EP 3: Orphaned in 16 Months

Episode Description:
Discussions with a Physician Assistant and Nurse couple about life, marriage, and loss.

Transcript:
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.

[00:00:37] Hi, everybody. Welcome to Hope4Med podcast with me, Dr. JB, as your host. Today, we have two amazing people here on our podcast.  We have Bridget, who is an RN in Florida and Derek, who is a PA in Florida. So Bridget and Derek, please tell me about yourselves.

[00:01:01]Bridget: I’m Bridget and I have been a nurse for I don’t know, a long time, over 30 years. Worked at the bedside for 20 of those years, and then went into education.  Did that full-time for probably about  six years, six or seven years and then part-time on and off, uh, for the last, maybe three years.

[00:01:27]I have two adult children and a brand new, well, not brand new, a granddaughter, and I get to spend a lot of time with her now, and I am just thoroughly enjoying that. So I get to mix time with her in, with, with work and it’s, it’s working well, so yeah.

[00:01:50] Dr. JB: Well, congratulations on your granddaughter. How old is she?

[00:01:55] Bridget: She’s two

[00:01:55] Dr. JB: Oh, beautiful age, you get to spoil her and hand her back to her parents.

[00:02:00]Bridget:  Well, it’s more like I get to spend time with her. I’m not really the spoiling kind of grandma, but I, I spoil her in good ways. We get to really spend some quality time together and I really enjoy her. She’s really bright, which is, you know, kids nowadays, I think they’re just born different. And their brains, I think, just work differently so there’s a lot that she picks up and words that she says, and I’m like, how do you even know what “appropriate” is? You’re two. So yeah, I have a lot of fun with her.

[00:02:35]Dr. JB: Awesome.

[00:02:35]Derek: I’m Derek  and I’m a PA in Florida, have been working as a PA for almost 28 years, maybe closer to 29. I’ve been in medicine for about 36 years. When I began in the military, I was a tech, became a paramedic, went to school and became a PA and finished my career in the military as a PA and became a civilian PA, and then I still do that now in the capacity of an emergency room PA. But I also recently obtained my doctorate in health education and I have served as a clinical director for one of the local PA programs, as well as a faculty member for another one of the local PA programs. I enjoy passing on what knowledge I have gleaned over these 27, 28 years to those who are coming along and desire to either go to PA school or med school.

[00:03:39] I too, I too enjoy our two-year-old granddaughter. I don’t have as much flexibility and time to spend with her as Bridget does, but I do see her frequently enough to enjoy her company and, you know, give her, you know, whatever I can. I’m the spoiling type though, so there is balance.

[00:04:04] Dr. JB: So yeah. So one thing we did not explicitly ask, but what is your relationship to each other?

[00:04:09] Derek: We have been married for 35 and a half years.

[00:04:15] Dr. JB: Amazing.

[00:04:17] Bridget: Yeah. So I’m the wife .

[00:04:18] Dr. JB: And so we are talking to a household of two health professionals. How, how’d you guys do it, how’d you guys balance your life with your work and raising your children?

[00:04:32] Bridget: You know, it was really, it was very intentional. So when we got married I chose to work, at the time they used to call it like a flex pool or staff relief, so I didn’t commit to working full time at a hospital, I worked through an agency and I filled empty shifts. So I had control of my schedule and what I realized was, at the time Derek was military, and, you know, for the most part, he, we lived a normal life. He went to work and came home everyday like every other husband, but I always knew that in a national emergency, they could call my husband, and we had children and I needed to be the one that was the flexible one, because he couldn’t necessarily be as flexible given his obligation. So I worked staff relief and I let them know when I was available and they scheduled me in shifts that worked. And so, I worked nights and he worked days, and sometimes now we even laugh about it because there was a period of time where he would get the kids up in the morning and bring them to me where I worked. We would switch cars and I would go home, do the mommy thing, and when they took a nap, I would take a nap. And at that time we were working eight hour shifts. So when he came, they would wake up and we would do the evening routine, have dinner and everything together, and after dinner, I would go take a nap and then get up and go to work at night, and then we would do it all again the next day. The other thing I did that was really intentional, that we did, is I didn’t work two days in a row. I worked every other day so I could to catch up on my sleep on the night that I wasn’t working. And that worked well for a number of years, and that’s uh, part of how we helped to manage both of us working in healthcare.

[00:06:41]Derek: The other part of that, is that as a PA, after I became a PA, I just wrote a standing order for the family to do whatever I said.

[00:06:54] Bridget: And how did that work out for you?

[00:06:58] Dr. JB: How did that work out? Well, I guess, I guess 35 years later, right?

[00:07:03] Derek: Nurses don’t always follow doctor’s orders.

[00:07:11]Dr. JB: Well, you know, it sounds to me like those hospital roles stopped at the, uh, entrance to your household.

[00:07:20] Bridget: Yeah,

[00:07:20] Derek: For the most part, yeah, we, we were intentional about not really bringing work or baggage home at least in the early years because we had young children that needed our attention and there were specifics of their education and the growth and development that we wanted and made sure that the environment spoke to that.

[00:07:48] Bridget: Yeah. And, you know, we even talked about, cause sometimes we’d be in company and people would say, oh, a PA and a nurse, y’all could work together and we were like, yeah, no, that probably wouldn’t work. And you know, we had conversations about it and I was clear that, you know, I do things differently and in my role, as a nurse working with him, I would have to do what he said, and that was clear. Okay? We can have conversations about it, but I wasn’t clear that that wouldn’t come home. So I was like, no, it’s best if we don’t work together, we need to work in our own, you know, separate areas as professionals. So that’s, that’s what we did.

[00:08:36]Dr. JB: And when you said separate areas, I know Derek, I think you mentioned that you are an, an emergency room PA, is that correct?

[00:08:43] Derek: I initially started in ICU and I did ICU for probably my first four, almost five, years of my military career. Then I went to the emergency room and did emergency room for about seven or eight. Then my last two, before I left to become a PA, I did OB GYN.

[00:09:07]Dr. JB: And about you, Bridget,

[00:09:09] Bridget: I worked in several areas. So when I was in the military, I worked in uh, what is it? It’s mother, baby nursery, and OB/GYN, that unit was all together. So I worked in that area and he worked in the emergency room. So we worked in the same hospital. We just didn’t work in the same areas at the same time. When I became a nurse and got out of the military, I worked in med/surg, I worked at a youth home, I did adult and pediatric home health, I worked in med/surg again, and then I went to PCU. I did neonatal intensive care and I ended up in PCU. That was my last hospital gig.

[00:10:05]Dr. JB: Nice. So you guys actually did a really good job in terms of making sure it stayed separate.

[00:10:11] Derek: Yeah, we did.

[00:10:13]Dr. JB: So, you know, tell me a little bit about the, the benefits and challenges of being married to another healthcare professional.

[00:10:21] Derek: I think the benefits to a degree centered around a common interest in serving and helping others, I think both of our hearts are specific to that, and so we would talk about those topics that dealt with that specific ideology. And, uh, we were pretty health conscious as well so we would also talk about the inadequacies, if you will, sometimes of the medical field in not maybe addressing as well preventive medicine to keep people healthier for longer periods of their life. And, uh, I think that was one of the benefits of working in the same career field.

[00:11:14] Bridget: Yeah, it was definitely a benefit being able to speak the same language, so to speak, and a level of understanding about commitments related around it that in some households could be more of an issue. And so for example, being able to, well sometimes getting off late, you know, we understand sometimes that happens in healthcare because people’s lives are what we’re dealing with. And sometimes you can’t leave right at seven o’clock. So that kind of thing was helpful. It was also helpful to be able to discuss certain things that may have happened and at work in general, like with a particular scenario, and not only get feedback but have somebody else like understand what happened. That was also good for talking about the various frustrations that we may have encountered as well as the, the amazing events that we get to, to share.

[00:12:16]One of the things that I am aware of, is keenly aware of, is that as a nurse, I get to stand in spaces that everybody else doesn’t necessarily get the privilege to stand in. I see people at their worst, and so to be able to be in a situation where something may have gone dreadfully wrong, and we still come away feeling good about what happened and how we handled the situation. Not everybody can understand how good that can necessarily feel, but my husband is able to understand that, he’s been there several times, as well as he’s in the environment where that’s that’s uh, something that he’s exposed to and deals with. Same with the other side, you know, sometimes something goes amazingly wonderful and, you know, the technical terms and all of that. So that was, those was the thing, being able to understand the time commitment and, you know, not always being at home, also and, and the sharing of the stories, but then also there is, you know, those, those times where we have hurricanes in Florida and we had, like, at one point we switched. One year he was the one that stayed at the hospital and then, and I told people, nope, I can’t come because my husband is doing whatever, and with the kids. Another year, roles were switched and then there was one year where I was able to take my kids with me to the hospital so that worked. So being able to navigate that kind of a thing, like we understand as healthcare professionals, this is what, this is what we do sometimes. So that worked, that was one of the things of benefit. A challenge? As a family, I’m trying to think of challenges, and I think we just, we just worked through whatever.

[00:14:20] Derek: Yeah. We just rolled through it. We knew, you know, family came first, but even though we were committed to the military, we still found a way to put family. I wouldn’t say above our commitment to the to the country, but it was neck and neck, if you will, whatever accommodations or adjustments we needed to make to both serve the country and serve each other and the family, when we just did that. It was almost like an innate behavior for us, it was never a question.

[00:14:58] Dr. JB: And in terms of balancing your life, did you guys, so I understand that at some point, at least early on in your marriage, Bridget, you worked nights, Derek you worked days, did you guys arrange your schedule so that you were off the same days?  You know, cause sometimes people feel like they’re strangers passing in the night, uh, when their schedules are opposite. How did that work for you?

[00:15:28] Bridget: So I think because of the intentionality of how I worked, we worked that out. So, because I was able to be flexible, we would talk about if there was specific days that we wanted to be home together, we would, we would plan that and make sure that I wasn’t scheduled to work. If there was an extra shift that either one of us had an opportunity to pick up, we would talk about that. How would that work with, you know, the rest of whatever. We also we also observed Sabbath and so we always knew for the most part that Friday and Saturday, we would be together as a family. And then everything outside of that was, was up for conversation. But the Fridays and Saturdays usually, and I don’t know how, you were working at the clinic. He was, yeah, he was working in the clinic, so that was Monday to Friday. It was me that had the, the nighttime shifting around thing and so with his stability, it was easy. I knew that everything, we knew, that every weekend he would be home, so we could schedule things on the, on the weekend. And then if there was a Saturday night that I was working, then that was a conversation before I, I scheduled myself. And then, if there were trips that we were going to take, of course we planned that. So yeah, it was just really intentionality and planning.

[00:17:02]Dr. JB: And it also sounds to me like communication, also was a big part of all of it. Awesome. Well, thank you so much for, uh, sharing a little bit about your history together and how you guys made your marriage work for 35 years. That’s really amazing, because unfortunately nowadays you don’t come across people that stay together for that long. So it’s very inspiring.

[00:17:27] Bridget: Thank you.

[00:17:28]Derek: Yeah, thank you.

[00:17:29]Dr. JB: So I understand that recently, both of you guys went through a pretty emotionally trying period. Uh, would you guys mind talking a little bit more about what, what happened?

[00:17:44] Derek: Uh we, and not jokingly, but we became orphans in a matter of 16 months. And both, all of our parents were in their late eighties or nineties and my mother in June of 2019 passed away, leaving my father who was 89 in a assisted living rehab facility because of complications with his diabetes. And, uh, 13 months after she passed, he passed unexpectedly, and she passed unexpectedly as well. And then I believe it was maybe three or four months after my father passed, Bridget’s stepmother passed away unexpectedly and, uh, 13 hours after we buried her, which was about three or four weeks after that, her father passed. So in a matter of about 16 months, we lost four parents.

[00:18:52] Dr. JB: Wow. That’s so, that’s so sad, I’m so sorry for you guys.

[00:18:56] Derek: But we are making it through day by day.

[00:19:01]Dr. JB: Well, it sounds like you guys have a really good support network amongst the two of you, but tell me a little bit more about how you got through this trying time.

[00:19:11] Bridget: So we knew, so for me, death is not something that I’m afraid of, death is something I am kind of familiar with because I come from a family of healthcare providers or professionals. So I was taught that death is just a part of the life cycle. Right? So I knew that at some point I would bury parents. Right? So the, and of course the older they got and, you know, some health challenges showed up, it was like, okay, yeah, it’s in the back of my mind that one day we’re going to do this. Right? Never in my wildest imagination did I know how it was going to happen. So, yeah, so when my mother-in-law passed away, we were just all like so shocked because of the four of them, she was the last one that we thought would be ready to pass away. So, we really, we stayed connected to family and the, I think one of the biggest things was that my in-laws had all of their final arrangements made. They had their advanced directives complete, they had their lot, their plots picked out and pay for, they had their programs planned. We didn’t have to do any of that. And they did that, I don’t know, several years before they passed away. So all we literally had to do was pick up the instructions and read and carry them out. It was amazing.

[00:20:59]Dr. JB: Wow. You said this, this was your in-laws or so were your parents did, were they health care, in the healthcare field?

[00:21:06] Derek: My mother was a nurse and my father was actually an orderly in one of the large hospitals in Brooklyn, New York, so, yes.

[00:21:18] Bridget: Yeah. And that made a really big difference. With my parents, we had advanced directives from my father and so that was clear, and my stepmother, we knew that she was more of “whatever they need to do, they will do.” So she didn’t want to have advanced directives and, but at least we knew where she stood with it. With all of them, the financials were in order, some of it we were privy to, some of it not. But when we, when we were at, well, that’s not really true cause we had, we knew all of it.

[00:22:01] Derek: Yeah, yeah, we knew everything.  The one thing that I should say is that Bridget and I were the primary caregivers for both sets of our parents and so we had, I had power of attorney over both my parents, and Bridget and her brother had power of attorney by the time they were really ill. So we were privy to pretty much all of their financial ongoings and, uh, we were fully aware and interactive in their healthcare up until when they passed.

[00:22:35] Dr. JB: So in terms of their advanced directives, was this something that they initiated on their own or was this something that you guys were involved in discussing?

[00:22:43] Derek: My parents did it on their own. They had all their advanced directives, they had their wills completely filled and I would say they probably had done it 15 to 20 years before they passed away.

[00:22:57] Bridget: Yeah, they had, they initiated theirs. With my parents, I had ongoing conversations where I would suggest that, you know, as you all get older, there’s some things that Ray and I need to be able to, to handle. Can we look at this? And so my father was okay, my stepmother was not, she did not like talking about death. And so it took a little bit of doing to, to get that, to get to a place. But as she, she had health challenges, and as she got more debilitated, she saw the need, it got to the point they needed to be placed in an assisted living facility. At that point we needed to consider and apply for Medicaid and so that started a whole other set of balls rolling that we then were able to get the power of attorney done. She was not willing to do the, she wasn’t willing to do the advanced directives, but there was a lot that got accomplished in that, because of that scenario. My brother had taken over the finances, I don’t know, maybe three years prior to, because we started noticing the decline.

[00:24:21] My father started to, to not, like he would search for words, so we could tell that he wasn’t always remembering and he would forget to pay some of the bills sometimes. So he, my brother took that over. I stuck mainly with the medical things and so as things came up, I would point out, look, we might want to look at doing this because this is the direction that things are going. But like I said, when it came to the place where they both needed to be in assisted living, then it was, it was almost a given. We had to do some things that were, more legally as related to the advanced directives and, and the power of attorneys.

[00:24:59] Dr. JB: You guys said that your parents, both sets of parents died between 2019 and 2020. Did any of their deaths have anything to do with COVID?

[00:25:14] Derek: Not directly. My mother never had any symptoms of nor tested positive for COVID. My father a few months, maybe about five or six months before he passed, was exposed in the facility and he had no complications. He was just hospitalized, by protocol for the 10 days and then he was allowed back into the facility, but he never exhibited any detrimental symptoms of COVID at all.

[00:25:47] Bridget: And with my parents being in the facility, both of my parents tested positive for COVID. When my stepmother, they found out the day that she died, like I’m literally going in to view the body, and they say, oh, we just got her results back she was positive for COVID. Now, she never had any symptoms and she had respiratory challenges, respiratory and cardiac conditions. So we, I don’t believe that her positive test had anything to do with her death. I think that, that was just a thing. My father, that same day, they told me that he tested positive for COVID and then he went into the hospital, but he didn’t have the typical signs. So I’m not sure. And with what was going on with him, he, he passed away because of his final wishes. I don’t believe that it was that he died of COVID. So…

[00:27:00]Dr. JB: Got it. But during this, this period, this pandemic, were you guys able to, uh, be around your parents before they died?

[00:27:08] Derek: After the initial lockdowns? No. There were probably between seven and nine months of, well, all of 2020, I did not see my father until he was on his death bed in the hospital and I was allowed to go in and basically watch his passing.

[00:27:29] Bridget: Yeah. And then with, with me, I was able to go in. So in the initial lockdown, I couldn’t go in at all, and that was probably a good six months, maybe. Then they started opening up where I could go and well, actually, with my stepmother, they requested that I start coming because she was beginning to get depressed and they thought it was better if she could see a family member face to face, as opposed to just through a glass or on a phone. So, they asked me to, to start coming in, they allowed me to come in. Then, probably like a week or two later, they allowed other people to start coming in. With my father, it was probably, I don’t know, it was shortly after I was able to start seeing my, my stepmother, that I was allowed to go over to the unit where my father was and then it was limited. They were only allowing I think one person to come in and you could stay for a certain amount of time. And that was, that was it. And that was the more challenging one. Once he got sick, the week that, so when my, my stepmother died on a Friday, and then on Saturday morning, afternoon, my father was rushed to the hospital.

[00:28:59] So in the hospital, I could go and see him. He could have one visitor a day, so I was able to go and see him. Once he came back over to the facility, they let me come to see him for, I think, a day or two. And then they locked down again because they had a positive staff member, so then I couldn’t see him. And then when he got really like, so when he went back to the facility, he went back on hospice and so they allow me to come and see him because he was on hospice and anticipating that he would pass away. My father didn’t want any, any invasive treatments, life-sustaining treatments, and he needed a G-tube when he came out and he didn’t want that so we didn’t do that. So when he came back over to the facility, he went back to hospice and we would just really in the midst of, okay, this is, this is going to be the end. And we’ll, we’re waiting for that because he wasn’t able to swallow.

[00:30:07] Dr. JB: I’m sure both of you guys have had experiences of patients near the end of their life who came into the hospital and did not have a living well. How did the experience of, of knowing your parents’ wishes help, if at all, uh, with their passing?

[00:30:31] Derek: I think for me, it totally eliminated any guilt as to “am I doing the right thing?” It was their wish for them to pass the way that they chose and that they felt they wanted to pass. And, uh, it was an honoring of what they felt important, and they intentionally made those decisions, so who would be, who would I be to overrule, you know, what it is that they wanted? And I’ve seen in my years of practice, families who are indecisive or feel guilty if something goes wrong and carry that burden, that they either didn’t do enough for their parents, or they made maybe technically the wrong decision to take him off life support or whatever cause there was no direction for them to go in. And they couldn’t speak to the individual because of their medical incapacitation.

[00:31:37] Bridget: Yeah, for me, it was very freeing. I was clear where I needed to stand as I advocated for both of my, my stepmother and my, my father. So I knew that when a health care provider came to me and said, “okay, this is what we want to do,” I knew, “yeah, no, we’re not doing that” or “yeah, sure, we’ll do that,” because I knew what they wanted. It was really like Derek said, like a position of honor. Like I get to say and honor your wishes and honor you in that way. It was also very, there was a different, like a different level of stress because there are other things that I had to deal with, that we both had to deal with. You know, as healthcare providers, there are certain things that you know about how things are supposed to work and they don’t always work that way. And when you’re the patient or the advocate for the patient and you see these things going awry, then you can address them because of your knowledge but I can’t imagine what it would be like to have to address all of that and still have to be dealing with, oh, I don’t know, like what, what do they want, what is the right decision to make here? I think it just would’ve made it a lot more stressful, so for me it eliminated some of the stress.

[00:33:10] Dr. JB: I think this question is for, I guess, both of you guys. So if I understand correctly, Derek, your, your mom and dad both had their living will and they were DNR. Bridget, your dad was clearly DNR, but your step-mom was a little bit hesitant.

[00:33:30] Derek: A lot hesitant.

[00:33:33] Dr. JB: Did she finally make a decision or you know, what happened when she was on her, her death bed?

[00:33:41] Bridget: You know, she was, she had a day on either a Tuesday or a Wednesday, a 24-hour period where she was so sick, they thought she was going to die. They let us go in and see her, I spoke with her, she was in and out, like people that wanted to see her went to see her that day. So that was Tuesday and I think Wednesday, Thursday, she got up like nothing happened. She got up, she had her breakfast, she was dressed, she was talking, she went to see my father. And then Friday I happened to call cause I normally call and I’m on the phone with the nurse and she says, well, I need to call you back because they’re coding her right now. And I said, excuse me, you mean coding like they are doing chest compressions, kind of coding? And she said yes, she said that she would need to call me back. She said we’re not, we’re not really sure what happened, but that’s what’s happening and I will call you back. And she called me back probably about 45 minutes later and told me that my stepmother had passed away. And you know, I just have to say that God knows and things happen the way they’re supposed to happen. She’s the one that we wanted to have the advanced directives, because we thought sure with her medical history, she would be the one that would end up on vent and we would have to make a decision about taking her off. That’s not what she wanted and she passed away with no, no need for any of that kind of conversation.

[00:35:26] Dr. JB: Hmm. Wow. Yeah. And it seemed very quick. Like, it seems like she was able to see the people she wanted to see, you know, she was able to see your dad one last time and then, you know, she died quickly.

[00:35:46] Bridget: Yep.

[00:35:49] Dr. JB: And then Derek, so with your parents and we knew their, their wishes that they did not want to be intubated, they didn’t want to be resuscitated at all, they just wanted to be made comfortable. Is that what happened with them?

[00:36:03] Derek: For the most part, like I said, their deaths were so unexpected that none of that really needed to be done. My mother had come and spent some time with me and one of the beautiful things about it is that we went to church and my mother is, uh, is a Caribbean woman and very staunch and very prompt and priss and all of that and she, you would never see her very emotional in church, especially singing. I don’t recall many times when she was singing, but the day that we were in church, they was playing a song and she was moving from side to side to the music and singing the song. And it touched me so much that I recorded it and sent it to my siblings. And we went home and I was working that night, so we went home, we ate lunch together, I fed her and we sat and talked a little bit and I said, well, mom, you know, I’m working tonight so I’m going to go and take a nap before I go to work. And it was the afternoon so she would have been taking a nap anyway, so she laid down also. Probably an hour into my nap, I hear her screaming my name so I rushed down and she was looking very ill in the bathroom and I think she said she threw up, but in either case, I calmed her down a little bit, got her back to the bed and say, just rest a little bit more. I’ll be, I’ll be close by. And she’s calmed down, and about 15 minutes later, the cry came back again. So fortunately, I live like five minutes away from one of the standalone emergency rooms so I took her there and they diagnosed her with a urinary tract infection, but because of her age and all of that, they said, let’s keep her and watch her a little bit and three days later, she passed away. And it was sepsis in the technical term, but it wasn’t what I have seen or how I’ve seen other patients go in the emergency room, but sepsis where they’re needing pressors and you know, all of these invasive things, and she just passed.

[00:38:22] And my father, they woke him up one morning, sat him up in the bed as they usually did, gave him breakfast, and went down to you know, take care of the other residents in the facility. And, it’s a fairly long hallway, by the time they got back down to his room to check to see how he was doing with breakfast, he had passed away and they found him on the floor. So nothing invasive needed to be really done for either one of them, at least not for long term. They did what they needed to do to hold them but when they contacted me, I quickly told them, you know, they didn’t want to have life support or anything like that so I’m going to consult my siblings just to let them know where we are and I will call you back. And so I painstakingly called my siblings and let them know the state of our parents and, uh, they concurred that we needed to honor their wishes so, went to the hospital, presented the documents to, you know, verify their wishes and, uh, stood by the beds and watched both of my parents pass away.

[00:39:34] Dr. JB: Hmm. So, in the emergency department, right, I’m an emergency room physician, our default is, unless I know a patient’s called status, I’m going to resuscitate you. Right? I want to abide by the patient and the family’s wishes, you know, and especially if I know their wishes, yeah, you know, I will abide by it. But if I don’t, then you will be intubated, you, you know, you will be put on a vent, you will be started on pressors, you will get that central line, you’ll get everything that I can possibly do to prolong your life. So, but because of the advanced directives that your parents had, they never had to go through that, correct?

[00:40:20] Derek: My mother was intubated for a day, my father, he was never intubated, because for some reason, we thought they had all the paperwork for my mother, but for some reason they did not. And so they instinctively, like you would have done, you know, put a tube down to continue her breathing and then they called and told me what had happened, what they had done. And I, you know, rectified the situation and said she needs to be removed cause that was not her wish to be preserved by any extensive or invasive measures.

[00:40:51]Dr. JB: And how did that conversation go with your family, when you told them that you’re going to have to extubate mom?

[00:40:57] Derek: It went well, they all fully understood, they all were aware. It was more shocking that the events occurred as quickly as they did more than “this is what we need to do” because none of us saw it coming. As we just had alluded to earlier, my mother was the healthiest of the four and we figured she would have survived all of them. And she was the first one to go.

[00:41:25]Dr. JB: Yeah. Wow. So you were at her bedside when she died?

[00:41:35]Derek: Yes, I was.

[00:41:36] Dr. JB: Both of you guys were present for the passing of, of all of them?

[00:41:40]Bridget: No, no. Derek and I weren’t present for the passing of his mother. He was present for the passing of his father.

[00:41:47] Derek: Because of COVID, they only allowed one person.

[00:41:49] Bridget: Right. And then I was not present for the passing of my stepmother of course, because it was so sudden, and I was not present for the passing of my father because, partially because of COVID, and partially because as I have thought back several times, the way I worded, what I, what I  worded. Hospice wanted to know what the wishes were for when he was passing and that was during the time of the lockdown. And so, I told him I didn’t want him to die alone. Well, when I, when things opened up, now I see what I could have done is let them know that I wanted to be there when he passed away, instead of just not dying alone, and with everything that was going on, that just never happened. So I wasn’t there for the passing of either one of them

[00:42:44]Dr. JB: And, well , Bridget,  first I’m, I’m sorry, again, you know, I know it’s been a while but you know, the death of a parent, of a loved one period, is, is definitely challenging and there’s a lot of emotions around it, and, and each day it gets better but it’s not something that somebody just quickly gets over. So, I appreciate you guys taking out the time to share your story with me and Hope4Med’s audience, uh, because I think that you guys are not alone in, in terms of what you guys experienced, period. And, and it is true, uh, Bridget, what you said that, death is essentially one of the seasons of life, right? It’s inevitable. We’re all going to go through it. You know, your, your parents had a very, very peaceful passing.

[00:43:48]Derek: Mhmm.

[00:43:48]Bridget: Mhmm.

[00:43:49] Dr. JB: And that’s wonderful. And, and the gift, which I just, I can’t stress this enough, it’s such a gift to families when loved ones let them know their wishes. Even if the wish is I want to be full code, fine. Right? So you continue,  you know, you tell the doc, you continue working, you know, cause at least, you know, their wishes. You know, because time is of the essence, right? Like you need to make a decision right now. And, and it’s so hard and it’s so heartbreaking, and I have these conversations all the time with families, and it’s just, it’s just really wonderful to, to hear, uh, your guys’ story in terms of your, your parents.

[00:44:36] Bridget: Yeah. You know, I had such a sense of accomplishment when everything was done. You know the day, I don’t know, I don’t remember what day it was, but I was standing in my kitchen and I was like, it was, it just had hit me, like what just happened. Like it had been years of caring for, advocating, supporting, and now the wishes and I was standing and I was like, how did I do that? And you know, God reminded me that, yeah, he was with me throughout that whole thing. But I had such an amazing sense of accomplishment at like, it was like, look, you got it all done, you did it. And you did it, you honored their wishes in the end. And you know, it does make a difference when, when those wishes are known, whatever the wishes are. It’s, it’s huge. It’s a huge gift to your family. So yeah, absolutely.

[00:45:36] Dr. JB: And one question for Bridget, cause I know you talked about your dad being placed on hospice. Was that a decision that dad had said that he wanted, or how did you go down the path of choosing hospice?

[00:45:48] Bridget: I had my, my stepmother placed on hospice as a, as another intervention, another physical human being that could be in her space and have conversations face to face because they could get into the facility whereas, at that time, we weren’t able to. So this was a part of her, of her plan to help to keep her from being depressed. And that same hospice was providing personal care, so they knew that my father was ill and we had kind of talked about, you know, when he got to a certain place, maybe hospice would be an option for him. He was doing therapy over in the facility and was beginning to plateau, and so they, they, the facility asked me if I thought that now would be the time to do it. And that, at the time that they did the intervention, it wasn’t quite the time, but when he went into the hospital and was coming out and we realized that, okay, this was definitely going to be end of life, then, I was like, okay. Yes, let’s do hospice now. And so that’s how we, how we chose it.

[00:47:06]Dr. JB: So it sounds like your experience with hospice was relatively brief.

[00:47:10] Bridget: Yes.

[00:47:11]Derek: But it had been talked about because probably a year or so prior to them really getting sick and needing it, it had come up as a concept for care. But as Bridget stated earlier, her stepmother, when you talked about hospice, she, she heard “you’re going to die and we’re not going to do anything about it.” And her sister was grossly opposed to even the mention of the word, so even in our attempts to have a meeting and just kind of talk it up and, and what it offered did not avail much.

[00:47:46] Bridget: Yeah, and also at the time that we initially had the conversation for my stepmother, physical therapy was still very much an option and she wanted to have the physical therapy. So, because she wanted to do physical therapy, it wasn’t going to work with hospice. At the point that she chose not to do the physical therapy and she was having these, what looked like depression, then it was appropriate to use hospice and so we did.

[00:48:13] Derek: And she was more amenable at that point.

[00:48:15] Bridget: Yeah, and she was more open to it at that point.

[00:48:17]Dr. JB: Cause she had somebody to, to come and be with her and talk and spend some time.

[00:48:25] Bridget: Exactly, yeah.

[00:48:28] Dr. JB: Did you guys find that you had space to grieve?

[00:48:35] Derek: I will say for me I probably had the space but didn’t recognize it. And I say that from the perspective of, I was, of all the siblings and there are six of us still alive, the only one in close proximity to my parents and so their caregiving was solely on me. I got input through phone calls and all of that, and my siblings did call and check in on them, but the face-to-face the navigation of, and all of that, fell solely on me. And so, I had to kind of trudge through, if you will, organizing the funeral and, you know, contacting who needed to be contacted, and so forth and so on, and making sure that it was as my parents wished but also amenable to those who were able to attend because of COVID. And so, I didn’t grieve for my parents until Bridget’s father passed away, which was a year later. And it was that time when I was talking to a colleague that I almost broke down because it was the fourth death in 16 months. And was this like, dude, you are carrying a lot and you have done nothing for yourself. And I took three weeks off and it was very liberating, to a degree, to know that I didn’t have to be strong or whatever. I could cry if I needed to, I could be upset, I could be angry for the time that I felt I needed to be angry, and up until that point, I was just carrying it.

[00:50:29] Dr. JB: Wow. It’s wonderful that you’re able to get the, those three weeks off.

[00:50:34] Derek: Yep, it was.

[00:50:36] Bridget: Yeah, it really was, and it, it was such an appropriate time, you know? Grief is just so, I don’t know that I understand it, and I know that you need to do it, and for me, my grieving process is just different than, than I think about grief. The three weeks that Derek was home, I think that first week is when we were dealing with my father’s funeral and then we were both home, not having to really deal with anything for the two weeks. And so, so it was good for us to be able to have that space and to share whatever we needed to share or could share in that space. It gave us the freedom to do that. Of course, I miss my parents, I miss my in-laws and there even, there were times then, and even now, when I have a deep sense of “man you’re really gone,” or “I miss you,” or I have a memory. I don’t have periods where, I don’t have periods where I’m breaking down or crying.

[00:51:50] I cried with my, my father, I think the first couple of days afterwards. My, of course my stepmother is not my biological mother but I did, I did have moments where I just really felt the loss of that. With my mother who had died like 20-something years earlier, I was a mess. Okay? I was still able to function, still able to do what I needed to do, but I got lost going home from work, I had to pull off of the road and just sit and cry. I had to choke in tears while we were watching some movie at, uh, when I was with the family of my patient. I was doing home care at the time, they were watching a movie and this mother was cooking all this food, and I was having all these memories about my mother, and it was the end of my shift luckily, but I was holding in tears because they reminded me so much of my mother. So Mother’s Day, it hit me. That’s the first time I don’t have to buy a mother’s card, a Mother’s Day card, and I’m in the store and I’m crying because, like that, so that was then, and this was so different. And I don’t really know what I could attribute it to, but this was a lot lighter. It was, again, I, I had time, and I think it really is the, maybe the stage of their life, maybe the circumstances, may be having done all that we had done upfront and the work of, of getting them to this place. But this was just different, but I, I do feel like I have grieved. I, I feel like I’ve, when things come up, I try to deal with them and allow myself to feel whatever it is that I’m feeling. So, yeah. I feel like I’ve had the space to grieve and it’s been, it’s just been different.

[00:53:48]Dr. JB:  Did you feel that you were supported by your job or your colleagues during this, this time of need?

[00:53:53] Derek: I did, because when it finally struck me that I needed to take off, it was just a phone call and they said, what do you need? And I told them, and they manipulated it around days that I already had off to extend it for the three weeks. I just threw in some dates and in combination with what my schedule had already said, the days off, it ended up that I was able to have three weeks off and if I needed more, I could have taken it.

[00:54:27]Bridget: Yeah. And for me I got, I felt supported by my colleagues in that they did what they normally do when we have these things happen with staff, and I got a couple of phone calls from, from them. I, I felt the, probably the most support, and totally unexpected, from childhood friends. They called, they send cards, they, they checked on me, and these are people some of them I haven’t spoken to in years. We’ve met up at certain big events, but not like a continued conversation, and they all called and offered their condolences, offered, you know, they, like I said, I checked on me. So I felt, I felt the support there. Some of my colleagues from work called to find out how I was doing once they, they heard. So yeah, I did feel supported by colleagues.

[00:55:31]Dr. JB: That’s actually excellent, excellent news. I’ve heard of other situations where that was not the case. But it’s really good that you guys are in an environment that’s very supportive. That’s definitely something that you need, especially when you’re dealing with, with the death of a loved one.

[00:55:50] Bridget: Oh yeah.

[00:55:51]Dr. JB: So since all this has, has happened, how has this affected your, your day to day in your respective jobs, you know, specifically when you’re interacting with, with patients and families near the end of life?

[00:56:08] Bridget: So for me, I’m in education and my father died the week of finals, so I was able to administer the final, and I am an adjunct and they did not have a need for an adjunct that next semester so I chose not to look for another thing to do, and I took some time off. And at the same time, my daughter needed some assistance with childcare with my granddaughter and so I took the opportunity to go and, you know, assist her with that. So I did not have to deal with patient care or even educational obligations or anything like that, during that immediate time. And I’m actually now just, yeah, the, the new semester is just starting so I just started with a class last week and I start another one next week. So I’ve had some space and so now it’s just, you know, picking back up again, kind of where I left off. There was a period of time right after where I felt like, wow, I have so much time, like, what am I supposed to be doing? What do I do now? And just trying to, like, I felt kind of out of sorts for a while, because I didn’t have my parents to tend to or their needs to be met. So it was a kind of a weird space, but, I just like embraced it.

[00:57:53]Derek: I think for me that three weeks was I wouldn’t say all that I needed, but it did allow me to kind of disconnect for an extended period from work and just kind of recenter, to a degree, and recharge and dive back in and do what I was trained to do and do what I still,  for all intents and purposes, enjoy to do. And know also that I’m making a difference not only in the lives of the patients, but to my colleagues and to the staff. And so there’s some motivation for me to return and, uh, hang in there a little bit longer and, uh, contribute what I can and, uh, just waiting for the right message or sign, say okay, it’s time to throw in the towel and walk away and your mark is made and, uh, let somebody else take over now.

[00:59:03]Dr. JB:  I am sure you guys have experienced during your career in healthcare that lots of healthcare professionals do not feel very comfortable having discussions about end of life. From the perspective of a family who has experienced this themselves, with the death of their, their loved ones, what would you say or what advice would you have for your fellow healthcare professionals when they are faced with this either in their personal lives or even in their day to day in the hospital, in terms of the importance of these conversations?

[00:59:49] Derek: I think that for me, the most important thing is to look for cues from the families or a member of the family who is either ready or you sense that they are contemplating or trying to figure out what to do and pull that family apart, if it’s a group of them or that individual who could be the spokesperson for the family, and say, hey, this is really what we are dealing with and these are the options, if you will, for treatment or care, to include, has, has the family talked about end of life measures, DNR, you know? What is it, number one that, you know, or feel is the intent of the individual, the patient, and what are the wishes of the family? And honoring that, if you know what they want to have done, and how can we facilitate that so that you feel heard and the wishes of the individual, the patient has been met. I think looking for cues as a big thing.

[01:01:07]Bridget: Yeah. I think, you know, looking for cues is a big thing and if you are the, the healthcare professional who is not comfortable having that conversation, then find someone who is going to be comfortable having that conversation. I think that as healthcare providers, we have a responsibility to provide that space for our patients because our patients don’t know, sometimes, what we think they should know. But you know, we do the cursory “did you sign the advanced directives?” or “did they get advanced directives when they came into the hospital?” Educate yourself as a health care professional. Like, what does that document really mean and how much more there is outside of that? Because that document is good for the hospital, but that patient has a whole life and a whole family outside of the hospital that that piece of paper does not necessarily cover. And so I would say, find a way to get yourself comfortable enough to at least initiate the conversation and offer that opportunity for the conversation to your patient. I think we do a disservice when we don’t take that responsibility on.

[01:02:25] Derek: And in my experience, I’ve seen where maybe it has been to a degree addressed, but as Bridget alluded to, somewhat in a cursory manner and the full intent of either the advanced directive or the DNR is not fully understood. And so, when measures are not taken because of what we see as healthcare providers and the question comes “why aren’t you doing anything?” then, you know, again, we’ve done a disservice because they didn’t understand when it was drafted and signed.

[01:03:05] Bridget: Yeah. And this is distinct from “I’m going to have the conversation with you so that you can make a decision now,” or that “I’m going to make you change your mind about anything.” This is an, an opportunity and an offer. Have you explored this? Is there something that,  some way that we can assist you with this? Have you considered this? Just as that healthcare professional may be uncomfortable having the conversation, the patient may be equally, if not more uncomfortable. That doesn’t mean that we don’t offer the opportunity. We’ve got to find a way to do that because some people in their discomfort will say, you know what, I haven’t been wanting to look at this, but I think I need to look at it. And that’s our opportunity to provide whatever it is that we can provide from a medical facility standpoint, to guide people into what the next steps are, to pull in family members, to support in that conversation.  I think we’ve gotta be the ones to, to initiate that. We’re the ones that are with our patients probably the most.

[01:04:14] Derek: And I think even in that, if they’re not truly ready, at least the seed has been planted and further watering and nurturing of that idea can be made by, you know, some subtle suggestions, you know, at an appropriate time and place. Even to the point of setting up some, you know, if they survive and they’re hospitalized, or they’re going to go home, planting a seed that they can get follow-up education on those matters so that a decision can be made. Because if you have a really sick family member, sometimes because of the condition, they abruptly and quickly passed away but many times because of, you know, what we have and the lack of having a directive or any guidance, they’re lingering on for days and weeks in states that are not amenable to really quality life. And because of either misunderstanding or selfishness or whatever it is, family members are reluctant to say, it’s time to let this individual go.

[01:05:27] Bridget: Yeah. And that’s, you know, the professional to the patient side, there’s also the professional-to-professional side. You know, there may be a patient on a unit who’s not your patient and, for whatever reason, you noticed that, yeah, this may be a good opportunity to have that conversation. We can speak to each other, we can ask, did you have that conversation? And, you know, partner with that person, with that other professional to have that conversation so that the conversations are being had. I think that, you know, and I probably said that, in this day and age, I don’t think that these are conversations that we should no longer be having. You know, I think the time for not having those conversations is, is far passed, we have progressed much further than that, we can, we can have those conversations.

[01:06:25] Dr. JB: What I have found is that oftentimes it’s, it’s pitched like we’re either gonna fight for this or we’re going to give up . And so when you start having these conversations about a DNR, about hospice, then it feels like, oh, that means we’re giving up. And, and I, I wholeheartedly disagree. I think patients want to know about options, right? And you know, talking about it as an option because it is an option, you know? Yes, you have the option or the choice to continue getting pumped with X, Y, Z medicine, continue being poked and prodded. You have the option to be put on a ventilator. You have the option to get chest compressions. You have the option for all of those things. You have the options to be made comfortable and to not go through all that. And in the end, it’s really up to you, you know, as a patient, ideally, or it’s up to your family. Right? And as healthcare professionals, we will abide by whatever it is that you want, but you need to know your options.

[01:07:41] Derek: Yep.

[01:07:43] Bridget: Exactly.

[01:07:46] Derek: It’s so true.

[01:07:49] Dr. JB: Well we are near the end and I just wanted to know if you guys had any last minute thoughts, comments, anything that you’d like to share with your colleagues before we close?

[01:08:03] Derek: I think the overriding message, and I’ll talk for myself, is that we need to care for ourselves if we’re going to care for anybody else, because if we’re broken, we can’t fix or help take care of other broken people. So as healthcare professionals and providers, we need to look at ourselves first and it’s not a selfish thing, it’s the right thing to do to ensure that, you know, yeah, we can get to work and we can intellectually manage patients, but that physical component may be broken or even near death itself. And that’s a very important part of, of, uh, connecting with your patient and, uh, that needs to be addressed. So, so take care of yourself and ensure that every aspect of your whole life and being is, is addressed.

[01:09:04]Bridget: Yeah. I think that would be my sentiment as well, you know? All over the highway and in several places is plastered that “all heroes don’t wear capes” and then you have these healthcare professionals that stand there. And yeah, we can be viewed as heroes but there’s a lot that we deal with as healthcare professionals, and we have to find a space, it’s a gift to ourselves to find a space where we can have an outlet so that we’re taken care of . We see a lot, especially now in this pandemic, I don’t know how many people, you know, healthcare professionals I’ve seen pass away. That’s not something to take lightly, find a space where that gets dealt with and not stuffed. Just outside of that, just the things, the various things that we deal with as healthcare providers, as educators, find a space where you can get that handled. Where emotionally you’re, you’re taken care of. And then yeah, physically. We work 12-hour shifts, we work long days, we, we do what we need to do to, to get the patients taken care of. Make sure you eat, make sure you get water, make sure you go to the bathroom, just those simple things. Just, you know, make yourself a priority if you haven’t been doing that and look out for each other. If you see people working long shifts and not eating say, hey, I’ll, I’ll do what I can while you go eat for five minutes or whatever it is, but we’ve got to take care of each other, take care of ourselves.

[01:10:38]Dr. JB: That’s perfect. I couldn’t have said it any better, you know, in terms of the mission for Hope4Med  is completely in line with what you guys just said. You know, this, this podcast, uh, this company, it’s all about really changing the paradigm so that our wellness as healthcare professionals, you know, as the caregivers who always put our needs last, right? Who give, give, give, give, give, give, give, but we can’t give, when our tanks are empty.

[01:11:13] Derek: You can’t give what you don’t have.

[01:11:15] Dr. JB: And, exactly, you know, where do we go to replenish? Where is that safe place to be able to have conversations like we just had?

[01:11:25] Derek: I think a part of it too, is that we should not feel guilty for taking care of ourselves. And that might be a big issue with healthcare providers is that if I am not, if I am not taking care of patients, then I am being, I’m selfish. Take care of yourself, it’s not a selfish thing to take care of yourself. It’s a primary need for you to do that so you can do whatever else you’ve been called to or feel you want to or can do as a human being.

[01:12:00] Bridget: Yeah. It’s a, it’s a gift to yourself to take care of yourself.

[01:12:05]Dr. JB: So , here’s to the future of healthcare, where we are more central, our wellness becomes more central, and we focus on our needs to really increase our longevity in this field that we all sacrifice so much to achieve. And I think you’d be hard pressed to find a healthcare professional who hates working with patients. It’s the wrong field, if it’s the patients, this is the wrong field for you. I don’t think it’s the patients.

[01:12:40]Derek:  I agree.

[01:12:41]Dr. JB: So again, thank you guys. Thank you, Derek, thank you, Bridget, for taking out time from your day to really just be here on this podcast with us and really share your experiences. I truly appreciated it and I’m sure my audience also appreciated it.

[01:13:00] Derek: Thank you for the opportunity for us to share. And we are hopeful that at least one person will find benefit from this time and our experience and our conversation.

[01:13:14]Bridget: Thank you so much.

[01:13:15]Dr. JB: 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 and learn some, each one, teach one, I’m done.

 

 

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