The Checkup with Doctor Mike - Everything You Need To Know About Dying | Hospice Nurse Julie

Episode Date: July 16, 2025

I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Listen to my podcast, The Checkup with Doctor Mike, here:Spotify: https://go.doctormikemedia.com/spotify/CheckUpSpotifyApple Podcasts: https://go.doctormikemedia.com/applepodcast/ApplePodcastsHuge thanks to  @hospicenursejulie  for joining me on this episode!IG: https://www.instagram.com/hospicenursejulie/?hl=enTikTok: https://www.tiktok.com/@hospicenursejulieBuy her book and journal "Nothing To Fear": https://www.hospicenursejulie.com/nothing-to-fear-journal00:00 Intro01:41 Starting Nursing09:44 Is She Jaded?16:53 What is Hospice?24:17 Communicating With Patients26:29 How Death Changed Her27:44 Is Dying Painful?32:10 Hospice Process42:48 Fear Of Death /Regrets48:38 How Does She Tolerate Death?52:55 Seeing An Angel1:00:53 Life's Final Moments1:01:53 Controversies / Morphine1:08:37 Shared Death Experience1:16:08 Dying Couples1:17:41 Thank Yous / Dirty Jokes1:21:10 The Worst Part1:26:14 Death Myths1:32:17 Planning For Death1:39:38 Your Pet When You Die1:43:23 Follow Julie!Help us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

In those conversations that you have with your patient once you're onboarding them, are they ever telling you that they're afraid of death? Every once in a while it does happen where someone's like, I'm really scared, you know. Generally, it comes out over time in conversation where they'll have a little bit of a breakdown. I just feel afraid or I feel overwhelmed. This feels scary. And I love those times because I say, congratulations. Like, you're the most normal person on planet Earth.

And the fact that you're even willing to say that makes it so much better for you. People who are willing to say the truth, no matter how scary it is, usually die more peacefully. Welcome back to the checkup. Today, we're leading into a conversation most of us love to ignore, what the end of life really looks and feels like. My guest is Julie McFadden, RN, better known online as hospice nurse Julie. After nearly a decade in the ICU, she moved to hospice care and started sharing unfiltered bedside lessons to millions on TikTok. Her New York Times bestselling book, Nothing to Fear, strips away the mysteries surrounding dying, and shows families how to turn those final days into something peaceful, prepared, and even meaningful. The new version even comes with a journal to help you process you or someone else's end-of-life journey.

In this episode, we'll debunk the biggest myths about dying, unpack what? what a good death actually entails, and explore how facing mortality head-on can actually make living healthier and happier. Take a deep breath. This one's real, raw, and absolutely necessary. So let's get started. Oh, hi, buddy. Who's the best? You are. I wish I could spend all day with you instead. Uh, Dave, you're off mute. Hey, happens to the best of us. Enjoy some goldfish cheddar crackers.

Goldfish have short memories. Be like goldfish. Bank more oncores when you switch to a Scotia Bank banking package. Learn more at scotia bank.com slash banking packages. Conditions apply. Scotia Bank, you're richer than you think. They say there's only two things in life that are guaranteed. death and taxes, and I consider you part of the problem.

I'm sorry. I'm sorry. It's true. In all seriousness, though, you've been around a lot of death, and you've done it from a perspective of understanding. At least you've presented the experience of death through understanding. What's your relationship with death as it's evolved in your career? I think I realized or did realize. It took me some time. So I've been a nurse for 16 years. I didn't

always have this really open idea around death, nor did I really even think about it, especially in the beginning of my career when I was an ICU nurse. But over time, as you know, I mean, I would see death in the ICU, whether I thought about it or not, right? People would die. And we were trying so hard to make sure they didn't and they still did. Sometimes to a fault. Sometimes to a fault. Oh yeah. I mean, I could talk forever about that. Hence why I was like, people are going to die. This is what I'm seeing in my life now as a nurse. And if that is the case, there has to be a better way to do this than what we're doing in the ICU in particular. So then I became a hospice nurse and then seeing how people died what I would consider like a natural death from something, right? But they're

naturally dying. It just opened my eyes to how our bodies seem to be biologically able to do it and to help us do it. And that has made me embrace the idea that we all die. How does the career pivot happen from going into the selection of ICU nurse to now hospice nurse? Being an ICU nurse, that is what, that's, that's how I pivoted. I mean, I had a plan. I was going to be an ICU nurse. I was going to go back to school for anesthesia. I was going to work as an ICU for two years. CRNA. Yes, yeah, and CRNA. And then after two years of being in the ICU, I was like, I don't know anything. I could never go back to school yet. Like, I need to keep doing this and like learning. So I did that. And then after another two years,

I was like, my soul is dead. I'm dying. A slow, miserable death. Okay. Why? I don't know why. I think it was like, you know my ego wanted the ICU i wanted to say i was an ICU nurse at the best hospital in the country and like look at me and i didn't realize i was doing that until i did it right and then and looking back that's why i chose the ICU and it just felt so impersonal most of the time my patients were mostly you know sedated and intubated and on a bunch of machines and a bunch of medications And it was like hurry, hurry, hurry, hurry, quick, quick, quick, like really task oriented. And I kept thinking, like, I want to know this patient.

I want to know the family. I want time to talk to them. This is really scary for them. This is really serious. And we are not openly discussing like what really is going on. We are like talking about little things like their creatini numbers that day are trending up and trending down. And the family has no idea what that means except for maybe that's good.

but meanwhile they have pancreatic cancer their surgery failed they haven't had chemo radiation yet they likely aren't going to get out of the ICU and even if they did they'd probably still die in six months because they have pancreatic cancer i mean don't get me started right so it was like over time i started seeing that patterns emerge and i was like i can't keep doing this that's got to be a scary thing to have put so much time into a career and realize perhaps intentions were good yeah but perhaps a lack of introspection about knowing yourself early on led you down the path that you didn't want to be on. Is that scary? Yeah, it was very scary. I thought, I really thought I made a wrong career choice and like, now what am I going to do? Because nursing was my second

degree. So I already, I already, I already, I had a degree in psychology. Okay. So I was going to maybe go into the therapy round. So, all right, a little bit of the foreshadowing was happening here. Yes. So it was scary and it still took me a good three or four more years in the ICU to finally just take the plunge. Like people were like, how'd you do it? What'd you do? I'm like, I literally just quit my job and applied for a hospice nursing job that said

must have experience and I didn't and I applied anyway. Well, you had experience. Well, must have hospice nurse experience. They wanted hospice experience, which I didn't have. But I just went to the interview. The closest next thing is ICU experience, perhaps even to a higher level from a functional capacity. I think ICU nurses make great hospice nurses because we've already seen the opposite side. I can talk to patients about the full gamut of what they probably have experienced.

If they didn't go on hospice, what they would be experiencing. I feel like it really has helped me be a great hospice nurse. Did any of your colleagues, while you were an ICU nurse, say, hey, you're really good at this other thing. Did they catch on? Or were they just supportive of your choice because they're your friends? They really didn't say anything to me about it. I think we were all like, I think we all had blinders on. I mean, I remember being in the ICU and having one doctor who was rounding, one attending doctor.

Her name was Rebecca. And she was really good at talking to families about. death and dying in family meetings. And that's, that's one of my stories I talk about my book is this, this one patient that I finally stood up for and said, like, I think we need to have a family meeting. Like, I think this person's dying and we need to talk about it, right? Not, I think. I mean, we all knew. We just weren't saying anything. Sure. And then we did and the family took them off machines and they died. And it was a profound experience for me. But my whole point is this doctor that was rounding in the ICU for a month, she was really good at doing that and talking

to people about death and dying. And I remember thinking, I want to do that. That is what I want to do. I want to be like her. And then I realize it's really hard, at least for me, to have the time to do that. So if I don't have the time to do that in the ICU and no one's really standing behind me to help me do that, then I need to switch it up. What did Rebecca do well? Took time and spoke to people not in medical terms in a very plain, English, I guess. Well, that's something that you say in the book to not use euphemisms. Yeah.

To be a little bit more straightforward in the language. What's an example of that? I think in the ICU, an example would be they most likely aren't going to get better. They most likely won't get out of the ICU. If they do, here's the journey that's ahead. And even with that, you know, we don't know what will happen. and after that, if you know they're going to die, how would you like them to die? Would you like them to be here?

Would you like them to go home? What would you like? And I think that's a weird example in the ICU, but to me, I think we need to talk about that a little more in the oncology world about, I think we need to be a little more straightforward about prognoses and like treatment, standards of treatment than after the standard of treatment, if it's not working or it fails or it can't. answer comes back. People need to know, I think, in very straightforward terms, that they will likely die from this disease. And it's likely going to be in this amount of time. And if you know that,

how would you like your life to luck? Right. What do you say to critics that perhaps call you jaded in that mindset? Like you've just seen so much death. Of course you think they're going to die, but my loved one's different. Fun. Or not fun, funny. I don't think it's a jaded. I don't think that's a jaded. I think that's a educated response and someone who has been in the healthcare world long enough, still not that long, 16 years, but long enough to say, I think you are owed that explanation. It's totally fine if you don't want to take that.

I just want you to understand what we generally see. Because what we generally see is this. So I want you to know that these are all the things you can do. And one of those things would be to go on hospice or not do that extra round of chemo or not do that clinical treatment. And I think more people would choose to go, I guess, I mean, I guess hospice is the option, but just choose not to treat the cancer because I think a lot of people are mis-they just don't fully understand that they're going to die.

Well, we're all going to die. We're all going to die. We're all going to die. That's a tough thing to accept at times. What do you think? Can I ask that? Like, what do you think? Do you think I'm being jaded by saying something like that?

I think not at all. In fact, a lot of your mindset and the way that you approach talking about death is how I like to do it in the hospital. Sometimes I have met families that believe on a spiritual level, on a religious level, that I am disconnected because I just believe in the science. And I'm missing the miraculous world, the emotional component of it. But to me, if I start mixing in emotions into my prognosis, I'm giving you a less accurate prognosis. So I try and explain to those patients that I'm not being emotionless. I'm trying to be as factual. And then we can have the emotion to support afterwards. Yes. So I agree with you, but I'm just curious how you approach those who have skepticism of someone who experiences death so often

that perhaps you think, well, everyone's going to die so you don't understand how hard this is. Yeah. And you know, what was that? What's the word? Like I have a little bit of a little bit of an edge, I think, because I'm usually talking to people who are already thinking about going on hospice, right? So I'm not usually talking to them when they're at the on. oncologist office with the, you know, with all, but, but I would like to, I, maybe not me personally, but I would like to talk to other healthcare workers to say, I think we should work this differently.

Well, I think a prime example of that is we do something called Medicare annual wellness visits where you're not supposed to do a physical. You're not supposed to actually examine the patient and listen to the heart lungs. You're supposed to just have a conversation about their specialists, their blood work, their screenings, their preventive stuff, but also their end-of life care. They're pulsed, filling out those paperwork, explaining to them options. And it's supposed to be done at a time where it's not emergent. And a lot of people get uncomfortable and uneasy with that conversation. Have you ever explored perhaps participating in that to some degree or educating on that to some degree? This is why I'm here, Dr. Mike. I mean, I would love to. I have not explored

that. But even as I'm talking to you, I'm thinking like, yeah, I feel like we need more voices. Well, because we don't do a good job at it. Yeah. Like they're, you know, we're slammed. Do you think that's because of time? A lot of times that's how I felt in the ICU was like I, maybe I'm just passing the buck here. I don't know. But I felt like I didn't have enough time.

It takes time, I think, to sit down, be empathetic, show people that you're not just here to go, you know, you're there to. And you don't have the time sometimes. Yeah, the way the system is set up right now, you definitely don't have the time. And that is a huge factor. Yeah. But also there's a emotional component that perhaps some doctors want to block that off because they feel uneasy with it. Yeah. And then also there's a knowledge component as well.

If they didn't spend time in the ICU, if they also haven't lost a loved one, they perhaps can find it more difficult to empathize in the situation. So they avoid the uncomfortable conversation. They say, hey, we have this form. I'm giving you a brochure and let's move on. Just check it out. Yeah. Check it out. Fill it out when you're at home.

Or they say, I think a lot of times, too, explaining the poll. so they'll be like, if something happens to you, do you want us to do everything we can to save your life? And they go, yes. They don't explain like what that means. I think that's the big thing of what I want people to understand from my videos or my book or wherever you see me is that education's key. People need to understand the progression of whatever disease they get diagnosed with.

And I think we do a really poor job in health care, really helping people understand what it looks like to quote, quote, like battle cancer. Right. There are many things that go into it, and you have choices. You have choices. And not just because you choose treatment, which I, which, P.S. If I got diagnosed with something tomorrow, I would do the standard treatment.

I would, I would, most likely, depending on what it is, but most likely. But just because you choose treatment doesn't necessarily mean life or means you live longer. And I think people don't know that, and we don't do a good job. but explaining that. Yeah. You know, thinking back to my time in the ICU, I remember the most extreme conversations

or dramatic conversations were happening during cardiac arrest, during a code blue, of trying to encourage a family to stop CPR. Yes. And that happens so often. Sometimes I'm running in the hallway with a family trying to explain it on the go

and slow it down as much as possible in the midst of running a code because ultimately you're hurting the patient in so many you can only throw so many statistics at someone when they're in that moment explaining that look based on the quality of life they had before this

now the fact that their heart has stopped bringing them potentially back will only bring them to a lower level of quality of life even if we do so like explaining to them all of those things is hard to do in a short time it's hard to forge some sort of connection as a hospice, physician, or nurse, you perhaps haven't had a lot of time with that family.

All of it is set up against you. But perhaps in the hospice space, because people are already coming in with a certain mindset, do you find that conversation to be more productive? Way more productive. That's what I mean by I have an edge. You know, being a hospice nurse and all the educating I do when I'm actually being a nurse, not just online, but being a nurse and with families, I have a lot of time. And they're not always prepared.

but they're usually a little more open about talking about it. How would you explain what hospice is to me as if I'm in eighth grade? Hospice is a program that helps people during their end of life. So we help you live out the rest of your life. To me, hospice is about living when you're dying. When we know you're dying and we're knowing you're dying somewhat soon. It's a program that helps you do what you want before you die. You get to make choices.

You get to advocate for yourself. Do you think the fact that so many of us have a fear of dying that it's actually preventing us from living fully? Yes. Or is that too philosophical movie quote-esque? I mean, that is. It is philosophical and movie quote-esque. That's why even me saying hospice is about living and feels so, I always say, I usually

always say like as cheesy as it sounds, but I stopped because it's true. It is cheesy, but it's true. I also feel like contemplating your own mortality on a daily basis, which I do, even more sometimes than just daily, is not as morbid as you think. It frees me. It helps me remember what's important in life. And it makes me live more freely, more fully. That's why I'm so passionate about it. Like truly, contemplating my own life on a daily basis has helped me live.

Wow. So you say death is not the worst thing. What's the worst thing? Suffering. Suffering is far, far worse. And I've experienced that years after years after years in the ICU when we kept trying to keep people alive. The suffering that existed was so so painful. Like we were talking earlier, it's hard for me to watch the show of the pit because I'm like, just takes me back to those times where it's like, this is too much to watch. Well, because if you're not the one getting the morning 5 a.m. wake-ups to draw an ABG, to change your vent settings, to do oral care, all those things, you just think, oh, the person's alive and they're good and we're keeping them alive and comfortable. It's not. Can you paint a more realistic picture of what actually happens when you're in an ICU setting? So it depends. But if you're the person I'm talking about, which is someone. who has been having complication after complication. They've been in the ICU for three months. They're on pressers, which is medication that constricts your blood vessels.

One, you usually start losing toes and fingers. We don't take them off yet because you're not healthy enough to even go to surgery to get your toes amputated or your fingers amputated, but they turn black. They're dead. They're necrotic. That's one of the main, not one of the main things, but those are the things that stick with me.

doing wound care on patients shriveled up black, raisin-like toes that are never going to come back. Obviously, we'd have to amputate them eventually. That's one of the main things we'd see, you know, pneumonia being trached. Then the trache getting infected. Feeding tubes, TPN, people getting bloated. I mean, you don't look like a human being anymore. You know, their blood pressure drops. And then the vasos, vasopressers aren't working.

So then we pump them full of fluid, but then their body can't handle the fluids. Then we diaries them. And it's just the cycle. And the family doesn't get what's happening, right? The family doesn't get it. And it's all sad. You know, skin breakdown on the back, no matter how much we turn someone. If they're laying in bed for three months, they're, and the skin's in Oregon, right?

The skin's an organ. The body's shutting down. so their skin is not going to be doing what it's supposed to be doing. So wounds develop. I don't know if they still do this, but we used to have, does everyone get flexicils still?

Yeah. I mean, not everyone, but a lot of, I just remember we used to get tons of, a rectal tube for folks there. Yeah, a rectal tube to catch stool, diarrhea or something if they're having it too. But then they would get wounds in their rectum,

like things like that where you're just like, what are we doing? Yeah. What are we doing? doing. Do you think it's because people have a hard time letting go? Is it because they're overly optimistic communication breakdown? What do you think is happening? I think it's communication breakdown. I think we work within a system when we're taught within that system, too, as healthcare providers, one, that we're supposed to be saving people. And like, we're not really

talking about end of life. I don't think we were, I mean, it could be different now. But, you know, 10 years ago, during rounds, never were we ever mentioning end of life or should we have a family meeting, is this a little too much? Are they really going to get better? And I started realizing that as the nurse, I could speak up and my voice mattered and it made changes and things happened when I spoke up, not like when I spoke up, but like just that, oh. When you introduced the conversation. Yeah, no one's talking about it because no one's talking about it, not because they don't want to. Right. So I think it's more of a communication thing. I think no one wants to bring it up or no one's really thinking about it because we have such blinders on, right? Also,

Also, you know, doctors and nurses, it's like the nephrologist comes in because, and they're working on that, you know, the pulmonologist comes in and they're working on the lungs. No one, everyone thinks it's someone else's job to bring up its end of life, right? Which is why I'm so sad for the decrease excitement surrounding primary care. Yeah. Because when you have a primary care doctor who's going to bat for you in the ER, in the eye, ICU, who understands what your wishes were because they've been treating you for decades as part of continuity of care. Now you have an advocate who understands the science and understands what's happening. Perhaps your family also knows them, trust them to make the right decision

as opposed to, oh, this is a nocturnist that I met last night. And now they're deciding whether or not my loved one is actually going to live or die. And they don't want to listen to you anyway if they don't know you or trust you. P.S. My family doctor that I've known since I've been little, came to my book signing. We got a picture together. See? Dr. Almquist.

But do you see like we're losing that? And partially it's due to systemic changes, incentive changing, students not selecting the field for fear of not making enough money to make ends meet, which is crazy. But we need to bring back the love for primary care because I think it addresses some of that in this spectrum. Also, when you have the lower ends of reimbursement. for psychiatry, family medicine, pediatrics, you're going to have students that perhaps don't want those specialties,

but fall into those specialties. They're not excited about those specialties. They're not going to be the ones that are going to go above and beyond to have the conversations about end-of-life care, to go to bat for their patients. So I want to make family medicine sexy again. Yes. For lack of a better to.

I was so many inappropriate things I was going to say, but I won't. I won't do it. I mean, well, what was, what I was going to say was about, like, you have to, I do feel like you have to, do you think anyone can be good at communicating? Because I do feel like there are just some people, like, I hear some hospice nurses and I'm kind of like, and no judgment. I mean, I'm always going for bad for, I'm going to bad for nurses, but sometimes I hear people

talk and I'm like, girl, you got to learn how to talk to people. Are there some mistakes that you've seen to make? Just being cold, not really explaining, not fully explaining something. So just being like, they're actively dying. We start morphine. They need morphine because they're actively dying. One, that's not true. Two, the family doesn't know what actively dying is.

They don't, they never, they're scared of morphine. Like, you need to do a little more talking, you know. And they don't realize that or no, I don't know. I don't know what they're thinking, actually. but um i mean the question you pose is are there people who are just not good at communicating yes are there people who are naturally weaker than others yes but can they work out and get stronger they can well they be slightly weaker than the person who's genetically more gifted in that yeah yes but that's okay so i think everyone can improve their communication but there are some people who are naturally better at

it just like you didn't feel a fit with some of the hands-on work related to the ICU but you felt more comfortable in the communication aspect. Yep. So there are obviously zones for people to fit into more naturally, which is why when med students or, let's say even high school students say, what specialty should I become? Should I become a doctor? Should I become a nurse? It's like, well, find what your passion is, but don't end there because a lot of people like, chase your passion. Chase your passion and what matches your skill set. Like that part is often left out. Because if you just chase passion without understanding who you are, what you're good at, where you're comfortable,

that's not going to bode well for the majority of people. I mean, I'm living case right there. Like, chase my passion. I thought for sure I was chasing my passion when I ended up in the ICU, which again, like everything, I'm okay with where I'm at now because I feel like it's really shaped me. Of course. I definitely was blindsided and like, what am I doing here? this is a what um what takeaways have you changed in your own life after witnessing so much death i think one of the most wonderful things i've learned just because when i became a new new hospice nurse was like i said the body seemed to help us die like i've seen many people have zero medications given not that i'm anti-medication at all but it was amazing to me because i was so used to

having to do so much to keep people alive, right? To then seeing people die these very peaceful, natural deaths, and it seemed like they didn't need anything. The body made them not hungry and thirsty. They slept all the time. They weren't having pain. They weren't having symptoms. And they just naturally died.

And it really, really made me feel not afraid of death. So I have many reasons why I don't fear death. And by the way, I still do ish. like I have, we'll have a human experience, you know, if I get diagnosed with something terminal tomorrow, I will still feel afraid and angry and sad and peaceful and, you know, all the gamut of human emotions. But generally speaking, I don't feel afraid for many like mystical reasons, but the main reason is just through watching so much death, seeing how well our body takes care of us and seeing how well our body seems like it's built to be able to do this. And the

less we mess with that, the better it usually goes. And that has changed everything for me. So why do you think sometimes death is more scary than other times? For example, I've run into some pretty dangerous situations that were stupid to defend my friends, for example, where like I should have never been involved. We should have all flight instead of fight. And yet, on the other hand, if you have me repelling off a mountain, totally safe because it's plugged in. It's with experts, et cetera. I am so afraid as if my life is ending. I'm getting vertigo.

It's both death in both scenarios. But why is it such a different experience? Well, one I think, well, in your specific circumstances. I'm just getting that as an example. I mean, I think because one is like your adrenaline's pumping and you are loyal and you're saving your friends. The other one, you're in fight or flight and your body is saying, hey, you're going to die. you're going to die, you're going to die.

So that's from those two circumstances. But I think in general, the unknown is scary. And this is the ultimate unknown. What happens after we die, leaving our loved ones, even the progression of a disease or what is it going to be like to die? So many people tell me, I'm not afraid to die, but I'm afraid of what I'm going to die from or if I'm going to suffer. people also associate dying with suffering, which, of course, that can happen, depending on how you die, right?

But generally speaking, there are certain diseases, certain things you might get diagnosed with, and that will likely lead to your death, and we know how that death looks, and we know how to treat it, we know how to help with the symptoms, and dying itself, like, doesn't really cause pain. People get so mad when I say that. Dying a natural death on hospice, technically, if you're just doing that, is not necessarily painful. Diseases you are dying from can cause pain. But like I said, when I was saying like someone's not eating, sleeping all the time, not

drinking water, they are not like writhing in pain just because of that. If someone's ever in pain, it's usually because of a certain disease they have that's causing pain. I'm getting, I'm not sure where I'm going with that. But I think generally speaking, people associate suffering with death, which makes them feel scared. And that's just not always the case. What do you think people's biggest misconception about the last few moments of life are? Oh, man, movies have done us a disservice because many people think the last few moments are someone giving a monologue, monologue of like, I love you, this and this and this and this.

And then I close her eyes and then they're dead. And that is never how it is. I don't think I've ever seen that happen. People have told me it has happened to them. So, okay, but I have never seen it happen. The, my most popular videos that I also get the most heat for are the ones when I show real life actively dying. People who are in their last moments dying, what it really looks like. I get these from followers.

I get permission. People think I'm doing like, some people love it. a lot of people hate it. But it's because people don't know what it looks like when someone is actively dying in those last few moments. And when they see it and it's their loved one, they were suffering. We couldn't, no one did anything. They looked awful. They were breathing like they were suffocating. And all of those things are usually just what actively dying looks like. You just don't know it. So you don't know that your loved one's going to have changes in breathing. You don't know that terminal secretions are not coming from the lungs and they're not like suffocating to death.

You don't know because no one's told you. So I think the biggest myth is that, you know, actively dying looks beautiful and it's going to look peaceful and your loved ones going to look just like they always looked when really they're going to look a lot different. They're going to sound a lot different. They're likely not going to be conscious. And it's going to be hard to see that. But the more we know, I think, the less we fear. Hospice officially begins when the prognosis is made of six months approximation, is that correct? From like an insurance paperwork side of things.

Once you enter a person's life at that stage, what conversations are you having with the person? Well, you do, at least for me, this is what I do. You do a hospice admission, which usually takes hours. and I start off explaining everything they're going to get from hospice and then everything they're going to lose once they get on hospice because you do quote unquote lose things. You know, hospice gives you a big benefit of what they will give you, which I go into. And then they, but you also lose, kind of, lose the right to go to the hospital, to be admitted to get to get scans, to get chemo, to get radiation.

Like you're not supposed to do that anymore. You can't do both, right? So I do a lot of explaining. But there's a point to that. There's a, yes. Because some people might hear that and say, whoa, you're not going to help that person? No, there's, I mean, there's not usually more to do. By the time they come on to hospice, there usually isn't radiation or chemo to do.

Or they've already done all they can do. So, and technically what I always say to my patients is, listen, no one's going to chain you to your house and say you can't go to the hospital. If you want to go, go. you'll just get taken off hospice. You can't do both. Hospice is basically saying, hey, we're going to pay for all of this stuff over here. So we're not going to pay for this stuff over here. And this stuff over here is hospital stuff. So we're going to help you be at home, be comfortable, live out your life. So I go into like all of the nitty gritty. I wouldn't say boring, but it could be boring stuff about like what we're really going to do for them.

And then I usually talk about their specific disease and what I've witnessed. caring for people with their specific disease, how we help them, what have been their main symptoms. I talk about what the average person dying looks like, right? If you have six months less to live, this is what you're really going to look like. This is how it's going to progress. This is how we're going to help you. How do they receive that? Most people are relieved. Most people are so relieved that there is someone who is willing to say your death, like not go maybe if you pass away you know i'm usually super blunt about like saying the word death saying the word dying um talking i always talking about it like an end of life journey that's

how i say your end of life journey we're all going to have one this is yours you know most likely so this is what i've seen and this is how we can help you um and then i ask questions and i would say like nine point nine times out of 10 they say no no people are people are grateful that someone's willing to talk about it i mean there's always that like point one percent who's like get out of my house you can't mention the word hospice and i have definitely run into that and it's okay too i mean we had to meet people where they're at but i'm not going to be the one who's tiptoeing around the around the conversation because i've seen what that does and doesn't help anybody. I'm sure it just leads to confusion, more fear. Yeah. More unnecessary tests,

invasiveness, which is more cruelty than anything else. Yeah. Yeah. Even though it's unintended. Natural question that I'm sure someone would think of, do people come off hospice? Yes. People do come off hospice. So they usually come back to hospice, but they do come off. So we allow them to stay on for six months, at the end of six months, if they are still alive, we have to monitor and basically recheck them to see if they have declined more since the first time we met. Not that we want them to, but in order to stay on hospice, we have to prove to Medicare basically that they have declined and they still are appropriate for hospice. So we can re-sign them up and then they stay on for another two months. And then every two months, we have to reevaluate. So eventually people can

come off hospice if they stop declining and they kind of plateau out. And there's a typical, typical patients who do that. So I think there's two types of hospice patients. I'm being general here, but generally speaking, there's like the cancer patients. And then there's the chronic life limiting illness patients like COPD, CHF, yeah, Alzheimer's disease. And those patients will have exacerbations where they're really looking like they're close to death. So they come on to hospice and they kind of crawl back up and then they plateau out. And those patients can come off hospice. What about people who have fears of the financial strain that this could cause?

It's a real fear. What is the typical, like, is this something that's covered, generally speaking? So hospice, so hospice will be covered. They don't have to fear that hospice won't be covered by Medicare or some type of insurance. Very rarely are there out of cost for actual hospice care. What is hospice care entail? Exactly. So that entails a team of people, a doctor, a nurse, a social worker, a home health aid, a chaplain, a volunteer.

There's a big team of people that will be your team and they will come to your house when you need them, ish, because you need them every day. But Medicare is our boss. And Medicare will say how often we can be there and what we can do. we also provide equipment, supplies, medication, 24-hour service. So if you do call it two of the morning with an issue, a nurse can come out to see and help you so you don't have to go to the ER, right? However, the thing that is very expensive is the day-to-day care. Basically, under no circumstance, hospice does not provide 24-hour care.

For day-to-day living, like for daily living activities, the thing that most families need, need. I'm supposed to change my husband who's bed bound. I can't physically do that. I'm supposed to give him all the medication. I don't feel comfortable doing that. I'm supposed to know when he's in pain and when to give the med. I don't want to do that. Hospice doesn't care. You know, basically Medicare doesn't care, not hospice, but they don't provide 24-hour care. So that's where it gets really expensive. And there's no easy answer around that. So what are families normally like to do? they normally find someone in the family to do it, which is hard if you are a working-class family because everyone's doing their thing. And people look at us like, how is this possible?

And that's one of the worst parts of my job because I don't have an answer for them. There isn't an answer. Even trying to get someone in a skilled nursing facility is tough. Even if we say, oh, they can't take care of themselves, they have to go. Sometimes we will instruct families to take their loved one to the ER to get admitted into the hospital. For disposition planning. Yeah. Yeah. So go off hospice, go into the hospital, then they'll place you there so you can get into a skilled nursing facility. It's a very broken system. It really is. How would you fix it? I don't know. I don't know. I honestly, I don't know enough to know how to fix it. I mean, I guess I would say,

universal health care and everyone gets this and everyone gets that everyone gets paid skilled nursing but I don't know how to do that yeah right I don't know because ultimately that's still a cost that someone has to bear and would everyone still get it and would we have enough people to staff that and I mean that's what I would love I think on hospice everyone should have 24 hour care doesn't be a nurse it can be a home health aid 24 hours a day seven days a week I would love that if will it happen I mean I probably not, but I would love it. Yeah. That's an unfortunate part of so many factors of health care that it's not enough for me to see my patient, create a good doctor-patient alliance,

find out what's going on with them, give them a proper diagnosis so they understand it. The treatment plan with steps one, two, three, if they don't work out, I then have to figure out if they can afford all this, the journey. I have to print their good RX coupon. I have to make sure that the prior authorization is done. And that's a new challenge for a lot of medical providers because that's not something that's taught in school. And it feels like it's outside of the spectrum of what you're supposed to do. But if you don't do that, you're almost not doing anything.

You're chat GPT at that point. How do I mean, I know I keep asking you questions, but that always is always so concerning to me. Like how do you, how do you do that? How do you learn how to do it? How do you... You have to learn on the fly. Yeah.

And a lot of doctors don't learn it. And the system is set up in a way where it makes it feel like every doctor is gaslighting you. Because the doctor basically has to answer to the hospital system. The hospital system has to answer to the insurer. The insurer has to answer to the government. And everyone is just passing the buck next. And no one's winning. everyone's losing medical providers are burning out patients are feeling dissatisfaction and not cared

for the only people that are winning the executives that are running this like it's a hedge fund and that's where the big disconnect is and i'm not one of these individuals that's like communism because i came from russia i know what terrible idea that's like yeah but there's a better balance to be had and i feel like the pendulum has swung too far the other way where it's become very profit motive focused as opposed to finding a balance between let's have industry, let's have patience, and find that middle ground. So I feel like that's similar to what's happening at end of life care. Just there, it's a lot scarier, I guess, to some degree, because of the unknowns.

Yeah. And if you don't do it, if you don't fill out certain things, that's the, that's the worst part of my job is paperwork. If you make one little mistake, the family doesn't get what they need, right? because you didn't code something right or you didn't put it in the system right. And, yeah, it's just hard. That's the worst part of my job. So in those conversations that you have with your patient once you're onboarding them,

are they ever telling you that they're afraid of death? Yeah, sometimes. Or at that point, have they reconciled well with it? No, I think the misconception is that everyone, just suddenly has like emotional maturity and can like openly talk about all their fears you know so it doesn't you every once in a while it does happen where someone's like I'm really scared you know generally it comes out over time in conversation where they'll have a little bit of a breakdown I just feel afraid or I feel overwhelmed this sounds this feels scary and I love those times because

I say congratulations like you're the most normal person on planet earth and the fact that you're even willing to say that makes it so much better for you. I know it might not feel like it's so much, but just personally from witnessing this so much, people who are willing to say the truth, no matter how scary it is, usually die more peacefully. Even if the truth is, I'm afraid, I don't want to. I'm angry that I'm dying. I'm angry. I'm so angry. I've had so many people eventually get to that, right, where they're crying and they're saying they're so angry. is nothing better than connecting with the truth. And I think it's just so normal. Like my book is called nothing to fear, but there's a caveat in there that says like, but really it's just normal

to fear. And the more we talk about how normal it is, the better things usually go. When I was in the hospital, I remember loving to round on my elderly patients, because they always had the most epic stories. Do you get some of those in talking with them? Yes. I, the best thing, about my job is the people I meet and the stories I hear. I go into home, like I'm home hospice. So I'm going into people's homes. Which is a much more setting than the hospital. Which can be insane and like disgusting and scary, but still amazing. But also like people's homes who they've had this home for 60 years. I kid do not. I walk in the same furniture is there from 60 years ago. There's like plastic on it. There's like fluorescent wallpane.

paper or like Tota, I have one lady who literally each carpet was like some kind of cat, like a cow, a zebra print, like disco balls. Her bed had a mirror at the top of it. This is an elderly woman who had a bed with a mirror at the top of her bed. Okay. Checking herself out. Like shimmery, glittery blinds. So it's not all like profound.

It's stuff like that, too, where you're like, I love you. Who are you? What was your life like? What was this house like in the 70s? Like, please tell me everything. That is the stuff I live for. Any wisdom that they've shared with you that stuck around? Yeah, there's so much.

There's so much. And that's another misconception that, like, they will just suddenly be like, here's my biggest life regret. You know, it's not usually said like that. No, no, no. It's not said like that. How is it? It'll be like they'll be eating something.

like a chicken wing or something. And they say I shouldn't have eaten that? What was that? They say I shouldn't have eaten that? No, they'll say, I wish I would have appreciated when I had taste. Oh. You know, like I can remember how this tastes and doesn't taste like that now. Like, I don't have the appetite for this anymore.

Like, they finally kind of wanted something, because most people in hospice don't want to eat much, right? But when they finally have something that sounds good and they bite into it and they'll be like, oh, it just doesn't taste the same. You know, I wish I would have appreciated my taste buds, my appetite, my, like, how things smell. I always think about that now in my life, like appreciating how coffee smells, appreciating like me wanting fries with ranch because so many patients will say stuff like that.

I wish I would have appreciated it. I loved walking around my neighborhood. I loved it. I wish I would appreciate when I could do that because I can't do it now. So it's like little things like that that I mostly hear about. Regrets are they're not appreciating their like general health when they had it. Yeah, you don't appreciate it till it's gone is a understatement. I struggle with that.

Seeing my patients obviously say that they've lost something and say I should have appreciated it. And then I try and do the same. Like I don't know. If I'm really thirsty and I have no access to water for a period of time, I'm like, oh my God, when I drink, I'm going to appreciate it so much. And maybe I do the first time I drink, but then it's gone the next day. And then it's fatiguing to constantly remind yourself, this coffee tastes so good. This weather is so nice.

How do you make it a more natural feeling as opposed to forcing it to happen because of what you've seen someone else go through? Any tips on that? I mean, I don't really have that. I don't have the fatigue. I mean, I really do practice, I mean, I guess I have fatigue sometimes, right? I have to check out sometimes. I'm still human and I want to like check out on a game or like watch TV and not think about

anything or feel anything. But generally speaking, I really do, and this is my practice in my everyday life for many reasons, but I really do try to live in the day, in the moment and like start my day with really realizing how grateful and lucky I am to be healthy and in a safe place. and I really do try to practice that in the day that I'm in. It doesn't actually get old for me for the most part. How do you check out? What's your cheat?

Television. Okay. Do you have junk TV that you watch? Well, I watch the office over and over and over again. It's my comfort. It's my comfort show. But I watch a bunch of stuff. I'm a big TV girl.

So TV is my really, really big vice. No. Enough of that, right? Yeah, enough of that. I do watch a lot of like murder shows. Oh, okay. That's dark. Yeah,

it's dark. So I like murder mystery, like murder. Murder mysteries. I love the office. I have certain movies that, like, are my comfort movies

that I like to watch over and over again. But I'm also a big movie buff. What's your favorite movie of all time? Oh my gosh. It's hard. It's hard. I can't pick one. Really.

Top three. What's one in your top 10? Okay. I'm trying to impress everybody. So, like, no, don't do that. You already did that with the ICU career.

And we saw where that went. Okay. Okay. Okay. So, like, comforts I wouldn't say it's the best movie of all time but it's a comfort no top 10 one comfort people yeah twilight I mean twilight's the worst movie ever made isn't it yeah but I'm obsessed with it why you like you like the biting and the wolf I love I love the absurdity of it like they need each

other like it's like so codependent and disgusting but like I think it's hilarious but I also love it and it's comforting to me I can watch it and feel like comforted but that's what I mean by like okay so it's top 10 movies of all time twilight yeah one of them that's what you're gonna be remembered for like another one is like inglorious bastards oh right it's funny I just said that to someone else

that it's in my top 10 and they judged me for and they said that they thought it wasn't that good was that you Dan? Really? Yeah all right good pick my favorite is man on fire I don't know if you've seen that I've never seen it down Denzel I'm a big Denzel fan okay me too yeah what's your favorite Denzel movie

I'm sure I've seen it then flight I love that I love it because Say I love you Oh see I don't remember shit I don't remember lines That's the most powerful line

In the whole movie He literally tells the flight attendant To say I love you And he goes What's your son's name And she says Joshua And he goes say I love you Joshua And she's like what

He's like black box Say I love you Oh yes No no Yeah good job That's the goose pump line I just got it See

I don't remember anything about anything. So you don't even remember in glorious bastards. No. And it's one of my comfort movies. But I could like Rodel off stuff. Also, the most violent comfort movie ever. Exactly. That's what I mean.

A movie about murdering people, just comfort. And then Twilight. Now, have you ever seen Moonlight? Moonlight's a very good movie. No. That won an Academy Award. Yeah. It was very, very good.

I like the Florida project. So, okay, you work with death and you relax with death. What's going on here? I know. I need help. Did you ever think about it? I guess I don't think it's depressing. So truly, like being a hospice nurse is not depressing.

That's just not my take. That's like, that's not a hot take of mine. That is real. It's not depressing. It's a beautiful career. I get to connect with people on a daily basis. That's what it feels like. I get to help people feel relief.

I get to help people feel a little more comfortable around something so scary. It's like one of my. Greatest gifts in life that I get to do that. So it doesn't feel sad, doesn't feel depressing. I feel like the luckiest person ever. I would actually do it for free, not 40 hours a week for free, but I would volunteer my time as a hospice nurse 100% because I love it that much. So I don't know.

So you're like friends with death? Ish. You befriended it. Yeah. I don't want to like sugarcoat. Do your friends, are your friends scared of you? my friends are surprised by me a little bit like because in my everyday life like you say you're a hospice nurse at like a dinner party most people are like you know god they don't want to talk to you um really i feel like it's so interesting yeah no right no most people do not want to talk about it or they just go like or they say the whole angel thing which is always super uncomfortable well let's let's get into that yeah tell me about the angels about the angel people think i'm an angel oh well of course you are but but i have seen an what i have seen an Angel, I think.

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patient's well obviously in the city of angels you saw an angel i saw i think All right. I saw an angel. Taking down my judgment hat. Tell me about the angel. I get the judgment hat. So I had a patient. First off, this is my one and only miracle story where I feel like I actually witnessed a miracle, Dr. Mike, for real.

A miracle. Yes. Hear me out. Just so you know, I am not really like this. I'm not like an angel girly, okay? So you're anti-angel? For the record. I'm just not sure.

Like, it's not like I study angels, okay? Is that a thing? This is, yes, these are people who, like, really believe in it. Even after my story, I'm still like, is this real? Okay. Well, listen. Okay, so I experienced one miracle. It has to do with the angel.

A patient was coming on to service. She was a young mom. Her kids were, in my opinion, young mom. Her kids were, like, in their early 20s. And when I was admitting her onto hospice, she was coming from the hospital. She was actively dying in the ambulance. Changes in breathing. Cyanod.

I mean, I got her oxygen. It doesn't really matter, but it was around 70. Maybe not even picking up, right? Yeah, like she was, she was going to die any minute, in my opinion. Almost agonal breathing. Like, that's how close to death she was. And I wasn't mistaken. I know what it looks like.

That's what it looks like. I was like, great, this is awful because her children were talking to me about, like, when can we get her PT? Literally. That's one of the questions I asked. When can we start PT? Hospice and PT, are they compatible? No.

Well, and, well, actually, people on hospice can get PT, but she was actively dying. It just told me that they had no idea that she was so close to death, right? So I get her situated in the bed. She's fully unconscious. She's comfortable, but I need to go to the kids. And I'm talking to them about, listen, your mom is actively dying. She's probably not going to make it through the night.

Like, whoever you need to call, get here, da, da, da, da, da, da, da, I'm sitting there talking to them. And I'm like, I'm not even going to leave because I know she's going to die, like any minute. So I'm just going to stay here, document, it's going to take a couple hours anyway. What was the cause, the disease? Pancratic cancer? A metastatic colon cancer, I think. Yeah. It was years ago, but something like that, I think.

Yeah. And I was just sort of waiting there for her to die, so I could be there for the kids, and I just figured it'd be any minute. And then it was like a couple hours. My documentation's done, and I'm like, she didn't die at this is crazy. But I guess I'm thinking this in my head. I'm not saying this all loud. So I tell the kids, listen, I'm actually done with my documentation, so I really do have to go.

but they had family on the way. I told them what to expect and what they can do and to call us when she dies. I go into her room. I say one quick little, I'm not like a prey over people, but I felt really bad for this family, and I just wanted her to like pass or die peacefully.

Put my hands on her bed and I closed my eyes, and I basically talked to her, and I was like, I hope you have a beautiful death, like, we're here for your kids, da-da-da-da-da, in my head. In that moment, I saw this flash of a thing. which I ignored. I'll get to it. A flash of this thing that I ignored,

because I'm not an angel girly, okay? And... What's a flash? It was like a, in my head, like an image of my head. Okay. Okay. And then I left the next morning.

No one had called the office to say she had died. No one made a death visit. So I was like, what the heck? So I'm thinking the family called the hospital. She's probably intubated in the hospital somewhere. They didn't let her die. I call the family. I'm like, what happened, you know, how did it? How'd the night go? What happened? And the sun answered really

happy. Hey, Julie, what's up? I hear people laughing in the background. I'm like, how'd the night go? You know, I didn't get a call. Oh, you know, mom slept through the night, which they knew she was unconscious. I don't know why they said sleeping, but mom slept through the night. She woke up this morning says she's hungry. She was hungry for pancakes. So she's up eating pancakes. And I'm like, what? You know, I couldn't really hide my shock because that's how much I thought she was going to die. And they were like, yeah, she's up eating pancakes. I can hear them laughing. And I go, wow, okay, well, can I come see you guys?

They were like, sure, because I needed to see this for myself. I get there. This woman is fully alert oriented, walking, talking, eating pancakes. I thought maybe this is like the biggest rally I've ever seen or something, like this burst of energy. But I still was completely like, this is a miracle. I can't believe this. Because she didn't die.

So I told the family again, bearer bad news being like, this is probably the rally. She should probably die soon, da-da-da-da-da, like breaking their hearts all over again. And then she didn't, though. She lived very well for three months. So she did die. She did die three months later. But for three months, she lived very, very well, didn't have many symptoms, didn't go back to the actively dying phase, was up walking, talking, and then died very peacefully three months later. She did go through like the last couple weeks of her actively dying.

But those three months, she was well, lived well. So to me, I felt like I witnessed a miracle. And that flash in my head, again, this is not my norm. Okay. I got an image of this huge being behind her bed that made me feel like, like gave me the feeling of power and strength. And like, this is, the message was, this is mine. and I meant whatever they were meant like she was theirs and like I've got this and I that happened in a split second and of course I cannot wait to hear what you had to say about this

my skeptical mind did was like so much so that I for I ignored it completely like I didn't even act like it happened okay I didn't pay any attention to it until the next day when she was fully alert and oriented eating pancakes and then live for another three months it did make me be like that thing that I saw might have been real because why did she live for three months? Why did I get that image? Why? And you know, honestly, I don't know why. And I'm not just saying that because I'm here with you and you're looking at me like what I really, I always say to people, I don't know why. I don't know what. I don't know what it means. I'm not really declaring that like angels are for sure real. But I do want to say when things like that happened to me and they

touched me and they make me feel like, wow, that was wild. That was my experience, you know. Tell me. Tell me. I have, I have nothing to say. I mean, that's it. Yes, you do. You have anything to say. Okay. I will tell you my one observation. Okay. And it's an observation of something I appreciate. Okay. In, in what a lot of people hope when someone is put on hospice or they're actively decompensating from already a bad position in the ICU. So not someone who's young and healthy and had a terrible accident that we can nurse back to health. Someone who's in a really bad place. The family wants miracles.

Yeah. And I like that in this example, you discuss a miracle that you experienced. But the miracle is more of a realistic miracle. That the miracle was that she got a few more months. Yes. Not the cancer disappeared. Yes. Which is what people view miracles as.

and I feel like that actually misleads people to making bad choices in end of life and throughout their lives. Agreed. So I actually appreciate that fact. That was my takeaway from that. Okay, yeah. But, you know, being not religious person, I don't know what that means.

What do people who are religious, how are they different in their end of days? They're not really different. Yeah, I would say they're not really different. Are they more comfortable because they feel like, like it's tied to their religion or it depends so some people can be more fearful um i found some people that are very religious who talk a lot about the religion at visits seem to be more fearful some seem to have a lot of faith and a lot of comfort um so i think it's like your relationship

to that religion and maybe to death it does people with some sort of faith in anything really It doesn't have to be, whatever. It doesn't have to be anything. A standardized religion. Yeah, standard. Yeah. Seemed to be more comforted. But generally speaking,

this is a bold statement, but generally, I think death is generally comfortable on hospice. Now, like the actively dying phase, that last phase of life. Yeah, let's discuss some of these terms. Yeah. What is actively dying? Actively dying is the last phase of life. it's the one that no one talks about it seems like except for me i'm just constantly saying actively dying all the time um it's like that last week right and most people are unconscious

most people will have changes in how they breathe they'll have terminal secretions which is like a death rattle changes in skin color changes in temperature almost everyone will look like that at the end of life unless you're dying from an accident or you know aculey yeah and i see you death looks different as well, for the most part. Because it's medically intervention. Yes, and they've already had tons of interventions, usually. Most people will look like that, and most people don't know that's what it looks like. So they expect their loved one to be able to still be walking at the end of life, still be

talking at the end of life. And that's usually not what's happening. They're usually unconscious. And the reason why it feels it's so peaceful is because they're usually unconscious. We still give all, we still give meds if we've been giving meds and we'll transition medications to, you know, being sublingual or through a patch or a subcue needle, something like that. So they're still comfortable if they were getting medications already. But most people are not rolling around, you know, screaming or agitated, no matter what.

Like that's usually... What about those with a psychiatric condition, even then? even then if we can get it if we can get them um comfortable so i am like a very strong believer in being like super super aggressive if someone cannot get comfortable terminal agitation is real and it can happen to anybody now there are certain diseases that more people are likely to have terminal agitation um sometimes it's cognitive stuff sometimes it's stuff with the liver uh young patients can be like that psychiatric patients can be like that. And I think a good hospice will be aggressive as hell.

And planning for it. In planning for it. And planning for it. And helping people understand, helping families understand. Sometimes people are just awake and agitated or asleep and not. And there's no in between. Very rarely are we going to just do that right away, right? But if that's what we're seeing, that's what I always try to explain to families.

Because they'll say, you just gave them medications till they died. you put up like basically put them under until they died and it's like some people that's what we have to do if your goal is for them to be comfortable and you see that when they're awake every single time they're not we will give them enough medications so they are asleep and comfortable but that rarely but that rarely happens yeah what about the death rally yeah the rally is the um the number one like phenomena that we see happen, it's like one, three people will have the rally. Yeah, what's that? It's when people look like they're getting close to death, like my lady with the pancakes, and then suddenly boom, a burst of energy. And they are up walking, talking sometimes,

or not sometimes, walking, talking, their personality kind of comes back, they're hungry, and then they die shortly after. So that's the, that's the, why does that happen so often? I don't know. Is there any literature or education as to why? Not that I know. Not that that's been like peer reviewed and, you know, there's theories. There is, you know, cortisol bursts or, or, I mean, a lot of people will say DMT. I don't know who's saying DMT is released. I don't even know if that's a real thing.

But like, wrong podcast. That's on Joe Rogan. Exactly. Exactly. Whenever someone says that in my comments, I'm like that, you're just saying that. No one knows that. No, but usually we're like, whoa. Yeah.

Yeah. Okay. So that, that happens. Do you ever get people, you kind of touched on this earlier, saying you're just trying to shorten this, you're trying to save resources, you don't want my loved one to potentially get better, maybe even in the past in the ICU. Do you ever get that? Yes, all the time. And I just have to continue to educate that. One that's just not true.

I mean, I don't know. And all I can do is show you. through time that that's not what's happening here. You know, your loved one will, unfortunately, look, a lot of it's grief, right? Unfortunately, and I say this, a lot of this, you know, your loved one will die no matter what we do. And I am sorry for that. And our job here is to help them die as peacefully as possible.

There is clinical research behind giving morphine at the end of life. And if it hastens death, which has been proven, it doesn't. It doesn't. So, and the idea, we have this idea that like morphine is so easy to OD because of the abuse around narcotics, which is like a whole other podcast. So that I have a passion of mine as well. But it's not that easy to overdose. Really, it's not, especially with what we're giving them on hospice. The amount of morphine we're giving them, a doctor that I love, that I used to work with all the time, had a patient drink the whole entire bottle of morphine and sleep. for 12 hours and wake up fine. Do you know what I mean? So it's like, I wouldn't recommend that. Well, if you think about what dosages are dilated, seven times stronger,

then you have fentanyl exponentially stronger. Right. So there's a lot of room there. And we're not giving it intravenously. And their bodies are not functioning as well. So it's not like they're, it's not bioavailable. It's just, it's just. And again, you're doing it for a purpose.

Yeah. And the purpose is not shortening anyone's life. No. The purpose is the comfort, which is ultimately what I think people, want, but perhaps miss in the sea of misinformation, misconception, concern, emotions, et cetera. That's also where I go to. I say, what is your goal is what I'll say?

And usually they say so they don't suffer and they're comfortable. And I say, that's amazing because that is my goal too. That is what I am here to do. I have no agenda whatsoever except for to make your loved one more comfortable and to make you understand how we're going to do that. outside of the story with the angel has a patient ever left the lasting impact on you that you remember that patient forever yeah i mean so many i really yeah i have i have what comes to mind well depends on where we're going to go with this well you tell me um yeah let me think

guide us like an angel yeah let me let me think let me think there are patients that have like i have one shared death experience, which I didn't know was called that until someone told me what it was, where I feel like a patient, a shared death experience is when someone's dying makes you kind of feel and take you with them in your mind. Okay. That has happened to me one time with one patient. So a very lasting effect because it was amazing and it was crazy. Wow. I know. I didn't tell P.S. I didn't. High phenomenon. I didn't tell anyone about this for years except for my best friend, Jenny, because I trusted her. And then many people ask, over the years, people kept asking me why I don't fear death, why I don't

fear death. And there's many reasons why. But one of the reasons is this experience that I had with one of my patients, who I will say was probably one of my favorite patients. I do have favorites, I guess. So there's extreme things like that, right, that will have a lasting effect on me forever. And then there's things that are also extreme, but don't seem as extreme, right? Well, wait, tell us about the share death.

you do want to hear it yeah i know you told jenny but now you could tell a million more people i know okay um if you're comfortable i'm comfortable with that it's in my book and stuff too and i talk about all the time but i always uh you know i am a woman of science too so this stuff weirds me out um well for example i mentioned the high phenomenon yeah this is um you you see people go to music concerts it's raves, et cetera. And some people are using drugs, Mali, MDMAX to see what have you in order to feel close to others. But some people are going sober and the music is bonding them.

The crowd effect is bonding them. And they feel like as if they're part of something larger. Yes. And I'm sure we've all experienced it to some degree, whether it's cheering for a sports team or being at a concert. Medically, it's hard to explain, right? Because like what's happening that you feel part of some grand movement that is larger than yourself. It doesn't make sense. But it's happening. So we can observe it. We can discuss it and

social psychologists talk about it. Jonathan Haidt on this channel came on and we talked about it. So this could be an example of that. Kind of the stuff I live for. That is like what I feel even just meeting a patient and connecting and laughing and seeing their home, I leave there almost like there was a high. Like I almost feel physically high from the interaction because it was so beautiful, just interacting with someone. but the shared death experience. So as a patient who we, again, younger patient, didn't have much family, came on with a pancreatic cancer diagnosis, and he was a hoarder and needed a lot of help. And our team, his hospice team came around him and like found distant relatives to come in

for the weekend. And he, for whatever reason, because he was sort of like surrendering everything, was able to like let go and let us all clean out this hoarded. apartment. Okay. So the next time I saw him, he was like in this nice apartment that is now clean after 30 years, you know, and not, and he could move around and it was safe and it was beautiful. So that, that really got the relationship going with the whole team. And then he'd lived well for probably nine months, which is kind of unheard of for pancreatic cancer usually. They usually come on too late and all these things. But for whatever reason he lived really well was fully alert and oriented. We talked about all types of things, just like life.

and existential stuff, and he talked to me about his fears and his life prior to getting sick and how being sick really helped him, like, feel free in a way. And I say all this because we got really close. And I really loved him. And on his last days, we had a continuous care nurse in the house with him 24 hours a day, and he was unconscious. And I could tell the last time I was there, he would die that day. I could just tell, by the way, he was breathing and whatever. So I sort of said my goodbyes to him in my head, told the continuous care nurse, hey, can you text me when he dies just so I know what's going on? And I left to go to my car, to go to my next patient. And in the car, I just stopped for a second. I kind of looked at this apartment. And

again, I said at my head, like, oh, thank you so-and-so. I'm so happy, like, we got to meet and whatever. And then all of a sudden, in my head, I heard his voice. And I can, like, feel it almost makes you cry almost every time I tell the story. Because I could feel his excitement. And he, it was like I could, I was like he was smiling in my head. And he was going, oh my gosh, Julie. Oh my gosh. Oh my gosh.

Like almost whispering. I can't believe this. I cannot believe this. This is so amazing if I only would have known. If I only would have known. And I, I just started like weeping in my car because I couldn't. the feeling was so overwhelming. It was like pure peace, joy, love. It was like he was flying and soaring and kind of laughing and giggling. And he wasn't saying much except for, oh my gosh, Julie.

And he kept saying my name, which I think really kind of what got me all like weird. Well, kind of like, what the hell's going on? Because he kept saying my name. Oh my gosh, Julie. Oh my gosh. And the message was basically this. Oh my gosh. If I only would have known, I wouldn't have been so afraid. And I could feel how free he was. And I knew. knew how not free he felt in his life and how he struggled with mental health all his life and then he basically got sick and then he felt free again and then he died and then so that was it I'm crying in the car I'm feeling all these things and then it was done and I sort of sat in my car like shell shock like what the hell was that and then my phone beeped and the nurse inside was like so-and-so

just died and I thought I know I feel like he showed me that he did. And that's it. I never said anything to her. I never said anything to anybody. But it changed how I felt. It felt very real at the time. And it was like a beautiful thing that I felt like he gave me.

So how does that impact your relationship with thinking about death? Well, I've always felt connected to something greater than me, whatever it is. I'm not particularly religious, although I did grow up somewhat. religious but that's not I just I've always felt I've ever since I've been a little girl I've been like this little girl who's like asking about life's biggest questions like why am I here mommy like where do we go when we die right and I've always felt like I've gotten answers as a little girl I've always felt connected to something I couldn't see and something greater than me I've always felt homesick for a place I like that feels like home that I can't quite remember

and experiences like this kind of reiterate like oh yeah maybe maybe that maybe I'm not crazy maybe that is what's going on I know what if I'm wrong I don't care what do you mean if you're wrong a place you got to be what place you got to be like I feel like if I'm wrong about there being an afterlife if I'm wrong about me experiencing that that this wasn't real I almost don't care it's like that's okay I'd rather like believe in something beautiful that I feel really connected to then then try to prove that it's not real why is it so often that when there's a couple that's lived together for a long period of time when one goes you almost always see the other one within a year pass well i think isn't there like research that shows that there is like

broken heart syndrome first off well yeah takasobos cardiomyopathy so that does happen but that's usually like a very stress-induced acute phenomenon like you get bad news in the moment and you drop dead but more so like my grandfather and grandmother they my grandmother passed away after a long battle with heart disease strokes etc and then my grandfather two months later was running to answer the door at age 90 slips fell broke his hip and you know at 90 years old if you're breaking a hip blood clot etc then all that so what is that is it just they're so connected in their daily activities that they end up dropping some of those things or is this something that's trained in our minds that's not bearing out in reality?

I think it depends, but generally speaking, change is hard for anybody. If you're elderly and then you're with someone for a very long time, so that's a huge change. So I think change is really hard on anyone. And then you're already elderly. So your end of life is kind of near, right? Then something traumatic happens, it's big change. Depression is real. And I think that can affect us.

It affects how we sleep, affects how we eat. It affects how we function in life, which again will make us deteriorate. And I think, but I don't really know. That's just what I see. That's a logical answer. You talked about this one very moving case. But then you said there's other ones that are just simple and yet they have a big impact. What are those?

Yes. Those are just people who say like a really heartfelt thank you. You know, like I had a guy who I sat down and like really talk. to even though he was super, super hard of hearing and super slow to respond. And in all honesty, I was like kind of annoyed in my head like, oh my God, how long is this going to take? Um, but then at the end, he like grabbed my hand and said, you know, I've never had a healthcare worker. Listen to me and hear what I had to say. Thank you. Like that stuff is like, you know, dagger to the hard or whatever you want to say. You're like, one, I feel so bad for like thinking rude stuff

on my head about this guy. But two, this is what I'm talking about. This is the only thing that matters in life sometimes is what I feel like. Or the patient who like, I had a patient whose last words because he like died seconds later were thank you to me because I covered him up with a blanket, you know, or patients who just made a joke. I had a guy once, it's the best thing ever. I had a guy. I had to check out a catheter in his penis because he had a catheter in his penis. So I just said, you know, I check a catheter, blah, blah, blah. Just make sure he knew what I was doing. And he goes, okay, well, one second. And he screamed for his wife. And he goes, honey, get the magnifying glass. And I was like, magnifying glass.

And he goes, well, you want to see it, don't you? What? I mean, dirty jokes happen. Dirty jokes happen. And like, I will never forget that man, ever. So it's like stuff like that, too, you know? Um, In getting a text, because you get text notified if someone passes, you're out with your friends at dinner and they're like, oh, so-and-so just passed. How do you deal with that? I don't actually do that. So I keep my work phone away from me. Got it.

Yeah, yeah. I've really, the only way I think I can, like, survive. That's another thing I should have said. The only reason why I can, like, love nursing and hospice nursing specifically is that I don't do stuff like that. I keep my work phone only on if I am working. So if I'm not working, it's not on. And I'm going to know that other nurses can do a good job and take care of. Yeah.

Yeah, because you need the teamwork component of it. Yeah, I need to have, I think all nurses, anyone works in healthcare, needs to have good boundaries, good work life balance. Have you ever got an interesting confession from someone? No, I wish. People always ask me that and I don't. I don't have it. Yeah. I don't feel like that's something that people do readily.

Yeah. At least not to a health care worker because we're not part of their life as much as their loved one perhaps is. Yeah. And also, so some people play up the confession thing because they say, oh, they told me something incredible. But a lot of times with end of life, there's hallucinations, there's psychosis, delirium, and they might not be telling you something that's real at all. Yeah. I mean, I've never had.

I've never really, like any kind of story or a thing I say that like feels like a lesson is always like over time and intermittent. It's never, it's never been like someone grabs my hand and says like, let me tell you the greatest lesson I've learned in life. It's never like that. At least for me, it's not. What's the worst part of being a hospice nurse? Charting. Really. It really is because you have to chart.

You're dealing with death. People are losing their lives. You're having complex conversations. And yet charting is the worst. Charting is the worst. And if I didn't have to chart, I would, I mean, I still love my job, but it would be the perfect job. Charting because it's against Medicare, it's for all towards Medicare guidelines.

And they're insane. And of course, your company only cares about, this is awful to say, but only cares about getting paid and getting money. Well, that's what the company does. Yeah, that's what the company does. And whether it's for profit or not, they both are like that. But anyway, so it's a lot of like, you have to do everything exactly. and it's annoying and torturous to me.

Have you had to do a lot of chest compressions? Yes, in the ICU, not on hospice. Yeah, in the ICU. And when you do them, what are the family members around you feel do? Are they like, keep going no matter what? Yeah, I mean, in the ICU, they are so, they're hooked up to so many things that very, well no we did have people die i just think we kind of bring them back because i think they're already hooked up to so many things that it's kind of like momentarily every once in a while

we could kind of almost see it coming and we would kind of talk to the family pre forks you could almost see that like hey this might happen so let's talk it through and then eventually only only twice i think did we actually stop and the person did die um and one of the times i a fellow was so amazing we could kind of see it coming we kind of prepared the family but the family still said yes we want if his heart does stop do everything you can yeah and we kind of explained like okay we will but here's how it's going to go there's going to be cycles and like eventually maybe we have to stop stop the cycle so we knew what was going on this person was not coming back so the fellow basically like ran the code like a few cycles through and then eventually

looked at the family and they said like okay we could stop but we all kind of knew we were doing it just because the family you know wanted to see that we tried are slow codes a thing they seem like in the ICU it felt like what's your definition of slow code seeing it kind of we kind of know what's going to happen oh no no no so people have this term slow code where they say oh well the staff knows that person is going to die and they're being forced to perform chest compressions and they're going to take their time. Oh, I don't think so. I don't think so.

Yeah, I've never seen it happen, but I get that question asked to me. Yeah, no, no, I don't, I mean, at least from my experience, which again, I haven't been in the ICU for, you know, eight or nine years, so maybe it's different. But back then, we weren't, we kind of knew what was going on, but we weren't like, we're just doing, we're just barely doing it because we did it. You did it. Yeah. But it's still, I mean, those were still hard.

I hated those days. I felt, you know, you're so conflicted. At least I was. I was so conflicted. I'm like, oh, man, this is awful. Are there hospice nurse retreats? Do you guys have a group? I'm sure there are.

I don't go to them. I don't go to. I needed to ask what that's like. What are you guys doing? I don't go to them. I had a retreat. I made my own retreat once. And then after that, I was like,

I don't think we're in a retreats. It was just educating about death and dying and myself and hospice nurse Penny and other hospice nurse who were kind of like-minded and um we did a retreat together a lot of times this might I hope I don't hurt anyone's feelings but a lot of times what I find is like hospice seems to be related to a lot I get invited to a lot of grief stuff which is fine but that's not my expertise like I'm not a therapist like I don't I'm not like an expert in how to grieve or how to do it well or whatever but I do find that there's a lot of like people in that space who are very much like, let's hold space and

oh, da, da, da, and I'm not really like that. I don't really like, I'm more of like a straight shooter like. Where'd you grow up? Pennsylvania. You feel Brooklyn. Yeah. Oh, thank you. That's a, that's a great compliment. Um, yeah. So it's like I don't always, I'm still very, like I said, I still live presently. I pray. I meditate. I know all these things. But I'm not. I'm not. like super sensitive I guess I know what you mean yeah because there's a lot of people that are very spiritual to a high level where it's a little bit too far but if it works for them right if it's but I'm just not into it right so like I don't want to sit around a circle and be like and sing kumbaya and like I just I'm just like and whenever I'm in that kind of space I'm like you guys

aren't going to like me very much because I'm just not going to be like that. Oh, my friend who's from upstate New York asked it to ask you a question. In his upstate community, they have a belief that if someone's passing, you have to open the window for the soul to escape. Is that a common belief? Because I never knew about it. I never knew about it until I started talking about this online. And everyone always asked me that.

Oh, they do. This is a thing. People always ask me, do I open a window? Do I open a window so the soul could leave. Oh, yeah. I always say no. You don't because you trap it and you're evil. I trap it and I'm evil and I put it in a jar.

No, I'm just kidding. I just don't do it because I'm not going to explain to the family. I'm opening a window so their soul can leave, right? Because not everyone's going to want to hear that. So I just don't do that unless they ask. Hey, if they ask me, hell yeah, I'll open a window so the soul can leave. But I'm not doing it unless you ask. Got it.

Okay, so that's a little bit misinformation. Yeah. But a lot of people, see, I think if hospice nurses are doing that without the family asking, they're incorrect and they need to be punished. But they just shouldn't, I just think that's wrong. I mean, not everyone believes in a soul. Not everyone believes in like, oh, that's like a wife's tail. Like, we don't do that kind of stuff. So, to me, there's a difference between misconception and misinformation. Misconception is people have a belief that morphine is shortening life. What's full on misinformation that's out there about end of life? That hospital, maybe, I'm not sure

if this is what this would be one, but like hospice kills people. There's, there's, there's whole groups dedicated to proving that like hospice kills people for profit. Why do they do that? Why would they do that? Why does this group exist? Is that, is there any truth? Because they really believe that.

No, no, no, no, no, there's no truth. In fact, people who stay on hospice, they, like the hospice company gets more money if, if you live. It doesn't make sense. People don't, people don't get less. You're like, it's against their financial interest. I'm like, I mean, not that, not that I care about that, but that's like literally. not right. The longer you stand hospice, the more money they get. So particularly if you don't need

a lot of stuff. So I don't know. I think it comes from grief and there's no talking to them because I've tried a bit because these groups really pick out people like me who's in the, so like they will do whole campaigns where they try to like take me down. Really? Really? What are those campaigns like? They're like sending a bunch of people into our comments, reporting our, um, pages reporting us to the nursing board. Oh, what do the comments say? That we kill people, that we murder people, hospice murders people, you kill people. That's mostly it.

It's mostly about murder. It's a lot of ridiculous. A lot of ridiculous. It's hard to take even serious. It's like I don't even know where to start, you know. Yeah, that's messy. You mentioned when we were talking outside about wanting to educate the medical field from a zoomed-out perspective, nurses, doctors, about end-of-life care, how to make the world

a better place, what do you want to teach them? Like, a lot of them are listening right now. Oh, wow, so much stuff. So if we're speaking, if I'm speaking only to other HCPs, hospice workers or no? No, no, no. Hospital care providers. Okay. I don't know what HCP stands for.

Me neither. Because there's a few, there's different, it depends on who I'm talking to it. No, nurses and doctors that are interested in end-of-life care that are not good at it. Well, one, hospice doesn't do everything. So that's one thing I hear a lot of other healthcare professionals say. Like, hospice will take care of it. We'll sign up for hospice and they'll take care of it. And we don't take care of it.

What is it? It is taking care of their loved one 24 hours a day. Oh, got it. Okay. Yes. So, like, many people think that that's what hospice does. and that's what hospice definitely does not do. No hospice does.

They will not be with you 24 hours a day. So that's one. Two, you don't always necessarily need morphine just because you're dying. I'm a big morphine girl. Like, give me all the morphine. So I'm not like anti-medication. But I think it's a misconception that just because you're dying, you're going to need medication, that is not true.

And just because you're actively dying does not mean you need medication. People don't need morphine just because they're actively dying. so that's another misconception um you need to use the words death dying dead people need to hear those words and not passing or gone you need to use the words death dying dead they only sound taboo because we don't use them we need to use them and I think we need to be a little more upfront with um not just prognosis because I think a lot of people probably are especially if they work in the area, but explaining what their progression will look like. I don't think many people understand that.

And I think we take for granted as health care workers that people understand what the progression will look like, what it means, and just be a little more open to talking about end of life. And I always say, this is still not saying death, dying dead, but it does make it easier. Saying end of life journey. Everyone has an end of life journey. yours may be happening soon. We don't know for sure.

We can always say, because we don't know for sure. That is the truth, technically. But we don't know for sure, but I still think it's really important. We talk about what you would like if X, Y, and Z happened. I mean, everyone needs to have that conversation. I think anyone who gets diagnosed with any kind of life limiting illness should have that conversation up front and then continued over time. should we have that conversation with people without a life-limiting illness?

Great point. Because I guess life is a life-limiting illness. Yeah, it's true. Yeah, I mean, yes, yes, if everyone's willing to, let's all talk about it. Well, how would, like, you talk about it in your book planning for death. What is planning for death? That, I mean, well, so generally speaking, if we, if you and I are just talking about it. Like, plan for my death.

Yes. Help me plan for my death. No, have someone in your life who knows all of your passwords for all of your things. your phone like your phone password okay wow i didn't even think about that yes where is your keys where's an extra key what's your passwords to your bank accounts who's your beneficiary to your bank accounts passwords to any investments you might have like all of that because someone is going to have to do those things when you're gone and if you suddenly go it's going to be eventually gets done but it's a lot of stress and a lot of work how do you want to be buried do you want to

want to be varied, do you want to be cremated? Would you want to be intubated? How long would you want to be intubated for? Would you want trial tube fees? Would you not? I mean, I could, like, the list is like a little overwhelming, but like that is the stuff I think, even as a healthy, however old you are, you should be having with someone. And of course, because you're healthy and young, it's going to change over time. But there's things like the passwords, right, or beneficiaries to any of your finances, but that should be done now. Should be done now. What, in scenarios, I see this play out on shows and I'm always like, consult a bioethics person. What happens when a patient has an advanced directive of, I don't want cardiopulmonary resuscitation?

And a family who's the health care proxy or power of attorney, whatever word you want to choose, says, I want it. And the person's still conscious and awake or not? No, no, no. The person's out. Their heart is about to stop. and you know we had to follow what they what the what the advanced directive says or what the power of attorney health care proxy i think what the proxy says even though it's against the patient's i don't know it's never happened to that's it's never happened to me well it just happened

on the pit which is why what did they do didn't they still do it um they had to do what the the people were saying yeah even though it was kind of against and then ultimately they came around and it ended up being in a way where everyone agreed but initially didn't start that way yeah we've never I haven't I'm sure it's happened but I've never actually run into that but I've always been told that we're supposed to do with the person who is like alive and talking us even if it's going against but doesn't that make sense well so it doesn't it doesn't because you know how you're always allowed to change yeah like even if you're dying and like as you're dying you could say no no I want it all now you're allowed to make that change so

doesn't the fact that you're giving someone else the proxy end up being you making that decision and should be changed at any time? Yes, this is why it's very important. You give that proxy to someone who actually understands. I do that and who actually understands. I always say I actually don't have this written anywhere. I should. Everything else is written about my sister's going to be able to do all the things for me. But she doesn't know healthcare. So it's known that my best friend, Jenny, who also heard about the angel story, will. be bedside. If I ever get in some kind of freak accident and I'm intubated, Jenny, I'm like, sorry, girl, you got to come out here and like be the person because

I trust you the most as far as making decisions that you know. Yeah, that's hard. I wonder who I would use. Maybe one of the doctors I train with or something. That'd be good. Well, I have a really, not a really big fear, but being intubated, I don't, I don't, if I'm We used to like, they would do rounds and do like a sedation vacation on people that were like fully vented like on SMI, like just like just fully vented not on pressure support like full and they would lose their shit of course because they feel like they're suffocating even though this machine's breathing for them. Anyway, so that is like one of my big fears. I never want that kind of stuff. I will be intubated if I have to be for certain things. Obviously to in hopes of recovery.

Yeah, yeah, yeah. But yeah, that's tough. I wouldn't want that either. I mean, quality of life. What do you think about that? Well, I think it's, I mean, everyone's a lot of their own choices. No, no, I mean, what do you think about the sedation vacation and, like, keeping them on? I always thought that was, I felt like doctors that did that were like cruel.

Well, I've never, I've never in my ICU's ever experienced sedation vacations. We did breathing trials to see if someone could breathe on their own to get them off of the ventilation. But that was in hopes of getting them off. Yes. Versus a true sedation vacation, which I don't think we did. We only had it. We had certain attendings that would do that. Only certain attendings would.

Interesting. I don't know what the current evidence base for that is because I'm not in the ICU anymore. But yeah, that's interesting. It sounds like it would be tough. Yeah. Because I don't know who that's helping.

Yeah. Eventually we would change event settings. Eventually, if they could prove that maybe something, you know, they were, but it was still like, I just saw a lot of suffering.

What's a tip for me? What's the best way to have your body taking care of? care of after you die. Who do you mean to do with that? Buried, cremated, what other cool avenues are there? Is there anything that I'm missing that there's interesting? There's like a new. What's a cool thing that you've seen people do that you're like, hmm.

I like the green burial. However, I've heard it's like maybe not that great for the environment anymore. What's the green barrier? Were you just like buried in the ground? Isn't that a traditional burial? No, like there's no. Oh, without the casket. Yeah, without the casket, without being embalmed, you're, like, shrouded and buried in the ground.

I think it looks really beautiful. But I've heard that the way we decompose might actually not be great for soil. I could be saying all of this wrong, people. I keep looking into the camera being like, listen. But I always like the idea of that. I like cremation myself, but also, like, not great for the environment. I think there's a little more, there's our more greener options that are probably more expensive and a little harder to find

depending where you are in the country. Like flash frozen or something? Yeah, or there's like water ones too where you're not soaked in water, but the way they maybe decompose your body is with water pressure. Yeah. Wow. So generally speaking, though,

if you want to save money and make it like most cost effective plan ahead, you don't want to do it last minute. Last minute is always more expensive. Really? there's an upcharge for me. I wouldn't say that, but for everyone kind of knows that.

Gravesite space and casket or what, you say plan ahead for financial, like what do you save money? Yeah, I mean, I feel like. The funeral service? Yeah, all of it, I think. I don't actually know the ins and outs of like what, what they're like upcharging you for and what they're, and I don't even know if they would call it an upcharge, but I just think at the last

minute, all of the services and things will be more expensive. Yeah. So if you have it already bought, already planned, it'll make it easier. Do you ever, this is so off a tangent, but it's, my mind is like that. Do you ever see pets have a unique relationship with someone who's dying? Yes, I just did a video about this. No way, tell me. It's definitely a thing.

I've seen multiple pets. One, so like the littlest things would be, you know, being protective over their owners, lying with them laying under their bed, but then I've seen a few take on their owner's symptoms. So nauseous, not eating, not drinking, vomiting, not wanting to walk if their loved one, if their owners like not walking, not taking them, and acting sick basically, acting like they're sick. I've seen, I've heard, see, I wasn't there, but I've heard that after their loved one dies, them you know laying on the bed for a long time like staying with staying with the bed where they

were howling I hope my dogs cause a nuisance if I die unexpectedly the babies I make a lot of barking noises you hope they do I hope they do I hope they wake up the whole day but I just did a video today the other day where I was like this is a little bit of a side note but I was kind of howling crying for whatever reason um but one of those like guttural cries that you have and I saw I got quiet because I was like what is that noise and other dogs in the complex were like howling because you were crying because I was crying about I had just broken him with my boyfriend we broke out and I would came back to our apartment that we shared together and he was gone like basically he we said like

okay you move out this weekend I'll leave for a little bit you leave and I came back after he was gone and he had left the note and of course like it was it was a amical breakup so it was like just sad well those are really yeah it's like we love each other but it's like not working so i was like finally crying and i was having one of those like guttural kind of moaning howling cries right and then that's when i like quieted down because i was like what the hell is that and it was other it was dogs it was dogs howling howling they knew i know i know dogs always know dogs are amazing. Like when I'm sick and I'm laying there, the dogs act weird. Really? Yeah. And I'm not saying like sick, like seriously sick, but like if I've strep throat or something from one of my patients,

probably. Yeah. I feel like they do. There's been a cat in Rhode Island. I just did a video about this. That's why I know all this stuff. There was a cat in Rhode Island who predicted 100 deaths. So it wasn't a friendly cat. Oh, like if it came up to you that you were dying. Yeah. Oscar the cat. cat away from me. My dad's name is Oscar. God damn it. Yeah. Oscar, the cat. And it would like not be cuddly at all to anybody, but then when someone was dying, it would be like, boop, jump on their bed and lay next to them and then they would die. Oh my God. I wonder what they probably, like that actively dying means something different to them. So they're, it's like a pheromone. They were saying that maybe they could smell the ketosis. That's one thing that I think is

really cool about death. Now, it doesn't happen to everybody because not everyone gets into ketosis, but if you, when you can, if you're, I see a lot of, really elderly people get into like this phase of actively dying maybe maybe even before because they're kind of so slowly doing it and slowly not eating and drinking and slowly getting into ketosis where they have like euphoria and it's really peaceful really really quiet it's it's beautiful well i'll say this yes for more conversation i'm not at nothing to fear but i'm less fearful. That's great. And I think I'm more empowered to have a conversation with my patients about it. So I thank you for that. Thank you. Yeah. Is there a place you want to push

individuals to keep following along your journey of life and death? I think my YouTube channel is my favorite. I mean, I have more followers on TikTok, but so I mean, I love all my social. Right. And what is they handle? At hospice nurse, Julie. Okay. Yeah. And my YouTube channel is to me the most informative and where I go live every Thursday so I can answer, you know, live questions. So what's a weird one that you got? Weird question. Yeah. Since you feel alive.

It's been coming up a lot where they ask, you know, why did my loved one make a really scared face right before they died? Just recently, I got that like multiple times. And my answer to that is one, I don't know, of course. I don't really know. But what I will say is I do think this whole like, When someone's in the actively dying phase, like I said, especially if they're right before they die, I, they are, their consciousness is not, it's not who, it's not who you know and love anymore to me. It is a body. You know, it is a dying body. That dying body is doing a bunch of stuff to die. So I think, is it a face of actual fear. Is there, I don't think there's, it's a face of actual fear, right? It's like you love this person and you see them going. So, but generally speaking, people, do all types of weird stuff before they die. They're twitching. And if you're not used to seeing it,

of course, you're like, they're afraid. This is awful. This is whatever. And generally speaking, I'd just say, just remind yourself that this is a biological body that is, that is systematically shutting down and dying. Okay. Well, people will be tuning in. Yeah. So thank you. Hope you enjoyed the conversation. I did. Thank you. Huge thanks to hospice nurse Julie for traveling all the way to New York for our interview. her book Nothing to Fear in the newly released journal that comes with it are full of so much useful information. I truly think that getting her book will make things a lot less scary. It's linked right there in the description. Make sure you follow and subscribe to our show so you can be alerted

when we drop new episodes. And if you enjoyed today's conversation, go ahead, drop a comment, leave us a five-star review as it's the best way to help us find new listeners. And as always, stay happy and healthy.