of Life FULA program because or end of Life DULA services. Not all dula's specializing legacy work, so having people's lives recorded in some fashion, whether it's just helping them write their own obituary, or helping them do scrap booking for their families, Helping then them tell stories, maybe put it on a place like story Corps, or just gather those stories so later on they can officiate a funeral or act as a celebrate. And then twenty twenty eight, right, So then everyone's left sitting around going what do I Life is precious And you'd think i'd know already, right, but you know even more so, it just came this pressure cooker, and I knew that I wanted to do more around grief in particular, so I chose to take two certificate courses, one as a Grief Support Specialists and the other as an end of life DULA. And I'm using all of those to continue to serve families as much as I can and give them as much education as I can from where I sit right now, which is typically after death. Well, and it seems like each one of those can and is its own profession. Also, they each make you stronger in the others, yes, I think so. Yeah. And some people are very they are naturally drawn to one thing and they're good at that one thing, and some things are more science based, and some things are more emotional based, and some things are administrative. And it's good to know all of those things. But it's also good to know what you're good at. Right, So if your specialty is doing this one thing, do it and be the best at it, and I will be so grateful for you to supplement where I'm not so good. Right. But the world of end of life dulas and by the way, they can be called different things, so they might call themselves death midwives, they might call themselves death coaches or end of life consultants. There's a lot of terms because it's not federally regulated. There's no set system, there's no set group of services that one's going to provide. So as you're looking for a death doula, you should interview them to see what it is they're doing, because you may not know what you want until you hear it. And so you look to see who's available and see what they specialize in and go with the one that feels like it will most fit your needs. But you know, some are really good at that legacy works, so that's what they do. Some are very practical, so they want to do they want to just do things for you, like clean up your house, right, you don't if you're with your mom, you don't need to clean the bathroom. We'll clean your bathroom. You'll be with your mom. Or you've been sitting with your mom for hours, you need a minute, you need to go get Starbucks or something, so we'll just sit with you. We'll sit with your mom so you can have that time to go and they feel cometable and natural just stepping in that role to be a support for you. What do you feel on the death duel A side is the role as the person or family starts to prepare for their the end of their life. Does it change? Does that the role of a death duela or end of life duela change at all? Or is it still just under the banner of one hundred percent serving that person. No? No, So that's why I say you should really look to see what the duela is providing so you're getting what it is that you need from them. So some may just say, we just want to support the people surrounding the dying, so we can be a little bit of an advocate for them so they know what to expect from the hospital or the hospice or from the funeral home. You know, empower them to get some knowledge around that, but also give them tools to decrease some anxiety, some stress. It's a stressful situation. It's an anxious situation. So anything you can, any little bits you can take away to decrease that as much as possible. So it could be as easy as one of my favorite things. It's so simple, but you don't think to do it. When someone is dying. Everyone tends to want to help. Everyone wants to do something, and sometimes the help is well meaning, but it's intrusive. So that person can help the family come up with a list of things that they would want people to do for them. Right, And so when someone calls and says what can I do, you can say I want door dash fully on Thursday, and then they're grateful to have something to do, and it's something that you need is feeling a need. Right, So just like these little practical things that make the experience Otherwise, you know, people could be giving things that you don't want, or you're worried about having to answer what people want, and the do look can do that for you too. So the do look can take on all those phone calls or take on those requests and then give the feedback of what the family needs so you don't have to do that. Also, like make visitor lists too, and communicate with the people who are visitors what the parameters of the visit might be. Right, So the person wants to be touched, the person doesn't want to be touched. The person wants to hear stories. The person does not want to be asked about what's going on with them. You know, the person just wants to hear from you. Just make the visit what the person would want, and then educate the people who are coming on how to have the best experience with that person as their transition. And it's like an advocate. I mean, it's your advocate totally, just like a birthdula would be your advocate because they know what your plan is best like plans, right, so they're going to do their best to follow it. But yes, and they know the systems well enough to know maybe what questions to ask that you don't know to ask, or what to ask for, when to give people space, when to get answers. Where did this come from? Is this uh something that's been around you know, thousands of years. I mean, I know you touched on it a little, but is this like steeped in tradition dating back to the Egyptians. I'm totally making this up, but yeah, no, that's a great question because I do think that within cultures there are people that kind of have this role naturally assigned to them, and we are melting pot of cultures and a lot of us that has served to make us what we might call like spiritual but not religious, or just lost touch with whatever our you know, the culture we came from, our ancestors were, and so I think this is kind of a call back to what is our role in the community to care for one another. And I think enough people were interested in it, enough people wanted to serve in that way, and I think it became something that deserves some structure around and so people came in to fill that gap. And so some duels are educational duel. I mean their job is to have training for dula's in training right. Going with Grace is a great example. Alua Arthur is huge in the end of life DULA community and such a great advocate for having a death experience that you can be kind of proud of and you can be proud of being a part of and just training so many people on how to navigate such hard topics and bring the conversation to awareness. Social media is also doing that too, right, So people the kids like me who are just getting into mortuary college, or you know, those kids who are not afraid of death and who are looking into it more just to learn more about it. Before we just had each other and now we've got the Internet, and so like if you're my Instagram feed, it's all like grief and funeral home professionals and even like parents documenting their anticipatory grief for a child that's maybe not well for various reasons, or people navigating their own grief journeys in stories and reels. So for me, death is really everywhere and it is anyway, but our life is our ig feed, Like that's one's out there. But I know enough to know that's not everybody's. In fact, like some people don't don't have an idea one about what it is, and so social media has been a way that people have. The voice is getting louder, the voice that says we need to start thinking differently about death, We need to start being empowered around it instead of giving up our power to other people, and then we are anxious because we don't know what's going on. Right. So the more that people are willing to talk and share their stories and be honest and vulnerable about their grief, you know what you're doing, like, you're taking your platform. You have this experience, you see what it meant to you to go through, and you're honoring your mom by having such a broad conversation. And I'm grateful to you for doing that. And people are more willing to do that now. And as that's happening, people like End of Life dulas are saying, there's a place for us now to have a title, to have a structure, to have to market ourselves as professionals and get the training we need to earn that right to help people who want to have a more empowered experience. I love that, and you know, and that is why I'm doing this. I'm the type of person who, probably to a fault, is too active all the time, and I'm the type of person that has to be doing And so I found myself, you know, not getting out of bed some days, and that is totally unlike me. And then it was I'm binging thousand pounds sisters, and I'm binging Hoarders and I'm binging Unsolved Mysteries and I'm like, you know, days and I'm like, what am I doing? And while I enjoyed, you know, thirteen seasons of Unsolved Mysteries, I was getting in a rut of it's turning into a spiral. And so the day my mom passed and I'm like, I have an idea for a show and it's called Death, Grief and other shit we don't discuss, and it's thirteen episodes and blah bla blah blah blah blah blah. No idea why I would do that hours after my mom passed, but I'm glad that I did, and that led to obviously doing the show and what I said to them because right after my mom passed, I'm searching podcast for Frank Talks on Death and I found a lot of lecture type podcast which is great, but it's just not for me. And I found a lot of straight up interview based shows. I wanted something that was a mixture, something that I could relate with, where I'm talking to somebody that I know their story mixed with the subject matter experts. So that's where I decided I want to do that. And it was also a challenge to myself because I'm the type of person that I not that anybody loves going to funerals or viewings or whatever, but I would actively try to not go before she passed for at least two months. I would say, I need to know you're gonna be okay, and I would get defensive, you know, and really kind of nasty almost, And I'm was extremely you know, I'm extremely close with my mom, and I would get kind of nasty, like what are you talking about? Mom? Like, I'm gonna be fine, You're gonna be fine. Why wouldn't I be okay? Everything's cool, you know what I mean? And then she would like, you know, maybe a week later or whatever, bring it up again, Kyle, you know, can you just please let me know that just no matter what happens, you're gonna be okay. And I'm like, why are you talking like this? You know, like, what are you talking about? Mom? Of course I'm gonna be okay. You're gonna be golden, So I'm gonna be golden, you know. Finally, a few days before she passed, she said Kyle like, for me, I need to know, for me, please give me that piece. You know, are you going to be okay? And then of course I broke down and uh, and I'm like, you know, I don't know how I'm gonna be okay, but I'm gonna find a way to make it through, you know. And I don't um. I don't want to live my life without you, but for you, I will. You know what I'm saying, because because I owed her that piece, I also kind of joke that it was an underhanded scheme on her part that her saying that is going to make me have to stick to that. You know what I'm saying, I'm kind of a mom thing today. Yeah, and so I am okay, Mom. You know I I'm trying the very best I can. And this is one of the ways that I'm trying to be okay. Is that maybe this conversation that we're having right now, maybe it's spurs somebody else to say, wait a second, you know what, maybe I can talk about my end of life or whatever I'm gonna die. You know, I always knew I would die, but I never knew I would die, you know what I'm saying. And when you're suddenly faced with the death of somebody so close to you, especially when I feel like it's premature, you know, she should have had another twenty five thirty years. It kind of made me realize my own mortality. And then I'm like, oh God, what am I gonna do, you know, for my death? And how am I going to handle that? Every single thing I love, from my dog to my Maleman to you know, if I get married or something, like everybody that I love is going to die. How do I handle that? This whole thing kind of got me forced, almost in many ways, to start that conversation, And there were two ways that I could have gone with it. I could have continued on that, like let me just binge watch thousand pounds sisters and deny that any of this is happening, or let me go and talk to the people who know what the hell they're talking about, and maybe they could give in some insight into what I'm going through. Because if they're giving insight into what I'm going through, there's you know, ten times that amount of people that are also going through it that could be benefited from these conversations themselves. Sorry, that's really long winded. No, But that's what we need is for people to be able to and you know, I love your mom. Good for her because she was she was just really trying to get you, and not to say it's not going to be sad, you know, Okay. It's such a loaded word. And we do try to coach people. Don't ever tell people it's going to be okay, because you know, if you say it's going to be okay, then we will agree with you. But I'm never going to tell you it's going to be okay because it's such a loaded word. But you know, what she wants to know. It's not that you're not going to be sad now, that you're not going to have moments where you just miss her so much, but just that you're going to keep moving and maybe do something with that grief. And that's what you're doing. And I'm a personal advocate for finding the thing that you can do with your grief, the activity that like lets it out in a positive and a healthy way. And that's exactly what you're doing. You're taking your talent think that you're good at and you're using it to work through your grief too. And by talking, I mean there's a reason why we go to therapists. You know, talk therapy is powerful. You know, doing this is another sort of version of that. I think of just letting it out, yeah, let it out, yeah, and having a safe space to do it. On the opposite side of what you do, it's called a funeral director, right. Licensing is tricky, So I'm I am license. I can only say that if I work for a funeral home, which I do. So if I had a funeral director's license but wasn't employed, I couldn't say I was one. Gotcha legal stuff. So however, yes, I am a funeral director. Not everybody you meet with necessarily has that title. Sometimes their funeral arrangers. Different states have different rules around it, lots of rules around the funeral professionals, and all the states have their own. So that's another reason maybe people are drawn to end of life dual is there's a lot less hoops. Yeah. Currently, I just spoke with a doctor who told us what happens physically when we actually die, when the body is whisked away from wherever, whether it's home or the hospital or wherever, what happens from there. So, depending on the rules, a person in California let's say a person has to be embalmed or refrigerated within twenty four hours, so that would be what happens one, right, So we come from the home, We go to the home, retrieve the person, bring them into our care, and then we put them safely wherever it is that they need to be, so in refrigeration if we need to do that, or if someone can perform an embalming relatively short time, we get prepared to do that, and then it depends from there what the next steps are. So is there a funeral, is there not a funeral? Is there just to cremation? Is there a service and then a cremation? And now there's new options in other states too, So there's composting, human composting which just became available in several states. There's water cremation, alkline hydrolysis, so different ways. But I mean, basically, we have to figure out what's in between retrieving the person and the disposition we could call it. So then presumably, well, I guess it depends on the situation. The family would have already spoken with you guys and come up within end of life plan, but not always right, right, Well, if you're a funeral home. So that's the thing. Many people come to a funeral home with no plans, they don't know what they want, and there's a lot of kids or a lot of family, and then you've got different opinions and it can be sometimes it takes time to navigate what's going on. But sometimes it's very clear, like the person was Catholic all their life, that you know, regular church goer, and so they're obviously going to have their Catholic Mass and their visitation and the same that are I guess you can't say obviously because you can't just assume, right. Also, you can't assume, so you know, you might expect though that they'll just come in and say, well, we want these things. But people will go with either what their culture or religion dictates, or they'll do what they saw someone else do and they thought that worked out well, or they'll do what their financial situation can handle. So it really depends on a lot of factors as to what happens next. But for me, I'm going to use this platform like I really that's one thing I wish I could do more as a funeral director funeral wrang that maybe I can do more if I am speaking as an end of life doula is to really encourage people to decide, to look at their options and to come up with what they feel is best for them, but also to let their kids or their family have some say into what that might look like. Because ultimately the service or whatever happens should honor that person that's dying, but it should be the thing that the family needs to get through because they're the ones here. They're the ones that have to have their moment, They're the ones who have to grieve, They're the ones that need that ritual to as a part of their grieving process. So collaboration talking about it, kids out there recognizing that their parents are mortal and so being willing to say, I know you're gonna die someday, and so let's talk about how best I can honor you but also get my needs met. How do we make this work? What are we looking for? The more you talk about it now and the more you get an idea of like what the laws in your state, like what I mean, that's a big deal, Like next of kin laws are such a through a wrench in the work. Sometimes because you might be the closest person in the world best friend for a million years. There's no other family. We don't really have rights because you aren't. You know, the legal laws says you don't have rights. I can't stand that. So you know, figure out who's in charge, who's being delegated, but also who's in ars legally. You know, get to know what is available to you, and then be willing to explore things that you may not even feel like you could do, like, you know, home services, you know, something like stay at home or you know, go to a park or go to a country club. I mean, whatever it looks like for you. But the more we can talk about it now, the more when you step into the doors of a funeral home on the worst day of your life, the more you feel like, I know what I'm here to do, and I know what, at least somewhat what to expect. You know, there may be some curveballs, but I know I'm walking in with knowledge, you know, not just devastated and nothing and I don't know anything, and I've got three other people to argue with exactly. And you know, that's that's one thing that I can say, I'm so thankful for my mom and dad for doing is they years before any of this. They had preplanned everything, so I knew exactly, you know, in case of kind of like that break this class in case from and say, yeah, yeah, I had that plan where I knew what they wanted should the worst case scenario happen. And then of course when it did with my mom, you know, luckily my dad was there, but there wasn't any agonizing over decisions or anything like that. It was very you know, I remember when my dad went there, he came back, you know, shortly after, and I'm like, uh, did you go, And He's like, oh, yeah, I just had to drop this, Like they everything was already taken care of way ahead of time, so it made it so much easier. And then you think when you bring more family into it, or if I had brothers or sisters or something and they didn't have this plan and my brother wants this for her, and my sister wants this, but I want that, and then if there's no plan, that is just not only a disaster in the making in regards to these choices, but but the agony that you're going to have with your loved ones in as you said, the worst time of your life on top of that, Yeah, you got you have other stuff to deal with you. You want to focus on what you need to do to work through your grief. You know, work through the other stuff. You don't need the red tape and all of that to bongy, don't even further work and making decisions. So I am a big proponent as much as you can learn ahead of time, and which is why I love the End of life do list so much, because they really do get that piece before someone passes. As a funeral home professional, sometimes it's too late to give information and drives me nuts. So as a professional and deathcare for over twenty five years, Karen has seen a lot. When we come back, I asked her what the universal truths she's learned on the human condition and death. Ever since I was little, I've always kind of wondered, and I feel, as ophical manner, what the universal truths are about the human condition and death. As humans, there's got to be some connection that when we lose somebody so close to us that we love, that are true for all of us? And what about death? Obviously we aren't all scared to die, but a lot of us are. I know I have been as an end of life, dula and a funeral professional. I thought Karen would be a great person to ask what are the universal truths that she's learned in her decades of experience on the human condition end on death. The thing that I've learned the most is that it sounds simple. People need to talk, and the ones who don't feel like talking, you don't pressure them, but you give them the space for when they're ready to talk. And just to see the difference it makes to listen to somebody versus get through the business, you know, run along or whatever whatever it is. But the more you're able to just sit with someone and let them talk about the person that they love, you see a change in their face. You see their like I can't describe it, but it's a it's something that I when I see it, I'm so grateful that the person is having that experience. So there's that. I would also say that more often than not, when people take a proactive approach and lean into death instead of push it away, it is often like you're sharing that it's a better experience than what you were thinking it would be. I think our brains build things up. I mean, anything we're not looking forward to right, it just builds it up into this monster that we're afraid to face, and then when we face it, it's typically less scary than our brains. Our brains are really good at making things more scary, and not that it's not scary, and not the it's not so much. But it's one of those things. The more you practice, the better you are at it. And that's, you know, that's and then that helps you in all kinds of grief too. If you start with this thing that's the most the thing that will probably be the hardest grief situation that you'll ever have in your life. If you practice leaning into that, all of the littler things that you do start to be what they are, which is not so big, you know. So I feel like that is the truth. The more you experience it, the more you are willing to put yourself into that process, the better you'll feel. There are exceptions. I don't want to you know, I don't want to say that, and then you give that gift your kids too. So for people who have young ones around you, as they see you make it not scary, then they don't grow up necessarily to think it's so scary either. And that's the way I think we sort of change society if we want to do that is maybe start approaching things in a healthy People say normalized, and then people say not to say normalized because it's normal, right, So you don't want to say like normalized conversations around death. But death is normal and it's common, but it's hard to talk about. So just talk about the things that are normal, you know. And it makes us more empowered, It makes us walk more confidently, It makes us make decisions that we wouldn't make if we were so scared. Yeah, and you know, as you say that, it also makes me think that it allows you to make more informed choices rather than having to make hesitant in the moment panic choices later on. Well, and then there's a time element, right, so you have time now, but once a death has occurred, you're sort of out of time. You've got a little you've got a small window, but it's a small window. So now you have lots of time to explore and learn and read. You know, having a death duela is great, and I absolutely encourage it, just like I encourage birth dulas. But you can empower yourself to have that same knowledge and do that same thing for yourself and your family. But just by gathering stories like being willing to listen to people, volunteering for hospice, attending funeral is like talking to people, you can develop those skills within yourself. How are you able to do all of the things that you do? And I am so thankful for that because I could not do it. How are you able to do it? I don't know. That's like the million dollar question. I don't know. I go back to this natural gifts and talents. This is what I was put on earth to do. And I one percent believe that I am a deathcare worker. There is nothing else that I will ever be. I started at eighteen. I will die being a deathcare worker. It's how I am meant to serve others. I don't know why I was built that way. I don't know what in my brain makes it palatable. It just always has been. And as I've learned more, I've increased the tools in my toolbox and it's just made me more empowered and more able to stand confidently on this career that I've I've done And you know why am I not a dentist? Because I can't do it? You know, I don't know. I don't know. So I think people people are built to be who they are. If you're lucky enough to tap into it and have the resources that you need to do it, if you're lucky enough to tap into your gifts and talents like that's that's where people what they call it, they're your dhrma know, when you just tap into that thing you were meant to do. So I was meant to do it, and I know a lot of other people feel the same when they're called to this work. I was just meant to do this well. And thank God, the universe, fate, whatever you call it, because we need people like you that not only are in this business, but that are in this business for the right reasons. You know. I want somebody who loves, you know, is going to be as loving with my mom as I would be if I'm unable to be there or whatever, you know, if I have to go to work or something and I'm leaving, you know, my mom in the care of somebody. I want somebody who's there because they love this work and they want to be in the service of others in that way, especially because a lot of it I wouldn't be able to do myself, you know, And so it's thank god we have people like you that are able to do it and find meaning in doing it, because otherwise, you know, we wouldn't want the type of people who are only doing it for a paycheck or something to be doing this, you know what I mean. Yeah, And I think that most people who are who are here and who stay, I mean, I think if you're not meant for it, you fall out of it. You know, people can read that, or you just natural selection fall off. But I think I think it's a calling, and I think that the people who are called to this work are here because they overwhelmingly care about people and this is their way of helping other people. And then we're grateful because people like you get to do this and give us a place to talk about the thing that we love most, you know, talk about the thing that we the gift that we're meant to give people, and you gave us the gift of being able to talk about it, which is also important to us. So thanks well, of course, thank you. And so finally, grief. You have dealt intimately with grief, both kind of pre grieving, if you will, you know, knowing somebody has a limited amount of time here, and then the kind of post death grieving. What have you found with grief? What have you found that are some tips that can help people on both ends getting a diagnosis, what are some tips there? And then after that person has passed tips there in the grieving process. The stages of grief are pretty well known, or at least that there are stages, right, So I think it's important to note that they are not linear, They're not in an order. You will experience maybe all of them, maybe it's simultaneously, maybe at different times. You never know at some point what is going to hit you, like and when you may not be anticipating it, and like out of nowhere, you're watching Netflix, right, And there's a part of that you just have like accepting that roller coaster is a part of it. You're on a roller coaster and life is a roller coaster, and then this is just another part of it and you're on it. You're on it, so that's what you volunteer for when you get on this ride. But also everyone you love is on a different roller coaster, so you're not at the same swoops at the same time. So grief is not going to look a certain way. There are patterns that you might notice or themes, but it does not affect everyone the same way, and so shows up for you and honor the way it shows up for somebody else. They do say that time makes it less acute. I don't think grief ever goes away. I don't think there's a moment that you say I am done grieving. I think it is constant, but it doesn't feel so overwhelming after some time has passed. Now, some people have complicated grief and some people there's a lot of different factors that are involved, and sometimes you know, finding a therapist, finding someone who can support you in that way, who's a professional. I don't. I tell everybody, like, don't be afraid of therapy, like therapist goal Fee. We should all have a therapist. I agree. So, like, you know, don't be so hung up on what you should be feeling that when it starts to get too much, that you don't reach out for professionals. I think one of the biggest lessons that I've learned doing this series over the last you know, almost a year, is that grief, as you said, will never end. You know, your love for that person doesn't end. You learn how to live with the loss. You learn how to adjust to living with that grief. And that has been kind of a game changer for me because you know, I also don't want to stop grieving my mom. And what I mean by that is I don't want to be a ball of you know, anxiety and crying twenty four seven. But I would never want to forget or something. And I'm always going to be sad, you know. I'm always going to be sad that my mom, that person that was my rock, my person, is no longer here physically, and so that is not something I'm ever going to get over. It really isn't you know. I just bought my first house and I'm like, damn, you know, she would have been here uninvited half the time, so I look, I got your curtains or something. Just that's how she was and she's not. So all of that kind of comes up, you know, here comes anger again, you know, and it's gonna be I feel like that for the rest of my life. If I have a kid or something, I'm gonna be angry because my mom was taken from me. And I'm gonna be sad because I want her wisdom and her love, and so it's learning to live with that grief and that loss forever. And that's okay too, you know. And it's going to be okay you know whatever that might mean using that loaded word, but broken down. You know, I am going to survive this. And as you said, it's not to say it's not easy or I'm not going to randomly break down and cry like I do sometimes today. But I will stop crying at some point and be able to function, you know. Yes, totally, yep. And what a powerful thing if you do have kids someday to be sad in front of him and say, you know, my mom would have loved you, you know, and I'm sorry that my mom wasn't here, but she you know, she was this. You know, they'll see one, they'll learn about her through you, and she won't have gone. I mean physically she's gone, but she'll still be there and your kids will learn that. There will be lost, but we can still talk about we can still there's still so much left loss of her. Isn't everything lost, you know, And so that'll be a powerful thing for you to take that grief and make something with it later, make it empowered little kids take that grief and make it something later. I love how Karen said that the loss of her isn't everything lost. And what that means to me is that though Mom isn't physically here, she is here with me. She promised me that on her deathbed, and I feel that I know that to be true. So what do we do? How do you deal with the aftermath? How do you get through on the next episode of death, grief and other shit we don't discuss. We deal with the immediate aftermath of losing someone that you love so much. What do you do in those moments, those minutes, those hours, those days afterwards? How do you get through? And I talk with doctor Kenneth Doka, Senior Vice President and for Grief Programs at Hospice Association of America and author of Grief as a Journey, Finding Your Path through Laws. We discuss how grief is not an illness that you recover from, but an individual and ongoing journey. For handouts, additional information and resources, please visit our website at death and Grief dot com and continue the conversation on Twitter and Facebook.