Demystifying Hospice: When, How, and Why It Matters w/ Karissa

#181: Death doesn't have to be a cold, clinical experience tucked away in hospital corners. Yet the word "hospice" still strikes fear in the hearts of so many, often because we fundamentally misunderstand what hospice truly offers.

In this profound conversation with Karissa, a veteran hospice nurse with eight years of experience across four different states, we peel back the layers of misconception surrounding end-of-life care. "If death is inevitable, it matters where and when and how," she explains, challenging our cultural tendency to avoid these conversations until it's often too late.

What exactly happens when hospice steps in? Far from being just for the imminently dying, hospice provides comprehensive support for both patients and families, sometimes for years rather than days. Karissa walks us through the full spectrum of resources available – from 24/7 nursing support and equipment to spiritual care and family counseling – all covered 100% by Medicare and Medicaid. We explore the telltale signs that it might be time to consider hospice for conditions like CHF, COPD, Alzheimer's, and cancer, and why waiting too long often leads to preventable suffering.

Perhaps most beautifully, Karissa describes her role as "midwifery for the dying," drawing a powerful parallel between how we usher life into this world and how we can compassionately guide it out. 

Whether you're a healthcare provider hesitant to broach this topic with patients, a family member wondering if it's time to consider additional support, or simply someone wanting to understand this inevitable part of the human experience, this episode offers practical wisdom, honest insights, and unexpected moments of lightness in what's typically considered a heavy subject. Listen, share, and join the conversation about making the end of life as meaningful and comfortable as possible.

You can now send us a text to ask a question or review the show. We would love to hear from you!

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Episode Transcript

Johnna (00:00):
What is up everyone?
Welcome back to another episodeof the Babbles Nonsense podcast
.
Before I get into what today'sshow is about, I want to first
apologize.
My mic is a little echoey inthe interview so I got to figure
out some equipment issues, butit's still a great interview
nonetheless.
Over here at Babbles Nonsense,you know that this is the show
where we do, you know, havemalfunctions with equipment, but

(00:21):
we also talk about the messy,the meaningful and sometimes
misunderstood parts of life.
Today's episode is one I havebeen wanting to have for a very
long time, because we're talkingabout something that touches
all of us but still feels tabooto say out loud, and that topic
is hospice.
I'm sitting down with anincredible hospice nurse and her
name is Carissa.
She's going to help pull backthe curtain, not just on what

(00:41):
hospice is, but what it isn't.
We're breaking myths, talkingreal emotions and even comparing
how an ER nurse and a hospicenurse can see quote-unquote
emergencies very differently.
If you've ever wondered whenhospice is actually needed, why
it's often called too late orhow we can stop treating it like
a scary last resort, thisconversation is for you.
Let's talk about death withhonesty, compassion and a little

(01:04):
bit of humor Because, yes, wecan all still laugh through the
heavy stuff.
Let's get into the interviewNonsense Podcast.

(01:27):
Today I'm sitting down with ahospice nurse, ms Carissa, that
I recently met and she just blewme away with the knowledge that
she had about hospice.
And, considering I do have amedical background that we
recently started talking abouton the podcast I don't know why
a long time I wasn't talkingabout it, but I thought you
would be the perfect person tokind of help guide this

(01:47):
conversation, because I thinkthis is a conversation that
needs to be had to kind of breakthat taboo-ish term hospice
away from other people.
Definitely so.
Welcome to the Bowels NonsensePodcast, thank you.

Karissa (01:59):
Thanks for having me.

Johnna (02:00):
Absolutely so.
First, I want to know a littlebit about you.
Like I know I've met you andwe've talked, so I know that you
came from the Chicago area yes,and I want to know, like, what
like is that where you'reoriginally from, in Chicago?
Yes, and what drove you to moveto Huntsville?

Karissa (02:18):
Okay, so I have been doing hospice for eight years.
I've been a nurse for 10 years,and I did grow up in Chicago.
I knew immediately in nursingschool that I wanted to be a
hospice nurse.
I have really good professors,though.
That told me maybe you shouldtry practicing your skills first

(02:42):
on the floor, and so I did that.
I did cardiac nursing for twoyears at the University of
Chicago and then I went intohospice.

Johnna (02:49):
And you said you've been doing hospice for how long?
Now?
Eight years, wow, that's a longtime for especially hospice.
Because what's the burnout rate?
Is it?
Is it 10?
Yes, so you're giving up onyour burnout rate?
Yes, Because I was in emergencycare for a total of let's see.
I started in 2011 to 22.

(03:11):
So, yeah, with a six-monthstint in trauma, which was no
different, so I hit my burnoutrate, especially with COVID.

Karissa (03:19):
Definitely.

Johnna (03:20):
Yeah, which I'm sure you saw a lot during COVID as well
we did.

Karissa (03:23):
Originally we did not take COVID patients.
At the time there was someuncertainty about it, and then,
obviously, as the deaths rose,we were able to start taking on
COVID patients and bringing themhome safely to pass away.

Johnna (03:38):
But you mentioned earlier.
You were like you knew when youwent into it, or before you you
went into it, that you wantedto be a hospice nurse.
Can you kind of explain how youknew?

Karissa (03:47):
that.
Yes, there was a moment innursing school and we had a
slide.
That was very minimal and itwas at the very last year of
nursing school.
We didn't really even talkabout hospice that much.
We don't right yeah and it wasjust one slide and she briefly

(04:10):
went over what hospice was whatwe do with it in nursing and
honestly it was like a warmlight went over me and you were
just like and I knew I was likethis is what I'm meant to do.
That kind of just gave me likewhole body chills.

Johnna (04:24):
Yeah.

Karissa (04:25):
It really is a calling .
You have to have that callingto do it.

Johnna (04:32):
I think it's also a personality trait.
Like you, have a very caringwhich and I've mentioned this on
my podcast before like peoplethink all nurses are that
nurturing, caring when we're not.
I think there's a place for itand a time for it.
Like me, being in the ER for aslong as I was, I did become very
cold and I'm going to get tothat conversation that you and I
had when we first met, but,like I think it was more because

(04:53):
you don't want to get close toyour patients in the ER, because
if I am sitting with a patientthat just passed and then I
still have a 12 hour shift to do, do, and it's maybe trauma or,
you know, a kid's sick orsomething you have to be able to
immediately, at that moment,move on to the next, you don't
have that time to debrief.

(05:14):
You know, whatever it is youmay do at home to like get
yourself back together for thenext day, you don't have that
time in the ER.
So I think you start slowlybuilding this wall that you
didn't realize you were building.
Yes, definitely, and I don'tknow if you do that in hospice
as well as a nurse to guard yourheart.

Karissa (05:30):
You can definitely experience a type of burnout and
we call that compassion fatigue.
Okay, yeah, that makes sense,you know, once you recognize
that it's time to step away fora little bit.

Johnna (05:45):
Have you ever had to do that?

Karissa (05:46):
like step away.
I did, I did.

Johnna (05:48):
Uh, it was after covid, after covid, that's when I I was
like I can't do this because,but I mean honestly, if you
think about it, like the erhospice, um, what other those
were?
in the icu so hard with you know, disease process, that was new,
but diving into hospice alittle bit deeper.

(06:09):
So for you, in your terminology, what does hospice mean to you?
Because I know, like, when Ihear it's not coming from the
hospice world or maybe I'vetalked to patients, families and
I'm not the best at it becauseI'm not from the hospice world
they immediately think no, no,no, that means I'm dying
tomorrow.

(06:29):
So to you, if you had toexplain it to someone, what does
it mean to you and how wouldyou explain it to someone?

Karissa (06:36):
Hospice is end-of-life care and if I could put it in a
couple of sentences, I wouldsay if death is inevitable, it
matters where and when and howso we receive these terminal
diagnoses.
It matters.
What do we do now?
And a lot of times a lot offamilies think they hear six

(07:00):
months and they say I think theyhave longer and that could be
so they could have longer thansix months.
This is true.
That's just a window that weuse when we say the disease, if
it takes its natural course,that, yes, the patient could
pass in six months, buttypically diseases don't take a

(07:21):
natural course, so we havepatients that are on hospice for
years.

Johnna (07:25):
For years, because I've seen, I've met patients I think
one was on for three years orsomething like that, and they
were.
I mean, it's such I'm trying topick up the words like it's so
like, because even after I metyou and I've identified more
patients like going forward,it's just such a it's almost
like a weight lifted off thatpatient's shoulder, because

(07:45):
sometimes I feel like patientsaren't doing it, like maybe they
in their heart know that's theright decision for themselves,
but maybe family's not ready, orvice versa, family's already,
patient's not ready.
So how do you navigate thatconversation when you're well?
First let's talk about whatdisease processes do you see
that should or could go tohospice.

Karissa (08:07):
Typically we see a lot of CHF, which is congestive
heart failure, COPD, pulmonarydisease and Alzheimer's.
Patients are taking care ofthem later than what we're

(08:28):
supposed to because we're notseeing, maybe clinically, as
many symptoms to alert us thatthey are at the end stage of
their disease.

Johnna (08:33):
I agree.
I agree with that because I dowork a part-time job.
I don't even know if I'vetalked about this on the podcast
.
I do work a part-time joboutside of my full-time job,
where I'm in assisted livingsand memory cares, and ever since
meeting you, I've even startednoticing patients that I'm like,
oh no, they probably should goto hospice, and that one's a

(08:53):
hard one that I've found havingconversations with families
because the patient doesn't looksick, right.

Karissa (09:00):
So that's where it's hard.
Yes, definitely, andAlzheimer's can be a disease
that goes on for so many years,and a lot of times the families
become complacent as well, andthey don't know how to recognize
those symptoms either.
That Alzheimer's is.
Even though the patient mighthave been diagnosed 10 years ago

(09:21):
, it's still a disease that willlead to their death.

Johnna (09:25):
Do you have a lot of cancer patients?

Karissa (09:27):
We have a lot of cancer patients.
However, typically we'll getour cancer patients towards the
very end of life, unless thatpatient is advocating for
themselves and saying, no, Idon't want treatment.
That would be someone whereI've had patients that were like
in their 80s right and they'rediagnosed with cancer and they

(09:50):
are very strong on.
There's no reason for me to dochemo.
I'm 87.
I don't want to do chemo.
And then we'll receive them atthe end of life.
Typically we'll have them for alittle while longer than our
younger cancer patients we'llhave them for a little while
longer than our younger cancerpatients.

Johnna (10:11):
Right, I've noticed that , like my uncle for one, he in
my opinion did not have probablythe best death he could have
had, if he maybe.
And this was when I was still anurse, so I didn't know much
about like I knew what welearned the one slide nursing
school and he was in Tennessee,so it wasn't like I was his, but
I feel like I kind of failedhim because I should have
educated him a little bit more.
I knew what his wishes were andhe had COPD and he also had

(10:33):
lung cancer and his wishes wereno intubation.
You know I'm giving up chemo.
I've lived a good life becausehe was older and unfortunately,
you know, he passed out at homewith his brother when it scared
him.
So you know they decided tointubate him.
He didn't, you know, have theproper paperwork in place.

(10:53):
I don't believe.
And so then you know he wastaken to the ICU and things like
that, and immediately when hewoke up, you know he was
coherent, he was awake, he wasable to write and he wrote get,
get this tube out of me.
He tried to take it out himself, which led him into restraints
and you know the whole process.
But then he had to then, youknow, be extubated and then pass
away in a hospital versuspassing away at his home.

(11:16):
That he told me that's what hewanted.
So I like, after seeing thatand knowing that, and then I
worked with the doctor, dr willWilliams.
I'm not sure if you're familiarwith her in town, but she is a
huge hospice advocate and wrotea book called Death and Dying
and she talks about how we talkabout it too late from and she
was talking about it from anemergency room doctor's

(11:36):
perspective, saying she has, shehates having to apologize to
patients and families, sayingI'm sorry, this is the first
time you're meeting me and I'mtelling you, it's probably time.

Karissa (11:46):
Yes, yeah, definitely.
You bring up a lot of greatpoints.
You know, as nurses too, we allhave that moment with our
family member that we feel likethat we could have done enough.
We could have done more, Ishould say, or we didn't do
enough.
So I understand your viewpoint.
With that, one of the importantthings that hospice actually

(12:06):
helps with is advanced planning.
So when families come to us andpatients come to us, we are
able to help them with their POApaperwork, living wills, dnrs,
and we have an entire team ofworkers that's able to help with
that planning.
So your uncle in that eventmaybe would not have been

(12:27):
intubated.
And we also do what's calledcompassionate extubations.
So we are available and presentat the hospital with the
families while that process istaking place, and we're also
guiding those nurses there, theICU nurses.
They really appreciate us beingthere because intubations is

(12:48):
their specialty, but notextubations, right.

Johnna (12:51):
It's a specialty anyways to like, like you said, have
that compassion with the family,to bond with that family and to
be able to walk them throughthat step by step.
Yes, Because I found that wasthe most difficult thing for me
in the ER, when it was somethingtraumatic or difficult like
that.
I found that hard because I hadbuilt that wall so high.
Yes, I didn't know how to tearit down, to be able to sit there

(13:12):
and go.
It's okay, you know.
No, I worked in the ICU for ayear and I, you do do that.
You sit with families, you holdtheir hands, you do those
things.
But in the ER we didn'ttypically typically, I'm not
saying we didn't do it any- itwasn't a norm.
Because you're seeing, you'reusually not seeing critical,
critical patients now again likeyou're in the ER.
You see a lot of just likenormal abdominal pain chest pain

(13:36):
not everyone is dying when theywalk into the ER right which is
what people expect from TVshows.
Um, but what would you say?
Because that's something Ithink that we don't do well
enough, even educating nursingstaff.
Because your nurses are thefirst line to that patient and
if I had a lot of nursingfriends listening to this, what

(13:58):
would you say?
When to advocate, advocate, howto advocate and how to start
that discussion, even if you'rescared and don't know what to
say.

Karissa (14:08):
Yes, definitely Pull in your resources, definitely,
of course, start with yoursupervisors, charge nurses, and
start there.
If they don't have the properresources, go a little higher up
.
Lean on those hospice companieswhen they come in.
When they come in, takeadvantage of those opportunities

(14:29):
when they are dropping offpamphlets, booklets, introduce
yourself.
If you feel a calling.
It's likely, because you'llapproach that you'll have that
situation or maybe something satuneasy with you.
Maybe you had a patient that youfelt like what would have
happened if I was morecomfortable to talk about
hospice with them.
So, definitely pulling on yourresources, going out to those

(14:51):
CEU events even, and learningmore about hospice so that
you're comfortable and confidentwhen you're able to sit down
and talk to those families.
Last but not least, again, ifyou need to call in a hospice
company to have a conversationwith the family, that is our
specialty, that is what we do.
So we have the time, whereasyou may only have five, 10

(15:13):
minutes, but you really fill inthis pool that this patient
needs hospice.
Call in your local hospiceliaisons.
They're able to do that,they're able to spend time.
I've had informationals lasttwo hours even, but that is what
I do.

Johnna (15:28):
Right, and I know when I first met you and we were, you
know it was over a hospicepatient, obviously, and I was,
and we were talking and that wasthe first question I asked you.
I was like I don't knowsometimes how to approach this
conversation with family or thepatient itself, because
sometimes you know, you learnyour patient and sometimes
you're like I don't think thispatient is ready to hear this.

(15:50):
And you gave me the best advice.
You said all it takes is asimple consult.
You can tell the family that.
You can tell the family like,hey, this is, this is a resource
, you know, do you want to hearwhat they have to say?
Just to get you in the door,because you're going to explain
it and sell it way better thansomeone who doesn't have that
experience.
So that was the best advice yougave me that day.

Karissa (16:10):
Yes, definitely, and that's what I was going to say
too, is we don't come intypically and just say, hi,
we're hospice, because they'regoing to just shut right down.
No, I don't want you, I don'tneed you.
That fear rises.
But when you say it in adifferent way, how would you
like to discuss more resourcesfor your loved one, your mom,

(16:33):
your dad, so that we can getsome more support in here, right
?
Typically, families are alittle more open to that
viewpoint.
Once I come in and I explaineverything I do, nine times out
of 10, they don't care what it'scalled.
They know that they need it.

Johnna (16:48):
Right.
Well, I told you, and I'll justkind of give an example, I had
a patient not too long ago thatAlzheimer's over 100 years old.
Which, wonderful for her Likeshe, you know, walking around
didn't look sick because it wasthat Alzheimer's disease.
but was starting to fall moreand starting to not want to eat,

(17:08):
refusing her medications.
And so the family, you know,had a conversation with the
family and I was like, have youever considered hospice?
You know that might besomething she's ready for.
And he was like she's not readyfor that.
And that's when I said okay, Iwas like you know, that's okay
if you're not ready, but this isjust something, maybe just to
hear what they have, theservices they offer, maybe they

(17:29):
have more nursing staff that canhelp.
So I did exactly and he thenwas like, okay, yeah, I'll hear
them out yes and called you in.
They heard you out and guesswhat?

Karissa (17:37):
yeah, they're on hospice.
Yes, exactly it worked.
Yes, it does initially.

Johnna (17:42):
That initial thing was no, she's not ready, and I was
like well, I think she could be.
But that's also a specialty.
It's no different, I guess,than sending someone to a
cardiologist for a heart problemor sending someone to the
oncologist for cancer.
You know, it's anotherspecialty.
Let's bring in someone whoknows how to talk about this in
a more compassionate way.

(18:02):
Who can bring it up?
So it's not like that immediate.
Like I said, it's very taboo.
No one wants to bring it up, noone wants to say the word
hospice.
Right, you know, it's almostlike saying Beetlejuice three
times.
Yes, you know, no one wants to.

Karissa (18:15):
Yes, they're so fearful of it.
You bring up a good point too.
So I have done hospice in fourdifferent states actually.

Johnna (18:21):
Yeah, I was going to ask you about that.

Karissa (18:23):
I have, and it's actually very much based on
location, because when I didhospice in Florida of course
that is our aging capital, ifyou would and so they were more
open to hospice.
When that was brought up, thefamily was like great, we

(18:43):
qualify, it's time, awesome, yes, bring them in.
Because they were more aware ofour resources.
And it also starts with thephysician.
It starts with the primary careand or maybe they've had a bad
experience with hospice, theydon't want their patients on

(19:17):
hospice.
Then that's what makes itdifficult for us to come in as
well with the families if theydon't have the support from
their primary physician, whothey've been seeing likely for
years, like 20, 30 years, yes,yeah Now.

Johnna (19:25):
So, since you have done hospice in different states,
what have you noticed I know youjust mentioned Florida, like
you noticed that they're morereceptive.
What have you noticed?
Difference wise, like even instate laws?
Is there differences in thestate laws around hospice like
Florida, alabama, and then youbeing in Illinois.

Karissa (19:45):
Yeah, so we are governed by federal, so the laws
across hospice are the same bythe state.
What I've noticed, though, inAlabama and Florida there is
what's called a certificate ofneed.

Johnna (20:00):
Yeah.

Karissa (20:01):
And so hospices just can't come and open.
The government has to see aneed for it in that area.

Johnna (20:08):
Yeah, that's the same with the hospital, unfortunately
.
That's why we only have one Ididn't know that yeah, so at
state of alabama state of need.
You know that for the hospital,hospital builds, yeah, so I
think it's that way, just forany.
I don't know if that'sconsidered like a government no,
it's not a government entitybut like, yeah, just medical

(20:28):
care, I mean's not a governmententity but like yeah, for just
medical care, I mean obviouslynot primary care physicians and
stuff like that, but for openinghospitals.
And then I didn't realize it wasa state of need for hospice.
I just thought it was only forhospitals.

Karissa (20:40):
I didn't know it was for hospitals.
I thought it was only forhospices.

Johnna (20:44):
Yeah, have you noticed a difference like in Illinois
versus Alabama, when likeperception wise with hospice
Definitely.

Karissa (20:52):
And that's because what I've noticed, something
that they're doing differentlyis they are educating the
residents before they come outof medical school.
So they are taking courses onhospice now, before they leave
medical school, and then doingthat now that when we have them
out in the field, they're morecomfortable with it, having
those conversations with thefamilies.

(21:13):
That's something that I'm notnoticing happening here and so,
but your local hospice usuallywill host those events and
typically you can get CEUcredits.
And so I would say if they'reoffering them, I would take it.

Johnna (21:27):
Where can someone so like I'm a provider, I haven't
seen these like where wouldthose events be posted so that
maybe, like, if people arelistening to this, they could be
on the lookout for it?

Karissa (21:37):
I would check your local hospice websites or even
give them a call, shoot them anemail.
If you have a known clinicalliaison, you can ask her.
Okay, those events are usuallyposted there, and a lot of times
too, we have those events atthe assisted living facilities.

Johnna (21:54):
Okay, that makes sense.
I mean age appropriate.

Karissa (21:57):
Exactly, or our skilled nursing homes, and
anyone is welcome to come.

Johnna (22:03):
No, I love that.
And what would you considerbeing the biggest myth or
misconception about hospice?

Karissa (22:10):
It's that the patient is dying right then, at that
moment.

Johnna (22:14):
Yeah, I agree, I've seen that too, because people like
I've seen it in their eyes.
It's almost like when you sayit they're very fearful of it,
but then it's almost likebecause I've seen both sides of
it, right, like I've seen whereI've talked to them about it and
they had that fear, but thenthey agreed to go to hospice and
then they're, like, the most atpeace once they made that
decision.
Yes, definitely.

Karissa (22:35):
And so and I know some listeners might say well, you
know, I did have a patient or afamily member that went to
hospice and they did pass awaywithin a couple of days, but
that's because we didn't gettheir referral early enough days
.
But that's because we didn'tget their referral early enough
because those signs were likelythere six months prior or more
and then we didn't get theactual referral for hospice to

(22:58):
come in until they were actuallytransitioning.

Johnna (23:01):
Right.
So what signs and symptoms canwe all, as providers, nursing
staff and maybe even families,start watching for in these
disease processes?

Karissa (23:11):
when you're like OK, maybe it is time to call in
hospice, yes, and taking intoconsideration their core
morbidities and what thediagnosis is, typically we look
for more weakness that they'rehaving.
We're looking for they're noteating anymore, they're not,
they're losing weight.
They're sleeping looking forthey're not eating anymore,
they're losing weight, they'resleeping more.
They're not engaging more, kindof like the body and the spirit

(23:35):
is starting to pull back.
You'll notice that more falls,increased ER visits, increased
infections.
Those are what we're lookingfor and they're specific to
diseases.
Yes, typically we'll see thosemore with our Alzheimer's
patients.
When we look at other diseaseslike heart failure or COPD, we

(23:55):
look at are they maxed out ontreatments?
You might have that patient, aCHF patient, that's constantly
calling after hours to theirprimary care physician or
they're going to the hospitalmore, more ER visits.
Hospice can typically come inat that time because likely
they're going to the hospitalmore, more ER visits.
Hospice can typically come inat that time because likely
they're maxed out on treatmentand what we need to be managing

(24:16):
is likely their anxiety andshortness of breath.
Right the symptoms, not exactlythe disease.

Johnna (24:22):
No, yeah, no, that's perfect, because I think that's
the hardest one I've seen withfamilies is like when the
elderly have quit eating youknow everyone in our country is
about.
Why are they not eating?

Karissa (24:35):
Yes, yeah.

Johnna (24:36):
But sometimes like it's I don't know how to say that
Like it's.
It's worse to then force thatinstead of just accepting it and
saying this is a sign.
Yes, you know that something'snot right.

Karissa (24:48):
So I have a little saying that I say to families
that really clicks with them.
And to start with that, withthe feeding, I say listen to our
bodies.
At that time the body is sayingI don't need it.
So if we have a car, if theengine is going out on the car,
the engine is out will we putgas in it Right now.

Johnna (25:09):
Right now.

Karissa (25:09):
Because the engine is going out on the car.
The engine is out.
Will we put gas in it Right now?
Right, no, because the engineis going out and it can make
things worse.
Because now we're forcing moreof the food, and it's because
that's the way we show love asAmericans.
You know, if you're sad, comeon, let's go eat, if you're sick
here, soup, that's how wesocialize, that's our gatherings
.
There's always food involvedand so that's ingrained in us.

(25:38):
And I typically just tellfamilies that you can show love
in other ways.
They feel like that they'regiving up or they're starving
their loved one.
But really it's the body sayingI don't need that right now, I
don't need that fuel.
And even when you get to thatpoint, you'll see grandma or
grandpa they're sleeping more,they're not going out, they're
just sitting in their chair.

(25:59):
So they're not using energyanymore either, and so they
don't need that fuel.

Johnna (26:02):
Right and it can kind of overwhelm them.
It's just I think that's thebiggest one that I've seen with
families when, like, when theycall me or something and they're
like I need you to do something, I need you to add some
medication to give them anappetite, or, and I'm like and I
think that's something that maybe a key to providers too if
families are calling you askingfor an appetite enhancement or

(26:23):
booze shakes or something likethat and I'm not saying all the
time, obviously this is with,like, we can't just say you know
, it's all dependent on thepatient, right?

Karissa (26:30):
And the end stage of their disease.
Where are we at Right.

Johnna (26:33):
And I think that may be a key to the provider, to them
Maybe at that point go hey, yeah, actually, let's talk about
that, you know, and then maybetransition into the conversation
of hospice, because that couldbe a potential way of bringing
that in as well.

Karissa (26:47):
Definitely so.
When we talk about that, likewe said, where are we with the
disease?
Had this family?
Have they been coming in more?
Have they been calling more?
Is this patient having falls?
How many ER visits have theyhad over the last three months,
six months?
How many infections have theyhad over three or six months?
When we start painting thatpicture and putting it together,
so it isn't just one thingwhere it's just increased

(27:10):
infections or just falls or justnot eating, we are looking at
all of these things and paintingthose pictures of.
Okay, maybe it's time to bringin some extra support for you.

Johnna (27:23):
And when we talk about the support that hospice has, I
know y'all have severaldifferent resources that people
don't even realize.
Yes, what kind of resourcesdoes hospice bring in?
Because I know that y'all havelike things like palliative care
, yes, and then extra nursingstaff, and so I've been taught
by another hospice company tosay, actually, this could just
be an extra set of hands for you, sure.

Karissa (27:43):
You can say that.
So we have an entire team.
We have our medical director,our hospice physician, we have
social workers, nurses,chaplains, and we have certified
nursing assistants as well.
That entire team is broughttogether for that family.
The reason why we have achaplain is because, as much as
a physical experience, it's aspiritual one as well.

(28:05):
So we might have I had apatient that was Catholic, and
three o'clock in the morningthat patient became active and
hadn't received their last rites, and so our chaplain was able
to get in touch with a priestwho was able to come to the
house at that time and give thepatient their last rites before
they passed away.
Some families haven't been ableto get to church, so they

(28:28):
appreciate when our chaplain cancome and there's some spiritual
experiences that they need totalk about before they can let
go as well.
We provide 24-hour support, sowe provide 24-hour support.
So 2, 3, 4 o'clock in themorning, if that family is
needing support, if the patientis needing some care, we can
have nurses want to be intubated, who did not want all that

(28:50):
stuff.

Johnna (29:10):
When you get to that moment, you don't know what kind
of decision you'll make,because I can't, like.
I know like I have a livingwill at a young age, at my age.
But things like not being ableto breathe, that could become
very scary for the patient ifthey're not on a hospice service
, for someone to give them thatsupport, to give them that
medication, if you're just athome trying to deal with it
yourself, that is a very scaryexperience.
I would say yes, intubate me.

Karissa (29:27):
Yes, definitely.

Johnna (29:29):
I mean who's trying to drown alive?

Karissa (29:31):
Yes, yes, yes, yes.
And typically when your nursecomes in we can catch that,
usually before it gets that badRight, because we are assessing
them and so we can say thispatient is having some increased
shortness of breath.
So we start titratingmedications, we get oxygen into
the home and so that way itdoesn't get nine out of 10 with

(29:54):
shortness of breath, and that's.
Another thing is that weprovide equipment as well.
That's all covered.
Hospice is 100% covered byMedicare and Medicaid.
That's crazy.

Johnna (30:05):
We don't even utilize it and I think you know some
people actually had a patientwhich our mutual patient, which
he educated me.
He was like can you put me onhospice?
I don't think I'm going to haveenough money to live the rest
of my life and I was like, waitwhat?
And I was like I don't thinkthat's a reason to go on hospice
.
I said but you do haveconditions, I think.

(30:29):
Could you know.
But he's very healthy elderlyman, other than like his his new
like, where he couldn't swallowbecause he had developed.
And I was like, yeah, let's doit.
You know, of course y'all werelike, yeah, he qualifies.
And I was like he just told methat you know he doesn't have
enough money.
You're like, yeah, all this iscovered.
Yeah, I was like I did not knowthat.

Karissa (30:42):
Yeah, a lot of families are like what?
This is all covered.
Yes, this is 100% covered.
We cover equipment, medicalsupplies and equipment.
Things like a bed you mightneed a hospital bed wheelchairs,
walkers we cover that Bedsidecommodes.
Certain medications yesdefinitely Certain medications,
anything that's related to theterminal illness and then, of

(31:03):
course, everything that'srelated to their symptom
management.
So once we explain that to thefamilies, they are like, oh my
God, a lot of them.

Johnna (31:15):
That's a huge weight, especially in the elderly, when
you're on a fixed income you'reon retirement.
You know, some people don'thave pensions, some people have
supplemental insurance planswhen they get older, so chronic
disease processes can becomevery expensive, which in itself
is a whole other podcast, yeah.

Karissa (31:35):
Yeah, yeah it is.
It can be very expensive.
And then even speaking ofexpensive placement is it can be
very expensive.
And then, even speaking ofexpensive placement, so when we
have an assisted living facilityand we have a patient in there,
a lot of times if the patientneeds more care with their
activities of daily living, theydon't qualify to be in that
assisted living facility anymore.

(31:56):
That nine times out of 10coincides with hospice, that
it's time to bring hospice in.
If this is happening, and so wealso help with placing the
patient, we have our socialworker reach out to different
skilled nursing facilities andwe take that weight off of the
family.
We find the facilities, wereview it with the families and

(32:18):
then that transition for thepatient Okay, going them,
admitting and all that.
Exactly, we take care of all ofthat.

Johnna (32:25):
And that is a huge stress reliever for families,
because trying to like take careof someone who's sick plus go
look for somewhere else for themto live is huge.

Karissa (32:35):
Yes, definitely, it's so big.

Johnna (32:39):
And you don't think about those things and how
helpful it can be when someonejust says, hey, have you
considered hospice?
And that's why I think you aresuch a valuable resource to even
bring in to have thatconversation, because as a
provider, I didn't know all ofthis until you and I sat down
and had a conversation, and Idon't think a lot of providers
do so.

(32:59):
Speaking of providers, have youever disagreed with a provider
or a family about startinghospice?
Certainly you ever have onethat like just sticks out to you
.

Karissa (33:10):
Certainly so.
I had a patient and she was inthe ER.
She was in the end stages ofheart failure and the family
called hospice in.
I came in to do a consult forher and the ER doctor was so
livid that the family wantedhospice and did not want this

(33:31):
patient treated and literallystood in the doorway and said
you are going to explain to meright now why I'm not treating
that patient's heart failure.
Wow, and in that I stayed calm.
I advocated Because this is notwhat you want as an ER

(33:52):
physician, this is what thefamily and the patient wants.

Johnna (33:55):
Right.

Karissa (33:56):
And I advocated for the family and I let her know
these are the services that weprovide in home.
She's in stage.
They don't want you to put in apacemaker.
They want to go home.
She wanted to put in apacemaker, and so what I did was
I just advocated for them andalso brought in my medical

(34:18):
director as well, so I was ableto call my medical director,
who's on call 24 seven, justlike we are, and we had a short
meeting right then and therewhere he was able to, physician
to physician, explain things tothat ER doctor.

Johnna (34:34):
Yes, I have noticed sometimes, like even working in
an ER, even being a nursepractitioner or a nurse not all
because I worked with some verygreat doctors, but then there
are a few that are more oldschool that you notice like it
had to be physician to physician.

Karissa (34:52):
Definitely.

Johnna (34:53):
And so it's unfortunate, but that's just what it has to
take sometimes.

Karissa (34:57):
Definitely.
I just pulled in that resourceand advocate it.
As nurses, we do have animportant title and that is
advocating for our patients aswell.
And so that was the hat that Iwore that day.
And you know, er physicians arethere.
They're here to treat right andsave your life Right.

Johnna (35:17):
Well, and speaking of that, so that brings me to the
conversation you and I first hadthe very first time.
So I made a mistake, guys.
Yes, me admitting I made amistake.
So I and you are trainedemergency and I think the rest
of the world and when I explainand I explained it to you too,
but I just want to bring this up.
So when I first met Carissa,she had called me in for an

(35:37):
emergent hospice patient and myfirst words out of my mouth was
there's no emergent hospicepatients.
And I got a look of what and Iimmediately knew I did something
wrong.
But in my mind what I wasthinking because I, you know,
sometimes talk before, I thinkwas being in a ER.
It's life or death, right, sowhen I'm being hospiced, that is

(35:59):
the goal.
So I was thinking what isemergent?
But then I had to ask my friendwho did palliative care.
I said I did something wrong,can you explain to me?
And she was like it's thesymptom burden.
Yeah, that's emergent, not thatthey're dying.

Karissa (36:11):
Right.

Johnna (36:12):
So can you explain what an emergency is in hospice
versus what we all as societythink emergency?
Like you, better do somethingnow.

Karissa (36:19):
Yes, and just like your friend said, from
Palliative it is, it's symptommanagement.
You know that patient washaving some increased delirium
hallucinations, but that didn'tmean that she was going to pass
right then and there.
So I totally understood yourviewpoint.
Her symptoms were not managedat all.
So that's where we look atthose symptoms and that could

(36:42):
also put that patient at dangertoo, because she was having
increased hallucinations anddelusions.
That increases her risk forfall, which increases the risk
of her breaking something, andthen we just spiral completely
out of control.
I've had patients where I'vecome into the home to admit them
and they are in severerespiratory distress and we're

(37:03):
able to get those medications tothem at bedside.

Johnna (37:07):
So they're not suffering .

Karissa (37:08):
Exactly, and they're not suffering or going back to
the ER or passing away in the ER.

Johnna (37:13):
Yeah.

Karissa (37:15):
And when they pass away at the hospital, that
increases the mortality rate forthe hospital as well.

Johnna (37:21):
Yeah.

Karissa (37:22):
And so we are looking at those symptoms.
Hopefully we can come in.
I would say over the years thatI've done hospice eight years
I've had about 20 percent of mycases have been emergent like
that.
Typically it's not Typically wedo come in, but when it is that
way it's very dangerous.

Johnna (37:43):
I was about to say.
Do you see that more, when it'sthey should have been on
hospice sooner, but eitherprovider didn't recognize it,
nursing staff didn't recognizeit, family wasn't ready, patient
wasn't.
Do you see the emergent?
Yes, like you said.
Like when someone like passesaway in the transitioning and
you know they just got onhospice.
Like when someone like passesaway in the transitioning and
you know they just got onhospice Definitely.

Karissa (38:02):
It is typically when they have not been educated on
hospice or we have a familymember that was hesitant on
putting them on hospice and thepatient couldn't advocate for
themselves.
That is where I see thoseemergent situations where there
was hesitancy about hospice.
Maybe hospice did come in andhave a conversation with the

(38:23):
family and the family said youknow, this is great, but we're
not ready.
And then two weeks later we'regetting that emergent call and
that the patient had been to theER three times, or that she
fell or shortness of breath,increased pain, they're
screaming in pain and so thehospital can no longer do
anything for them.
That's typically where I'll seethose emerge and it's

(38:46):
unfortunate and it breaks myheart because every time I'm
like if we would have got heresooner, the patient and the
family wouldn't have to gothrough this.

Johnna (38:56):
No, I agree, and you've done so good educating me that
I'm trying to do my best torecognize it sooner.
I mean, you know it's a teameffort because the provider has
to recognize this the nursingstaff has to recognize it.
Family and patient have to bewilling.
So it is a collaborative effort.

Karissa (39:13):
Definitely, and you've been doing a great job Well.
Thank you Awesome.

Johnna (39:17):
Awesome.
Oh, as if you pat yourself onthe back for that.

Karissa (39:18):
Oh, as if you pat yourself on the back for that.
You've done a wonderful job andit does like you said.
It's a team effort.
Typically, if the providersstart that conversation, that
opens the door for us and we'll,nine times out of ten, finish
it.

Johnna (39:33):
And I encourage everyone to just find a hospice nurse
and speak to them.
Yes, Because, seriously,without that conversation that
day like even though I wordvomited and said some things,
without that conversation thatday I wouldn't have been
educated.

Karissa (39:47):
Yes.

Johnna (39:48):
And I'm a huge believer in everything happens for a
reason.
So, I'm glad that I said what Isaid in that moment.
Yes, because otherwise Iwouldn't have known better.

(40:14):
Right, yeah, it was justeducation, that's all, and it
happens.
I've ran into a few providersthat you know it happens.
They just being open andwilling to listen to someone
else's side in general in lifeis a huge thing.

Karissa (40:26):
Right.

Johnna (40:26):
Just to be able to say, okay, well, I messed up, I
shouldn't have said that.
Now that you've explained whatyou've said, have you ever felt
guilty or the need to act whenyou know you shouldn't?
As a hospice nurse, no.
Okay, so you are through andthrough.
Yes, so you've never been like,oh, I want to save them.

Karissa (40:47):
No.

Johnna (40:48):
Yeah, Because you know what it's a good thing.

Karissa (40:49):
Yeah, I know that, the services that we provide for
the patient and typically whenwe get them and I look at their
history, I do an entireevaluation and I look at
everything that they've beenthrough over the years.
Then it's time and usually atthat point death is inevitable
anyways.
And so it just goes back to now.

(41:11):
How are we going to do this?

Johnna (41:13):
Right, I agree.
If you could leave a stickynote for every ER doctor or
nurse practitioner or primarycare provider, what would it say
?

Karissa (41:28):
don't be afraid of what you don't know.

Johnna (41:31):
Yeah, I love that and just ask for help.

Karissa (41:33):
Ask for help, use your resources and follow your
instincts as well.
So you know, with ER doctors orany type of specialty ICU
oncology we have those instinctsin us.
I remember in nursing schoolwhen my instructor said you'll
have an instinct and act on it.
I had no idea what she meant,but over the years I know what

(41:57):
she means now.

Johnna (41:58):
Yeah, I was on the triage team in the ER and I had
to tune into my gut instinct alot, because you're just seeing
a patient in vital signs andthat's it.
You don't know their history,you don't know their medication
and you have to be able to lookat someone and say something's
not right here and you have totap into that quick.

Karissa (42:18):
Yes, yes, if you feel like something's not right, we
shouldn't be doing all of thisfor this patient, maybe if I
just bring up hey, you know, doyou think we can talk to the
family about hospice?
That is what I would say isfollow that little nudge because
you felt it.
You know that's your idealpatient, that you're doing

(42:41):
compressions on.

Johnna (42:42):
I was about to say we've all done compressions on
something and you're like whyare we doing this?

Karissa (42:46):
And sometimes it is the family that's pushing for
that and so still, having that,bringing that up to the family,
can we just bring in someonethat can offer you a different
viewpoint?
Because in that moment they'relooking like you are just such a
bad guy for not bringing my 95year old grandma back to life.
So after that you candefinitely look into.
Can I have someone else come inand give you a different

(43:09):
perspective, because we talkedabout personalities too.
Right?
The ER is hey, I'm here to saveyou right now.
Right, but you might bring insomeone from hospice that has a
little bit more time and can sitwith that family and answer all
of their questions through andthrough.

Johnna (43:26):
No, that is something that is beautiful.
Now, speaking of beautiful,what is something beautiful
about death that people don'ttalk about?

Karissa (43:37):
I look at what I do as midwifery for the dying.

Johnna (43:42):
No, that is a good analogy.

Karissa (43:44):
Yeah, yes, and so the same way that we encourage
babies to come into this world,right, we're like, come on, it's
okay, you can come that is howI look at it where we are
assisting the dying and we areletting them know it's okay, you
can go, and we're here withyour family, they're not alone,

(44:06):
you're not alone in this.
And so I think that is justsuch a beautiful thing that we
can give to families.
It's hard when they are, youknow, in a hospital.
You have visitation limits,it's cold, it's sterile.
We just had a woman that was inher 40s and, unfortunately,

(44:28):
pulmonary embolism.
She was, at the time, a fullcode, but the ICU let the family
know that they couldn't do muchmore for her.
However, they wouldn't allowher eight-year-old daughter to
come say goodbye.
Because the ICU rules yeah,right and so, but they were able
to call hospice and weadvocated.

(44:51):
We went all the way up to theCEO of the hospital and we
advocated.
And because she was under ourcare we do take care of patients
in the hospital so because shewas in the hospital but under
our care, we were able to comein and we brought counselors
that specialize in children'sgrief.
They sat with the daughter fora while and talked to her, and

(45:13):
we brought counselors thatspecialize in children's grief.
They sat with the daughter fora while and talked to her and
then we were able to get her into see mommy one last time.

Johnna (45:19):
That's an amazing story.

Karissa (45:20):
So it circles back to right.
When death is inevitable, itmatters when, where and how.

Johnna (45:25):
No, it does Now, if you're OK with it.
You know we've talked aboutsome heavy topics with hospice.
Yeah, I want to do a littlelaughing a little bit, try to
make it a little bit morehumorous and, you know, lighten
the mood a little bit.
Would you be fine for somerapid fire questions?
No thinking, just speaking.
Oh my goodness.

Karissa (45:47):
Yes, okay, they're not bad.
They're not bad, I'm down, okay.

Johnna (45:54):
What's one medical term you?

Karissa (45:55):
hate hearing in the hospice world, in the world
Morphine killed my grandpa.
Yes, that was more than oneword, but no, that's fine One
phrase, yeah.

Johnna (46:03):
Okay, finish this sentence.
Death, but make it blankBeautiful.
Okay, weirdest place.
You it blank Beautiful.

Karissa (46:13):
Okay, weirdest place you've ever cried on the job In
my car.
It's not really weird, but I'vecried in my car.
There's not really a lot ofweird places to cry.

Johnna (46:25):
I mean, as nurses, I feel like we've all cried in the
car.

Karissa (46:27):
Yeah, yep In the closet.
Yeah, definitely Yep Having toturn away.

Johnna (46:35):
So you have 30 minutes to yourself.
Do you nap?
Netflix or wine?

Karissa (46:42):
I nap.
I think just sleep is just sucha beautiful thing.
As a mom and a nurse, I justlove sleep.
Yeah, I agree.

Johnna (46:50):
Favorite patient nicknames you've ever been
called.

Karissa (46:53):
Well, I just love it down here in the South because
they just know how to make a galfeel so special.
Baby and honey, and oh mygoodness.
So those are my favorites.
It's funny because I have onepatient.
My name is Carissa, but he justcould not get that right, so
the entire time I took care ofhim, he called me Marissa and I

(47:16):
just let it go.

Johnna (47:17):
I love that.
You know my name's kind of hardtoo, because people they don't
they either call me Johanna,Johanna, Jonah, Joanna, like not
, none of it.
It's like they put an A inthere somewhere and I go with it
too.
If someone's like, hey, Joanna,like not John, none of it, it's
like they put an A in theresomewhere and I go with it too.
If someone's like, hey, Joanna,come here, I'm like, okay, my
uncle, the one that passed Italked about called me, johanna.

Karissa (47:41):
until the day he died, the man was in his upper 70s
when he passed away.

Johnna (47:43):
at that point I'm like yep, that's it.
Hospice nurses deserve hazardpay for dealing with blank.

Karissa (47:51):
Family fights.
There are a lot of family feudswhen it comes to end-of-life
care.
Yeah, a lot.
Because some want them to go, orsome want them on hospice, some
don't want them on hospice, orthere's just a disagreement on
how the patient is being takencare of in the home, you know,
with their caregivers, certainblack sheep of the family,

(48:14):
things of that nature, andthat's why we have our medical
social workers.
Of course, as a nurse, if we'rethere, we'll help as much as we
can, but we would definitelytell our social worker you
probably should come and seethis family as soon as possible.

Johnna (48:28):
Yeah, yeah, I've seen that too.
Mm-hmm, if you had a hospicemascot what you probably should
come and see this family as soonas possible.
Yeah, yeah, I've seen that too.

Karissa (48:35):
If you, had a hospice mascot, what animal would it be?
Mine would be an eagle, becauseI'm always looking at the
bigger picture.

Johnna (48:41):
Oh, I love that, yeah, always.

Karissa (48:47):
What's your comfort food after a rough day?
I would say pizza.

Johnna (48:50):
Oh, I love some pizza.
Yeah, I love pizza.
Do you have a favorite placethat you have your pizza at?

Karissa (48:55):
Here or Chicago.

Johnna (48:57):
Well, you know.

Karissa (49:00):
Because it's really hard to find Chicago pizza.
Do both.

Johnna (49:04):
I've never been to Chicago.
I need to go you should visit.

Karissa (49:07):
It's a beautiful city, very beautiful city.
Any pizza in chicago and here Iwould have to say um, it's a
place on 31, oh my gosh, it'sleaving me.
Starts with a d oh, um domic,I'm donna co's something like I
know what you're talking.
Yes, yes, they are amazing.

Johnna (49:26):
Love their thin crust amazing, I can't think.
I know exactly what you'retalking about.

Karissa (49:29):
Yes, yes, they are amazing.
Love their thin crust Amazing.

Johnna (49:32):
I can't think I know exactly what you're talking
about.
I can't think of the.
I can see the place, yes.

Karissa (49:37):
Right the red.
Yes, yes, they are amazing,love their pizza.

Johnna (49:41):
Did you say Chicago, anywhere, anywhere, mm-hmm Is
yeah it really is.

Karissa (49:47):
I mean, it's so good, it's amazing.
So I would say, anywhere inChicago we have a large Italian
population there.

Johnna (49:55):
Okay, so is that why it's like?
Because I know, I've heard thatChicago pizza is like the
number one place to eat pizza.
Yes, and so it's, even though Ithink New York and Chicago are
farther it's like neck and neck.

Karissa (50:04):
It is.
It's like neck and neck and wemake it different, but we have a
lot of Italians there, so it'svery authentic.

Johnna (50:15):
That's nice.
Yeah, kind of like is it?
Cause you know we loved when wego to New York, we loved going
to little Italy, so is it kindof like that.
Oh yeah, cause you know, whenyou walk up and down the street
the pizza is just oh my gosh.

Karissa (50:21):
Yes, yes, so we do.
We have a little Italy, we havea what's called Greek town, we
have a lot of Greeks that livethere.

Johnna (50:29):
Nice, we do it is.

Karissa (50:36):
It is, so it's basically another.

Johnna (50:38):
New York, basically, but without the big rats.
Which one are you under stress?

Karissa (50:45):
Let me speak to the manager, or let me go cry in the
supply closet.
I would probably cry first andgather my thoughts.

Johnna (50:50):
Let's talk to the manager about this, yeah.

Karissa (50:52):
I would cry first and gather my thoughts, and then I
would talk to the manager.

Johnna (51:00):
What is your biggest?

Karissa (51:02):
non-clinical talent Gardening.
I grow a lot of foods that willcome in handy when this barrel
crumbles.
Right, exactly so.
I actually garden quite a bit.
I grow tomatoes and cucumbersand corn and potatoes and you
know I have chickens Is thatwhen you moved down here, did
you do that in Chicago as well?

Johnna (51:22):
I did that up north, I did.
Did anybody else do that?
Or did people look at you likewhat are you doing?

Karissa (51:28):
No, they did, Because what I try to explain is that
I'm from Chicago, but if youreally look at the map the
Midwest we are country.
I mean, that's all farmlandIndiana.

Johnna (51:39):
Yeah.

Karissa (51:39):
You know, Missouri, Illinois, outside of Chicago,
it's all country, Like we say,y'all you know because we are.
There's a lot of farmland there.

Johnna (51:51):
So typically outside the city it's just country.

Karissa (51:54):
Yes very much so.

Johnna (51:56):
Yes, very much.
So.
What's your go to line when afamily is panicking but you're
calm on the outside?

Karissa (52:04):
And typically that's how it goes.
I tell them to let's take amoment here.
Let's take a moment and I I askwhat is making you panic?
What are your fears, typicallywhen they tell me that I'm able
to put out the fire becauseyou're able to talk them through
.

Johnna (52:21):
Yes, I talk them through it, because if you don't know
what they're afraid of, youdon't know how to help them
exactly, exactly.

Karissa (52:26):
So I'll always ask what exactly is making you
afraid right now?
What's making you anxious?

Johnna (52:31):
You know what that would also work for little kids.
Yeah, yeah, I just thoughtabout that.
Yes, it would, though it wouldBecause then kids can articulate
like what they're trying to,because you know kids have a
hard time telling you whatthey're thinking.
Yes, yes.
If you could ban one hospitalphrase forever, what would it be
?

Karissa (52:54):
Hmm.

Johnna (52:56):
That one was a hard one, because I couldn't even think
of anything.

Karissa (52:58):
Yeah, one hospital phrase Calling a family or a
patient difficult.

Johnna (53:08):
Yeah.
I would say that family or apatient difficult, yeah, I would
say that, yeah.
And then the last one I have iswhat do you do to take care of
you when you have such a hardjob that takes a lot of your
effort, energy, soul, heart?
What do you do to take care ofyou?

Karissa (53:25):
First, I imagine, when I'm walking to my door, that
I'm carrying bags and before Ienter my home, my sanctuary, I
drop those bags, whateverhappened in the field, whatever
grief that I'm carrying, I leavethem at the door and I created
a space for myself that I canmeditate, release and I make

(53:50):
sure that I take care of myselfmentally, because, being a
hospice nurse, you do connectwith families and patients, and
there have been some deaths thathave stayed with me or patients
and families that I'veconnected with, and so I
experienced my own grief.
And I also go to our chaplain.
Our chaplain is able to give usbereavement as well in

(54:13):
counseling.
So I'll reach out to my team.

Johnna (54:16):
That's very nice.
Yeah.
Do you see yourself doing thisfor years to come?

Karissa (54:20):
Yes, I do.

Johnna (54:21):
That's amazing to hear, because we need good people.
You know that that's theirpassion and that they care about
it.
Like you said, if it's nolonger your passion, step away
from it.
But that's really good to hearbecause I can tell, like even
when speaking to you, that thatis your passion.
Like you can tell that itexudes off of you.
So if you didn't know that itdoes, Well, thank you, I love it
so much.

Karissa (54:42):
I have moved around in different positions as well,
which makes me well-rounded inhospice.
So, because we have 24-hourservices, I've done on-call
nursing, so I was the one thatwent out at 3 am.
I've done case management thenurses that come weekly.
I've done strictly admissions,so I was the first face that
they saw and that I fell in lovewith, because I love hospice so

(55:05):
much and I love to comfortthose families.
In that first moment it was soimportant.
And now in my role as liaisontoo, so I moved around and I
have such a big picture of itand I don't see myself doing
anything else.
I I just missed hospice so much.

Johnna (55:23):
I miss the patient care and the families.

Karissa (55:33):
Hospice is that one that you can take care of the
families as well as the patients, and so I miss that and I came
back.
I don't see myself doinganything else.
I love it so much.

Johnna (55:44):
Do we not touch on anything that you feel we need
to touch on?
Or do you feel like we coveredit all for everyone?
Because I want to make sure wetry our best to just make this
an easier conversation or easierto educate yourself to have a
conversation.
Do you feel like there'sanything that we left out for
anyone?

Karissa (56:01):
I just want to say the hospice is a holistic approach
to die.
It really is, and we don't haveto do hardcore drugs if that's
not needed or that's not wanted.
We follow what the familieswant.
We have had where we've had toarrange marriages oh wow, we've

(56:21):
had, you know where the patientwas passing, but they wanted to
get married, so our team puttogether a small wedding in
their backyard.
We've had where, you know, wehad a veteran and he only had
his dog.
We were able to get him homeand so that he could pass away
and his dog could be there withher by his side.
So we follow what the familyand the patient wants while

(56:45):
guiding them as such a specialtime really in their life.

Johnna (56:49):
No, I think that's beautiful.
So thank you all.
If you're still here, I knowthis is a hard conversation to
have.
Thank you for sitting with usthrough this powerful
conversation.
Death doesn't have to be cold,clinical or feared, and hospice
it's not a death sentence.
It's a doorway to comfort,dignity and peace when it
matters most.
A huge thank you to our guestfor reminding us that the end of

(57:10):
life can be just as sacred andintentional as the beginning.
If this episode moved you ormade you think differently,
share it with someone who needsto hear it.
And if you're a provider, let'sdo better by our patience.
Let's have the conversationsthat matter and let's do them
early, before it's too late.
Until next time, guys, let'skeep staying honest, stay
curious and don't be afraid totalk about the things that we

(57:33):
were taught to whisper about.
Bye you.