The Art of Manliness - #171： The Dying Experience -- Myths and Answers

00:00:00.000 brett mckay here and welcome to another edition of the art of manliness podcast so death

00:00:18.620 dying it's not a topic we like to talk about in modern day life particularly in america where

00:00:23.760 everything is awesome and everyone will be eternally forever young but as a result of our

00:00:29.260 hesitation about talking about death and sort of coordinating off to the hospitals or the nursing

00:00:34.560 homes there's a lot of misconceptions about death and the dying process and a lot of myths and

00:00:40.120 consequently a lot of fear about it you know from my own experience i can count on one hand the number

00:00:44.660 of people close to me who have died and i never actually saw them go through the dying process i

00:00:49.300 saw them at the funeral when they've they're gussied up in the casket but this is all going to

00:00:54.580 affect us at one point in our lives either we're going to die because we get a terminal uh diagnosis

00:00:59.500 cancer or something like that's untreatable or we have a parent who's going to be dying of an old age

00:01:05.520 or we're going to die one day eventually sometime so it's be good to know what exactly is going to

00:01:11.920 happen to us physically emotionally mentally as we get closer and closer to death well my guest today

00:01:18.880 has spent her life trying to educate people about the dying process the dying experience her name is

00:01:25.460 barbara karns she's a hospice nurse as well as a writer and speaker and she goes around the world

00:01:30.720 around the country in america talking and sharing with people what the dying experience is like to

00:01:37.060 prepare them for this experience and how they can make the process more meaningful and less scary

00:01:42.360 so today on the podcast we're going to discuss dying what's it like the physicality of it

00:01:47.420 the psychology of it the the emotional aspect of it the social aspect of it and what we can do to

00:01:53.860 prepare to die today i know it sounds kind of like a downer podcast but i think you'll be surprisingly

00:01:59.900 be uplifted at the end of it because you'll have some knowledge that you can actually use

00:02:03.940 for an experience that we are all going to encounter at some point in our life whether you're

00:02:10.020 rich poor uh doesn't matter death affects us all so without further ado barbara karns and the dying 1.00

00:02:16.560 experience barbara karns welcome to the show thank you uh so can you tell us a little about your

00:02:30.320 history how did you become a hospice nurse well um i graduated from nursing school in 62

00:02:39.720 and thought wow i've made a huge mistake i should have been a social worker but in the 70s elizabeth

00:02:48.880 kubler ross came forward dr elizabeth kubler ross with how poorly we americans were treating

00:02:56.040 people who were dying in the hospitals and at the same time in england dame cicely saunders was creating 0.87

00:03:06.200 a uh a plan of care for people who were dying and she called it hospice well the idea was that

00:03:17.460 she would hospice would throw out all the rules that the medical establishment was using to take 1.00

00:03:26.040 care of people who were dying and that they would treat them differently you know um they could have

00:03:32.560 the dog on the bed and and it wasn't about the medicines it was about quality of life and i thought

00:03:40.000 this is what i want to do and so i got back involved in nursing and uh became a hospice nurse

00:03:49.540 and i was a bedside hospice nurse for oh five six years and then got into administration and eventually

00:04:00.900 uh was the director of two different hospices in kansas city i liked the holistic approach

00:04:08.840 to um to care that we're more than a physical body we're emotional mental and spiritual beings

00:04:17.440 and um the hospice approach dealt with all aspects of the person as well as working with the family

00:04:26.560 where our medical model is really just focused on the physical uh physical body and on the person

00:04:34.740 that's sick so we'll talk a little more in detail about what intel what exactly hospice care is and

00:04:40.140 what's involved with it um before we get there you talk about how there was a need for hospice care

00:04:45.220 because in america at least and probably in other western countries as well we started treating death as

00:04:52.020 a physical disease almost and we've become really uncomfortable with it we isolate it we send people 1.00

00:04:59.200 who are dying to the hospital and we just kind of forget it why are modern americans so uncomfortable

00:05:05.480 with death and was there a time in our history when death was more integrated into our daily lives

00:05:10.980 very definitely there was a time because grandma used to live at home you know we were multi-generational

00:05:19.360 all in one home um all in one home and when grandma got sick she didn't go to the hospital she went to 0.80

00:05:25.240 the upstairs bedroom and there she died and when she died we didn't call a funeral home we washed her

00:05:33.500 body and we put her in the parlor and family and friends and neighbors came to our home and paid their

00:05:41.520 respects well today um grandma lives in a senior citizen high rise and when she gets sick she goes

00:05:49.360 to the hospital and from the hospital she goes to a nursing facility and there she dies and because

00:05:56.920 we're not multi-generational all in one home we're scattered all over the world family comes in the last 0.94

00:06:05.700 week or so before grandma dies and then we see her in the coffin and in a funeral home and we have have

00:06:15.080 made dying as you said a medical event when in reality it's it's not medical dying is social it's a communal

00:06:25.700 event but we've we've taken it out of the home we've taken it out of the normal naturalness of it

00:06:35.520 and we've made it um something to be frightened of we've made it a pathology where in reality life is a

00:06:46.040 terminal illness you know we're all dying from the moment we're born um but we americans have

00:06:51.940 have become very afraid because all we have is television and the movies that show us what death is like

00:07:01.260 we're not experiencing it firsthand with those that we care about we'll talk about some of those myths

00:07:07.820 about death uh and dying in a bit but like what do we lose in the process i mean what have we lost in

00:07:12.780 the process of isolating our our loved ones who are dying you know into a hospital somewhere i mean i'm

00:07:19.520 sure the the individual who is dying loses something and i'm sure those who survive or also lose something

00:07:25.420 as well what is that exactly well we we're losing the normalness of it um and replace that normalcy with

00:07:37.040 fear um with the unknown and of course we're always afraid of that which we don't know or haven't

00:07:43.720 experienced before for the person that's dying there is a from a disease or old age there's a process

00:07:53.860 but most of us don't understand that there's a process to dying from disease or old age most of us

00:08:01.540 think a person's alive one minute and dead the next and so we start trying to take care of people who

00:08:10.340 can't be fixed as if they can be fixed and um then you add your fear of i don't want to talk about

00:08:20.960 this because i don't know what to say or i don't know what to do and we have an isolation that goes

00:08:28.640 um around the person that has the illness and is approaching death as well as an isolation

00:08:36.240 um with the family because not only do people not know what to say to the family um you know they

00:08:44.780 they are all by themselves they don't we don't talk about dying we don't talk about death it's

00:08:51.740 almost like if i talk about it then i probably will die so i better not bring it up right um so let's

00:08:59.900 talk about this one of the things i i found so enlightening about your book is you get into details

00:09:03.880 like the nitty-gritty details of what dying is actually like because you know i've i've probably seen

00:09:10.640 i'm gonna i'm gonna like off the top of my like i can count on my number of fingers the number uh on

00:09:15.460 my single hand how many dead people i've seen right and they they'd actually died um i've had

00:09:20.520 grandparents and that happened when i was a little kid so i have never actually seen someone go through

00:09:25.620 the dying process and so reading your book talking about what goes on was really helpful i mean it took

00:09:31.360 some of the mystery away from it uh so before we actually talk about what death is actually like or

00:09:36.140 dying is actually like what are some of the biggest misconceptions or myths that people have about

00:09:41.200 the process of dying well number one i think that um look at look at your movies how someone is saying

00:09:51.720 something very profound they're um giving this message and then you know they close their eyes and

00:09:59.340 their mouth and they're dead and people in the hours to minutes before death they're not saying

00:10:06.400 something profound they're generally non-responsive um and if they are talking they're probably not

00:10:14.640 making any sense because they're otherworldly so one of the misconceptions is that we literally think

00:10:21.020 we're alert and alive and talking and then one minute later we're dead and that that's not how it

00:10:29.840 works even um with what i call fast death is where you're in an accident or you have a heart attack

00:10:38.380 even then you're you're not saying something profound and then we also expect people to have their eyes

00:10:46.040 wide open and people don't have their eyes wide open when they die they have their eyelids open kind

00:10:53.600 of a half mask but not wide wide open in a blank stare um and then in the movies you you see someone

00:11:01.860 take their their finger and their um thumb and they close the person's eyelids well if you do that

00:11:11.580 their eyelids don't stay shut they open right back up but people don't know that i'm sure it freaks

00:11:18.760 them out when they come back yeah it's like you know i have to scrape everyone off the ceiling when

00:11:24.000 that happens because that the movies it doesn't happen like that are on television and that's our only

00:11:31.200 role models anymore because we're not at the bedside when someone who's dying uh and when we are

00:11:37.840 there we're there we're there because we're emotionally involved and when you're emotionally

00:11:45.260 involved you don't see what's really happening because if everything that you perceive comes

00:11:51.880 through your culture your role models your stereotypes your fear your belief system your experiences

00:12:00.540 and all of that distorts what's really happening okay so you've hit on some of the things

00:12:06.260 what dying is really like uh you're not keeping your eyes open there's usually not profound words

00:12:12.200 spoken at the very end but let's talk about what dying really is like i'm sure most people who are

00:12:17.360 listening unless they're doctors or they're working hospice as well they probably never seen someone

00:12:23.220 die or go through the process of dying so what are the signs that someone is beginning what you call

00:12:29.200 i think this is interesting you call dying sort of liking it to a birth labor um what are the signs

00:12:35.520 that someone's getting close to dying and why do you liken death to pregnancy labor okay i'm gonna i'm

00:12:42.600 gonna back up a little bit for labor okay and say that there are just two ways to die and we in the

00:12:50.840 medical profession make it really complicated and it's so easy you either die fast which is uh getting

00:12:58.120 hit by a truck or a heart attack or suicide or you die gradually and gradual death is either through

00:13:06.400 a disease or old age and gradual death has a process it doesn't just happen if it just happened it would

00:13:14.960 be fast death so that process of a gradual death or dying gradually begins two to three to four months

00:13:27.580 before death actually occurs and three things start happening one is a person's eating habits change

00:13:37.460 food is what holds us on this planet food is our anchor to this world and if the body's preparing to die

00:13:47.340 it doesn't want the grounding or that energy or the hold that food gives us and so the person all by

00:13:57.080 themselves will cut back and stop eating over this period of months and that's the hardest thing for

00:14:04.300 people to understand and it's not that the person doesn't want to eat it's literally they can't eat

00:14:12.320 they want to because they see what it does to us but their body is rejecting the food so gradually they

00:14:19.880 stop eating they gradually start sleeping more and over a period of months they will sleep more and more

00:14:29.320 and more until they're asleep more than they're awake and then the third thing is they start withdrawing

00:14:38.880 from the world around them they're not interested in their favorite football team they're not interested

00:14:45.560 in socializing and eventually on this continuum of months right up to death they're not they've gone within

00:14:54.860 and they're not um they're totally withdrawn and they're not interacting with other people and they're not

00:15:03.140 interested in what's going on on this continuum there comes a point one to three weeks before death arrives

00:15:13.620 where a person begins what i call labor we go through labor to get into this world we go through labor to

00:15:22.220 leave it and the labor to leave this world is harder on us the watchers than it is on the person that's dying

00:15:31.300 because they're so withdrawn and removed from their body that they're not experiencing anything in this in the

00:15:41.440 what we consider a normal way so when labor begins that's one to three weeks before death occurs

00:15:50.240 a person is sleeping almost all the time they're sleeping with their eyes partially open kind of at half

00:15:59.580 mass they're picking at the air or their bed clothes they're restless and agitated um there they may be

00:16:10.500 puffing and and you just see their kind of their lips coming together and blowing a little bit or they'll do

00:16:18.520 what i call start and stop breathing where you look at me and you think oh my gosh he just died he's not

00:16:25.720 breathing and then he starts breathing again start and stop breathing what you're going to remember

00:16:33.420 when labor begins is that nothing in the physical body works right it's all shutting down so you can

00:16:41.800 have a fever and fever goes with dying you're not going to do a bunch of lab work to see why a person has a

00:16:48.540 fever if they're in the dying process you're going to get them some Tylenol and cool claws um you're just

00:16:56.320 the body is shutting down then um part of their body can be hot another part can be cold you're just

00:17:06.000 going to remember nothing works right then there are changes that occur in the hours to minutes well

00:17:16.740 let's do days days to hours and that key change is called modeling and it's a bluish purple to the

00:17:25.900 hands and the feet and the legs and it's the body shutting down it's not the circulation isn't normal

00:17:34.520 anymore and then days to hours uh or hours to minutes excuse me hours to minutes a person is generally

00:17:45.440 non-responsive that means their eyes are partially open um they can be talking but they're not making

00:17:53.860 any sense but they don't respond to this world and you call their name they don't respond touch them

00:18:02.600 they don't respond and then um they start breathing like a little fish breathes just picture of a fish

00:18:13.480 and how it breathes in the water how its mouth open and closes well that's how they're breathing

00:18:19.640 in the hours to minutes before a person dies i think it's important to know that a person can hear you

00:18:28.420 in the moments before death and so you talk to that person even though they're not responding

00:18:35.700 even though it appears they don't hear you you talk to them tell them what's in your heart

00:18:42.880 say your goodbyes um this is an opportunity um to love them as they go from this change

00:18:52.360 from this world to the next and then their breathing gets slower and slower and slower

00:19:00.000 till they're taking maybe five or six breaths a minute and then they stop breathing

00:19:06.700 and then they're gone and after they stop breathing they may take one or two or three long long spaced

00:19:16.680 out breaths where you think they're not going to take one and they do and that's kind of scary

00:19:21.920 um but that's that's how we die and even a fast death will do the the hours to minutes um

00:19:34.340 that that i've just talked about and if you know what to expect then you know that mom's doing a good

00:19:42.980 job you know that she's doing what she's supposed to be doing that nothing bad is happening it's very

00:19:51.260 very sad when someone we care about dies but it doesn't have to be bad there is a normal way that

00:20:00.160 people die and it's not bad and it's not scary if you know what to expect right that was really

00:20:06.760 fascinating and actually i did not know that like i did not know that's how it went down um but also

00:20:12.700 what surprised me too i didn't know this and i actually i had a we're talking to a friend while

00:20:17.780 i was reading your book her father passed away from cancer and she went through the in details and

00:20:22.740 like it literally it followed everything that you said and one thing she's mentioned too and you wrote

00:20:27.560 about in your book is that you know talking about how your body is in is failing uh there's issues

00:20:33.240 of incontinence and you know you're going to be going to the bathroom in the bed you have no control

00:20:38.040 over it and it's like really messy and my friend's like she was changing sheets quite a bit for her

00:20:42.380 father and i did not know that that happened yep i and i should have mentioned that in the weeks

00:20:49.020 before death and for sure in the days to hours before death a person's going to be peeing and pooping 0.58

00:20:56.460 the bed because they're releasing everything in their body it's just letting go you know they're not

00:21:03.640 in control of their body anymore and there's also a point of confusion and we get really upset when

00:21:14.320 when they start in the weeks before death they start talking and they're not making any sense

00:21:20.080 and they're talking about hearing people and things that we don't see and we get real confused scared

00:21:28.320 um and so what i what that confusion is is think about they're sleeping more than they're awake

00:21:38.160 and so their world is not this world anymore they're talking about their dream world and so what's

00:21:48.300 what they're what they're talking about is making sense to them but not to us and if they're not

00:21:55.840 a danger to themselves falling out of bed or hurting themselves you don't have to give a lot of

00:22:01.880 medications you know listen to them you know they're telling you what their world is like um and this is

00:22:09.460 perfectly normal if someone gets very very agitated and and you think they're going to hurt

00:22:17.540 themselves um then of course you're going to get some held all or out of van or something to calm them

00:22:24.420 down but generally that confusion and you know people will say oh they're hallucinating and they're

00:22:34.260 delirious they're telling you what their world is like um we don't have to be afraid of that

00:22:41.500 um another thing that you mentioned i think it confuses some people it happens in some people

00:22:47.140 who are dying i've heard it uh two family friends who had died this happened to them but like the day

00:22:52.060 before they actually died they had like the sudden burst of energy oh yes i call it the calm before the

00:22:59.340 storm and it's it doesn't always happen but it happens enough that we hear these stories where

00:23:06.720 you know dad's been in bed for a month and he's been sleeping all the time and not eating at all

00:23:13.400 and he wakes up and he says i want a steak dinner and i want a baked potato with my steak

00:23:21.920 and call the kids and get them all over and we're going to the dining room table and he does and he

00:23:29.800 visits and he eats his food and what we think is the miracle has happened he's going to be better

00:23:40.420 all of our prayers have answered you know this is fantastic and 48 hours later he's dead and you think

00:23:49.300 what happened here now this is purely me it is not medical this is just what what barbara karnes

00:23:57.140 came up with um is i think that nothing operates in a void and as our physical energy starts with

00:24:08.820 drawing from our body that since there's no void a spiritual energy starts filling in that space

00:24:19.380 to help us get from this world to the next and some of that energy lops over into the

00:24:26.780 physical and we have this wonderful little gift of interaction but we're so startled by it and so

00:24:37.500 caught up in our own expectations that we off that we miss the gift you know we're in the forest and

00:24:44.120 we don't see the trees and it isn't till the visitation that we then start saying what in the

00:24:50.040 world happened i think it's just a little gift that some of us get interesting um so you write you said

00:24:58.880 this uh several times in your book that people die like they live what do you mean by that well there

00:25:07.260 are dynamics to dying and um one of them is we die the way we've lived dying is just really one

00:25:18.480 one more experience in life you know it's it's one more challenge that all of us are going to

00:25:28.220 experience and we are going to deal with that challenge in the same way that we've dealt with

00:25:35.640 any other challenge in our life so if i have run away from my challenges in living then i'll be in

00:25:43.680 denial about my approaching death if i've been organized and very much of a doer then i'll have

00:25:53.360 my dnr in place and i may even write my own obituary dying doesn't change our personality it intensifies

00:26:04.140 it so if i'm ornery and cantankerous in living then i'm going to be an absolute monster in dying

00:26:13.260 because it's not going to change who i am we don't suddenly go from being ornery to being a saint

00:26:19.660 it just intensifies our personality and so you know we use the word dying all the time and if you

00:26:29.500 think about it that's a misnomer because life is a terminal illness from the moment of ball up that

00:26:37.580 we're born we begin to die cells in our body die every day it's all a part of living and so

00:26:47.620 really the time that i talk about the dying process it's really our final act of living

00:26:56.820 it's a living process i thought that was there was no deathbed conversions

00:27:03.260 rarely yeah no all right so get it get it go get it get it right now right yeah you better do it

00:27:09.940 while while you're very alert and very grounded because as you're as you're dying there isn't

00:27:16.980 going to be time to say oh i've changed my mind so i think because we're so unfamiliar with death

00:27:22.900 and we like as a society uh we don't know how to act around people who are dying right and you

00:27:28.940 a friend gets that uh diagnosis of cancer and they only have six months um and you just don't know

00:27:36.480 what to do like what like you do do you talk about it like you would avoid talking about it because you

00:27:41.060 don't want them to like feel uncomfortable so how should we approach individuals that we know who are

00:27:46.720 dying how do we how do we approach them and talk to them and interact with them i think it depends upon

00:27:54.100 the closeness of your relationship with them you know if they're a neighbor and you only see them

00:28:02.040 when uh they're out walking and you wave and say hi you're not going to suddenly show up on their

00:28:09.920 doorstep and say i hear that you've got a life-threatening illness talk to me but if it is a close

00:28:17.180 friend that has been given a diagnosis of a life-threatening illness of course you're going

00:28:25.260 to want to support and be there with them i think that you look to first to the the depth of your

00:28:36.860 relationship with the person that's going to determine the depth of the conversation that you'll

00:28:44.140 have with them the other thing is um you want to see what they're comfortable with i i had a i just

00:28:57.320 wrote an article uh for the blog about a person who has a life-threatening illness and she said um

00:29:06.760 i i i am so tired of people asking me how i am and what i'm doing and telling me that i look good

00:29:17.040 she said i know i don't look good um i don't want what can i say to people um who who talk to me and i

00:29:27.660 don't want to talk to them and i said you can say to them you know i'm fine the journey's been

00:29:36.720 rough one and i don't want to talk about it you know be honest be open um so my key there is to be

00:29:45.460 yourself and if you have a relationship that's close enough with a person that you talk about

00:29:53.760 stuff then talk about this because you may be the only one that has approached this person um to say

00:30:01.880 let's talk about it so what about if you are the person right you go to the doctor and the doctor

00:30:06.400 says look you're you're dying you need to get your affairs in order how do you i'm sure there's there

00:30:13.240 might be people who are listening to this right now that that might be them and it might happen to

00:30:16.620 want some of us at some point we don't know um how do you how do you respond psychologically

00:30:23.700 that i mean how do you come to terms with your pending death very interesting because i'm not

00:30:30.960 sure we do um number one is in the months before death when we've been told by a physician that we

00:30:40.380 can't be fixed i don't think we believe it i don't think we can comprehend our own death you know

00:30:48.440 i don't think we can see that in the months before death it's like there'll be a cure though doctors

00:30:55.540 are wrong there'll be a miracle um we can't really see ourselves as being dead even though we can talk

00:31:03.340 about it but in our core we don't really believe it um then as this progression as we get closer to

00:31:14.880 dying um and we get to weeks before death then that knowledge that intellectual knowledge that we

00:31:25.280 haven't really grasped um becomes real and we know indeed we are dying we may not share it with anyone

00:31:37.780 but in in our very core we'll go yeah they were right i'm gonna die and what we also have at that time

00:31:52.340 is we're so disconnected from this world you know we've spent these months withdrawing sleeping more

00:32:02.100 eating less and so we're going within but we're not our our mind is more

00:32:12.820 within and it's not thinking like we normally think if that makes any sense at all it's really hard to

00:32:23.160 describe it but we in when labor begins the one to three weeks before death we really

00:32:31.160 don't care we just don't care we just don't care because we're just so withdrawn that um our emotions

00:32:42.120 are different and so that fear that we all are going to have every single one of us are going to be

00:32:52.320 afraid as we approach death because it's the unknown we haven't done it before we're always afraid when

00:32:59.380 we do something new and so that fear can be manifested in restlessness it can be in agitation

00:33:09.280 um when i see someone really really in labor and agitated i put that on fear can be lack of oxygen but

00:33:22.060 more than likely it's fear and i'm going to do relaxation techniques um they aren't at a point

00:33:30.660 where i can sit down and have a conversation with them but i can still talk to them because they can

00:33:36.680 hear me and i will try and help them relax and be more at ease so i mean it seems like uh when we talk

00:33:45.720 about hospice care now i mean is that what hospice care is all about i think when people hear

00:33:49.380 hospice the the typical image they have is like well it's sort of like uh they come to your home

00:33:54.280 or you go to a special nice little place where they just help you you know care for the dying but

00:33:59.360 what exactly is involved in hospice care and not just hot good hospice care i think you talk about

00:34:06.080 that in your book you make a distinction between hospice care and good hospice care right it's real

00:34:10.800 hospice is changing a lot and so it's it's getting more and more difficult to find a good and i put that

00:34:20.300 in quotes hospice um you you want for hospice you want some you want a hospice that has the same nurse

00:34:32.440 coming every time because you want to trust and develop a bond with that nurse because that nurse

00:34:41.340 is going to guide you through this experience and i think the key role for hospice is education

00:34:51.700 is to educate the family and those significant people that are going to be involved with that

00:34:59.500 dying time that process that they understand it so that they can put their fears aside it is hard work

00:35:09.740 it's 24 7 taking care of someone dying at home it isn't easy but it is a gift it is an opportunity

00:35:20.280 to have a closeness um that it's even hard to have words to describe how great you will feel

00:35:30.480 after you've done it but it's scary to think about yeah i'm bringing mom home and she's going to die

00:35:37.860 here in bed and how am i going to take care of her well hospice will bring in um nurse's aides who 0.92

00:35:47.100 will give her a bath and change the bed they will they have chaplains to give you spiritual guidance if

00:35:54.660 you want it um they have social workers who can help you connect with community services and just give

00:36:02.800 you the the emotional and and support uh through this experience they have volunteers that will come in

00:36:12.940 and and and help stay with you so stay with mom so you can go to the grocery store you know just to 0.94

00:36:21.280 um have a little respite time um all of this is what hospice can give the the really sad thing that i'm seeing

00:36:33.740 today is that hospice referrals come when a person looks like they're dying because we think hospice

00:36:45.180 takes care of people who are dying well when a person looks like they're dying is when labor begins

00:36:52.400 before that time in the months before death they look frail they look sick but they don't look like

00:36:59.440 they're dying well so we wait till they till labor begins and then hospice comes in they can't really

00:37:07.560 do anything for the patient other than teach mouth care and positioning because the person who's dying

00:37:15.660 is so removed from their physical body that you know you're just going to do physical care for them

00:37:22.920 and the family is in crisis because no one has said to the family mom's dying now we're talking a matter of

00:37:31.500 days or a week or so so they're in crisis if you get hospice when the dying process begins months before

00:37:42.460 death then the hospice people can work with the patient and help them live the best they can within the

00:37:52.480 confines that their body and disease has put them in and they have time to educate and support the

00:38:00.860 family i the key to hospice that they don't always have time to do is to teach to teach the dying process to

00:38:15.640 teach how to care for the person they're the support but it's all about education so i'm curious for our

00:38:24.800 listeners who are listening they might have parents who are you know in their 80s and 90s and maybe

00:38:28.940 they're healthy and going active they're strong right now but how do they know at which point they should

00:38:33.620 bring in hospice because their their parent is dying of old age okay old age is is a different ball game

00:38:44.220 in that old age okay in that old age a person will have the same signs of approaching death the not eating the

00:38:53.280 sleeping more the withdrawing but those signs occur over years instead of over months where gradual death

00:39:04.060 from disease occurs over months so there's a bigger timeline when you get to the point where

00:39:13.720 labor begins where the person who's just old is um sleeping all the time is not eating is totally

00:39:25.660 withdrawn that's the time you're gonna think okay now let's call hospice and see let's talk to the

00:39:33.660 physician and see if the physician will refer us to hospice because you have to have a physician

00:39:42.520 referral to be on the hospice program okay and if it's disease like it's just when do you know

00:39:48.520 as soon as you get the the diagnosis or should you wait a little bit when should you decide to bring in

00:39:53.200 hospice if the doctor has sat down with you and has said look there's nothing we can do um we don't

00:40:01.720 recommend any chemotherapy or radiation um we can't fix you um then i think that that's a very very

00:40:13.080 appropriate time of course you've got it i i need to know what the disease is sure um but for a lot of

00:40:22.880 of cancers um remind me to talk about dementia but like copd is unpredictable so that's harder to know

00:40:33.840 when to bring on hospice congestive heart failure if you're if you decided you're not taking all the

00:40:41.180 meds that that they have then that would be the time to call hospice and the cancers if you're not

00:40:48.420 having uh chemotherapy that depending upon what kind of cancer may be the time so you have to go

00:40:57.280 through your doctor um and that that's a whole nother issue too because doctors are often hesitant

00:41:05.620 to to recommend hospice they'd rather do the treatments they want to fix yeah that's what

00:41:13.080 they're taught to do and they're um my philosophy is just because you can do something medically

00:41:22.320 doesn't mean that it's appropriate to do it right because you might be able to extend someone's life

00:41:28.320 by a month or two but in the process it could probably do more damage or just make you really

00:41:33.760 uncomfortable or make everyone's life uncomfortable right right your your quality of life for living that

00:41:40.020 extra month or two um is it worth it if if you had known would you have traded the pain and the

00:41:48.640 sickness um and the debilitation uh for another month some people would say yes i would i don't care

00:41:57.040 others would say no you know i really would have rather been able to um interact with my family

00:42:05.700 more to not be so sick and debilitated to have taken this gift and that's what a gradual death is a gift

00:42:14.840 it's a gift of time a lot of us throw that gift away um and when we've been told we can't be fixed we

00:42:22.740 basically stop living but it's a gift an opportunity to do and say that which we want to do and say

00:42:31.860 um so that's another thing hospice tries to help people see that they've been given a gift and how

00:42:39.740 can we help you utilize this gift in the very best way so you talk about this you hit on this a little

00:42:47.160 bit in your book um and it actually is very timely uh it's the issue of advanced directives and living

00:42:52.780 wills and it's very curious to talk to someone who's seen people what it's like to be in the last

00:42:57.920 stages of life you have a terminal condition and you know there's putting feeding tubes in you and

00:43:02.200 hydration tubes you know my wife and i are trying to figure out okay what are we going to do like i'm

00:43:05.960 unconscious but i'm terminal there's nothing the doctors can do do i want a feeding tube i want

00:43:11.140 hydration so i'm curious i mean from your experience of decades of working with people and watching people

00:43:18.120 who have gone through the dying process right and have been sustained maybe beyond you know the natural

00:43:25.640 course of life because they've had treatment or hydration or feeding tubes is it is it worth it

00:43:32.640 or should we just let nature take its course is my like i don't i have no idea like because i've never

00:43:39.320 seen that process i have no idea what decisions i should make i think it depends upon the person's

00:43:45.920 personality um you know my my father-in-law my my stepfather said i want absolutely everything done i want

00:43:55.540 everything you know and if i'm on a ventilator you know i want to be brain dead for three days before

00:44:02.680 you disconnect the ventilator you know some people want to do absolutely everything but there are other

00:44:11.000 people that'll say you know look if you can't fix me then i i want to be able to to leave with

00:44:21.160 dignity and um i want to be able to live um as as best i can as long as i can but living is is the

00:44:33.020 operative word here i want some quality i don't want to just breathe and we have the medical capabilities

00:44:39.940 to keep a physical body breathing um for a long time after actual life and the interaction and

00:44:52.440 enjoyment of life is gone so you have to ask yourself what do i want and then if you decide you know

00:45:01.840 i don't want to just be hooked up to a machine and that's all just my body breathing then the natural

00:45:12.940 way we die is not eating and that includes not drinking and so you wouldn't want a feeding tube

00:45:23.320 um or ivs for fluid because you would be going against the natural way that a body dies and you would

00:45:35.360 just be prolonging now again you have to look at um the disease you know uh and how fixable it is

00:45:46.580 if i can have an active life by having a feeding tube and i'm not in the dying process but whatever

00:45:59.240 my disease is that i can't put food in my stomach but i can still walk around and i can interact then

00:46:09.460 yeah i'm going to have the feeding tube but if the doctors can't fix me and i'm in the dying

00:46:16.580 process then no i'm not going to have a feeding tube because that's just going to prolong

00:46:22.980 um my leaving this world and and my dying you're with me yeah i'm with you and and let me say about

00:46:34.440 fluids because this is so important um and that is the normal way that we die is being dehydrated

00:46:45.740 when we die when we're dehydrated the electrolytes in our bloodstream get out of whack and our calcium

00:46:55.440 goes up and we close our eyes we go to sleep and we don't wake up that's how we die and that's part

00:47:05.860 of the reason we stop eating and we stop drinking um so that we get to that place where we close our eyes

00:47:12.960 and we go to sleep and we don't wake up we interfere with that normal process and that easy gentle way

00:47:21.300 to die when we start doing ivy floods so it's not uncomfortable that's the thing i was worried

00:47:26.420 about like man is this going to be uncomfortable if they it's not okay it is dehydration dehydration if

00:47:33.300 i'm healthy and well yeah that's uncomfortable but if i am in labor in the labor of dying

00:47:42.780 one to three weeks before death dehydration is not uncomfortable always always always offer food

00:47:53.400 and water you always offer it right up to the last breath offer never deny offer but don't force

00:48:05.100 don't force so barbara i'm curious this has been a really just fascinating conversation um you know

00:48:11.620 i'm 33 and i don't i don't have any signs of a terminal illness um i hope living you know another 60

00:48:19.000 60 odd years hopefully but is there a way for me and other young people who are listening to this

00:48:25.200 like to start preparing for death right now or is it something you just have to deal with once it comes

00:48:29.900 right great great question the first thing that everyone should do is have um a durable medical

00:48:39.840 power of attorney assigned to someone you should have your your advanced directives

00:48:47.840 filled out so that if there is an accident um you can die be allowed to die the way you want to be

00:49:00.020 want to if you don't have an advanced directive then you're going to die the way the medical profession

00:49:07.080 wants you to but if you have opinions you don't want to be on a respirator for seven years um then

00:49:16.920 you've got to have an advanced directive and a durable medical power of attorney that's a must and then

00:49:26.200 the second thing you do to prepare for your death is you live your life the very best you can you

00:49:36.920 recognize how precious being alive is and enjoy the moment enjoy living and we get so caught up in our

00:49:48.540 durable wheel of routine that we forget to really the old cliche smell the roses you know um i think that's

00:50:00.080 the best preparation for for dying that there is is to live and enjoy the life that you have

00:50:08.300 well barbara on that note we're going to end this thank you so much for this enlightening conversation

00:50:12.720 where can people learn more about your work you can go to my website which is www.gonefrommysite.com

00:50:24.680 you can read my books you can ask me questions you know go to the website if you have questions

00:50:31.960 go to the blog section and ask me questions and i'll i'll write about it and if you give me an email

00:50:38.880 address i'll give you a personal response um and answer your question personally as well

00:50:44.500 barbara karns thank you so much for your time it's been a pleasure

00:50:47.580 oh thanks brad my guest today was barbara karns she's a hospice nurse as well as the author of 0.59

00:50:52.740 several works on the dying process she mentioned gone from my site it's a really great little book

00:50:57.100 you can find that on amazon.com you can find more information about her work at barbara karns.com

00:51:02.860 really go check it out even if you don't think you're dying or you know someone who's going to

00:51:06.860 be dying anytime soon really read this stuff because it really will enlighten you about the

00:51:11.200 dying process it was a completely eye-opening experience for me to learn this information and

00:51:15.560 i'm actually feeling not completely comfortable with that but i'm not feeling as uncomfortable about it

00:51:20.880 as before so again barbara karns.com

00:51:23.480 well that wraps up another edition of the art of manliness podcast for more manly tips and advice

00:51:30.680 make sure to check out the art of manliness website at art of manliness.com and if you enjoy this podcast

00:51:34.900 and you've gotten something out of it i would really appreciate it if you give us a review on

00:51:38.160 itunes or stitcher help us get the word out about the show and as always i appreciate your continued

00:51:42.900 support until next time this is brett mckay telling you to stay manly

00:51:46.660 you

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The Art of Manliness - January 23, 2016

#171： The Dying Experience -- Myths and Answers

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