Nurse Jen Durrant of Integrated MD Care shares her views on dying and why she believes it should be more accepted in society.     Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text.  We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Dr. Bob: Welcome to another episode of A Life and Death Conversation. Today, I'm going to introduce you to a very dear friend of mine, and a colleague, member of the Integrated MD Care Team, who I'm very excited to introduce to you and let you get to know her a bit because she is a remarkable human being. She is a remarkable nurse, and she is a true, gentle, compassionate, and healing spirit. I know I built her up quite a bit, and she's embarrassed, but that's too bad. Jen Durrant, please say hello to our listeners. Jen Durrant: Hello, listeners. Thank you for embarrassing me, Dr. Bob. Dr. Bob: That is one of my skills, so Jen is a nurse. She is the Director of Nursing for Integrated MD Care, my comprehensive, in-home practice for people with complex and terminal illnesses, and Jen is someone who I can truly say understands what it takes to truly care for people, and she has a wealth of knowledge, and wisdom, and has just been a joy to work with. Jen joined us in our practice just a few months ago, but I've known her for several years. Jen, do you remember when we first met, because I do, and if you don't, that's okay. Jen Durrant: You remember it better than I do. Dr. Bob: I do remember it better than you do, so I remember a few years ago, I was working as a physician with a hospice company. I was doing palliative care and hospice, and I was called out to see a patient because the family was having a lot of struggle with what was going on. The mom was dying, and the family was having a hard time giving up hope of her getting better, and they wanted her to have more treatment, and it was clear to everybody around that she was not in a position to benefit from treatment, and she really, truly was in her last if not hours, then days of life. I came in to try to just be a support, and help guide the family a bit, but I didn't have to do any of that, because when I came in, I saw Jennifer, who with the hospice admissioners, working with this family, and what I saw was a person who was so gentle in her approach, sensitive to what the family was going through, but firm in her conviction that the patient really needed the support of this hospice team, and should not be subjected to any more aggressive types of treatments. I'm not sure. You may not remember that exact moment, but I'm sure that's a familiar scenario in your work in hospice over the years. Jen Durrant: Yes. Especially being a hospice admissions nurse, I was usually the first contact. Sometimes even the physicians hadn't had that discussion with the family yet, so I was used to stepping into those situations, and supporting the family, and helping them see what was really happening with their loved ones. Dr. Bob: Yeah, and I just remember being really impressed. I had not met her before, and I hadn't actually been involved in hospice all that long, so I was learning as well, and I remember thinking, this gal knows what she's doing, and she's doing it really, really well. At some point in the future, if I ever had my own practice, I'd be looking for someone like her to join me. Fast forward a few years, and I was no longer working with that company, and Jen was no longer working with that company, and I was looking for a nurse to join the practice. I heard through the grapevine that she was in transition, and looking for a new home, and I reached out, and it was ... I wouldn't say it was love at first sight, but it was a match, and it's been a great experience, and I think that we have a lot of great opportunities to work together ahead. I hope you feel the same way. Jen Durrant: I do feel the same way, except for me, it was love at first sight. Dr. Bob: I want to ask a little bit, so we've gotten through that. I've told everyone how wonderful you are, and as you know, I share that pretty freely, because I do think you're wonderful. I want to ask, how did you get to the place of being so comfortable in that position, stepping into situations that are so emotionally charged, and everybody kind of coming at you in many cases, needing answers, needing the solutions. How did you come to be comfortable in that role? Jen Durrant: I think it started when worked in pediatric hospice, as a nurse in pediatric oncology, as a nurse assistant, and many times the patients got better and went home, and we got pictures from their high school dances. Sometimes they didn't, and we were there as the kids were declining, and they were getting sicker, and the family ... They're not usually prepared to lose their child. The parents are supposed to go first, and I just found that I had a knack for holding space for them, and mostly what they needed was someone to listen to them, and you didn't have to solve all their problems. They just wanted to be heard, and from then on, I knew that I wanted to work on end of life, and so after nine years of being a nurse assistant, was finally just take that part out. After nine years of being a nurse assistant, I finally decided to go to nursing school, so I could more fully support people in that phase of their lives. Dr. Bob: When you went to nursing school, did you know at that point you wanted to work at end of life work in hospice? Jen Durrant: I had no idea hospice or palliative care even existed, and so once I learned about that, I knew that was exactly what I wanted to do. Dr. Bob: Yeah. Jen Durrant: Yeah. Dr. Bob: It's a good thing. One of the things that I've noticed about you, and it's commented on by patients and families, is your calm presence. You don't get excited. You don't get worked up. You just, you're a very calming supportive presence, and you do. You listen, you hold that space, and yet you also are firm, and provide the right guidance, so people feel very confident in your presence, so I appreciate that. Jen Durrant: My pleasure. Dr. Bob: Yeah. I could tell. We're going to get that piece out, too. I know I asked you to prepare a few things in preparation for our podcast, and because this is a conversation about life in death, I want to ask you first, what are the things in your life that you treasure most? What is most important to you in life? Jen Durrant: That's easy. That's my family. My son, my spouse, my extended family, my friends I consider family, they're all most important to me. Dr. Bob: Yeah. I get that. What do you think about death? What's your ... Just kind of from a high view, what ... When you think about death, what comes up for you? You're around a lot of death. You see people die. You're in the presence of people dying, and you're not a stranger to death, so what's your feeling about it? Jen Durrant: It's a natural part of life, and just so much as birth is a natural part of life, so is death, and I'm very comfortable residing with people that are dying, with the families that are supporting the people, their loved ones that are dying. I don't feel afraid of death, for the most part, I should say, but I feel it should become more normal, normalized process, and less clinical, not a clinical experience. Dr. Bob: Mm-hmm (affirmative), less of a medical phenomenon, and just more of a normal part of life. Jen Durrant: Right. Dr. Bob: Like it used to be. Jen Durrant: Mm-hmm (affirmative). Dr. Bob: Yeah, and I think we're trying to move the needle more in that direction, and I think part of our goal of our practice is to help people get to the place where when death is inevitable, that they're no longer struggling against it, or fearing it, but it's becoming ... It's just; this is the part of life that we all share, right? We share two things. We're all born, and we all die. There's very little else that we can all say absolutely we will share in this life. I think your comfort with that is a really important part of how you're able to provide comfort to others in that space. Yeah, but we're not always ... I think one of the things that I want to also talk about is the life part, because our practice, while we are really good at helping people die peacefully, we're also really good at helping people feel better, and experience some more, a greater sense of joy, and peace, while they're still living. Can you talk a little bit about how you see your role in that? Jen Durrant: Yes. I think being around people that are passing away and their families is actually really life-affirming for me, and I take that to our patients, and to our families, and I feel I'm able to encourage them to say yes to life and try things they may not have considered before. Dr. Bob: What are some of the things that you have encouraged patients and families to try to enhance the quality of their life, that they may not have been open to, or thought about? What are some of those things that you're really excited about being able to bring to them? Jen Durrant: Working with you has broadened my horizons, and being part of the practice, so really encouraging them to try the alternative therapies that we offer, and the practitioners we team up with. I think a lot of people get stuck on just the medical solution to the problem. They want a pill to take their symptoms away, and so we really explore what does acupuncture look like? What does cannabis therapy look like, or massage, music therapy, being able to talk with a social worker, and pain, for example, going at it from all angles. Yes, we'll medicate to make sure you're comfortable, but let's try some acupuncture. Let's try massage, or maybe it's a spiritual pain or existential pain that they really just need to be heard and have someone to talk to, so I feel we take a more broad approach, and it's really nice to be able to open their minds to alternative therapies, instead of just medication. Dr. Bob: Yup. I completely agree with that, as you know. You've been in the traditional hospice world, and now you're working in this world, which is a private model that doesn't have the same constraints. What's it like to be practicing here? How do you ... I guess from the perspective of a nurse practicing in this realm, and what do you think it's like from the perspective of a patient to have, to be part of our practice versus a traditional hospice model? Jen Durrant: As a nurse, it's really freeing. I felt very constrained by the hospice model. Most of the time I felt I was providing 10% of my time towards patient care, and supporting the family, and the other 90% of the time sitting at my computer charting to Medicare guidelines, and everyone needs to fit into the hospice box. Whereas here, there are no boxes, and we're really thinking outside the box to support the patient and family in ways that weren't possible when I was working with hospice. I've been learning a lot, and learning how to support patients and families in ways that don't just include medications, or offering a visit from a chaplain, but really being able to be with them, become part of the family, and support not just the patient and the family, and the caregivers, and I think from the patient's point of view, they're really just getting a lot of extra support, and love, and involvement that they don't get anywhere else. Dr. Bob: Yeah. That's what I see. One of the things that I recognize with our practice is, there's something unspoken. It's hard when you talk about what it is that we provide that's different, the knowledge that the patients and families have that there's somebody available to talk to at any time of the day or night, and it's not going to be a bother. They're not going to get a runaround. They're going to speak to someone who knows them and cares about them, and who they've developed a trust with. I think that that is ... There's no substitute for that, and it immediately, from the moment they realize they have that, it immediately reduces their stress level, and their anxiety, and I think that allows people to sleep better, to feel better, to eat better, and I didn't quite get how important that was, how vital that was, until enough people had told me that, I just feel so much more relaxed, and know that I can call Jenna for anytime, day or night. Whether it's two in the morning. Jen Durrant: That's right. Dr. Bob: Do you have any particular experiences with dying people, or in death that were really especially impactful or meaningful, that came up? Was that one of the questions that you explored? Jen Durrant: Yes, there are so many. I'll share a couple. One, I was with a patient with his wife in the hospital. I went to do a hospice evaluation, to see if they were appropriate to start service and get them started. When I got there, the patient was already passing away, and I told the family, "We won't have time to get him home. If we try, he may pass away in transport," and they were not comfortable with that, and I could have pushed through with the admission, and made them do a bunch of paperwork, and answer a bunch of questions, but I decided not to, and I just stayed for an hour, and provided support, and guidance, even though they weren't officially under our care. Just to see that peace come over the patient and the family, just because they had a supportive presence there, was really powerful. They felt like they were floundering in the hospital and the system, and just having someone to support brought them peace, and I was there as he passed away. I didn't provide any sort of medical care, because they weren't our patient, but just to be there and watch him transition peacefully really meant a lot to me, and it meant a lot to the family. I've attended a couple more difficult deaths, where the patient's suffering, the family's suffering even more so because it's hard to see their loved one having difficulty, and sometimes I didn't have all the tools I needed to ease symptoms, as far as medications with hospice, and it was really just being able to support the family through that hard transition. I believe as a patient's passing away, even though they may have symptoms, they may have trouble breathing, or make strange sounds when they're breathing, I believe the patient isn't conscious at that point, and perhaps their soul's already floating above their body, and that they're not experiencing that discomfort. I know everyone else may not believe that, but because I believe that they're not really experiencing that, I can help support the family and say, tell them they're not conscious. They're most likely not feeling this pain. They'll be okay. It brings them a lot of comfort just knowing even though they look like they're suffering, there's a calm presence telling them, and supporting them through the process that it'll be okay. I'm here for you. What can I do to help you feel better? It's really an honor to just be there, to guide them, and support them, and ... Dr. Bob: I am sure that it is incredibly impactful, and it changes that experience for them, right, an experience that they could be completely out of control, and terrifying, that they would potentially feel guilty about for the rest of their life, maybe decades. You change that. You couldn't necessarily say the person who was dying, that wasn't the role you were playing, but just to be there, to make sure that they had a better sense of what was happening in a calmness. When they look back at that experience, it will be very different than it would've been otherwise, so I'm sure that ... I know the feeling of the power of knowing that you saved people from having potential years of angst, and regret. That's really phenomenal. Jen Durrant: That's my hope. Dr. Bob: That's our hope. That's what we're doing. Yeah, we're here to support the patients, and comfort them, and guide them, but that's just a piece of it, and those patients will die, and they're gone, living on in the memories of their loved ones, but the memories of their loved ones, and the way that the loved ones then go on in the world, is really part of our work, too. Jen Durrant: Right. Dr. Bob: That's really meaningful, and you get that, which is why you're part of the team, so, and thank you for that. Jen Durrant: Thank you. Dr. Bob: Yeah. What do you think happens after we die? Do you have any direct knowledge of that, or are you ... Can you speak from a factual place, or can you only speak from what you believe? Jen Durrant: Both. Dr. Bob: Really. Jen Durrant: Yes. Dr. Bob: Okay, well, share. Jen Durrant: [inaudible 00:22:47] I've been with a lot of dying patients, and in the process of dying, they will reach out to people only they can see. They will have conversations with people only they can see. I had a really strong experience when I worked in pediatric oncology. There was a patient there. He was 21, and he was only in the pediatric ward because he had relapsed multiple times, and so he came back to the children's hospital to continue treatment. He was about six-four, tall, African American kid, and so he took it upon himself to make friends with all the little ones, or with the new patients, and help them feel supported, and like they had a friend that would understand what they're going through. There was a little boy who was five, and they just bonded. They were both terminal at that point, and that patient would spend hours with this little boy, just talking with him, and telling him not to be afraid. He said, "When you pass," it's making me emotional, "When you pass, I'll be there waiting for you. I'm going to go first, so you don't have to be afraid." The patient passed, let's say, on a Wednesday, and the little boy passed the very next day, at exactly the same time, and before he took his last breath, he looked up, and smiled, and put his hands up in the air. To me, that's a fact, that there is an afterlife, and there are people that are watching out for us. Dr. Bob: And waiting for us. Jen Durrant: Mm-hmm (affirmative). Dr. Bob: That's beautiful. Jen Durrant: It is. Dr. Bob: Thank you for sharing that. I'm sure that ... I think that that will be comfortable for many people, so that's ... Based on that, and other experiences and just your life evolving, you're confident and comfortable with that? I guess confident may be a stretch, but you feel pretty comfortable that when we die, there are people wait ... You'll see your loved ones and people waiting for us? Jen Durrant: I do. I've seen it too many times to be able to say there's anything else different. Dr. Bob: Yeah. I'm in complete and full agreement with that, so have you ever had any messengers, or messages directly that you feel were from loved ones, people who have died? Jen Durrant: I do, more so in my dreams. There was a patient when I was a brand-new hospice nurse. I was really close with her, and her family. She had a young daughter about my age with a son about my age, and the daughter was doing all she could to care for her mom, who was very near death, and so I was highly involved in their care, trying to support the patient, and support the daughter as much as I could, probably doing things out of the scope of my practice, but I was okay with that. The night before my patient passed, I had a dream about her, and in my dream, she was up and walking, but she was trying to take her clothes off, and telling me that her clothes don't fit anymore, and it's time for her to take them off, and find something else. When I woke up, I knew that she would pass away that day, and she did. Dr. Bob: She took off her clothes. Jen Durrant: Yeah. She was ready to go, go out the way she came in. Dr. Bob: Yeah, I've had ... I think I've shared before stories of maybe, not in this form, but my strong connection with dragonflies, who have come to visit me after loved ones have died, and there's just no question in my mind that those are messengers just coming to comfort, and let me know that I'm being watched and loved, and I'm always ... When I'm with people whose loved ones are dying, and we have the honor of being able to talk to people who know they're dying, and will be dying soon, and engage in discussions with them and their loved ones, and so I'm always asking them to have a conversation about how they will communicate, as long as they're open to it. I try not to force, push my belief system on others, but if they're open, then I try to have them make that sort of agreement, and I think that ends up being very comforting for people. Jen Durrant: My wife's grandma was murdered. We don't need to get into the details of that, but when her house was being cleared out, they found jars, and jars, and jars of buttons, and she would save the buttons in case someone needed one for their shirt, or whatever they needed it for. Her sister took some of the buttons and made necklaces for the family, and to this day, we will find buttons in places there should not be buttons. One day we were at the beach, and it was a particularly hard day for my wife because it was the anniversary of her grandma's passing, and on the sand, at the beach, there were about 20 buttons, different shapes, colors, and sizes, and that brought a lot of comfort to my wife, and of course we collected them, and took them home with us. Dr. Bob: Of course you did. Anything else that you ... Any other really important or unimportant thoughts that you'd like to share with folks? Jen Durrant: I think these podcasts are important, and it's important to continue the conversations about death and dying, and living, and getting to a point where we talk about death as comfortably as we do about birth. Dr. Bob: I appreciate that, and I know you're part of that movement, and will continue to be, and will continue to bring immense comfort to many people throughout your life, so thank you for being you, thank you for being part of our tribe, and thank you for joining me on the podcast today. Jen Durrant: You're welcome. Thank you for having me.