Compassionate Communication in Medicine with Amy Flanagan

Amy Flanagan has had a diverse career journey that led her to a unique role in medical education. Initially pursuing acting from a young age her passion shifted, leading her to the Uniformed Services University, the U.S. military's medical school. There, she played patients with different illnesses, aiding medical students in honing their diagnostic and communication skills.

Her enthusiasm for teaching through experience propelled her to become the director of the facility, a role she cherished until 2015 when she retired due to a diagnosis of narcolepsy. She continues to contribute as a part-time consultant, specializing in helping doctors improve their communication skills, especially in delivering challenging news to patients.

Amy highlights the need for enhanced communication training in medical education, noting that while it's present, it often gets overshadowed by other curriculum demands. She emphasizes the importance of doctors learning to convey compassion and empathy effectively, particularly in delivering distressing diagnoses or news.

Amy talks about the human aspect of healthcare professionals and the significance of providing support and guidance to navigate difficult conversations with patients. She shares anecdotes illustrating the impact of effective communication and the challenges inherent in delivering bad news. In her current role, Amy offers individualized training and support to improve communication skills. 

Drawing from personal experiences, including the loss of her sister to a rare illness, Amy emphasizes the unpredictability of life's challenges and the importance of accepting and preparing for difficult circumstances. She emphasizes the need for empathy and understanding in healthcare, acknowledging the emotional toll on both patients and providers.

Amy's commitment to improving communication in medicine reflects a broader societal need for compassionate and empathetic care.

https://www.buzzsprout.com/2104812/14515794 My episode on her podcast The Savvy Communicator. 

@savvycommunicator on all social media 

Transcript

[00:00:00] Amy: Of course, you love your patients. That's why you got into this business. You want to heal people and healing people isn't just fixing this problem. Sometimes healing them means being with them through something terrible. 

[00:00:14] Jill: Welcome back to Seeing Death Clearly. I'm your host, Jill McClennen, a death doula and end-of-life coach.

[00:00:20] Here on my show, I have conversations with guests that explore the topics of death, dying, grief, and life itself. My goal is to create a space where you can challenge the ideas you might already have about these subjects. I want to encourage you to open your mind and consider perspectives beyond what you may currently believe to be true.

[00:00:40] In this episode, I talk with Amy Flanagan, the host and producer of the Savvy Communicator podcast. where she discusses communication techniques that we can use every day. Amy and I talked about her beginnings in theater to her role at the Uniformed Services University, where she combined acting and medical training, starting off playing patients to coaching doctors and delivering sensitive news with compassion and empathy.

[00:01:06] She shares with us her personal experiences, including the death of her sister, and we talk about the importance of effective communication in navigating difficult situations. Thank you for joining us for this conversation. Welcome Amy to the podcast. Thank you so much for coming on. I was on your podcast already, but when we did our intro talk and you were telling me about what you have done for a career before this, I was like, this is fascinating.

[00:01:34] We need. to have more of a conversation about it. So thank you. I appreciate it and welcome. I am so happy to be here. Thank you so much for having me. Can you just start us off? Just tell us a little bit of background about you, maybe where you're from, if you want to share how old you are, anything like that.

[00:01:49] So we get an idea of who Amy is outside of the work that you do. 

[00:01:53] Amy: Okay. Uh, my name is Amy Flanagan. I'm 50 years old, and it's funny because I was born in Washington, D. C., and now I live very close to Washington, D. C., so I came back for graduate school and never left. I love the city. I started out from a very young age deciding that I wanted to be an actor.

[00:02:11] And that's what I did through high school. And that's what I did through college. And then I had to earn some money. And so I worked for a while with some different theater companies and then I really needed to earn some money, you know, and I worked at a couple of places and then went to graduate school for theater as well.

[00:02:29] And when I got out of graduate school, again, the theme of earning money came back into it. And I started working for the federal law enforcement academies around D. C. They hire actors to help their students learn how to do interviews and things like that. And I thought, this is wonderful. I get to run around and act stupid and get paid.

[00:02:51] Paid, again, was what I was thinking. But it didn't take very long before I really became enamored with the process of teaching through experience. And instead of just staying in the classroom, giving people a chance to really try things and try them again and try them again in order to get comfortable with doing something so that when they go out in the real world to do it for the first time, it's not the first time, they have that experience behind them.

[00:03:16] And I started to work at a place called Uniformed Services University, which if you hadn't heard of it, I've never heard of it until I started to work there. And it is the medical school for the U. S. military. They have their own school. And I started doing the same thing there. They hired me as an actor to play patients with different types of illnesses so that medical students could come in and practice learning how to take a history.

[00:03:39] Practice doing parts of the physical exam. Practice giving people a diagnosis and saying, okay, you have the flu. This is what we're going to do for you. And I just loved it. And I stayed there and I started, like I said, as a standardized patient, but I worked my way up to a trainer and eventually I became the director of the facility and just loved it.

[00:04:01] It was wonderful. But in 2015, I had to retire because I was diagnosed with narcolepsy. And that became something that I couldn't really balance on a daily level. So now I'm a part time consultant, and I do more work one on one with doctors that are having communication issues. But one of the things that I teach a lot is helping doctors learn how to break bad news to patients, whether that's an unfortunate diagnosis, Or unprepared death.

[00:04:33] Things like that. It could be something simple, which is saying we thought this was the flu, but actually what it is, is a respiratory disease. And you're going to be okay, but we have to treat you in this manner. All the way up to, this is going on, but You're not going to be okay. Your family member's not going to be okay.

[00:04:50] And teaching them how to do that in a manner that's compassionate and thorough, not only for the patient's sake, but also for the doctor's sake as well, because it's absolutely hard on them too. 

[00:05:01] Jill: I love it that you do that work. Partially because that's one of the, I don't know, I guess probably the most negative feedback that I hear about doctors is they don't communicate well, especially around things that can be, like you said, it's difficult for them to have to sit somebody down and say, Hey, I We can't do anything else, you're gonna die.

[00:05:23] I am compassionate for them that that must be a very difficult thing to say to somebody. Also, that's part of their job, I would think. Yeah. So having somebody like you that can train them and help them get better at having this conversation. It seems really needed. Didn't know that they didn't do that, really, in medical schools.

[00:05:46] Amy: Oh, yeah. As far as the idea of communicating well is certainly present in medical schools and they have mnemonics and they have tutorials and all kinds of things. But honestly, in my opinion, four years is too short for medical school. They really need to have more time because so much is crammed in that communication is one of the first things that goes by the wayside.

[00:06:12] And they'll be like, okay, you have to tell the patient this by the way, communicate it. Well, go. And I don't say that to imply that doctors, especially teaching doctors, are inconsiderate, are not compassionate in any way. It's just something that gets gently left by the wayside, if that makes any sense. And it really wasn't until the last 15, 20 years or so that communication began to be taught seriously in schools as part of their simulation activities where they come in and practice with patients.

[00:06:47] Now there are very involved standards that a student has to pass and then a doctor has to pass on the boards in order to get their final check off for being a full doctor. But even that I think still isn't enough. I think there should be more and more chances to practice, more chances to explain and confront the things that will hurt them as well as the patient.

[00:07:16] Because when I talk with doctors, a lot of the time what I tell them is, hey, of course you love your patients. That's why you got into this business. You want to heal people. And healing people isn't just fixing this problem. Sometimes healing them means being with them through something terrible. It doesn't mean that you have to cry with them.

[00:07:37] It doesn't mean that you have to feel that terror that your patient might feel. But it does mean that you can be with them and you can help them through it. And that can be uncomfortable. 

[00:07:50] Jill: Absolutely. Nobody, well I shouldn't say nobody, there's probably some people that enjoy it, but most people don't enjoy having to tell somebody something that really causes them to feel pain.

[00:08:02] Absolutely. But you're right in that, I like the way that you said it, and I don't remember exactly how you just said it, but where it was like your job isn't just to fix somebody's problem, part of your job is also to be there with them. When nothing else can be done and to sit and support them and hold that space.

[00:08:22] And even for me, when my grandmother was on hospice and she was dying, she had had the same doctor. When I was a child, we used to go to his office. I only ever remember her going to see this one doctor and she was dying. I called him and I, I mean, she wasn't like actively dying, but like, what was the last couple of weeks of her life?

[00:08:44] I called him and basically the nurse in his office was like, well, she's dying, so he's not going to see her. And I was like, are you kidding me? Oh yeah. I was heartbroken. I think even though there's nothing he could have done, just his presence there would have made me feel better. Would have potentially, I mean, she would have known it.

[00:09:08] And the fact that he just was like, nope. Not going to do it. I was like, Oh, Oh, this is so not cool. No, really upset about it. 

[00:09:18] Amy: Oh, that's awful. 

[00:09:19] Jill: It was awful. And the crazy thing too, he's Mennonite. So I felt like being a man of God, like especially even more. And again, he'd been our doctor for at least 30 years.

[00:09:30] Oh my. A really long time. And I think that was one of those first moments when I was like, Oh, okay. Well, doctors, they are just human, but also they're not all they're cracked up to be. I think a lot of us do this. We put them on pedestals. Absolutely. Right. Because they're doctors and they know everything.

[00:09:47] And we think that they're doing what's best for us and for our family members. And in the long run, that's not. The truth. Yeah, it's not always completely their fault, right? Like if they're not being taught these things in medical school, how are they supposed to know it, right? Unless they go out themselves, right?

[00:10:06] Maybe somebody would come because I guess that's the thing. Like if I was a doctor and I said to myself, Hey, you know what? I want to get better at doing this thing. Is that when I would call you? And be like, this woman helps me get better at communicating. Is that how your job works now?

[00:10:20] Amy: That is pretty much how it works now.

[00:10:23] And I want to just jump back to what you were saying is that it's so true. Doctors are human. And if you're not taught something adequately, you're probably afraid to do it. And if you're afraid of something, you're going to avoid it means you're going to shove it off on somebody else. Or you're going to grit your teeth and get through it as fast as possible.

[00:10:39] Or not do it at all, which has happened sometimes. I have a story about that that I can tell you. But yes, now what happens is that sometimes a person's supervisors will call me up and say, Hey, We have this intern, we have this resident, their patients are giving feedback on the resident that, hey, he's not really coming across as compassionate.

[00:11:01] He or she, I should say, or they. Sometimes the intern or resident will call me up themselves and say, hey, can I work with you? Because I noticed you said X and Y about my technique and I'd like to get better with that. And I'm really fortunate in that right now I'm working mostly with military doctors and they have.

[00:11:21] an office of graduate military medicine that I work through. So if somebody wants to work with me individually, I'm really fortunate to be able to go to someone and say, yes, what are you concerned about? What are you worried about? Let's figure it out and get it so that you don't feel that way anymore.

[00:11:41] And it's just, it's just a wonderful thing to be able to do. 

[00:11:44] Jill: I really am so happy that you do it. I didn't know that people like you existed. I really didn't until we met. Yeah. Virtually. I didn't know. 

[00:11:53] Amy: I think there are very few of us out there and one is my personal circumstance with being part time and second is having all the experience working at the simulation center for uniformed services and because I did that for about 20 years and being able to say, okay, This is how we would do it in the curriculum, we're going to bend it to fit you.

[00:12:14] But hopefully there will be a lot more of us very soon. Because that's the thing, when you are a medical student, you graduate in June, and you're a full blown doctor in July. And so much is expected of you. And you're working 24 hours, 36 hours at a time. Everybody, including experienced doctors, agree that it's not the best way for things to be handled.

[00:12:38] And it certainly isn't the best way to teach somebody, but nobody's come up with a better idea yet. So we're doing that. And there's lots of wonderful things that go on in medical schools. And for the vast majority, they are graduating people that do have compassion and do want to do good and do want the best for their patients.

[00:12:59] When you don't fit into that mold. You might need some help and having help ready to go, no matter what kind of work you do is something that again, it makes it easier on you and it makes it easier for the people that you work with. 

[00:13:11] Jill: And I like to believe that about people that most people, I think, want to do the best they can.

[00:13:17] Right. They, they're 

[00:13:18] Amy: right. I want to believe that too. I really do. Yeah. 

[00:13:22] Jill: Doesn't mean that I always. Feel that way when I meet some people but yeah, I try to remind myself that I don't know what happened to them that day I don't know what happened to them that year. I don't know what happened to them in their lifetime So they're doing maybe the best they can do but especially when it comes to doctors I like to think that They go to medical school for the right reasons.

[00:13:44] I do wish that medical schools and doctors could be a little bit more, I don't know, realistic, maybe not the word that I want, but this idea that death is not the failure that they're kind of taught that it is. 

[00:14:00] Amy: Yes. 

[00:14:00] Jill: Right. Because then I think it leads to people going through treatments that don't necessarily really help them.

[00:14:10] And it leads to more pain and suffering than just letting the disease do what it was going to do and allowing them to experience what they had left of life versus being in a lot of pain and a lot of suffering. That's one of the things that I'm hoping for in the next few years is that we shift a little bit of that.

[00:14:32] And it doesn't mean that I think people need to just give up and say, well, you know what? It's fine. They have the disease. We're just going to let them die. I don't think that's right either, but we need to find a better way to do it. But again, I'm not a doctor. I'm just somebody that came in from the outside and was very surprised to see some of these things.

[00:14:51] Amy: But that's so important to be that person coming in from the outside because you see and experience things differently. And, you know, doctors are surrounded by doctors and other health care providers all day long. And getting that outside perspective is so valuable. And that's one of the things at the simulation center where I worked, we tried to emphasize to both the people portraying patients and the students is that this is going to be one of the only times you get feedback from a patient.

[00:15:21] Most of the time in the real world, they're upset with you about something. They just don't come back. then you're not aware of it, then you don't get any chance to change it. So coming in as an outsider with your valuable perspective, you're going to be able to give that to people and you're going to be able to help them change something if it needs to be changed and go on from there.

[00:15:44] You could absolutely help improve the professional lives of doctors. It doesn't matter that you're not a doctor, you still have perspective that's just as valuable. 

[00:15:52] Jill: And sometimes I tell myself that, and then I feel so intimidated of like, why would they want to listen to me? But I think viewing it that way of they're constantly surrounded by other doctors and nurses and people that have the same experience.

[00:16:09] And so me coming in from the outside, it could be valuable to some of the ones that maybe will want to listen to me. We'll see. And actually, I really want to hear more, too, about the work that you did. What is it called? Uniform? Uniform Services University. Uniform Services University. I had no idea that that was a thing.

[00:16:30] Yeah, I didn't either. Yeah, it doesn't surprise me now that I know about it, that it's a thing when you're working as somebody that is going into this experience, right? And you're pretending that you have this disease or that you were hurt. What does that feel like as a person day in and day out going through this process and hearing this news, even if it's not?

[00:16:53] real, right? You're still being told, like, you're gonna die or we have to cut your leg off or whatever it is. Did it impact you? Were you bringing that home with you? Were you able to keep it separate? Like, how did you kind of navigate that? 

[00:17:07] Amy: That's a really excellent question and that's one question. That we tried to mitigate at the Sim Center as well, because though a lot of people that work there are professional actors, there are some that would be all shaky if you suggested that what they were doing was acting.

[00:17:23] And then they would go out and play this hard alcoholic or something like that beautifully. They'd be like, Oh no, I'm not an actor. And even professional actors aren't immune from getting that sort of overwhelm from doing something over and over. And so we'd have to keep it in the forefront of what they were doing.

[00:17:43] So example, people that play depression cases. We would try to bring them all in afterwards because it does have an effect on you. It has a biochemical effect on you. We'd bring them all in afterwards and either watch a funny video or tell stories or do things to kind of give them a little boost before they went on about their day.

[00:18:04] If you were doing a case of breaking bad news or a case of a bad diagnosis where you might have to portray some serious emotion, we would make sure that nobody did. too many encounters in a row that they got a break where they would be able to go and read a book or text their friends or whatever in order to have a break from that.

[00:18:24] For me personally, what I found was that as the day would go on, I'll just give you an example. There's a case I did. It was an ectopic pregnancy and the student comes in and if they ask all the right questions and they do the right physical exam, they should know this is an ectopic pregnancy. This patient needs to go to surgery.

[00:18:44] But if you don't ask the right questions, and you don't do the right physical exam, it looks like appendicitis. And you think, okay, we got to get your appendix out. No problem. And as the day went on, the more, if I got misdiagnosed, quote unquote, throughout the day, I would get angry. I would start to feel this is my life here.

[00:19:04] This is my potential reproductive future here. And you're getting it wrong. Did you not study? Did you not do these things? And you'd have to take a break. And breaks were built in. And they were built in for two reasons. One is so that when I was feeling that way or anybody was feeling that way, you get a break, you get your head back.

[00:19:20] Two, because we were evaluating students and studies had been done that showed that standardized patients did not do very well. if they had to do three or more encounters in a row, that their accuracy would go down. And as standardized patients, you think, well, they're not a medical person. Therefore, they can't evaluate students.

[00:19:40] That's wrong. They can evaluate up to 94 percent accuracy, which is better than a lot of doctors. Actually, the break was for the students benefit and our benefit as well. Doing a case that's really emotionally heightened, like Breaking Bad News, it was very hard not to take it personally when a student came in and didn't do well.

[00:20:02] Because when you hear something like, I'm very sorry, but this is stage four cancer, And there's nothing we can do. It's very hard to not take it personally, to not internalize it somehow. Not the, it's stage four cancer part, because you're able to keep that separate. You're like, I know I don't have that.

[00:20:23] It's somebody saying there's nothing we can do. It's like, are you giving up on me? What does that mean? If I can't get help from you, where am I supposed to get help? I'm not, I'm not getting any. That was the part that is, is really easy to take home. That makes sense. 

[00:20:39] Jill: Yeah, that totally makes sense. And I think that really adds An interesting perspective as well as to why it's so hard for doctors sometimes to say to somebody, look, if we give you this treatment, it's actually just going to make things worse.

[00:20:54] It's not necessarily going to make things better because if you're sitting across from somebody and you're saying to them, I'm sorry, there's nothing else we can do. And they're like, what do you mean? There's nothing else we could do. And they're potentially crying. Their family members are there. They're crying.

[00:21:09] Yes. Of course, if there's something that they're like, well, I know it's not going to help you, but I'm not going to say that. I'm going to be like, well, we can try this thing. We can try this treatment. Maybe it's, you know, something that they're testing. They don't even know that it works yet. Some people are willing to try anything at any age because of course it's easy at 45 for me to say, If a doctor said to me, you have stage four cancer, there's nothing we could do.

[00:21:36] I'd be like, get the hell out of here. You need to try something. I have two kids, try something, anything. I don't care because if I'm going to die anyway, try it. But if I was 85 or 90, that might be a different story. Then I might be like, all right, sure, let's keep me comfortable and let me go in peace. So yes, I could see how then that adds to even more of the doctors.

[00:21:59] I don't know if uncomfortable is even the right word, but inability to communicate that sometimes to people. 

[00:22:05] Amy: Yes. Can I share a little anecdote that I think really brings out what your story is? So I had a sister named Elizabeth who at age, 34, 30 was diagnosed with stage four colon cancer. And it had been a terrible journey that they didn't find it for a very long time.

[00:22:22] And I remember I'd gone with her, she was going to get a colonoscopy, and this was going to be the deciding factor and hopefully tell us what was wrong. And when we came in afterwards, she said, to us. Elizabeth said to us, it's cancer. And I said, well, what does that mean? Because I was in shock. I didn't know.

[00:22:39] It was a doctor that I had seen also just for regular stuff said, well, it's stage four colon cancers. And stage four is a surgical stage, just means the kind of surgery that we have to do. And we thought, Oh, okay. All right. We'll get in there and do that surgery. And he was very, very kind. And I feel for him to this day, he could not tell us that this was going to probably be what Liz would die from.

[00:23:06] She was so young. We weren't even in a separate room. We were in a little colonoscopy bay. And And to his credit, he immediately leapt on the phone, he found the surgeon, he got somebody off of vacation to do that. And he went and saw Elizabeth that weekend and apologized to her and said, I'm so sorry that this is happening to you.

[00:23:26] I never thought it would. And I hope that that helped as well. But yeah, I mean, it was a miserable experience for all of us, but for him too. And I don't know if he wasn't trained in it or just didn't expect it with her and so he was as shocked as we all were. Yeah, but it was very, very hard. Very, very hard for him.

[00:23:46] Yeah, and I'm sorry to hear that about your sister. Thank you. 34 is very young. It was very young. She lived until she was 37. So about, about two and a half years, but all the chemo was palliative. They said, we can do this so that you will live longer if you want to try this, but you know, it would be very tough.

[00:24:05] And it was, but she has two small children and she wanted to live as long as she could for them. 

[00:24:10] Jill: And again, that is a deciding factor for some people. When you have children, You do want to do everything that you can because you want to be around for them. 

[00:24:22] Amy: I 

[00:24:22] Jill: get that. That's a really human thing. And even with your background, because you probably know more than a lot of doctors do, right?

[00:24:30] Like doing the work that you did. I'm sure. Because I'm thinking when you talked about going in and describing your symptoms, you had to learn those symptoms. It's not like you made it up. You were like, well, I'm just going to go in and say, I have this thing. Like you had to learn the symptoms. So you probably know a lot of information about a lot of different things that go on.

[00:24:50] And it was still hard for you to hear this about your sister. 

[00:24:54] Amy: Oh yeah. It's just, it's the principle. It's like, well, it would never happen to us. Oh, that's a terrible thing that happens to somebody else. That's never going to happen to us. Especially what it turned out was that her case was very unique.

[00:25:07] The diagnosis was very unique that it doesn't happen to a lot of people. And it happened to her and it happened to all of us. But I knew as we led up to getting this final diagnosis, I knew things were not good, but she had blood tests that came back okay and other tests that came back okay, which added to our shock when they finally came back with the diagnosis, but I knew things were not good.

[00:25:35] In fact, one of the first times I was ever a standardized patient, the doctor said to the group of students that were with them, they said pain and weight loss. is a bad combination. And that's exactly what she had going on. So I was really worried and I didn't talk to her about it because I didn't want her to feel upset or worried.

[00:25:52] We trusted that the doctors would get it right. And I think all the doctors were acting in her best intention and they got it wrong. 

[00:26:00] Jill: Yeah, that is so difficult. And as much as I talk to people all the time about their experiences with death and dying and grief, there's still always that little part of me that inside is like, but that's never going to be me.

[00:26:13] Yeah. Even though, logically, I know that's not true. There's still that part of me. That's like, that's not me. It's never gonna be me. And maybe that's just a protection mechanism that humans have. Or else maybe we couldn't exist in a world where there's death and dying and suffering all around us. Maybe it would just collapse us, right?

[00:26:35] If we really were able to fully understand that it could be any of us at any point. I don't know. 

[00:26:42] Amy: You're so right with that. The thing is, we think it couldn't be us because up to this moment in time, it isn't us. We don't have a reference for saying, well, what if this happened to me? You don't. You try to grab mentally, like, well, what is this?

[00:26:56] And you don't have it because it hasn't happened to you yet. And I think you're right, that it would be very hard to function if we could see, you know, the procedures and outcome of every possible way that death might come into our lives. It's very, it's very tough. Like you said, it's very tough. But it's a natural thing and we shouldn't feel bad about it, but just, it just is what it is.

[00:27:19] Jill: Yes, it is definitely something that we shouldn't feel bad about, even though there's still that part of me that feels like we could all probably have more compassion for others suffering. And also realizing that it is very easy for us to judge people, right? Like, well what did you do wrong? Did you not eat right?

[00:27:40] Were you not exercising? Did you drink too much? Did you smoke? Like, we look for all these things that they did wrong that caused this to happen to them. 

[00:27:49] Amy: Right. 

[00:27:50] Jill: When really sometimes we can do everything right. And still have bad things happen. 

[00:27:55] Amy: Mm hmm. There's a quote from, I don't know if you're a Star Trek fan, but there's a quote from Star Trek The Next Generation where he said, It is possible to do everything right and still lose.

[00:28:06] So that is not a failure, that is life. And I've kind of kept that quote with me in my heart because it's true, it's true. And yes, we want, and especially doctors, they want a reason. They want a reason so they can say, this is how it happened. Because I know how it happened, I have a better idea of where it's going.

[00:28:26] and where we're going to be. So that's not a slight on doctors. It's just, of course, that's how they have been taught to think. That's the clinical procedure. That's what they're going to do. And that's the right thing to do. But sometimes there isn't a reason. Sometimes things just happen. 

[00:28:41] Jill: And I actually, as you're saying that, that like doctors are trained to look for the reasons.

[00:28:46] My grandfather in the early eighties. cancer. And it spread to his brain. But he was a very heavy smoker because back then everybody smoked. Everybody smoked. Right? I mean including doctors in doctor's offices. Like everybody smoked everywhere. So even if you weren't a smoker, You were constantly surrounded by it, and so I'm glad that they were able to say, why are all these people getting this lung cancer?

[00:29:13] Like, let's figure it out. Because now smoking is down. People my age, I don't really know that many people that smoke cigarettes. A handful. But not many. Most of the young kids I see now, you don't see as many teenagers smoking. Of course, they're vaping, which is not great. And I guess now there's some other new thing that is getting nicotine in their systems.

[00:29:36] Either way, it is good that we are able to look at it so that we can prevent some of these things. But I think there's that difference between Looking at it to try to figure out how to stop it from happening to other people versus blaming the person for what's happening to them. That doesn't seem productive to me, but I don't 

[00:29:59] Amy: know.

[00:29:59] No, that's very true. And it's certainly not anything that achieves the goal that you want, whether you're a doctor or another health care provider, or whether you're the patient. The doctor saying, well, the reason that I've been searching for is that you did this bad thing. Everything kind of shuts down after that.

[00:30:20] The patient is going to leave going, I did this bad thing, therefore I deserve what's going to happen next. And nobody deserves to be ill. and possibly die from that. In a sense, I want to say, well, nobody deserves to die because we look at death as being a terrible thing, and we want to forget that it's a natural thing that's going to happen to all of us.

[00:30:41] But when something comes along that is going to cause death earlier, we want that reason. It can be very easy to blame the patient and say, You smoked. You drank. You went skydiving. I don't know. It could be all kinds of things like that. 

[00:30:56] Jill: I think, too, how when you go to the doctor and they ask you all the questions, like, How many alcoholic drinks do you drink?

[00:31:02] How much do you smoke? What kind of drugs do you take? There are studies that are done that people lie anyway, right? They're lying on there because they don't want to feel shamed. They don't want to feel blamed. They don't want to feel like they're bad or that they're doing something wrong. And so, yeah, most people lie.

[00:31:23] Yeah. Again, I understand we're humans. We want to try to protect ourselves from being shamed and guilted. But I just, I had thought that was interesting when I heard that. 

[00:31:34] Amy: It's very interesting. And I'll tell you, there's a secret doctor formula that says whatever a patient says about how much they drink, they take it and double it.

[00:31:43] Now, does every doctor in the world do that or it's not? I could never speak to that, but I do know from working on particular cases and working with faculty members that develop the case. That is being built into their learning that people may not want to admit these things, especially if they're alcoholic and out of control.

[00:32:00] People don't want to admit that. You have to consider it in their health for their benefit. You have to, you have to consider that. Nobody's come up with a better way of asking, how often do you drink? And hopefully someone will at some point, but for right now, that's where we are. with that is that we can just hope for honesty and try to make it as simple as, well, you know, I want to make sure that you're breathing correctly and I want to make sure that you're doing this and I want to make sure about the things you ingest.

[00:32:31] Just like I ask about your diet and if you're getting vegetables and if your cholesterol is a certain number, I'm going to ask if you drink, I'm going to ask if you smoke and hopefully it'll become easier. 

[00:32:40] Jill: Yeah, because I don't think I've ever lied on there, but I'm not a good liar, right? I never really have been.

[00:32:46] So now I'm thinking, oh my gosh, I wonder if doctors were like, she says she has maybe two glasses of wine a week, which means she probably has this much. And I'm like, but no, I actually really did only have that much. Now I actually don't really drink at all. So when I say zero, they're probably like, well, she probably has a little bit.

[00:33:03] Yeah. 

[00:33:03] Amy: Maybe just a little bit. 

[00:33:04] Jill: Oh, okay. I don't know. It makes a lot of sense, though, because you're right. They're doing it for your benefit, where if they are seeing maybe some signs of something that could potentially be alcohol related, but you're saying, well, I only have Mm hmm. A glass of wine every night, and it's like, but I don't know, your tests are actually saying something different.

[00:33:26] Amy: Yes, they do have to consider that. Now if you came in because your toe hurts, probably they're not going to ask you about your alcoholic usage. But if you come in and you say, my stomach hurts, then they are going to ask because that's one of the things that can really hurt your stomach, even if you don't drink very much because a lot of times things are not your fault.

[00:33:47] Mm hmm. Even though it can seem like it is the way that they ask questions. 

[00:33:52] Jill: I'm glad you shared the story about your sister. I think it's helpful for people to hear the realities of these experiences. That, again, we're potentially all going to lose somebody very close to us unless we die first. 

[00:34:05] Amy: Yes. Yeah.

[00:34:06] Thank you for having an environment in which I can talk about her. That's the other side of death and dying and losing somebody is that often you need to talk about it a lot more than you're able to because, you know, people ask, how are you doing? Be like, I'm doing okay. Because we don't often have the ability in this culture to say, we'll sit down because I want to tell you exactly how awful it was.

[00:34:30] We slide over. that and we protect people from those worries and we protect them from going through the same thing that we went through because it was awful and we don't want to put that on anybody else. So I'm glad that I was able to mention her a little bit and hopefully that will help somebody.

[00:34:47] Jill: Well, I'm glad you are too. And that's part of why I do the podcast is to give people a safe space to talk about things. I like to think that I wasn't uncomfortable before this before I became a death doula. But I'm sure I was a little uncomfortable if somebody said that their sister died or their parent died.

[00:35:06] I think it's more that I wasn't uncomfortable. I just didn't know what to say. I didn't know that sometimes not saying anything. It's really the best thing, just being able to listen and letting somebody talk about it, because it does seem like, especially if it is somebody that's younger, right? If you say like your parent died at 90, people are 

[00:35:26] Amy: Sure.

[00:35:27] Jill: A little more willing to Kind of have that conversation. But if you say that somebody was younger and you know, how hard it was and how painful it was, they just, they don't know what to say. And so it makes them so uncomfortable, this inability to say something to fix it or make it better for you or whatever else.

[00:35:47] So they shut down the conversation. 

[00:35:50] Amy: Yeah, there's a whole book entitled, I don't know what to say. That's about breaking bad news and death dying. I will see if I can find it for you. I don't know if it's still in print, but there's probably copies around. 

[00:35:59] Jill: Oh, I'm sure. I love thrift books, which I'll plug in there for thrift books just because I love them because you can find all kinds of books.

[00:36:08] And I love getting the old copies of books because a lot of times people have written notes. Oh, yeah. which I really love. So I buy all kinds of books on thrift books because you can find all the old ones there. I'll definitely look it up on there and add to my massive library. 

[00:36:23] Amy: Yeah, 

[00:36:24] Jill: which it's funny because my husband asked something about like, well, what book am I going to take on vacation?

[00:36:29] It's like, I don't know, because I don't really read books now, unless they're about death or dying or Greece. That's kind of it. Not exactly beach reading. No, and he was like, maybe you should try reading something just for pleasure. And I'm like, honestly, the last couple times I tried, I either got fiction books that turned out to have some big death story in there.

[00:36:48] Oh, 

[00:36:49] Amy: Yeah, 

[00:36:49] Jill: it's like somebody recommended the book, Not Your Perfect Mexican Daughter, I think, right? And so I found a copy. It was at a used place. So I picked it up and I was like, Oh, I heard this was really good. And the first line was like, so my sister died. And I was like, Oh, Here we go. And the whole book was basically about her sister's death.

[00:37:09] And it was a really good book. I mean, the person that recommended it, they were right. It was an excellent book. But it was just funny where I was like, of course, I'd find another book about 

[00:37:18] Amy: death. When that's your work and when that's your art. It's okay to want to get away from it, especially on vacation and take some time to reset.

[00:37:25] Jill: Yeah, we'll see what happens. I'll try. I'll try. But I do. I love this work. I love having these conversations with people. And so I don't feel like it's work sometimes when I'm just like out and I'll go out to a party or something. And when people hear what I do, they'll want to tell me their stories about their family members dying or whatever it is.

[00:37:46] And I actually really love that. Because what else are we going to talk about? Yeah. I don't want to chit chat about something that in the long run doesn't really matter. It doesn't really mean anything to me. But yet hearing your story and being potentially that person that can sit there and witness it and hear it and not shy away and not get uncomfortable.

[00:38:07] I'm here for it. It's all good. Yeah. 

[00:38:09] Amy: It's so important. There are very few people like you that are doing this and hopefully there will be more, but people desperately need to be able to sit down and talk and be like, my father died. Want to hear how bad it was? Let me get a drink because here we go. And that's something that a lot of therapists can't do.

[00:38:29] A lot of family members can't do. And to be able to say that to someone who is prepared and not afraid. is so important and I think such an exquisite way to give communication to people. So I think what you do is so important. 

[00:38:47] Jill: Well, thank you. And I think what you do is really important. Again, I love that you're doing it because I have seen that there's a need.

[00:38:54] So it's really nice to have randomly met somebody. I think, I don't know, you put up a post on a Facebook page or something. I thought I was just going to come on and talk to you about, like, how I talk to people about death, having no idea about what you do. So that worked out really well. 

[00:39:09] Amy: Oh, listen, well, it's so funny when we did our little, you know, meet up before the interview.

[00:39:14] And you said, I don't know if I should be doing this. I'm not a doctor. Listen, I hope you walk right in there and say, I am absolutely the person to do this, to talk to doctors, to talk to nurses, to say, Hey, there are things that you can accomplish in different ways. And what I recommend is that you say, of course, this will help the patient, but this will also help you because they don't get a lot of that.

[00:39:35] And you're absolutely the person to be doing it. 

[00:39:37] Jill: Well, thank you so much. And I appreciate it. Because again, if nothing else, I love to learn things and I love to read things. And so it would be something that I'm sure will help me just get better at my job. And I absolutely love reading. Learning things to just help me do better to help me serve people better.

[00:39:57] I don't know. I love this kind of work This is yeah, I'm so glad you came on today Is there any laughing you want to leave us off with do you want to share any anything your Instagram handle or anything? You don't have to share anything. Whatever you are. 

[00:40:10] Amy: Sure No, people are welcome to join us at the savvy communicator podcast all of my handles Our at Savvy Communicator, that's Instagram, that's Facebook, that's LinkedIn.

[00:40:22] And I would love to see you on our show. And we are just about to post an episode with a fabulous Jill McLennan, who gave us a lot of really good insight on how to talk about death and dying. So I hope that you will join us for that and take a look at other episodes and see if those interest you as well.

[00:40:41] Savvy Communicator, all one word. Perfect. 

[00:40:44] Jill: And I'll put links in the show notes to all of your handles. And I think this will probably come out after my episode. So I'll put a link to my episode on your podcast in the show notes of my podcast. 

[00:40:57] Amy: Wonderful. Wonderful. 

[00:40:59] Jill: Well, thank you again, Amy. I really appreciate this.

[00:41:01] This was lovely. I really enjoyed it. 

[00:41:04] Amy: I really enjoyed it too. Thank you for the opportunity. I had a great time. 

[00:41:07] Jill: Thank you for listening to this episode of Seeing Death Clearly. In next week's episode, my guest is Sue Burns, who shares her journey of uncovering and preserving her great great grandmother Mary's diary from the late 19th century Iowa farm life.

[00:41:24] She discusses the realities of infant mortality rates at that time and Mary's experiences with grief and managing the family farm. After the death of her husband, we talk about the importance of preserving family histories and how we need oral history to fill gaps left by written records. Join us as we explore Mary's life and the value of preserving personal stories from the past.

[00:41:48] If you enjoyed this episode, please share it with a friend or family member who might find it interesting. Your support in spreading the podcast is greatly appreciated. Please consider subscribing on your favorite podcast platform and leaving a five star review. Your positive feedback podcast to others.

[00:42:04] The podcast also offers a paid subscription feature that allows you to financially support the show. Your contribution will help keep the podcast advertisement free. Whether your donation is large or small, every amount is valuable. I sincerely appreciate all of you for listening to the show and supporting me in any way you can.

[00:42:21] You can find a link in the show notes to subscribe to the paid monthly subscription, as well as a link to my Venmo, if you prefer to make a one time contribution. Thank you. And I look forward to seeing you. In next week's episode of seeing death clearly.