EP 11: Compassion Fatigue

Episode Description:

In this episode, Dr. JB discusses Compassion Fatigue with featured guest Barbara Rubel. We explore the definition of compassion fatigue,  how to identify it, and how to combat it using a FABULOUS framework. Enjoy!

Connect with our guest, Barbara Rubel:
Website: https://www.griefworkcenter.com/
LinkedIn: https://www.linkedin.com/in/barbararubel/

Find Barbara Rubel’s book, “But I Didn’t Say Goodbye” on Amazon:

Transcript:

[00:00:00] Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Well, welcome to Hope4Med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med. This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med.

[00:00:38] Hi, everybody! Welcome back to the Hope4Med podcast, this is Dr. JB. I am so excited for today’s conversation. We are going to be talking with Barbara Rubel, she is a speaker who focuses on compassion fatigue in healthcare professionals. Barbara has a B.S. In psychology and a master’s degree in community health with a concentration in thanatology, which is the study of death, dying, and bereavement. Welcome, Barbara.

[00:01:09] Barbara Rubel: Thank you so much for inviting me.

[00:01:12] Dr. JB: Alright Barbara, so tell my listener a little bit about you, your background, how you got interested in thanatology.

[00:01:20] Barbara Rubel: Well, come back with me to 1986, my father had deteriorating discs and he was not doing well. At the time when I was in the hospital, awaiting the birth of not one baby, not two babies, but three babies, I was about ready to give birth to triplets, my husband walked into the hospital room and said that my father shot himself in his head and he killed himself right before becoming a grandpa. And so I could not attend the funeral, I could not attend the wake, because the babies were in utero and they weren’t born until three weeks later. And his death, his suicide put me on this journey. I wanted to learn whatever I could about death, dying, bereavement, and especially related to sudden death, because at the time I realized that not many people knew how to manage suicide or even were comfortable talking about death and dying. And so his death propelled me into my career. I became a mom of triplets and I did all that mommy stuff, but I went back to school. I already had my bachelor of science in psychology, but I got my master’s degree in community health with a concentration in thanatology. So all of my research, all of my studies focused on traumatic loss.

[00:02:45] And I realized that I wasn’t alone, that there were so many people out there like me, survivors of suicide, homicide, accidents, drug misuse death, or anticipatory loss as well. I went back to school, got my masters, and then worked at hospice with those who were terminally ill. I was the bereavement coordinator, I facilitated different types of support groups for those who were experiencing Alzheimer’s or AIDS or different types of losses. But I was also teaching at Brooklyn college. I was teaching– I taught a lot of undergraduate courses– but I was teaching a master’s level course, Crisis Intervention, during the week of September 11th, 9 1 1.

[00:03:28] How do you teach a course on crisis during the worst crisis in New York city? Because I was teaching at Brooklyn college. And it was in the car ride home where I couldn’t stop crying. It was, it was an out of body experience, because I had during the day my hospice patients who were terminally ill and dying, I had my support groups two to three times a week, and I’m teaching these individuals, these students on crisis. And I realized I couldn’t hear one more story. I didn’t know, am I burned out? Am I experiencing compassion fatigue, vicarious trauma, secondary trauma? I did not have the words for what I was experiencing. All I knew was “I’m done.” And that’s what brought me in. Yeah.

[00:04:17] Dr. JB: All I can say right now is, wow. I don’t even know where to begin in terms of my questions. What an amazing yet heartbreaking story. If we go back to the beginning, you said 1986, 1986. You’re pregnant. Triplets. As somebody who’s been pregnant myself, when you’re nearing the end, you just want them out, right? You’re just imagining life, oh, without walking around with a enlarged uterus. For me, it was just one child, not three, but so you’re, you’re counting down until you become a mom, and you have your triplets, and you’re nesting, and you’re getting ready. And then for such a tragic event to occur. And some people, once this tragedy happens, it can completely, uh, destroy them, really. Right? You took this tragic event and you used it to find, to create good, and how, how were you able to do that?

[00:05:33] Barbara Rubel: I found meaning in it. I believe that when we are grieving a loss, it impacts the very core of ourselves, our self-esteem, our sense of self. It moves deep into who we are, and so we, we struggle with a sense of identity. I was no longer a daughter. I was a suicide loss survivor as well as a daughter, so I had to, like, reconstruct a new sense of myself and basically revise basic assumptions about my world. My world was not safe. I didn’t trust the world. I had a daddy who always took care of me now, my dad’s dead. So I needed, you know, based on Neimeyer’s work with meaning making, I needed to interpret and incorporate my dad’s suicide into my life story from the very, very beginning.

[00:06:21] And finding meaning, the way people find meaning, you can make no meaning at all, or you can make negative meaning out of your loss, but what people can experience is a meaning of coping. They can feel very strong, in fact, that they coped with the worst loss and they could say, “I’m dealing with it,” or they could say, “I am– I found meaning through lifestyle changes, I don’t drink anymore,” or “I do less drugs,” or they could find meaning by saying, “I value life, I don’t take it for granted.” So when we experience a great tragedy, great loss in our life, one of the first things we do is find meaning through what’s called a “loss narrative,” and a loss narrative is how we share our story. When, when I shared my story with you, I felt your empathetic nature, I felt your compassion, and I heard you say, “wow.” That meant to me she deeply listened to me. She understands what I’m going through, because of your empathy and your compassion. And when we are surrounded with people who get it and we find meaning in what happened, then we’ll be able to manage it and deal with it, and incorporate it into our entire life story.

[00:07:39] Dr. JB: But how do you start talking about it? Because that’s very difficult.

[00:07:42] Barbara Rubel: It’s very difficult to talk about your story. And for some people they can’t, because they’re afraid if they open up and share their traumatic grief and share their complicated loss and share their story, then they may never stop crying, or it’ll be too difficult to come back from it, or that the person they’re sharing it with cannot contain it.

[00:08:05] Dr. JB: That’s very interesting because that’s also a concern, right? That it’s too heavy a burden to share with another individual.

[00:08:16] Barbara Rubel: Well, because you don’t know how they’re going to respond. I’m a keynote speaker, I was on stage at a mental health congress with hundreds of people in attendance. I finished the keynote and during– I self-disclose during my programs– and I shared that my father died by suicide, in one part of the program, then went on to talking about vicarious trauma. At the end of the program, someone came onto the stage– now people do not do that, you wait ’til the speaker comes off the stage– she proceeded to go on the stage and speak into my Lavalier mic, which was still on, and she said, “Barbara, that was a great keynote, thank you so much, but you do know your father’s in hell?”

[00:08:55] Dr. JB: Oh my goodness.

[00:09:00] Barbara Rubel: Yeah. Well, I’m a pastoral bereavement counselor, so I just said, “God bless you.” I can’t hit her. I’m being paid to speak. I can’t smack her, you know, hey, there’s cameras, exactly, and I was being taped. Um, but I proceeded to go off the stage, I walked off the stage, and you have all these, you know, social workers, and therapists, psychologists, they all needed to wait and not go out into the breakout room, they needed to hug me and tell me that my father wasn’t in hell. And I have to tell you, after 30 or 40 people hugging you and telling you, your, your father’s not in hell, you start to believe, what are these people telling me this for? I was like, “oh my God, is he in hell?” It became like humorous to me, and I think that’s one of the things that I use as, as a mechanism, is my humor to manage, you know, such a difficult loss in my life.

[00:09:52] Dr. JB: But , that experience with that attendee coming onstage and saying that to you happened a while after the incident, right?

[00:10:03] Barbara Rubel: Oh, years later, like 20 years later.

[00:10:06] Dr. JB: And it wasn’t right when it happened, when you first got the courage and the strength to start talking about it, that you were encountered with such an experience or that you encountered such an experience. So what would you say–

[00:10:22] Barbara Rubel: So what happens, what happens to that for that person who hears that individual say that in the very beginning? They’d break down and they’d never speak about it again.

[00:10:31] Dr. JB: Exactly.

[00:10:31] Barbara Rubel: It disenfranchises our grief. Ken Doka speaks about disenfranchisement in grief, and what that means is that you cannot openly share your loss, or perhaps you had a, um, an abortion and so you live in a community of Christians who will not embrace you in your grief of that child. Or you are living in a nursing home and the person who slept next to you in your room died, and they just didn’t do anything in the nursing home, and a new person’s laying there the next day. Or a young child is not allowed to go to a funeral home. We are disenfranchised in our grief. And for suicide loss survivors, for those who’ve experienced loss by AIDS or homicide, in my support groups, I would call one mother whose son died in prison, it was gang violence, and he had to go to prison, but then he was murdered in prison, and one of the individuals in the groups said, “oh, your son was in prison,” like, like it was a horrible thing, and that disenfranchised her grief, and I had to reel that in and make them see that we don’t compare or judge. But that is the world in which we live. That’s it.

[00:11:43] Dr. JB: And that’s so unfortunate.

[00:11:45] Barbara Rubel: Yeah. And that’s why we need to be very mindful of who we speak to, what we share, and surround ourselves with people who can hold you and embrace your loss, so you can manage it and you can understand what you’re going through is normal. Many people believe that they have to go through stages as they grieve, and there are no stages of grief. That was a Kubler-Ross model from the 1970s on those who were terminally ill, and it was a great model because there was nothing else there, and so she brought awareness to the dying process, but through the years, media and, and, you know, individuals believe that we have to apply that to those who are grieving and we don’t. We don’t. There are no stages, it’s a process that ebbs and flows throughout a lifetime.

[00:12:39] Dr. JB: And I think that’s definitely something to really hone in on. That it is a process that ebbs and flows throughout a lifetime. Because some people feel like, “oh, I should be, over this by now.” “It’s been X amount of time , be it a few days, a few weeks, a few months, a few years, why is it still affecting me?”

[00:13:02] Barbara Rubel: Yeah, it affects you because you had a relationship with someone, you were attached to that person, and when you grieve, you are robbed of that person, that relationship and the memories that are shared died with that individual. And it is very, very painful. And so you mourn, you show society, you show the world that, you know, you’re grieving a loss by wearing black or whatever it is you do by creating rituals, but grief is painful. It is a physical, emotional, cognitive, behavior, and spiritual reaction that change the fiber of your being. You are changed when you experience a loss.

[00:13:43] Dr. JB: I think that the unexpected loss is even harder, the sudden death, we talked about suicide or accidents or homicides. Those – that just came out of left field. How do you even begin to process that?

[00:14:00] Barbara Rubel: Well, that’s what makes it complicated. Yes, you’re absolutely right. It’s called complicated grief, it used to be called traumatic grief, or now it’s called prolonged grief disorder, and it does complicate grief because it influences how you react. It was sudden, it was traumatic. Also there’s a multiple death, the age of the person that died, who told you about the death, death notification. I teach death notification, on how to talk to families who, you know, you have to share their loved one just died. There’s so many nuances to the experience. It’s not just “my baby died,” or “my sister died,” or how they died, but it is all of those characteristics of loss that influence and make it traumatic and make it complicated.

[00:14:46] Dr. JB: Wow. And so how do you know who is safe to confide in?

[00:14:52] Barbara Rubel: Wow. How do you know who is safe to confide in? Um, I would, I would actually tell the person to pray on that, to really take the time to think about who is in their inner circle. It could be a very good friend, it could be a coworker, it could be a physician, or it could be someone that you’ve never worked with before, like a a group facilitator in a support group, or a psychotherapist, or a clinician. I think they really need to pause and take the time to really think about who is in that inner circle that could hold it and not have to fix it. So let’s take, for instance, the suicide loss survivor, who will say, “why?” You know, “why daddy, why did you kill yourself? Why did you kill yourself when I was in the hospital giving birth to triplets? Why?” Now someone may say, “well, Barbara, there’s a link between depression and suicide,” or you know, “maybe the serotonin levels,” or “he had deteriorating discs.”

[00:15:54] As a suicide loss survivor, we don’t need you as a listener to give us their answer to our reason why. What we need is a place, a soft place to land. It’s a place where we could share our story. So just simply sharing our story, because when we grieve, we shared the same story over and over again. Last week I did a presentation for a NICU, the NICU nurses, and the emails that I received from these, these NICU nurses after, I mean, we talked in the chat bar, but afterwards, just sharing stories about things that they heard, how, what people said, things to mothers, like, “you’ll have another baby.” So you know, you think you feel safe and you’ll tell someone, “oh my baby just died,” and this “oh, you’re young, you’ll have another baby,” that disenfranchises your grief. And that, that’s absolutely so, so disconcerting it’s, I can’t even believe people say things. So again, if you had to really share with someone, it needs to be someone who you trust and you set up, you basically set up a system before this. “I’m about to tell you something that’s really hard for me to say, and it’s traumatic, and it’s very sad, um, can you handle it? Is this something that you want to talk about now or should we talk about it at another time?” Ask permission to share it. They may not want you to share it.

[00:17:18] Dr. JB: Wow. That’s, that’s definitely a, a valid point. But then, what would you do if the person says, um, “no, I don’t want to hear it”?

[00:17:27] Barbara Rubel: And then I would say, “thank you.” “I love you, I thank you for, for being here for me, um, and I understand that, you know, you are not equipped to handle my distress.” Because what I’m going through is stress and distress, and, and grief, and trauma, and that’s a lot to, to share with someone who’s not trained.

[00:17:49] Dr. JB: That’s true.

[00:17:50] Barbara Rubel: You know, especially the stories that I hear, I am an expert in sudden traumatic loss. I hear stories that I can’t even believe they’re sharing with me, and I’m trained, I’m a thanatologist, I’m an expert in my field, and sometimes my heart is breaking. I can’t imagine the, you know, the next door neighbor over a cup of coffee who’s listening. And, and being a listener, what a God gift that is to truly deeply listen to someone, but don’t share your story unless you’ve found that person who you think can, can handle it. Maybe your clergy, your clinician, someone like yourself, who’s compassionate and empathetic, just be very mindful of who you’re sharing with.

[00:18:31] Dr. JB: Yeah. That’s, that’s so true, and people think that physicians know how to deal with grief and grieving. And you find yourself sometimes in situations as a clinician, especially if you’re not used to these scenarios, where you feel like you, you have to say something. It can be very uncomfortable being just present.

[00:18:56] Barbara Rubel: Well, you’re not taught this in medical school.

[00:18:57] Dr. JB: Exactly.

[00:18:59] Barbara Rubel: That’s what all the physicians in my program say. And I, and what they hate is I do these little case studies, and I bring them up to the room, and I’m like, okay, well, I’m going to be the grieving client, and they’re like, “no, do I have to be the doctor in this?” I’m like, you are a doctor. “I don’t want to play that role, pick somebody else.” And nobody– everybody looks down or they stare at their, their handout, you know, because it is so uncomfortable because you’re not trained. And that’s what I do, I teach physicians, I teach clinicians, therapists about grief, but not just Grief 101, but complicated grief, and how to really be mindful of your own feelings and open up your heart to someone who’s sharing their story and be comfortable with listening. And you’re not even responding, but just truly listening and looking at them, patting them on the shoulder, you know, appropriately, showing them that you are truly listening. There’s nothing, there’s nothing better than someone who’s who listens, deeply listens to you. You know, as, as a hospice bereavement counselor, I, for years I would go to wakes and I would, I would attend funerals and sometimes I would say nothing, I would just show up. I can’t tell you how many times I received letters, “Barbara, thanks so much for what you said during the funeral, what you said during the wake, it was wonderful, we couldn’t have gone through it without you.” I said nothing.

[00:20:31] Dr. JB: But your physicial presence–

[00:20:32] Barbara Rubel: But my presence, that gift of, they felt like I, I– so, so now I realized if I want to do well in the world, just shut up.

[00:20:41] Dr. JB: Just be present.

[00:20:43] Barbara Rubel: Just be present. You’re a doctor, people come in, you don’t have to do a damn thing. You would just sit there for a half hour and then leave.

[00:20:50] Dr. JB: It’s gonna be this weird, awkward, uh, I could just imagine, I think there’s certain scenarios where that’s more appropriate than, than other settings.

[00:21:03] Barbara Rubel: I think you have something right there, absolutely.

[00:21:06] Dr. JB: But it’s, it’s true. You don’t have to have the words and sometimes there aren’t any words, right? Oftentimes there aren’t any words, everybody’s grief and experience is different.

[00:21:18] Barbara Rubel: You’re absolutely right, there are no words. But how compassionate and empathetic when you say, “it sounds like this is so hard for you” or, or “this must be the most difficult point in your life.” You know? Just, just acknowledge how hard it is, how difficult it is, “I hear what you’re saying.” You know, I’ve said that so many times in my support groups, “I hear what you’re saying,” and they start crying. And afterwards I’ll say, “you know, when I said, ‘I hear what you’re saying,’ you cried,” they’ll say, “nobody ever hears what I said,” or “I never said that before.” Very profound.

[00:21:52] Dr. JB: Very, wow. Wow.

[00:22:03] So, I guess this was an example just now of being present

[00:22:05] Barbara Rubel: But you see, silence is a beautiful thing. We just had a moment of silence to allow our listeners to process what’s being said, there is a lot going on between us, and we are not even aware of all of the losses out there. People who are listening who just experienced so much loss because of COVID, non death-related loss and death-related loss, and they are grieving, and they are listening, and they are feeling, and being present for what we have to say. And, and hopefully in this time together, they’re realizing that “yeah, you know, I really, I really need to find someone to talk to,” or “I really need to get into a grief support group.” Or look up some books online on, on grief and loss and learn, you know? We, we need to keep being teachers to ourselves. Like, I’m, I’m strength-based so I, I teach professionals about how to manage compassion fatigue, and so I always focus in on strengths. So my greatest strength is love of learning. I love to read the research on grief and trauma and compassion fatigue and burnout and vicarious trauma. I’m well-versed in the current research, but my other strength is wisdom. So I, as a speaker and keynoter and webinar instructor, I’m constantly teaching what I know to clinicians.

[00:23:28] So my strengths, I’m using, I know my strengths, and I’m putting them to practice. And I think whether you’re coping with grief, especially after COVID, or you’re coping with the stressors of your job, you need to know what are your strengths and how do you put them into practice to manage your stressful career and to manage your losses.

[00:23:50] Dr. JB: So what’s the danger of not dealing with it? You know, if you just say, “whatever, I’m just gonna, uh, pushed this under the rug.”

[00:24:00] Barbara Rubel: Well, some people need to do that because they are so traumatized and they experienced, you know, perhaps attachment issues early in life, and they, you know, they there’s so much going on in their life, that it’s better for them, because they haven’t processed all of the trauma in their life, that it’s better for them to just go through life without dealing with it. But perhaps one day it can bubble up or maybe it’s displaced. So I always think it’s best to find a professional, especially if you’re dealing with traumatic loss, to someone to talk to, to process it. Oh, that’s, why do, why do you think so many people drink? Why do you think the alcohol is, is like crazy right now, and drug use and misuse death? I do so many trainings on drug misuse deaths and, and in the past five years, I think that was my number one training. Why is that? Why is there such drug abuse? Why, why are people dying from drug misuse death? And because probably they had so much trauma in life and grief and loss that has not, you know, their ACEs scores are probably through the roof, they probably haven’t dealt with it. So it’s easier to self-medicate and die.

[00:25:12] Dr. JB: So the, so the thing about it though, is that you just can’t, you can’t go through life without dealing with it, right? So you can intentionally deal with it or you can quote, unquote, “not deal with it,” but clearly , you’re still dealing with it because you’re turning to other substances that aren’t healthy, you know, it’s still affects your life.

[00:25:28] Barbara Rubel: Right, you’re dealing with it in a negative way.

[00:25:29] Dr. JB: Exactly,

[00:25:30] Barbara Rubel: Absolutely, that’s exactly right.

[00:25:31] Dr. JB: You can’t pretend like it’s not going to affect you. It’s always going to affect you. So either your, your, um, it’s your conscious– your conscience. Let’s try this again. Either you are aware of its effect on your life and on your day to day, or you are unaware, but it’s still going to affect you. And so, in my opinion, that is why it’s important that you deal with it. On your own terms, when you are ready.

[00:26:01] Barbara Rubel: Oh it’s so important to deal with it. But if, you know, they say you can drag a horse to water, but you can’t make it drink?

[00:26:07] Dr. JB: Exactly. Exactly, on your own terms, when you’re ready, but don’t go through life thinking it’s not going to affect you because it will, it will 100%.

[00:26:18] Barbara Rubel: It’s going to affect you in a very negative way. It may affect you in your relationship. It may affect you with, um, you know, divorce, it may affect you with, um, you know, there’s domestic violence. I’m also a consultant with the Department of Justice Office for Victims of Crime where I talk about vicarious trauma and with police especially there is domestic violence issues, and drug issues, and alcohol issues and, you know, because of all the traumas that they see. So we need to focus in on positive ways to manage our loss, our trauma, instead of, you know, killing ourselves. That’s basically what we’re doing every time we self-medicate.

[00:27:06] Dr. JB: Exactly. Exactly. And then, you mentioned COVID and so we can talk a little bit more about COVID because that’s such a huge issue, right? Especially for, I was going to say especially for healthcare professionals, but for everyone, right? We’re, we’re going through this global pandemic and as a healthcare professional, especially if you are one of the frontline workers, so emergency medicine, ICU, et cetera, you have had to deal with your fair share of COVID patients, COVID patients dying on you, COVID patients dying alone.

[00:27:42] Barbara Rubel: Yes. I did several programs for nurses who became, they actually became the family member to the person who was dying because the family was not allowed in the room. And they, these, these individuals became very, um, mentally fatigued. You know, they really experienced compassion fatigue taking on that role. It was just too much and too many patients needed them. It was very, very hard. The first responders, they, they went through hell and they’re still going through hell. It is not, not easy, definitely not easy, and they’re grieving, it’s professional grief. They’re experiencing professional grief with all of their own losses dealing because they had this intimate relationship with the family who cannot be there. So they had to get on the iPads, or they got on the telephone with the family, and it was an extension of the family. They became the family. And so that made, that made it so much more difficult for them. It was, it was very, very, very hard. So they’re dealing with professional grief, they’re dealing with compassion fatigue, they’re dealing with, um, burnout and also vicarious trauma. They had, they had the whole kit-and-caboodle.

[00:29:04] Dr. JB: Everything. You know, and when you have this camera, um, or this phone and you’re showing the family the loved one. Right? So they could physically see them, but they can’t hold their loved one’s hand. Right? So as the healthcare professional in the room that’s facilitating this conversation, you know, often times yes, us as physicians or nurses or ancillary staff , like you said, had to be the family, held the patient’s hands, told them it’s going to be okay as they took their last breath.

[00:29:40] Barbara Rubel: Yeah. But it’s not just holding their hand. You know, as a professional, you’re holding the patient’s hand and that patient is, is acutely dying, um, however you have become a vessel. Your hand holding that other person’s hand is so meaningful to the family member because they are there through an extension of your being. So that’s how you find meaning in your loved one’s passing, knowing that you were there through the nurse who was compassionately holding your loved one’s hand, so your loved one as they took their last ebbing breath knew you were present in the room. It’s not just holding a hand, there’s so much more there spiritually. It is, it is– and that’s why those nurses are so exhausted, you know, the compassion fatigue, they’re so exhausted because it, it ran through the core of who they were.

[00:30:39] Dr. JB: Yeah. And, and some people are like, how is it possible that you could develop compassion fatigue, how is that even a possibility?

[00:30:48] Barbara Rubel: Well, if you are working with people or pets, it’s a huge possibility. Basically, if, if you defined compassion fatigue, it’s a state of tension and preoccupation with the continuous trauma of your patients. You’re exposed to this compassion stress and it happens in a clinical setting or happens with first responders to trauma, basically you succumb to the demands of your patient’s care over your self care. That’s the key to compassion fatigue. That you, you are so empathetic, you are so compassionate, you are so caring, you do so much for that patient, but you do not take care of yourself. And that’s why when I look at compassion fatigue, I always, I always tell people it’s a relationship with others. If you want to take care of yourself– because we don’t, we, we put ourselves on the back burner, especially clinicians who always put their patients first– I look at it like a relationship, if you want to take better care of your patient, you must take better care of yourself. So you’re, you’re, you know, you’re empathetic, you’re constantly giving yourself, but you cannot neglect yourself or your patients will suffer. And that’s I think the way I get clinicians to listen, cause it’s going to make the relationship better with your patient and the outcome for them will be better.

[00:32:19] Dr. JB: And so, throughout your career, you have been focusing on compassion fatigue. What made you decide to take that on?

[00:32:29] Barbara Rubel: Oh, it was in that car ride home. I was coming back from Brooklyn College, it was the week of September 11th, I’m teaching crisis intervention, a master’s level course, I’m working as a hospice bereavement coordinator during the day, and everyone’s dying. I feel like everyone’s grieving and I, I don’t know what it is I’m feeling, but I love my patients. I don’t want to stop working with my, I don’t want to stop teaching grief and death and dying, I don’t want to stop, but I, I felt like I can’t hear any more stories. So I changed the focus of my, my life’s work away from patients and clients and to those professionals like myself, let’s keep us healthy so we can keep doing our job. So if you’re a physician and you focus in on compassion fatigue, then you continue doing the work without burning out. If you are a psychotherapist, a social worker, a dentist, a nurse, whatever your role is, if you focus in on compassion fatigue and vicarious trauma and burnout, there’s less chances of you leaving your job, there’s less chances of mistakes being made, high mistakes, you know, death can happen, um, so that’s what got me involved. When it happened to me, when I actually felt like I couldn’t hear one more story, that was my compassion fatigue.

[00:33:49] Dr. JB: So could you develop compassion fatigue from engagement in this work around compassion fatigue?

[00:34:01] Barbara Rubel: Absolutely. Oh my goodness, I’m a full, I do a keynote, but I also do full day trainings, and many in attendance, you know, you sit at a table of 10, I could have 2, 3, 400 people in a room, and I give them case studies and different activities and self-assessments, and there are times I’m walking around the room and I hear them share stories where I feel like, you know, you’re, revictimizing someone here, you know, you’re talking about a homicide or, or you’re talking about, you know, an AIDS related death or, or an accident where a child or, and I’ve listened, and then I go back up to the room and I’ll say, ” everyone, we have to stop sharing our stories at the table because we’re just revictimizing ourselves and we’re just giving more of a burden to others.” This is about managing our stressors, managing the fatigue, managing the burnout, but we don’t need to keep readdressing “why.” It’s not so much why it’s happening, it is about how we could manage the “why,” how we could deal with it. Things that we can do, concrete steps to manage compassion fatigue by first, identifying the symptoms, and then figuring out this, I have this fabulous framework for self-care, so know, figure out a framework that works using our strengths to manage the compassion fatigue without sharing our story.

[00:35:23] Even in the support group, sometimes I’ll say, okay, we’re not here to share our story today because sometimes the stories don’t change, the way they share their story is the same way week after week, and I’ll say, just share with me what ritual you created for yourself this past month that’s, that’s helping you, or a book you read that you’re finding wisdom in, or what strength did you really need to manage a particular feeling or, you know, you can move to the positives in life and not just dwell on the story. Although it’s very, very important, and you have to move that story to finding meaning. ,

[00:36:02] Dr. JB: We’ve highlighted this area a little bit, but haven’t quite listed it out. So could we just take a second to list out what are some of the symptoms of compassion fatigue?

[00:36:17] Barbara Rubel: You know, I’m research-based and so everything I bring to you listeners is based in the research, but when it comes to these symptoms, it’s not research-based, it is based on all of the nurses and the physicians and the social workers who have come to my trainings and keynotes for the past 25 years. And I would say emotionally, the emotional symptoms, what they have told me is the disconnection they feel from the world, self contempt, anxiety, and powerlessness. That’s what keeps coming up over and over again. In regard to cognitive symptoms, denial, uh, they’re thinking about quitting, they, they can’t concentrate, mental fatigue, I hear that one all the time. Physical symptoms, headaches, stomach aches, irritability and numbness. Behaviorally, problems with relationships, they’re isolating themselves, they don’t want to go out with their friends, again of course, poor self care, they’re self-medicating, insomnia, getting up in the middle of the night, waking up with thoughts of their, their patients, exhaustion, I mean, nightmares is huge. And, and spiritually, I hear over and over again, “Barbara, I have a decreased sense of purpose. I just don’t feel like I have any purpose anymore. It’s just too much.” , and that’s not even the research, it, it touches upon that, especially the mental fatigue, the numbness, and the nightmares, that keeps coming up in all the research too, but what scares me is that decreased sense of purpose. I think we really need to, to hone in on the spiritual reactions, because it is our spirit that’s going to get us through this. Yes, we have a mind and a body, but it’s our spiritual connection to the world, to a feeling that we found, meaning in being a clinician for a greater good, you know? And if we have a decreased sense of purpose that will impact us every single day.

[00:38:18] Dr. JB: And, and not only the decreased sense of purpose, but also the decreased sense of effectiveness. Right? Especially if we take it back to the context of COVID that we’ve been dealing with for over a year now, um, and being in front of a patient who is decompensating before your very eyes, despite everything you’re throwing at them. Right? And just feeling so helpless.

[00:38:44] Barbara Rubel: Yeah. Yeah. You’re, you’re helpless in keeping them alive perhaps because you know, maybe they or maybe perhaps, you definitely know they are going to die. It is the end of their life, but you may feel what’s called realistic optimism rather than pessimism, and realistic optimism, you realize, “okay, I’m, I’m helpless here, the situation is hopeless, however, I will make sure in my capacity they, they don’t have to deal with pain.” I will make sure that the family is aware so they could be present at the patient’s bedside. I will make sure that the nurses or those who are taking care of this patient, we’re all on the same page for the best quality of, of life as they take their last breath. So if the situation may be hopeless, but if you’re a realistic optimist, like, you know, when I worked for hospice, I was such a realistic optimist because I knew I was going to bring in a harp, I had the right passage for, you know, in a New Testament because they were Christian, or I knew that I was going to get the family there in time. You know, it’s realistic optimism.

[00:39:56] Dr. JB: Yeah, I think oftentimes when we go into this career of, of healthcare, right, of medicine, the goal is to, um, to cure, to, to discharge from the hospital, we don’t think about the other, um, aspect, the other season of life. Right? And when we do not take into consideration the fact that there are seasons of life, there’s a season to be born, there’s a season to be healthy, there’s a season to be sick, and there’s a season of death.

[00:40:32] Barbara Rubel: Yeah, but if you use that metaphor, the seasons of life, then I would invite you to put on a heavy winter coat, a heavy, heavy winter coat and a hat and gloves, and enter into the season of death that winter. And if you’re going to be more comfortable wearing that coat and hat metaphorically, wear it to protect yourself emotionally, but still be present and get used to it because it’s the greatest gift that you can give your patient, is being present for them in every single season. Just using that metaphor, just get comfortable wearing the right clothes.

[00:41:15] Dr. JB: That’s correct. That’s correct. Being equipped with the right tools, and, and realizing that as amazing as it is to be participatory in bringing forth life, right? Like catching that baby that’s being delivered and the joy of that, it’s also an amazing experience being present when somebody is dying, it’s like a spiritual feeling that, and it’s, it’s very hard to describe, um, you may have better words than I do, but my experiences just being there and just being present, there’s, there’s just like this, the air in the room changes, it’s like this, this intimate yet spiritual feeling slash connection that occurs in that moment as death approaches that is also amazing. And, and it’s just such an honor and a privilege to be present in that moment.

[00:42:28] Barbara Rubel: Yeah. I look at it as satisfaction, compassion satisfaction. We understand job satisfaction. We know as clinicians, why we love doing what we do, there is also compassion satisfaction that we are satisfied with the level of compassion we give to that patient as they leave this earth. And we have to move into ourself, our own spirituality, our on knowledge, our own being, our own self, and we give, we don’t think of anything else in that moment. We’re not thinking about what we’re going to have for lunch, we’re not thinking about our laundry, we are present as that person takes their last breath. What an honor it is to be present for someone when they take their last breath, and for you to be there as they do so, to represent, you know, from one life to the next, you know, you’re, you’re there, you’re present for that passing, and to be satisfied with the level of compassion you’re giving them, even without saying a word, just being present and that compassion satisfaction, it will just lift you up. It will truly lift you up.

[00:43:41] Dr. JB: Yeah, a privilege. That’s, that’s definitely a way to describe it, because it is, it’s such a, such a privilege. If you’re there with the family or even without the family, it’s such a privilege. It’s, it’s hard, it’s, it’s easier to, to, to see it in that light when you have one patient who dies every X amount of days but, but that experience is difficult. And to see it as a privilege is harder when you have a lot more deaths.

[00:44:26] Barbara Rubel: Oh, absolutely. When I do grand rounds, and sometimes because I work with emergency departments, and I’ll have to do two or three different meetings too because not everyone can attend, I’m sitting in a room, let’s say with, let’s say four nurses or five nurses at a time and they’re sharing with me that they work in, in the emergency department, or they work in ICU, or the NICU, um, as they going around the room, sharing their job, they’re crying. They’re crying more times than not. And I’ve been doing this for 25 years. Why are they crying? Because they are caring, compassionate, empathetic people, and they do not fear death, they are not anxiety-ridden when they’re around death. They just realize that people are dying and it is sad. And we just need to recognize that we are human and that it is sad, but not to be afraid of it, not to be anxiety-ridden about it, and to just accept that we have a role to play in this and that we should be honored when we are playing that role.

[00:45:29] Dr. JB: And there’s nothing wrong with feeling sad.

[00:45:31] Barbara Rubel: Nothing wrong with. I remember working at hospice and one of my patients died, and I loved that person, she was on hospice for like a year and a half, and I was crying when she died and the family was hugging me. And later, one daughter said to me, your crying, made us feel so much better because we knew my mom was loved. My tears helped them in their grief.

[00:45:56] Dr. JB: Wow. You know, that’s, that’s definitely interesting because oftentimes healthcare professionals, uh, don’t know if it’s okay to cry, especially in front of the patient. Right? They don’t know if it’s okay to cry period, but then of course, like why would I go, I can’t, I can’t cry, in front of the patient or their family, oftentimes we feel like we are taking away from their grief and their experience by contributing our own tears.

[00:46:28] Barbara Rubel: I think that it is a gift to the family to see that the clinician truly cared. That is a gift, to show that you are educated, you’re a clinician, but you are also human and you cared about that person that just died. What a gift you are giving to that family.

[00:46:47] Dr. JB: Yeah.

[00:46:49] Barbara Rubel: And a lot of like physicians, I do grand rounds with physicians, and a lot of them say, you know, sometimes I do, I do cry, I go into the closet and I spent five minutes in the closet and cry. And what I’ll tell most clinicians is if there’s a death, don’t do anything, you know, do the pronounce and then stand there for five minutes and just be mindful of what you are experiencing, say a prayer over the patient, depending upon your faith, you know, silently, and just breathe, diaphragmic breathing, and everyone on the team just stay there for five minutes and do your meaningful work and your diaphragmic breathing and your silent prayer, and then get to the next patient. Take a moment for yourself to process your role and to process what happened and then move on to the next incident, or patient, or whatever it is that you’re involved in.

[00:47:42] Dr. JB: Yeah. And so, I guess I have two questions for that. One, when they engage in an activity like that, does that affect them crying afterwards?

[00:47:59] Barbara Rubel: No. I find, what I’m finding when I go back to the hospitals or I do a little post-test and I ask them about what they’re doing, they’ll say there’s less tears afterwards. They don’t have to go into the closet to cry because they processed it with their team. So the physician, the nurse, the assistant, whoever was in the room at the time, they stood there and processed it together, acknowledging what happened, honoring the deceased, recognizing their role and not just moving on, but appreciating that moment in time. Being respectful to their experience and the patient’s experience, they didn’t need to go hide because they were able to shed a tear in front of someone else they work with, or even giving each other an embrace, or shaking each other’s hand or whatever it is, or some of them have told me when they raise their hand and I’ll, I’ll ask them, what, what else do they do, they’ll say they, they hold hands at the very end. So, you know, that’s nice too. I’m not a hand holder, so it’s not my thing. Um, but you know, hey whatever works, listen, every team’s different.

[00:49:03] Dr. JB: one of the things that’s so important about what you said is that it doesn’t take that long of a time. You know, people feel like, oh–

[00:49:09] Barbara Rubel: Oh my God. I remember one guy, um, I wish I could remember, I think it was in Minnesota, about two years ago, he said, we give it the best minute of our life, that’s what he called it. And he said, um, everyone knows because they talked about this beforehand, that when a patient dies, that this is what we are going to do. So they’re all on the same page before, like, they, they’ve all agreed “this is what we’re going to do.” And they take one minute to say a silent prayer, to do some diaphragmic breathing, to say a prayer for themselves, you know, to give themselves the courage to keep moving throughout the day, to remember this patient fondly and to, you know, and just find meaning in it and in their role and find purpose in life. And it only takes a minute because you breathed into it, you found meaning in it.

[00:50:03] Dr. JB: Yep. That’s so amazing. And I think that a lot of healthcare professionals could find a lot of benefit, um, from engaging in a practice like that.

[00:50:17] Barbara Rubel: And get permission from, from those on your team beforehand. During a team meeting, say, you know, patients are going to die, let’s incorporate a practice, what are two or three things we could do it less than five minutes, you know, when a patient dies? And ask for suggestions and implement their strategies and then make it work.

[00:50:34] Dr. JB: Yeah, I love that. I absolutely love that. So going back to the compassion fatigue, you mentioned something about a framework, that strength-based framework, a fabulous strength-based framework?

[00:50:49] Barbara Rubel: Yeah, I love my framework. It’s fabulous. It’s fabulous. It’s a fabulous framework and it is basically eight pillars to manage compassion fatigue. So we take the acronym FABULOUS, and F is flexibility, that’s about being cognitively flexible about what’s going on, A is having a positive attitude, B is about keeping your boundaries, U is understanding job satisfaction and why you love being a clinician, L that was laughter, having a sense of humor, um, the sixth thing is Optimism, and that’s rather than being a pessimist it’s about being a realistic optimist, the seventh pillar is being United, being connected with your team, and your community, and your faith, your pet, whatever, and the last eight pillar is S and self compassion, that’s taking care of yourself when, when you screw up, when things go wrong, and it’s just eight pillars of resilience, it’s eight pillars of self-care.

[00:51:50] Dr. JB: And so do you apply these eight pillars every day, throughout the day?

[00:51:54] Barbara Rubel: Every single day in your life. So, so let’s say you’re a clinician and you want to work on these eight, eight pillars. So the first pillar is flexibility, so throughout the day, you need to be alert to your critical thought and change it. You need to recognize knee jerk reactions to avoid behaviors that screwed you up in the past. Um, maybe you want to adjust your thinking to accept new knowledge, or you want to brainstorm to deal with a problem, maybe, you know, a patient died so you don’t want to focus on one bad thing instead of all the good things throughout the day. So the flexibility is, is how can you be open-minded and cognitively change the way you think to manage all of your stressors, but you do that by looking at a strength. So let’s say for argument’s sake, you took the strength “open-minded.” “Oh, Barbara, I am so open-minded, I notice a negative thought about my role as a clinician and I try to reframe it into a positive thought.” Or you might say, um, judgment. Judgment, I’m a critical thinker, I adjust my thinking while I’m solving issues with my patients, so being open-minded and being a critical thinker, these are two of my strengths. These are how I put it into practice throughout my day, using the first pillar of cognitive flexibility. So you use it throughout the day to manage all of the stressors that occur. And that’s just F, we have eight of them.

[00:53:27] Dr. JB: Wow. This is, this is such an awesome framework. How did you come up with it?

[00:53:33] Barbara Rubel: Well, I’m a keynote speaker so I throw out so much junk into the audience, hats and, and, uh, little parachutes and twirly birds and whatever, and I wanted to give people pins. And so, you know, “ask me why I’m fabulous,” because if you attend my workshops, the training, “I’m fabulous because now I know how to take care of myself, I know self care, blah, blah, blah.” And then I said, I have to come up with something because everybody’s wearing these stupid pins or hats that say, “Ask me why I’m fabulous,” so I came up with it because I have all these clinicians walking around with stupid hats. I mean, that’s basically it.

[00:54:13] Dr. JB: “I need to turn this to an acronym, they’re used to acronyms.”

[00:54:18] Barbara Rubel: I did, because I, you know, with, with, Rhode Island Novelty it’s called, where you get all these little trinkets and things, and I hand out so much stuff because I’m very playful, I think we need to play when we learn, and so many people had on these hats and pins that say, “ask me why I’m fabulous,” that we’re all saying, you know, “why are you fabulous?” “I’m fabulous because I work as a nurse in the NICU,” you know, that kind of thing, you know? Um, but I said I have to come up with an acronym, and it worked. Like cognitive Flexibility, Attitude, keeping your Boundaries, Understanding job satisfaction, Laughter, Optimism, being United, and Self-compassion, like, hello!

[00:54:53] Dr. JB: Yeah, it’s perfect. It’s perfect.

[00:54:57] Barbara Rubel: And it’s, and it’s, uh, it’s a fun training too, because it really makes you dig deep into your eighth strengths, the eighth strengths that are going to get you through the day.

[00:55:08] Dr. JB: We talked about such emotionally charged topics, as an emergency medicine physician, you find that laughter is so important in terms of getting through such traumatic experiences that we all experience. And so you’ll find that there’s a lot of laughter in the emergency department.

[00:55:35] Barbara Rubel: Oh my gosh, what they will say, their greatest strength, those who work in an emergency department, their greatest strength that keeps coming up over and over again is laughter. I use– no playful, playful– I use gallows humor with those on my team, that’s an amazing thing. And you know what doctors say? Zest. And I find that such an interesting strength, but that comes up a lot. They’ll say I start each day with a sense of excitement. They say by the end of the day, you’re ready to crawl into the bed, but that doesn’t matter because they start their day with zest. And, and I love laughter because, do you like stand up, you know, like comics, jokes, funny stories, do you like slapstick, physical comedy? Sarcastic, I love dark comedy or gallows humor, like that grim misfortune humor, or observational humor, things that are not planned, self-defeating where you poke fun at yourself.

[00:56:27] I have to tell you a story. This, this is really happened to me, this is going back to 2005. I was a keynote speaker. I spoke on compassion fatigue in school nurses, there were 1300 nurses at this annual conference in 2005, it was the National Association of School Nurses in Washington, DC, in a ballroom. And I told those in attendance that they must go home and decompose. I thought I was saying decompress, in my mind. I told 1300 nurses to decompose. They were so kind like they, first of all, it was like a shock, you know? And then, you know how there’s two, when you, when you do these ballrooms, there’s two microphones on both sides and these compassionate, God bless them, they came up to the front and in the microphone, “uh, Barbara, I think you’re telling us to decompose.” And I’m like, no, I said decompress. I said decompress. And what was the funniest thing back then with keynotes, they used to give out cassettes, well they didn’t give them out, you had to buy it, cassettes of the keynoter, and when I went to pick up my copy at the end, he said, “we have none left, this was the first time we sold out like a thousand cassettes.” And I said, no, it’s not because I’m a good keynoter at all, I screwed up and I told them to decompose and they just want that. He goes, “I was wondering why so many people bought your keynote.”

[00:58:01] Dr. JB: They’re going to fast-forward to the end and put it on repeat, “go home and decompose.”

[00:58:03] Barbara Rubel: Absolutely, fast-forward right to the end when she told us to decompose. Yeah. Yeah. Great. No, one’s hiring me to speak, that’s for sure.

[00:58:11] But it’s about having a sense of humor. You know, we need to have a sense of humor to figure out what, like what strength, like what would you say, would you say playful, zest, you know, hopeful, love, what, what is your greatest strength?

[00:58:29] Dr. JB: I am hopeful. I am one of those people that usually sees the glass half full. Even though today may be grim, there’s always tomorrow. I was always that person for every test, I would say, you know what’s the best thing about test day? They’d be like, “what?” When it’s over! You know?

[00:58:56] Barbara Rubel: Yes. I love it. I love it, because there I see your, your strength of humor and being playful and being hopeful, you know, and also anticipating the best possible outcome. It’s just that I think a lot of clinicians don’t know their greatest strengths. What I do, like, I kind of do a pre-test/post-test in my trainings, and I’ll say right now, write down eight of your greatest strengths, you have 60 seconds. They come up with two, some people hand up hand hold up, like zero. They’re like, I don’t know. I mean, that’s pretty scary. I think a lot of people think it’s boastful or it’s pride, you know? Uh, but it’s not, if you focus in on your strengths as a clinician, you will be a better clinician. You’ll be more human. There’ll be a greater attachment between you and your patient, and, um, it’s a win-win for both.

[00:59:45] Dr. JB: I love that. I’m all about win-wins.

[00:59:48] Barbara Rubel: Yeah, it’s authentic right? Authenticity. You know, just, just know what you need as, as a clinician, what do you need? You need to, to provide support and care, you know, and, and just express whatever it is you’re going through as a human being, and I think that your patients will really be honored in that. And I think it’s a good thing.

[01:00:10] Dr. JB: So, Barbara, you know, I know that there are a lot of health professionals that are grieving and they just may not know the best way to process their grief. One of the things that we highlighted today is going to a patient’s funeral, and is that something that you like ask permission to do?

[01:00:40] Barbara Rubel: You can ask permission from the family, um, I think it’s a wonderful thing to do, but you don’t know if they blame you for their patient’s death. There’s a lot of people search, it’s called search for a culprit, so I would definitely attend, but I would ask for permission. I would send an email to family members or, or call and ask for permission. And more times than not, they will say we would love for you to attend. But I would say ask, don’t just show up because especially with, um, suicides or where they blame the psychotherapist and the psychotherapist shows up and, you know, you know, “my loved one was seeing you and he died, what did you do wrong?” I think it’s very important to just ask for permission with the understanding that it’s a really great thing to attend. And also write a condolence letter, they love that, bereaved love when the clinician takes the time to write a condolence letter. It’s a beautiful thing.

[01:01:42] Dr. JB: Yeah. And that’s also helpful for the clinician to just write, you know, their condolences and just, just release. Um, and then I would also add on that you could have your own personal ceremony for your patients.

[01:02:00] Barbara Rubel: Oh, yes, I am the queen of rituals. I love rituals. And so I would invite the clinician to think about what ritual would help them. Uh, would it be, um, like lighting a candle when they get home for the patients that, you know, died that day. Um, it might be, I know one nurse mentioned this in one of my trainings and I love it, she has a jar on the counter, and when she walks in the door, she has a little slip of paper and she writes down what she is grateful for that day. And very often it might be, I’m grateful that I was present when that patient took their last breath. So it’s important to figure out what ritual works for you, but to have a ritual, you know, I don’t just do presentations for clinicians, I also do them for the judicial system and first responders, and one judge told me that they hang up their robe before they leave the court. And the moment they hang up the robe, they say like, whatever it is, they needed to say for all those victims that they had to come in contact with, very traumatic stuff, but then they walk out of the courthouse and they’re a different person. They put on like a totally different metaphoric, metaphoric robe to embrace the world in a positive way.

[01:03:23] Dr. JB: Wow. Man, that takes a lot of practice.

[01:03:30] Barbara Rubel: Yes. But you know what, God, God willing, we have a very long life to keep practicing.

[01:03:34] Dr. JB: Yes we do. Yes we do. You know, that’s so amazing. I mean, we have so much amazing examples during this conversation of different rituals, uh, different practices that we can adopt as healthcare professionals to really help us throughout our day and to courageously face the potential trauma that we’ll be exposed to, and help us cope, and help us thrive and help us be fabulous. I love that word.

[01:04:14] Barbara Rubel: Yeah. Yeah. Well, the bottom line is we, we understand that we have to turn off that maladaptive stress response and you’re going to hear get eight hours sleep, progressive relaxation, deep breathing, uh, aromatherapy, visualize peaceful images, exercise, yoga. Listen, I’m a size 14, the last thing I’m going to do is do yoga. Okay? The bottom, the bottom line is just find what works for you. Get creative. Yes, it might just be like, I have a brand new granddaughter who’s five-months-old, just holding her, that does it for me. So just find that sweet spot in your life, you know, thank, thank God that you, you, if you know, you, if you have faith, for, for your abilities and, and just continue being human in the world and you’re going to be okay.

[01:05:06] Dr. JB: And you’re going to be okay. I love it. So Barbara, if my listener would like to get in touch with you to find out more about what you do and offer, how can they do that?

[01:05:24] Barbara Rubel: Thank you. Uh, they could reach out to me at my website, griefworkcenter.com, G R I E F W O R K C E N T E R dot com, or barbararubel.com, and that’s R U B E L dot com. They could follow me on LinkedIn, I’m on LinkedIn, I would love to, um, link in with others. Uh, they could also, um, really just type in Barbara Rubel you know, in, in Google and read so much of my materials. I’m on Amazon, I wrote “But I Didn’t Say Goodbye: Helping Families After A Suicide.” I wrote a 30-hour continuing education course book for nurses on, on loss, grief, and bereavement through Western schools. I wrote “COVID-19: Loss, Grief, and Bereavement” from Elite healthcare, nurses get contact hours. So my stuff is just out there, if you just plug in my name, and reach out to me if you have a grief need and you just want to talk.

[01:06:19] Dr. JB: Barbara. I truly enjoyed this conversation. I think you do such amazing work.

[01:06:24] Barbara Rubel: Really? Come on!

[01:06:26] Dr. JB: No, I really do.

[01:06:29] Barbara Rubel: It was wonderful talking to you, you are doing fabulous work. And I hope the listeners, that it touched their heart and that they, they felt like, you know, yeah, I could, I could really work on this, I could be with those who were terminally ill, I could be with dying patients, I could hold the hand of someone who is taking their last breath, I could talk to family members, I could build my resilience, I can realize that I’m fabulous. You know, they could do it.

[01:06:56] Dr. JB: And all of these things just takes that first step, right? The first time may not be very comfortable, but the more and more you do it. The easier it gets.

[01:07:06] Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one teach one. I’m done.

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