Tomorrow, Today - Death & Tiktok with Nurse Penny

Episode Date: August 29, 2022

The strained relationship that humans have cultivated with death over the previous 2 centuries became painfully evident as Covid took hold these past few years. As folks were unable to sit beside their loved ones as they died, death anxiety continued to accelerate and an entire generation has begun to reassess its relationship with death. Coming to terms with death as it is, not as what we want it to be, is a complex personal relationship that demands vulnerability and honesty. In this illuminating conversation, we're joined by Tiktok celebrity Nurse Penny, a hospice nurse, to discuss the realities of the process of dying, what people should be aware of, and what we need to do to come to terms with the fact that we will die, and so will the ones we love. To hear more of Nurse Penny's thoughts, find her on TikTok & Instagram @hospiceNursePenny 

Welcome to Tomorrow Today, the podcast where we talk about tomorrow today. I'm your host, Nashflin, joined as always by my co-host, whose name I promise I'm going to remember someday. Andy. Are you sure? Randy. I feel like it was Ken. I don't look like a Ken. I feel like no one looks like a Ken's.

Ken's look like Ken's. I don't know that I've ever met a Ken now that I've said this out loud. You've definitely met a Ken. Anyways. Yeah, we got distracted. Today we're talking about hip things. TikTok. The clock app.

We're doing it. We're going to talk about TikTok. Get your clock wound. TikTok. This is going to be exactly how you think it's going to go. This is two people who do not use this app who are too old and irrelevant to use this app talking about this app. With somebody older than us. Who's better at it than us?

Like way better. Miles better. So maybe it's not an age thing. Maybe. Hear me out. Okay. Age is a state of mind. Or maybe it's a me thing?

Maybe it's a you thing. Me specifically. Yeah. Today we got to sit down and talk to Nurse Penny, who is a TikTok phenomenon where she talks about normalizing death, a thing I didn't know we could talk about on TikTok. She's like the Nurse Penny Hardaway, throwback. No? You don't know who that is. No, I have no idea who that is. Okay.

Are you going to explain that? So there was a basketball player in the 90s that his name was Amphernie Hardaway, but he went by Penny Hardaway. Okay. So every time you kept talking about Nurse Penny, all I could think was Penny Hardaway. Is the only other person I've known that's named Penny, not actually, but you know what I mean. Okay, sure. We'll go with that. You have the weirdest references.

What? He lit it up on the court. She lights it up on the talk of ticking. Okay. Okay. So what are we talking about? So we're going to talk about normalizing death and using social media as a way to get people. Why are you always talking about death?

Well, I mean, I think you know the answer to that, to be honest with you. I think you know the answer to that. Yeah, but that's not. helpful. Okay. I feel real depressed every time I sit down and it's an interview that you've done and I'm just like, yeah, I'm going to die. I know this. I mean, here we are. That's a pretty like common theme of people who have discussions with me. Like you walk away depressed. Dead. Well, sometimes if I'm really, if I'm really on a roll, sometimes I guess you could walk away dead and I wouldn't notice. But yeah, no, so this is my like third or fourth interview talking about death because

yes, I have a problem and it's death and my eventual death and also other people dying. But I do think this was one of those conversations that is unique in that it's not necessarily presented academically. So unlike some of the other interviews we've done where it's somebody doing research in a field and we're spouting our nonsense the first 20 minutes of every episode trying to help you understand that research. This is somebody who's not in the research field, but is actually on the ground dealing with death in a different way, I think. Going one-on-one. Getting in the paint. In the ring. Paint.

Nash. I don't know what that means. Oh, my God. So it's a big deal because for the first time, I think, we're really starting to use social media to sort of talk about some uncomfortable things. You know, when social media was like invented or whatever, right? It was basically like, what are you thinking right now? You know, you logged on a Facebook and it was like, what's up? It was like, so and so Andy is.

And then you'd be like reading a book. Yes. Even though you're typing. Yes. And it was literally. You want everyone to know you're reading a book. The worst version of ever. one, you know. Yes. It was like, how, how vein can you be without, like, your veins actually

bursting from your skin? You could be in complicated relationships with other people. Like, it would literally say, like, before it was cool. Yes. To be polyamorous. To be in complicated relationships. Yes. No, it was the thing you could publicly declare. Anyway, so this is cool because we're seeing this trend, obviously. We're us dealing with death on a more public, more noticeable scale, right, because of COVID. And because of that and because of that and because I think we spent a lot of time at home sort of wondering about our own mortality in a way while we watched the numbers take up. I think there has been a collective increase in anxiety about death.

And so- Because you can literally die anytime now if you just got the wrong strain of COVID. Right. Or like anything, you know. I mean, always have anything. But I mean, like, with COVID, it was more of a, hey, even if you're super fit and healthy, this thing that's like the flu that wouldn't kill you if you were healthy. Right.

This one might randomly, you're just shit out of a lot. for some reason. Exactly, especially, you know, in the early days where we didn't have a lot of information about it. And now we have sort of our second pandemic-worthy disease, the monkeypox, which is actually I know very little about, to be honest with you. It's pox. Instead of like Tupac, it's monkeypox. Oh, well, that makes so much more sense. I will delete my WebMD tab open about monkeypox now. I've got all the information. We're starting to get these conversations happening about very real things. You know, there's a lot of anxiety about death. And one of the things that nurse Penny gets to do is to talk about her experiences working in hospice. She's still an active

hospice nurse. So she sort of ushers people to the other side, right? Is this why there's a half bottle of Soco in the corner of the office? Yes. Okay. Yeah. Okay. I just wanted to clarify. Wasn't there last time I was down here. Yeah, it was, it was full and at a store the last time you were down here. We're fine. It's fine. I'm fine. Great conversation. And anyway, no, I'm just kidding. That would be weird. So there are more users on TikTok, I think, than any other social media app right now. more active users. Really? I think so. We probably, we should probably fact check that. I won't, but we probably could. Biggest app's ever existed. I'm Donald Trump now. We're just spouting things and hoping that I'm right. Huge. China. So it's interesting to have these conversations in a very,

very public way, talking about our death anxiety. And one of the things that's most interesting about Nurse Penny's TikTok is actually looking at some of the comments and seeing people say, you know, I was really worried about my own death. I was really worried about my grandparents' death. And one of the things that Nurse Penny does really, really well is talking about alleviating some of those anxieties. You know, if my dying person seems like they want food all of a sudden, is that dangerous for them? If they want more morphine, if they're not responsive at all. So addressing some of those questions that I think we have a hard time getting elsewhere and that we have sort of turned our back on as a collective understanding. You know, people don't really die at home that much anymore.

You know, we're not accustomed to sitting bedside with people. So it makes us all very uncomfortable and having a place where we know we can go that get some of, of those answers and get some of them in a humorous way, I think, has been very, very effective and very moving in a way that I think we've not yet seen social media do. When we think about death, like you're saying, we have a really weird relationship with it. And COVID, especially as people started early on, couldn't sit with their loved ones as they died. Like, the way we're dying became very apparently, like, disconnected. And then there's this other piece of, how do I trust somebody to give me advice that isn't selling something to me? And so,

media, while there's opportunities to make money on things like TikTok, at the very least, especially someone that's offering free, unsolicited advice, can try to at least alleviate some of those concerns that you're getting unbiased information. And I think that's really in demand right now. And a lot of different facets, not just death, but people realizing that you're always being sold a commodity of some sort. And I think as a generation in 2022, millennials and zoomers are at this point where it's just kind of like traditional marketing doesn't work because no one believes anything. We can't even agree on like basic facts in the news, never mind like what a brand is explicitly trying to sell us. Right. And I mean, I do think that

social media has sort of helped us unpack a lot of what that means or doesn't mean as a generation that I think has been sort of growing up with technology. You know, you and I had this conversation briefly before we started recording about how the millennial generation are probably going to be the fastest, most efficient typers because that's, you know, we learned talking to each other on instant messenger and now the younger generations have phones and they've been texting basically this whole time. They'll have arthritis and their thumbs at like puberty. Yeah, I mean, yes, but totally different conversation. Yes, we will table that for now. But I do think it's worth understanding the correlation of getting information from a source that's trying to deal with it

in this way. You know, if you're scared about death, you have death anxiety, you're having a loved one that's in hospice or that is sort of facing the end of things or gets a terminal diagnosis. Nurse Penny's TikTok provides a place for you to feel like you can ask questions or just watch some of those TikToks humorously because some of them are quite funny and just try to understand the process a little bit better and get a little bit more comfortable with it. And I think that's the piece that we've really been missing is the comfort level because we're not right now. We're incapable of accepting death.

I think we're so used to like, I think we're so used to the digital one. world where nothing ever dies, that the idea that our physical body will cease to exist, compiled with this century, centuries of distancing from death, it's just magnified that reality because of the fact that our digital persona will continue to live on as long as nobody goes out and deletes it, basically. Right. And also the boomers don't really think they're going to die, right? Yeah, and that's a whole other. You know, I think, and I think we grew up with that discourse, right? You know, our parents as they were aging, we started to hear, you know, oh, by, you know, in 100 years, they're going to just be replacing organs and, you know, we're just going to be downloaded into

the sphere. Like, I feel like there was a real belief in the boomer generation that they weren't going to be mortal. They got everything else they wanted in life. Why not? I also wouldn't want to die if my life was as great as boomers. I buy a house for $20 and like a pocketful lint in 1992, and it's worth like $2.4 million now. So younger generations really struggle with death and we're we're reconnecting with it and that is a really uncomfortable process. Right. And that's okay for it to be uncomfortable. Exactly. And that's, I think, largely nurse Penny's point is, is there's going to be a lot of this that seems uncomfortable. Watching somebody die is a process that goes on for for days, if not months. And being a witness to that process is where a lot of that

anxiety, a lot of that vulnerability, a lot of that worry comes in. And so facing it, I think, with humor or with social media or with both is a way to really start to get the conversation started about accepting dying, accepting death. And the more you can accept it, the easier the whole thing is for everybody, not just for your dying person, but for you when your time comes. Yeah. Yeah, I think it's, yeah, I have nothing to add to that. That was poignant. Nailed it. Nailed it. So let's, let's get into the interview then. No? Maybe. Today I got the opportunity to sit down with Penny Smith, or as roughly half a million TikTok followers know her as nurse Penny. Nurse Penny is a hospice nurse, which means that she provides medical care for those in the

final stages of life, generally from about six months to death. Penny, thank you so much for sitting down with us today. Thank you for having me. My first question for you is a bit personal, actually. So we deal with death in modern America, both the physicality and the reality of it. You know, we're very sheltered. We're not in war. We're not in famine.

So we deal with it basically not at all. You know, we don't know how to talk about it. We don't know how to deal with it. So I think it could be hard for some people to understand why somebody might choose it as a career. So how did you decide that death work was your calling? Well, you know, I actually didn't become a nurse until I was 40 years old. And I chose nursing because my ex-husband and I were getting divorced. And I needed to have a career after being a stay-at-home mom, homeschooling my daughters for 10 years.

I needed to do something to be able to allow us to divorce. and his mother, about probably a year prior to us making the decision to divorce and me making a decision to be a nurse was on hospice. She had cancer and she was on hospice. And, you know, I kind of have a little bit of a rough background in my earlier life. I got into trouble with the lawn, trouble with drugs. And I felt like I really wanted to do something that was meaningful, that would be service work. And so having that experience with the hospice nurses who cared for my former mother-in-law,

I decided that that would be something that would be really interesting to me. I also suffered from death anxiety. So strange as it sounds, I kind of had a morbid curiosity about it after having gone through several years where I felt very anxious about death and dying, had never seen a dead bond.

and didn't have a concept of an afterlife. And so it kind of intrigued me a little bit. So there were a couple of different factors that played into the decision. But I knew going into nursing school that that was going to be probably going to be my chosen path. That's fascinating. I do find that the people that are most uncomfortable with that, that have that death anxiety from an early age, actually tend to follow this path. I know that I did. I was fascinated by as a child. I remember, you know, being six years old and being worried about

about what my death was going to look like. And now, you know, I do, I do what I do. So I do feel like that generally pushes us in that path. So can you walk us a little bit through, you know, the process of dying? Has anyone ever had any interesting or memorable last words? I know that's something we love, like history-wise. And have there been any experiences that really stuck with you or changed how you understood dying? So, so the, first of all, to be on hospice, a person has to have a life expectancy of six months or less. And the national average for hospice length of stay is like 71 days. So we often get people on service for a really short period of time because people are under the false assumption that you have to be right at the final, you know,

end of days to go on hospice, which is not the case. We like people to come on when they're kind of further upstream so that we can get to know them and we have a lot of services that we can provide to them. So when a person is is dying, the dying process, is pretty much going to be similar for everybody. So anybody that's dying in natural death, they're kind of going to have the same types of symptoms, not all of them, but usually people are going to,

they're going to, the first thing that happens is they're going to sleep more and they're going to eat less. Their body starts to shut down, digestion shuts down. They're no longer very hungry and they're sleeping a lot more for energy conservation. A lot of times people will also kind of become very introspective at this time.

like they're not really wanting to communicate as much with other people. So those are kind of the earlier things that typically happen when somebody's going through the dying process. As they get closer to the end, we see things like visioning where they will talk about seeing their deceased loved ones or pets. That's very common. Oftentimes they will speak metaphorically about going somewhere, going on a trip, going home, or even getting ready to die. That's also really common. physically we start seeing changes like they're continuing to sleep more and eat less, but then we're also going to start seeing things like respiration changes, breathing changes.

That's kind of closer to the end of life. We see color changes and the hands in feet as again the body's shutting down. Circulation is changing. We see like this marbled or modeled appearance where they have like purple or blue marbling on their hands and feet. They can be very icy cold when they get to that stage. oftentimes they'll have a fever, typically right at the, and then sometimes, and this is interesting, and so they become, they're sleeping more and more until they become really unresponsive.

And then sometimes people will have what we kind of refer to informally as a rally or a surge. Recently they have, they've called it terminal lucidity. So that's now the medical term for it. There's no explanation for why this happens with people, but they'll be really close to the end of life. and then all of a sudden they kind of wake up and they have a burst of energy and they want to sometimes eat a meal, hang out with their family. One lady wanted to play bridge with their family after she had been unresponsive and dying. Somebody who's been in the bed all of a sudden wants to get up and walk. And that usually lasts a day or less. And then they go back into that

actively dying stage where they're unresponsive and they usually die within about a week or so. as they get really, really close to the end, they're no longer responsive. Oftentimes they'll be kind of picking at the air with their arms reaching up, messing with their clothes, kind of picking at their clothes. They're not really coherent at all. Eyes are usually open. The mouth is dropped open, you know, jaws hanging down. And then they will, again, have a lot of these breathing changes.

And sometimes we hear the death rattle where the secretions have built up in the airway and they start gurgling or rattling. And then they stop breathing in death. I'm curious about people's resistance to talking about this because, you know, I think it's one of those things that we've all had a loved one die is something we all experience. We all have older people in our lives who are like, you know, at my funeral or you can have this after I die. And I feel like that usually generates part of our uncomfortable. We're like, no, Nana, you're 86. You're going to live 100 more years, which is just unreasonable.

So can you talk a little bit about what you think is the driving force between, like, for our reluctance to talk about and accept death? Well, you know, I think really it probably comes down to people being more concerned about the death of their person than their own death. They don't want to think about death because it will take them to a place where they're thinking about their person dying or their people dying. And that is hard to deal with because, you know, you're going to miss your people. You don't want to lose your people. So I think that's that's part of it. And also because it is such a taboo subject and we just don't talk about it. People have just a fear about what dying looks like and what death brings, you know,

like what really does happen after you die. And so they just don't want to go there. They just don't want to go there because there's so much really fear, I think, and anxiety, fear of losing their loved ones and fear of, you know, the unknown. Right. So you mentioned earlier that you started this process having no concept of the afterlife. Has working with hospice changed that at all? Yeah, definitely. I grew up with no religion. My parents are probably atheists. I think maybe my mom's agnostic. I don't know. We never talked about religion. Any religious experience I had was my own searching, you know, going to church with friends. So I didn't have a concept of heaven or hell, which is good. I still don't. I guess, yeah, I don't buy into that.

But I had no concept of any afterlife. And so I worried, you know, like, what if there's nothing after we die? What if there's just nothing? Working in hospice and seeing people visioning, deceased loved ones and pets has been enough to convince me that there is something more after this life. And also, you know, basic chemistry, nothing ever really goes away. It just changes its shape.

sometimes that's in the form of energy. I had an experience with my dad after he died where he came to me in the form of energy. And so I just somehow think that there's just there's something more. You know, people like to to kind of write off the end of life visions or the deathbed visions and say, well, it's just the drugs that they're on. And yet we see consistently the same thing over and over with people regardless of whether they're on any kind of medication. And the medications that we give at the end of life are not medications that will typically cause hallucinating. So, you know, if you work in death care and you see that enough times where somebody

tells you, my wife is right in the corner, I see her there and she's coming to get me, you know, it's very convincing. And it definitely gives you pause for thought. And it was enough to convince me that there's something more. That's great. I mean, I'm not looking forward to finding out soon, but I'm sort of where you were. I have trouble conceptualizing anything sort of after the fact. But for me, that's kind of a relief, you know. I'm kind of like, Jesus, at least I can take a break after this is all over, you know? Yeah, right. I can't imagine getting to the other side and be like, well, now it's time to go to work in your afterlife job. So have there been any specific experience where you were watching somebody die and they did something profounder that there was a part of it that, for you was the first moment where you conceptualized an afterlife? So there's a couple, actually. So the very first time that I really had this idea that there's something more was when I was

caring for a patient who was a, her daughter was a nun. And so she had lots of nuns visiting her. And one evening I was at the nurse's station and the last visitor was leaving. She was a nun. She came to the nurse's station and she said she's gone. And I grabbed my stethoscope and I said, oh, okay. And she said, no, no, no, her body is still doing the work of dying, but her spirit has left. You can see it in her eyes.

And so after she left, me being a new hospice nurse, was really curious. And I went in and looked at her. And sure enough, this is when, you know, I observed this lady had what we now call the death stare or the God stare or the heaven stare where their eyes are open at the end of life, but they're just not looking at anything. It's just a very unfocused. It's, it's hard to describe, but really it looks like the lights are on, but nobody's home. And having her explain that to me in that way, it was like an epiphany, like, oh, wow, she's right. And then over the years, you know, you see this where you have this idea that people are, they're kind of here and then they're somewhere else, you know, and they're back and forth for a while during that dying process before they come, become completely unresponsive.

But another situation that really sticks out in my mind is that, so, you know, we feel like people can kind of have control over their death sometimes. You know, you've heard, I'm sure, that somebody was waiting for Uncle Joe to visit before they could die. And a lot of times, and I would say probably even more so the situation is they're waiting for people to leave before they can die. so that we can kind of keep people here in a way and that sometimes we are able to let people go. And this lady was, she was just beloved by her family. All of her kids were in the room with her and she had several adult children. And the youngest daughter was probably in her maybe mid-20s or early 20s. And the lady was, they put the call light on and they called me in there.

And the son said, you know, we think she's gone. And so I got my stethoscope out and I was listening, you know, listening, listening to hear nothing. She's not breathing. No heartbeat. And the daughter is on the bed on her knees and she's just freaking out. And she's just crying, no, go, don't go. And then her brothers were like, no, you have to let her go.

You have to tell her it's okay. And she's sobbing and it's okay. It's okay. Clearly was not okay. And I'm just about to pronounce this lady. and all of a sudden she just takes this gasping breath. And then she lives for like two more hours until the daughter finally calmed down. So that's something that really is memorable to me as far as like the, I mean, and I have lots of

other stories too that I could. I mean, I've seen a lot of things, you know, being a hospital. Yeah, I imagine. I imagine. So actually, it was funny. So before we started recording, I was telling you that my grandfather passed away early this year. He was in hospice for a very, very brief time. He got an esophageal cancer diagnosis in the fall. He was doing okay. They found tumors all over his bones. He broke one of his legs. And the decline after that was very, very quick. So he moved to hospice. We were there for about four days.

It was a hospice center, so he wasn't at home. It was me, my mother and my mother's brother and my grandmother. So his immediate family plus one of his grandkids. He's several grandkids. I think there are nine of us now. And he hung on for four days. He slipped into some. sort of a coma. He didn't really wake up. So we didn't get any of the, any of the death process. He fell asleep on Tuesday and died on Thursday. But he waited for the one minute that I walked out of the room. So it was just his wife and his two surviving children. And I was like, so mad at him at first. Like, how dare you? I've been here for four days. But then I was like, that's how, that's exactly how he would have wanted it. Oh my gosh. I've heard that so many times where somebody will say, I was at the

bedside. I didn't even leave for anything. I was there the whole time. And then I stepped out for a minute and then they died. You know, and it happens a lot. Yeah. I was furious. Oh, yeah. I have a, I have a great story about that where so this guy, he had two adult daughters and his wife, who was his second wife. So she wasn't the mother of the daughters. And I got there and he was, so we call we say people are transitioning. So when some is I like to explain it like this. Like we who are not dying are more living than we are dying. We're all dying, right?

We're all going to die someday. When a person is terminally ill, there gets a place where they turn a corner and they're more dying than they are living. And that's when they're transitioning. So some people transition really slowly over time and sometimes it's really quick. This guy was just like right now transitioning. And I realize like I can tell by the breathing pattern that he is very close to the end of life. And I say to them, I think he's really, really close to the end of life and like minutes away.

And his dog was under the bed. So I said, I'm going to just go in the kitchen and I'm going to do some documentation and you come and get me when you're ready, meaning when he dies. So I go in the kitchen and I'm in there for like 20 minutes. And I'm like, God, I can't believe he's not dead yet. Like, he was really, really close. They do this thing with their tongue when they thrust their tongue forward. And if you see them do that, like they're usually minutes away. So I go back in there and they're all standing there. And so when I told them that he was really close, they each grabbed like a hand.

And one of them had a foot and they were like stroking his hand, stroking his foot saying, Dad, it's okay, it's okay. You can go, it's okay. So I go back in after 20 minutes and they're still doing that. They're like, it's okay, it's okay. We're here. We're here.

And I said, is he the kind of guy that would have liked you doting over him? And one of the daughters looked at me and she just dropped his hand and she goes, I have to go to the bathroom. And the other two did the same thing. They just like drop their body part and turn around and they all left the room. And then all of a sudden, I'm there with the dog and with the guy. And so I walk out of the room and I said, you know, sometimes we tend to keep people here. We don't mean to. But if we do something that's not comfortable to them, then we can sometimes keep them here. And that conversation probably took me two minutes and I went back in the room and he was dead. So it was, it was, it definitely. It definitely,

definitely, you know, you can keep people here if they don't, they're not comfortable. That's funny. Did the dog know? Do we suspect that the dog was aware? Oh, yeah, I think the dog was definitely, the dog was had been under the bed like all day and had never left at all. So pretty sure the dog knew what was going on. Animals are intuitive. Yeah, I was going to say, I feel like animals usually are way smarter than we are when it comes to death. Oh, yeah. Yeah, definitely. That's really fascinating. So for our listeners, you're not doing. just a hospice nurse. I mentioned in the intro that you also have a really impressive TikTok following, particularly TikTok. You also have a pretty big following everywhere else,

where you bring comedy into your work stories and observations. Can you talk a little bit about what drove you to bring death and dying to TikTok and have any of the responses to your work surprised you? Yeah. So, you know, during the pandemic, just like everybody else, I was in lockdown. My husband worked nights. I worked days. I heard about TikTok on a news story and decided to download the app and check it out. I got sucked in by the shuffle dancing. I was trying to learn how to shuffle dance. I've always had a little bit of a creative flair. I used to be in a rock band and I did community theater. And so I kind of was testing the waters by doing some of the silly trends. And then I was, as I was on it more and more, started seeing more serious things on there. And so I

told the story about the lady with the nun daughter, that story. And it went viral and I started getting a lot of followers. And I was like, oh, wow, I guess people, you know, want to know about hospice and death and dying. And, you know, as far as doing comedy and the trends, I just, I'm really creative. And I just kept thinking, so working in hospice is not sad, first of all. People think working in hospice is going to be sad, right? It's not. It's not. We all kind of have a dark sense of humor. And you learn that your patients and your families, a lot of times, they also use humor. to cope. So it's not sad all the time. There can definitely be a lot of humor involved. And so, you know, being creative, I thought, how can I turn a trend into like education for someone? How can I

make this educational? And also understanding that, you know, adult learning, people learn in different ways. So sometimes somebody might want to hear straight talk. And sometimes maybe they, They don't want, you know, like a real somber monologue about the dying process. And also, death and dying is a dark subject. So I thought maybe I could just lighten it up for people by adding a little twist, making it funny, using a trend. And people just really liked it. You know, they responded. What surprised me is that I learned that I was not the only one that had suffered. from death anxiety. I learned that it's very common. A lot of people have death anxiety. And I learned that just like being a hospice nurse helped my death anxiety, people who were watching my TikToks were telling me that they were no longer afraid of death and dying because of watching my TikToks. Like it relieved that anxiety. And I really understood then that it was more than just for me, like my death anxiety resolved because I kind of developed this concept of an afterlife,

but it was more than that. It was actually opening up this tabby topic for discussion and bringing it to the forefront and saying, let's talk about death and dying because what's it called when you are afraid of something and like you're afraid of spiders? And so then they have you get close to spiders to get over that fear. Oh, yeah. What is that? Some kind of therapy, right?

Yeah, yeah, yeah, where they, like, expose you deliberately in, like, measured outcomes. Yeah, yeah. Exactly. And so that's really what it started to look like to me was like, oh, okay, when people are watching my videos about death and dying, they're able to overcome their fear around death and dying. That's really fascinating. I'm surprised. I'll be honest with you. I'm surprised that it was embraced. I mean, I'm incredibly impressed, but I'm surprised because I do feel like maybe this is a generational thing. I'm a millennial. I feel like in my perspective, largely TikTok is Zoomers, is Gen Z.

So maybe they're just a little bit, you know, more open to it. But I feel like, you know, as a millennial, I have a significant amount of death anxiety. I feel like learning more about death and actually getting a PhD in death has not helped me at all. I'm still just as anxious as I was as six years old. Well, I'd be curious to know like, so for me, I always say, you know, by lightening it up, making it kind of funny, you're almost laughing at it in a way. Probably what you're learning in your Ph.D. program is not quite the same as TikTok death learning. That's very, very fair. And to be to continue to be fair, I think, you know, the people that I'm studying have been long gone. And so there are narratives are sort of written and neatly packaged and you can make them whatever you like. And I think that's what drives a lot of my. So I have suicidal ideation. I've fought it for most of my life. And it's interesting that I'm still so afraid of death and dying. And yet my brain is like, hey, we should do that. But I do think that that anxiety sort of drives it. Right. Like you don't know what the narrative is going to be. You don't know what the start to finish looks like. And so you just worry about the ending. And your brain is kind of just like.

I think we should just get it over with it. We should take control of it and do it ourselves. But I digress. So like I said, I study death history, which is looking at the historical pieces of how we got to where we are today. So you're more in death's present, but I'm curious. Have you seen any changes in your career in how we handle death and dying? And has COVID changed any of that in the last, you know, two or three years?

I'm trying to think if I feel like I don't think like within hospice, I've seen changes in how we handle death and dying. I guess I've seen some changes. You know, there's the movement to try to have people die at home more often. Hospitals don't want the deaths on their record. And also, you know, it makes sense for people to die at home. You know, it's just, it's not a medical, death is not necessarily a medical event, you know. people can die peacefully in their own home easily without a lot of medical intervention.

I mean, that is ideal. So I've seen that change. I think that through being on social media, what I'm observing is that there are a lot more people who are interested in talking about death and dying. Although it's hard for me to be able to really gauge that as far as, I mean, my experience from pre, social media was through taking care of patients and their families. And I know that a lot of people are uncomfortable talking about death. They don't plan for death. And now I see this big movement on social media, especially Instagram, where there are these communities of death care workers,

doulas and hospice nurses and, you know, who are educating about death and dying a lot. And people are really interested in that. So I think that that is something people are more interested in learning about. And I do think that COVID probably has a lot to do with that. There were a lot of deaths from COVID. And, you know, our country and our world was faced with, holy shit, there's a lot of people dying now. And so that really brought death to the forefront in a way that it hadn't been for a long time. You know, we didn't, we haven't really. How, a lot of situations where there were pandemics in many of our lives. And I'm a boomer. You know, I was born in 62 and in my whole life there's never been a pandemic. So, so I do think that that's,

that's kind of been an, you know, an impetus for more curiosity about death and dying, more discussion about it as people were kind of learning, you know, what, what it was like for somebody to to die from COVID. You know, it was really out there a lot. People were hearing about it a lot more. I mean, I think it's really fascinating. And for me, I keep coming back to, you know, the American Civil War. So the American Civil War changed how America dealt with death. We were still in the middle of the Victorian idea of dying. So you died at home. Everybody was with you. There was this very, you know, your deathbed was the sort of holy place where everybody was sort of ushering you spiritually into the next phase of your existence or non-existence, depending on where you fell in that. And then, you know,

And, you know, after the Civil War, there was so much death we started inventing and balming, so we dealt with it a lot less. We couldn't get the bodies home to folks. And so we started sort of covering it up and making it very, you know, we invented hospitals and then people died at the hospital. That became very normal. So we really took a step back. And now the first time we're really seeing death in a big scale in America has sort of put

us in the reverse. You know, everybody sort of wants to die at home now with their families. And COVID, I think, barred some of that. Well, so, yeah, I mean, and I don't think it's necessarily that people, people want to die at home. There's often still a lot of resistance to that. But what happened with COVID was people were dying alone in the hospital and their families could not bear that.

That was so hard for people to know that their person was like, it's one thing for a person to die in the hospital if everybody can go visit. But now they're being told they can't visit and that person has to die alone. And so I think that kind of started getting people maybe more amenable to the idea that having somebody die at home could be better because the alternative was dying in the hospital alone where that used to not be the situation. And now it was. And it's interesting too, like you say about embalming. The other thing that's really changing as far as the death movement that I've seen is the way that we handle a dead body. So there are more alternatives now to

burial or cremation. There's the, what do they call it? The hydromation, is that what it's called where they use water to dissolve people. There's the green burials where they don't embalm somebody and then there's the teramation where they decompose the body. So that's really changing too. The industry of dead body disposal, if you will, is changing a lot. And you know, the whole embalming thing to me is weird and I've never liked the idea of embalming. And I remember even as a youngster telling my mom, you know, as I would talk about death with her, don't embalm me. I want to be buried in a pine box. So like just wrap me in a shroud and put me in a pine box because I just had this idea that I needed to go back to the earth.

I don't want to be embalmed. I don't even think cremation was around back in those days. That's how old I am. But, you know, embalming was like, we are like making these bodies last forever. Like if you embalm somebody, they just don't decompose. Yeah. It's gross. For 10 years.

That's, yeah. It's gross. I'm actually, like, academically fascinated by embalming. I would never, ever want it for myself or any of my loved ones. But I started looking into it recently because of Vladimir Lennon's body. I don't know if you're familiar. But his 99-year-old corpse is still on display because of embalming techniques. Like, you could still go visit him.

And he was very clear that he wanted to be buried. and, you know, for whatever reason, the Russian government was like, absolutely not. I guess they were USSR when he died. But, yeah, he's still just chilling out there. It looks, from photographs, he looks very alive. I think if you got close, it would be less alive. It's a really fascinating branch of science, but I wish we weren't doing it to people. Because, you know, if you're not decomposing for 10 years, like, what does that 10 years buy you, you know?

Like a couple hours, fine, you know, the alcohol breaks down. six hours and then you're ready to be a corpse again. That's whatever. But it's not. It's a very long shelf life for you to be buried and then usually under like a like a cement sort of layer. So like nothing's getting at you. Right. And you just look like you. I don't know. The whole thing is wild to me. Well, and the other thing too is is the chemicals. Now some funeral directors will say, oh no, the embalming chemicals, they're not harmful for the environment. And then recently I saw someone who is in the business who was like, no, that's absolutely not true. They are harmful. chemicals, they're harmful for the environment and we're putting them in the ground. Maybe that's why we

put people in a steel-lined cement vault so those chemicals don't leach into the groundwater. So we'll be drinking our relatives. I imagine if it's stopping normal decay, normal decomposition for 10 years, it is not good for you to be addressed at all. Yeah. That just can't be the case. Anyway, So one of the best parts about this podcast is that we deliberately wonder about tomorrow. And so we always ask our guests to speculate wildly on what the future of their field and their research might look like. So my question to you, though, comes in two parts. So what do you think the future of death in America looks like? And if you could change any part of the process, death, dying, whatever, what would you change and why would you change it? So I think the future of death looks like more people

are going to be choosing to be at home and having a death with their family around them. Just like with birth that grew and more people do, like at home births are natural births versus for a while with C-section, right? Everybody gets a C-section all the time. And now people are moving back and going, well, let's do a natural birth or let's do a vaginal birth or let's do an at-home birth. I think we're going to move in the direction of more people are going to be dying at home. I think there's going to be less trying to prolong people's lives beyond where their quality,

you know, keeping somebody alive on life support is no quality of life at all. So I think we're going to move in that direction. And maybe I'm just being hopeful, but I do think, you know, I would say that I think that just because of the feedback that I get from my social media and the young people who are really interested in learning about death and dying. And so I think that's partially what's driving it. but also because I think we have to. I don't think we can afford.

I don't think health care can afford to keep putting people in hospitals and prolonging their lives forever. You know, it's just, it's not sustainable. As far as what I could change about the dying process, do you mean like physiologically, like if I could wave a magic wand and say this part of the dying process will be gone? Is that what you mean? I just meant in general like any way you want that to mean. Okay, well, that's what I want it to mean because I think that. One of the ways that people would be more comfortable with death and dying and for their person to die in home and their home and their presence is if there was no such thing as the death rattle anymore.

So if I could wave my magic hospice nurse wand, I would get rid of the death rattle. All right. I don't actually think I know what it sounds like. I imagine it's sort of like flemy. It's very gurgly sounding. You can Google it. Like I've actually done videos where I grabbed a YouTube and stitched a YouTube of a person with a death rattle. Sometimes if it's really extreme, it can sound like a washing machine. And really, it's just a noise. It's not harmful to the person, but families are so distressed by it. And it doesn't matter how many times you explain to them that it's not uncomfortable, it's just a noise.

They're not going to drown in their secretions. Families are just very, very disturbed by it. They just hate that sound. If that was within my scope, that's what I would do. If for something not in my scope, I would say I really wished at the Medicare hospital, this benefit would change and allow us to bring people onto service before they were at that six months of life or less and that they would allow us to bring people on service who were still pursuing curative treatment such as chemotherapy so that we could do concurrent care and that we

could get them to where they need to be. So they would most likely be in the hospital less. They'd use the ER less. And they would probably quit doing the chemotherapy. therapy earlier if their quality of life was improved by being on hospice. So that would be my, if more realistic one, let's put it that way. Don't need a magic wand for, I kind of need a magic wand for that because it is a government thing. But, you know, I was going to say, it's, it's sort of governed by insurance and they, they want that, they want that cash. So I don't know, maybe we do need the magic wand for both things. Yeah. Well, thank you so much for sitting down with me today. This has been an absolute pleasure.

Good.