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>> Hi I'm Jennifer Blomquist.

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So that's why there's the phone number at the bottom of the screen.

The phones are open now.

They'll be open until eight o'clock.

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So don't be shy.

Give us a call any time we're going to go ahead and jump into our topic tonight which is palliative care and hospice medicine and we have a returning a guest it's been a few years but Dr. Jeffrey Brown has been with us before and he specializes in palliative and hospice medicine.

So thank you for coming on.

>> My pleasure.

Appreciate it.

We were talking before the show.

It's not really the kind of topic most people bring up because it's it's sad for a lot of people to think about end of life care, especially for somebody who has a disease for which there's no cure and it's terminal.

>> You know, it's it's the same reason that that we put off doing our will and doing our advanced directives and um you know, it's it's hard to face our mortality even though we all know that that we're mortal and oftentimes it it's it's not until we're really faced with you get a diagnosis, you have an issue that's that's progressing.

We're a family member with with a with an illness that that is life threatening that you often are forced to be thinking in those terms.

>> It's always easier an ideal to do it ahead of time because when you're in the moment of of facing a daunting road ahead, there's lots of emotions that that obviously make it make it different very difficult to to have a lot of a lot of well-meaning people asking you to make very difficult rational decisions at a time when when you know emotions rule one if you've got siblings I mean I know my mom experienced this she's one of eight children and when their mom was dying my grandma was dying from pancreatic cancer.

Sadly there were there was a lot of tension as well.

I mean everybody was sad but people who normally would have been very levelheaded and nice to each other or not it kind of brought out the worst in people.

>> It was it was very challenging.

It is we say this a lot that you know, at times when when if this was a TV show or a movie that you know, it would bring people together really tends to to unmask or create dysfunction.

Yeah.

And it's just that that you have there's strong emotions.

>> Yeah.

One of the difficult the most difficult things is to make decisions when you're in that position and making a decision for someone you love.

Our brain has very strong defense mechanisms and in the pain of loss is just as real as the pain you'd get putting your hand on on a stove burner but your brain won't let you do that right.

And it also doesn't want you to experience that pain of loss and it can twist things around where you think you're making decisions for for your loved one when really you're making decisions to avoid losing this person that you that you love and that's that's what makes it so so it's such a difficult difficult situation to to make make those kind of decisions at that time.

>> And you know, I've heard people say a number of times because with all of my grandparents nobody's death was sudden.

It was a long term illness.

Three of the four died from cancer and people would say well at least you had a chance to say your goodbyes and that was probably easier.

Not as sad.

I didn't agree with that as opposed to yes, I had the shock of if somebody has an accident or dies very unexpectedly but I don't know if the grief is in the know and I think in obviously the majority of people the majority of us will die of chronic illness or or a few of chronic illnesses as opposed to as opposed to a sudden death.

But I don't think the time to prepare is probably more helpful perhaps for the for the patient the person who's dying rather than I don't think that that those who are those of us left behind to grieve it it's any easier I think whether that's that's a sudden event or or whether that's something that you can prepare for , I don't think we're ever prepared, you know, to to to lose someone.

>> No, no.

And it yeah.

it is it's very sad no matter what the circumstance.

So but this is one area of medicine where family members or loved ones or caregivers are very involved.

It's not because sometimes the patient may not be able to communicate with you and I would say that that that a lot of the focus of the care um obviously when we're treating symptoms we're treating the the a person who's who's suffering from an illness but everyone around them is suffering in a different way and much of the the the focus in in end of life care particularly you know, in the hospice care is actually supporting family members, caregivers through through through those those those symptoms that they're dealing with.

>> So I just want to clarify with people so hospice because you know, to me I've seen people have hospice care that comes to the house like you can or there are hospice facilities .

Is there will there be any reason I mean some people really just want to be in their own home and others I don't know.

>> Maybe they don't.

So how do you I would say that the hospice movement was all about allowing people to die in their own home so they come to the medicalising of the dying process.

>> I think when you're in the health system, you know it sometimes it can it's almost like being on a bullet train that that you know and express that's just you know, your skip and stops and and you just can't figure out how you're supposed to get off.

Yeah.

The having control having having having your loved one in their home and for many patients that's that's their goal.

The vast majority of of patients who receive hospice care die in their own home now that that their home can be whatever they call home.

It could be you know, they're they're a family member's home that they've been staying and it could be, you know, assisted living facility.

>> Retirement community.

Yeah.

And um but yes, there there are exceptions thank goodness other you know, not the rule where patients are having symptoms that are significant enough that it's difficult to maintain comfort in their own home and then an inpatient facility whether that's a hospice home or a hospice unit in a in hospital, um can can use different tools to to get better symptom control.

Um and in there are you patients families who when the time comes you even though maybe the plan was to be at home that they they do get to a point where where they feel overwhelmed and yeah one of the the the nice effects of being in one of these inpatient units is is that you know that daughter can be the daughter again and doesn't have to also be the caregiver doesn't also have to be the medication manager and the uh and it's uh and that's a good it's a good option to have um not every hospice agency has the ability to do that we're blessed and in Fort Wayne that we have more than one that can yeah.

>> I was going to say we've besides having a tremendous medical community I mean we do have a very nice hospice, a hospice availability and things to look into if that's what you need.

If you have any questions you'd like to ask Dr. Brown he's only here till eight o'clock and he's going to be talking about hospice care, palliative medicine maybe you know somebody in that situation or maybe just for peace of mind you want to know something just to be prepared for something in the future.

So there's a number again, it's we keep it up at the bottom of the screen for you throughout the show.

It's (969) 27 two zero two two toll free number if you put in 866- in front of their I remember when my grandma was dying and we probably got a call there was a somebody from hospice was there all the time probably called my parents three times.

She went around the Fourth of July and lived until around Labor Day weekend.

They probably called three times and said we don't think she's going to live through the night and then she did and then this will go on for weeks and it was very heart wrenching but there's no magic.

>> I mean her symptoms you she was still drinking water but nothing really eating how you know how long can somebody linger like that or how does somebody in hospice know this is probably the last day that they could live the the there are there are clues that that those of us who do this a lot, you know, know to look for that tend to make us think that that the time may be nigh.

>> Certainly when you're inpatient setting like that, you know the hospice home or in a hospital the staff would want to air on the side of calling family to let them know and so if they want to be there they could be there.

But you know, I also believe it's between the patient and the and the man upstairs if you believe in that kind of thing, it's there's a lot of spirituality.

There is there is not yeah.

We don't unfortunately have an expiration date tattooed on the back of our ear or something that would give us a clue but it's he said but there there is there common themes that we all tend to pass through regardless of of of what ultimately is is leading to our death, whether that's a cancer or heart disease, lung disease, liver disease we tend to have this goes through the same stages in this final few weeks most most people will lose the drive to eat or drink with with weeks left left to live, OK?

>> And I didn't realize it could on and so it typically once people have quit taking fluid in usually where we're just in a week or two at that point but I said there are people who who surprise me all the time but and then there are certain symptoms that tend or signs that tend to show up when we get to the point of the last day or two people have a regular breathing patterns.

Oftentimes they they will quit swallowing their saliva and that's since I've heard of them, especially cancer patients that lose the ability to swallow and it's hard to imagine somebody being able to live and not be able to swallow.

>> Yeah, yeah.

But it's you know and I think at the point when when you're in that last day or two it's often that they don't even sense there's there's anything in the back of their throat and and so you often you know, they'll have a Radley kind of breathing pattern.

Yes.

Yeah.

That that is kind of instinctively unnerving for for those of us on the other side, not something that bothers a patient per say but um but for family and caregivers there's like I said, it's instinctive.

It's kind of thing that makes the hairs on your neck go up and it's very uncomfortable something we often try to treat and decrease with repositioning or even using the medications that have have some effect on that.

>> I know you've been around people at the end of their lives the vast majority of your career but they you know, if somebody lost consciousness I know sometimes people say I don't even know if my mom knows I'm here.

They talk to them and and you know, they'll tell me, you know, some things that they really wanted to say.

>> But then some people will say but I don't know if she really heard me or he heard me or or knows I mean I would say that we don't really know.

Yeah.

If any if anyone hears us.

But I will say I've been doing this a long time and I've seen enough stuff to make me think that people are aware and I think that I don't get metaphysical here but I think it's on on a level beyond our corporeal understanding, you know that you know, not to invoke spirituality but I think that there's there people know there's a presence in that room even when you know in medical terms we'd say someone is comatose which by definition means unawakened, not aware that that clearly you know, whether that someone who's holding on for something and and the grandson finally gets in from his military leave and and sits there and you know, sits next to them and thirty minutes later they pass and sometimes it's the other way around where you have family that are holding a vigil and and at the point when everybody sides are going to go downstairs and get some lunch and and that's the moment when they're left alone.

That's when it when it happens.

So yeah, I think that I think people are absolutely aware there's a song about that.

>> I remember we sang that my high school choir softly I would leave you softly because I can't bear to you know it's from the cancer patients perspective is that I don't they want to pass away while their loved one was asleep.

>> You really want to see them go through what they Yeah.

Was inevitable.

So I don't want to interrupt you Dr. Brown but we did have somebody call in.

They want me to ask the question for them.

So Sue, thank you for calling in.

This is a good good question.

Is there any sort of special insurance or Medicare in that you need if you're going to put somebody into a hospice facility or a home for care?

>> I that is a good question.

>> Yeah, I would say that if we're in in the in the small package of end of life care that we're talking about tonight in hospice care hospice care is is is provided by Medicare for the most part at no cost to patients family.

>> Oh that's a that's a benefit of Medicare.

Now patients who are younger who don't have Medicare most private insurances will have a similar hospice benefit.

>> Medicaid certainly has a hospice benefit which is more relevant I think for for children.

>> But but in this in a way if the question is is as I'm reading this more about when, when and during the aging process and as people get debilitated maybe before you know, we're we're talking about true end of life.

>> But but that continuum then that's probably one of the biggest shortcomings we have in our in our health system today.

The Medicare does not provide any assistance and in paying for nursing facilities for what we would call residential care if someone needs to be in a nursing home for a short period of time for rehabilitation, some skilled need that can be paid at a short term the otherwise it's either out of pocket there are long term care insurance options that can help pay for those things and then but for most people who are in a long term residential care situation, they ultimately would would likely end up on Medicaid and Medicaid will pay for that.

But that's only available once folks have exhausted their their savings and their funds, which is again kind of a one of the shortcomings of of our of our system as it is maybe something even talk about, you know, is you're making plans or well or you know like you said directives you know, asking somebody you know who can answer for you if you become incapacitated.

So I want to thank you.

That was a great question.

Thank you, Sue for calling in and we have about maybe five or six minutes still left in the show.

So that's enough time to answer a question or two if you want to give us a call (969) 27 two zero again we're talking about palliative care and hospice medicine.

You were talking before we kind of were bringing the spiritual aspect of this and I can't tell you how many people and this was true with one of my grandparents too.

Once the kids said things like don't worry, we're going to we'll take care of mom or it was like they just had to reassure the person that it was OK to let go and and and then that person passed away and that was true with my with my with my grandpa.

I think he was just worried.

I mean my grandparents were married for sixty some years you know didn't want didn't want to leave and even my grandma had to tell him it's OK to let go I'll be OK but it was very very hard and he did pass away that that evening after being bedridden for weeks so it is much of the discomfort pain as you will that people experience with a terminal illness is is as much nonphysical as it is physical sometimes more and it's just those it's the the concern about what you're leaving behind, whether it's parents who have young children and the fear of abandoning abandoning them, you know, whether you know a spouse is going to be taking care of the it can be whether whether a family pet is taken care of .

>> Yes, yes.

Yes.

A lot of stuff to do that and and the fear of the unknown, you know, so there is there's oftentimes a patient with a terminal disease will will be grieving for their own life lost not because that they're not necessarily ready although that sometimes often is the case.

Had a patient tell me once that I'm not afraid to die but I'm not in a hurry.

>> Yeah, I don't think anyone well yeah.

Fear of the unknown and it's but you know that's right.

And he told me, you know I'm scared to death and you know, I don't know in the questions that come up about, you know what's next.

Yeah.

And and which are easy for us when when that time isn't coming up any very soon.

>> Right.

Hopefully not.

Well, I think you know, we were talking about the you've such a spiritual aspect to your profession and people if you're a person of faith I would imagine reaching out to somebody from your church or somebody from your faith.

I've heard of a lot of people that have said that was very comforting to the family and the patient.

>> Absolutely.

And I think there are there are chaplains who work with hospice is palliative medicine programs who can be extremely helpful.

>> And and I would say to that ,you know, there are there are plenty of of people in the world without that don't have faith who may not be identify themselves as religious but we're all very spiritual and even even folks who who don't necessarily feel that they believe in one higher power or they have a different religion than what the majority of us do.

Everybody has has those same spiritual challenges that they have to face when when when they're dealing with with a serious illness.

Sure.

That's a good idea.

You know, the holidays are coming up.

I mean I did see some Christmas trees on display at the store the other day and one thing that we've talked about on the show with a variety of medical professions and specialties is the holidays are a good time to talk about stuff like this not to be a downer but talk about, you know, illnesses or what runs in your family or you know, somebody might say, hey, you know, if I die tomorrow I you know, I don't want to wake or I don't I want a small it sounds I had but I'll tell you I think the greatest gift you can give your family is letting them know what your wishes are.

Yeah, I know it's it's you know, we're you know, advance directives wasn't our topic tonight but this is really something that that's intertwined.

We talk about how difficult this process can be.

>> A lot of it is is the pressure that's put on on when a group of family have to come up with a decision for what they think mom would want.

Yeah.

You know, if if ideally the best thing you can have is a health care decision maker, health care representative, someone who understands that you can speak with and say these are the things that I would want I wouldn't want to live like this but I'd be OK with dealing with these problems and sure.

And and so God forbid you're in that situation.

There's someone there who you trust to speak for for you.

Yeah.

And put your needs in front of you know, as we talked about their own emotions and and that's a which is a tough job but but that's that's yeah.

And get the time to do that is when when you're together it doesn't have to be as much of a downer as it sounds like you can be lighthearted about it or just you know.

Yeah my mom she's already told us just a couple of songs were forbidden to play at her funeral so you know she's yeah.

>> So we just at least we have that.

My mom has told me there's a couple of people there for the funeral so there you go.

>> Oh goodness.

So yeah, you know it's it's a part of life but yeah the holidays something to keep in mind when you see all your friends or relatives coming up in the next few months.

Of course the time goes so quickly, Dr. Brennan and we are at the end of the program.

>> So pleasure to have you back it is it is my pleasure any time I appreciate it and I'm sure I know I always learn a lot every week especially tonight was very interesting and hope you did too.

So tune in one week from tonight.

HealthLine is always on every Tuesday seven pm right here on PBS Fort Wayne.

>> Take care.

Have a great rest of the week.

We'll see you next Tuesday