Season 1 Episode 9: Admin is Admirable

Season 1, Episode 8: Spiritual Care: More Than Meets the Eye Thanks for joining Hospice Nurse Penny and Halley (Hospice Social Worker) on the journey to #NormalizeDeath! Our guest is an amazing multi-tasker in hospice medical records. Esme is a 35-yr-old mother of one, who came to the U.S. as a child of 8. She has been working in the healthcare system in various ways for nearly ten years, the last 4 in hospice medical records. Thanks for joining Hospice Nurse Penny and Halley (Hospice Social Worker) on the journey to #NormalizeDeath! You can reach us at [e-mail], on all places you find podcasts are found. A video option can be found on YouTube at https://www.youtube.com/@DeathHappensInsiders Hospice Nurse Penny on the socials: @HospiceNursePenny Halley on Instagram, TikTok, and Facebook: @HospiceHalley Our intro music was composed by Jamie Hill (misfitstars.com)

Episode Transcript

(00:02):
- Damn it.
- fucking technology.
- Oh my God. Duh.
- Yeah. I don't thinkthis one's gonna make it
onto YouTube. .
- No. Well, YouTube putan audio on YouTube.
- Okay.- All right.
As you just heard,
we were having sometechnical difficulties.

(00:22):
I salvaged as much ofthis audio as I could
because the interview withEsme was really, really good
and had great information and insight.
So please bear with us.
This episode will be audio only,
and we will put this up onthe YouTube as audio only.
Hang in there for the tough audio.
They won't last long,and it'll be worth it.
Plus you'll get to hearhow frustrated we get,

(00:42):
but it won't last long,
and we'll get back intothe content right away.
Thank you.
- Welcome to the Death Happens Podcast,
an insider guide to dying.
We're your insiders.I'm Hospice Nurse Penny.
- And I'm Halle Hospice social worker.

(01:04):
Today we have someone fromour medical records team,
which is pretty exciting
because I really feel like they're an
overlooked part of hospice.
But before we get to Esme, I know
that Penny has a hot topic for us,
- Right?
Yeah. Speaking of thehospice medical team,
we do function as a team.
As you know, Halle Hospice isone of the very few programs

(01:27):
or medical programs
that actually use aninterdisciplinary team
to manage the care of their patients.
Mm-Hmm. So in the field,we have the nurses,
the social workers, the chaplains,
the hospice aides, our volunteers.
And then in the back officewe have medical records, some
of our medical providers,
and we have sometimes if we're lucky,
a hospice team, pharmacist.

(01:48):
So recently on TikTok, therewas a hospice pharmacist
who said she has been a hospicepharmacist for nine years,
and she put out quite acontroversial video saying that, uh,
death in the home is horrific
and that everybody shoulddie in the hospital.
She went on to explainthat a nurse had called her

(02:10):
and the patient was neurotoxic.
So what happens when yougive too much opioid to, not,
not too much opioid,
but when a person can'ttolerate the amount
of opioid they're getting,
because everybody has adifferent tolerance level,
they can become neurotoxic.
It's called opioid toxicity,
and it can cause them tohave an increase of pain

(02:30):
and some other symptomsthat go along with it.
The pain isn't any worsethan any other pain crisis
that a person can have,like if they have cancer,
but she described it asbeing the, the worst,
most horrific pain thata person can ever have.
And so she rattled a few cages, .
Um, there's quite a few hospicenurse creators on TikTok

(02:52):
who got up in arms about that.
I was one of them. I was tagged
multiple times in that video.
People were coming to me saying,
what do you have to say about this?
And you know, what I had tosay was, that's bullshit.
And she's a pharmacist.
And while we appreciateour pharmacists, very much,
their experience is very limited to
what they hear on the phonefrom, you know, the nurses

(03:14):
who are calling them for advice.
And mm-Hmm. ,typically when a nurse is calling
for advice, it's
because they have a patientwho's having symptoms
that are being difficultto manage in the home.
Mm-Hmm. . Soshe's never getting the full
picture of what hospicereally looks like when
people die in their own home.
And despite many nursestelling her that, she, so
what she said was, nine out of 10 patients

(03:35):
will have a horrific deathin the home, which was
Mind blowing because Iwouldn't even say that one out
of 10 patients has a horrificdeath at home, you know?
Right. In my experience, it's very rare
that we can't get a person'spain managed at home.
Yeah. And then if we can't, we, you know,

(03:55):
we can do continuous care.
We can put them GIP in a, um,
hopefully a hospice care center.
Mm-Hmm. . Butwhat, what she was saying was,
was so, so false
and perpetuating this fear around
dying in your own home, which is
where most people want to die.
- Yeah. I was, I thought therewas a lot of good responses,

(04:18):
a lot of measured responsesby a couple different nurses,
to that first initial video.
It was a bit upsetting thatshe initially doubled down,
but it sounds like shetook the video down,
and hopefully that gavemore people insight into
the differences between peoplethat are actually at bedside.
I mean, you
and I have both been to many, many,

(04:40):
many people'sbedsides when they're dying.
Me, not as much as the nurses,but I certainly have been.
And like you, I don't think,I could not say one in 10.
I don't even know if Icould say one in a hundred.
That's, and not even horrific.
I know that's like onein a hundred is maybe
not as peaceful.
Right. I don't know. So yeah.

(05:00):
- I, I would I agree.
Like one, I mean, honestly,I've, I've seen one
death that wasn't peaceful,
and then at the very end, he was peaceful.
And that's out of literallythousands of patients
that I've cared for who were dying.
Right. Um, I've had patientswho had pain crisises,
pain crises, pain crisis,

(05:23):
- I- Think crises.
And, uh, but we were able toeither manage their symptoms
or sometimes we do haveto do palliative sedation,
which we can do in the home.
Um, Mm-Hmm. .But one of the things
that she said, and shedidn't just double down,
she like tripled down, quadruple down.
She made video after video addressing this
and saying that, you know,maintaining that hard line
that people ha are dyinghorrible deaths in their home.

(05:45):
- Well, and, and the, there was things
that we couldn't do in the
home that they do at thehospital. That's so, oh,
- Yeah. I
- Didn't understand that.
- She, she said, uh, thatthe man had lots of wounds,
bedsores, and that turning him
to give him rectal meds would cause him
to have more discomfort.
And I thought, don't you knowabout like the maci catheter?

(06:06):
Because you, you can actually give rectal
meds without turning the patient.
If you have a, a maci catheter,
we can do subcutaneous infusions.
We can do, if they have a port
or a pick, we can do, um, intravenous.
Um, yeah. You know, there'slots of things that we can do.
But I think for me, oneof the things that really
I felt was just really inappropriate was

(06:27):
that she kept saying that the nurses were
tussling in her comments.
And, and I felt like, youknow, we're not tussling.
We're trying to educate and,
and try to backtrack outof this misinformation
that you have now put out there.
Yes. Um, as hospice nurseswho are at the bedside,
and, you know, we are ateam, we work together.

(06:49):
And it just wasn't very collegialof her to continue to toe
that line and say, no,the nurses are tussling.
It's horrible. I know.
I've been a pharmacist for nine years,
and I'm like, you'venever been at the bed.
Ever. Yeah. You know, and,
and my team, we used to havea, a pharmacist on my team,
and she was amazing.

(07:09):
She was amazing. But she wasnever at the bedside. Never.
Not once ever. That's not what they do.
So that was just not true.
- . Well, on thatnote, we'll get back
to the good side of thebackside of hospice ,
and, uh, we'll go to talk to Esme.
- Let's do it.- Welcome Esme to the podcast.

(07:31):
We're so happy to have you.
- Thank you for having me.
- I'm hoping that you may be able
to tell us a little bit about
yourself as we get to know you.
- Okay. I'll be an open book.-
- .
- How long have you beendoing medical records?
- I've been doing medicalrecords for about,

(07:55):
I wanna say four years.
Four years and a half.
I started off as just ahelper, travelers a day.
And then my boss must have liked me
and she wanted to keep me full time.
So she snatched me froma different department
and had me work with her full time.

(08:17):
- And what were you doingbefore you came to hospice?
- Before I came to hospice, I used
to work at retirementhome, like assisted living.
Well, it was a continuing care
'cause it's independent,assisted in memory care.
I would, I used to be a receptionist,
and then I became a assistantto the marketing department.

(08:37):
So I used to do all ofthat, move in paperwork,
all the back work for them
so we can get those residents moved in.
- Did you have very much interaction
with patients when you were in the other
place? The assisted living?
- Oh, yeah. On a daily basis.On a daily basis. Every day.

(08:58):
I think I spent more timewith them than with my family.
. , yeah.
- Feels like that sometimes, doesn't it?
- It does, yeah.
- Do you miss that aspect of work now
that you're working inmedical records, you
probably don't have anyinteraction with patients anymore?
- Uh, yes, I do miss it very much.

(09:20):
At first it was very hard
because you don't talk to anybody.
Uh, you're just in an office.
And I mean, I like oldpeople more than I like
younger people or people my age.
They're just so funny.
They're fun, they're interesting,they have amazing stories.
It was definitely hard working.

(09:41):
I worked there for I thinkabout three, four years as well.
So it was definitely hard. Yousaw those people every day.
In a way, you do becomefamily in a way just
because you're the firstthing they see in the morning,
because you're right at the front.
And sometimes it's like you're,if you're working, you know,
like a double shift, you'rethe last thing they see

(10:03):
before they go to bed whenthey're passing through the halls
and they're like, okay, it's time for bed.
And I mean, these peoplego to sleep like at seven
and they're already going to bed.
- Sounds like me, .
- So it was definitely hardnot having that interaction
with, with people.
- What made you switch to hospice?
- Um, working at a retirement home

(10:26):
or any like, type of skilled facility.
It's hard. You get burnedout really quickly.
It's very, very, you're not just, um,
I think when they hireyou, they don't tell you
what you're actually going to be doing.
It's more than just doing your job.
You have to put a lot of hats on
and do things that arenot part of your job.

(10:49):
But if you wanna givethese people, you know,
the, the care and theattention, you do it.
So I think I was, I was burned out
after, after a while.
You definitely get burned out.
- For me, one of the reasons that I wanted

(11:09):
to have medical records aspart of this podcast and death
and dying journey thatwe're talking about is
that the back office peopleare just as vital as the rest
of the team that are forwardfacing to the patients.
On top of which, in,
in our particular agency medicalrecords is also the people
that are answering phones.

(11:29):
And so sometimes you're thefirst contact with someone,
at least via phone to get the impression
of what hospice is like.
So I think that's a really important piece
that people don't really think about
is when you're first calling
someone, who are you talking to?
And what's the sense of the culture
that you're getting?Mm-Hmm. .
- Yeah. That's really important.

(11:50):
I wa I didn't actually knowthat about your position.
Um, 'cause I work for areally big hospice agency,
so our medical records,
people are completely in the back office,
but I do know that our receptionists
and the people who answer the phone,
they are really skilledat talking to people.
You have to be, becauseyou are representing the

(12:10):
face of the agency.
And I remember one time listening
to our receptionist talkingto a patient on the phone,
and she was actually triaging them.
You know, she was saying, nowwhy do you need your nurse?
Kinda like, what's going on?
Let me see if I can help you find
the right person to talk to.
And then she listened towhat the person was saying,
and then she said, oh, itsounds like you probably need

(12:31):
to talk to the social worker.
Let me put you through toher. Mm-Hmm. .
And I was so impressed becauseI thought, wow, you know,
you wouldn't think that somebodywho's answering the phones
is gonna have thatinteraction with patients,
but they do all the time
because the patients arecalling, the families are calling
and you guys are taking that call.
- Yes. - Yeah. How doesthat feel to be that person?

(12:52):
Like when you're in the middle of doing a,
a medical records packet or a review,
and then all of a suddenyou have to transition to,
you know, being that face of a voice?
- Um, yes. So it, it is, youhave to like, take off one hat
and put a different one on.
And you know, you haveto remember, you know,
there's someone on the other line.
You don't know if they'relike in crisis mode if,

(13:16):
you know their loved one just passed away.
So yes, it's definitely,you always have to keep
that in the back of your head.
Mm-Hmm. ,
- Have you ever hadany calls that you felt
were especially difficult to handle?
Or, you know, somebody thatwas calling in a crisis and,

(13:36):
and you had to like, youknow, really think about how
to help them the best way or?
- Yes. We don't have, so I speak Spanish.
I was born in Mexico. So one
of the advantages I haveis that I speak Spanish.
And I think one time I hadjust started working there.

(13:58):
It was towards the end of theday when it's changing from,
you know, a triage nurseto tell a page nurse.
And we had somebody who spoke,it was a Spanish speaking,
a family member, and the familymember had just passed away.
And you could hear thebackground of everybody crying
and yelling and, and me listening to that

(14:21):
and trying to get somebodywho would take that call,
because you, you tryto get ahold of triage,
but it's right at that fiveo'clock mark when it's changing.
So it's like, you have toget ahold of, tell Paige,
you know, Hey, this person.
And then they don'tspeak English, Spanish,
their primary language.
So that was one of thethings that it's like,

(14:43):
I think it stuck with me.
I mean, somebody wasable to take the call,
but I think that's one ofthe, the times that it really,
it stuck with me.
Mm-Hmm. that,
that background noisedefinitely stuck with me.
Mm. Yes. But, um,
and sometimes with, I thinkI can remember mostly all
of our Spanish speakingpatients, we don't have a lot,

(15:07):
but the ones that we dohave, they do stick with me.
- I'm sure it's gotta be acomfort when they actually do
get someone that speaks Spanish.
- Yes. And it kind of makesme feel good in a way just
because I can connectwith them. So I like that.
- Do you have any fun memories
or experiences with answering the phone?

(15:29):
- Uh, yeah. I mean, we alwaysget those location to call
and I mean, they may justmake the funniest request,
like they, you know, wantus to deliver food for them,
or they want us to calla cat for them ,
or they want us to dojust like random things.
I was like, what are you needing ?

(15:50):
Like, you know, you want your Popeye's.
It's just, you know,funny things like that.
But yeah, there's alwaysthat one or two patients.
- I have a questionthat's not work related,
but since you mentioned yourHispanic background Mm-Hmm.
. I'm wonderingif you can give us any insights

(16:10):
into Hispanic culturearound death and dying.
- I, it's,
so hospice over there isthe same as hospice here.
And I learned this from a patient who,
what hospice means over thereis, it's pretty much a place
where they take you to die.

(16:30):
That's what it means. Um, so it's
- A, it's a different word, right?
Like SPI or something.
- Um, oio.- Oio. Mm-Hmm.
- . So it, yeah. It, it has a
completely different meaning.
It's basically where you'rejust thrown pretty much to die.
But death, something I learned is that in,
in Hispanic cultures isyou fight until the end.

(16:53):
Mm-Hmm. . It doesn't matter
what doctors tell you,you fight until the end.
Yes. Yeah. Even though we docelebrate death, you know,
we celebrate it as somethingbeautiful in that, you know,
once a year they comeback and we greet them
and all of this.
So it's very, it's interesting.
We fight till the end,

(17:13):
but then once it comes,we celebrate it. But yes.
- So that's, uh, is it Los De?- Yes.
- Is that what it is? Los De- Yes.
- Yeah. I definitely havehad those patients who
were Hispanic who fought until the end.
It seems like there'susually a folks person

(17:35):
or a decision makerfor the family as well.
Mm-Hmm. ,it's a hierarchy of,
um, decision making, right?
- Yes. Like, yes. It,it's always, it always is.
You don't wanna give up.You, I mean, especially
with the Hispanic community,
we're always so close to each other.
We always wanna, we don't think death is

(17:58):
ever gonna come .
Um, and , it, it reallyis like you just, that's
- Kind of sounds like everybody
- And you know, you don'tthink it's gonna come.
And honestly, the best wayI can put it is you have
to fight until the end.
And because religionis very important too.

(18:19):
Very, very important. Uh, you know,
you believe God is gonna,I don't wanna say fix you,
but you know, it's notgonna let you let you down.
- Yeah.- So, yeah.
- And to clarify, we've already had some
of these conversations outside of this,
so I'm not bringing upanything we haven't discussed.
Um, but to clarify, uh, Ibelieve I remember you saying

(18:42):
that you are one of the DACA kids.
- Yes.- So I wanna tie that into death
and dying and how this relates.
But can you just brieflyjust explain to us,
or for the listeners, I shouldsay, um, what a DACA kid is?
- So basically what it is,
is it's a deferred actionchildhood, something.
Basically, it's who were, who

(19:04):
immigrated from whichever country.
I think the very first person who
received DACA was from North Korea.
Hmm. But it's basically kids,you know, who were young, um,
who weren't decisionmakers, who
to the United States, weren't able
to make a decision for themselves.
So Obama

(19:26):
that he granted us.
And basically it's a, a two year permit,
a work permit that you can have.
And every two years we renew it
and we can, you know, legallybe in the United States
and work as well.
- So first of all, what a bigold pain in the ass to have

(19:46):
to do that every twoyears when you've been
here since childhood
- And money.
I have. Yeah.
- How old were you when- You came over?
I was eight years old. Yeah.
I've eight years old
and yeah, I have to do it every two years.
I have to, and I will saythis, that, you know, a lot

(20:07):
of times people think that
this is just giving out to anybody.
If it's not, you have tohave a perfect record.
You have to have a clean record.
I mean, you have to be fingerprint.
They ask you if you havetattoos, they ask you everything.
You know, somebody, to someone,you have to have some type

(20:27):
of education background.
You know, they, everything.
I think everything,
- Hold on, hold on just a second. I
- Guess a decent humanbeing to be in the country.
- Hold on just a second. Asyou're now an adult. Mm-Hmm.
, um, youwere saying you have
to have a perfect record and fingerprint.

(20:49):
You, and you have to renew this,
this green card basicallyevery two years. Right?
- So it's not a green card, it's a permit.
It's just a work permit.
You can, the only thingyou can do is work.
You can't leave the country, you can't do
anything. You can just work.
- So you can't even travel

(21:09):
to Mexico right now if you wanted to.
- I can't leave the country. No.
- That is baffling to me.
The reason I wanted to talk about it is
because we do have all ofthese amazing immigrants
and children of immigrantsthat are in our workforce,
and yet we're putting them through this

(21:30):
craziness when you'recontributing so much to society.
And I don't think peoplereally think about all
of the different ways that immigrants
and immigrant children help,especially in healthcare.
I mean, particularly in healthcare.
- Yes. Definitely.
- This is so frustrating.
I'm glad you have continued to, to fight
and, uh, resisted the urgeto, to go visit Mexico,

(21:51):
because that's frustrating too.
- It's, you know, it's, it is.
Especially 'cause you can't leave
and you can't, I mean,I have a, a daughter
and you wanna show her where you,
- Where- You come from, and you can't do that.
So that's frustrating. Yeah.

(22:14):
- Is it, is there a pathway for you
to become an Americancitizen at some point?
- So first, a lot
of people don't reallyknow how the law works.
So basically it's, first youhave to become a resident.
After five years you canbecome a US safe citizen.
And that's where you takethat test, that you go
to immigration and they ask you like, oh,

(22:36):
how many stars does the flag have?
How many stripes? What do they mean?
That type of thing. Oh, you
- Mean the test that mostAmericans couldn't pass
that test?
- That test.
Yes. . Um, so the only way
to my knowledge is if you marry somebody
who is a USA citizen.

(22:57):
But I don't think I would bewilling to do that. .
- I don't, not my, I don'tthink that, I don't think
that automatically makes you an American.
So my mom was Canadian
and she married my dadwho was an American.
He is dead now. Mm-Hmm.
, that's why I saywas, but she was Canadian up
until probably five yearsafter they got married.

(23:21):
She did have to take that testand to become a, an American
and had to renounceCanada as her home country
and adopt America and all this stuff.
Mm-Hmm. .So now granted that was
60, 55 years ago, somaybe things have changed,
but I don't think you can just get married
and that makes you an American.

(23:41):
I think you still have totake the, the test. Correct.
- They can, so they can petition for you.
So they petition for you
and then once they petitionfor you, then you can get it.
But it's not something that,it's, it, well for one,
it cost money too.
And I would fact to findsomebody who .
So I would marry in and do all that with.

(24:06):
- So is there any way to nothave to do it every two years?
Like is there a green card pathway
or some other way
that you could still keepyour Mexican citizenship?
- You can, I could still keep it.
If, let's say there was a wayI would just be a resident
of the United States, but Iwould have my, my Mexican.
So resident and citizenare two different things.

(24:29):
So those are, when youbecome a USA citizen is,
I believe is when you canactually vote here in the US a
resident, you just residehere and you can travel
and do all that stuff.
But once you become a citizen,it's like you're actually
an American citizen.
It's different than a resident.

(24:49):
- So what does it take tobecome a resident then?
So you're saying theycan travel or whatever?
- Yep. They can do everything.
Um, I think except vote,I'm not quite sure.
But like I said, it's the same thing.
I mean, the only way I think I,
that I know other people havedone it is if they get married
with a USA citizen

(25:09):
and then you can apply for your residency.
And then after five years,I believe you can apply
for your citizenship.
But I believe that's when you do kind
of give up your rights ina different from wherever
you're originally from.
- This just goes to my pleato the government that we need
to fix the immigration problemfrom many different angles.

(25:32):
And this is, but one,
and it's exactly for thereasons I've already stated
because there's so much contributing to
the healthcare system in particular,
but many other areas of, of everything.
Mm-Hmm. . That makes our
society function for crying out loud.
Yeah. Well, switching back into the death
and dying mode morespecifically, I understand

(25:53):
that you also have recently had a kind
of a hospice experience of your own death
and dying experience of your own.
So if you're willing to, I would love
to hear your experience,
whatever you're, you're willing to share.
- Yeah. So my, um, my grandmajust recently passed away.
She had complications from Covid.

(26:13):
She had had covid, you know, she was fine.
And then it was going backand forth from the hospital.
You know, we would take her in.
And then finally they decided that
it'd be best if she came on hospice.
It all happened very, veryquickly, very, very quickly.

(26:36):
She came on services one, one afternoon,
the next day everything was
okay at night, not night.
Right. As I was leavingwork, my aunt calls me.
'cause I explained to her, I'm like, okay.
I'm like, you can't take her
to the hospital once she comes on hospice.
And, and if that's the casethat you do wanna take her

(26:59):
to the hospital, thisis the paper you have
to fill out revocation.
Um, and yeah, we revoked hospice services.
Like I said, it tiesback with the, you know,
we fight until the end.
Mm-Hmm. ,we're not gonna give up.
Especially when it comes to afamily member, it's different.
It feels different. So we, ofcourse, we revoke hospices.

(27:21):
We took her to the hospital
and she passed away in the hospital. Yeah.
- Well first I'm sorry foryour loss. Of course. Yeah.
Um, it, when you say it feelsdifferent, it really brings me
to how many people tell uswhen we're out in the field
or just meeting someonethat you randomly run into
and they find out what youdo or you work in hospice.

(27:44):
Oh, that must be so hard.
And every time I say it'snot my person. Yeah. Mm-Hmm.
. If it was myperson, that's different.
I'm coming to you as a professional.
So I, it really resonates. Of course.
And then I wonder if it felt different
being already in the hospice world
and trying to navigate thatwith the rest of your family.

(28:06):
- You know, I always told them what I did
and what hospice did,
and you know, no matterhow pretty you paint it,
it still doesn't cover the fact that
when it's a love a familymember, it's different.
Mm-Hmm. , I can tell them

(28:27):
this is what we offer.
You know, we have massagetherapy, music therapy,
pet therapy, all that stuff.
But at the end, we are end of life.
You know, we're trying tojust make your last days more
help you and your family.
But it's because the end is coming.

(28:50):
And I guess on our end and mymy personal view, it's like,
but if we go to the hospital,they're gonna fix you.
Mm. They're gonna take care of you
and then we're gonna come back home
and you're gonna be betterbecause the hospital has
something that hospice doesn't have.
You know? And in the, inmy family's point of view,

(29:11):
how I saw it, and I, I don'twanna say my point of view
because deep down I knewthere wasn't anything else
that they could have done.
Mm-Hmm. But in my family's point of view,
it's like the hospital will fix you
and they have something thathospice can't, can't do.
And it goes back
to the .

(29:36):
- Uh, oh. - I didn't wanther to, we're freezing again.
- I know. I really wanna
hear whatever you just said. Mm-Hmm.
- . I know. ,
- Do you remember where you were?
- For what, what was the question?
- ,- You were, you were talking about your,
your grandmother going to the hospital

(29:56):
and you said you had said it goes back to
- Yes.
So once you, once it goes backto fighting until the end,
not wanting to give up on your loved one.
You know, the hospital, us believing
that the hospital's gonna dosomething that hospice can't.
And I actually think back to

(30:19):
another Hispanic patient that we had,
they revoked hospices multiple times
because they kept me totake patient to the hospital
because they, they trulybelieved too as well
that the hospital was gonna fix it
and then be discharged.
Um, and better, I mean, of course

(30:43):
talking to this person on the phone,
in reality it's like they'renot gonna get better.
They're just gonna manage the symptoms
that this patient might have.
But the illness is still there. Right?
- Mm-Hmm.- . So,
Mm-Hmm. . Yeah. Yeah.
- I, I've had many of those patients
and it's not just Hispanicculture, to be fair,
there are other culturesas well who Mm-Hmm.

(31:04):
will go into the hospital
and sometimes it's a matterof, not necessarily they think
that the hospital cando something for them,
that hospice can't,
but they don't want to die in their home.
They wanna die in the hospital.Mm-Hmm. .
So I've had those patients whohave ended up in the hospital
just because they didn't,
they didn't wanna bein their home when they
took their last breath.
They didn't want theirfamily to have them be there.

(31:25):
And, you know, there is a lot of, uh,
other cultures that are like that.
But I, I can recall manyHispanic patients that I had
that would revoke orwanted to do everything.
Probably one of the hardestcases I can recall is when I was
working in a hospice care center
and my patient was 28 yearsold and had ovarian cancer

(31:46):
and was really at the end ofher life and was Hispanic.
Didn't speak English, actually,and had a pain crisis.
And it was just very traumatic.
It was, it was a lotof us really having to
reassure the family thatthere was nothing more
that the hospital could dofor her that we couldn't do.
Being an inpatient hospicecare center, we were able

(32:07):
to provide medications inthe amounts that she needed
to have her pain managed in amounts
that hospitals are often reluctant to give
because they're afraidthey're gonna overdose the
patient or cause their death.
And we were able to put an infusion on her
and, and make her comfortable.
But it was, it was reallya very, very sad situation.

(32:28):
She was so young. 28 hadyoung kids, you know? Mm-Hmm.
It was just really sad.
- Well, and I, I don'twanna discount either
as you're speaking, penny,I'm thinking about obviously
as a field social worker, I'm calling
or emailing to fax packets for placement
or, you know, whatnot.
And she's seeing all of ourpatient's information come

(32:51):
through of those crises,those placements, those deaths
and all of the emails.
So I wonder what effect that has on you,
not being out in the field,but still seeing all of this
- Sometimes and young- Probably.
- And young, young people,
- Because we do have peds on our service.
- Yes, we do. That's hardwhen we have children.

(33:15):
When, when you see someonethat's the same age as you,
and then you see, I mean, when you see all
of these, you know, like thediagnoses that people have
that you didn't even know existed.
Mm-Hmm. It's crazy.
To me it's, it's just, it, it's so crazy

(33:36):
to me that somebody canhave so many like, illnesses
or like, it's like, what is,you know, sometimes even Google
what that, what that is.
Um, but yeah, it's hard whenit's somebody, you know, young,
when they have kids involved.
It, it's definitely,it's, it's hard. Yeah.

(33:56):
- Has working at hospice given you more
or less end of life anxiety?
- Oof. Uh, I think nobody
can prepare you for it.
. I mean, it can happen
whenever, you know, for,for example, with, with
, if you asked me

(34:18):
we had anything planned, we did not.
Nothing.
- I'm so sorry you're- Cutting out again.
- But I, I think whatyou started saying was,
if you would've asked me about my grandma,
did we have a plan?
Ah, shit. Mm-Hmm. ,
- Just keep it rolling.
It says actual recordingis higher quality.

(34:40):
- It was just something thatwas not talked about. Mm-Hmm.
. So wehad a like, scrambled.
We did not know that
when there's multiple childreninvolved, you have to ask
for permission for everysingle one of them.
Ah, if those are
- No healthcare power- Attorney, her, she, it, it was,

(35:03):
it was definitely in that sense.
We, I guess in a way, yes.I know my mom's wishes.
She let, all of my mom has six kids.
All of them know what her wishes are.
They know that at the end
of the day when thecomes, it's gonna be me.
Who's gonna decide what to do.

(35:24):
- Do you think we should just switch
to audio and see if that helps?
- Yeah, maybe so. 'cause it'sjust breaking up. Can, are
- You able to turn your videooff and just keep talking on
- The same day?
So interested in what you're saying.
I can't hear you because itkeeps cutting out .
- Oh yeah. Let me, how do I turn off my,

(35:45):
- Oh, I don't know ifthere is a way to do that.
- Is that better? Okay.- Oh yeah, there we go.
- If that, let's give it a try.
- Okay.- It's still
- Technology is the wording us today.
, I'll tell you.
- So your grandmotherhad no power of attorney,

(36:09):
- No advanced directives who- Was designated, right?
No advanced directives, nodesignated power of attorney.
Is that what you were saying?
- Correct. We only, the onlything that we really had was
she lived with one of my aunts
and my aunt was alwaysthe one who would take her
to her appointments and, youknow, just oversee her care.
So that's really all we had

(36:29):
and a pulse that she musthave gotten at the hospital.
- Okay. And so for,
and then you were saying thatyour mom now has designated
you as power of attorney
and your siblings, shehas talked to them about
what she wants, right?
Correct. When she issomeday potentially dying on
hospice. Mm-Hmm.
- . Yep.- So I just wanted to say

(36:52):
that's cultural shift rightthere in your own family from,
even though, you know, yourmom still may want everything
done at the time, you know,if it gets down to that,
but she has moved in the direction
of at least starting to plan for it.
- Yes. It was definitelya rude awakening for us.
I mean, even though we don't like it,

(37:14):
we don't wanna talk about it.
It's something that had to be done.
And you know, now, now I guess we're,
we're a little bit more prepared.
- I, I hope so.
I'm hoping that as hospiceis more talked about,
more discussed just culturally in general,
because we in Americadon't really like talking
about death and dying either.

(37:35):
It's not strictly a, a Mexican situation.
So I'm hoping that that starts to shift.
And even if people do choose to continue
to get treatment, it's all the way up.
And there are these othersupports available if
Yeah. If they want
- Yes- Options.
- So Esme, you should go speak, you know,
you should find a Spanish

(37:56):
or a Hispanic cultural center somewhere,
and you should go speakto people about this.
You should talk to people about hospice
and you should talk about your grandmother
and how she ended up inthe hospital and what a
and a, you know, a wake up call
that was for you and your family.
And I mean, I think
that would be really awesomefor you to do that. ,

(38:18):
- You know, as much as Ilove hospice in my job,
the people I work with, I don't know.
, I think that'smore of a Halle thing
should be learn Spanish .
- Well, we could go with you and then you
and we'll, we'll do the, we'll talk
and then you'll justinterpret what we're saying.
.

(38:39):
- Damn it.- fucking technology.
- Oh. Oh my God. Duh. Yeah,
- I don't think this one'sgonna make it on YouTube.
- No. Well, you can putan audio on YouTube.
- Okay.- There's also, there's some kind
of a music something

(38:59):
or other on, I'm not stoppingrecording in case she pops up.
Okay. Again, well,
- I'll let you editthis one because I can't
- Even Yeah, it's gonna be shit. Begin
- To imagine how we'regonna edit this thing.
Uh, yeah, I could do, what Icould do is I could do an audio
and then I could just haveour pictures on there.
You should see the thumbnails I've
been creating. They're pretty cool.

(39:19):
- I bet. Esme, can you hear us?
Ah, goodness.
If I just, I I, I, we willsee, we'll see how much
of this actually gets recorded.
If it doesn't, then
- Hello?
- Hi, can you hear me now? ?
- Can you - Hear me? I canhear you. Can you hear me?
- I can hear you. I was
- Like, hello?

(39:40):
But you can't hear us on the video.
- No, I couldn't hear you guys in the
- Video at all.
Wanna hear Penny? So, um,
unless I put you up to the ear piece,
and maybe you can hear us both .
- Yes, I can hear you. I can hear her.
- Okay. All right.
Esme, I'm so sorry aboutthese technical difficulties.
I don't know what the hell is going on.

(40:00):
I'll see what I can pull from this audio.
And in worst case, I will come to you
and we'll redo a short one.
Is there anything elseyou'd like the people
to know about medicalrecords, about Hispanic death
and dying culture, about your own personal
beliefs, whatever you wanna tell us.
- Yes, just that every timewe get a new hospice patient,

(40:25):
each hospice patient gets a puzzle.
Sometimes that puzzle can be a
50 piece puzzle.
Sometimes it can be a hundred,
sometimes it can be a 500 piece puzzle
in each department.
If a piece of that puzzle,medical records, myself,

(40:47):
you know, we may not bea middle puzzle like a
nurse or a social worker.
We're just the corner puzzle.
Uh, but at the end of theday, you know, we still need
that corner puzzle to completethat puzzle and, you know,
and give that patient the best care

(41:08):
that they can possibly get from us.
- Hell yeah. Well, Esme, thank you so much
for being on this podcast with us,
for sharing your perspectiveand your personal story.
And we will definitelylet you know when the
recording comes out.
- Thanks, Esme.- Thank you
- For having me.
- Thank you. Oh,

(41:30):
technology is the b of my
- Fucking technology. Gosh.
- Ugh. And she had suchgreat things to say.
I'm so frustrated. I hope we got some
- Of that.
She did. And she's gorgeous.Yeah, she's beautiful.
- . Oh, she's,- We could have,
we could have got moreviewers just on that alone,

(41:50):
just on having a pretty face on you.
- I know, I, uh, it's funny
because the question I didn't get to ask
because we were dealingwith this technology was,
I was gonna say, okay,
but seriously, who's yourfavorite social worker?
- .- Oh goodness.
Well, another one in the can,hopefully. Fingers crossed.
- Yeah. Hopefully.

(42:11):
- And we'll get to a few more awesome
guests for this first season.
I think we're already starting
to compile our season two list. I know,
- , yes.
Yeah.
- And I'm excited for this
to be out in the worldand for people to hear it.
And until our next patient,until our next, uh,
- Until our next patient.
- That's, it feels likeour next guest, .