extremely powerful in a lot of ways this kind of hunting you so you tell stories you tell individual stories of people that you were with on their deathbed and very different people and at the same time you put in your observations and your feelings which makes it very compelling and i think the thing that for me was  the biggest take away for me was that you are with people probably the most intimate moment in their lives they are getting ready to leave their bodies and their bodies are falling apart and then all the emotional stuff and whatever it is so it takes a very special i think and intentional kind of person to be with them and it then i'm going to read and ask for your reactions so you said it's my belief that the stories will enhance people's understanding that even though there may not be a cure there can be great healing within the dying process so can you say some more about that in one of the stories or a few of them i've i've demonstrated the story of someone who accepts being vulnerable for instance and then they allow their families to take care of them where in their in their normal lives they were life they were very independent and in charge i have rick that moraine yeah i remember the who in aurora and he just want to do it his way was a very wonderful loving strong man and when i finally had a little talk with him and impressing upon him that there's no longer separation between he and his family and he this body that is giving the gift for his family to let that to allow them to take care of him would be a wonderful gift for them and sometimes you'll see when you talk to someone and when you talk to someone at the end of when they're at the end of their life it's not a long discussion it's  effective guy and his identity is that had gone and so he was the one who insisted his family wanted to take care of him at home he insisted on going to hospice he insisted on them not seeing him and they would hang around waiting for glimpses of him through the door and it's heartbreaking because this is the time where you know it's time to let go of the other identity and as you say let his family contribute to him and what i saw  admired was that you had that conversation with him and he did allow them in yes and that's that was very courageous of him because i had felt as though i crossed the line a professional line with him but i had to have i have when you care for someone who is very vulnerable you have to know yourself and he was he was tuning into a fear of mine which was wasting time and not recognizing love when i saw it and so i felt very intensive and i was intense with my conversation with him because a lot of it came from my own my own thing about my my my fear of wasting time so i have to win every so it's kind of wasting time that precious moment where you could see such possibility for you know at the end of his life and and it also could have gone another way and he could have died without that final connection with his family and there are certain symptoms and signs we see within the physical sassaman that we know when someone will be approaching coma a coma toe state and there's a little window of time they have where they don't realize that this is the only time you have the symptoms you're having when we decide to the very specific assessment that it isn't the medications or something else affecting their especially their mental state and say which is very i think profound and hard for some people to understand so there were a couple of things one is you can't come into their space and bring your own agenda whether it's a religious agenda or how you think they should die and so i think that's what you were alluding to when you said you know i kind of crossed a boundary but you saw an opportunity and it wasn't as if you went in and slammed him verbally or whatever you know you just kind of woke him up for a moment  but the idea is that you have to embrace what ever wherever they're at and step into their space yes and you also use the words you know if you have sympathy that kind of no longer allows you to be of service because sympathy is kind of comes from your own fear you sympathize and then your own fear comes into the space where as if you come from love it's really compassion comes from the space of love which would then allows for who they need to be in that moment i'm so glad you got that yes yes it's because a lot of people say to to me how do you do that work i am too sensitive i'm too i would cry all the time i would feel sorry for them and then when i learned that compassion is so different than sympathy because that's about them when you are as yeah and kind of reflect that yeah yeah yes and so yes when you just said was so wonderful and eloquent i'm glad you got that from the yeah and but then there was the example of because it's not you're human you know and you get triggered and so there was the case of the guy who was a pedophile and he was dying and i think some of the staff had strong feelings about that i mean talk about stretching compassion you know because we're human beings and so what can you say about that ho step into that space well it's always easy to love someone who's loving you back great it's nice and and i would have what happened whether the volunteer googled his name and found him on the megan's list and lists and and they did everything change with him with with the with especially with the volunteers and when you when you feel they come from compassion judgment it could be there are so many layers to every human being and perhaps this is the only time he's being accepted and loved in a safe environment and we owe that to it's usually you have a lot of frustration you get burned out yes and i think i think that would be exactly the result burn out because your coming in with your own agenda and your own opinions and it's not to say that that's easy to do because we have very strong feelings about people who have done certain things but almost like stepping outside of your opinions and just coming from the heart of compassion for another you know it's like mother teresa somebody asked her you know how do you pick up these people who have sores and boozing and whatever and you know and on a human level i can imagine it's pretty daunting and she said i just look at them as jesus in his most distressed form so it's kind of taking it out of the personal and creating just another human being sure i mean i go to the visual part of they were want kind leveling loving lovely man and broken in his own way but that didn't mean you couldn't be have compassion for him for all those other things he was on this he was on this earth yes he did it and he had a ls and and ls seems to be developed and people who work are just courageous and magnificent and when i say that no highly decorated soldier in the trenches has anything on my als patients i mean but he has he had built a deck and i what had happened with him i had put a caregiver and there a there sade who was quite unconventional but she was she's my buddy and when i have a really complicated cases and she's available i will try try to get her in there and his wife was having a real hard time with the with just accepting or denied accepting or even doing the daily tasks of caring and so when i got her in there and there it was quite magical because his father had died from a l s and he knew sort of what what perhaps would be going on with him so those those those magic moments when your your heart is so broken yet it's so open that it just i mean sometimes i'm the first person crying and then when i get to the house i'm the first person just witnessing though when you would mean but with him we took him out to his i was called a two thirty in the morning by that nurse aide she just come on i'll get over here mckissic so i went over i said what is that she could have done everything that i did and she said she went out to the deck and said that's the reason we have to get and to see his last moment full moan because he loves them so as well those giant harvest moon that magnificent so we she was magical the nurse aids who do all that hands on care home i can as so wonderful and we got him out there she i just did what she told the doctor who right it was that he was like bundled he looked like a big pile of clean washed it was just bundled up and we and we dissent there witnessing something to create an open space around it because it is their death their departure where are you at do you fear death i mean having worked with so many people now i don't know  hospice that gave you that or did you already have that i think i work with hospice because i was an intensive care unit nurse are teaching nursing med surgeon are saying before that everything is to get them to survive and so yeah i guess it's about fixing fixing anything surviving yes i wanted to read something from the book you said how does one find quality in their life while living among the devastating changes of terminal illness i've cared for two scientists who worked on the manhattan project wealthy socialites a professional body builder and homeless people who have told me they were happier now than they had ever been  any other time in their lives they've told me it was exhausting to be them and many said this was the first time in their lives where they could pay attention to the cool breeze coming through the window the long lasting scent of chicken noodle soup and the fragrance their loved ones left behind after a visitation i thought that was so profound that it was exhausting to be them and if we look at our daily lives it's exhausting to be us in a lot of ways and we're so you know we've got this identity and then we've got all the things we're say we're committed to and everything else but there's there's a lack of beingness and it's not to say you can't just be and be in a meditative state throughout everything you do but most of us aren't and so we've got to keep up the facade and we've got to keep up the stories and we've got to keep up the impressions we want other people to have of us and we don't want to be vulnerable and when you finally know i don't have time for this i could see where there might actually be a huge sense of relief and actually embracing the moment yes someone famous recently died with his name ask or something but he's was saying it was so nice not watching the news anymore because if you feel as though he had to save the world and be involved in exactly and that's not to say we should escape i think it just gives us an awareness of bringing more for me cell in their being to remain alive are finally have said mating to the process it's quiet now i breathe with them the breath is shallow like the end of a moan after making love if i've managed their symptoms well they no longer have the sounds and sense that terrify their loved ones they gasping gurgling and sighing at the end of the exhalation and the oily laughable scent of separating cells and closing out as they did manish the mouth open says joss relax and one or more eyes may gently slowly close the heart quiets less work to do now my hands remain under and over their heart the hand on their back between the shoulder blades absorbing the beating the slowing the quieting i close my eyes and imagine strength and peace i place my mouth next to the ear and whisper good work go with love thank you and sometimes i add say hi to my sister mary jane wow so  is a challenge there and then how do you meet the challenge of the needs of your patient which sometimes isn't in alignment with what the family wants and while it's really happening happening a lot now with people googling every symptom and then the dynamics of really changed the family when we admit someone to hospice there's a team involved that specializes in end of life care and the social work opponent usually has a really wonderful assessment of the family dynamics even when i go to admit someone a loved one say their children are their adult children maybe i can tell where everyone seated around a loved one what their roles are within the family and every family has a dance that they've done and they perfected and i am not there to change the dance but i am there to make sure that the patient is is emotionally and physically comfortable so when you have a family that is in direct opposition to the the patient sometimes you just have to let it be and sometimes just families have that argumentative disagreeing battling it out and then i can bring bring the rest of the team in the possible that they have or if they're religious with their chaplain are hospice chaplains are amazing and see what see what their fear is about this whole experience just a couple of weeks ago you had these two women in their sixty's and their mother wasn't as of carrying you know dying and they said do everything we don't want our mom to mommy to die or  fine use that but but so we just have to explore the family dance that they've done yeah and keep our patients safe really and sometimes we can show them what compassion looks like  sometimes people are afraid to touch the dying and sometimes they don't think that they're still the sense of humor and there's their personalities are still there and i'll ask things and and there are many times they'll say to one of the to one of us i can't believe you just did that you just went over and gave my dad a kiss and made him laugh or something so to speak you have to get to know what the family the style of the family and feed the person and i think what happens very often is you have this relationship and then the person is ill and dying and then you see them as and ill and dying human being rather than the person that they were with this added so as you say you know that you start to be careful you don't touch the you miss the opportunity of making them laugh and you may even make them laugh about death and you know i think we're just not skilled at it  and i think it's also we have the opposite to someone who doesn't like to be touched a lot is dying and all of a sudden people are touching but that sometimes the conversations we have with the patient alone is very different than the ones we have with the families because opportunity at that stage to say things you talk about you know you mentioned about every every family has its secrets but you know if i had some points not waiting till the deathbed to address those secrets the whole family dynamic could have changed in a transformational kind of a way and so this whole idea of waiting till the to say these things is kind of a wake up call for us it is i think under the guise of protection someone you're actually confusing them and i tell parents sometimes if the children are very very adamant about getting history there or their parents history i'll just mention to them well you know to you it's personal to them it's their history so perhaps you may want it but you don't have to do anything right but yeah the family secrets that that come up sometimes sometimes they're blown apart because there can't be maintained anymore right there was the woman who in the in the book clar yes yeah so that was pretty wild witnessing that and being jealous part of adequate great that he actually did that for himself because she was the one who he really wanted to be with yeah i don't know what the collateral damage seemingly ugly but if you listen to it that's sometimes how would a family or two people respond i mean i i've been cursed out and then asked to come back the next day write that kind of thing so i think we have to just lighten up on ourselves the dying have so much to teach us about it like you were saying before be sponsibility is compared to obligations and and don't wait don't wade to if you can if you don't know what to say to someone i had a call last night what i say to my mother who's dying and i said if you don't know what to say say that say i don't know what to say all i know is i'm scared my heart's broken and confused and that's on it and then oh yeah that's real so don't wait to make things pretty don't so many people will not call someone because they don't want to treat them any differently than they usually treat them right i think that is a very different so all right so we're at the end of our time i want to thank you i encourage people to check out your book i found it a very compelling read and not just compelling in that it was interesting but it's very  thank you for joining us