Solving Healthcare with Dr. Kwadwo Kyeremanteng

Understanding Grief, with Heather Bousada

Episode Summary

This episode is ultra-valuable. In this epic episode, we tackle the difficulties of dealing with death and dying in the general public and among healthcare providers. We interview grief expert Heather Bousada, who has a master's in social work and has had additional training in bereavement and grief counselling. Take home points: 1. Legislators/Administrators: Take care of your employees! Grief is tough and unpredictable. People need time and space to heal. 2. Clinicians: Take time for yourself. Be with your family. Be with your loved ones. Be there for each other. 3. General public: Experiencing loss is hard. Be kind to yourself, be kind to others. Be present. Heather Bousada has worked as a social worker at The Ottawa Hospital for over 25 years. She has worked in ICU, palliative care and general internal medicine. She has been given 7 guardian angel awards for the compassionate care she provides. She has her BA in psych, BSW, MSW and Loss Certification through the Center for Loss, accredited through Colorado University. This episode is brought to you by the Resource Optimization Network: https://bit.ly/2IpStHL

Episode Notes

Dr. Alan Wolfelt's website:

centerforloss.com

Resource Optimization Network website: https://www.resourceoptimizationnetwork.com/

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Transcript for this episode:

Kwadwo:                             00:37                     Heather Bousada, welcome to the podcast. Thank you very much. Um, do you remember how we met? Gosh, that was a long time ago. Long time ago. Cause if you off the hook, I don't actually remember how we met, but I do remember how I met your husband. So to the listener, I was playing hockey game and he, he didn't know, he didn't know who I was and I, I approached him after the game after a hard fought game, which I think we won by the way. You guys were dirty. We were done. And I approached Chris and I said, Hey, I know your wife. And he's like, what did you just say to me? Oh I really know your wife.

Heather:                              01:31                     And then he did recognize you. Yeah. And that I explained that to everybody in the teleconference one. Yes. Unknowingly.

Kwadwo:                             01:40                     Well thanks for doing this Heather. It means a lot. And so maybe we could start off with what does a day in the life of the Heather Bousada look like, whether it's at the hospital doing what you do or in your work with grief.

Heather:                              01:57                     Yeah. Uh, well it's busy. It's very busy, but, uh, most of my time spent in the palliative care and the palliative care team and I also work in medicine and I've worked with you in ICU, but, uh, I, you know, my love and passion is palliative care and grief. So a lot of my days spent with the palliative care team, meeting families and patients and talking about terminal illness and impact it has on the family and their goals and their hopes and their dreams and basically what's happened to them and providing them support through that very difficult time

Kwadwo:                             02:32                     and crazy hours long days is that

Heather:                              02:36                     they're long days, they're long days. And sometimes I walk out of here pulling my hair and other times I'm like, wow, I feel like I was able to make a difference, you know? And that feels good. Yeah,

Kwadwo:                             02:45                     absolutely. One thing that I do appreciate that you guys do is, you know, I run into, I'll have a family meeting or two in the afternoon and I feel emotionally I'd, no, I actually just physically, emotionally and physically exhausted. You're doing this every day.

Heather:                              03:05                     Yeah. Well we all are in healthcare, aren't we? We're having really difficult conversations all the time. I don't think, I think, uh, one of my colleagues I was talks about if we only had a GoPro, I don't think people would believe what we go through in a day in terms of the conversations that we have. They're really detailed. Intimate people are at their worst times often, right? And trying to make really serious decisions, um, on, not sometimes for themselves, but oftentimes families are having to make that for their loved one and they, they're not sure what to do when they're feeling stressed and scared and they're not understanding how, or, you know, looking for support. And feeling in a world that's not part of their typical day. Right? Yeah.

Kwadwo:                             03:49                     Imagine you literally can't imagine being in the spots that and, right. Like, it's not something that you think about, dream about, it's just,

Heather:                              03:58                     well, people don't get practice at this right now, let's say to people like, it's not something you sign up for. And then all of a sudden you find yourself in the hospital having to have conversations about end of life, either for yourself or your family. And it's, it's a, it's, you don't get practice at it. Right? Yeah.

Kwadwo:                             04:15                     So we'll talk about some of the details of, you know, these difficult conversations in a bit, but you have a expertise in grief counseling and what are some of the things that you wish more people knew about the grieving process?

Heather:                              04:34                     Yeah, that's a, it's a huge topic. You know, it's, it is my passion and not only for patients and families, but expecially for health care providers. You know, one of my passions lately is that, uh, as healers, we need to be okay, right? We need to, we're doing some really serious work here. And if we're not understanding, you know, for having to go through our own grief and mourning through loss of a family member, you know, I see it all the time, I see at the hospital and people are coming to me and you know, oftentimes they feel like what is going on. You know, I used to be able to take care of five, 10 people. Now all of a sudden just taking care of one person, I feel like completely overwrought and I don't know what's going on with me. Right. And sometimes just having conversation about what it is and what's happening to them, to their body, to their mind, um, really kind of helps take off.

Heather:                              05:21                     Oh, OK. Cause we're not only a death denying culture, but we really, um, you know, there's that whole, whether it's implicit or explicit out there that you got to buck up, right? You got to buck up, you got to get on with it. Um, you know, have a stiff upper lip and you know, people are looked at as courageous if, Oh, they look so strong. They haven't even cried. Not everybody cries, but there's that sense of, you know, if you're only being strong, if you're, you know, just keep moving forward. But the interesting part about grief and mourning is it's not about moving forward. Everything we do in grief and mourning is about going backwards. So I mean, if you look at grief and mourning, and I think that's an important part, I, well one I want to start with a lot of my approach degree from morning is from dr Alan Wolfelt.

Heather:                              06:06                     He has a companion and approach and that's where my training is from. Um, as a social worker, I've also, I've gone down, there's a center for loss and life transitions and it's actually really a wonderful approach. And I, I heard dr Wolfville years ago and you know, just working in this field, I, when he talked about what grief and mourning as in going from the head to the heart, really it was what it's about. And it's that, um, that journey that we experienced that it just resonated with me, but it's throughout our system, right? So like if you look at brief families or the hospices, the Canadian military, the American military, they have also adopted this approach because it's a, it's meeting people not from the head and the intellect. It's meeting people with the heart, right? It's companioning somebody and companion is means to break bread and it's like sitting down with somebody and actually saying, you know what, I'm not necessarily the expert in what your relationship was with that person or what you went through, but I have some tools and I have an open, compassionate heart to be able to explore. What was that loss like for you? Right.

Kwadwo:                             07:11                     I feel like that's a big fear for a lot of people. It's like when you know somebody has experienced a loss, I can't count how many times people say, I do not know what to say to them. I do not know what to do. I don't know what to bring. I, you know, it's, it's awkward for awkward for some people, some people, and even as a palliative care doc that in certain circumstances where it's like, you know, I literally, I'm not sure what to tell this person.

Heather:                              07:41                     Yeah. And there's actually, we can talk about that a little bit later, but I think it's important to start off with like, you know, there's a lot of jargon out there, you know, brave man grief, mourning, like people throw out the words, right? But it's really, it's important to understand what the concepts mean, right? So that you can make some sense of it. So when you're looking at at, for instance, bereavement, it's a loss of a loved one. But what, what's really fascinating about the word is it actually means that the Latin root word of it means to be torn apart. So, um, you know, it's amazing whether it's here or people would call me when I was doing my private practice with grief counseling and in some shape or form, they would be describing that their world has been blown apart. Right. Um, and that's basically what it is, is that your world's been torn apart.

Heather:                              08:28                     But the, the, the grief is important cause it's the grief is there are internal thoughts and feelings. So unless you're a sociopath, you're gonna feel that loss, right? When you love somebody, I mean, grief and love are the flip side of the same coin, right? Cause if you love somebody, you're gonna feel that loss. So it's the thoughts and feelings. But where we get stuck is people just have that feeling, right? They have that feeling, but they're not sure. So they're not sure how to process it. Right? And we don't get taught that and everybody's teaching them to, Oh, just move on. Right? But where the real work is in the morning, right? And that's the part that, um, that I tried to help people understand and, and how to kind of go about doing that. Like the morning is the outward expression of that grief.

Heather:                              09:11                     So emotions need motion. Um, so the more that you, it's a social, a shared response to loss. Sometimes it can be specific to one's culture or rituals that you might do. But unless you're sharing that loss and expressing it and um, and I see it all the time with patients and families, once you get them to start talking about that relationship and who that person was, you can see the movement, right? It's a natural unfolding. You know, people think of it as like mental health. It's grief and mourning is a natural thing that we all go through, right? Unfortunately we like to avoid pain and suffering, but we will experience it and it can't get people around it. You got to go through it. But in that journey is as a really kind of beauty in it in terms of recognizing what you've experienced and how you then integrate it. I mean, grief is, if you really look at it, it's, it's moving from one of physical presence, um, to one of memory. That's the ultimate shift that what you're doing in the morning work, right? So again, you're moving that from physical presence to one American memory and you're integrating that into your new life, right? There is no new norm. There's a new normal now, right? You can't go back to the old normal as a new normal. So you're integrating that.

Kwadwo:                             10:28                     Wow. So there's a lot there. So one thing actually, so Heather maybe talk a bit about what to expect when you're going through that process. Yeah. Obviously there's going to be a lot of distraught pain, you know, there's that new normal as you described, but what are some of the things that people might expect?

Heather:                              10:57                     Yeah. Like for yourself and other people. Yeah, and that's what I find fascinating is um, people don't understand, like people think, assume it's a, it's just an emotional response, right? But it's the totality of your whole being, right? It affects you physically, cognitively, socially as spiritual ritually. And especially if, if I make reference to the healthcare workers, we need to be game on, right? So like as yourself, as an ICU doctor, you need to be there. You need to be present. But if you're going through a lot, us, you are, um, not only physically your body, you get extreme fatigue. Uh, you exhausted your appetite. You know, 80% of people lose their appetite, 10% gain another 10% that are neutral sleep disturbance. You know, so often people will tell me, you know, they're quick to go to bed to sleep cause they're so exhausted, but they wake up frequently, right?

Heather:                              11:53                     Um, so you're not getting a lot of sleep. Your immune system's down, right? Cause you're in this critical state, like you're in this hyper arousal because you've got this in either an impending loss or a loss, right? So, um, physically it's affecting you emotionally. You've got like multitude. There's no, you can find many different feelings at once and it comes in waves, right? Um, and cognitive is, it was interesting part, especially with healthcare is that healthcare workers is you, you know, we multitask, right? We're constantly multitasking and, and life and death. Like you're making life and death decisions. Um, and you all of a sudden you're, and it's, there's a lot of research on it and uh, people will start to, uh, you'll find it's difficult to concentrate. Um, it more irritable. Uh, the multitasking often goes right out the window. Um, so all of a sudden you're like, wow, you know what's, and that's where people often in healthcare come to me and say, I don't know what's going on, but you know, I was used to, I would could do this with my eyes closed.

Heather:                              12:54                     Now I can't even, um, you know, concentrate on, on two patients that I have. Um, I mean I, for a personal example, I remember I've been in palliative care like for 19 years and I remember when my own mom was, um, uh, terminally ill and she was in the hospital and I went with my team to go meet a patient and the doctor and the nurse and myself when we sat down. And sometimes you're not aware of it, right? Cause you're so in grossed and what's happening that you're not really aware of how difficult it is for you. So I remember sitting there listening to the nurse and the doctor talked to the patient a conversation I have every day and I couldn't even process what they were saying. At least I had the wherewithal to go, wow, I shouldn't be here. Yeah, I need to step back.

Heather:                              13:42                     And, and I did, I stepped back. I mean it cause it's cognitive that couldn't wrap my brain around it. Like what was going on, what was being said. Um, yeah. And this was fairly recent. Oh, about four years ago. Yeah. Um, and uh, recently with my dad. But uh, yeah, it, it, uh, it's, it's good to recognize it. Right? It's important for, uh, for people in general, but especially for healthcare workers that they're not doing a bad job. That there's nothing wrong with them. They're going to the natural processes of grieving. Right. Yeah. We talked a bit about this beforehand. It's a very unique scenario for health care providers to try and take care of others. Yeah. You definitely, yeah. You know, like for the reasons you mentioned prior about how unique it is for health care workers, you're literally taking care of people. You're seeing death and dying every, yeah.

Kwadwo:                             14:52                     And then when they experienced the loss, when they're not able to think as clearly when they see that emotional tie to their dad or their mom or whoever might have experienced loss, you know, I don't know if we talk about that enough. I don't know if we support each other enough.

Heather:                              15:12                     And I don't think, I mean, I don't think it's through bad intention. It's, again, it's a, it's a S a social, cultural Mileah of, of Western society in general. We don't tend to talk about pain and suffering. Dewey, you know, we talk about being happy, being independent and um, eh, so to talk about pain and suffering, we don't, when we don't often teach our children about it either. Right? So I'm often talking to families about how do you help children through the loss or the are about to lose someone important to them because we're not taught. Right? So all of a sudden when we're faced with it, we don't know what to do. And as health care providers in general, um, you know, whether your community or in a hospital, uh, we want to take it on. But if we're not understanding, we should be the very role models and understanding because we're going to be out there trying to heal others and if we are not healed ourself are not going to be up to speed. Right. Yeah.

Kwadwo:                             16:06                     It's, it's very much that cause the culture in medicine. Like I try not to get too personal, but you know, when I, I found out my dad passed away, it was a Thursday while I was on ICU and it didn't even occur to me to get somebody to cover, you know, it was just sort of ingrained in me like that plug away. And I didn't even tell anybody. Okay. I told them one person actually TP, just a just thing. So I just want it to have that kind of, um, security in case things became overwhelming during that time period. But, uh, yeah, it's for whatever reason, it's that culture, it's that talk about it, let's grind away at what we're doing. Even, you know, healthcare aside, even had a conversation with somebody that, that recently relatively recently experienced a loss, you know, and it was kinda like you alluded to at the beginning where it's like, I just want to do a bunch of stuff that keeps my mind off it and all I think about this and maybe it's worth diving into more, what are the consequences of not letting things sink in of always running?

Heather:                              17:34                     Well, I mean, when you look at, um, the six central needs of mourning, like through the companioning model, one of the things is, um, acknowledging, um, the reality of the death, right? And they're not stages, right? You can come back and forth, back and forth, but primarily initially you're trying to acknowledge the reality of the death, right? And depending on the circumstances, um, that may take weeks, right? So like for instance, if people don't actually get to see the body, you know, say somebody died overseas and they regret it, that acknowledging the reality, the reality of what that the person is gone. Again, remember, grief is about one of physical presence to one a memory. So you haven't actually been there to see it. It's hard to integrate it into ourselves. Right? So, um, and then, you know, and then we start to identify or start to, um, embrace the pain of the loss, right?

Heather:                              18:31                     And our body and our mind has this wonderful ability to be able to do that. So like it's about encountering innovating. So it's okay. Like our mind can't take it all in at once. Right? So our mind has a guy call it nature's anesthetic. So when we need initially have the loss of somebody, we, our body has this way of kind of numbing us a little bit and it's just because it otherwise it's too overwhelming and it ends as that numbing starts to kind of wear off a little bit and the reality of that person gone starts to set in that the pain really comes out. And that's actually the hard part. Like that's actually when I would find, I would get calls for grief counseling was around that stage. So, you know, somebody passed on, they have all this family and friends coming to provide them with support.

Heather:                              19:19                     Um, and their new normal hasn't really introduced themselves yet, right? Because they're still living in that world of that person being there. Cause everybody's around, right. And then as people start to go back to their normal day lives and people that are the person, the bereaved person's left and they just looking around going, Whoa, what happened? You know, where is that person? I'm, you know, I'm used to getting up every day and having a coffee and then we head off to work and then we come home and we do this. That's not, that's not there anymore. So then the pain starts to come in. And that's when people would call me and they'd say, I don't know what's going on. Like I thought it was doing okay, what? Now I'm just like, this is awful. This really is painful. And, and, and that's when I'd say, well, I can't get you around it, but you know what?

Heather:                              20:07                     There's a way to go through it. Right. And that's where the remembering that, you know, the morning comes in remembering the person who's died, right? And it's that work. And I see it not only in grief like a post-death, but I see in palliative care, it's really kind of that wonderful transition, you know, where you see families initially like, wow, I can't believe this is happening. No, it can't be in there in crisis. Right? And they're questioning the diagnosis and the prognosis and what's going on and they're in this state of helplessness. Right? Um, and then as you develop this kind of, um, time to give them space, uh, to answer their questions, provide education and support and of honor the process that's going on. It's this beautiful movement that you see, right? As they shift from the head to the heart and acknowledging that person's about to pass. And I love that, you know, after like a while, and you walk in the room and they're all sitting around the bedside and they're sitting vigil and they're sharing stories and they're laughing and they're crying. You see that morning work coming in, right? And that starts there. And it's really quite a beautiful process. And it's not that they want their loved ones to pass, but they're, they're acknowledging it, right? And they're giving honor to that person. And that's a really wonderful thing to be doing.

Kwadwo:                             21:23                     Yeah. And I mean, I could speak also from the clinical side. I think you would agree with me on this being part of that, being in that privileged part of being, of watching them go navigate through these tough times. And the very reason I got into palliative care was those moments and the life where you're sitting with the family, you're talking about uncle Gus funny jokes at Christmas and that funny outfit he wore at Halloween and you're laughing and you're crying in here and you're just, you're being present.

Heather:                              22:05                     Yeah. You're honoring the joy. The love. Yeah. Yeah, yeah. No, it's, it's incredible. I know. Cause people haven't say, well, how can you work in palliative care? It's, I'm not, it's not about the dead, it's about the living, right. It's about honoring the living and uh, it's that, it's that it's life, it's life affirming. Right. And it's really quite life affirming. Yeah.

Kwadwo:                             22:26                     So maybe we could speak to what to do to help our fellow employee, our fellow nurse or a fellow loved one, navigate through this process. Cause once again, come like I alluded to at the beginning, sometimes a lot of people just don't know what to do. They want to say to, you know, send them a song. Do you, you know, I can write a Paul, what do you do? What's the best advice that we could give people listening.

Heather:                              22:58                     Yeah. Well, you know, whether you're talking to a colleague or families that are going through it is it's important just to meet them where they're at, right? That's the first step. Um, because again, like grief is about, I'm going backwards before going forwards. It's about saying hello before you ever say goodbye. And what we tend to do is in our society in general, we tend to want to move things forward, right? Sometimes that's because it makes us feel better. But really that person, like when you're working in healthcare, people will often notice that, uh, families will keep going back to questions and keep going back. Well, why did that happen? And did, did we do the right thing? And, and it can be frustrating sometimes cause you think, Oh my God, I've told them how many times. Right. But it's because mourning there actually. And that's where I say, okay, you know, just take a moment because they're going backwards.

Heather:                              23:51                     I just had a family recently and lovely daughter's sitting vigil by the bedside and they kept going back and I kept going back. And then finally I just sat down and I said, can I describe a little bit about grief and mourning to you? And I did. I sat down and I talked about what is grief, what is mourning and what we need to do in that process. Um, and uh, I said a lot of it is about going backwards. And I said, and that's what you're doing. So I'm going to honor that and I'm gonna answer your questions, but I want you to know that that's what you're doing right now. And they just kind of went, Oh, okay. I see. Okay. Cause otherwise they think, well, why I'm going crazy. These questions are driving me nuts, you know? Yeah.

Kwadwo:                             24:30                     That really is enlightening because I got to tell you, without knowing this as a clinician sometimes I'm like, I've answered this question three times. I'm like, what's happening? And I always related it to being in shock because of all the things I going through, which is totally understandable. But what you're saying makes a lot of sense. We James downer, he's initiating an ICU study actually on bereavement and this was quite eye opening for me. Like ICU. A lot of the families have tons of questions after they leave us and you know, not being on that side, like I've never had a loved one in ICU and I wouldn't know what it would be like to hear that information on, you know, your loved ones dying and trying to process all that, you know, and in that time frame. But hearing James speak to the matter, it's like a lot of these people are, have questions after they have all these kind of, uh, concerns that, you know, there's no real process to, to help navigate and, and my whole, I mean, the whole point of doing this podcast, the whole point of doing what we do is to help others and to help them reduce their pain.

Kwadwo:                             25:55                     And so, you know, it's, I hope this is at least helpful also too, a lot of the clinicians out there hearing these things and, you know, it really comes down to being, making time, being present, not giving the bullshit answer of like, all you'll get through it and we'll move through this, you know, your warrior move forward. But to sit with them, you know, sit with them and hear them out and we don't need to give a rah rah speech every time we see them. It's just being present, acknowledging it's hard.

Heather:                              26:27                     Yeah. It's especially difficult in ICU because the unexpectedness often, right. Right. So that's another flavor entirely around it. So, um, again, so they're in that unexpectedness and so moving from the head to the heart, it's not about what, you know, it's what you feel right in grief. So when you've got somebody in a try, usually a tragic situation in ICU and uh, that, that kind of reality of the loss is going to take them a little bit more time. Right. It's, you know, it's gone from zero to a hundred and like one minute of their lives often. Right. So, yeah, that's a whole other flavor as well. Um, and trying to, to help them through that. So yeah, they're going to have a lot of questions cause they're trying to kind of, their mind is trying to connect with their heart in terms of what just happened and just then trying to acknowledge that person. Right. So hadn't how that's transformed and transition for them. So sext or work for sure. Yeah.

Kwadwo:                             27:34                     You've experienced loss in your life. You lost your both parents relatively recently, especially your dad was just December, December, coming up and coming up here and I want to know how it's affected you as a grief counselor or a social worker in hospital. Do you feel

Heather:                              28:00                     it's changed?

Heather:                              28:03                     Um, well, typical social worker is going to redirect it back to you, but uh, yeah, of course it does. It, it, uh, you know, that's when I talk about the beauty and grief and mourning, people go, wow, was she talking about, um, but when you've had a loss yourself, like we can all kind of relate to it, right? You know, there's empathy and sympathy, you know, sympathy is, you know, I feel sorry for you. Empathy is, let me understand what you're going through. And the big buzz word now is compassion is meeting somebody heart to heart. You know what? Suffering is a shared risk. We all go through it, right? We all so when you've gone through a loss, and if you don't mind me saying, so quad Joe, I remember in your Facebook after your, I think your dad's anniversary. Okay. To talk about, um, I loved what you wrote because you said, um, that it made you a better doctor.

Heather:                              29:00                     And it's not like you're going to sit with your families and patients and like whale and cry, but you know what it is to be human and you know, what loss means and how painful it can be and that we all are in that together. You know, the world's a mystery. Do I have all the answers to everything? No. Do you know, but we, we recognize in our fellow man that that sense of pain and suffering and, you know, when I'd have like the F the patients or clients that I had in grief counseling, I think almost everyone said to me something along the lines of, you know, I never really understood it, you know, um, until I felt it myself and I feel more for other people. Yeah. I can relate to their pain more. Like one lady had said to me, uh, you know, so-and-so lost their mom recently at work and last year I would've probably thought, Oh, whatever, just hurry up and get back to work. Yeah. But she said, you know what, now I look at her and I, I go over and I give her a hug. And I said, wow, this is hard, isn't it? Yeah. You know, welcome to the club kind of thing. You know, the shared human existence. And uh, that's the beauty I'm talking about. Right. And to connect again to say, wow, you know, this is how we, this is what we go through. Right?

Kwadwo:                             30:20                     Yeah. I, I gotta tell you the, after going through it, the way I see people that are now going through a loss is, I want to say it's a completely different, but I am, I'm there, I understand more where they're coming from until the empathy and the compassion. It's inevitable. And one thing that I did totally appreciate is you take it almost tell by how someone hugs you if they've experienced lost themselves recently or not. Like the like meaningful bear hug would usually come from people that like, I know what's going down, I know how you feel around. Um, but yeah, it's amazing. Like I that did give me personally a lot of solace knowing that you can make good out of the bad situation. I mean, it sounds cheesy, but I truly believe I'm a more compassionate, compassionate, dark. Now. I think I'm more present when someone's telling me about loss and now I give less of a damn too. I'm like, I don't think I'd be doing this show if it wasn't for experiencing loss and knowing how, you know, like can just be done. And so let's live now

Heather:                              31:45                     for [inaudible]. You did the, you, you took the time to do the morning work. Right? And that, that's where sometimes people get stuck because they don't know what it is. They understand they're feeling this awfulness but they don't know how to move it. Right. And what you did learn about that and you shared, you had a social response to it, right? You share to everybody what it was like for you and you worked with your family and you started to move in that process. And it's not that it wasn't painful, but in, in some respects you were able to move, right? You moved from that physical presence of your dad to want a memory. Cause I mean, death ends a life. It doesn't end a relationship.

Kwadwo:                             32:24                     Interesting.

Heather:                              32:25                     And yeah, that's, that's really powerful. And because it does it, you will forever have a relationship with that person. It's integrating into that your new normal and your new identity that they're not there in your life anymore physically. But they're still really powerfully there all the time. I mean, I know with your dad and even with my mom, as I get older, I can look back at my mom and go, Oh wow. Yeah, she's just, we're all just human beings trying to do the best we can. Right. You know, and as you evolve and you go through your own life transitions, you go back to that relationship, right. And you see it differently. It evolves just like as you evolve.

Kwadwo:                             33:05                     Yeah, no, it's, it's true. This is why I want to do on the show. I like, I'm a bio to care doc. I'm an ICU doc. I see death all the time. And after experiencing it at a, with my father, it was, I didn't know all this stuff. I didn't expect all this physical, spiritual, mental difficulties that were to, uh, that I experience. And so I really think it's important to share this with people, to be able to be open, to be there for their fellow man or woman and be less of a denying culture. And I really think we will go a lot further if we approach this with open arms.

Heather:                              33:58                     Yeah, absolutely. And by not only the, you know, the public, but especially as healthcare workers, we need to kind of honor that. What that happens to each other and to be, do we all have to be grief counselors? No, but do we all have a responsibility and maybe, uh, to be more aware so that when we see our fellow colleagues who would go, Hey, yeah, okay, I get it. I get it. Okay. They're not just being lazy or they're just, they're just self-pitying. There's actually something going on in there. Like, even like people just sitting vigil, like when they're sitting with their loved ones dying, I will say to them, you know, I talk a lot about self care to them because even though you're just sitting there, you're running a mini marathon inside, right? Because so much is going on and processing and there.

Heather:                              34:45                     So I remind them, I said, you know, you're mint, your body's physically running a mini marathon. Make sure you drink, make sure you get some rest. You gotta be good to yourself. Um, and it's the same thing when we're grieving, right? There's a lot like it's, so if I, if you had a broken leg, I wouldn't be expecting you to be running around the hospital. Just, you can't see it. You can't see when somebody's grieving. Right? So, but I, it's what dr Wolfelt says, he actually gives out pins. I love it. It says, uh, if you're in grief, you put a pin called under construction. Yeah. And it just gets your mankind to say, Hey, you know, I'm slower right now. Be patient with me. There's a lot going on in here and you can't see it. But it's there. Right.

Kwadwo:                             35:26                     So you, you even brought up a point too when we were talking earlier about the house, just some cultures, like, you know, they're grieving based on attire. So it's like part of the culture to

Heather:                              35:38                     be able to whether visual or, um, take time with the loved ones. But that's part of, yeah. Well that's a fascinating part is that we've, we've moved away from that, right? People used to die in the home, you know, grandma and grandpa lived with us or extended family and uh, they didn't tend to die in the hospitals. Like what 70% of people die in the hospitals now it's often removed. So it's often away from us. So, um, you know, before people would die, the was a national part of life, right? And now it's kind of removed from us. Um, and before like, like maybe what, 80, a hundred years ago, uh, if you're a widow, do, you'd be wearing black and you'd be walking around. But what's wonderful about that is you'd be walking around in your black attire and you would start to do the morning work. Cause people would stop you and say, Hey, you know who passed away?

Heather:                              36:34                     Was it George, your husband? Yeah, I did. And he started talking about George, right? And then you're that shared response to loss. It starts to evolve and you get to talk about that person. And so it's a wonderful thing, right? But we've moved away from, we're not supposed to talk about it, so I'm comfortable. Um, and that's healing. It's incredibly healing. That's incredibly healing. And you know, people often have, you know, just a little tidbit, like people are afraid to say, Oh, I saw so and so when I don't want to say anything. Uh, I know they just lost their mom, but, uh, I don't want to remind them of the death. Well, I'll tell you what, they know that person's died, but when you say something to them, what you're doing is you're reminding them that person lived and that's the part that really needs to be done.

Heather:                              37:21                     I remember recently actually a shout out to cam on a five and medicine. Um, yeah, as I said, my dad passed away in December. And is this a, this is part of what I'm talking about is she did this, and I don't even think she knows, maybe she does now. Um, but I was sitting at the five nursing station just charting and uh, she came over to me and I forgot that she taken care of, both of my parents were in their hospital and then she started talking to me about travel or something and then she started to say, Oh yeah, your dad's from Scotland and you told me about this. And he said this. And he, she started sharing stories and I was like, wow, that's my dad. He was like, wow, he is in the room for a moment. It's like, I got a piece of my dad.

Heather:                              38:03                     And I was like, wow. She just did some amazing morning work and she didn't even realize it. That's, uh, that's the funny part is when I talked to nurses or other healthcare providers about grief and mourning, it's just sometimes as simple as like going into the room of somebody who's, you know, terminally ill and picking up the photo frame and saying to the husband, Oh, I love this photo. What's going on here? And then you see that kind of often stiff and often I've, I don't think I've ever remembered anybody not wanting to share. Right. And then they start talking about that person and um, they're, they're moving, they're, you know, they're trans and that's what we, it's so important. So vital.

Kwadwo:                             38:41                     Wow. I think, I hope it serves a little bit as a inspiration to a lot of people seeing patients out there like take that time. It doesn't, it's a little like, you think I'm learning about doing, we shows and so far it's like they really is a little things like literally looking up that picture and saying, wow, look at that. Look are from a few years back.

Heather:                              39:08                     Yeah. Oh yeah. Do you see the smile on their faces when you do that? Yeah. Well, it's kind of like, you know, people don't really want to know what you have to say unless they know you care. And like more like for physicians that's really important, right? Cause you're sitting down giving really bad news and you're making recommendations and if you're doing it from a, you know, intellectual kind of, this is what it is and people aren't going to respond as well. But if you sit down and say, Hey, you know, this is tough, tell me a little bit about whoever it is in the bed and then start to work from there and say, okay, well this is what's going on. And they feel like that person's in the room, that they're not just a number and just another person to take up a bed. But they're real, that they mean a lot to them. Right.

Kwadwo:                             39:53                     Wow. Some good shit. Yo, I hope you all are buying in. Um, last couple of things, uh, while I have you have there. Okay. So just to give some context, Heather's got like, I don't know how many guardian angel things on our, on our, uh, [inaudible] lanyard on your land planning yard when you're, yeah, she got about seven guardian angels on her lanyard, which is like weighing her down actually. She actually walks with a limp. It's crazy. Um, so just to give you a sense of how giving and how much love she gets at the Ottawa hospital, but can you share a story where, you know, you've been appreciated because we, you know, we appreciate you all every day, but like,

Heather:                              40:47                     yeah. Um, yeah, I'm so bad at names, but I never forget a story. Like I almost remember stories when people tell me them, well, I guess recent, like I always, if somebody passed at the hospital, I always make a point of giving them a followup call because it's not part of my protocol, but I think it's essential because all of a sudden you've got all this support at the hospital, people are coming in and talking to you, and then your loved one dies and then boom, you totally disconnected. Right. And they may have questions and worries. So I always generally give them a call after. So,

Heather:                              41:24                     and I love to hear about how they're doing. But I think recently I had a family. Um, if father husband was dying, two older sons and a lovely family, just, just beautiful the salt of the earth. And you can see how much they loved this man and you could see it walking in the room. And that, that journey I talked about where it was like, Oh my God, what's going on? Can't we do this? Can't we do that? You know, that like that helpless. I think one of my favorite quotes in grief is, uh, by C S Lewis, he wrote Narnia. I used to have it in my grief office. Um, no one ever told me that grief felt so much like fear. Wow. Cause it is, it's, it's absolute like, it's, uh, an insult to your identity. It's an insult to your safety and security. And it's an insult.

Heather:                              42:13                     Well, men, since [inaudible] insults a strong word but affects your sense of meaning, right? So much unknown. People are terrified and you see that and there's no where in this world where you feel more helpless when you're not able to stop what's happening and you're watching this deterioration. So I S I witnessed this family, um, in that state and then as we evolved and we talked and we shared and they have some education and understanding of our own what's happening, that really cool family just kind of sat in this tight two bedroom in the hospital. But I would open up the curtain and I would just go, wow, this is so much sacredness right here. Wow. You guys haven't nailed. Like even though it was in a tight, awful kind of setting, they made it beautiful, you know, just that honor. And you could hear the stories and the children were coming and um, we actually, I got the kids to do a hug blanket, which is something I love doing with the kids.

Heather:                              43:11                     So, you know, if the kids can't be there all the time or they need to feel part of it, you know, you're old enough to love your old enough degree. Right. That's very important. So I've got the kids do a hug blanket where they kind of draw their arms on it and write all over the blanket and then they put it over the grandfather. So they had done that. And so you walk in there and you'd see this beautiful blanket and all the kids riding on it and everybody just loving this man, you know? So when I called afterwards and I spoke to the family, uh, they had sat Shivah and they had brought out the hug blanket. So when people would come over and, you know, people come over and pay their respects and all that, they would bring out the blanket and they'd share about it.

Heather:                              43:50                     I was so touched. I was like, wow, that's beautiful. Like that was really, uh, that just, yeah, that was really beautiful. Wow. Eh, before ending, I know there was another, speaking of about some pretty cool initiatives at a conference you went to recently. Yeah. The normal, if you want to mention that. Yeah. Well, grief and mourning in general is really misunderstood and it's, um, in a lot of myths and misconceptions about it. And oftentimes when you just really trying to sit and tell people about it, they really feel more understanding about what's happening. Um, and it's been kind of one of my, um, ones I want to bring more forward to the healthcare community cause we're supposed to be at, man, we're supposed to be the mentors. We're supposed to know what this is all about. This is what we deal with every day. But yet there is a loss in that.

Heather:                              44:45                     There's, there's not a lot of understanding around it for, um, you know, especially for each other. Right. And we really need to bring that forward, um, to support each other as we go through these really difficult times. Right. Um, and not to feel that what's wrong with us and I'm going to lose my job and you know, we need to be supported and no matter where we are, what other, what agency or what company we work for, we all need to feel that way. Um, but when I went to recently the Canadian hospice palliative care, or did I have to say that Canadian hospice palliative care association, they had a conference recently here in Ottawa and, uh, because it's been one of my babies about, and, and I think it's partly because people like you and other doctors and nurses and managers have come to me because they are like, what is going on with me?

Heather:                              45:31                     I don't understand this. Like, wow, like something I just assume everybody knows go. No, it's really not understood. And then we start to beat ourselves up. You know, what's wrong with me that I'm not moving on. And, um, so I wanted to bring this more to our workplace. Right. How can we help other, each other cause, and so part of this conference there was, I went to one of the workshops and I was really excited. Uh, it was a lady, uh, just spoke to her, Karen Brownrigg. Actually, I did ask her if it's okay to say her name on this. She said, yeah. So under the Canadian hospice palliative care association, they have something called Canadian compassionate companies. So they recognize that this grief and taking, you know, the stress of caring for somebody who's terminally ill, it's a chronic condition. So the policies and procedures that are in most institutions in places of work are behind the times because they're not aligned with how things are now in society.

Heather:                              46:28                     Um, you know, modern technology, advancement of science. I mean, you see it all the time, how we people are living longer and often living longer though with chronic illnesses and often debilitating States, right? So not only are you, uh, trying to, uh, attend to your family member, your loved one, um, but this can be an ongoing issue, right? And our policies aren't in place to help support that. Um, and if you show you support your employers during those times, you're gonna have more retention of them. Uh, you're going to have, um, attract more people with, uh, good qualifications to want to be working there. When you maintain that good, healthy work life balance, people are happier. And when you happier employee employees, you're gonna have better care. Right? So it's, it's actually so the Canadian compassionate companies, I'm just learning about it, but um, they can actually come to the HR and start to educate and bring in policies to workers who are going through this. So when you have, when you have a policies and procedures around it, the culture starts to change, right? Because then it's normalized and validated that, yeah, this is hard. You know, I care about your psychological safety cause if you're safe, everybody else here is safe. Right. And that's important not just for our colleagues but for our patients and families. Right. So I was really excited about it and like that. Yeah.

Kwadwo:                             47:52                     I think it's definitely worth mentioning because it's, I want to say innovative. It's, it's, I wouldn't say this is common practice in areas amongst companies and amongst healthcare providers. So anything that's going to help people get through these tough times and provide better, ultimately provide better care we should embrace.

Heather:                              48:14                     Absolutely. Absolutely. Yeah. So yes.

Kwadwo:                             48:21                     Been a dream. I really, I can't express the work that you do and how meaningful it is that we see it day to day. I'm going to speak for, you know, like my ICU colleagues, my palliative care colleagues, my medicine colleagues, the work that you guys do, it's underappreciated, undervalued, and it goes in. It's one of the most important things we provide. And I just want to say that you do amazing work and whatever we could do to get the word out to how important these things are, including grieving, we need to do it. And I hope this is just a hopeless, I hope this helps.

Heather:                              49:08                     I hope so. I hope it moves things forward. Yeah, that would be great. And I'm there to help it out as much as I can and vice versa. It's been so great working with you, Kwadwo over the years. Yeah. Yeah. Right. Thanks so much. .

 

Episode Transcription

Transcript for this episode:

Kwadwo: 00:37 Heather Bousada, welcome to the podcast. Thank you very much. Um, do you remember how we met? Gosh, that was a long time ago. Long time ago. Cause if you off the hook, I don't actually remember how we met, but I do remember how I met your husband. So to the listener, I was playing hockey game and he, he didn't know, he didn't know who I was and I, I approached him after the game after a hard fought game, which I think we won by the way. You guys were dirty. We were done. And I approached Chris and I said, Hey, I know your wife. And he's like, what did you just say to me? Oh I really know your wife.

Heather: 01:31 And then he did recognize you. Yeah. And that I explained that to everybody in the teleconference one. Yes. Unknowingly.

Kwadwo: 01:40 Well thanks for doing this Heather. It means a lot. And so maybe we could start off with what does a day in the life of the Heather Bousada look like, whether it's at the hospital doing what you do or in your work with grief.

Heather: 01:57 Yeah. Uh, well it's busy. It's very busy, but, uh, most of my time spent in the palliative care and the palliative care team and I also work in medicine and I've worked with you in ICU, but, uh, I, you know, my love and passion is palliative care and grief. So a lot of my days spent with the palliative care team, meeting families and patients and talking about terminal illness and impact it has on the family and their goals and their hopes and their dreams and basically what's happened to them and providing them support through that very difficult time

Kwadwo: 02:32 and crazy hours long days is that

Heather: 02:36 they're long days, they're long days. And sometimes I walk out of here pulling my hair and other times I'm like, wow, I feel like I was able to make a difference, you know? And that feels good. Yeah,

Kwadwo: 02:45 absolutely. One thing that I do appreciate that you guys do is, you know, I run into, I'll have a family meeting or two in the afternoon and I feel emotionally I'd, no, I actually just physically, emotionally and physically exhausted. You're doing this every day.

Heather: 03:05 Yeah. Well we all are in healthcare, aren't we? We're having really difficult conversations all the time. I don't think, I think, uh, one of my colleagues I was talks about if we only had a GoPro, I don't think people would believe what we go through in a day in terms of the conversations that we have. They're really detailed. Intimate people are at their worst times often, right? And trying to make really serious decisions, um, on, not sometimes for themselves, but oftentimes families are having to make that for their loved one and they, they're not sure what to do when they're feeling stressed and scared and they're not understanding how, or, you know, looking for support. And feeling in a world that's not part of their typical day. Right? Yeah.

Kwadwo: 03:49 Imagine you literally can't imagine being in the spots that and, right. Like, it's not something that you think about, dream about, it's just,

Heather: 03:58 well, people don't get practice at this right now, let's say to people like, it's not something you sign up for. And then all of a sudden you find yourself in the hospital having to have conversations about end of life, either for yourself or your family. And it's, it's a, it's, you don't get practice at it. Right? Yeah.

Kwadwo: 04:15 So we'll talk about some of the details of, you know, these difficult conversations in a bit, but you have a expertise in grief counseling and what are some of the things that you wish more people knew about the grieving process?

Heather: 04:34 Yeah, that's a, it's a huge topic. You know, it's, it is my passion and not only for patients and families, but expecially for health care providers. You know, one of my passions lately is that, uh, as healers, we need to be okay, right? We need to, we're doing some really serious work here. And if we're not understanding, you know, for having to go through our own grief and mourning through loss of a family member, you know, I see it all the time, I see at the hospital and people are coming to me and you know, oftentimes they feel like what is going on. You know, I used to be able to take care of five, 10 people. Now all of a sudden just taking care of one person, I feel like completely overwrought and I don't know what's going on with me. Right. And sometimes just having conversation about what it is and what's happening to them, to their body, to their mind, um, really kind of helps take off.

Heather: 05:21 Oh, OK. Cause we're not only a death denying culture, but we really, um, you know, there's that whole, whether it's implicit or explicit out there that you got to buck up, right? You got to buck up, you got to get on with it. Um, you know, have a stiff upper lip and you know, people are looked at as courageous if, Oh, they look so strong. They haven't even cried. Not everybody cries, but there's that sense of, you know, if you're only being strong, if you're, you know, just keep moving forward. But the interesting part about grief and mourning is it's not about moving forward. Everything we do in grief and mourning is about going backwards. So I mean, if you look at grief and mourning, and I think that's an important part, I, well one I want to start with a lot of my approach degree from morning is from dr Alan Wolfelt.

Heather: 06:06 He has a companion and approach and that's where my training is from. Um, as a social worker, I've also, I've gone down, there's a center for loss and life transitions and it's actually really a wonderful approach. And I, I heard dr Wolfville years ago and you know, just working in this field, I, when he talked about what grief and mourning as in going from the head to the heart, really it was what it's about. And it's that, um, that journey that we experienced that it just resonated with me, but it's throughout our system, right? So like if you look at brief families or the hospices, the Canadian military, the American military, they have also adopted this approach because it's a, it's meeting people not from the head and the intellect. It's meeting people with the heart, right? It's companioning somebody and companion is means to break bread and it's like sitting down with somebody and actually saying, you know what, I'm not necessarily the expert in what your relationship was with that person or what you went through, but I have some tools and I have an open, compassionate heart to be able to explore. What was that loss like for you? Right.

Kwadwo: 07:11 I feel like that's a big fear for a lot of people. It's like when you know somebody has experienced a loss, I can't count how many times people say, I do not know what to say to them. I do not know what to do. I don't know what to bring. I, you know, it's, it's awkward for awkward for some people, some people, and even as a palliative care doc that in certain circumstances where it's like, you know, I literally, I'm not sure what to tell this person.

Heather: 07:41 Yeah. And there's actually, we can talk about that a little bit later, but I think it's important to start off with like, you know, there's a lot of jargon out there, you know, brave man grief, mourning, like people throw out the words, right? But it's really, it's important to understand what the concepts mean, right? So that you can make some sense of it. So when you're looking at at, for instance, bereavement, it's a loss of a loved one. But what, what's really fascinating about the word is it actually means that the Latin root word of it means to be torn apart. So, um, you know, it's amazing whether it's here or people would call me when I was doing my private practice with grief counseling and in some shape or form, they would be describing that their world has been blown apart. Right. Um, and that's basically what it is, is that your world's been torn apart.

Heather: 08:28 But the, the, the grief is important cause it's the grief is there are internal thoughts and feelings. So unless you're a sociopath, you're gonna feel that loss, right? When you love somebody, I mean, grief and love are the flip side of the same coin, right? Cause if you love somebody, you're gonna feel that loss. So it's the thoughts and feelings. But where we get stuck is people just have that feeling, right? They have that feeling, but they're not sure. So they're not sure how to process it. Right? And we don't get taught that and everybody's teaching them to, Oh, just move on. Right? But where the real work is in the morning, right? And that's the part that, um, that I tried to help people understand and, and how to kind of go about doing that. Like the morning is the outward expression of that grief.

Heather: 09:11 So emotions need motion. Um, so the more that you, it's a social, a shared response to loss. Sometimes it can be specific to one's culture or rituals that you might do. But unless you're sharing that loss and expressing it and um, and I see it all the time with patients and families, once you get them to start talking about that relationship and who that person was, you can see the movement, right? It's a natural unfolding. You know, people think of it as like mental health. It's grief and mourning is a natural thing that we all go through, right? Unfortunately we like to avoid pain and suffering, but we will experience it and it can't get people around it. You got to go through it. But in that journey is as a really kind of beauty in it in terms of recognizing what you've experienced and how you then integrate it. I mean, grief is, if you really look at it, it's, it's moving from one of physical presence, um, to one of memory. That's the ultimate shift that what you're doing in the morning work, right? So again, you're moving that from physical presence to one American memory and you're integrating that into your new life, right? There is no new norm. There's a new normal now, right? You can't go back to the old normal as a new normal. So you're integrating that.

Kwadwo: 10:28 Wow. So there's a lot there. So one thing actually, so Heather maybe talk a bit about what to expect when you're going through that process. Yeah. Obviously there's going to be a lot of distraught pain, you know, there's that new normal as you described, but what are some of the things that people might expect?

Heather: 10:57 Yeah. Like for yourself and other people. Yeah, and that's what I find fascinating is um, people don't understand, like people think, assume it's a, it's just an emotional response, right? But it's the totality of your whole being, right? It affects you physically, cognitively, socially as spiritual ritually. And especially if, if I make reference to the healthcare workers, we need to be game on, right? So like as yourself, as an ICU doctor, you need to be there. You need to be present. But if you're going through a lot, us, you are, um, not only physically your body, you get extreme fatigue. Uh, you exhausted your appetite. You know, 80% of people lose their appetite, 10% gain another 10% that are neutral sleep disturbance. You know, so often people will tell me, you know, they're quick to go to bed to sleep cause they're so exhausted, but they wake up frequently, right?

Heather: 11:53 Um, so you're not getting a lot of sleep. Your immune system's down, right? Cause you're in this critical state, like you're in this hyper arousal because you've got this in either an impending loss or a loss, right? So, um, physically it's affecting you emotionally. You've got like multitude. There's no, you can find many different feelings at once and it comes in waves, right? Um, and cognitive is, it was interesting part, especially with healthcare is that healthcare workers is you, you know, we multitask, right? We're constantly multitasking and, and life and death. Like you're making life and death decisions. Um, and you all of a sudden you're, and it's, there's a lot of research on it and uh, people will start to, uh, you'll find it's difficult to concentrate. Um, it more irritable. Uh, the multitasking often goes right out the window. Um, so all of a sudden you're like, wow, you know what's, and that's where people often in healthcare come to me and say, I don't know what's going on, but you know, I was used to, I would could do this with my eyes closed.

Heather: 12:54 Now I can't even, um, you know, concentrate on, on two patients that I have. Um, I mean I, for a personal example, I remember I've been in palliative care like for 19 years and I remember when my own mom was, um, uh, terminally ill and she was in the hospital and I went with my team to go meet a patient and the doctor and the nurse and myself when we sat down. And sometimes you're not aware of it, right? Cause you're so in grossed and what's happening that you're not really aware of how difficult it is for you. So I remember sitting there listening to the nurse and the doctor talked to the patient a conversation I have every day and I couldn't even process what they were saying. At least I had the wherewithal to go, wow, I shouldn't be here. Yeah, I need to step back.

Heather: 13:42 And, and I did, I stepped back. I mean it cause it's cognitive that couldn't wrap my brain around it. Like what was going on, what was being said. Um, yeah. And this was fairly recent. Oh, about four years ago. Yeah. Um, and uh, recently with my dad. But uh, yeah, it, it, uh, it's, it's good to recognize it. Right? It's important for, uh, for people in general, but especially for healthcare workers that they're not doing a bad job. That there's nothing wrong with them. They're going to the natural processes of grieving. Right. Yeah. We talked a bit about this beforehand. It's a very unique scenario for health care providers to try and take care of others. Yeah. You definitely, yeah. You know, like for the reasons you mentioned prior about how unique it is for health care workers, you're literally taking care of people. You're seeing death and dying every, yeah.

Kwadwo: 14:52 And then when they experienced the loss, when they're not able to think as clearly when they see that emotional tie to their dad or their mom or whoever might have experienced loss, you know, I don't know if we talk about that enough. I don't know if we support each other enough.

Heather: 15:12 And I don't think, I mean, I don't think it's through bad intention. It's, again, it's a, it's a S a social, cultural Mileah of, of Western society in general. We don't tend to talk about pain and suffering. Dewey, you know, we talk about being happy, being independent and um, eh, so to talk about pain and suffering, we don't, when we don't often teach our children about it either. Right? So I'm often talking to families about how do you help children through the loss or the are about to lose someone important to them because we're not taught. Right? So all of a sudden when we're faced with it, we don't know what to do. And as health care providers in general, um, you know, whether your community or in a hospital, uh, we want to take it on. But if we're not understanding, we should be the very role models and understanding because we're going to be out there trying to heal others and if we are not healed ourself are not going to be up to speed. Right. Yeah.

Kwadwo: 16:06 It's, it's very much that cause the culture in medicine. Like I try not to get too personal, but you know, when I, I found out my dad passed away, it was a Thursday while I was on ICU and it didn't even occur to me to get somebody to cover, you know, it was just sort of ingrained in me like that plug away. And I didn't even tell anybody. Okay. I told them one person actually TP, just a just thing. So I just want it to have that kind of, um, security in case things became overwhelming during that time period. But, uh, yeah, it's for whatever reason, it's that culture, it's that talk about it, let's grind away at what we're doing. Even, you know, healthcare aside, even had a conversation with somebody that, that recently relatively recently experienced a loss, you know, and it was kinda like you alluded to at the beginning where it's like, I just want to do a bunch of stuff that keeps my mind off it and all I think about this and maybe it's worth diving into more, what are the consequences of not letting things sink in of always running?

Heather: 17:34 Well, I mean, when you look at, um, the six central needs of mourning, like through the companioning model, one of the things is, um, acknowledging, um, the reality of the death, right? And they're not stages, right? You can come back and forth, back and forth, but primarily initially you're trying to acknowledge the reality of the death, right? And depending on the circumstances, um, that may take weeks, right? So like for instance, if people don't actually get to see the body, you know, say somebody died overseas and they regret it, that acknowledging the reality, the reality of what that the person is gone. Again, remember, grief is about one of physical presence to one a memory. So you haven't actually been there to see it. It's hard to integrate it into ourselves. Right? So, um, and then, you know, and then we start to identify or start to, um, embrace the pain of the loss, right?

Heather: 18:31 And our body and our mind has this wonderful ability to be able to do that. So like it's about encountering innovating. So it's okay. Like our mind can't take it all in at once. Right? So our mind has a guy call it nature's anesthetic. So when we need initially have the loss of somebody, we, our body has this way of kind of numbing us a little bit and it's just because it otherwise it's too overwhelming and it ends as that numbing starts to kind of wear off a little bit and the reality of that person gone starts to set in that the pain really comes out. And that's actually the hard part. Like that's actually when I would find, I would get calls for grief counseling was around that stage. So, you know, somebody passed on, they have all this family and friends coming to provide them with support.

Heather: 19:19 Um, and their new normal hasn't really introduced themselves yet, right? Because they're still living in that world of that person being there. Cause everybody's around, right. And then as people start to go back to their normal day lives and people that are the person, the bereaved person's left and they just looking around going, Whoa, what happened? You know, where is that person? I'm, you know, I'm used to getting up every day and having a coffee and then we head off to work and then we come home and we do this. That's not, that's not there anymore. So then the pain starts to come in. And that's when people would call me and they'd say, I don't know what's going on. Like I thought it was doing okay, what? Now I'm just like, this is awful. This really is painful. And, and, and that's when I'd say, well, I can't get you around it, but you know what?

Heather: 20:07 There's a way to go through it. Right. And that's where the remembering that, you know, the morning comes in remembering the person who's died, right? And it's that work. And I see it not only in grief like a post-death, but I see in palliative care, it's really kind of that wonderful transition, you know, where you see families initially like, wow, I can't believe this is happening. No, it can't be in there in crisis. Right? And they're questioning the diagnosis and the prognosis and what's going on and they're in this state of helplessness. Right? Um, and then as you develop this kind of, um, time to give them space, uh, to answer their questions, provide education and support and of honor the process that's going on. It's this beautiful movement that you see, right? As they shift from the head to the heart and acknowledging that person's about to pass. And I love that, you know, after like a while, and you walk in the room and they're all sitting around the bedside and they're sitting vigil and they're sharing stories and they're laughing and they're crying. You see that morning work coming in, right? And that starts there. And it's really quite a beautiful process. And it's not that they want their loved ones to pass, but they're, they're acknowledging it, right? And they're giving honor to that person. And that's a really wonderful thing to be doing.

Kwadwo: 21:23 Yeah. And I mean, I could speak also from the clinical side. I think you would agree with me on this being part of that, being in that privileged part of being, of watching them go navigate through these tough times. And the very reason I got into palliative care was those moments and the life where you're sitting with the family, you're talking about uncle Gus funny jokes at Christmas and that funny outfit he wore at Halloween and you're laughing and you're crying in here and you're just, you're being present.

Heather: 22:05 Yeah. You're honoring the joy. The love. Yeah. Yeah, yeah. No, it's, it's incredible. I know. Cause people haven't say, well, how can you work in palliative care? It's, I'm not, it's not about the dead, it's about the living, right. It's about honoring the living and uh, it's that, it's that it's life, it's life affirming. Right. And it's really quite life affirming. Yeah.

Kwadwo: 22:26 So maybe we could speak to what to do to help our fellow employee, our fellow nurse or a fellow loved one, navigate through this process. Cause once again, come like I alluded to at the beginning, sometimes a lot of people just don't know what to do. They want to say to, you know, send them a song. Do you, you know, I can write a Paul, what do you do? What's the best advice that we could give people listening.

Heather: 22:58 Yeah. Well, you know, whether you're talking to a colleague or families that are going through it is it's important just to meet them where they're at, right? That's the first step. Um, because again, like grief is about, I'm going backwards before going forwards. It's about saying hello before you ever say goodbye. And what we tend to do is in our society in general, we tend to want to move things forward, right? Sometimes that's because it makes us feel better. But really that person, like when you're working in healthcare, people will often notice that, uh, families will keep going back to questions and keep going back. Well, why did that happen? And did, did we do the right thing? And, and it can be frustrating sometimes cause you think, Oh my God, I've told them how many times. Right. But it's because mourning there actually. And that's where I say, okay, you know, just take a moment because they're going backwards.

Heather: 23:51 I just had a family recently and lovely daughter's sitting vigil by the bedside and they kept going back and I kept going back. And then finally I just sat down and I said, can I describe a little bit about grief and mourning to you? And I did. I sat down and I talked about what is grief, what is mourning and what we need to do in that process. Um, and uh, I said a lot of it is about going backwards. And I said, and that's what you're doing. So I'm going to honor that and I'm gonna answer your questions, but I want you to know that that's what you're doing right now. And they just kind of went, Oh, okay. I see. Okay. Cause otherwise they think, well, why I'm going crazy. These questions are driving me nuts, you know? Yeah.

Kwadwo: 24:30 That really is enlightening because I got to tell you, without knowing this as a clinician sometimes I'm like, I've answered this question three times. I'm like, what's happening? And I always related it to being in shock because of all the things I going through, which is totally understandable. But what you're saying makes a lot of sense. We James downer, he's initiating an ICU study actually on bereavement and this was quite eye opening for me. Like ICU. A lot of the families have tons of questions after they leave us and you know, not being on that side, like I've never had a loved one in ICU and I wouldn't know what it would be like to hear that information on, you know, your loved ones dying and trying to process all that, you know, and in that time frame. But hearing James speak to the matter, it's like a lot of these people are, have questions after they have all these kind of, uh, concerns that, you know, there's no real process to, to help navigate and, and my whole, I mean, the whole point of doing this podcast, the whole point of doing what we do is to help others and to help them reduce their pain.

Kwadwo: 25:55 And so, you know, it's, I hope this is at least helpful also too, a lot of the clinicians out there hearing these things and, you know, it really comes down to being, making time, being present, not giving the bullshit answer of like, all you'll get through it and we'll move through this, you know, your warrior move forward. But to sit with them, you know, sit with them and hear them out and we don't need to give a rah rah speech every time we see them. It's just being present, acknowledging it's hard.

Heather: 26:27 Yeah. It's especially difficult in ICU because the unexpectedness often, right. Right. So that's another flavor entirely around it. So, um, again, so they're in that unexpectedness and so moving from the head to the heart, it's not about what, you know, it's what you feel right in grief. So when you've got somebody in a try, usually a tragic situation in ICU and uh, that, that kind of reality of the loss is going to take them a little bit more time. Right. It's, you know, it's gone from zero to a hundred and like one minute of their lives often. Right. So, yeah, that's a whole other flavor as well. Um, and trying to, to help them through that. So yeah, they're going to have a lot of questions cause they're trying to kind of, their mind is trying to connect with their heart in terms of what just happened and just then trying to acknowledge that person. Right. So hadn't how that's transformed and transition for them. So sext or work for sure. Yeah.

Kwadwo: 27:34 You've experienced loss in your life. You lost your both parents relatively recently, especially your dad was just December, December, coming up and coming up here and I want to know how it's affected you as a grief counselor or a social worker in hospital. Do you feel

Heather: 28:00 it's changed?

Heather: 28:03 Um, well, typical social worker is going to redirect it back to you, but uh, yeah, of course it does. It, it, uh, you know, that's when I talk about the beauty and grief and mourning, people go, wow, was she talking about, um, but when you've had a loss yourself, like we can all kind of relate to it, right? You know, there's empathy and sympathy, you know, sympathy is, you know, I feel sorry for you. Empathy is, let me understand what you're going through. And the big buzz word now is compassion is meeting somebody heart to heart. You know what? Suffering is a shared risk. We all go through it, right? We all so when you've gone through a loss, and if you don't mind me saying, so quad Joe, I remember in your Facebook after your, I think your dad's anniversary. Okay. To talk about, um, I loved what you wrote because you said, um, that it made you a better doctor.

Heather: 29:00 And it's not like you're going to sit with your families and patients and like whale and cry, but you know what it is to be human and you know, what loss means and how painful it can be and that we all are in that together. You know, the world's a mystery. Do I have all the answers to everything? No. Do you know, but we, we recognize in our fellow man that that sense of pain and suffering and, you know, when I'd have like the F the patients or clients that I had in grief counseling, I think almost everyone said to me something along the lines of, you know, I never really understood it, you know, um, until I felt it myself and I feel more for other people. Yeah. I can relate to their pain more. Like one lady had said to me, uh, you know, so-and-so lost their mom recently at work and last year I would've probably thought, Oh, whatever, just hurry up and get back to work. Yeah. But she said, you know what, now I look at her and I, I go over and I give her a hug. And I said, wow, this is hard, isn't it? Yeah. You know, welcome to the club kind of thing. You know, the shared human existence. And uh, that's the beauty I'm talking about. Right. And to connect again to say, wow, you know, this is how we, this is what we go through. Right?

Kwadwo: 30:20 Yeah. I, I gotta tell you the, after going through it, the way I see people that are now going through a loss is, I want to say it's a completely different, but I am, I'm there, I understand more where they're coming from until the empathy and the compassion. It's inevitable. And one thing that I did totally appreciate is you take it almost tell by how someone hugs you if they've experienced lost themselves recently or not. Like the like meaningful bear hug would usually come from people that like, I know what's going down, I know how you feel around. Um, but yeah, it's amazing. Like I that did give me personally a lot of solace knowing that you can make good out of the bad situation. I mean, it sounds cheesy, but I truly believe I'm a more compassionate, compassionate, dark. Now. I think I'm more present when someone's telling me about loss and now I give less of a damn too. I'm like, I don't think I'd be doing this show if it wasn't for experiencing loss and knowing how, you know, like can just be done. And so let's live now

Heather: 31:45 for [inaudible]. You did the, you, you took the time to do the morning work. Right? And that, that's where sometimes people get stuck because they don't know what it is. They understand they're feeling this awfulness but they don't know how to move it. Right. And what you did learn about that and you shared, you had a social response to it, right? You share to everybody what it was like for you and you worked with your family and you started to move in that process. And it's not that it wasn't painful, but in, in some respects you were able to move, right? You moved from that physical presence of your dad to want a memory. Cause I mean, death ends a life. It doesn't end a relationship.

Kwadwo: 32:24 Interesting.

Heather: 32:25 And yeah, that's, that's really powerful. And because it does it, you will forever have a relationship with that person. It's integrating into that your new normal and your new identity that they're not there in your life anymore physically. But they're still really powerfully there all the time. I mean, I know with your dad and even with my mom, as I get older, I can look back at my mom and go, Oh wow. Yeah, she's just, we're all just human beings trying to do the best we can. Right. You know, and as you evolve and you go through your own life transitions, you go back to that relationship, right. And you see it differently. It evolves just like as you evolve.

Kwadwo: 33:05 Yeah, no, it's, it's true. This is why I want to do on the show. I like, I'm a bio to care doc. I'm an ICU doc. I see death all the time. And after experiencing it at a, with my father, it was, I didn't know all this stuff. I didn't expect all this physical, spiritual, mental difficulties that were to, uh, that I experience. And so I really think it's important to share this with people, to be able to be open, to be there for their fellow man or woman and be less of a denying culture. And I really think we will go a lot further if we approach this with open arms.

Heather: 33:58 Yeah, absolutely. And by not only the, you know, the public, but especially as healthcare workers, we need to kind of honor that. What that happens to each other and to be, do we all have to be grief counselors? No, but do we all have a responsibility and maybe, uh, to be more aware so that when we see our fellow colleagues who would go, Hey, yeah, okay, I get it. I get it. Okay. They're not just being lazy or they're just, they're just self-pitying. There's actually something going on in there. Like, even like people just sitting vigil, like when they're sitting with their loved ones dying, I will say to them, you know, I talk a lot about self care to them because even though you're just sitting there, you're running a mini marathon inside, right? Because so much is going on and processing and there.

Heather: 34:45 So I remind them, I said, you know, you're mint, your body's physically running a mini marathon. Make sure you drink, make sure you get some rest. You gotta be good to yourself. Um, and it's the same thing when we're grieving, right? There's a lot like it's, so if I, if you had a broken leg, I wouldn't be expecting you to be running around the hospital. Just, you can't see it. You can't see when somebody's grieving. Right? So, but I, it's what dr Wolfelt says, he actually gives out pins. I love it. It says, uh, if you're in grief, you put a pin called under construction. Yeah. And it just gets your mankind to say, Hey, you know, I'm slower right now. Be patient with me. There's a lot going on in here and you can't see it. But it's there. Right.

Kwadwo: 35:26 So you, you even brought up a point too when we were talking earlier about the house, just some cultures, like, you know, they're grieving based on attire. So it's like part of the culture to

Heather: 35:38 be able to whether visual or, um, take time with the loved ones. But that's part of, yeah. Well that's a fascinating part is that we've, we've moved away from that, right? People used to die in the home, you know, grandma and grandpa lived with us or extended family and uh, they didn't tend to die in the hospitals. Like what 70% of people die in the hospitals now it's often removed. So it's often away from us. So, um, you know, before people would die, the was a national part of life, right? And now it's kind of removed from us. Um, and before like, like maybe what, 80, a hundred years ago, uh, if you're a widow, do, you'd be wearing black and you'd be walking around. But what's wonderful about that is you'd be walking around in your black attire and you would start to do the morning work. Cause people would stop you and say, Hey, you know who passed away?

Heather: 36:34 Was it George, your husband? Yeah, I did. And he started talking about George, right? And then you're that shared response to loss. It starts to evolve and you get to talk about that person. And so it's a wonderful thing, right? But we've moved away from, we're not supposed to talk about it, so I'm comfortable. Um, and that's healing. It's incredibly healing. That's incredibly healing. And you know, people often have, you know, just a little tidbit, like people are afraid to say, Oh, I saw so and so when I don't want to say anything. Uh, I know they just lost their mom, but, uh, I don't want to remind them of the death. Well, I'll tell you what, they know that person's died, but when you say something to them, what you're doing is you're reminding them that person lived and that's the part that really needs to be done.

Heather: 37:21 I remember recently actually a shout out to cam on a five and medicine. Um, yeah, as I said, my dad passed away in December. And is this a, this is part of what I'm talking about is she did this, and I don't even think she knows, maybe she does now. Um, but I was sitting at the five nursing station just charting and uh, she came over to me and I forgot that she taken care of, both of my parents were in their hospital and then she started talking to me about travel or something and then she started to say, Oh yeah, your dad's from Scotland and you told me about this. And he said this. And he, she started sharing stories and I was like, wow, that's my dad. He was like, wow, he is in the room for a moment. It's like, I got a piece of my dad.

Heather: 38:03 And I was like, wow. She just did some amazing morning work and she didn't even realize it. That's, uh, that's the funny part is when I talked to nurses or other healthcare providers about grief and mourning, it's just sometimes as simple as like going into the room of somebody who's, you know, terminally ill and picking up the photo frame and saying to the husband, Oh, I love this photo. What's going on here? And then you see that kind of often stiff and often I've, I don't think I've ever remembered anybody not wanting to share. Right. And then they start talking about that person and um, they're, they're moving, they're, you know, they're trans and that's what we, it's so important. So vital.

Kwadwo: 38:41 Wow. I think, I hope it serves a little bit as a inspiration to a lot of people seeing patients out there like take that time. It doesn't, it's a little like, you think I'm learning about doing, we shows and so far it's like they really is a little things like literally looking up that picture and saying, wow, look at that. Look are from a few years back.

Heather: 39:08 Yeah. Oh yeah. Do you see the smile on their faces when you do that? Yeah. Well, it's kind of like, you know, people don't really want to know what you have to say unless they know you care. And like more like for physicians that's really important, right? Cause you're sitting down giving really bad news and you're making recommendations and if you're doing it from a, you know, intellectual kind of, this is what it is and people aren't going to respond as well. But if you sit down and say, Hey, you know, this is tough, tell me a little bit about whoever it is in the bed and then start to work from there and say, okay, well this is what's going on. And they feel like that person's in the room, that they're not just a number and just another person to take up a bed. But they're real, that they mean a lot to them. Right.

Kwadwo: 39:53 Wow. Some good shit. Yo, I hope you all are buying in. Um, last couple of things, uh, while I have you have there. Okay. So just to give some context, Heather's got like, I don't know how many guardian angel things on our, on our, uh, [inaudible] lanyard on your land planning yard when you're, yeah, she got about seven guardian angels on her lanyard, which is like weighing her down actually. She actually walks with a limp. It's crazy. Um, so just to give you a sense of how giving and how much love she gets at the Ottawa hospital, but can you share a story where, you know, you've been appreciated because we, you know, we appreciate you all every day, but like,

Heather: 40:47 yeah. Um, yeah, I'm so bad at names, but I never forget a story. Like I almost remember stories when people tell me them, well, I guess recent, like I always, if somebody passed at the hospital, I always make a point of giving them a followup call because it's not part of my protocol, but I think it's essential because all of a sudden you've got all this support at the hospital, people are coming in and talking to you, and then your loved one dies and then boom, you totally disconnected. Right. And they may have questions and worries. So I always generally give them a call after. So,

Heather: 41:24 and I love to hear about how they're doing. But I think recently I had a family. Um, if father husband was dying, two older sons and a lovely family, just, just beautiful the salt of the earth. And you can see how much they loved this man and you could see it walking in the room. And that, that journey I talked about where it was like, Oh my God, what's going on? Can't we do this? Can't we do that? You know, that like that helpless. I think one of my favorite quotes in grief is, uh, by C S Lewis, he wrote Narnia. I used to have it in my grief office. Um, no one ever told me that grief felt so much like fear. Wow. Cause it is, it's, it's absolute like, it's, uh, an insult to your identity. It's an insult to your safety and security. And it's an insult.

Heather: 42:13 Well, men, since [inaudible] insults a strong word but affects your sense of meaning, right? So much unknown. People are terrified and you see that and there's no where in this world where you feel more helpless when you're not able to stop what's happening and you're watching this deterioration. So I S I witnessed this family, um, in that state and then as we evolved and we talked and we shared and they have some education and understanding of our own what's happening, that really cool family just kind of sat in this tight two bedroom in the hospital. But I would open up the curtain and I would just go, wow, this is so much sacredness right here. Wow. You guys haven't nailed. Like even though it was in a tight, awful kind of setting, they made it beautiful, you know, just that honor. And you could hear the stories and the children were coming and um, we actually, I got the kids to do a hug blanket, which is something I love doing with the kids.

Heather: 43:11 So, you know, if the kids can't be there all the time or they need to feel part of it, you know, you're old enough to love your old enough degree. Right. That's very important. So I've got the kids do a hug blanket where they kind of draw their arms on it and write all over the blanket and then they put it over the grandfather. So they had done that. And so you walk in there and you'd see this beautiful blanket and all the kids riding on it and everybody just loving this man, you know? So when I called afterwards and I spoke to the family, uh, they had sat Shivah and they had brought out the hug blanket. So when people would come over and, you know, people come over and pay their respects and all that, they would bring out the blanket and they'd share about it.

Heather: 43:50 I was so touched. I was like, wow, that's beautiful. Like that was really, uh, that just, yeah, that was really beautiful. Wow. Eh, before ending, I know there was another, speaking of about some pretty cool initiatives at a conference you went to recently. Yeah. The normal, if you want to mention that. Yeah. Well, grief and mourning in general is really misunderstood and it's, um, in a lot of myths and misconceptions about it. And oftentimes when you just really trying to sit and tell people about it, they really feel more understanding about what's happening. Um, and it's been kind of one of my, um, ones I want to bring more forward to the healthcare community cause we're supposed to be at, man, we're supposed to be the mentors. We're supposed to know what this is all about. This is what we deal with every day. But yet there is a loss in that.

Heather: 44:45 There's, there's not a lot of understanding around it for, um, you know, especially for each other. Right. And we really need to bring that forward, um, to support each other as we go through these really difficult times. Right. Um, and not to feel that what's wrong with us and I'm going to lose my job and you know, we need to be supported and no matter where we are, what other, what agency or what company we work for, we all need to feel that way. Um, but when I went to recently the Canadian hospice palliative care, or did I have to say that Canadian hospice palliative care association, they had a conference recently here in Ottawa and, uh, because it's been one of my babies about, and, and I think it's partly because people like you and other doctors and nurses and managers have come to me because they are like, what is going on with me?

Heather: 45:31 I don't understand this. Like, wow, like something I just assume everybody knows go. No, it's really not understood. And then we start to beat ourselves up. You know, what's wrong with me that I'm not moving on. And, um, so I wanted to bring this more to our workplace. Right. How can we help other, each other cause, and so part of this conference there was, I went to one of the workshops and I was really excited. Uh, it was a lady, uh, just spoke to her, Karen Brownrigg. Actually, I did ask her if it's okay to say her name on this. She said, yeah. So under the Canadian hospice palliative care association, they have something called Canadian compassionate companies. So they recognize that this grief and taking, you know, the stress of caring for somebody who's terminally ill, it's a chronic condition. So the policies and procedures that are in most institutions in places of work are behind the times because they're not aligned with how things are now in society.

Heather: 46:28 Um, you know, modern technology, advancement of science. I mean, you see it all the time, how we people are living longer and often living longer though with chronic illnesses and often debilitating States, right? So not only are you, uh, trying to, uh, attend to your family member, your loved one, um, but this can be an ongoing issue, right? And our policies aren't in place to help support that. Um, and if you show you support your employers during those times, you're gonna have more retention of them. Uh, you're going to have, um, attract more people with, uh, good qualifications to want to be working there. When you maintain that good, healthy work life balance, people are happier. And when you happier employee employees, you're gonna have better care. Right? So it's, it's actually so the Canadian compassionate companies, I'm just learning about it, but um, they can actually come to the HR and start to educate and bring in policies to workers who are going through this. So when you have, when you have a policies and procedures around it, the culture starts to change, right? Because then it's normalized and validated that, yeah, this is hard. You know, I care about your psychological safety cause if you're safe, everybody else here is safe. Right. And that's important not just for our colleagues but for our patients and families. Right. So I was really excited about it and like that. Yeah.

Kwadwo: 47:52 I think it's definitely worth mentioning because it's, I want to say innovative. It's, it's, I wouldn't say this is common practice in areas amongst companies and amongst healthcare providers. So anything that's going to help people get through these tough times and provide better, ultimately provide better care we should embrace.

Heather: 48:14 Absolutely. Absolutely. Yeah. So yes.

Kwadwo: 48:21 Been a dream. I really, I can't express the work that you do and how meaningful it is that we see it day to day. I'm going to speak for, you know, like my ICU colleagues, my palliative care colleagues, my medicine colleagues, the work that you guys do, it's underappreciated, undervalued, and it goes in. It's one of the most important things we provide. And I just want to say that you do amazing work and whatever we could do to get the word out to how important these things are, including grieving, we need to do it. And I hope this is just a hopeless, I hope this helps.

Heather: 49:08 I hope so. I hope it moves things forward. Yeah, that would be great. And I'm there to help it out as much as I can and vice versa. It's been so great working with you, Kwadwo over the years. Yeah. Yeah. Right. Thanks so much. .

 

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