Caring for the Mind, Body, and Spirit: A Oncology Nurse's Guide to Understanding Palliative Care

Nurse Em
I went into nursing to, you know, it's the stereotypical to help people right but as I've been in my career and I've worked in, you know, for the past six years, the biggest thing about nurses I love is really getting to know my patients you know, learning from the like, especially in oncology they have taught me so much about life and about the value you know what really matters in life right? When you're hit with a disease as brutal as cancer you know it it forces you to come face to face you know, to confront your mortality maybe for the first time in your life right and as a result patients have really you know, like learned to live life to the fullest and to never take you know life for granted and I've I've kind of adopted those those lessons myself

Brooke Smith
Hey, everyone, welcome to MDF Instruments Crafting Wellness podcast.

Nurse Em
My name is Em @thatspitfirenurseem on Instagram. I am an oncology palliative care nurse. So I've been an oncology nurse for about six years now. And I've been in palliative care for the past two years. I work closely with oncology patients in the outpatient setting, and I'm based out of Houston, Texas.

Brooke Smith
We really are excited to kind of dive into what you do because you're in a bit of a niche field, I think and a field that maybe doesn't have a big light shining on it as far as what you do, and how you help patients. And I know there is some misinformation sometimes even in the medical field itself, can you kind of just walk us through what palliative care is, and oncology nursing and what you kind of do what your day to day life is like as a nurse.

Nurse Em
So palliative care is actually a very unique specialty. Like I said, there's lot of misinformation but what palliative care is, is a service dedicated to symptom management and dedicated to optimizing quality of life in the oncology patient population, palliative care in oncology run hand in hand, because you know, we want to make sure that our patients who are undergoing these pretty brutal treatments on their cancer itself are able to get through, you know, their treatments and able to live normal lives. You know, cancer is one of those very, it's a very destabilizing disease, and it throws people off, right. So our job and pallative care is to make sure that they are able to live as normal life as possible while still having cancer oncology was it's kind of funny, I mean, I always say I didn't think I was going to end up in oncology nursing. But now I can't see myself leaving. I took a chance kind of when I, when I was in my final semester of nursing school, just because I didn't think I had the heart to work with oncology patients, a very special pocket patient population. You know, they're very vulnerable at the same time very, very strong patient population. So I took a chance I started working on inpatient unit, right out of nursing school, and I fell in love with it done inpatient. I've done infusion and I work in a clinic, where I combine oncology and Palliative Care Nursing, which is my true my true passion. And, you know, I do a lot of education about palliative care. As I said, there's a lot of misinformation about it, even among healthcare providers. People tend to confuse it with hospice, which, you know, palliative care is an umbrella term that includes hospice, but they're not interchangeable terms. And I think that patients you know, theirs are are afraid of hospice and are afraid of, you know, because they associate hospice dying. When really, you know, hospice is about making sure that you are comfortable, you know, as you pass, which, you know, as healthcare workers, we can't really, that's, that's what we want, we want, like our patients are dying in our you know, in that final stage of life, you want to make sure that it's as peaceful as possible. So my day to day life now is I kind of have the best job I work five days a week, sometimes four days a week, no weekends, no nights, no holidays, that's exactly the way I like it, I actually do a lot of telemedicine, which is interesting, I didn't think that that was going to be what I what I did when I accepted this job, but I really liked telemedicine kind of forces you to kind of step outside your comfort zone, when you're assessing patients because you can't physically lay your hands on them. But for these patients who are struggling with symptoms, sometimes you know, fatigue being the biggest one, you know, they're not able to come into the clinic, because they're just so wiped out or they're in such bad pain that they can barely get out of bed, you know, it's helpful for us to be able to provide this service for them. So we can still see them, we can still, you know, give them the care that they so desperately need without, you know, without putting them at risk for falling when they come into the clinic. So that's kind of what my day looks like. And I've been doing that for the past two years. And again, I can't see myself do anything differently.

Brooke Smith
I love it. That's awesome. I know you're really passionate about it. I love watching all of the content you make educated about what palliative care is oncology nursing. You talk about symptoms of Cancer, I mean, you really run the gamut. Anybody can find your your content purposeful, whether you're in the field medical field or not, because you really do give some education and some advice on things to look out for. And you talk a lot about, I know, insurance is a big thing. And all kinds of battles that you as a nurse are constantly fighting, that aren't just about the patient, sometimes you have to fight the insurance company to be able to get help to the patient. And so really kind of fighting fighting a lot of battles that people don't always see.

Nurse Em
Insurance, you know, and when you're in nursing school, they kind of touch on it, but they don't really tell you how, how much, you know, how big of a grip insurance companies have on health care. And, you know, I just created a video about this, about the things that you know, they don't teach you in nursing school. And honestly, it's really kind of disheartening to see, you know, insurance companies deny these light treatment treatments for patients. You know, I've spent hours, countless hours on the phone with insurance companies battling for patients, you know, all behind the scenes. And meanwhile, patients are, you know, either they get mad at us at the team, because why is it my memory, if you could only see how many times I've spent fighting for you, and a lot of them, you know, especially in oncology, because these cancer drugs are very, very, very expensive. And even some of the medications that we give to help manage their symptoms can be very expensive as well. So they're kind of aware of what we know of the process, they know how insurance works, and you know, what, how, you know, the propensity for insurance companies to die their treatments. So that's, you know, it's helpful in that end, but it's also disheartening, because you know, you want to, you want to do your best to help your patient. And sometimes, you know, even when you do everything, right, you know, you'll hit that roadblock at the end, that always has to do with dollar signs, and you're kind of helpless. And I've, I've lost a few patients, because they weren't able to get the treatments that they needed, because they couldn't afford their treatment. And even if insurance does cover it, you know, co pays for these medications can be incredibly high as well, and patients will bankrupt themselves. It's, it's devastating. And, you know, it's one of the dark sides of healthcare that you really, again, don't learn about in school, or don't learn about enough. So, yeah, that's unfortunate.

Brooke Smith
Yeah, that has to be frustrating, as a nurse who's there trying to do everything you can, if a patient can't be saved, obviously, you're, you're you're doing your best, you know, working with the rest of the medical team to try this and save a patient. I mean, obviously, that's first priority, but some sometimes, you know, in his terminal there, there isn't a lot you can do except make the patient comfortable, you talk about that a little bit as that is what palliative care is, is is helping the patient manage their symptoms, making their life as most most comfortable as possible. And that's not just physical, and it can be emotional as well mental as well. I know the care kind of spreads throughout all of those, all of those ways. But as a nurse, trying to fight and protect and save and help do all of these things. That has to be one of the most frustrating things to watch is when you know that you can alleviate some symptoms or help help in a way but you just can't get into the patient because of financial restrictions, or the insurance isn't going to cover it or the patient can't afford it. And that's really, it's really a sad thing to see that money is the thing that out even at the end of life is going to decide if you can really have the care that you as a nurse would want to give to everyone.

Nurse Em
Oh, you realize very quickly when you when you enter healthcare, that healthcare is business, right. And businesses can't run without without money. You know, so, as much as we want to do, you know, the best for our patients, sometimes, again, we're very limited, these limitations that I've run into are not just financial, a lot of them are but, you know, with pilot care, right? It's one of those fields that's controversial, even among healthcare providers, right, you know, patient health care providers were educated, obviously, we want to go to school, we all learned about what palliative care is, but healthcare providers are still resistant to to consult us and I think it it's, you know, twofold one, like No, just the the health care model, you know, people want especially providers, you know, are trained to help patients right to to always try to cure them, you know, it's like the medical model. So, when they palliative care they associate Patrick you with hospice and giving up right they don't want to give up on the patient and the same thing with a patient perspective, right a patient doesn't want to they think palliative care they think hospice and they think oh, I don't want to give up because it's not you know, this is on I don't want to die. Right when in reality it's it's very no hospice is end of life. Obviously like you know, you have to have a certain qualifications. Six months to live that is the biggest one, but with palliative care anyone With a complex disease can qualify for palliative care and cancer is one of them. In an ideal world, in my head, everyone who is diagnosed with cancer should immediately have a palliative care console. Because we are there to help the whole patient, right physical symptoms, psychological ones, spiritual ones, that is our game, right? We are here to help you get through some one of the worst parts of your life, right? Cancer is a terrible disease. And it has, you know, ripple effects, physical effects, and especially, you know, mental mental ones and emotional ones, it affects not just the patient and affects the family as well. And we are invited here, we're here to help the whole unit, we want our patients to succeed, you know, with as little symptom burden as possible, and no, like offense to my my oncology colleagues, but I've worked in oncology. So I know, you know, what, and I worked in the clinic as well. But you know, the, they tend to focus more on physical symptoms, just because, you know, there, the patient will come in, they'll do a, you know, an assessment on them to make sure that the chemotherapy, they're cleared to receive their treatment, but it's kind of, they don't really have time to address the mental health, you know, burden that cancer can cause. And that's kind of where we come in, right, we're our appointments are longer, and we're really there to sit down with a patient and just literally just say, Hey, tell me what's going on. Right. And we have a certain set of symptoms that we go through and an anxiety and depression is our true, the big ones that we assess, and that we actually have time to assess and really go in depth into. And a lot of patients find it very, I think relieving, they're able to talk about it, you know, I've seen even the strongest of men crumble, you know, and just open up. And I think that is something that's super rewarding as nurse to be able to, to break, you know, patients have patients trust you enough to open up and tell it, you know, tell you about all the things that they've been bottling up inside, right, you know, they don't want to burden their family with all these with all the sadness that they're having. But once they finally get it out, they feel better. So that's definitely one of the best parts of my job, I think,

Brooke Smith
you know, when you're battling something as difficult and serious as a cancer diagnosis, I feel like a big part of that battle is meant, because you have to have the optimism and the will to fight. And sometimes I think, you know, you, your brain is a very powerful thing. And if you give up on yourself, because you're depressed and sad, and you're like this is it for me, then your body is going to kind of follow suit. And it's it's one of those things if you can have the mental strength and fortitude to say, You know what I know, I don't feel like eating, I'm nauseous, I can't keep any food down. There's no point I don't want to but like having that mental fight to live in that will it will get you through those moments. I know I can't survive. I can't fight this cancer without nutrition. And that was a big thing with my father who had prostate cancer was he had no appetite, you know, after radiation after chemo, no appetite, and his weight just kept going low, low, low, low, low, and it was causing anxiety and me watching the scale go down because I'm like, Well, how far until we're worried? Like how far like yeah, how much weight can you lose before we're concerned about this. And, you know, I got fought with a little bit of like, the mental anguish that that puts on a patient of the extra stress of like, they see the weight coming off too. And you like don't want to scare them, but at the same time, it's like okay, what at what point do we want to say something because, you know, so I did have that kind of fight of because as his daughter, I wanted to say, Dad, you need to eat like let's get you know, and so you don't really always know what the right thing to do is but the the mental anguish that the families go through and the patient goes through, I think having palliative care and people who are experienced who have seen countless different people and run the gamut of different kinds of cancers and different ages and different sexes and all different walks of life and everything that you guys are the ones that kind of have that knowledge and experience to say okay, here's how we can handle this in a way that's going to be conducive to the healing of this person or is going to make this less stressful for them and less anxiety than you're actually bringing more to your dad than you want you know that you're hurting him or that you're helping him because he can't eat you know, it's not his fault. So I think there's definitely that like push pull situation and I can imagine that family members also find you guys very helpful and useful when they're looking for how to also help their family member go through this this the hardest most work, you know, Battle of their lives. , Yeah,I mean, it's funny you bring up appetite because that is probably one of them. what's concerning symptoms? For families? Right. But it's such a multifaceted symptom. You know, there's multiple things that can be causing loss of appetite, you know, physical, obviously being dissipation have an obstruction, you know, they nauseous. But there's also, you said, the mental health aspect, right? Patients who are depressed and who may not know that they're depressed, you know, loss of appetite is is a symptom of depression. Right? So being able to sit down with patients and really kind of dig deep and be like, Okay, tell me really what's going on, right? Because patient be like, Yeah, I just don't know why I'm not eating. And I'm like, okay, and then like, you finally get to know them. And it may take, you know, it may take a session or two, but you really come to realize, okay, this patient is, you know, is beating themselves up, right. You know, they're, they're, they feel like a burden on their family. And as a result, they just feel you know, that, that that's causing depression, and that depression is preventing them from eating. And I think families have a hard time as well, seeing patients, not IE, I think numeral diet, nutrition, we're, you know, it's part of our daily life and cancer can alter that greatly, right? Whether it's causing nausea, or whether it's causing lack of taste, right, can't like chemotherapy, wrecks, tastebuds, and can make food just tastes awful. So it's, it's, it can be hard to eat. And I've seen patients being like, yeah, I forced myself to eat because I know I have to, or because I know, my, you know, my sister who lives with me wants to know, I don't want to I don't want her to make, you know, to feel bad. You know, there is like you said, there is definitely like, a threshold, we're like, okay, we need to do something, right. Like if a patient is losing an insane amount of weight. And the reason weight is so important is because treatments are based on weight. So the patient loses, you know, what 10% of their of their starting weight initially will meet their treatment plan that back, you know, the chemotherapy plan has to be altered, because it's not safe to give it. But it's, it's one of those things where it's, it can be, you know, that it's quantifiable. So when a patient's like, yeah, my appetites better, and like everyone gets, you know, like I'm eating and that their families, like I'm eating, you know, they're eating, and it makes them feel great. But oftentimes, I will, you know, there'll be times with the patients like, I, I'm just forcing myself and I, you know, I feel bad, but you know, I don't want to tell like, it hurts to it physically hurts to eat. So I'll bring in, you know, the family member, and we'll have a sooner or have a sit down, or, you know, just converse and be like, Look, what, what's normal, what was normal for them back, then it's not normal for them now, right, you know, their stomach is shrinking, or they're not able to tolerate this, or maybe just food just tastes so bad that it goes, no makes them want to throw up, like, you can't change that and forcing them to eat and make, just because it makes, you know, it's something that makes you feel better, as you know, as a family member is not conducive here. So we do have these conversations all the time, appetite is just one of them, but with family members, so they can kind of put things in perspective, because they're used to their normal, right with with with the patient, but that normal is is different now with cancer. So it's, it's difficult, and you know, I have no problem being the bad person and being like, you know, like, this is what this is what we need to do, right? And so the patient doesn't feel like they have to, you know, cause, you know, create conflict among their family, because they really need them. Do as you probably know, with your dad, no one, cancer is not a solo disease. It takes a village. And patients who have support from their families tend to do a lot better than patients who are alone. So

Brooke Smith
yeah, and nurses like you who advocate for their patient, I mean, you are the liaison, you're the communicator between, you know, the patient and their family to kind of help set the tone of what the expectation is. Because, you know, if you've never experienced cancer before, and you have no idea, you really don't know these things until you're walking through it. And so what you do is extremely helpful. My question is, how do patients come and find you? How do they how does one come to find palliative care? So most of the time, the majority of the time, it's the provider referring the patient and telling them okay, like, you know, I think, you know, you're not just getting out of control, your pain is getting out of control. You know, I think we need to refer you to a team that can better manage this. It's very rare that a patient will request palliative care services. And that's kind of what I do on social media as I tried to educate patients and be like, Okay, if you're struggling, you ask your provider, you know, don't cancer is just one of the myriad diseases that palliative care can benefit. But ask your provider right at worst, you know, they'll say like, you know, I think you know, I think your you know, your your symptoms are pretty controlled right now, but we I don't think it's Time to refer which case that's a different conversation, right? But most of the time, they'll be like, Yeah, of course, like, let's get you, let's get you to see them. There's no harm done in seeing this, right? It's not giving up. We're not We're not here to talk about hospice, right? We're not here to talk about end of life, we're here to talk about how can we make the symptom that you're struggling with right now better. And a lot of the times of oncology, the biggest symptom that we get referred for is paying, if the cancer is not getting treated, or if the cancer you know, is not responding to diseases, that pain will get worse. And there's a point where providers are not comfortable prescribing, you know, medications, you know, high dose pain medications, for these patients, but our team specializes in that, right, we do pain, and we we manage pain very, very well. It's like some hospitals don't have kind of care teams, I work in a very large cancer situation that does have a very, you know, a long established kind of care team. But there are small ones that don't. But there are community palliative care teams that were available as well. So even if the hospitals didn't have it, there'd be like, let me put a referral to case management to see if we can get you connected with a palliative care team or even a pain team. Right. There's chronic pain teams all over the country that are, you know, outside of the hospital, comes from the provider and the healthcare well as health care providers, I certainly think that we need to do better about you know, referring patients early to palliative care, and not just when their symptom is so uncontrolled, that you know, maybe we don't even have any options in palliative care to help them. Right or classic that we get is this patient is there no more Truman lot, you know, Trump no more treatments available when he does talk about goals of care? Right? I'm like, like, how would you feel? Right, if you wore getting referred to a team, and they talk to you about how you, you know, about code status about sensitive topics, like goals of care for the first time without ever having met them? Right, you're like, why? Who is this person? My and we get a lot of pushback from patients, too, because they're like, I didn't even know I was referred for this point. I don't know if disappointment is that like, sorry, your doctor didn't know your provider didn't tell you right? You know, you have a you have a right to complete transparency. So it's healthcare, healthcare providers. 100% needs to be better, it needs to be more open, they need to communicate better with their patients, let them know what the what the the console is referred is is for and let them know that you know, maybe, and consult way earlier, I tend to find that when these goals of care conversations do have to happen. And they happen more often than not in oncology. Know that if the patient's already established trust with us, and they trust us. Those conversations are a lot easier to have.

Brooke Smith
Yeah. And so no wonder there's no wonder that there's a confusion with palliative care and hospice if, if the referral is coming so late down the line, then it might seem to people Oh, piloted care and hospice are like my options. And can I can understand how the confusion would happen if, if the referrals are coming in so late and there's not so much palliative care you can even do at that point, because they're pretty much talking and of death wishes and you know, do we resuscitate breast resuscitate you and like all of that stuff? Is it true that it's not just for cancer, like palliative care can be for I think you said COPD and some other things like that, but you personally just are an oncology palliative nurse, is that right? That's correct. Yeah. In order in order to qualify for palliative services a patient has has to have a complex disease, right. So basically a disease that requires multimodal management. So COPD, heart failure, dementia, Alzheimer's, all of those are, you know, our classic, complex diseases, right. And I love palliative care. I've always kind of been passionate about it. But my floor that I started on, had both oncology service and palliative care service running hand in hand. So I kind of got that exposure early, which is kind of what led me to where I am now. But yeah, I I'm a palliative care nurse, and I only work with oncology patients. And I kind of I love my like, I love my oncology patient population. So I think as much as I love palliative care, I don't think I would work outside on my oncology patient population, just because I have a close knit relationship with with those kinds of patients.

Brooke Smith
Yeah, I can see that I am. I have a few other questions about I know that you kind of you go over this on social a bit, but could you just give us a kind of a cliff note version of the difference between payactiv care and hospice? Because I know that as you spoke earlier in this podcast about how with hospice you have to have basically you have six months or less to live approximately no one can really tell you but approximately So there are certain things that differentiate between hospice and palliative care and why there's a confusion between the too could you just kind of give us a little kind of tell us that the differences between the two?

Nurse Em
horse I care is is the general is the big term, right? It actually includes hospice, but palliative care is symptom management, right? That is what we that is the focus of palliative care, pretty much optimization of quality of life, right quality over quantity. You don't have to have, you know, like I said, just have to have a complex illness, you don't have to be dying, right, you can be diagnosed, you can be referred to kind of care service at time of diagnosis. Whereas hospice, hospice, you have to have a life expectancy of six months or less, that has to be diagnosed by a hospice qualified physician. And then you also have to give up all, like treatment with curative intent. So you can still pursue palliative treatments, right. So for example, like palliative radiation to, you know, to help with pain in the, in the spine, right, you can still do that. But you just can't do anything that might cure your disease. Palliative care, you certainly can, you know, we walk hand in hand with with oncology teams, we tried to get patients through their treatment to achieve remission, right, that is kind of the the thinking behind palliative care not in the oncology setting. But hospice, yeah, you can't, you can't pursue any curative treatments. However, you know, hospice is not binding, right. So a patient has the right to revoke hospice at any time, right. And if they live past six months, they also, you know, it's not like you're automatically come out of hospice, right? Every couple of months or so you have, you know, a hospice provider who goes out and re certifies hospice, right, they still think that the patient still has a life limiting disease, that they're going, you know, they can, they can recertify. So that's kind of the main difference between hospice and palliative care.

Brooke Smith
A place where you can go to manage all of your symptoms to help fight while you also pursue, cure or getting better. Whereas with hospice, you really can't do any all life altering things to get the cure, like you can't go get a tracheotomy, or, you know, they don't, they don't do treatments like that they let you, you probably eat and you know, like normal pain meds and stuff like that, and hospice, but they're not doing anything to interact with what the natural, what is naturally happening with your body. Whereas positive care is a great as you say, it's the big umbrella, which is, hey, come over here, let us help you manage your symptoms, let us help you mentally, physically, emotionally, let us get you help manage your pain, and help, you know, maybe counsel your family and let you like less than expectations here for what they should expect you to be doing. Because things are different for you now, and really kind of work hand in hand with I would think, their their medical provider to just kind of alleviate those symptoms. And in a way, I think you're kind of alleviating some of the burden from the medical provider who's probably also overwhelmed because they have a lot of other patients. And that's not necessarily their specialty. Whereas you are, as you're in the specialty of biotech care and oncology, so you're going to be specifically able to meet their needs in a way that maybe their medical provider just can't do.

Nurse Em
I could not have said it better myself.

Brooke Smith
Perfect. Okay, so, what? For you as a nurse, what is something I want to hear what you love most about being a nurse, I want to hear what you wish I could change about what you do in the nursing industry. I want to hear what you wish people knew about what you do, or how other people can help spread awareness or make your job easier. And I kinda Yeah, I kind of just want to talk a little bit about life for you as a nurse and, and kind of use the time to express what you would like the world to know as, as you are in such a unique situation. A lot of times with what you do and you are obviously very passionate and I know that that can also take a toll on you as you are only human. So I'd love to hear a little bit about that.

Nurse Em
You certainly I you know, I went into nursing too, you know, it's it's the stereotypical to help people right. But as I've been in my career, and as I've worked in, you know, for the past six years, the biggest thing about nursing I love is really getting to know my patients. You know, learning from the like, especially in oncology, they have taught me so much about life and about the value you know what really matters in life, right? When you're hit with a disease, as brutal as cancer, you know it, it forces you to come face to face, you know, to confront your mortality, maybe for the first time in your life. Right. And as a result, patients have really, you know, like learned to live life to the fullest and to never take you know, life for granted. And I've, I've kind of adopted those those lessons myself, they give up this one patient, I haven't, you know, he's, he's fantastic. He has, you know, metastatic cancer, but he is the most optimistic patients that I know. And he said, You know, there's, there's no use in dwelling on, you know, something that I can't control, right, I can only focus on the future, and, you know, trying to make myself better for both me and my family. And I've adopted that mantra, you know, you focusing on the past is, is not helpful. And remaining in the present, even focusing on the future, right, because you don't know what the future holds. But focusing on the present, and what is happening here now, and really, truly living in the present is the best thing that you can do for yourself and for your mental health. I'll hand it off, I thought I wanted to be an ICU nurse. And I thought I wanted to be a CRNA. And I would have made a horrific ICU nurse or CRNA. Because I like talking to my patients. That's my favorite part of my job, which is why you know, telemedicine is perfect. I, you know, or even being in the clinic and talking to my patients face to face, I learned so much about them, they learned so much about me, we develop these relationships, I know all of my patients by name. And I love being able to do that, right? It's I see them all the time, I see them once a month. And I've developed you know, like friendships with a lot of these patients. And it makes it hard, because obviously, I know that some of them are not going to do well. And I've lost quite a few patients that I've been very, very close with. And that is one of the worst parts of the job. Especially in oncology, because you know that that's going to happen, right, you know, that cancers terminal, it can be terminal. So you try to kind of, you know, do your best for these patients and keep your distance, but sometimes it's just personalities click and you become really close,

Brooke Smith
how do you take care of yourself? Because you, you know, obviously you're gonna get attached, you're you care about your patients, you're very passionate. And sometimes, you know, you're seeing them from months and months and months, maybe even years while they fight this fight. And I know that, like you said, not all of them are going to make it? And how do you take care of your mental health? And your? I don't know. Yeah, I guess just your mental health mostly because your emotional well being, because I know that. For me. I mean, obviously, I don't have an expert, I don't have experience like you. But you know, there's a certain certain empathy that I also have where it's, it's so hard to watch. And I know that like, you have to do it, and you have to keep going like you could lose, you could lose two patients in a day and find that information out and you have to keep going, you've got another appointment where you have to, like go help somebody and and it's a completely different scenario. And you got to put that smile on and be optimistic and help them fight that fight. So how do you how do you do that? Um, so two things really, that kind of helped me get through. Number one is I am an expert, compartmentalize er, so what that looks like is that, you know, I when I clock in for work, I'm there, right? I own 200% available for my patients, that when I clock out, I check I check out, right, I really, unless there's something that's really like, you know, I had a really hard day like, I'll allow myself, you know, I usually call my boyfriend in the car on my way home, I have maybe 2320 minute commute on the way home. And at that time, you know, I kind of decompress. But when I walk into my house, my house is a safe space, I do not talk about my job at my house when I'm home. Because for me, I need to have a place that I can retreat to, and that I don't associate with my job. So that really, really helps. Because, you know, like you said that it can be difficult to dwell on these things. But, you know, it's the way I protect myself. It's been a protective mechanism since I started nursing. And it's really, really helped me deal with some of the rougher days that I've had. The other thing is, I talked about this a lot is you know, the way I view death in in the oncology patient population, right. When I first started nursing, my preceptor on my inpatient for said, told me that, you know, death is a release for these patients, right, released from the suffering the endless suffering that they've been dealing with, you know, with cancer, you know, inpatient. We dealt with a lot of, you know, patients so get admitted for symptom burden, unless it's really bad, right, and it can't be handled outpatient. So, you know, when we had a patient past inpatient, it was because, you know, it was peaceful. And that perspective on death has, and that was happened, like, literally my first month nursing. And I've been a nurse for six years now. So that perspective alone has really helped to shift my perspective. And, you know, it's, it's sad, and like, of course, like, you know, I don't, I feel sad for the patient's families, who may not have this kind of, you know, this perspective. But for the patient, I know, it's, I'm happy that they're no longer suffering, and that they're able to be relieved of these, you know, these physical burdens, even mental burdens that they've been dealing with, for sometimes years. That really helps me get through. And no, my roommate is a nurse as well, she's my best friend, she's a pediatric oncology nurse. So, you know, she deals with the same thing I do, but with kids, and she kind of does the same thing. She's also you know, a palliative care nurse. And she, she loves what she does. And it's really truly inspiring to see her do you know, everything because, you know, a lot of my patients when they pass, you know, they're, they've lived a good life. Right, you know, 50 6070 years, 80 plus years. But for my, for my roommate, you know, she's, she loses infants, you know, she loses patients who are barely get the chance to live. But she does it with such grace. And, you know, she really loves her job. And, you know, a lot of actually gets to the point now, where a lot of other nurses and even providers go to her for advice on how to deal with death and dying and that patient population, and that's truly, you know, it's a, it's a spectacle, and it's testament to her, you know, her characters nurse. And then finally, obviously, I surround myself with supportive friends and family. I don't, I don't keep anything in, you know, I have a psychiatrist that I love. You know, I used to go through therapy, I think that talking and getting your emotions out is the best thing to do, especially in a field as typical as nursing. And, you know, I was medication, same thing. I'm not ashamed, you know, I'll never be ashamed of, you know, pursuing treatment for for my own mental health. You know, I don't think anyone any nurse doesn't, you know, I don't know any nurse doesn't have a little bit. You know, it's the job, it comes with the job. But I'm a big believer in you know, in talk therapy, and making sure that you're, you know, you keep your emotions in check, and you, you know, you're aware of them. So, if that means no talking to therapists, that means talking to my friends and family, I have a very supportive parents, very supportive boyfriend, and obviously, I have my best friend. And that really helps as well.

Brooke Smith
Just to kind of add on to that I, I was having, personally, for my experience with cancer, my dad with prostate cancer, it was really rough, because he was in ICU for two months, and every three days would be a new doctor. And so towards the end, in the second month, a new doctor would come and that doctor would say, your dad needs he's, there's a difference between saving life and prolonging deaths. And then we would all prepare to take them off on life support. And then a new doctor would come in for the next three days, and then they would say, No, actually, we should try tracheotomy so he can get bed or, you know, whatever. And so there was a lot of like, back and forth, back and forth. And it was, it was horrific to go through because you go from thinking like woman, okay, I'm going to lose my dad today to Okay, actually, we're going to try treatment, maybe we can help him. And it was, it was a lot of yo yoing around. And of course the hospital was very apologetic. But um, you know, we wanted to do our due diligence as a family to make sure we're doing everything we could to, to save him or help him or make things easier for him. And but that that sentence that that doctor said, you know, there's a difference between saving a life and prolonging death. And that is the thing I think that finally got my family to the point where we're like, you know, it's time to say goodbye. There's nothing more we can do. And it's really funny because my father hated hospitals hated. And he wanted to like even when he really needed to go into the hospital, he would refute like, you'd be like, do not put me in the hospital like all I'm going to be fine. And so when he was battling cancer, and so when he was obviously unconscious, he was on life support. He had a tracheotomy. He had tubes like everywhere that you could think of to have tubes. And they're like we decided, okay, we're going to take them off life support and it was expressed, okay, you know, it could take a couple hours, it could take, you know, a little longer could take 18 hours, you know, but he's not breathing very well like on his own. So we think that it won't take that long. And hospice wasn't an option because they didn't believe he was strong enough to take the trip to hospice, they were worried about him passing in transit, which they don't want to do. So we're like, Okay, well, one day goes by two days. Three days go by, my dad starts to better off of life support, his vitals are up his all his all of his fluids, like everything was just improving. So much so that on like, day four, hospice said, You know what, we think that he's well enough, we can transport him to hospice. So he got to hospice. And the next morning, he passed in hospice. And one of the last things my dad said to me was, I don't think I'm going to make it out of here. I love you. He told me that in the hospital and ICU. And I, when we when he got into hospice, I was like, Dad, you're wrong, you did get out. You got out. And he passed in hospice. And I was so thankful for hospice, because it was such a beautiful space. My dad hated hospital, it was quiet, he had his own room, it was comforting to the family, there was more space, and high ceilings, that was just a really beautiful place. But I think that my dad was waiting for us to get him to hospice, so that he could peacefully say, goodbye. And my dad, he was a pilot his whole life. So aviator, and he died on August 19th, which was National Aviation Day, well, sometimes you just have to say, You know what, there's nothing sometimes we can do as people like, sometimes when it's someone's time to go, it's their time to go. But the best thing that we can do is comfort them, and advise them and try to help them pass as peacefully as possible. And that's why I love so much what you do, and the fact that I had an opportunity to talk to you before a lot of that happened with my father. But I just think it's really important perspective to have because yeah, you might lose the patient in the end, but the care that you're giving through the process of that is invaluable to the PERT to the patient and also to the family because that brings so much comfort, like I don't even have words to express how much comfort we we had great nurses, helping us the way the burden of like the worry of like leaving my dad for a couple hours, because I slept in a hospital overnight in the ICU for two months, I was there pretty much every every night. And so that like relief of burden of having someone who was passionate and cared and wanted to help my father that I felt like I could trust was, I couldn't have made it through without nurses like you am. So I just want you to know how grateful I am for you and what you do. And also just I think people are so so appreciative. If you don't hear it enough, you need to know. Yeah, thank you for sharing your story. That's, you know, that's so powerful. And you know, I'm really glad that he passed peacefully, I think that ultimately is what everyone wants. And that's what our goal is, you know, in in palliative care as well. I always say you know, you don't get to choose where you enter this world, right but you can choose where you leave it and nobody wants to die in the hospital right everyone wants to wants to pass it home surrounded by the people that they love in a in a setting that's comfortable for them and giving the patients the opportunity to do that you know fighting for them to make sure that you know like this is this is what they want. They don't want to be you know, they don't want you know all these all these life saving measures right and having a patient and advocating for a patient and making sure that not just the providers but also their families you know understands this is my biggest my biggest passion you know, my best friend to she she does the same thing and you'll show ask patients well, she was a kid so obviously the ones that are older but you know how do you want you know, your loved ones to see you when your pass? Right? Like no one no one wants to see i I can't I don't know anyone that would want to answer that question. Be like I want to see my you know, my mom connected to all these tubes and whatnot, right? No, you want to see her as she is right as you know as the person that you know that you love. and minus all these, you know, these artificial devices that are just keeping her, you know, her heart beating, but maybe you know, not when nothing else. So it's, it's, we have these conversations, right? You know, we have to have these conversations with, with families and with patients and with providers. And it's not easy, but it's, it's absolutely 100% necessary. And I, you know, I love, I love what I do, and I love doing that because it is, like I said, that's the biggest, my biggest joy is having a patient being able to, you know, advocate for themselves and be like, I want to die home, and I want to go in my own way, right, Night night connected tubes, not in the hospital, and I want to be, you know, at home, in my final days, you know, to the nurses out there who think that, you know, they're, they're not being heard or not being seen, you know, patients and their families are seeing you thing, and they are appreciating you for what you know, for what you do, whether or not may or may not be in the hospital, you know, I've been yelled at by plenty of family members, you know, plenty of patients, body providers, and that's, you know, part of the job as well. Unfortunately, it comes with the territory, but you have to know that what, what you're doing is is right. And whether or not you're not, you know, appreciating the moment once because patient patients and families are, you know, emotion is very runs very high in the hospital. And rational thought is not exactly, always present. But when it does, and when patients and families come to their senses, you know, they are really genuinely appreciative.

Brooke Smith
Yeah, and I think that's why it's so important that awareness be risen on the fact of what palliative care is, and that it exists and that it's an option for people and patients. Because I'm sure there's a lot of people out there who would take advantage of that opportunity to have that care if they only knew it existed. So I definitely think it's important that we shine a light on palliative care what it is, and you Em who are a nurse who go through this on the daily and help patients. Exactly, um, you know, it's patients in my own institution, right, so we don't even call our department palliative care of supportive care. But, you know, at first I had an issue with that, but now honestly, it actually has done quite a, you know, it's done a lot better for patients because they're less fearful to see us but at the end of the day, they're like, yeah, like, you know, is this, you know, when we explain in the apartment, you know, I obviously explain what palliative care is, but we call it supportive care. And then when patients are, you know, the ask like, oh, yeah, like, is this palliative care? And they're like, why don't you just call it that? I'm like, Well, would you have come to us know, if we had said palliative care and a lot, you know, 50% of the time patients are like, no, but they're also very grateful and thankful that they have been referred to us because, you know, you know, we help them. So like, you know, to, to patients that you know, and providers, you know, let us help the patient, let us help you, as a patient, get through, you know, some of the worst times of your life, right. And not just the patient, the family, they're the caregivers as well, you know, we do a lot for the caregivers. And we want to make sure that, you know, their their burden is lessened as well. You know, as you probably know, with your dad, being a caregiver to a patient with cancer is very difficult, and very difficult emotionally. And it's hard to be strong for two people. And that's, you know, talking to both a caregiver and as a patient, right. So, at the very least, let us help you unburden some of that, you know, those emotions that you're dealing with, that you're struggling with, so that you don't have to carry it alone.

Brooke Smith
So beautifully said Em. I okay, so I have to ask you. I want to segue a little bit into what did getting your first stethoscope. Whatever stethoscope it was. What did that mean to you? Like do you remember the moment when you got your first stethoscope?

Nurse Em
Yeah, I actually I was like, my parents caring for me. When I you know, before I started nursing school, and I wanted like the best one. I was like, I want to like be flashy about this. And I Yeah, so I was like, I want to be all out like all I was I went to Duke for nursing school and I knew that people would know they would be doing the same thing. But to me, and it'd be like you it wasn't even more so getting a scope is using it for the first time. And I'm like wow, like this is like tests You know, you wear it all, you know, you wear it everywhere you go and you're like, I'm a nerd, right? You know, but it, it is it's like no listening to someone's heartbeat and like being like, okay, cool. If this is like what my job is going to be right? This is how I'm going to identify, you know, illness. Right is it's a big step. Of course I could, when you first listen, you have no idea like, you're like, Okay, that's a heartbeat, like, you know, but you can't, that's all you know, you're like, Oh, I could take a deep breath, like, okay, cool. Like, I can see that you're breathing. But it is it's kind of it's you know, kind of validation that you're what you're there for, and what you're about, you know, the field that you're about to step into. So it was a cool moment. I've done a couple giveaways with you guys. And it's always been popular because MDS scopes are amazing. Just the amount of designs that you guys have alone, I think exceeds any other type of soap company out there. And it's fun, like, right, you know, when you want to customize your stethoscope, you want to make it your own, right? Because you know that you're going to be with this thing and let you know for all right, this is going to be like your right hand, man when you're when you're when you're working. So, yeah, always fun to partner with you guys. If you're a new nurse, and you're struggling, right, just know that it's, it's gonna get better, right you're in, everyone may not start off in a role that they like, right? I love my first job, but I knew that it was not what I was destined to do. Right. And if you're questioning, you know, your, your job, or you know your role, or you know your purpose, know that, you'll find it right, everyone has a niche in nursing, it's, and you'll find your niche. And once you do, you will find that passion and you will sell and you will love what you do. And you will find that drive to go to work every day and help your patients. And once you do that, it'll reflect on your patient care. It took me a couple of years to find mine. But here I am doing what I love. And trying to pass that message on to y'all. I love

Brooke Smith
I love that. And for everybody listening and watching, can you drop your social media handles so that everybody can come over and give you a follow and check out all the informative information you have on your page? @thatspitfirenursem on Instagram, give me a follow I posted like goofy, somewhat educational informative videos every week, so come by.

Brooke Smith
It's so fun. Sometimes she's, she's knocking out another doctor with them. And sometimes she's dancing. She's always always finding interesting ways to educate, entertain, and also give great advice. And, you know, you post some really great vulnerable things on there, too. You know, I saw the posting where you were going through and saying, you know, social media isn't. It's a highlight reel, it's not all of it is glamorous, and you kind of showed the things that you shared this the struggles that you have, personally, and I think it's really important that we all remember that, you know, we're all human, we're all trying our best, and we have good days and bad days and to be kind to each other. And to ourselves.

Nurse Em
Absolutely, I think nobody's perfect. And, you know, I knew I had to do that post because my social media who you see on social media is who I am in real life, right? I don't I am not. I made that a promise to myself when I started this page. And so you know, when that when that trend came up, I knew I had to post and you know, let people know, you know, what I deal with? And how I manage it. And it's, it's been touching a lot of people have reached out and said, you know, like, Thank you for sharing, I deal with the same things. And that's what it's all about.

Brooke Smith
Yeah. And I think it just, it makes everybody feel less alone, when they see that you're struggling or going through the same kinds of things that they're going through. And it's like, oh, it's not just me. Because sometimes we can trick ourselves into thinking, Oh, everybody seems to be knowing what they're doing. everybody's lives seem to be great, like what's wrong with me? Because people don't, they don't have the tendency to share that as much. So I think it's a really great message to bring closeness to have related be relatable, but also just to make people feel less alone in the world. Who are who are going through in maybe a similar career path as you or even on the other end as a patient. Just knowing that, like, it's hard on both ends. It's hard for the patient but it's also hard for the nurse, it's hard for the medical staff. It's hard for everybody because, you know, watching someone go through those things. It's it's no easy feat and it's it takes a toll emotionally mentally and physically on I think on both sides. No 100% I Yeah, you know, it's it's tough to be vulnerable. But you know, I I owe it you know, I owe it to my patients who I asked them to be vulnerable with me, you know, and so it's, if I'm not true to myself, and I'm not, you know, practicing what I preach, then, you know, what? What am I doing, you know, with my nursing career. And, you know, I love that you bring up not feeling alone because you know, nursing is 100% a team based profession, that's what I love nursing, right? You're only as strong as your weakest, you know, as your weakest link. And you can't, you know, you can't save a life by yourself. Right? So when, you know, when an emergency happens, it's good to know that you have people around you. And the nursing community is so strong. And it's so large, and you know, we have our own internal struggles. But I like to think that nurses will always support each other. You know, when, when things happen, and when things happen in the hospital or at home, you'll always have someone who will return to, to to help you get through.

Brooke Smith
I love it. Well, um, thank you so much for joining our crafting on this podcast. It's been such a pleasure having you on again, and please, for everyone listening and watching who want to go follow am that Spitfire nurse and check her out. I'm sure she's open to answer questions, you can DM her. And we'll drop her handle below here so you can also check her out. But thank you so much for being on today. Thanks.

Nurse Em
Thanks for having me, Brooke. It's always it's always a pleasure.