February 27, 2024 • 58 mins
Are you ready to gain valuable insights into Chaplaincy, Advanced Care Planning, and the importance of open and honest conversations about end-of life preferences?
Chaplain Marrisa Click is here to discuss the essential roles of chaplaincy and advanced care planning for aging adults. She also shares her personal journey into chaplaincy (which is very intriguing! Did you know they have Wilderness Chaplains?) and highlights the importance of spiritual and emotional support for individuals in the later stages of life.
Some Key Takeaways from our conversation you will hear as you listen to this episode are:
1. Chaplains play a crucial role in providing peace, spiritual clarity, and comfort to individuals in the later stages of life. They act as guides, helping individuals navigate the transitions and challenges that come with aging and declining health.
2. Advanced Care Planning is a proactive approach to making decisions about future healthcare scenarios. It involves having conversations with loved ones and choosing a healthcare agent who can make decisions on your behalf when you are unable to do so.
3. Advanced directives and POST forms are important documents in advanced care planning. Advanced directives outline future medical decisions, while post forms are doctor’s orders for current healthcare scenarios. These documents ensure that your wishes are respected and followed, even if you are unable to communicate them yourself.
The importance of Advanced Care Planning and the role of Chaplains in healthcare cannot be overstated. These conversations and preparations are not always easy, but they are essential for ensuring that our wishes are respected, and our loved ones are supported during times of crises. Having open and honest discussions with our families, we can alleviate stress and prevent potential conflicts. It is never too early to start these conversations and make your wishes know. Take time today to fill out an advance directive and consider discussing a post form with your doctor. Be proactive in our approach and we can empower ourselves and our loved ones to make informed decisions in the face of uncertainty.
We encourage you to visit our website now at www.connect-empower.com to explore more information on our guest and to access our resources.
To ask us your questions or to share your story, email us at podcast@connect-empower.com.
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John & Erin
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
John (00:10):
[Mic bleed] Power, the podcast that
Erin (00:11):
and I'm Aaron.
You're listening to connect andpower the podcast that proves
age is no barrier to growth andenlightenment.
John (00:18):
break down complex subjects into bite sized,
enjoyable episodes that willleave you feeling informed,
entertained, and ready toconquer the world.
Our guest today will illuminatethe essential rules of
chaplaincy and advanced careplanning, offering invaluable
advice for aging listeners.
Her mission is to bring peace,spiritual clarity, and comfort
(00:40):
to those in the later stages oflife.
So whether you're an aging adultseeking to secure your future, a
concerned family member, oranyone with a curiosity about
aging and planning, she is hereto provide the answers you need.
She is the Oncology andPalliative Care Chaplain at St.
Alphonsus Regional MedicalCenter and the Bereavement and
Bluebird Health.
(01:02):
Our guest believes in helpingpeople make meaning out of the
transitions in life that theyfind themselves in.
And she's also a board certifiedchaplain.
with national recognitionachieving the 2018 world class
award in hospice care.
Let's warmly welcome our guestChaplain Marissa Click.
(01:22):
Welcome.
Marissa Click (01:23):
Thanks for having me.
Erin (01:24):
Yeah.
Welcome.
We're such a pleasure to haveyou.
I know that when we met not toolong ago, you had so much
amazing information that we werelike, Oh my gosh, this is a gold
nugget to share with everybody.
So thank you so much for beinghere.
Marissa Click (01:39):
Happy to be here.
John (01:40):
So we'd love to, uh, hear your story, how you got into the
industry and, you know, what ledyou down the path of becoming a
Marissa Click (01:48):
Mm hmm.
Yeah.
I'm part of a faith tradition.
Most chaplains have their ownpersonal religious background.
not always, but for the mostpart they do.
And so I was heading down thepastoral path at first.
I became a Christian, out ofhigh school and was connected to
(02:10):
a non denominational Christianchurch in Nevada where I grew up
and really, connected with thatcommunity well because, I just
fit.
I felt like I found a communitythere that I hadn't really
experienced before.
And so I was doing a lot ofleadership things.
They were really...
(02:31):
Breathing into life these skillsthat I didn't really know that I
had until someone startedencouraging me in those.
And so I was kind of leading.
worship for the youth group andplanning, mission trips.
And along the way decided, Ithink ministry is where I want
to be.
I didn't want education to be abarrier, so I decided to go to
(02:55):
seminary.
So while I was in college, I wasstudying, religious studies,
which is just learning about allthe different kinds of
religions.
And one of the classes I tookwas the Bible as literature.
And so it was really challengingbecause I was a baby Christian
myself, having a lot of reallydeep theological discussions
(03:16):
about, this sacred text thatChristians uh, And so luckily, I
was living with a family at thetime as their live in nanny, who
were graduates of EmanuelChristian Seminary in Tennessee.
And I would come home every day,and I'd have all these questions
about faith, and the Bible, andhow do you live your life well,
(03:39):
if these things are true or not.
And instead of giving meanswers, they just gave me
better questions.
They would just keep asking memore things so that I could come
to the conclusions for myself.
And I really loved that model ofspirituality and faith
(03:59):
formation.
So I thought, I'm going to go toschool where they went to school
because that was really great.
I ended up going to EmanuelChristian Seminary out in
Tennessee.
And...
While I was there, I wasthinking I was going to still do
traditional pastoral ministry inlike a church setting and was
working in a church out there.
(04:20):
And things just kept not workingout.
I dealt with some sexualharassment at the church and,
along the way of trying to getordained, my home church in
Nevada said no because they,didn't believe in women in
ordained ministry.
And that was really, it wasreally hard to hear because
(04:41):
these were the people whoencouraged all of these
leadership skills, but theydidn't want to, bless me in that
way with the actual papersaying, yes, you are meant for
leadership and ministry and allof this.
So I actually had a chaplain inseminary and, she was amazing.
She is the reason that I'm inchaplaincy today.
(05:03):
Her name is Heather Holland, andshe's great.
and she was like, from the getgo, Oh, no, no, no, no.
You're not meant for traditionalpastoral ministry.
You're a chaplain.
You need to go do chaplaincy,and that's gonna be great.
we had some different people,like different groups would come
and and talk to us asseminarians about different
ministry opportunities.
(05:24):
So one of the groups was,Christian ministry in the
National Parks.
I did a summer in the NationalParks with them as a chaplain
and led college students andconnected people.
Our main focus was on buildingrelationships with the staff
because working in NationalParks can be really, um, it's a
(05:47):
really transitory kind ofposition and, You make and break
relationships pretty quickbecause you just have a season
together, right?
So, there's a lot of, drug use,and there's a lot of, sexual
promiscuity, and there's a lotof, questioning of, of life.
(06:07):
Because when you don't havetechnology, because you're out
in the middle of the wilderness,you start asking really big
questions about yourself, right?
we would also do, Like churchservices at some of the camps so
that when people come and travelto the national parks, they can
have a religious service if theywant.
So that was pretty cool, I lovedit, but it still wasn't quite
(06:29):
right.
And so at the seminary that Iwent to, we, had the opportunity
to do what's called clinicalpastoral education.
just like nurses and doctorshave to do residencies and
education.
In the setting, before theybecome, licensed.
chaplains have to do that too.
(06:50):
And that was part of therequirements at my seminary.
Was that everybody has to gothrough, a semester of clinical
pastoral education.
And I absolutely fell in love.
It was the exact right fit.
I worked at a hospital that wasa trauma one center.
So, That means it's a lot higheracuity kind of care.
(07:13):
they often have a burn unit andit's a educational like teaching
facility.
there's just a lot morerequirements for it and so you
see a lot.
they also have pediatrics andjust the whole gamut of
healthcare that could be in afacility.
And I just learned so much andreally felt I belonged.
(07:33):
that same kind of sense ofcommunity that I got when I
first And so I continued,another full year residency of
clinical pastoral education, andthat really launched me on the
path into chaplaincy.
John (07:48):
Wow.
What an amazing story.
Erin (07:51):
and just in that little bit learning, the park and recs,
I had no idea.
Yeah, The national parks.
John (07:58):
Wow, what a better place to, to, have, have spiritual
growth surrounded by mountainsand trees.
that's talking my language.
Erin (08:07):
say when she mentioned that I was like, Oh, that's John
right there.
I think that's why we looked ateach other.
When
Marissa Click (08:13):
And I think it's common, like I said, when, when
we tune out the things aroundus, right?
When we don't have thedistractions of technology and
the responsibilities of work andfamily that we love having.
Right?
We choose to have those, butthey can be a burden at times.
Or, burden maybe isn't the rightword, but
Erin (08:34):
Distraction maybe.
Marissa Click (08:35):
Distraction.
Yeah.
another responsibility.
Something that's just, it'spulling your time, right?
You only have so much of timeand it has to be kind of
navigated and where you're goingto put it.
And So when you don't have thosethings, and you're in a
landscape that is really big,that makes you question how
(09:00):
small you are compared to theuniverse, right?
I think it means that peoplestart asking those deeper
questions that get lost in theday to day hustle.
Erin (09:13):
That's like John and I were trying to have better daily
habits because our time is solimited and we're like trying to
read books to educate our mindsand just little things here to
improve ourselves to improve foreverybody else that you serve
all day long, right?
Can you explain what achaplain's role is in the
healthcare sitting, particularlywith our aging adults and then
(09:35):
how you can support theiremotional and their spiritual
needs?
Marissa Click (09:38):
Yeah, so um, First there are lots of
different kinds of chaplains asI mentioned a little earlier
Most chaplains have their ownspiritual or religious
preferences.
So let me suss that out a littlebit.
I believe that everybody isspiritual.
right?
We all have things in our lifein which we make meaning and
(10:00):
value.
It's kind of those things thatgive our lives a higher purpose.
right?
That's being spiritual.
for some people that might betheir family.
For others, maybe it's theirwork.
Some people like to connect withnature, like you all.
but for some, And thatconnection to their spirituality
(10:21):
comes through religion.
So religion has a certain set ofbeliefs, but mostly it's the
practices around those beliefs.
That guide and shape our lives,right, the ways in which we
choose to function in the worldhave these kind of, rules, for
lack of a better word.
And chaplains have their ownpersonal spirituality or
(10:46):
religion, but we in healthcareespecially have ethical
guidelines that say that we areavailable to people of all
traditions and no tradition.
there are chaplains that areBuddhist chaplains, there are
Muslim chaplains, there areChristian chaplains, there are
chaplains who don't have areligious background, there are
(11:07):
humanist chaplains.
But the, the goal that chaplainshave is to meet people where
they are.
And when you come into thehospital, or you start having
changes in your health, that cancause a lot of strife.
Again, You start asking a lot ofquestions about yourself, and
(11:28):
your family, and what'simportant.
And that's why having a chaplaincan be helpful, because we can
act as guides, right?
And there's a lot of transitionsthat happen when you have a
health crisis.
People might start askingquestions like, why me?
(11:49):
Why did this happen to me?
There are a lot of questionsabout fairness.
Where is God in the midst of mysuffering?
Why me and not somebody else?
People start to wonder, Who am Iif I don't have XYZ in my
health?
And those are really big andscary things to be wondering
(12:13):
when you're already in a reallytransitory time in your life.
right?
when you're trying to cope withMaybe you're aging and your body
isn't doing all the things thatit used to do so easily.
Or your mind isn't as sharp asit once was.
Or the experience that you'rehaving isn't what other people
(12:35):
are experiencing, I'm thinkingof people with mental health
issues or those experiencingdementia or Alzheimer's who are
seeing things or hearing thingsthat Maybe other people can't in
that moment.
And that can be really lonely ifyou don't have somebody who's
willing to sit in that with you.
(12:58):
You know, as much as ourfamilies love us and support us,
they want to fix it.
Right?
The doctors want to fix it.
And so, there's always anagenda.
And that agenda can maybe be agood one.
But sometimes we need space towork it out for ourselves.
And so having someone who cansit in it with you, who can ask
(13:23):
better questions, and help youcome to the conclusions that you
need to come to, to be okay withwhatever you're going through,
that's the heart of chaplaincy.
And so, when we meet people, Iget, I get that, question a lot
of Oh my gosh, am I dying?
Because everybody thinkschaplains are only here when
you're dying, which is not true.
(13:44):
We do come when people are atthe end of their life.
but not always.
And so the majority of our timeis actually spent just getting
to know people and, and helpingthem navigate this new
experience or Maybe they need totell their story.
And we're big collectors ofstories and we love listening.
(14:05):
Maybe somebody needs a ritual tohelp get them through, right?
We have rituals in society allthe time.
coming of age is a big time ofrituals, where we might shower
somebody in gifts or they haveto perform some kind of test to
move from childhood toadulthood.
And so we have those same kindsof rituals when we have health
(14:28):
changes, too.
And so we help navigate thosethings.
we're also, ethical teammembers.
And so when there are ethicalquestions that come up in
healthcare, which happen, wemight be on the team that's
trying to help advocate andbring additional perspective to
the group that's trying to makethe best decision for somebody.
(14:52):
So it's pretty broad.
All the things that we do.
John (14:57):
What triggers, triggers the, Um, discovery that there's
a chaplain available.
Say I go into the hospital orsomebody I love goes in the
hospital and they have just beendiagnosed with something or they
are, feeling themselves havingto.
can come to the realization thattheir health is, is, really
(15:20):
declining.
And they're concerned with that.
How do they know that there's,there's a chaplain available?
How do they know that?
Because most of the time, yes,if somebody comes on to hospice
care, that's part of thedisciplinary team, right?
That comes out to take care ofthem.
But however, in the hospital,are chaplains available for
everybody and at what?
(15:41):
time can they say, Hey, I'd liketo see a chaplain or is there a
chaplain available at what timedoes that, that occur?
Marissa Click (15:48):
Yeah.
So in most hospitals, Everyhospital's gonna have a little
bit, different protocol orstaffing, but most hospitals are
required to have a chaplain.
And chaplains are available justabout all the time.
At least at, at St.
Al's we have coverage 24 7, 365.
And so most of us will justround and visit and introduce
(16:11):
ourselves and ask, right?
So I go door to door.
If you're in the hospital on myunit, there's a good chance
you're going to meet me at somepoint.
John (16:20):
How great.
Marissa Click (16:21):
others, other places might have protocols
about if you've been there for,a certain amount of time, right?
The longer you're in thehospital.
Maybe that means that you'reexperiencing more setbacks or
more decline.
That's a good reason for achaplain to be triggered.
sometimes when people havereally high acuity needs, those
(16:43):
areas of the hospital might getmore, more support than other
areas.
Right, so I'm thinking ICU oroncology.
Or, the emergency department,because those can be really
trying areas of the hospital.
(17:05):
doctors, there's usually in theelectronic medical records of,
of facilities, there's usuallyways to trigger a referral,
anybody can ask for a chaplainat any time, it's part of the
rights that we get as peoplewhen we become patients.
And anybody can ask and areferral can be put in.
Erin (17:23):
I'm learning a lot today.
John (17:26):
I think we learn a lot with every podcast.
We do.
I'm
Erin (17:31):
I didn't know there was a difference with pastoral and
chaplains.
so advanced care planning, Idon't really know what that is.
I have a clue, like you got aplan for the future, but really
what is advanced care planning?
How does it work?
Where do you get started?
The importance of it for ouraging adults and maybe how it
(17:53):
supports them and their family.
If you could just brieflyexplain or share with us.
Marissa Click (17:58):
I like to think of advanced care planning as a
gift.
And I say that because there aremany times in the hospital
setting where some kind oftragedy has occurred, whatever
that looks like, and we don'tknow as the medical team what
this person would have wanted,and the family doesn't know
(18:18):
either, they're stuck withmaking this huge decision for
their loved one at a veryheightened emotional time.
Not knowing all of the termsthat are being thrown out and
the medical jargon that's beingused, and it's really scary.
(18:39):
So advanced care planning isreally an opportunity for people
to take away some of that fearand responsibility.
By putting down in writing andhaving conversations with people
about what they would want infuture healthcare scenarios.
And who they would want to speakon their behalf.
(19:02):
So at the heart of it, it's aconversation.
And then there's some detailswith paperwork.
And so, things that are helpfulfor people to think through
before they get to the detailsof putting things down in
writing.
In healthcare, we often justkeep doing things to people.
(19:23):
And there is this ethos, thisbelief system in healthcare that
we want to fix it all the time,right?
We want to make people better,that's why people get into
healthcare, they want to help.
But there comes a point in ourlives where we can't fix it
anymore.
As amazing as medicine is, itstill has limitations.
(19:47):
It's still run by people whodon't know enough, and
technology will never get to thepoint where we can live forever.
I don't know about y'all, butI've never met somebody who's
gotten out of this world alive.
And so at some point, we're allgonna die.
And so, talking through what isimportant to you as a person,
(20:10):
how do you define quality inyour life?
And quality can be defined inlots of different ways.
For some people, quality mightlook like having their cognitive
abilities.
their abilities to havemeaningful conversation and to
recognize their loved ones andto understand what's being said
(20:31):
to them.
Other people might say theirfunctional abilities are the
most important thing.
And those might be their abilityto walk or...
provide personal cares tothemselves independently like
showering, bathing, eating,going to the bathroom.
(20:54):
And so if they lost thosethings, maybe that's not a
quality of life that they wouldfind acceptable.
Other people might say, if theycouldn't do their very favorite
hobbies like Just, just end itthen cause what's life worth
living if you can't go flyfishing or something?
(21:16):
And a lot of times when a nurseor a doctor or the medical team
is, is talking to folks abouttheir treatment options, we
don't always think about, isthis treatment option going to
get me to that goal, to how Idefine quality?
Because why would we choose atreatment?
That doesn't actually get us toour goal.
(21:39):
And so if we can prioritize ourthinking to highlight those ways
in which we define quality andthen filter the decision making
through that, we can often makebetter decisions that align more
with who we are as people andwhat's important to us rather
(22:02):
than just...
continuing to do things for thesake of doing things.
having these conversations isn'talways easy, because it's, it
has to be done with people, andas we know, everybody has a
different perspective, differentideas of what's important,
different belief systems thatmight be influencing the
(22:23):
decisions that they would make.
And so it can be vulnerable tobring those up with people that
you care about because nobodylikes to be judged.
Nobody wants to hear that howthey choose to live their life
or how they choose to prioritizewhat's important to them is
wrong.
(22:44):
Or maybe not wrong, but it'sjust different than somebody
else, right?
That can be hard to be open todifferences in perspective and
experience.
But that's why having theconversation is important
because the other part of it ischoosing someone to speak on
your behalf to help makedecisions based on what you said
your goals are.
(23:06):
And so you want to pick somebodythat is gonna make those
decisions even if they don'tagree with them.
that's kind of the, the startingpoint of advanced care planning.
John (23:20):
so when you select somebody and you have that
person that's going to advocatefor your, for you during that
moment of crisis, it doesn'talways have to be in the moment
of crisis.
we can, we can plan that and geta power of attorney for health,
power attorney for finances andso forth.
I think it's best that we all dothat.
(23:42):
Way early in our lives, right?
Because we don't ever know whensomething could happen.
and I, I love that you said it'sa gift, too, because I do think
it's not only a gift to theperson that eventually will go
through some sort of crisis, butit's a gift to their loved ones
because it can create so much.
tension and stress and infighting within families when,
(24:07):
they haven't selected somebodyas a power of attorney and
crisis hits.
Am I correct on that?
Marissa Click (24:13):
Oh, you're very correct on that.
And There are so many times inthe hospital where somebody has
maybe not chosen someone.
And so in Idaho, at least everystate has their own laws around
this, but in Idaho, there'sactually laws in place.
It's the Idaho statute andthere's a bunch of numbers after
that I can't remember, but itdictates who can make healthcare
(24:37):
decisions on your behalf and it,it has a very strict order.
I think the order is if you havea guardian, then if you don't
have a guardian, it goes to, alegally married spouse.
So I'm going to emphasizelegally married because the
state of Idaho does not honorcommon law marriage.
Legally married.
(24:58):
then it would go to an adultchild, And then siblings,
parents, and then any othertrusted adult.
not uncommon for us to havemaybe strained relationships
with some family members atdifferent times throughout our
lives.
if you have a strainedrelationship with somebody who
(25:20):
is first in line in that Idahostatute and you haven't chosen a
healthcare agent, that person'sgoing to make decisions on your
behalf.
And if that's not who you trustto do that or who knows you well
enough to do that for you, thatcan be really not great
sometimes.
the other part is, sometimes insome families, There are certain
(25:46):
members of the family that kindof rise up and they're the doers
in the family and they're theones who want to take control.
But maybe they're not the bestperson to make decisions.
And so maybe you want, someonewho's a little bit quieter or
that you're closer to.
And so again, if you don't putthat down in writing, it can
cause increased strife in yourfamily as they're working
(26:09):
through their own familydynamics.
And.
The role that they play in thefamily, some of this is also, in
certain cultures, certain peoplespeak on behalf of the family.
if, if you're the person who isthe spokesperson for the family,
but you're the one in healthcrisis, then in the background,
(26:29):
your family's having to reorder,who's going to be the new
spokesperson or the head of thefamily.
So it's really important to, tohave this in, in place.
there's never a bad time tostart the conversation.
I know I recently had thisconversation with my husband.
I'm 34 years old, don't reallyhave a lot of health issues, but
(26:51):
I see the worst case scenariosevery single day at the
hospital.
And so, I made an advancedirective.
And it was hard to have theconversation with my husband
because initially I didn't wantto choose my husband to be my
health care agent.
Mostly because he's had somepersonal grief issues and family
(27:14):
loss that still affects himtoday.
And I was concerned that thatwould be too difficult for him
to make those decisions.
But we had a conversation and,yeah, it changed my perspective
because of what he chose toshare.
And so it made me feel morecomfortable having him be my
person.
And we had to hash out, all thedetails that come with those
(27:38):
health care decisions and talkthrough them because he and I
have different perspectives onwhat we would want.
Erin (27:45):
where do you start?
Do you start with your lawyer?
Do you start pulling stuffoffline?
Do you start with your doctor?
Marissa Click (27:53):
Yeah, So this is a, it's going to be a multi part
answer.
So there are different kinds ofSo, depending on what kind of
document you want to fill out,will determine where you want to
start.
So, as you mentioned, there'sdifferent kinds, like, there's
financial power of attorney andthere's medical power of
(28:16):
attorney.
Anything financial has to gothrough a lawyer.
But, they can also do medicalstuff too.
So if you feel more comfortablegoing through your lawyer, you
can go through your lawyer.
I don't always recommend doingthe healthcare stuff through a
lawyer, only because you mighthave some specific medical
(28:37):
questions that you want answeredthat a lawyer will not be able
to, that's not within theirscope.
Financial stuff?
Thousand percent.
They're definitely going to knowall the details that you need
for the financial stuff.
Medical, I would encouragehaving a conversation with your
physician, again, depending onthe type of document.
(28:59):
So I'm not going to really talkabout the financial power of
attorney stuff, I'm going tofocus on the medical.
So there's two different kindsof advanced care planning
documents for medical care.
There's an advanced directiveand there's a post form.
So, an advanced directive is forfuture medical decisions.
(29:24):
It's not for right now.
A post form is for right now.
an advance directive is reallygreat to fill out for anybody at
any time over the age of 18.
Erin (29:35):
And you get that from your primary care doctor?
Marissa Click (29:38):
You can get it from your primary care doctor.
You can get it when you're inthe hospital.
if you've got home health comingto you, you can fill it out with
them.
Most healthcare entities willhave advance directives.
So there's two parts to anadvance directive.
(29:59):
There's the durable power ofattorney for health care.
So this is your health careagent, the person that you
choose to make health caredecisions on your behalf when
you can't make them foryourself.
Whether that's because maybeyou're unconscious, maybe you've
lost decisional capacity, whichcan only be determined by a
(30:20):
doctor, but that could include,uh, maybe you've got some
confusion, maybe you're dementedand can't make decisions
anymore, um, maybe somemedication is altering your
mental state and that canresolve, right?
Capacity is always an ebb andflow, But at some point, you
(30:42):
lose the ability to make yourown healthcare decisions.
And so your healthcare agentmakes them for you.
This person has to be over theage of 18, right?
A legal adult has to be the oneto make decisions.
And again, you want it to besomebody that you trust to make
decisions for you, even if theydon't agree with them.
And so having a conversationwith them about your decisions
(31:05):
is important.
so some of the things yourhealth care agent can do They
have the ability to start orstop any treatment, medications,
procedures.
They can choose which healthcare agencies to go to and which
health care professionals tosee.
They can access your medicalrecords.
(31:25):
for example, if you primarilyget care at St.
Al's, but something happens andthen you go to St.
Luke's, maybe St.
Luke's needs your medicalrecords.
And So your agent can go to Al'sand get them and bring them to
St.
Luke's.
And then should you pass away,it gives your healthcare agent
the ability to take care of yourfinal arrangements.
So like funeral home kind ofstuff.
(31:47):
an advance directive only getstriggered if a future healthcare
scenario comes into place.
And this is the scenario.
Whatever illness or injurybrought you to the hospital or
is occurring gets evaluated by adoctor.
And they feel like there'snothing more they can do to fix
whatever is happening, even withartificial life sustaining
(32:09):
procedures.
And your death is likely.
Or, you're in a persistent,vegetative state.
Now that's different than braindeath.
People often ask, like, well, ifI'm brain dead, just let me go.
there are specific, tests thathave to be done in order to
determine brain death.
And, in the United States...
(32:30):
Brain death is death.
And that can be really confusingfor people because often when
somebody has had brain deathoccur, they might still be on
artificial life sustainingequipment that makes them look
alive.
right?
Their heart might still bebeating.
They might still be breathingbecause they're on a ventilator
(32:52):
machine that's breathing forthem.
And That can be hard for usbecause we, we think they're
breathing and there's aheartbeat, they're alive.
When in reality, based on legaldefinitions and these testings,
that person, if they've beendetermined to be brain dead, is
dead.
So, I just want to clear that upbecause when somebody has died,
(33:18):
there aren't any more decisionsto make.
They've died.
Sorry, going back to the,scenario in which triggers your
advanced care directive.
so whatever illness or injurybrought you in is no longer
curable.
We can't fix what's going onanymore.
There's three options that youcan choose from.
(33:38):
And in all of these threeoptions, the priority is going
to be to make sure people havedignity and honor and that their
symptoms are going to bemanaged.
Right, we don't want to seepeople in pain or suffering, and
we want to make sure thatthey're treated well.
And so no matter which option ischosen, people are always going
(34:00):
to be treated well.
But those three options are, thefirst one, if I'm in that end of
life scenario, I just want tofocus on comfort.
Don't do anything else to try toprolong the process or alter
what's happening.
Just let me go when it's my timeto go and keep me cozy comfy in
the meantime.
(34:22):
There's a middle ground optionwhich is keep me cozy comfy but
I want some artificial lifesustaining procedures like
artificial nutrition andhydration.
So a feeding tube or IV fluids.
the third option is doeverything.
All aggressive cares, so thatmeans going to an ICU level of
(34:44):
care.
That means if your heart or yourbreathing were to stop, they're
going to do CPR, which couldinclude both chest compressions,
possibly defibrillation, whichis where they shock ya.
and it does include being put ona ventilator, so a breathing
machine.
At least I've never seen CPR beperformed and somebody not be
(35:07):
put on a breathing machine.
So those are the three majoroptions to choose from.
There are several extra parts tothe advance directive.
Now There are areas where ittalks about if you're pregnant,
what would you want to do withyour advance directive.
If you're not going to bepregnant in the future, and that
(35:28):
doesn't apply to you, don't fillthat part out.
for some, there's a section inthere that talks about, if you
don't have an end of lifeillness, a terminal illness,
maybe you have a more chronicissue, uh, but you lose your
cognitive abilities and yourfunctional abilities, would you
(35:50):
want to focus on comfort at thattime?
So that's a...
Little caveat in there.
There's a free text option inthe advanced directive that you
get to put whatever you think isimportant.
So sometimes people will put inhow they define quality.
Again, this can be a great wayto help guide your health care
(36:12):
agent and medical team intochoosing the best treatment
options for you.
if those treatment optionsaren't gonna get you to your
goal, why would you choose them?
Sometimes people will put,especially if they choose that
second option where there's kindof a middle ground where they're
choosing certain, artificiallife sustaining procedures,
(36:33):
maybe they'll put stipulationson that, I want a time limited
trial of artificial nutritionwith the goal of getting off of
it, right?
a time limited trial of, threeweeks, and if...
I don't make any progress orgain any weight, then withdraw
that treatment and let me passpeacefully.
(36:55):
Other people might put, ifthey've got certain, religious
rituals or spiritual needs atend of life, maybe they'll put
those in there.
or if they want to put theirfinal arrangements in there.
and then finally, there's asection that talks about if you
have a post form or not.
I had said earlier, AdvancedDirectives are for the future,
(37:17):
Post Forms are for right now.
So POST stands for Physician'sOrder for Scope of Treatment.
So it's actually a doctor'sorder.
And so you have to have theconversation with your doctor
for a POST specifically.
Advanced Directives can befilled out with anybody.
POST has to be with a doctor.
at some point when somebody ishospitalized, They will, the
(37:40):
doctor will often come talk tothem about what they want their
code status to be.
So that's asking, if you're hardof breathing where to stop, do
you want us to perform CPR andtry to do everything to bring
you back?
Right?
Including being on event orgoing to the ICU.
And so that conversation aroundcode status is what's happening
(38:00):
in a post form.
It's the same kinds ofquestions.
If something happened to you,what would you want?
But instead of being for thehospital setting, it's for out
in the world, right?
this is important because in ourcountry, the default is full
code, do everything.
if somebody, Joe Schmo iswalking down the street, and
(38:21):
they fall down, their heartstopped, maybe they had a heart
attack or something, and theyget found, the default for us is
we're going to try to doeverything to bring them back to
life, save their life.
Perform CPR, blah blah blah.
You call 911, EMS comes.
do you fill that out before, orlike at the same time as
Erin (38:52):
Do you fill that out before or like at the same time
as the medical directive?
Are they both filled out or isit separate or is it only, like
how does it
Marissa Click (39:00):
work?
I would say they're usuallyfilled out separately.
advanced directives, everyoneshould have.
All the, I am gonna plug that,everybody should have an
advanced directive At any age.
Yeah.
It's always good to have a postform.
Not everybody needs one rightnow.
Because again, it's not aboutfuture, it's about right now.
if you're really thinking about,I'm gonna still go to the
(39:23):
hospital to get care ifsomething happens.
I'm still gonna try to seekmedical attention to fix
whatever goes wrong.
You probably don't need a postform right now because we're
gonna do that anyway.
But if there's a point in yourlife where maybe you have a lot
of chronic illnesses or a lot ofhealth issues going on where
(39:46):
you've decided, I don't want totreat these anymore or...
I wouldn't want to go back tothe hospital anymore to seek
care.
And we know time is shorter,probably one to two-ish years
based on your medical stuffthat's going on.
That might be a good time totalk about filling out a post
(40:08):
with your doctor.
Erin (40:09):
Would you also do that if you didn't have one before, if
you were to go on hospice, youwould fill one out at the time?
Marissa Click (40:15):
Mm-Hmm?
.Yeah.
So.
Mo, most of the time if you goto like a nursing home, or
sometimes assisted livings, butmostly like nursing homes,
they'll have you fill out apost.
when you come on hospice,they're definitely going to have
you fill out a post.
again, because it's thatdoctor's order, and we know that
(40:36):
you're terminal.
John (40:38):
I, love what you've, you've shared.
Erin (40:42):
That's a lot I didn't know.
Cause we've talked about likethe five wishes and he's filled
his out.
I haven't done mine
John (40:48):
Yeah.
so Marissa, one thing that I've,I've really it's really.
Reaffirm my belief system, andit's so important that if we
want to alleviate a lot ofstress, not only for ourselves
or for others, it's reallyimportant to plan things early,
(41:09):
because we live in such areactive world, right?
And so it's more and more It'sso much more important to be
proactive.
And one of our, our tagline ofour company is it's your life,
your choice, right?
And so we want to, we want toempower people.
Type of control.
But the only way you do it is byhaving those vulnerable,
(41:30):
discussions by sitting down withyour family and saying, gosh,
I'm not trying to scare you orwhatever, but let's have these
discussions because we love eachother.
And we don't want thatinfighting and we don't want
that stress to roll down on us.
Is that correct?
Is that what I'm
Marissa Click (41:45):
that what I'm gathering?
Erin (41:47):
on us.
Is that correct?
Is that what I'm gathering?
Very correct.
Yeah.
John (42:06):
can ask, Yeah, can ask to engage that discussion because
like for instance, I'm goinghome very soon while Aaron's
going with me for Thanksgivingand after the holidays, my dad
is.
My dad's 80 now, and, and mymother's getting up there in age
two, and I don't even know ifthey've done their advanced
(42:26):
directives, and, and they filledout any paperwork, and so it's
really important, that balanceof respect.
But then also that balance ofit's important that we have this
discussion because, we all needto know.
And it's not something that noneof us have not thought about.
what happens if dad gets ill ordad has a heart attack or
(42:46):
something happens to mom?
What's the plan?
So what are some questions thatyou feel with your expertise
that you could help ourlisteners?
Start that conversation withtheir loved ones, maybe their
husband, maybe their wife, maybetheir children.
Marissa Click (43:02):
Yeah.
So I think you're right.
We are very reactionary.
So being proactive is alwaysgreat.
I would say, it's good to thinkabout how communication works in
your family because every familyis different, right?
Some people are really directand honest and just really dive
deep into it.
And they're not afraid of maybe,hurting some feelings a little
(43:25):
bit because we got to get itdone.
Other families maybe want tolike ease into it a little bit
more, right?
So think about that in yourapproach, right?
Because it's it's all aboutapproach.
So for some, it might bestarting out more broadly of
hey, have you ever thought aboutwhat if you happen to have to
(43:45):
live in a facility?
What do you think that'd belike?
Because it's less scary.
Having, hypotheticals thansaying, What do you, Aaron,
want?
And that can feel really,attacking.
I've also found, doing ittogether, So instead of saying,
Hey Dad, or Hey Mom, or whoever,You need to do this.
(44:08):
Because we don't like being toldwhat to do.
It's saying, Let's have aconversation around this.
there's this really, this isvery silly.
But there's this really fun gamethat I have that actually, you
can play a game that talks aboutdeath and dying.
John (44:24):
I'm excited.
Let's hear it.
hear it.
Marissa Click (44:27):
And it's got, these little questionnaires on
cards.
And it's just a whole bunch ofdifferent stuff of have you ever
thought about this before?
John (44:34):
Is this something you can buy?
Yes, buy it.
Do you know the name
Marissa Click (44:37):
of this?
I'll have to look to remind, totell you guys the name so you
can put post it.
But yeah, it's a little, it'sjust in a little box.
I have it at my house.
I didn't even think about, oh, Ishould bring this so that you
guys can see it.
Erin (44:48):
It's like conversations that you have at dinner box, but
it's conversations you haveabout,
Marissa Click (44:54):
death and dying.
Yeah.
yeah.
I think the other part of havingthese conversations with people
is really wanting to emphasize,this is coming from...
A place of care and concernbecause we love you.
We're not bringing it up becausewe want to make you feel
uncomfortable or because we'retrying to force you into doing
(45:18):
something you don't want to do,but because when that time
comes, because again it will,we're all going to be at that
point in our lives at some time,We want to be able to honor you
as a person.
And we want to be able to makesure that we know what you want.
And that our feelings and ouremotions and our desires don't
(45:39):
get in the way of that.
I think that's a really greatplace to
John (45:45):
I
Erin (45:46):
I remember we were talking somewhere, or maybe I saw it
somewhere, or read it.
I think it was in a book we bothread.
Either way, it was pretty muchOkay.
You need to share this andexpress what you need.
Cause if not, this person'sgoing to put you here and this
person's going to just pull theplug.
And Oh yeah.
(46:08):
Precious.
yeah.
I was like, Oh, that just is,but it's so true.
If you don't plan, I just mightpull the plug on you.
If I had a bad day,
John (46:19):
and I There was a type of relief for me when I filled mine
out, it was, it was strangegoing through it because I
consider myself pretty healthyand don't go to the doctor very
often and so forth.
But there was a type of reliefthat came to me to know that I
was going to share what I trulywanted with my life with with
(46:42):
Aaron and give her a copy ofthat and know that it.
My boys weren't going to beburned with this stress, that,
that Aaron has such an amazingability to say, gosh, these are
your dad's wishes.
these are not wishes.
I wrote down on the sheet ofpaper.
These are what he wrote.
And we have to honor this.
(47:03):
And there was a type of power.
In knowing that I had gottenthat done and with five wishes,
the one that I did, it was free,it didn't cost a penny.
sometimes you have to go see alawyer for your financial power
of attorney and there's costsassociated with that.
but it's things that we don'tplan for, right?
And if you don't plan early inyour life, And now that I'm in
(47:26):
my fifties, I see the importanceof it.
But if you don't plan early inyour life and then down the
road, you're on a fixed incomeand you don't have the money to
hire an attorney, to resolve allthese things, it can be a scary
thing to even have aconversation about, right?
Because some people fear money,but it is so important because
it will destroy families.
(47:47):
It will destroy connections, you
Marissa Click (47:50):
destroy families, it will destroy connections,
doctor.
they have the ability to billyour insurance for it.
So they should be taking thetime to have these conversations
with you.
You can also reach out tochaplains and social workers.
(48:11):
Even if you're not in thehospital currently.
This is always a resource toyou, for free, that you can use
anytime.
You can get these documents fromyour primary care.
in our state, the Department ofHealth and Welfare now owns
them, and so there are formsonline you can download.
you can, search for, there'slots of different kinds of
(48:33):
documents.
So, like you guys havementioned, Five Wishes.
There used to be HonoringChoices that was here.
so there's lots of options
Erin (48:42):
was one of my questions to you.
Are there books people can readthat can help them ease, that
transitioning into the later, aswe're getting ready to die, but
then our what's availableonline, all the stuff that they
families can use, or as anindividual myself, I can go
online and go, okay.
And then to know that it's, itwill be honored, I think, is
(49:05):
huge, too.
Marissa Click (49:06):
Yeah, there's this book by Hank Dunn called
Hard Choices for Loving People.
Now, I'm a little biased aboutthis because it's written by a
chaplain, right?
So, I'm gonna plug it.
But, it, it's really beautifulbecause there's a lot of, the
science and the math and themedical.
(49:26):
stuff, right?
So he, he breaks down all theterminology, but he also gives
you the statistics of how likelyare these things to work based
on, what other health issues youhave or your age or other things
like that.
And that's, I think, helpful toknow, but Hank really emphasizes
(49:47):
that these decisions come froman emotional place.
it doesn't matter how many factsand figures we have.
We're always going to make themfrom a place of emotion.
And so he talks about some ofthe emotion that is behind some
of these decisions.
So, for example, one of the mostdifficult issues I think people
(50:08):
have is talking throughartificial nutrition and
hydration.
So, different kinds of feedingtubes and IV fluids.
Emotionally, that's difficultfor us because...
feeding people and giving themsomething to drink is how we
show love and care.
It is ingrained.
It is societal.
(50:30):
It is something we're raisedwith, right?
The minute somebody walks intoyour home, what's the first
thing you do?
You offer them something to eator something to drink.
the idea of withholding food orwater from somebody can be very
emotionally difficult for us.
Especially when it comes to thepeople that we love most.
(50:53):
But the facts and figures talkabout how, in the dying process,
our body produces all of theseenzymes and hormones that make
it so that we don't feel hungeror thirst, right?
There's this fear that we'regoing to starve our loved ones,
but in reality, their body isgoing through a purging process
and they're not going to feelhunger the way that you or I
(51:16):
would feel it.
Right, but emotionally, that'sreally hard to accept, So those
are the kinds of things.
That Hank Dunn talks about inhis book, Hard Choices for
Loving People.
Great book if you're more of areading kind of learner.
Yeah.
If you're more of a, like,practical action, like, we're
(51:39):
going to get into theconversations, there's this
website called planningmyway.
org.
And it's a step by step guide tohelp you work through the
completion of advanceddirectives and how to have those
conversations and things tothink through as you're talking
it out.
And so it breaks it into foursteps, right?
(52:01):
So you've got you're thinking,like, what do I want?
Right, we have to work it outfor ourselves first.
So it's like thinking, and thenyou're planning, and then having
the conversations, and thencompleting the documents, right?
Because that's the final thing.
Always have the conversationfirst, that's always super
helpful.
For your medical team, it'sgreat to have it in writing.
(52:22):
And with our advanceddirectives, once you've gotten
to that step where you'veactually completed the form, in
the state of Idaho, it justneeds a signature.
You don't have to have a notaryor witnesses in the state of
Idaho.
Oregon has different, rulesaround that.
(52:43):
Other states have differentrules around that.
Erin (52:45):
You would just ask your doctor, Hey, what are the rules?
Do I need to have it notarized?
Or can I just sign it?
Like, how do you know?
Marissa Click (52:54):
most of the forms will have it.
laid out for you in it, right?
So the, the Department of Healthand Welfare Advanced Directive,
it only has a signature line atthe bottom.
that's pretty clear.
Erin (53:04):
Yeah
Marissa Click (53:05):
so people always ask, what do I do with my
documents once I've completedthem?
Alright, so one, make somecopies.
And give it to your healthcareagent so that they have it.
Give it to your primary caredoctor.
And if you haven't had theconversation with them already,
have the conversation with themabout what you want and say,
Here's my form.
your hospital of choice, right?
(53:25):
So wherever you tend to gethospital care or where you might
get hospital care.
And, if you have a lawyer, youcould take it to your lawyer.
That might also prompt you tostart the conversation around
financial power of attorney.
John (53:40):
oh my gosh, so much incredible information today.
It's been really exciting havingyou here and sharing all this
I've learned.
I, and I know you as well, Aaronhave learned so much about all
of this and the importance of,having these.
These things filled out inadvance and, really planning,
(54:01):
planning to, to, be lessreactive in this world.
So I know that Erin's got thisquestion that she asks all of
our guests, and I love thequestion too, because it's,
Erin (54:11):
you ask it?
You don't ever ask
John (54:13):
don't.
Okay.
All right.
I'm gonna ask it today.
so Aaron and I love to traveland we've been some.
Amazing places and we've donesome incredible things.
And so to kind of change thesubject into something that we
want to know about you as wellas if you could do something or
go some amazing place, whatwould be on the top of your
(54:35):
adventure list?
Marissa Click (54:37):
Yeah, so I have to think about this for a
minute, but when I hearadventure, I don't always think
about going.
Somewhere, I think about doingsomething.
so, before the pandemic, I wasstarting to learn how to, play
roller derby.
So, I really want to get backinto that because it was super
fun.
I'm not a very, like, physicalperson.
(54:59):
I'm very, like, emotional and inmy brain, but I'm not in my body
a lot.
And so, learning to, how to usemy body
John (55:09):
And knock people down and skate past them and all that?
Marissa Click (55:13):
Yeah,
Erin (55:13):
I mean, okay, we, like you say, you go from this very
emotional and compassionate, ah,I'm going to take my frustration
out on you.
Yes! That's
John (55:22):
just, I've never heard of a chaplain wanting to go smash
people on a roller derby course,But that's wow.
Two sides of you.
I guess there's two sides to allof us.
so thank you so much for being aguest today.
I'm so glad that Aaron connectedwith you and, she was so
incredibly excited.
she's been talking about thissince, since.
(55:43):
we all were at that event andshe just said, Oh my gosh, I
can't
Erin (55:46):
wait it's a lot of a lot of good information for people
to go more in depth into detailinstead of just saying it's a
post and it's a directive.
what does that mean?
And where do I start and reallygive me all the dirty details so
I feel comfortable about it.
So I appreciate you sharingthat.
Marissa Click (56:00):
Yeah.
Yeah.
I've just been thrilled to be onthe show.
Anytime that I can offer.
advice or guidance.
I just want to help people.
So any format that I can dothat, I'm going to jump on.
Erin (56:12):
Yeah, thank you so much.
I appreciate it.
we'll
John (56:16):
Thank you for tuning in to another episode of Connect
Empower.
We want to express our gratitudeto you for being part of our
community, and we hope today'sepisode has provided you with
valuable insights andinspiration to enhance your life
and that of a loved one.
Erin (56:31):
We are more than just a podcast.
We are a community dedicated toenhancing the lives of our aging
adults and their support system.
We encourage you to visit ourwebsite now at www.
connect empower.
com.
Explore more information aboutour guests from today's episode
and to access our freeresources.
John (56:52):
resources.
Our mission doesn't end at theconclusion of this episode.
We invite you to take action nowby sharing the knowledge you've
gained today with someone whomay benefit from it.
Whether it's a family member,friend, or colleague, your
influence can spark positivechange.
Erin (57:07):
Remember, Subscribing to our podcast ensures you never
miss an episode and we have moreincredible guests and resources
in store for you.
So hit that subscribe button andstay connected with us.
Your commitment is the drivingforce behind our mission and
together we can create amovement for a brighter future
as we age.
John (57:27):
I'm John.
Erin (57:28):
I'm Erin.
Until next Wednesday.
[Mic bleed] Power, the podcast that
Erin (00:11):
and I'm Aaron.
You're listening to connect andpower the podcast that proves
age is no barrier to growth andenlightenment.
John (00:18):
break down complex subjects into bite sized,
enjoyable episodes that willleave you feeling informed,
entertained, and ready toconquer the world.
Our guest today will illuminatethe essential rules of
chaplaincy and advanced careplanning, offering invaluable
advice for aging listeners.
Her mission is to bring peace,spiritual clarity, and comfort
(00:40):
to those in the later stages oflife.
So whether you're an aging adultseeking to secure your future, a
concerned family member, oranyone with a curiosity about
aging and planning, she is hereto provide the answers you need.
She is the Oncology andPalliative Care Chaplain at St.
Alphonsus Regional MedicalCenter and the Bereavement and
Bluebird Health.
(01:02):
Our guest believes in helpingpeople make meaning out of the
transitions in life that theyfind themselves in.
And she's also a board certifiedchaplain.
with national recognitionachieving the 2018 world class
award in hospice care.
Let's warmly welcome our guestChaplain Marissa Click.
(01:22):
Welcome.
Marissa Click (01:23):
Thanks for having me.
Erin (01:24):
Yeah.
Welcome.
We're such a pleasure to haveyou.
I know that when we met not toolong ago, you had so much
amazing information that we werelike, Oh my gosh, this is a gold
nugget to share with everybody.
So thank you so much for beinghere.
Marissa Click (01:39):
Happy to be here.
John (01:40):
So we'd love to, uh, hear your story, how you got into the
industry and, you know, what ledyou down the path of becoming a
Marissa Click (01:48):
Mm hmm.
Yeah.
I'm part of a faith tradition.
Most chaplains have their ownpersonal religious background.
not always, but for the mostpart they do.
And so I was heading down thepastoral path at first.
I became a Christian, out ofhigh school and was connected to
(02:10):
a non denominational Christianchurch in Nevada where I grew up
and really, connected with thatcommunity well because, I just
fit.
I felt like I found a communitythere that I hadn't really
experienced before.
And so I was doing a lot ofleadership things.
They were really...
(02:31):
Breathing into life these skillsthat I didn't really know that I
had until someone startedencouraging me in those.
And so I was kind of leading.
worship for the youth group andplanning, mission trips.
And along the way decided, Ithink ministry is where I want
to be.
I didn't want education to be abarrier, so I decided to go to
(02:55):
seminary.
So while I was in college, I wasstudying, religious studies,
which is just learning about allthe different kinds of
religions.
And one of the classes I tookwas the Bible as literature.
And so it was really challengingbecause I was a baby Christian
myself, having a lot of reallydeep theological discussions
(03:16):
about, this sacred text thatChristians uh, And so luckily, I
was living with a family at thetime as their live in nanny, who
were graduates of EmanuelChristian Seminary in Tennessee.
And I would come home every day,and I'd have all these questions
about faith, and the Bible, andhow do you live your life well,
(03:39):
if these things are true or not.
And instead of giving meanswers, they just gave me
better questions.
They would just keep asking memore things so that I could come
to the conclusions for myself.
And I really loved that model ofspirituality and faith
(03:59):
formation.
So I thought, I'm going to go toschool where they went to school
because that was really great.
I ended up going to EmanuelChristian Seminary out in
Tennessee.
And...
While I was there, I wasthinking I was going to still do
traditional pastoral ministry inlike a church setting and was
working in a church out there.
(04:20):
And things just kept not workingout.
I dealt with some sexualharassment at the church and,
along the way of trying to getordained, my home church in
Nevada said no because they,didn't believe in women in
ordained ministry.
And that was really, it wasreally hard to hear because
(04:41):
these were the people whoencouraged all of these
leadership skills, but theydidn't want to, bless me in that
way with the actual papersaying, yes, you are meant for
leadership and ministry and allof this.
So I actually had a chaplain inseminary and, she was amazing.
She is the reason that I'm inchaplaincy today.
(05:03):
Her name is Heather Holland, andshe's great.
and she was like, from the getgo, Oh, no, no, no, no.
You're not meant for traditionalpastoral ministry.
You're a chaplain.
You need to go do chaplaincy,and that's gonna be great.
we had some different people,like different groups would come
and and talk to us asseminarians about different
ministry opportunities.
(05:24):
So one of the groups was,Christian ministry in the
National Parks.
I did a summer in the NationalParks with them as a chaplain
and led college students andconnected people.
Our main focus was on buildingrelationships with the staff
because working in NationalParks can be really, um, it's a
(05:47):
really transitory kind ofposition and, You make and break
relationships pretty quickbecause you just have a season
together, right?
So, there's a lot of, drug use,and there's a lot of, sexual
promiscuity, and there's a lotof, questioning of, of life.
(06:07):
Because when you don't havetechnology, because you're out
in the middle of the wilderness,you start asking really big
questions about yourself, right?
we would also do, Like churchservices at some of the camps so
that when people come and travelto the national parks, they can
have a religious service if theywant.
So that was pretty cool, I lovedit, but it still wasn't quite
(06:29):
right.
And so at the seminary that Iwent to, we, had the opportunity
to do what's called clinicalpastoral education.
just like nurses and doctorshave to do residencies and
education.
In the setting, before theybecome, licensed.
chaplains have to do that too.
(06:50):
And that was part of therequirements at my seminary.
Was that everybody has to gothrough, a semester of clinical
pastoral education.
And I absolutely fell in love.
It was the exact right fit.
I worked at a hospital that wasa trauma one center.
So, That means it's a lot higheracuity kind of care.
(07:13):
they often have a burn unit andit's a educational like teaching
facility.
there's just a lot morerequirements for it and so you
see a lot.
they also have pediatrics andjust the whole gamut of
healthcare that could be in afacility.
And I just learned so much andreally felt I belonged.
(07:33):
that same kind of sense ofcommunity that I got when I
first And so I continued,another full year residency of
clinical pastoral education, andthat really launched me on the
path into chaplaincy.
John (07:48):
Wow.
What an amazing story.
Erin (07:51):
and just in that little bit learning, the park and recs,
I had no idea.
Yeah, The national parks.
John (07:58):
Wow, what a better place to, to, have, have spiritual
growth surrounded by mountainsand trees.
that's talking my language.
Erin (08:07):
say when she mentioned that I was like, Oh, that's John
right there.
I think that's why we looked ateach other.
When
Marissa Click (08:13):
And I think it's common, like I said, when, when
we tune out the things aroundus, right?
When we don't have thedistractions of technology and
the responsibilities of work andfamily that we love having.
Right?
We choose to have those, butthey can be a burden at times.
Or, burden maybe isn't the rightword, but
Erin (08:34):
Distraction maybe.
Marissa Click (08:35):
Distraction.
Yeah.
another responsibility.
Something that's just, it'spulling your time, right?
You only have so much of timeand it has to be kind of
navigated and where you're goingto put it.
And So when you don't have thosethings, and you're in a
landscape that is really big,that makes you question how
(09:00):
small you are compared to theuniverse, right?
I think it means that peoplestart asking those deeper
questions that get lost in theday to day hustle.
Erin (09:13):
That's like John and I were trying to have better daily
habits because our time is solimited and we're like trying to
read books to educate our mindsand just little things here to
improve ourselves to improve foreverybody else that you serve
all day long, right?
Can you explain what achaplain's role is in the
healthcare sitting, particularlywith our aging adults and then
(09:35):
how you can support theiremotional and their spiritual
needs?
Marissa Click (09:38):
Yeah, so um, First there are lots of
different kinds of chaplains asI mentioned a little earlier
Most chaplains have their ownspiritual or religious
preferences.
So let me suss that out a littlebit.
I believe that everybody isspiritual.
right?
We all have things in our lifein which we make meaning and
(10:00):
value.
It's kind of those things thatgive our lives a higher purpose.
right?
That's being spiritual.
for some people that might betheir family.
For others, maybe it's theirwork.
Some people like to connect withnature, like you all.
but for some, And thatconnection to their spirituality
(10:21):
comes through religion.
So religion has a certain set ofbeliefs, but mostly it's the
practices around those beliefs.
That guide and shape our lives,right, the ways in which we
choose to function in the worldhave these kind of, rules, for
lack of a better word.
And chaplains have their ownpersonal spirituality or
(10:46):
religion, but we in healthcareespecially have ethical
guidelines that say that we areavailable to people of all
traditions and no tradition.
there are chaplains that areBuddhist chaplains, there are
Muslim chaplains, there areChristian chaplains, there are
chaplains who don't have areligious background, there are
(11:07):
humanist chaplains.
But the, the goal that chaplainshave is to meet people where
they are.
And when you come into thehospital, or you start having
changes in your health, that cancause a lot of strife.
Again, You start asking a lot ofquestions about yourself, and
(11:28):
your family, and what'simportant.
And that's why having a chaplaincan be helpful, because we can
act as guides, right?
And there's a lot of transitionsthat happen when you have a
health crisis.
People might start askingquestions like, why me?
(11:49):
Why did this happen to me?
There are a lot of questionsabout fairness.
Where is God in the midst of mysuffering?
Why me and not somebody else?
People start to wonder, Who am Iif I don't have XYZ in my
health?
And those are really big andscary things to be wondering
(12:13):
when you're already in a reallytransitory time in your life.
right?
when you're trying to cope withMaybe you're aging and your body
isn't doing all the things thatit used to do so easily.
Or your mind isn't as sharp asit once was.
Or the experience that you'rehaving isn't what other people
(12:35):
are experiencing, I'm thinkingof people with mental health
issues or those experiencingdementia or Alzheimer's who are
seeing things or hearing thingsthat Maybe other people can't in
that moment.
And that can be really lonely ifyou don't have somebody who's
willing to sit in that with you.
(12:58):
You know, as much as ourfamilies love us and support us,
they want to fix it.
Right?
The doctors want to fix it.
And so, there's always anagenda.
And that agenda can maybe be agood one.
But sometimes we need space towork it out for ourselves.
And so having someone who cansit in it with you, who can ask
(13:23):
better questions, and help youcome to the conclusions that you
need to come to, to be okay withwhatever you're going through,
that's the heart of chaplaincy.
And so, when we meet people, Iget, I get that, question a lot
of Oh my gosh, am I dying?
Because everybody thinkschaplains are only here when
you're dying, which is not true.
(13:44):
We do come when people are atthe end of their life.
but not always.
And so the majority of our timeis actually spent just getting
to know people and, and helpingthem navigate this new
experience or Maybe they need totell their story.
And we're big collectors ofstories and we love listening.
(14:05):
Maybe somebody needs a ritual tohelp get them through, right?
We have rituals in society allthe time.
coming of age is a big time ofrituals, where we might shower
somebody in gifts or they haveto perform some kind of test to
move from childhood toadulthood.
And so we have those same kindsof rituals when we have health
(14:28):
changes, too.
And so we help navigate thosethings.
we're also, ethical teammembers.
And so when there are ethicalquestions that come up in
healthcare, which happen, wemight be on the team that's
trying to help advocate andbring additional perspective to
the group that's trying to makethe best decision for somebody.
(14:52):
So it's pretty broad.
All the things that we do.
John (14:57):
What triggers, triggers the, Um, discovery that there's
a chaplain available.
Say I go into the hospital orsomebody I love goes in the
hospital and they have just beendiagnosed with something or they
are, feeling themselves havingto.
can come to the realization thattheir health is, is, really
(15:20):
declining.
And they're concerned with that.
How do they know that there's,there's a chaplain available?
How do they know that?
Because most of the time, yes,if somebody comes on to hospice
care, that's part of thedisciplinary team, right?
That comes out to take care ofthem.
But however, in the hospital,are chaplains available for
everybody and at what?
(15:41):
time can they say, Hey, I'd liketo see a chaplain or is there a
chaplain available at what timedoes that, that occur?
Marissa Click (15:48):
Yeah.
So in most hospitals, Everyhospital's gonna have a little
bit, different protocol orstaffing, but most hospitals are
required to have a chaplain.
And chaplains are available justabout all the time.
At least at, at St.
Al's we have coverage 24 7, 365.
And so most of us will justround and visit and introduce
(16:11):
ourselves and ask, right?
So I go door to door.
If you're in the hospital on myunit, there's a good chance
you're going to meet me at somepoint.
John (16:20):
How great.
Marissa Click (16:21):
others, other places might have protocols
about if you've been there for,a certain amount of time, right?
The longer you're in thehospital.
Maybe that means that you'reexperiencing more setbacks or
more decline.
That's a good reason for achaplain to be triggered.
sometimes when people havereally high acuity needs, those
(16:43):
areas of the hospital might getmore, more support than other
areas.
Right, so I'm thinking ICU oroncology.
Or, the emergency department,because those can be really
trying areas of the hospital.
(17:05):
doctors, there's usually in theelectronic medical records of,
of facilities, there's usuallyways to trigger a referral,
anybody can ask for a chaplainat any time, it's part of the
rights that we get as peoplewhen we become patients.
And anybody can ask and areferral can be put in.
Erin (17:23):
I'm learning a lot today.
John (17:26):
I think we learn a lot with every podcast.
We do.
I'm
Erin (17:31):
I didn't know there was a difference with pastoral and
chaplains.
so advanced care planning, Idon't really know what that is.
I have a clue, like you got aplan for the future, but really
what is advanced care planning?
How does it work?
Where do you get started?
The importance of it for ouraging adults and maybe how it
(17:53):
supports them and their family.
If you could just brieflyexplain or share with us.
Marissa Click (17:58):
I like to think of advanced care planning as a
gift.
And I say that because there aremany times in the hospital
setting where some kind oftragedy has occurred, whatever
that looks like, and we don'tknow as the medical team what
this person would have wanted,and the family doesn't know
(18:18):
either, they're stuck withmaking this huge decision for
their loved one at a veryheightened emotional time.
Not knowing all of the termsthat are being thrown out and
the medical jargon that's beingused, and it's really scary.
(18:39):
So advanced care planning isreally an opportunity for people
to take away some of that fearand responsibility.
By putting down in writing andhaving conversations with people
about what they would want infuture healthcare scenarios.
And who they would want to speakon their behalf.
(19:02):
So at the heart of it, it's aconversation.
And then there's some detailswith paperwork.
And so, things that are helpfulfor people to think through
before they get to the detailsof putting things down in
writing.
In healthcare, we often justkeep doing things to people.
(19:23):
And there is this ethos, thisbelief system in healthcare that
we want to fix it all the time,right?
We want to make people better,that's why people get into
healthcare, they want to help.
But there comes a point in ourlives where we can't fix it
anymore.
As amazing as medicine is, itstill has limitations.
(19:47):
It's still run by people whodon't know enough, and
technology will never get to thepoint where we can live forever.
I don't know about y'all, butI've never met somebody who's
gotten out of this world alive.
And so at some point, we're allgonna die.
And so, talking through what isimportant to you as a person,
(20:10):
how do you define quality inyour life?
And quality can be defined inlots of different ways.
For some people, quality mightlook like having their cognitive
abilities.
their abilities to havemeaningful conversation and to
recognize their loved ones andto understand what's being said
(20:31):
to them.
Other people might say theirfunctional abilities are the
most important thing.
And those might be their abilityto walk or...
provide personal cares tothemselves independently like
showering, bathing, eating,going to the bathroom.
(20:54):
And so if they lost thosethings, maybe that's not a
quality of life that they wouldfind acceptable.
Other people might say, if theycouldn't do their very favorite
hobbies like Just, just end itthen cause what's life worth
living if you can't go flyfishing or something?
(21:16):
And a lot of times when a nurseor a doctor or the medical team
is, is talking to folks abouttheir treatment options, we
don't always think about, isthis treatment option going to
get me to that goal, to how Idefine quality?
Because why would we choose atreatment?
That doesn't actually get us toour goal.
(21:39):
And so if we can prioritize ourthinking to highlight those ways
in which we define quality andthen filter the decision making
through that, we can often makebetter decisions that align more
with who we are as people andwhat's important to us rather
(22:02):
than just...
continuing to do things for thesake of doing things.
having these conversations isn'talways easy, because it's, it
has to be done with people, andas we know, everybody has a
different perspective, differentideas of what's important,
different belief systems thatmight be influencing the
(22:23):
decisions that they would make.
And so it can be vulnerable tobring those up with people that
you care about because nobodylikes to be judged.
Nobody wants to hear that howthey choose to live their life
or how they choose to prioritizewhat's important to them is
wrong.
(22:44):
Or maybe not wrong, but it'sjust different than somebody
else, right?
That can be hard to be open todifferences in perspective and
experience.
But that's why having theconversation is important
because the other part of it ischoosing someone to speak on
your behalf to help makedecisions based on what you said
your goals are.
(23:06):
And so you want to pick somebodythat is gonna make those
decisions even if they don'tagree with them.
that's kind of the, the startingpoint of advanced care planning.
John (23:20):
so when you select somebody and you have that
person that's going to advocatefor your, for you during that
moment of crisis, it doesn'talways have to be in the moment
of crisis.
we can, we can plan that and geta power of attorney for health,
power attorney for finances andso forth.
I think it's best that we all dothat.
(23:42):
Way early in our lives, right?
Because we don't ever know whensomething could happen.
and I, I love that you said it'sa gift, too, because I do think
it's not only a gift to theperson that eventually will go
through some sort of crisis, butit's a gift to their loved ones
because it can create so much.
tension and stress and infighting within families when,
(24:07):
they haven't selected somebodyas a power of attorney and
crisis hits.
Am I correct on that?
Marissa Click (24:13):
Oh, you're very correct on that.
And There are so many times inthe hospital where somebody has
maybe not chosen someone.
And so in Idaho, at least everystate has their own laws around
this, but in Idaho, there'sactually laws in place.
It's the Idaho statute andthere's a bunch of numbers after
that I can't remember, but itdictates who can make healthcare
(24:37):
decisions on your behalf and it,it has a very strict order.
I think the order is if you havea guardian, then if you don't
have a guardian, it goes to, alegally married spouse.
So I'm going to emphasizelegally married because the
state of Idaho does not honorcommon law marriage.
Legally married.
(24:58):
then it would go to an adultchild, And then siblings,
parents, and then any othertrusted adult.
not uncommon for us to havemaybe strained relationships
with some family members atdifferent times throughout our
lives.
if you have a strainedrelationship with somebody who
(25:20):
is first in line in that Idahostatute and you haven't chosen a
healthcare agent, that person'sgoing to make decisions on your
behalf.
And if that's not who you trustto do that or who knows you well
enough to do that for you, thatcan be really not great
sometimes.
the other part is, sometimes insome families, There are certain
(25:46):
members of the family that kindof rise up and they're the doers
in the family and they're theones who want to take control.
But maybe they're not the bestperson to make decisions.
And so maybe you want, someonewho's a little bit quieter or
that you're closer to.
And so again, if you don't putthat down in writing, it can
cause increased strife in yourfamily as they're working
(26:09):
through their own familydynamics.
And.
The role that they play in thefamily, some of this is also, in
certain cultures, certain peoplespeak on behalf of the family.
if, if you're the person who isthe spokesperson for the family,
but you're the one in healthcrisis, then in the background,
(26:29):
your family's having to reorder,who's going to be the new
spokesperson or the head of thefamily.
So it's really important to, tohave this in, in place.
there's never a bad time tostart the conversation.
I know I recently had thisconversation with my husband.
I'm 34 years old, don't reallyhave a lot of health issues, but
(26:51):
I see the worst case scenariosevery single day at the
hospital.
And so, I made an advancedirective.
And it was hard to have theconversation with my husband
because initially I didn't wantto choose my husband to be my
health care agent.
Mostly because he's had somepersonal grief issues and family
(27:14):
loss that still affects himtoday.
And I was concerned that thatwould be too difficult for him
to make those decisions.
But we had a conversation and,yeah, it changed my perspective
because of what he chose toshare.
And so it made me feel morecomfortable having him be my
person.
And we had to hash out, all thedetails that come with those
(27:38):
health care decisions and talkthrough them because he and I
have different perspectives onwhat we would want.
Erin (27:45):
where do you start?
Do you start with your lawyer?
Do you start pulling stuffoffline?
Do you start with your doctor?
Marissa Click (27:53):
Yeah, So this is a, it's going to be a multi part
answer.
So there are different kinds ofSo, depending on what kind of
document you want to fill out,will determine where you want to
start.
So, as you mentioned, there'sdifferent kinds, like, there's
financial power of attorney andthere's medical power of
(28:16):
attorney.
Anything financial has to gothrough a lawyer.
But, they can also do medicalstuff too.
So if you feel more comfortablegoing through your lawyer, you
can go through your lawyer.
I don't always recommend doingthe healthcare stuff through a
lawyer, only because you mighthave some specific medical
(28:37):
questions that you want answeredthat a lawyer will not be able
to, that's not within theirscope.
Financial stuff?
Thousand percent.
They're definitely going to knowall the details that you need
for the financial stuff.
Medical, I would encouragehaving a conversation with your
physician, again, depending onthe type of document.
(28:59):
So I'm not going to really talkabout the financial power of
attorney stuff, I'm going tofocus on the medical.
So there's two different kindsof advanced care planning
documents for medical care.
There's an advanced directiveand there's a post form.
So, an advanced directive is forfuture medical decisions.
(29:24):
It's not for right now.
A post form is for right now.
an advance directive is reallygreat to fill out for anybody at
any time over the age of 18.
Erin (29:35):
And you get that from your primary care doctor?
Marissa Click (29:38):
You can get it from your primary care doctor.
You can get it when you're inthe hospital.
if you've got home health comingto you, you can fill it out with
them.
Most healthcare entities willhave advance directives.
So there's two parts to anadvance directive.
(29:59):
There's the durable power ofattorney for health care.
So this is your health careagent, the person that you
choose to make health caredecisions on your behalf when
you can't make them foryourself.
Whether that's because maybeyou're unconscious, maybe you've
lost decisional capacity, whichcan only be determined by a
(30:20):
doctor, but that could include,uh, maybe you've got some
confusion, maybe you're dementedand can't make decisions
anymore, um, maybe somemedication is altering your
mental state and that canresolve, right?
Capacity is always an ebb andflow, But at some point, you
(30:42):
lose the ability to make yourown healthcare decisions.
And so your healthcare agentmakes them for you.
This person has to be over theage of 18, right?
A legal adult has to be the oneto make decisions.
And again, you want it to besomebody that you trust to make
decisions for you, even if theydon't agree with them.
And so having a conversationwith them about your decisions
(31:05):
is important.
so some of the things yourhealth care agent can do They
have the ability to start orstop any treatment, medications,
procedures.
They can choose which healthcare agencies to go to and which
health care professionals tosee.
They can access your medicalrecords.
(31:25):
for example, if you primarilyget care at St.
Al's, but something happens andthen you go to St.
Luke's, maybe St.
Luke's needs your medicalrecords.
And So your agent can go to Al'sand get them and bring them to
St.
Luke's.
And then should you pass away,it gives your healthcare agent
the ability to take care of yourfinal arrangements.
So like funeral home kind ofstuff.
(31:47):
an advance directive only getstriggered if a future healthcare
scenario comes into place.
And this is the scenario.
Whatever illness or injurybrought you to the hospital or
is occurring gets evaluated by adoctor.
And they feel like there'snothing more they can do to fix
whatever is happening, even withartificial life sustaining
(32:09):
procedures.
And your death is likely.
Or, you're in a persistent,vegetative state.
Now that's different than braindeath.
People often ask, like, well, ifI'm brain dead, just let me go.
there are specific, tests thathave to be done in order to
determine brain death.
And, in the United States...
(32:30):
Brain death is death.
And that can be really confusingfor people because often when
somebody has had brain deathoccur, they might still be on
artificial life sustainingequipment that makes them look
alive.
right?
Their heart might still bebeating.
They might still be breathingbecause they're on a ventilator
(32:52):
machine that's breathing forthem.
And That can be hard for usbecause we, we think they're
breathing and there's aheartbeat, they're alive.
When in reality, based on legaldefinitions and these testings,
that person, if they've beendetermined to be brain dead, is
dead.
So, I just want to clear that upbecause when somebody has died,
(33:18):
there aren't any more decisionsto make.
They've died.
Sorry, going back to the,scenario in which triggers your
advanced care directive.
so whatever illness or injurybrought you in is no longer
curable.
We can't fix what's going onanymore.
There's three options that youcan choose from.
(33:38):
And in all of these threeoptions, the priority is going
to be to make sure people havedignity and honor and that their
symptoms are going to bemanaged.
Right, we don't want to seepeople in pain or suffering, and
we want to make sure thatthey're treated well.
And so no matter which option ischosen, people are always going
(34:00):
to be treated well.
But those three options are, thefirst one, if I'm in that end of
life scenario, I just want tofocus on comfort.
Don't do anything else to try toprolong the process or alter
what's happening.
Just let me go when it's my timeto go and keep me cozy comfy in
the meantime.
(34:22):
There's a middle ground optionwhich is keep me cozy comfy but
I want some artificial lifesustaining procedures like
artificial nutrition andhydration.
So a feeding tube or IV fluids.
the third option is doeverything.
All aggressive cares, so thatmeans going to an ICU level of
(34:44):
care.
That means if your heart or yourbreathing were to stop, they're
going to do CPR, which couldinclude both chest compressions,
possibly defibrillation, whichis where they shock ya.
and it does include being put ona ventilator, so a breathing
machine.
At least I've never seen CPR beperformed and somebody not be
(35:07):
put on a breathing machine.
So those are the three majoroptions to choose from.
There are several extra parts tothe advance directive.
Now There are areas where ittalks about if you're pregnant,
what would you want to do withyour advance directive.
If you're not going to bepregnant in the future, and that
(35:28):
doesn't apply to you, don't fillthat part out.
for some, there's a section inthere that talks about, if you
don't have an end of lifeillness, a terminal illness,
maybe you have a more chronicissue, uh, but you lose your
cognitive abilities and yourfunctional abilities, would you
(35:50):
want to focus on comfort at thattime?
So that's a...
Little caveat in there.
There's a free text option inthe advanced directive that you
get to put whatever you think isimportant.
So sometimes people will put inhow they define quality.
Again, this can be a great wayto help guide your health care
(36:12):
agent and medical team intochoosing the best treatment
options for you.
if those treatment optionsaren't gonna get you to your
goal, why would you choose them?
Sometimes people will put,especially if they choose that
second option where there's kindof a middle ground where they're
choosing certain, artificiallife sustaining procedures,
(36:33):
maybe they'll put stipulationson that, I want a time limited
trial of artificial nutritionwith the goal of getting off of
it, right?
a time limited trial of, threeweeks, and if...
I don't make any progress orgain any weight, then withdraw
that treatment and let me passpeacefully.
(36:55):
Other people might put, ifthey've got certain, religious
rituals or spiritual needs atend of life, maybe they'll put
those in there.
or if they want to put theirfinal arrangements in there.
and then finally, there's asection that talks about if you
have a post form or not.
I had said earlier, AdvancedDirectives are for the future,
(37:17):
Post Forms are for right now.
So POST stands for Physician'sOrder for Scope of Treatment.
So it's actually a doctor'sorder.
And so you have to have theconversation with your doctor
for a POST specifically.
Advanced Directives can befilled out with anybody.
POST has to be with a doctor.
at some point when somebody ishospitalized, They will, the
(37:40):
doctor will often come talk tothem about what they want their
code status to be.
So that's asking, if you're hardof breathing where to stop, do
you want us to perform CPR andtry to do everything to bring
you back?
Right?
Including being on event orgoing to the ICU.
And so that conversation aroundcode status is what's happening
(38:00):
in a post form.
It's the same kinds ofquestions.
If something happened to you,what would you want?
But instead of being for thehospital setting, it's for out
in the world, right?
this is important because in ourcountry, the default is full
code, do everything.
if somebody, Joe Schmo iswalking down the street, and
(38:21):
they fall down, their heartstopped, maybe they had a heart
attack or something, and theyget found, the default for us is
we're going to try to doeverything to bring them back to
life, save their life.
Perform CPR, blah blah blah.
You call 911, EMS comes.
do you fill that out before, orlike at the same time as
Erin (38:52):
Do you fill that out before or like at the same time
as the medical directive?
Are they both filled out or isit separate or is it only, like
how does it
Marissa Click (39:00):
work?
I would say they're usuallyfilled out separately.
advanced directives, everyoneshould have.
All the, I am gonna plug that,everybody should have an
advanced directive At any age.
Yeah.
It's always good to have a postform.
Not everybody needs one rightnow.
Because again, it's not aboutfuture, it's about right now.
if you're really thinking about,I'm gonna still go to the
(39:23):
hospital to get care ifsomething happens.
I'm still gonna try to seekmedical attention to fix
whatever goes wrong.
You probably don't need a postform right now because we're
gonna do that anyway.
But if there's a point in yourlife where maybe you have a lot
of chronic illnesses or a lot ofhealth issues going on where
(39:46):
you've decided, I don't want totreat these anymore or...
I wouldn't want to go back tothe hospital anymore to seek
care.
And we know time is shorter,probably one to two-ish years
based on your medical stuffthat's going on.
That might be a good time totalk about filling out a post
(40:08):
with your doctor.
Erin (40:09):
Would you also do that if you didn't have one before, if
you were to go on hospice, youwould fill one out at the time?
Marissa Click (40:15):
Mm-Hmm?
.Yeah.
So.
Mo, most of the time if you goto like a nursing home, or
sometimes assisted livings, butmostly like nursing homes,
they'll have you fill out apost.
when you come on hospice,they're definitely going to have
you fill out a post.
again, because it's thatdoctor's order, and we know that
(40:36):
you're terminal.
John (40:38):
I, love what you've, you've shared.
Erin (40:42):
That's a lot I didn't know.
Cause we've talked about likethe five wishes and he's filled
his out.
I haven't done mine
John (40:48):
Yeah.
so Marissa, one thing that I've,I've really it's really.
Reaffirm my belief system, andit's so important that if we
want to alleviate a lot ofstress, not only for ourselves
or for others, it's reallyimportant to plan things early,
(41:09):
because we live in such areactive world, right?
And so it's more and more It'sso much more important to be
proactive.
And one of our, our tagline ofour company is it's your life,
your choice, right?
And so we want to, we want toempower people.
Type of control.
But the only way you do it is byhaving those vulnerable,
(41:30):
discussions by sitting down withyour family and saying, gosh,
I'm not trying to scare you orwhatever, but let's have these
discussions because we love eachother.
And we don't want thatinfighting and we don't want
that stress to roll down on us.
Is that correct?
Is that what I'm
Marissa Click (41:45):
that what I'm gathering?
Erin (41:47):
on us.
Is that correct?
Is that what I'm gathering?
Very correct.
Yeah.
John (42:06):
can ask, Yeah, can ask to engage that discussion because
like for instance, I'm goinghome very soon while Aaron's
going with me for Thanksgivingand after the holidays, my dad
is.
My dad's 80 now, and, and mymother's getting up there in age
two, and I don't even know ifthey've done their advanced
(42:26):
directives, and, and they filledout any paperwork, and so it's
really important, that balanceof respect.
But then also that balance ofit's important that we have this
discussion because, we all needto know.
And it's not something that noneof us have not thought about.
what happens if dad gets ill ordad has a heart attack or
(42:46):
something happens to mom?
What's the plan?
So what are some questions thatyou feel with your expertise
that you could help ourlisteners?
Start that conversation withtheir loved ones, maybe their
husband, maybe their wife, maybetheir children.
Marissa Click (43:02):
Yeah.
So I think you're right.
We are very reactionary.
So being proactive is alwaysgreat.
I would say, it's good to thinkabout how communication works in
your family because every familyis different, right?
Some people are really directand honest and just really dive
deep into it.
And they're not afraid of maybe,hurting some feelings a little
(43:25):
bit because we got to get itdone.
Other families maybe want tolike ease into it a little bit
more, right?
So think about that in yourapproach, right?
Because it's it's all aboutapproach.
So for some, it might bestarting out more broadly of
hey, have you ever thought aboutwhat if you happen to have to
(43:45):
live in a facility?
What do you think that'd belike?
Because it's less scary.
Having, hypotheticals thansaying, What do you, Aaron,
want?
And that can feel really,attacking.
I've also found, doing ittogether, So instead of saying,
Hey Dad, or Hey Mom, or whoever,You need to do this.
(44:08):
Because we don't like being toldwhat to do.
It's saying, Let's have aconversation around this.
there's this really, this isvery silly.
But there's this really fun gamethat I have that actually, you
can play a game that talks aboutdeath and dying.
John (44:24):
I'm excited.
Let's hear it.
hear it.
Marissa Click (44:27):
And it's got, these little questionnaires on
cards.
And it's just a whole bunch ofdifferent stuff of have you ever
thought about this before?
John (44:34):
Is this something you can buy?
Yes, buy it.
Do you know the name
Marissa Click (44:37):
of this?
I'll have to look to remind, totell you guys the name so you
can put post it.
But yeah, it's a little, it'sjust in a little box.
I have it at my house.
I didn't even think about, oh, Ishould bring this so that you
guys can see it.
Erin (44:48):
It's like conversations that you have at dinner box, but
it's conversations you haveabout,
Marissa Click (44:54):
death and dying.
Yeah.
yeah.
I think the other part of havingthese conversations with people
is really wanting to emphasize,this is coming from...
A place of care and concernbecause we love you.
We're not bringing it up becausewe want to make you feel
uncomfortable or because we'retrying to force you into doing
(45:18):
something you don't want to do,but because when that time
comes, because again it will,we're all going to be at that
point in our lives at some time,We want to be able to honor you
as a person.
And we want to be able to makesure that we know what you want.
And that our feelings and ouremotions and our desires don't
(45:39):
get in the way of that.
I think that's a really greatplace to
John (45:45):
I
Erin (45:46):
I remember we were talking somewhere, or maybe I saw it
somewhere, or read it.
I think it was in a book we bothread.
Either way, it was pretty muchOkay.
You need to share this andexpress what you need.
Cause if not, this person'sgoing to put you here and this
person's going to just pull theplug.
And Oh yeah.
(46:08):
Precious.
yeah.
I was like, Oh, that just is,but it's so true.
If you don't plan, I just mightpull the plug on you.
If I had a bad day,
John (46:19):
and I There was a type of relief for me when I filled mine
out, it was, it was strangegoing through it because I
consider myself pretty healthyand don't go to the doctor very
often and so forth.
But there was a type of reliefthat came to me to know that I
was going to share what I trulywanted with my life with with
(46:42):
Aaron and give her a copy ofthat and know that it.
My boys weren't going to beburned with this stress, that,
that Aaron has such an amazingability to say, gosh, these are
your dad's wishes.
these are not wishes.
I wrote down on the sheet ofpaper.
These are what he wrote.
And we have to honor this.
(47:03):
And there was a type of power.
In knowing that I had gottenthat done and with five wishes,
the one that I did, it was free,it didn't cost a penny.
sometimes you have to go see alawyer for your financial power
of attorney and there's costsassociated with that.
but it's things that we don'tplan for, right?
And if you don't plan early inyour life, And now that I'm in
(47:26):
my fifties, I see the importanceof it.
But if you don't plan early inyour life and then down the
road, you're on a fixed incomeand you don't have the money to
hire an attorney, to resolve allthese things, it can be a scary
thing to even have aconversation about, right?
Because some people fear money,but it is so important because
it will destroy families.
(47:47):
It will destroy connections, you
Marissa Click (47:50):
destroy families, it will destroy connections,
doctor.
they have the ability to billyour insurance for it.
So they should be taking thetime to have these conversations
with you.
You can also reach out tochaplains and social workers.
(48:11):
Even if you're not in thehospital currently.
This is always a resource toyou, for free, that you can use
anytime.
You can get these documents fromyour primary care.
in our state, the Department ofHealth and Welfare now owns
them, and so there are formsonline you can download.
you can, search for, there'slots of different kinds of
(48:33):
documents.
So, like you guys havementioned, Five Wishes.
There used to be HonoringChoices that was here.
so there's lots of options
Erin (48:42):
was one of my questions to you.
Are there books people can readthat can help them ease, that
transitioning into the later, aswe're getting ready to die, but
then our what's availableonline, all the stuff that they
families can use, or as anindividual myself, I can go
online and go, okay.
And then to know that it's, itwill be honored, I think, is
(49:05):
huge, too.
Marissa Click (49:06):
Yeah, there's this book by Hank Dunn called
Hard Choices for Loving People.
Now, I'm a little biased aboutthis because it's written by a
chaplain, right?
So, I'm gonna plug it.
But, it, it's really beautifulbecause there's a lot of, the
science and the math and themedical.
(49:26):
stuff, right?
So he, he breaks down all theterminology, but he also gives
you the statistics of how likelyare these things to work based
on, what other health issues youhave or your age or other things
like that.
And that's, I think, helpful toknow, but Hank really emphasizes
(49:47):
that these decisions come froman emotional place.
it doesn't matter how many factsand figures we have.
We're always going to make themfrom a place of emotion.
And so he talks about some ofthe emotion that is behind some
of these decisions.
So, for example, one of the mostdifficult issues I think people
(50:08):
have is talking throughartificial nutrition and
hydration.
So, different kinds of feedingtubes and IV fluids.
Emotionally, that's difficultfor us because...
feeding people and giving themsomething to drink is how we
show love and care.
It is ingrained.
It is societal.
(50:30):
It is something we're raisedwith, right?
The minute somebody walks intoyour home, what's the first
thing you do?
You offer them something to eator something to drink.
the idea of withholding food orwater from somebody can be very
emotionally difficult for us.
Especially when it comes to thepeople that we love most.
(50:53):
But the facts and figures talkabout how, in the dying process,
our body produces all of theseenzymes and hormones that make
it so that we don't feel hungeror thirst, right?
There's this fear that we'regoing to starve our loved ones,
but in reality, their body isgoing through a purging process
and they're not going to feelhunger the way that you or I
(51:16):
would feel it.
Right, but emotionally, that'sreally hard to accept, So those
are the kinds of things.
That Hank Dunn talks about inhis book, Hard Choices for
Loving People.
Great book if you're more of areading kind of learner.
Yeah.
If you're more of a, like,practical action, like, we're
(51:39):
going to get into theconversations, there's this
website called planningmyway.
org.
And it's a step by step guide tohelp you work through the
completion of advanceddirectives and how to have those
conversations and things tothink through as you're talking
it out.
And so it breaks it into foursteps, right?
(52:01):
So you've got you're thinking,like, what do I want?
Right, we have to work it outfor ourselves first.
So it's like thinking, and thenyou're planning, and then having
the conversations, and thencompleting the documents, right?
Because that's the final thing.
Always have the conversationfirst, that's always super
helpful.
For your medical team, it'sgreat to have it in writing.
(52:22):
And with our advanceddirectives, once you've gotten
to that step where you'veactually completed the form, in
the state of Idaho, it justneeds a signature.
You don't have to have a notaryor witnesses in the state of
Idaho.
Oregon has different, rulesaround that.
(52:43):
Other states have differentrules around that.
Erin (52:45):
You would just ask your doctor, Hey, what are the rules?
Do I need to have it notarized?
Or can I just sign it?
Like, how do you know?
Marissa Click (52:54):
most of the forms will have it.
laid out for you in it, right?
So the, the Department of Healthand Welfare Advanced Directive,
it only has a signature line atthe bottom.
that's pretty clear.
Erin (53:04):
Yeah
Marissa Click (53:05):
so people always ask, what do I do with my
documents once I've completedthem?
Alright, so one, make somecopies.
And give it to your healthcareagent so that they have it.
Give it to your primary caredoctor.
And if you haven't had theconversation with them already,
have the conversation with themabout what you want and say,
Here's my form.
your hospital of choice, right?
(53:25):
So wherever you tend to gethospital care or where you might
get hospital care.
And, if you have a lawyer, youcould take it to your lawyer.
That might also prompt you tostart the conversation around
financial power of attorney.
John (53:40):
oh my gosh, so much incredible information today.
It's been really exciting havingyou here and sharing all this
I've learned.
I, and I know you as well, Aaronhave learned so much about all
of this and the importance of,having these.
These things filled out inadvance and, really planning,
(54:01):
planning to, to, be lessreactive in this world.
So I know that Erin's got thisquestion that she asks all of
our guests, and I love thequestion too, because it's,
Erin (54:11):
you ask it?
You don't ever ask
John (54:13):
don't.
Okay.
All right.
I'm gonna ask it today.
so Aaron and I love to traveland we've been some.
Amazing places and we've donesome incredible things.
And so to kind of change thesubject into something that we
want to know about you as wellas if you could do something or
go some amazing place, whatwould be on the top of your
(54:35):
adventure list?
Marissa Click (54:37):
Yeah, so I have to think about this for a
minute, but when I hearadventure, I don't always think
about going.
Somewhere, I think about doingsomething.
so, before the pandemic, I wasstarting to learn how to, play
roller derby.
So, I really want to get backinto that because it was super
fun.
I'm not a very, like, physicalperson.
(54:59):
I'm very, like, emotional and inmy brain, but I'm not in my body
a lot.
And so, learning to, how to usemy body
John (55:09):
And knock people down and skate past them and all that?
Marissa Click (55:13):
Yeah,
Erin (55:13):
I mean, okay, we, like you say, you go from this very
emotional and compassionate, ah,I'm going to take my frustration
out on you.
Yes! That's
John (55:22):
just, I've never heard of a chaplain wanting to go smash
people on a roller derby course,But that's wow.
Two sides of you.
I guess there's two sides to allof us.
so thank you so much for being aguest today.
I'm so glad that Aaron connectedwith you and, she was so
incredibly excited.
she's been talking about thissince, since.
(55:43):
we all were at that event andshe just said, Oh my gosh, I
can't
Erin (55:46):
wait it's a lot of a lot of good information for people
to go more in depth into detailinstead of just saying it's a
post and it's a directive.
what does that mean?
And where do I start and reallygive me all the dirty details so
I feel comfortable about it.
So I appreciate you sharingthat.
Marissa Click (56:00):
Yeah.
Yeah.
I've just been thrilled to be onthe show.
Anytime that I can offer.
advice or guidance.
I just want to help people.
So any format that I can dothat, I'm going to jump on.
Erin (56:12):
Yeah, thank you so much.
I appreciate it.
we'll
John (56:16):
Thank you for tuning in to another episode of Connect
Empower.
We want to express our gratitudeto you for being part of our
community, and we hope today'sepisode has provided you with
valuable insights andinspiration to enhance your life
and that of a loved one.
Erin (56:31):
We are more than just a podcast.
We are a community dedicated toenhancing the lives of our aging
adults and their support system.
We encourage you to visit ourwebsite now at www.
connect empower.
com.
Explore more information aboutour guests from today's episode
and to access our freeresources.
John (56:52):
resources.
Our mission doesn't end at theconclusion of this episode.
We invite you to take action nowby sharing the knowledge you've
gained today with someone whomay benefit from it.
Whether it's a family member,friend, or colleague, your
influence can spark positivechange.
Erin (57:07):
Remember, Subscribing to our podcast ensures you never
miss an episode and we have moreincredible guests and resources
in store for you.
So hit that subscribe button andstay connected with us.
Your commitment is the drivingforce behind our mission and
together we can create amovement for a brighter future
as we age.
John (57:27):
I'm John.
Erin (57:28):
I'm Erin.
Until next Wednesday.
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