Caring Through Crisis: A Deeper Look at Palliative and Hospice Care

In this episode of Soma Says, Dr. Soma sits down with Anne Front, a licensed Marriage and Family Therapist and Advanced Palliative Hospice Social Worker, to explore the emotional, physical, and spiritual dimensions of palliative and hospice care. Anne shares her personal experience as both a cancer survivor and a caregiver, offering profound insights into end-of-life care, the value of early palliative support, and the importance of preserving dignity and humanity in healthcare.

Whether you're a healthcare provider, a patient, or a caregiver, this episode will deepen your understanding of what it means to care — truly and fully — through some of life’s most vulnerable moments.

Timestamps:

00:00 – Introduction and Disclaimer

 

00:41 – The Importance of Humanity in Medicine

 

01:25 – Guest Introduction: Anne Front

 

02:02 – Understanding Palliative Care

 

02:38 – Anne's Journey into Palliative Care

 

04:06 – Challenges in End-of-Life Decisions

 

08:01 – Palliative Care vs. Hospice Care

 

10:04 – Anne's Personal Experience with Cancer

 

13:08 – The Role of Palliative Care Teams

 

19:36 – Understanding Hospice Care

 

22:54 – Discussing Quality of Life

 

25:32 – Evaluating Treatment Options

 

26:46 – Understanding Quality of Life

 

27:24 – Medical Perspectives and Patient Trust

 

29:25 – Cultural Differences in End-of-Life Care

 

30:13 – Advanced Healthcare Planning

 

31:01 – Challenges in Palliative Care Communication

 

33:17 – Doctors' Emotional Struggles

 

36:07 – The Importance of Humanity in Healthcare

 

43:47 – Professional Care for Healthcare Providers

 

44:20 – Final Thoughts and Resources

💬 Connect with Anne Front: Website: annefront.com TikTok: @thepalliativetherapist

🎧 Subscribe to Soma Says for more conversations blending Western tools and Eastern wisdom in women’s health, emotional wellness, and whole-person healing.

Episode Transcript

(00:00):
Hi, this is Dr.

(00:01):
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show. 6 00:01:06,380.023 --> 00:01:10,970.023 Being treated as a human feeling, listened to, and heard and seen. 7 00:01:11,450.023 --> 00:01:17,600.023 To me, that's better medicine than anything that we can do in terms of prescriptions and things. 8 00:01:19,165.193 --> 00:01:23,365.193 It's really about how can we preserve the humanity so that people. 9 00:01:24,65.193 --> 00:01:29,335.193000001 Whatever the course of illness is they're feeling like human beings and not just Yeah. 10 00:01:29,335.193 --> 00:01:30,655.193 A science experiment. 11 00:01:32,40.363000001 --> 00:01:37,710.362999999 There's a lot of help out there and with serious illness, people feel so isolated and alone. 12 00:01:37,810.362999999 --> 00:01:38,950.362999999 that breaks my heart. 13 00:01:38,950.362999999 --> 00:01:39,790.362999999 I would rather. 14 00:01:40,125.363 --> 00:01:43,675.363 Connect people so that you feel like we're all in this together. 15 00:01:49,613.05 --> 00:01:59,373.05 Anne Front is a licensed Marriage and Family Therapist and Advanced Palliative Hospice Social Worker specializing in grief, serious illness, and caregiver support. 16 00:02:00,103.05 --> 00:02:11,473.05 Drawing from her personal experience as a cancer survivor and spouse of a cancer thriver, she offers compassionate, holistic care through her private practice in Studio City, California and via Zoom. 17 00:02:12,213.05 --> 00:02:22,303.05 Anne is also a published author, educator, and the voice behind TikTok’s “The Palliative Therapist,” where she shares insights on navigating life’s most challenging transitions.​ 18 00:02:23,483.05 --> 00:02:26,513.05 I wanted to officially welcome you to my podcast today. 19 00:02:27,93.05 --> 00:02:29,403.05 we're talking about palliative care. 20 00:02:29,773.05 --> 00:02:35,533.05 It's a topic that, frequently comes up in terms of my own patients. 21 00:02:35,893.05 --> 00:03:01,833.05 And unfortunately there's a lot of confusion on the part of not only patients, but sometimes the doctor about, what palliative care is, how it works, how it differs from hospice So I think this will be a great podcast, to educate people in general, tell us about yourselves and how you basically got into focusing on palliative care. 22 00:03:02,458.05 --> 00:03:13,198.05 Okay, so I'm a psychotherapist and I've been in the field for over 30 years and I've always taken approach with my career that just say yes because you never know where it's gonna go. 23 00:03:13,618.05 --> 00:03:17,948.05 And so it's led me on this circuitous path to getting here. 24 00:03:18,248.05 --> 00:03:22,988.05 I was working in a behavioral health inpatient program and I got really bored. 25 00:03:22,988.05 --> 00:03:26,378.05 It was just like if I told somebody one more time, you matter. 26 00:03:26,753.05 --> 00:03:28,133.05 Life is worth living. 27 00:03:28,133.05 --> 00:03:29,543.05 I was like, I'm gonna kill myself. 28 00:03:32,93.05 --> 00:03:36,803.05 So I switched to working in the medical side and I was doing a lot of case management. 29 00:03:37,523.05 --> 00:03:43,433.05 And I was transferred to the ICU and I had a patient that was in his nineties. 30 00:03:43,433.05 --> 00:03:51,703.05 The adopted son was having a really hard time making decisions about shifting to comfort focused care. 31 00:03:51,703.05 --> 00:04:00,683.05 And I was really working with him on the importance of making decisions is, do we really want chemo and radiation and escalation of care where his heart. 32 00:04:00,963.05 --> 00:04:02,553.05 Was at high risk of stopping. 33 00:04:02,553.05 --> 00:04:05,493.05 So son could not make a decision. 34 00:04:05,533.05 --> 00:04:17,373.05 He ended up, the patient ended up coding and there's these big guys, doing CPR on him and you're hearing the ribs crack, it just felt like an assault to this guy that could have had a really peaceful death. 35 00:04:17,463.05 --> 00:04:19,143.05 And it just broke my heart. 36 00:04:19,173.05 --> 00:04:21,663.05 And I think just still hearing that. 37 00:04:22,13.05 --> 00:04:30,683.05 And seeing that image fuels me that this is really important work and that we have a better better options to die. 38 00:04:30,683.05 --> 00:04:35,33.05 We, a lot of people don't wanna think about dying, but we don't really have a choice. 39 00:04:35,33.05 --> 00:04:42,383.05 And as our the sort of the sandwich generation as we're seeing our parents or the older folks in our lives. 40 00:04:42,968.05 --> 00:04:47,948.05 Having, we're having to make decisions for them or they're making decisions about how to die. 41 00:04:48,228.05 --> 00:04:58,238.05 and I think our generation that, what is the option? What's the bigger picture here and how can we remap the way we want our, our end years to be. 42 00:04:59,223.05 --> 00:05:00,3.05 I agree with you. 43 00:05:00,53.05 --> 00:05:02,3.05 This is always a tough topic for me. 44 00:05:02,53.05 --> 00:05:06,153.05 One of my favorite patients just passed away a week ago. 45 00:05:06,303.05 --> 00:05:08,823.05 I believe she was 95. 46 00:05:09,123.05 --> 00:05:16,143.05 And my most favorite patient is currently still alive, and she's 103 at this point. 47 00:05:16,213.05 --> 00:05:16,303.05 But. 48 00:05:17,308.05 --> 00:05:29,938.05 When it comes to end of life and advanced directives, it is a topic that I always talk about with patients whether they're 25 or they're 95. 49 00:05:29,988.05 --> 00:05:33,378.05 Because it's really important to know what your wishes are. 50 00:05:33,613.05 --> 00:05:38,413.05 What you would like us to do or not do, and that may include everything. 51 00:05:38,863.05 --> 00:05:56,883.05 But what I often find, Anne, is that even when I go through all of that, sometimes it amounts to not having any Effect at all because something, dramatic happens and I'm like, I thought we decided that, we wouldn't be doing all these things. 52 00:05:57,213.05 --> 00:06:00,823.05 So do you find that with your patients? Yes. 53 00:06:00,828.05 --> 00:06:05,113.05 It's really hard because as you're in a medical crisis, it's like. 54 00:06:05,663.05 --> 00:06:10,743.05 I don't know a lot about biology, but it's like we have this natural want to be alive. 55 00:06:10,773.05 --> 00:06:13,23.05 Maybe it's a, survival instinct. 56 00:06:13,23.05 --> 00:06:22,613.05 And so when somebody says you're having a harder time breathing, or you're needing more medical support, what do you wanna do? I think the natural inclination is, I don't wanna die. 57 00:06:22,613.05 --> 00:06:23,693.05 I don't wanna give up. 58 00:06:23,693.05 --> 00:06:24,53.05 I don't. 59 00:06:24,318.05 --> 00:06:25,668.05 I still wanna be here. 60 00:06:25,938.05 --> 00:06:30,468.05 And so all of the planning for the future just gets thrown out the window. 61 00:06:31,18.05 --> 00:06:39,708.05 I think, this is where we could talk about how palliative care can be really helpful 'cause you're building that relationship over time, particularly in the outpatient setting. 62 00:06:40,228.05 --> 00:06:44,428.05 But also I think when you're in those critical situations, like as the. 63 00:06:44,773.05 --> 00:06:48,613.05 Primary physician setting, all those things up. 64 00:06:48,943.05 --> 00:06:57,873.05 But in the moment when the person's dying, you're having specialists say, do you want this or do you want that? And the kidney doctor says, your kidneys look great. 65 00:06:57,873.05 --> 00:06:59,313.05 You're gonna be living a long life. 66 00:06:59,313.05 --> 00:07:04,113.05 And the heart guy is saying, this isn't looking so good, but we could try A, B and C. 67 00:07:04,688.05 --> 00:07:10,418.05 People tend to grab onto the positive news, not really looking at the whole body. 68 00:07:10,418.05 --> 00:07:14,978.05 And that's where I think palliative care can be important, but also just the language. 69 00:07:15,588.05 --> 00:07:21,378.05 I mean it's a lot of it's the patient and the family and just unpacking that stuff. 70 00:07:21,378.05 --> 00:07:25,238.05 That why are we clinging into life when, you know the person is so sick. 71 00:07:25,628.05 --> 00:07:30,258.05 But for the providers, the healthcare, it's really making sure our language is clear. 72 00:07:30,528.05 --> 00:07:41,408.05 Or do you want everything you know, or what do you want? It's everything could mean transferring from the hospital to home with hospice, where you're getting care and support and your family can be there. 73 00:07:41,618.05 --> 00:07:47,588.05 Or it could mean, going up to the ICU and getting on machines and things, and people don't always play out. 74 00:07:47,598.05 --> 00:07:48,558.05 The scene. 75 00:07:48,858.05 --> 00:07:59,138.05 I have a patient right now that I see in the nursing home and it just, every time I see him, it breaks my heart because he wanted, everything when he was in a critical state. 76 00:07:59,138.05 --> 00:08:03,308.05 He ended up having a stroke and now he's on a permanent tracheostomy. 77 00:08:03,528.05 --> 00:08:05,538.05 It's like this is what life looks like. 78 00:08:05,598.05 --> 00:08:10,878.05 Parent family may have come every day or every week and now the visits get slower. 79 00:08:11,388.05 --> 00:08:13,968.05 And I don't know, that's not quality of life to me. 80 00:08:13,968.05 --> 00:08:23,908.05 But when we say, do you wanna do everything, it's assumed yes, because I'm gonna get back to being the person I was yesterday and that's most of the time not the case. 81 00:08:24,433.05 --> 00:08:26,113.05 Unfortunately, you're right. 82 00:08:26,413.05 --> 00:08:41,378.05 Maybe you can educate my listeners because I think I see this a lot in terms of patients where when you bring up the words palliative care versus hospice care they don't necessarily understand the difference. 83 00:08:41,648.05 --> 00:08:49,788.05 And often when you use whichever words interchangeably, they often think it, you are basically saying that. 84 00:08:50,718.05 --> 00:08:54,528.05 Everything will come to a stop that nothing will be done for them. 85 00:08:54,798.05 --> 00:09:01,318.05 So can you educate us about what palliative care is and how it differs from hospice care? Yeah. 86 00:09:01,318.05 --> 00:09:05,998.05 When I was working in the ICU, we had the difficult discussions in a conference room. 87 00:09:05,998.05 --> 00:09:08,578.05 And so I had a patient that was like, I'm not going in there. 88 00:09:08,788.05 --> 00:09:09,868.05 I'm not going in there. 89 00:09:10,243.05 --> 00:09:13,258.05 And it was this idea that if we talk about. 90 00:09:13,658.05 --> 00:09:18,668.05 Goals and what's important to you that this means we're giving up and this means you're dying. 91 00:09:18,668.05 --> 00:09:24,578.05 Whether or not the doctor's saying you have that prognosis, you guys are keeping stuff from me, and that's what's really happening. 92 00:09:25,58.05 --> 00:09:31,393.05 So it is important to have a definition of what palliative care is, beyond what end of life care is. 93 00:09:31,478.05 --> 00:09:36,983.05 And if you think of palliative care as overarching we're working from initial diagnosis. 94 00:09:37,383.05 --> 00:09:39,183.05 Straight through to end of life. 95 00:09:39,273.05 --> 00:09:44,763.05 And hospice is a small part of palliative care, but palliative care is that whole spectrum. 96 00:09:44,763.05 --> 00:09:50,193.05 So a lot of my patients are coming in newly diagnosed with a serious illness. 97 00:09:50,253.05 --> 00:09:54,553.05 We say that you have to have a life limiting or life altering diagnosis. 98 00:09:54,553.05 --> 00:09:56,563.05 So for example, cancer. 99 00:09:56,903.05 --> 00:10:11,903.05 Is a life limiting disease, but with all of the interventions, you can live with cancer for 20, 30, 40 years, or you may not even die of cancer, but just to qualify it, it is a very serious disease that has a trajectory. 100 00:10:11,903.05 --> 00:10:14,993.05 So a lot of my patients are newly diagnosed. 101 00:10:14,993.05 --> 00:10:29,38.05 Sometimes going through chemo or radiation and having symptom burden, whether it's the physical part of the chemotherapy or, nausea, a lot of pain or if there's the psychological part, it's just very emotional. 102 00:10:29,248.05 --> 00:10:30,598.05 And I'm a cancer patient. 103 00:10:30,598.05 --> 00:10:36,268.05 My husband has metastatic cancer, and it's just been an hugely emotional journey. 104 00:10:36,268.05 --> 00:10:40,858.05 Some parts are traumatic, just being poked and prodded and worried about your. 105 00:10:40,968.05 --> 00:10:41,808.05 Your lifespan. 106 00:10:42,298.05 --> 00:10:45,58.05 So there's that whole emotional and existential part. 107 00:10:45,58.05 --> 00:10:50,638.05 And getting palliative care early on can help address some of that distress. 108 00:10:50,638.05 --> 00:10:57,258.05 And as the cancer, or the serious illness progresses, like with my husband, he's non-curative now. 109 00:10:57,258.05 --> 00:10:59,778.05 It's in his lungs, it's in some of his bones. 110 00:11:00,318.05 --> 00:11:02,148.05 So we are having to revisit. 111 00:11:02,703.05 --> 00:11:04,743.05 Yes, you probably have a long life. 112 00:11:04,743.05 --> 00:11:12,693.05 Yes, there's a lot of interventions, but let's start preparing ahead of time so we don't have to make those rush decisions. 113 00:11:13,3.05 --> 00:11:20,393.05 And it also helps families in the end because we've had those conversations, we have that relationship with the patient and the family. 114 00:11:20,783.05 --> 00:11:24,503.05 So that we can say, let's go back to what we talked about a year or two ago. 115 00:11:24,503.05 --> 00:11:29,333.05 Let's go back to who you were 20 years ago and what was important to you. 116 00:11:29,603.05 --> 00:11:34,373.05 And now we're in this critical thing where we say, yes, I wanna do everything. 117 00:11:34,373.05 --> 00:11:36,743.05 But let's go back to that logical piece. 118 00:11:36,803.05 --> 00:11:41,453.05 And that's where developing the relationship with the palliative care team is so important. 119 00:11:41,723.05 --> 00:11:42,983.05 'cause we can get you back. 120 00:11:42,983.05 --> 00:11:46,643.05 Let's look at that whole picture, not this critical event. 121 00:11:47,843.05 --> 00:11:49,893.05 So I'm sorry to hear that. 122 00:11:49,893.05 --> 00:11:54,73.05 about your husband and you mentioned that you also have cancer. 123 00:11:54,673.05 --> 00:12:01,853.05 I had so he was diagnosed in 2019 and then 2020 hit when Covid wrecked our world. 124 00:12:02,273.05 --> 00:12:06,353.05 And then I was diagnosed in 2021 when the world was opening back up. 125 00:12:06,353.05 --> 00:12:08,713.05 I have, stage one breast cancer. 126 00:12:08,713.05 --> 00:12:15,43.05 So I had radiation, I had surgery and I'm in, we call it no evidence of disease or in remission. 127 00:12:15,373.05 --> 00:12:18,313.05 So mine is wrapped up other than medication. 128 00:12:18,623.05 --> 00:12:21,593.05 But it's been an interesting journey 'cause I'm working with cancer. 129 00:12:21,593.05 --> 00:12:21,623.05 I. 130 00:12:21,973.05 --> 00:12:27,643.05 I've been through it and then really seeing my husband through more of a palliative care case. 131 00:12:28,33.05 --> 00:12:31,573.05 We, with palliative care, oftentimes we work with new diagnosis. 132 00:12:31,573.05 --> 00:12:35,233.05 A lot of people stay with us in the middle course of the disease. 133 00:12:35,563.05 --> 00:12:38,293.05 'cause you're dealing with the physical symptoms you're dealing with. 134 00:12:38,623.05 --> 00:12:42,683.05 Planning for the future and the emotional and the spiritual part of it. 135 00:12:43,383.05 --> 00:12:48,123.05 Can you describe what your own experience has been? As long as you feel comfortable, obviously. 136 00:12:48,203.05 --> 00:12:57,943.05 In terms of palliative care, has it been like a group of people that have helped you? So my listeners understand 'cause a lot, again, a lot of people get confused. 137 00:12:58,13.05 --> 00:13:02,643.05 And they think I'm just writing them a script of, sending them to their deathbed when I'm not Right. 138 00:13:02,743.05 --> 00:13:17,243.05 So can you share that experience? What kind of people have you worked with under that palliative care umbrella? Yeah, and that's where we get that all the time and the importance, I think for your listeners, if you have a question just. 139 00:13:17,583.05 --> 00:13:20,793.05 Get more education, just talk to a palliative care program. 140 00:13:21,123.05 --> 00:13:22,593.05 You're not gonna get jinxed. 141 00:13:22,593.05 --> 00:13:28,803.05 It's not gonna mean that, you know the universe is gonna go against you, but just really trying to understand. 142 00:13:28,803.05 --> 00:13:32,913.05 But with my palliative care patients, basically we're an extra resource. 143 00:13:32,913.05 --> 00:13:35,433.05 We don't replace any of the other physicians. 144 00:13:35,433.05 --> 00:13:37,293.05 We're just an adjunct to that. 145 00:13:37,343.05 --> 00:13:43,583.05 I don't know the Latin word, but basically the word means to cloak to provide that extra support. 146 00:13:43,973.05 --> 00:13:49,413.05 So when we're coming in, we're like, let's treat you as a person, not as a, as a patient. 147 00:13:49,653.05 --> 00:14:00,753.05 Because if most of the times when you have a physician visit, you're coming in for 15 or 20 minutes, you're very focused on the physical, you're out the door, you get in the car, you have a bunch of questions you forgot to ask. 148 00:14:01,238.05 --> 00:14:03,368.05 palliative care is whoa, let's step back. 149 00:14:03,368.05 --> 00:14:18,488.05 Who are you as a person? What do you do for a living? What's your family like? What's important to you? What are your priorities? What are your hobbies? And as we get to know you as a person, it starts to make sense what the treatment options are for you. 150 00:14:18,488.05 --> 00:14:21,278.05 So if you're 95 and. 151 00:14:21,453.05 --> 00:14:24,723.05 You maybe love your garden and wanna be at home. 152 00:14:25,213.05 --> 00:14:31,943.05 Palliative care can talk about this is the advantage of hospice maybe, or this is the advantage of not going back and forth to the hospital. 153 00:14:32,483.05 --> 00:14:40,763.05 If you're, in your forties or fifties and you're working and you have high productivity, you're taking care of your kids, you're probably gonna want. 154 00:14:40,768.05 --> 00:14:50,338.05 Pretty aggressive interventions because you know there's a good likelihood of getting either back to where you were or to at least to be able to do things that are important to you. 155 00:14:50,758.05 --> 00:14:54,838.05 So palliative care, the first part is really getting to know you as a person. 156 00:14:54,838.05 --> 00:15:00,58.05 And then based on that, what is quality of life to you? And that's different for everybody. 157 00:15:00,548.05 --> 00:15:05,198.05 A lot of my patients have, they come in with pain or high anxiety. 158 00:15:05,718.05 --> 00:15:09,878.05 And sometimes other symptoms like bowel issues or nausea or things. 159 00:15:10,208.05 --> 00:15:21,118.05 So sometimes the first priority is let's get you physically feeling better and the palliative care physicians or nurse practitioners or specialists just in symptom management. 160 00:15:21,118.05 --> 00:15:21,868.05 they're not gonna. 161 00:15:22,423.05 --> 00:15:26,43.05 Prescribe radiation or prescribe, cardiac rehab. 162 00:15:26,343.05 --> 00:15:34,933.05 They're just simply there to say, how are you feeling and how can we medically address so that the one doctor's not giving a head of medication. 163 00:15:34,933.05 --> 00:15:35,653.05 The other is I. 164 00:15:35,653.05 --> 00:15:47,83.05 Giving a different, like how are they interacting? What are, what is right for you? So managing that, and then once we get the physical part, oftentimes the emotional part comes down. 165 00:15:47,83.05 --> 00:15:55,753.05 I had a patient just last week that was all physical and the chaplain and I were also in the room and we're just sitting back like, we don't know what's going on. 166 00:15:55,753.05 --> 00:15:57,223.05 We don't know what to talking about. 167 00:15:57,718.05 --> 00:16:01,518.05 And, he physically was just talking about all this nausea and pain. 168 00:16:01,968.05 --> 00:16:17,98.05 So then the doctor and the nurse did their part and the chaplain and I start talking like, how are you feeling? Like, how is this making sense to you? So then all of us had a discussion about, wow, we didn't know you did that for a living, or, we didn't know your kids were nearby or whatever. 169 00:16:17,638.05 --> 00:16:22,208.05 Started having this conversation and at the end of the session, he was like. 170 00:16:22,503.05 --> 00:16:23,643.05 It's so weird. 171 00:16:23,643.05 --> 00:16:25,383.05 I don't feel nauseous anymore. 172 00:16:25,383.05 --> 00:16:28,53.05 Like my pain feels better, and it was like. 173 00:16:28,908.05 --> 00:16:33,498.05 Being treated as a human feeling, listened to, and heard and seen. 174 00:16:33,978.05 --> 00:16:40,128.05 To me, that's better medicine than anything that we can do in terms of prescriptions and things. 175 00:16:40,458.05 --> 00:16:41,418.05 So that's palliative care. 176 00:16:41,418.05 --> 00:16:42,678.05 We slow it down. 177 00:16:43,8.05 --> 00:16:51,918.05 We try to get to know you as a person and then find out what your goals are, what your values are, so we can say in the lens that we know your. 178 00:16:52,298.05 --> 00:16:54,428.05 Your illness is going to progress. 179 00:16:54,728.05 --> 00:16:56,48.05 Let's plan for this. 180 00:16:56,48.05 --> 00:16:58,778.05 So we don't lose the humanity in the process. 181 00:16:59,888.05 --> 00:17:08,578.05 The nature of your practice, do you work independently? Do you work with a group or a hospital system? I'm just trying to understand how you function. 182 00:17:09,148.05 --> 00:17:11,453.05 And then also educate us. 183 00:17:11,513.05 --> 00:17:19,608.05 What kind of specialists would you be seeing in a palliative care team? so palliative care exists across settings. 184 00:17:19,608.05 --> 00:17:26,868.05 So in the beginning stages of palliative care, it was a lot of inpatient medical making critical decisions. 185 00:17:26,958.05 --> 00:17:31,508.05 And then it really evolved to my team we're outpatient. 186 00:17:31,508.05 --> 00:17:38,648.05 So you would get a physician and, physician order, and then you would see us the first visits like for an hour. 187 00:17:38,648.05 --> 00:17:40,868.05 And then we do monthly follow ups for a half hour. 188 00:17:41,423.05 --> 00:17:46,853.05 Sometimes our patients are getting more and more sick and it's hard to get out of the home. 189 00:17:46,853.05 --> 00:17:48,723.05 They're needing more eyes on. 190 00:17:49,23.05 --> 00:17:52,503.05 So then in home palliative care becomes an option. 191 00:17:52,993.05 --> 00:17:54,553.05 so it's various settings. 192 00:17:54,553.05 --> 00:17:57,123.05 And then there is palliative care in nursing homes too. 193 00:17:57,543.05 --> 00:18:01,458.05 My team in the outpatient setting, we have a physician we have a. 194 00:18:01,713.05 --> 00:18:03,483.05 Director who's a nurse practitioner. 195 00:18:03,483.05 --> 00:18:05,523.05 I'm a social worker therapist. 196 00:18:05,823.05 --> 00:18:07,983.05 We have a chaplain on the team and a nurse. 197 00:18:07,983.05 --> 00:18:12,963.05 And so we all have our own specialties, the nurse and the doctor or the physical. 198 00:18:12,963.05 --> 00:18:27,523.05 I'm more of the emotional, the chaplain is spiritual and existential, but we overlap because if we're gonna have four different meetings, different things are gonna come up and they don't always connect, but like with the patient with nausea. 199 00:18:27,848.05 --> 00:18:34,778.05 And pain, I'm guessing he had some anxiety about meeting with us, meeting with this four people on a team. 200 00:18:35,228.05 --> 00:18:36,878.05 one minute we're talking about pain. 201 00:18:36,878.05 --> 00:18:43,828.05 The next minute we're talking about anxiety or depression, and then we're going into, I feel punished by God that this is happening to me. 202 00:18:43,828.05 --> 00:18:48,498.05 Or how do I make meaning because, I feel like my life has changed because of this. 203 00:18:48,858.05 --> 00:19:00,508.05 So it's like these wormholes that are constantly, talk about one thing we get to somewhere else, and then as things come up in a more natural conversational flow, then you get to the bottom of it. 204 00:19:00,508.05 --> 00:19:06,628.05 Like people won't even know what to ask or what to say, but then there's certain clues that we'll say oh, okay. 205 00:19:07,108.05 --> 00:19:12,358.05 Maybe this is the issue and then we can present it and cross work together on that. 206 00:19:12,358.05 --> 00:19:19,348.05 So all of us have our specialties in within that group, but we also have training so that we overlap. 207 00:19:19,348.05 --> 00:19:24,598.05 So if the nurse isn't there, I have enough knowledge to say, okay, this sounds medical. 208 00:19:24,598.05 --> 00:19:32,938.05 Let me get the physician, the nurse involved, or if it's emotional, like trouble caregiving burnout or trouble accessing resources. 209 00:19:32,968.05 --> 00:19:34,738.05 Okay, let's move that to them. 210 00:19:34,948.05 --> 00:19:36,658.05 But there's a basic knowledge. 211 00:19:36,758.05 --> 00:19:37,538.05 Some of the. 212 00:19:37,568.05 --> 00:19:44,818.05 Teams in larger groups and things have palliative medicine, not necessarily the social worker or the chaplain involved. 213 00:19:45,148.05 --> 00:19:59,608.05 And so sometimes people get a referral to palliative medicine and it's important to ask are there other resources like either embedded in the team, the social work and the chaplain, or at least have some adjunct resources outside of that group. 214 00:20:00,928.05 --> 00:20:08,188.05 So we've talked a lot about palliative care educate us as to what hospice care is. 215 00:20:09,313.05 --> 00:20:14,623.05 So hospice is a service that really you're bringing the medical piece into your home. 216 00:20:14,653.05 --> 00:20:17,863.05 A lot of people think that hospice is a place that you go to. 217 00:20:18,253.05 --> 00:20:24,583.05 In some states, in some places there's hospice homes that you can pay for, usually privately. 218 00:20:24,953.05 --> 00:20:31,943.05 But generally hospice comes to you wherever you're at, whether if you're in a nursing home, if you're in assisted living, or you're in your own home. 219 00:20:32,448.05 --> 00:20:39,438.05 So hospice is generally prescribed based on Medicare guidelines as having a prognosis of six months or less. 220 00:20:39,708.05 --> 00:20:43,968.05 I have patients that have been on hospice for a couple years or even longer. 221 00:20:44,278.05 --> 00:20:55,648.05 But generally if we say the patient has a prognosis, if they had no curative focus treatment, it wouldn't be surprising that they would be at the end of life in the next six months. 222 00:20:55,958.05 --> 00:21:05,918.05 Hospice comes in where, like palliative care, you have a physician, you have nurse practitioner, social worker, chaplain nurse, and they come in and provide the care. 223 00:21:06,258.05 --> 00:21:08,958.05 They also provide, it's a bundled rate. 224 00:21:09,8.05 --> 00:21:12,458.05 Hospice comes in as a bundled rate, so they provide everything. 225 00:21:12,458.05 --> 00:21:15,8.05 So you have a crisis in the middle of the night. 226 00:21:15,8.05 --> 00:21:16,478.05 You don't go to the hospital. 227 00:21:16,508.05 --> 00:21:19,88.05 The nurse comes to you within an hour or so. 228 00:21:19,358.05 --> 00:21:21,38.05 They provide all your medications. 229 00:21:21,38.05 --> 00:21:29,948.05 They provide equipment like a commode or hospital bed or things, so that the goal is to keep you as comfortable as possible in the home. 230 00:21:30,183.05 --> 00:21:42,8.05 this is a really helpful benefit for people that are really like, I'm just going to the hospital all the time, or I'm having a hard time getting outta bed, but I need to go to all these specialists and it's not changing. 231 00:21:43,18.05 --> 00:21:46,738.05 I'm still on a trajectory where I'm at the last chapter of my life. 232 00:21:47,68.05 --> 00:21:54,848.05 So how can I have the best quality without trying to chase things that aren't gonna be cured? So it's an excellent benefit. 233 00:21:54,848.05 --> 00:21:58,898.05 And my frustration and probably yours, is that people don't. 234 00:21:59,193.05 --> 00:22:04,623.05 Allow for hospice until it's so late that they are in the dying process. 235 00:22:04,623.05 --> 00:22:06,363.05 Because I don't want hospice. 236 00:22:06,363.05 --> 00:22:07,473.05 This means I'm giving up. 237 00:22:07,473.05 --> 00:22:08,733.05 It means I'm gonna die. 238 00:22:08,793.05 --> 00:22:14,13.05 And so people wait to get on hospice and then they die within seven to 14 days. 239 00:22:14,63.05 --> 00:22:16,673.05 Every time I have a patient that starts. 240 00:22:16,928.05 --> 00:22:21,188.05 Sooner when hospice is recommended, they say, I wish I would've done this sooner. 241 00:22:21,188.05 --> 00:22:22,418.05 This is what I want. 242 00:22:22,418.05 --> 00:22:24,38.05 This is what's meaningful to me. 243 00:22:24,98.05 --> 00:22:29,618.05 And then that's where we're making the right decisions to have a peaceful death for that person. 244 00:22:30,18.05 --> 00:22:37,8.05 Rather than like my patient I discussed before where you're in the ICU and escalating care that probably they didn't really want. 245 00:22:38,388.05 --> 00:22:57,38.05 Thank you so much for sharing that, because I think that will actually help people understand the difference and also practitioners, because I think, there's confusion amongst people who see patients about what the difference is and when it can be useful for people. 246 00:22:57,308.05 --> 00:23:00,688.05 Obviously the palliative care provides. 247 00:23:01,73.05 --> 00:23:04,283.05 A holistic approach for patients. 248 00:23:04,903.05 --> 00:23:18,363.05 You were mentioning a patient that, you visit who had, who wanted everything and ended up having a tracheotomy and is now in a not so great situation. 249 00:23:18,933.05 --> 00:23:28,698.05 How do you talk to your patients about quality of life? Because this can be a very sensitive topic and. 250 00:23:30,83.05 --> 00:23:45,63.05 I often run into confusion, not just from the patient but from the family members as well, because the definition of quality of life can be different for the family member who is taking care of the patient possibly. 251 00:23:45,883.05 --> 00:23:48,763.05 And the individuals quality of life. 252 00:23:48,943.05 --> 00:24:01,318.05 How do you approach the patient and or their family members with that? And sometimes it's the same and sometimes it's different when you have a patient that's able to speak for themselves. 253 00:24:01,738.05 --> 00:24:11,88.05 I have a lot of patients with neurological issues like dementia, and so the burden is on the loved ones, the caregivers, to make those decisions about what quality of life is. 254 00:24:11,893.05 --> 00:24:28,293.05 But I think it goes back like today, what is quality of life to me as a 56-year-old? When I look at my future, how do I wanna live my final days? And then when a person gets to a place where their illness is really advanced, really evaluating. 255 00:24:28,813.05 --> 00:24:41,223.05 Who was Anne when she was 56? What was important to her? What things have changed? I imagine the end of my days watching prices, right? Eating potato chips, doing whatever I want. 256 00:24:41,553.05 --> 00:24:44,313.05 I do not wanna be in a rehab, exercising. 257 00:24:44,313.05 --> 00:24:45,693.05 I don't even wanna do that now. 258 00:24:46,83.05 --> 00:24:51,113.05 So that's I'm guessing that'll be my course as much as if that's a possibility. 259 00:24:51,383.05 --> 00:24:55,223.05 So remembering again, like who is that person? I have people that I. 260 00:24:55,798.05 --> 00:25:00,958.05 They're like, we just like being in the house and looking at the garden and I'm not asking for a lot. 261 00:25:01,78.05 --> 00:25:14,508.05 And other people that are like if I can't go to the gym, if I can't go to the senior center, be around other people, be talking, be connecting, then that's a different qual quality of life to consider. 262 00:25:14,508.05 --> 00:25:21,138.05 Because if I have a stroke and I am laying in bed and I can't communicate, I can't recognize my family. 263 00:25:21,703.05 --> 00:25:36,723.05 Would that be quality of life? And so having those conversations and just reflections as family members or the patient helps remember, let's put this in context of a person, not the patient, not the interventions. 264 00:25:36,963.05 --> 00:25:52,373.05 Because when you go to the hospital, when you're dealing with a lot of doctors, you're looking at what can we do to cure you? What can we do to extend life? And then you become a body, not a full, fully rounded person, right? That's where we look at what the quality of life is. 265 00:25:52,373.05 --> 00:26:05,533.05 And then within that, what's the story of your illness? Where your treatments, how is this looking if I take chemo and radiation, what does that look like for me in six months? Am I going to be. 266 00:26:05,928.05 --> 00:26:10,938.05 So sick that I'm gonna go in the hospital and I'm still not gonna be cured. 267 00:26:10,938.05 --> 00:26:16,398.05 That my illness is gonna get worse and maybe even more painful because of all the side effects. 268 00:26:16,698.05 --> 00:26:25,798.05 Or is it gonna be really bad now? But if I, white knuckle it through in a few months, I'm gonna be back to where I wanted to be. 269 00:26:26,158.05 --> 00:26:27,928.05 That, it's understanding. 270 00:26:28,193.05 --> 00:26:30,833.05 The medical perspective of where we're going. 271 00:26:31,163.05 --> 00:26:38,393.05 And then the other part, what's important, I had a, an oncologist that would say, let's just kick the can down the road a little. 272 00:26:38,843.05 --> 00:26:40,543.05 And I was like people aren't cans. 273 00:26:41,713.05 --> 00:26:48,493.05 And then, so then offline, the palliative care said what does that mean to kick the can down the road? Very. 274 00:26:48,868.05 --> 00:26:50,818.05 Very bad symptom issues. 275 00:26:51,68.05 --> 00:26:52,568.05 It'll give her another month. 276 00:26:52,598.05 --> 00:27:17,218.05 how do I want my last month to look like? If I know that either way I'm going to die? Do I wanna be in all this craziness of treatment and not feel well? Or do I want something like hospice and be comfortable and have time to say goodbye to my family in my home? quality of life just shifts as we get older, as our issues change, I have people that say, I want everything. 277 00:27:17,218.05 --> 00:27:19,168.05 I want every intervention possible. 278 00:27:19,168.05 --> 00:27:20,988.05 I have a I think he's about 60. 279 00:27:20,988.05 --> 00:27:22,248.05 He has a teenager. 280 00:27:22,458.05 --> 00:27:25,458.05 I wanna stay here till she graduates from high school. 281 00:27:25,758.05 --> 00:27:31,298.05 But as his condition changes, it's I don't know if I'm gonna live long enough for her to graduate. 282 00:27:31,298.05 --> 00:27:45,718.05 And so what do I do? To have the best quality of life, to have the best treatment I can to stay longer, but not suffer and not have her suffer watching me when, it's just, it's hurtful to everybody. 283 00:27:45,723.05 --> 00:27:48,453.05 I think, you touched on two that different things. 284 00:27:48,453.05 --> 00:27:51,773.05 One is that, and I don't come from a medical family. 285 00:27:51,773.05 --> 00:28:01,533.05 I'm the only doctor in my family, and so the world of medicine, When I finally started residency there were so many things that it was like an entirely new world for me. 286 00:28:01,533.05 --> 00:28:06,873.05 And one of the things that I learned is oncologists love to keep their patients alive. 287 00:28:09,543.05 --> 00:28:14,573.05 Oncologists And to the dismay of the cardiologist and the neurologist, It's true. 288 00:28:15,233.05 --> 00:28:20,33.05 Who already talked to them about advanced care planning and what they may or may not want. 289 00:28:20,603.05 --> 00:28:22,73.05 And it all goes out the window. 290 00:28:23,603.05 --> 00:28:32,313.05 And that's the hard part 'cause they're relying on, tried and true interventions or clinical trials and I don't know what it would be like to be a doctor. 291 00:28:32,313.05 --> 00:28:36,873.05 I think it's incredibly hard because a lot of people, especially the older generation, I. 292 00:28:37,63.05 --> 00:28:38,233.05 Doctor is God. 293 00:28:38,233.05 --> 00:28:41,173.05 And so if you tell me what to do, I'm gonna do it. 294 00:28:41,633.05 --> 00:28:46,523.05 My mom's a nurse and sh I grew up saying, being told, do not talk to doctors. 295 00:28:46,523.05 --> 00:28:47,783.05 Do not speak back. 296 00:28:48,23.05 --> 00:28:50,333.05 Don't ask questions, what they say do. 297 00:28:50,513.05 --> 00:28:54,653.05 And so it was this very patriarchal, kind of relationship. 298 00:28:55,83.05 --> 00:28:58,563.05 the newer doctors as they're coming up, it's more no, we're all kinda. 299 00:28:59,93.05 --> 00:29:00,683.05 On equal playing field. 300 00:29:00,683.05 --> 00:29:00,743.05 Yeah. 301 00:29:00,793.05 --> 00:29:01,723.05 this is your life. 302 00:29:01,723.05 --> 00:29:03,133.05 So let's have a conversation. 303 00:29:03,163.05 --> 00:29:03,643.05 Yes. 304 00:29:03,643.05 --> 00:29:05,623.05 I don't like that kind of role. 305 00:29:05,873.05 --> 00:29:11,88.05 So I don't necessarily take on that role that you just mentioned. 306 00:29:11,88.05 --> 00:29:16,58.05 And I understand that's probably a different generation of doctors that you're referring to. 307 00:29:16,58.05 --> 00:29:20,878.05 But I think also patients there's a whole lot of information that they have. 308 00:29:21,668.05 --> 00:29:27,188.05 And I tend to have smarter patients, so they do a lot of reading before they come in. 309 00:29:27,188.05 --> 00:29:35,108.05 So for me to say, I'm the boss of this, I'm the captain of this ship and you will do whatever I tell you to do, that would be a hardship to navigate. 310 00:29:35,643.05 --> 00:29:45,553.05 Yeah I think we need to be mutual partners, especially when it comes to certain obviously when quality of life and end of life issues start happening. 311 00:29:45,973.05 --> 00:29:49,603.05 So the other part of it is I come from two different backgrounds. 312 00:29:49,603.05 --> 00:29:53,348.05 I was born in the States, but I also have an eastern background. 313 00:29:54,83.05 --> 00:30:07,673.05 One of the things I've realized having studied a little bit of medicine in England was that the approach to end of life is very different when it comes to different countries. 314 00:30:07,913.05 --> 00:30:11,333.05 And I think in America, that's the other part. 315 00:30:11,333.05 --> 00:30:19,123.05 And I didn't realize this until I went to another country, and also understanding a little bit of how healthcare is in India. 316 00:30:19,633.05 --> 00:30:23,563.05 We tend to keep people alive for a long time. 317 00:30:24,733.05 --> 00:30:29,918.05 And yeah, with that, that comes, a whole different set of issues comes about. 318 00:30:29,968.05 --> 00:30:32,23.05 So you have to wonder why we do that. 319 00:30:32,113.05 --> 00:30:34,513.05 I'm not necessarily sure what the answer is. 320 00:30:35,293.05 --> 00:30:37,243.05 So I was mentioning to you that. 321 00:30:37,423.05 --> 00:30:39,43.05 Advanced healthcare planning. 322 00:30:39,523.05 --> 00:30:50,903.05 One of my struggles is even when I do address it, I'm not saying it happens all the time, but there are times when I address it and I don't say do you want everything? 'cause I'm like, what does that mean? right exactly. 323 00:30:51,753.05 --> 00:30:55,663.05 You have to be a little more specific, as to what questions you're asking. 324 00:30:56,63.05 --> 00:31:05,203.05 pull the plug So I often go through all these painful questions and sometimes I have to spell it out, okay, this is what's happening to you. 325 00:31:05,243.05 --> 00:31:07,103.05 This is a hypothetical situation. 326 00:31:07,103.05 --> 00:31:08,753.05 This is what's happening to you. 327 00:31:09,23.05 --> 00:31:15,753.05 What would you want us to do? And if they were like, okay, what do you mean? Do you want us to do chest compressions? Do you want us to. 328 00:31:16,148.05 --> 00:31:17,918.05 Put a tube down your airway. 329 00:31:17,968.05 --> 00:31:21,478.05 Sometimes it's not fun to have to talk to people that way. 330 00:31:21,558.05 --> 00:31:25,368.05 It's a crucial component though, of palliative care. 331 00:31:25,558.05 --> 00:31:34,8.05 What are some of the challenges that you experience when you talk to patients Talk to about advanced healthcare planning, who are facing this process. 332 00:31:34,8.05 --> 00:31:46,748.05 Maybe they're completely healthy or maybe they've been newly diagnosed with something, and how do you assist them during this process? I think like you're saying, the earlier the communication, the better. 333 00:31:46,748.05 --> 00:31:56,858.05 And my kids went off to college and we did an advance care directive because the number one thing I think is that you have to have a person that you trust that can speak for you. 334 00:31:56,858.05 --> 00:32:02,528.05 And if you go to the hospital and your neighbor is there and says, Hey, I'm the decision maker. 335 00:32:02,768.05 --> 00:32:05,948.05 And then the mom comes in and says, no, I'm the decision maker. 336 00:32:05,948.05 --> 00:32:10,968.05 It's like you're left to, your treatment provider's trying to figure that out. 337 00:32:10,968.05 --> 00:32:21,258.05 So it's really important to have a designated person and a person that you feel like will have your best interest, that can speak in your voice, not what they want, but what you want. 338 00:32:21,648.05 --> 00:32:23,388.05 And it's really a conversation. 339 00:32:23,388.05 --> 00:32:25,398.05 It's hard to have that one and done. 340 00:32:25,933.05 --> 00:32:31,723.05 And as, especially with my patients that have serious illness, their condition gradually changes. 341 00:32:31,723.05 --> 00:32:35,833.05 So quality of life changes, types of intervention changes. 342 00:32:35,893.05 --> 00:32:40,363.05 And so really revisiting that I know a year ago we talked about. 343 00:32:40,943.05 --> 00:32:42,623.05 Let's do chest compressions. 344 00:32:42,623.05 --> 00:32:47,273.05 Let's do everything because it's likely that your illness is gonna get better. 345 00:32:47,273.05 --> 00:32:59,573.05 But now we're in a different spot where your cancer's now in your bones, and if we do CPR, it means it's gonna crush your bones or you're gonna be in a lot more pain and your cancer's gonna continue to progress. 346 00:32:59,573.05 --> 00:33:06,593.05 So it's having that ongoing conversation and then also building up just a general trust and. 347 00:33:07,313.05 --> 00:33:19,913.05 I think the primary care physicians outpatient, even if you're not on palliative care, just you having that good relationship with your doctor so that in an emergency you can go back and say, Hey, doctor. 348 00:33:20,458.05 --> 00:33:22,318.05 I'm scared, I don't know what to do. 349 00:33:22,708.05 --> 00:33:28,258.05 And the doctor can go back and say we've had this discussion and this is what's really going on. 350 00:33:28,258.05 --> 00:33:32,338.05 When you have five different specialists telling you all these different things. 351 00:33:32,938.05 --> 00:33:41,978.05 What I see and I think it requires bravery on the treatment team's part to be able to lean in and to tell the truth. 352 00:33:42,8.05 --> 00:33:46,718.05 And I think a lot of times the medical profession, it's hard to tell the truth. 353 00:33:46,798.05 --> 00:33:49,78.05 My husband, we were, he's still. 354 00:33:49,528.05 --> 00:33:54,748.05 Figuring out the chemotherapy stuff, but the doctor said, probably chemo's on the table. 355 00:33:54,748.05 --> 00:33:58,648.05 And I've been doing this for years and my gut reaction was, it's okay. 356 00:33:58,648.05 --> 00:34:00,118.05 Chemo isn't gonna be that bad. 357 00:34:00,238.05 --> 00:34:01,288.05 It's the good chemo. 358 00:34:01,738.05 --> 00:34:05,28.05 And I just wanted to protect my husband you're not gonna get sick. 359 00:34:05,298.05 --> 00:34:09,548.05 Even though knowing what I know that it can be pretty brutal. 360 00:34:09,548.05 --> 00:34:11,348.05 So it's hard. 361 00:34:11,348.05 --> 00:34:12,158.05 It's really hard. 362 00:34:12,158.05 --> 00:34:16,898.05 And I think as healthcare professionals really leaning into our own. 363 00:34:17,648.05 --> 00:34:26,828.05 Our own, feelings about mortality and maybe our own knowledge that we're not, God, we can't save, we, we can't fix everything. 364 00:34:27,158.05 --> 00:34:33,363.05 And so learning that, how do we keep the humanity in the healthcare? But I think it, I. 365 00:34:33,423.05 --> 00:34:37,623.05 It's not a one and done conversation, it's something we keep needing to talk about. 366 00:34:38,433.05 --> 00:34:48,588.05 I think I, when I was a young resident versus now I think the priorities of not the priorities different word the. 367 00:34:49,643.05 --> 00:34:56,303.05 The goal if you wanna use that word, initially it was to save as many people as I could. 368 00:34:56,303.05 --> 00:35:02,123.05 And as I got older, I realized, okay, first, obviously, those words do no harm. 369 00:35:02,633.05 --> 00:35:04,313.05 Definitely come more into play. 370 00:35:05,138.05 --> 00:35:12,818.05 Then secondly, I was, I'm always about, making sure that people are their healthiest and happiest. 371 00:35:13,268.05 --> 00:35:19,248.05 And my goal is not always to, make you live the longest that you can. 372 00:35:19,348.05 --> 00:35:23,338.05 If that happens and you also stay healthy and happy, that's awesome. 373 00:35:23,738.05 --> 00:35:27,528.05 As we're not always in command of how that goes. 374 00:35:27,988.05 --> 00:35:46,268.05 The other difference that I see is that the cultural aspect is that it, I think in America, I think I, I think, how do I say this? there's, I think even amongst people, we, as a society I think there's like this. 375 00:35:48,443.05 --> 00:35:51,573.05 This belief that we're invincible. 376 00:35:51,573.05 --> 00:35:51,633.05 Yeah. 377 00:35:51,963.05 --> 00:35:54,213.05 And that nothing will happen to us. 378 00:35:54,213.05 --> 00:36:01,578.05 Whereas I think on a more Eastern, if you subscribe to this, you realize that we're not invincible. 379 00:36:01,873.05 --> 00:36:02,953.05 there's a finite. 380 00:36:03,248.05 --> 00:36:05,408.05 Aspect to everything. 381 00:36:05,838.05 --> 00:36:08,198.05 And I straddle both of those things. 382 00:36:08,318.05 --> 00:36:14,778.05 And I try to incorporate both of that with my patients, but it's often very difficult. 383 00:36:15,78.05 --> 00:36:37,488.05 So how do you teach? Doctors such as myself about how to effectively communicate with patients when it comes to these difficult conversations that we often need to have with people, I think it goes back to helping people or doctors to get in touch with their humanity. 384 00:36:37,918.05 --> 00:36:39,363.05 There's studies that show that. 385 00:36:40,23.05 --> 00:36:45,483.05 What the doctors prescribed to another patient that I would go to the ICU, I would do all these things. 386 00:36:45,933.05 --> 00:36:51,513.05 If you asked them what they would do for themselves, if they were in that situation, they would say, no, I don't want all that. 387 00:36:51,963.05 --> 00:37:05,703.05 As a, putting yourself in the other person's shoes, looking at the bigger story and what does that come up for Me as a professional that I am not able to fix everything, that I am not able to be that superhero. 388 00:37:05,703.05 --> 00:37:08,943.05 Not that I think most doctors go in that way. 389 00:37:09,398.05 --> 00:37:12,498.05 But there's just the, you're trained to, to heal. 390 00:37:12,498.05 --> 00:37:24,928.05 You're trained to fix things and when you can't, sometimes, physicians feel that's something on them that they didn't do enough and I think the other part is it's just really hard to sit and be in the room. 391 00:37:25,288.05 --> 00:37:31,728.05 And I see this when I work with the doctor and the nurse, I'll see a patient crying or really emoting and being scared. 392 00:37:31,728.05 --> 00:37:33,498.05 And the doctor and nurse are let's do this. 393 00:37:33,498.05 --> 00:37:35,418.05 Let's give medica, let's do something. 394 00:37:35,838.05 --> 00:37:44,778.05 And sometimes something is sitting back and just holding a hand or just letting the person cry and not feel like you have to fix it. 395 00:37:44,808.05 --> 00:37:50,368.05 And so helping, I guess doctors go to that softer place that it's okay. 396 00:37:50,758.05 --> 00:37:56,928.05 And I have, our doctor even gets frustrated sometimes and he is I feel like I'm just sitting there not doing anything. 397 00:37:56,928.05 --> 00:38:00,618.05 And it's okay, maybe the patient just needs to be heard. 398 00:38:00,978.05 --> 00:38:09,108.05 And that's where sort of the social work, the therapist, the chaplain part comes in because we are talking more what you're saying that. 399 00:38:09,573.05 --> 00:38:14,673.05 It's a life cycle and not everything is, gonna be, there's not a pill for everything. 400 00:38:14,673.05 --> 00:38:18,3.05 So let's step back and just be with the person. 401 00:38:18,33.05 --> 00:38:22,233.05 And oftentimes patients know how their illness is going. 402 00:38:22,233.05 --> 00:38:23,733.05 They know what's ahead. 403 00:38:23,733.05 --> 00:38:31,23.05 They might be scared, they might not wanna talk about it, but there's this weird codependence between the physician and the patient. 404 00:38:31,73.05 --> 00:38:35,813.05 I don't wanna tell you that I know my illness is getting worse and that I'm probably dying. 405 00:38:35,893.05 --> 00:38:41,623.05 Because I don't wanna disappoint you, the doctor who's invested so much time and energy on me. 406 00:38:42,13.05 --> 00:38:45,133.05 And then the doctor's saying, I don't wanna tell you that. 407 00:38:45,998.05 --> 00:38:58,98.05 This isn't going well because I don't want you to lose hope or I don't want you to be sad, or, and a lot of times I can speak for you, but a lot of the doctors I work with just, they have a hard time with the emotions. 408 00:38:58,98.05 --> 00:39:00,588.05 It's when the emotions get soft. 409 00:39:00,588.05 --> 00:39:01,68.05 It's ooh. 410 00:39:01,188.05 --> 00:39:02,928.05 I wasn't trained to do that stuff. 411 00:39:03,358.05 --> 00:39:04,528.05 Let's go back to science. 412 00:39:04,528.05 --> 00:39:09,848.05 Let's go back to the hard knocks, I still have, it's, I'm more used to it. 413 00:39:09,848.05 --> 00:39:10,593.05 I should say. 414 00:39:10,653.05 --> 00:39:15,33.05 Because I realize that I can't make everyone live forever, nor do I want to. 415 00:39:15,513.05 --> 00:39:18,983.05 But I still feel that I've. 416 00:39:19,383.05 --> 00:39:19,983.05 Failed. 417 00:39:20,313.05 --> 00:39:27,283.05 It's almost this feeling of failure that, and I'm like, okay, but this person, and then the other side of me is okay, that person was 95 years old. 418 00:39:27,843.05 --> 00:39:29,13.05 99 years old. 419 00:39:29,13.05 --> 00:39:36,148.05 What were you trying to do there? Not that I was actually trying to make them live longer than that but it's just It's It's very difficult. 420 00:39:36,148.05 --> 00:39:40,718.05 And often their family members, even if they're not my patients, often they are. 421 00:39:40,768.05 --> 00:39:46,258.05 You see it in their eyes and it's like, how do I look at them with the compassion and still. 422 00:39:46,918.05 --> 00:39:47,938.05 Telling the truth. 423 00:39:47,998.05 --> 00:39:48,28.05 Yes. 424 00:39:48,113.05 --> 00:39:49,73.05 It's really hard. 425 00:39:49,163.05 --> 00:39:49,253.05 Yes. 426 00:39:49,253.05 --> 00:39:56,603.05 I think it's about saving their dignity and their grace in their lifecycle because we can't fix everything. 427 00:39:57,83.05 --> 00:40:04,223.05 And if we're talking about saving to the nth degree when a person, if they knew better, they may not make those choices. 428 00:40:04,583.05 --> 00:40:08,783.05 It's really about how can we preserve the humanity so that people. 429 00:40:09,483.05 --> 00:40:14,753.05 Whatever the course of illness is they're feeling like human beings and not just Yeah. 430 00:40:14,753.05 --> 00:40:16,73.05 A science experiment. 431 00:40:16,223.05 --> 00:40:16,583.05 Yeah. 432 00:40:17,303.05 --> 00:40:30,123.05 I don't and I'm thankful for it because I don't think it's meant for me to see, but it often sometimes comes up like, is this how you want to remember? Your parent or your loved one? Yeah. 433 00:40:30,153.05 --> 00:40:34,253.05 Is this how, let's say that person can't make those decisions anymore. 434 00:40:34,253.05 --> 00:40:35,963.05 Is this something that you want to. 435 00:40:36,478.05 --> 00:40:37,408.05 Continue. 436 00:40:37,458.05 --> 00:40:48,398.05 And have you ever had conversations with them as to what they would or wouldn't want? Sometimes even after the, in the aftermath, you're still having those kind of discussions. 437 00:40:48,808.05 --> 00:41:03,438.05 With family members I often see multiple generations of people in a family, I'm still having those conversations even though I'm not in the hospital because I'm taking care of that person's son or daughter, or even right. 438 00:41:03,708.05 --> 00:41:04,608.05 Grandchildren. 439 00:41:04,858.05 --> 00:41:09,268.05 And you're probably the one that they trust the most because you've had that relationship. 440 00:41:09,318.05 --> 00:41:15,478.05 Trusting your outpatient doctor is really an essential part because you're the sort of the neutral person. 441 00:41:15,958.05 --> 00:41:25,858.05 But then I think for doctors also, like when you're describing these really complex relationships and intergenerational, there's grief, I think for the doctors too, that Oh, yeah. 442 00:41:26,298.05 --> 00:41:28,278.05 I don't wanna lose this person. 443 00:41:28,278.05 --> 00:41:32,638.05 I'll with my patients, we've seen patients for years and it's oh, that hurts. 444 00:41:32,638.05 --> 00:41:33,598.05 That one hurts. 445 00:41:33,648.05 --> 00:41:35,238.05 And you move on. 446 00:41:35,718.05 --> 00:41:39,258.05 But it's allowing space for yourself too, that it's o okay. 447 00:41:39,258.05 --> 00:41:40,788.05 That we have feelings about it. 448 00:41:40,788.05 --> 00:41:40,848.05 Yeah. 449 00:41:40,878.05 --> 00:41:42,378.05 We're, it's just human. 450 00:41:42,388.05 --> 00:41:44,698.05 We should be connecting on that level with people. 451 00:41:44,748.05 --> 00:41:46,98.05 That's what good care is. 452 00:41:46,518.05 --> 00:41:49,848.05 I, in New Jersey, we do have medically assisted suicide. 453 00:41:50,388.05 --> 00:41:50,778.05 Yeah. 454 00:41:50,878.05 --> 00:41:55,258.05 So I do have one patient and she ultimately decided not to do it. 455 00:41:55,658.05 --> 00:42:05,178.05 But when I got a letter saying that this was the step that she was going to take, I was the one who was like, oh, no, don't do it. 456 00:42:05,228.05 --> 00:42:05,828.05 yeah. 457 00:42:07,718.05 --> 00:42:09,188.05 Not knowing anything. 458 00:42:09,238.05 --> 00:42:11,698.05 But yeah, I was like, please don't do that. 459 00:42:12,898.05 --> 00:42:14,368.05 Like you're my baby. 460 00:42:14,368.05 --> 00:42:14,818.05 Keep going. 461 00:42:17,848.05 --> 00:42:18,268.05 It's hard. 462 00:42:18,598.05 --> 00:42:19,293.05 It's really hard. 463 00:42:19,358.05 --> 00:42:27,878.05 But I think it's just, it's such a complicated relationship 'cause you're holding bodies to put them together to live longer. 464 00:42:28,298.05 --> 00:42:38,228.05 But then you're also holding the hearts that these are people like, these people, like wedge into your heart where they matter and so it's a lot of responsibility. 465 00:42:38,278.05 --> 00:42:48,470.05 That doctors have, and it makes sense to me that sometimes it just, it's really hard to have those complex discussions because we don't wanna be the ones, to, We don't. 466 00:42:48,475.05 --> 00:42:53,118.05 But it, it's a burden that comes, if you wanna call it a burden. 467 00:42:53,118.05 --> 00:42:54,83.05 It's a responsibility. 468 00:42:54,233.05 --> 00:42:54,523.05 Yeah. 469 00:42:54,763.05 --> 00:42:59,982.05 A responsibility that we have, to make sure that if we can give a person. 470 00:43:00,672.05 --> 00:43:05,952.05 The best end of life, then that's a responsibility that we should take. 471 00:43:05,952.05 --> 00:43:06,12.05 Yeah. 472 00:43:06,162.05 --> 00:43:07,92.05 It's not a burden. 473 00:43:07,92.05 --> 00:43:07,152.05 Yeah. 474 00:43:07,477.05 --> 00:43:10,957.05 'cause we are not always lucky enough to have that. 475 00:43:11,387.05 --> 00:43:16,637.05 But if we can provide that for someone that's actually a privilege and an honor. 476 00:43:16,637.05 --> 00:43:21,647.05 And so when, there are times when I know that, okay, my patient, who I've known for. 477 00:43:21,912.05 --> 00:43:27,557.05 God knows how long and they passed away peacefully and they lived the best life. 478 00:43:28,242.05 --> 00:43:29,82.05 That they can. 479 00:43:29,242.05 --> 00:43:32,192.05 It's an honor to be able to say, okay, I was a part of that. 480 00:43:32,762.05 --> 00:43:33,602.05 It really is. 481 00:43:33,722.05 --> 00:43:34,22.05 Yeah. 482 00:43:34,72.05 --> 00:43:37,102.05 But then also knowing, and I find this with palliative care too. 483 00:43:37,102.05 --> 00:43:45,322.05 Obviously we're dealing with a lot of complexities but really holding space for ourselves in each other that this is hard work that we're doing. 484 00:43:45,322.05 --> 00:43:57,892.05 And I think for most of us, for me, it's a calling This is what gives me meaning, but it doesn't mean that I'm not human and that the cumulation of patients and special ones that they're not gonna hit me. 485 00:43:57,892.05 --> 00:43:58,642.05 They are. 486 00:43:58,972.05 --> 00:44:10,152.05 And so how do I take care of myself so I can maintain that objectivity? 'cause it weighs on you if you don't provide yourself the compassion and space to let those feelings out. 487 00:44:11,132.05 --> 00:44:11,882.05 Of course. 488 00:44:11,882.05 --> 00:44:27,752.05 And I think, for those of us who deal a lot, and I think that includes primary care physicians, oncologists, there are certain specialties where we're frequently seeing this and dealing with patients who are closer to the end of life. 489 00:44:27,932.05 --> 00:44:36,637.05 I think it's important that we, have professional care ourselves where we have an outlet where we can talk to someone. 490 00:44:37,782.05 --> 00:44:43,122.05 Objectively and in a safe space where we can let out our emotions and be safe. 491 00:44:43,842.05 --> 00:44:43,932.05 Yes. 492 00:44:45,102.05 --> 00:44:50,232.05 So we've learned a lot from you, Ann, and honestly, it, I think this will be a. 493 00:44:50,957.05 --> 00:44:59,507.05 great listen for anyone who wants to learn about palliative care and hospice care and how we can, really help people. 494 00:44:59,807.05 --> 00:45:22,417.05 What haven't we talked about that you would like to include in the podcast? I think the only thing I would say is that, even as much as we've talked about it, there's just so much confusion and just being okay to ask questions to I'm on TikTok, so a lot of times I'm like, there's so much information on there or on YouTube where social media, just to get like basic. 495 00:45:22,792.05 --> 00:45:33,647.05 Put the questions out there and see but then also talking to professionals that it doesn't hurt you to call a hospice company or to call a palliative care and just say, I don't really know if this. 496 00:45:34,652.05 --> 00:45:37,652.05 It was helpful to me, but just wanted to get more information. 497 00:45:38,42.05 --> 00:45:45,92.05 And if you for instance, called me and said, I don't really know, and I say, you're seem like you don't need palliative care. 498 00:45:45,452.05 --> 00:45:51,942.05 I have enough experience to know what, maybe you need chronic pain or maybe you need some other avenue that we have. 499 00:45:52,592.05 --> 00:45:58,112.05 A lot of experience and the doctors have a lot of experience to know where to plug you in. 500 00:45:58,112.05 --> 00:46:09,732.05 So just not being afraid to take the risk and especially we're talking about palliative care, how much of a support it is that just don't be worried about the semantics of it. 501 00:46:09,732.05 --> 00:46:11,352.05 Just go in with an open mind. 502 00:46:11,352.05 --> 00:46:24,892.05 If my listeners did want to find you on TikTok or Instagram or on your website where should they go to get that information? my website is ww w ann a NE front.com. 503 00:46:24,892.05 --> 00:46:26,572.05 So ann front.com 504 00:46:26,932.05 --> 00:46:30,192.05 and then the TikTok is the palliative therapist. 505 00:46:30,192.05 --> 00:46:41,622.05 So you can find me there I started the TikTok because I keep answering the same questions over and over again, and it tells me there's so much information that's wanted, but not out there. 506 00:46:41,622.05 --> 00:46:44,932.05 whatever you can do to educate, ask the questions. 507 00:46:44,932.05 --> 00:46:50,602.05 There's a lot of help out there and with serious illness, people feel so isolated and alone. 508 00:46:50,702.05 --> 00:46:51,842.05 that breaks my heart. 509 00:46:51,842.05 --> 00:46:52,682.05 I would rather. 510 00:46:53,17.05 --> 00:46:56,567.05 Connect people so that you feel like we're all in this together. 511 00:46:57,167.05 --> 00:46:59,327.05 Thank you so much for joining us today. 512 00:46:59,687.05 --> 00:47:00,317.05 Thank you for having me. 513 00:47:01,7.05 --> 00:47:07,817.05 Yes, this is a great topic and I think it really will help a lot of people in terms of understanding. 514 00:47:08,67.05 --> 00:47:11,337.05 what palliative care is and how important it is. 515 00:47:11,387.05 --> 00:47:12,197.05 To healthcare. 516 00:47:12,747.05 --> 00:47:13,857.05 Thank you for all you do. 517 00:47:13,907.05 --> 00:47:18,467.05 You're on the front lines, so I really appreciate all the work you do. 518 00:47:19,737.05 --> 00:47:22,167.05 Honestly I enjoyed talking to you so much. 519 00:47:22,347.05 --> 00:47:25,17.05 So you're always welcome to come back and Thank you. 520 00:47:25,272.05 --> 00:47:26,307.05 You can talk more. 521 00:47:26,602.05 --> 00:47:26,992.05 I'd love that. 522 00:47:27,82.05 --> 00:47:27,292.05 Yeah. 523 00:47:27,342.05 --> 00:47:31,592.05 This will be available on Apple Podcasts as well as YouTube. 524 00:47:31,962.05 --> 00:47:32,982.05 Thank you for your time. 525 00:47:32,982.05 --> 00:47:35,112.05 It was really nice to have this discussion. 526 00:47:35,112.05 --> 00:47:39,212.05 And don't forget to like, share and review my podcast. 527 00:47:39,762.05 --> 00:47:43,552.05 Remember, it's always ladies first on Soma Says. 528 00:47:43,852.05 --> 00:47:47,512.05 Let's make a difference one conversation at a time.