Jan 27, 2018
Meet Julie Chrisco, a nurse practitioner with Integrated MD Care, who is passionate about helping people have the best experiences as the age as well as creating peace at end of life. Transcript Dr. Bob: Today I am really happy to be introducing you all to one of the newer additions to our team here at Integrated MD Care, Julie Chrisco. Julie is a nurse practitioner who's got tons of experience working with people at the end of life, both in palliative care and hospice. She is I think as passionate about this work as I am, which is why she's here working with us. Julie, welcome. Julie Chrisco: Thank you. Dr. Bob: Absolutely. You're very, very welcome. Thanks for taking the time. I'm really looking forward to having people get a sense of who you are and why this work is so important to you, and what you bring to it. This whole life and death conversation idea is really just to allow other people to listen in and hear the discussions that are so meaningful and poignant. I think as we have conversations day in and day out about some of the aspects of care for our patients and the ways that we're trying to support them and enhance their lives, and the challenges, I think so much of it is just so fascinating. I wish that people could be more consistently listening in and hearing these things because it would make, I think it would be ... It's very, not only is it interesting, but I think it is helpful for them to see how things can be addressed, and how challenges can be overcome, and how the final phase of a person's life can be supported. Again, thanks for being here. You know what, I'm going to jump right in. I'm going to talk a little bit about some of your background, and we'll add that in. Bottom line is you've been a nurse for many years. You've been in the hospice world for quite a while now. You're a nurse practitioner doing deep, deep work with people who are dealing with challenges, who are in many cases dying, taking their last breaths. Is it okay if I ask you a couple personal questions? Julie Chrisco: Sure. Dr. Bob: I figured that was the case. One of the things that I like to do with the guests who come on the show is to get a sense of how they feel about death, about the experiences that they've had, so that, because obviously there has to be a certain comfort level with death to do this work right? Julie Chrisco: True. Dr. Bob: I mean if you were afraid of talking about it, if it was anxiety provoking, I imagine you wouldn't be really effective at taking care of people who are in this phase. I'm just going to put it out there. What are your thoughts? Do you have any fear of death? What are your thoughts about death? How do you view it? Julie Chrisco: I can truly say I'm not afraid to die. I'm not going to lie, but there are things that I question, and I wonder, but I wouldn't call it fear. Fear is one of those loom and doom type things that I don't, that's not my perception of death. I've been involved with a multitude of deaths from patients that iv cared for to family members. In my opinion, death is just as life as part of what exists. Births come, and death comes too. It's just it's all part of the continuum of life. Therefore, I am not fearful of ending my life. I wonder and I worry maybe, I don't know if worry is even, I just I truly honestly want to capacitate myself, or be encompassed in a group of people, or my family, who are on the same page as myself because I know that end of life can be super peaceful, and comfortable, and wonderfully meaningful. That's what I need for my end of life experience to be, but I also know that there are tragic end of life experiences that happen where people don't, aren't allowed the ability to have that sort of thing. I don't fear that. I don't fear a quick, instantaneous death. I fear more of the human suffering that can go on. But I know that if you encompass yourself in a team of like-minded human beings and people who are on the same page as you, that doesn't have to look like that. Being in this work for as long as I have, I've seen so many beautiful end of life experiences. I will say that I have a really strong faith in the Lord and the hereafter. I truly believe that the hereafter is way better than the human suffering that goes on here on Earth. Yeah, there is, it's a peaceful feeling to think that there's not going to be pain and suffering in the hereafter. That looms in me, or resides in me, in a way that death is not scary to me. Dr. Bob: I imagine ... Well, thanks for sharing that, and I resonate with that very well. I also have this sense of how critical it is to ensure that the final phase of life, before we move into the hereafter, that the final phase of life is as you described supported and peaceful. I think we've both seen that that can be accomplished. That with the right planning, with the right conversations, with the right support, death, the actual act of death, does not have to be traumatic and painful and a struggle. Would you agree with that? Julie Chrisco: Totally. I mean I have truly seen some situations where I've walked in and thought, "Oh, this is not going to go well." With the appropriate conversation and the team, and the family, everybody being on board and everybody collaborating to an effort to make this final chapter of a human's life the best that it can possibly be, it has been so beautiful that it often times brings me to tears because what a great way to transition. Just like you want your pregnancies and the birth of a child to be very beautiful and peaceful and wonderful, you also want that for your end of life experience. It can go really, really well, and it can be one of those things that sort of almost takes your breath away, or it brings you to a moment of complete humbleness because of how well orchestrated it can be. Dr. Bob: I love that. The orchestration part is to me; I get this image of like a beautiful symphony that everything is working together. Really it can bring you to tears. It's odd, not a lot of people would think about death that way, but I think those of us who are in this field and in a position to put those things in place, and have seen how a well-orchestrated end of life experience can go, it does feel that way. It feels like you're creating almost a work of art- Julie Chrisco: Right. Dr. Bob: By doing that. Why doesn't it happen? When doesn't it happen? In your experience, what keeps people from having that really peaceful beautiful end of life experience? Julie Chrisco: I think there's a multitude of things. I think there's the resistance to death. I think that's a huge component. Whether that resistance to death is a personal thing, like an actual patient, has the resistance to the death and therefore they sort of resist all levels of transition, or if there's a family, or friend, or whoever, caregiver situation where they're super resistant to the end of life. I think that can create turmoil and chaos in that. Another huge thing is for the patient to not have been allowed the space to explore what the end of life experience is going to be for them. I think it's a conversation that you and I are accustomed to, but I would say the norm amount of people in the world, it's not a conversation they're having. They're not telling their children or their grandchildren, or their spouses, this is how I want it to be, or they aren't even going there in their mind because if they go there in their mind, that means it's imminent, that might make the process happen faster. All those types of things I think are huge obstacles for people not being able to have the picturesque end of life experience that we all grant, or we hope for everyone. Dr. Bob: My sense is ... Yeah, I agree with all of that. My sense is that there's just a lot of avoidance. It takes a unique; I think it takes a unique sort of caregiver or healthcare professional to break through that. I feel like there's a discomfort with a lot of healthcare providers as well. Most physicians, unfortunately even doctors who are taking care of a lot of older adults, it seems like they're not having the conversations about what is coming. Julie Chrisco: Right. Dr. Bob: I see that there's probably a number of different reasons for that. One is just their inherent discomfort. They don't get trained in it, and they don't quite know how to broach it, and it creates a certain amount of discomfort. The other is I think lack of time. In the traditional healthcare system, the physicians just don't have time to be starting that conversation because it's not a 15- or 20-minute conversation. Julie Chrisco: Right. Dr. Bob: It feels to me like so much struggle can be avoided if we somehow are able to find the right mechanism to have the conversations with the patients and the families, and figure out to sort of break through the discomfort with that and resistance. That's a talent I think, so I'm not quite sure how to get the masses. I know how we do it with our patients. We have the luxury of having these relationships. We're in their homes. We have multiple opportunities to broach this. But in the kind of traditional system, we need to figure out a way to get the providers comfortable opening up those conversations. Julie Chrisco: For sure. Dr. Bob: Yeah. There's work to do still, right? Julie Chrisco: Of course. Our work is never-ending. Dr. Bob: I'm sure that in the course of your work, as in mine, we encounter people who are nearing death. They may not be, well sometimes they're days away, sometimes they could be weeks or months away. When you encounter somebody who is clearly afraid of dying, and sometimes they don't quite know why they just know that the whole idea is really just terrifying to them, what are your, how do you tend to approach that? Do you have a process or a system that you use? Julie Chrisco: I would honestly, I will say that I think the fear of death stems from numerous reasons. It's really important for me as the provider to sit down and have a conversation with them about where does this fear stem from. It could be the fear of the unknown about what happens in the hereafter. It could be the fear of how this process will go, the symptomatology that may evolve. Will it be painful? Will I suffer? Those types of things. Or it could be a fear of what's going to happen to my loved ones when I'm gone. Being a mother of young boys, I would honestly say that the only worry I have about not being here tomorrow would be how will my kids function the way that they function now without me. I think you have to start the conversation by really understanding what fears them. Older patients don't really so much worry about their kids and how they're going to function because they're adults, and they have their own lives. I guess getting to the source of what the fear is, whatever the reason for the fear. Then I would encourage a conversation about the reason, and try to understand why and where it stems from. I may want to show them some of my own personal stories about death and dying to create a perspective on the situation. Because I've been so blessed to be involved in numerous end of life, from young people to old people, and personal family members, I can gleam a little bit of personal perspective, even though that's not always necessarily what they want, but I just try to help them understand, or try to have them identify the fear and realize and determine whether it's a true fear, like if it's a real thing, or if it's a fear that they've sort of built up. Real fear is, yes, there's a lion coming at me, or I'm going to fall off a bridge. Or is something that they're just, they've built up to be a fear and when you can break it down, or minimize and talk through all of the components of the fear, is it a legitimate fear or is it something we can talk through and work out. Death, as I've said, can be a beautiful continuum of life. I would strongly reassure people not to fear the unknown. There's a large difference between perceived fear and real fear. To focus on the fear of the unknown is really a perceived fear, and you can ... When you identify that it's not a legitimate fear, it's something that we've sort of created through a conversation in our heads, then you can minimize that quite a bit. Dr. Bob: Yup. That's awesome. That's some really great insight and advice. I completely agree that the, I think the key, in my experience, the key is like you say identifying the fear, bringing it into the light. When it's lurking in the shadows, when it's just stuck back in the recesses of our mind, occasionally shooting out its little tendrils, there's no way to really deal with it, manage it effectively. It really does need to be brought out. In that way, then we can help people understand where it stems from and get a better sense of like you say, whether it's based on reality or it's based on some stories that they've been told or have for whatever reason come to believe. Julie Chrisco: Right. Dr. Bob: I'll tell you with my patients, like you I get to know them incredibly well. We spend a lot of time together. One of the things that I truly feel the most blessed about and have the most gratitude for is being in that space of communicating with people, sharing intimately with them when they know their life is coming to an end. The wisdom that comes up, just the true humanity that gets shared, and I get to be a part of, is a gift beyond anything I could have imagined. What I find is that very few people have this sort of existential angst, especially as you get into the really later years. Most of them either believe in an afterlife of some kind and they're comfortable with that, or they think that everything is just over, there is no afterlife, it's just this is it, when they're gone, they're gone. Those people, for the most part, are comfortable with either. What is really keeping people awake and kind of freaking them out, is how they're going to die. What's it going to be like at the very end? Are they going to be in pain? Are they going to be struggling to breathe? Are they going to be aware of what's happening and unable to do anything about it? I think that this is a fairly ubiquitous fear that the final moments of life are going to be terrifying. When we get to assure our patients and their families that that will not happen, that we are incredibly skilled at making sure that there is no struggle that people will perceive of when their life is ending, it almost, it changes everything for them. Julie Chrisco: Yeah. Dr. Bob: They can have this peace that well whatever is happening is happening. I can't necessarily change what's going to happen, but now I feel like I don't have to worry that it's going to be terrifying and that I'm going to struggle. Once they have that, and once the families feel that way, there's just palpable relief. Everything from that point forward feels a little bit better, or a lot better, or amazingly better. Have you experienced that as well? Julie Chrisco: Yeah for sure. For sure. When you can ... I mean just even in a conversation, an hour or a two-hour visit with a patient and family, and allowing the conversation to happen. Then when you leave that visit, they're like a whole different body of people. The patient feels better. The family feels better. Everybody's sort of at ease in a place that you didn't know existed for them because when you met them, or when you started the conversation, everybody was so angst and everything was intense. Really it's my goal when I communicate with people is to generate some ease, to generate some comfort in knowing that A, I'm going to be there. I'm your resource, and I'm going to be there no matter what you need. You can call me; you can reach out to me. I'm here for you. And to create that whole I've been through this hundreds of time, and I can tell you from past experiences here's the way it can be, and here's what we're going to do for your loved one to make sure that it looks like that. Dr. Bob: Yeah. That's a beautiful thing. Not everyone does that. That doesn't happen universally. One of the things that I tell people about when they're looking for that support for the end of life phase, when they're looking for a hospice agency or physician care, that they really have to, that there are people who care as deeply as we do and are willing to be there and make those assurances, but it's not a sure thing. People need to be, and families, need to be advocating strongly for themselves and on behalf of their loved ones to find those resources, to find those people who can give them that assurance. It's there, but it's not a given that just because you get on hospice that that's the kind of support and care and assurance you're going to receive. People like you, and I'll say me, we're out there, but we're not everywhere. Julie Chrisco: Unfortunately we're not. Dr. Bob: I think, and I don't know why ... Well, I guess I do know why, but I feel like it's so unfortunate when people are having this experience, and they're living with this fear, and those fears are either not addressed, or they're not brought out. People will sometimes continue having that intense level of fear up until the time that they're taking their last breaths. If the conversations haven't happened, if the connection hasn't happened where somebody is coming in to personally assure you that they will be there to give you and do whatever is necessary to maximize your comfort and minimize your distress, there are unfortunately people who are dying with a lot of distress and fear. Would you agree with that? Julie Chrisco: Yes, definitely. Dr. Bob: So what really irks me, and I guess part of what our mission is, is to see that that doesn't happen when it can be avoided, which is I would say the vast majority of the time. Julie Chrisco: Yeah. Dr. Bob: We continue to have great work to do. I'm really grateful that you have the same passion for that, and the philosophy, and just the comfort of being that person who's going to be there for people to support them regardless of what they're going through. I didn't get a chance to sort of introduce you more thoroughly and talk about all of your incredible accolades, and your education and training, but I do want to if I could just read the last part of what you have in your biography because I think it's really poignant and it will help people get a better sense of ... I think people get a sense of who you are just from listening to this conversation, but I'm going to read this anyway if that's okay. Julie Chrisco: Yeah, that's great. Dr. Bob: Julie is extremely passionate about allowing patients to do what is best for themselves and creating a journey that augments their wishes. She enjoys working with a team of professionals to enhance the quality of life for our patients and their families. Julie is currently working at Integrated MD Care, that's us, where her love of human beings and her drive to produce the highest level of care go hand in hand. That's beautiful, and that's what it's really about right. It's about love for people. Julie Chrisco: And that at the end of the day is why I love my job, and I can get up every morning and say I love what I do. Really all this work is connecting with humans and then using some knowledge that I gained through nursing to make it a little better. But at the end of the day, really it's just about making a human connection and allowing people to know that I'm going to do the best I can for them, and provide the best level of care, and love them no matter who they are, what color their skin is, where they come from spiritually, no matter who they are as a human being. That's the benefit of this work, the human connection and the relationships that I get to build with these people. That's what makes getting up every morning so meaningful for me. Dr. Bob: I get that, and I so appreciate it. That's why you are such a valued member of our team. I guess the one thing ... I want to cut this off before too long because we could continue this conversation for hours, but that love of people, that human connection, it's so integral as life is winding down and in the very final stage of life. But what's been amazing to me, and I think you're seeing this now as a member of the team, is when we introduce that, our style of care, this total love for people and desire for personal connection, and we bring that into the care plan of people who aren't necessarily dying, who are just elderly, they're people with dementia, they're people with other health challenges. When we bring people, who feel the same way, who are there to make connections, and then just to facilitate and bring their own unique talents and skills to the mix, people they blossom. People who had a prognosis of a month or two to live because of lymphoma, or people who have heart failure, or there's a myriad of different conditions and things that we've seen, we start bringing in massage therapists and music therapists, people who work with them on breathing exercises, or physical exercises, and with the basic tenant of making human connection and trying to improve a person's life moment by moment, that is so powerful. It's just kind of blowing my mind to see that happening time and time again. Julie Chrisco: For sure. Dr. Bob: I get passionate about that. Julie, it was really wonderful to have the conversation with you. I wanted to share you with the listeners. Over time, I imagine that we'll have an opportunity to come on together again and provide updates on how things are going with the practice and our lives. Thank you very much for being here. Julie Chrisco: Thank you for inviting me. This was a great conversation.