Death Doula Kacie sat down with nurse anesthetist Nick Angelis to talk about processing death and grief without emotional trauma. PTSD is a growing problem, but how do we talk about such triggering topics with those we love? Both Kacie and Nick have seen many people die during their nursing career, but what makes a good death? How can we plan for one, and what do we have to resolve beforehand?
Transcript:
hello and welcome to the Ascend Health show I’m Nick Angelis I’m one of the owners of Ascend Health Center and I’m a nurse anesthetist and I’m here with Casey gono did I pronounce it right this time gono close so close so close it’s all right I’m used to it she’s a nurse and a death Doula which I’ve met death douas before but probably all of you are like wait what what did you just say so why don’t you explain to us what a death Doula is
yeah absolutely I’d love to so people have um more commonly heard of birthing doulas and birthing douas kind of help somebody labor into this world so a death Doula does the similar thing just on the opposite end of life so I help my clients to safely and comfortably labor out of this world
oh wow that’s really neat and what this has to do with mental health and a sent Health Center not that all of our guests have anything to do with my clinic honestly uh is that a lot of times the ketamine infusions that we do is almost like a near-death experience and there’s a lot of research uh psychedelics camine specifically too of how uh these substances can also help you as you said labor out of this world because no one really likes to talk about death uh but it’s such an important topic in our society for our own mental health for our spiritual health uh the American way is like let’s just work really hard make some money ignore death until it comes and die in an ICU after uh 4 weeks and $345,000
yeah I know you’re absolutely right so at some point along the way right humans have been around for a long long time but at some point along the way um this idea that dying is a medical experience is is what came along but really it’s more of a human experience right so for such a long time people thought that you know to die you would need to be in the hospital or something like that but um it just doesn’t have to be that way it can be so much different and it can be so much better and so much more personal and beautiful and planned and like you said um nobody wants to talk about death right and I find that people just let it happen to them you know cuz we don’t want to talk about it and we don’t want to plan for it so death just happens to people and it happens how it happens but it can happen so much better if we do talk about it and if we do plan about it and if we are educated about what could happen and how it could happen and how we could uh you know what kind of interventions you would put into place in certain scenarios things can just go so much more smoothly um so for me you know I like to Rattle everybody’s cage and make them think about death and talk about death all the time all aspects of death whether it’s planning for your death or what your death could look like or you know the use of psychedelics in relation to end of life and things like that so yeah
absolutely because it’s going to happen sorry that uh we just burst everyone’s bubble here but you’re going to die so you might as well plan for it because there’s a lot of things in life that happened that maybe didn’t need to happen but they did because you didn’t talk about it uh whether that’s divorce or job loss bankruptcy there’s a lot of things that like after after the fact people like oh if I had only talked about it or thought about it or had a plan in place and so this is similar except for the fact that it’s going to happen unlike all the other awful things I mentioned but and even good things sometimes people just stumble into it but it’s like you know what this could have been even better had I planned for it uh you think of lottery winners where a lot of times they go bankrupt and it’s something like well this was a good thing but again because there wasn’t a preparation for this it didn’t work out right
yeah so what we’re talking about is a good death basically yeah so honestly what I like to say is that I help people die better and that’s really what I do um when things are perfectly planned and when people do think about and know about and understand what could happen at the end um we’re able to plan it to be a truly beautiful experience and I can give you a little bit of uh an example right so people sometimes don’t realize that you don’t usually just die one day you know some there is a small percentage of the people in the world that do die that way um but for the most of of us it is a labor out of life and your body takes a period of time to shut down and that period of time can be 5 to 14 days even but during that time you’re usually not able to speak for yourself or even move yourself around you’re kind of just laying there while your body does its thing so for me I like to make people think about this like what would you like that to look like so if you were laying in bed for 5 days for the last 5 days of your life and you couldn’t communicate with me and you couldn’t really move around like what could we do to make that a beautiful experience for you so I love to make people think about how we can make it a sensory experience so while people usually aren’t able to communicate it is my belief that they still are able to experience the things that are happening around them the smells The Sounds the feels the touches things like that right so I like to make people think about that right what are your favorite smells what kind of smells can I fill the room with um in the last days of your life that’ll make you feel calm and comfortable is it lavender people love Lavender is it chocolate ch chip cookies cuz if so I’m going to bake chocolate chip cookies for everyone you know um I can really make it just a truly beautiful experience instead of it being a really chaotic stressful experience because nobody knows what’s going on and everybody’s nervous and scared
yeah and the thing too is so what I see in our practice um obviously being a nurse and neis I’m more on the camine side as opposed to our counselors or a psychiatrist but it still is there’s so much trauma around death um a lot of times people are reliving the death of loved ones we have a lot of veterans sometimes they’re reliving some of their War experiences and uh death is traumatic regardless a lot of times there is loss there is grief but if we can make that uh a more gentle passing then it’s not only for the person it’s not only for your patient it’s for everyone that they interact with so that they don’t carry they’ll still carry the grief but again they don’t carry the traumatic loss as heavily knowing that this went uh the way that we prepared for it to go yeah and um you know part of what I do as a death duel so I’m not a counselor but there is a little bit of I don’t know if it’s counseling or just talking through things that happens um but for me like you said there is sometimes a lot of trauma and um regret and grief and guilt and all of these things that people will keep down inside and I believe that if you can get those things up and out that sometimes people can die more comfortably because they aren’t holding on to that stuff um so there is a little bit of that aspect to it as well where you know in talking to people and learning about them and how they feel and they’re diagnos and their future and their life I’m usually able to also kind of identify that you know if there’s something else you know a little something where they’re they’re sensitive around um you know it’s good to kind of get that out and talk about it and people are actually um you know sometimes family members will bring something up like this is a sore subject they’re never going to want to talk to you about it and then it’s funny I won’t even really have to bring it up it’ll just kind of come out organically and they will want to talk about it so um I think that people find me I’m not family you know I’m a different person and I don’t hold judgment and I haven’t known them their whole life so I think that sometimes it’s a little easier for people to get that stuff out when they’re talking to me because we often think of that as a positive way like Grandma held on until Aunt Carol could come over but you’re saying sometimes it is that somebody needs to get something off their chest before they can die peacefully yeah and sometimes if they don’t the death maybe won’t be so peaceful is why I like to really encourage people to get that out I mean if you’re holding on to a lot of anger and stress and things inside of you then sometimes your death can kind of resemble that as well it can just be an uncomfortable agitated type death so I really love to you know send people into that active dying stage in a beautiful healthy space in their head because that’s going to help their body die more comfortably right and and I see that too in the hospital so I’ve been a cardiothoracic nurse no intensive care nurse I’ve been a nurse anesthetist for about 13 years now uh I’ve done a lot of trauma cases and even when someone is dying suddenly and we’re trying everything to save them that death still is different often depending on what’s going on yeah and and I think one thing that’s important too uh because I want to discuss a lot of these awkward spiritual issues too is that um a lot of times death isn’t fair you know as a nurse anesthetist there’s been plenty of times where there’s a prayer chain of 500 people going for somebody that should really make it through surgery nope it died under my hands doing the anesthesia and there’s other cases where you know it’s a child alone and somehow they miraculously make it and nobody even knows their name so we have to remember too that um death isn’t a time to figure out what makes sense is God just what’s going on it often is what it is and we to accept it as what it is uh because when we put our own feelings into it I mean that’s again I mentioned the arbitrary $325,000 in the ICU right A lot of times like no I know you haven’t settled these things but it’s time for them to go know we don’t need them on 17 different DPS keeping their heart alive as everything else dies right slowly yeah I I like to say I actually have heard this before it’s not like I made this up but death doesn’t discriminate so that’s kind we’ll give you credit nobody I don’t like steal credit but yeah death truly doesn’t discriminate right so you know I’m a death Doula and so a lot of people meet me and they’re like oh I don’t need you know I don’t need a death Doula but there’s a lot of stuff that I can teach you because you know at any age you have no idea when your time is going to be up nobody does you know and so there’s a lot of things that I can teach people to help them plan for the worst should it happen no matter when you know whether that’s to happen very inconveniently at an early age or a later age too uh speaking of teaching you also teach death duelas correct I do yes I do I train death douas so um most death douas are non-medical death Doula by you know trade the name it’s a non-medical thing so in working as a death duela I’m not practicing medicine or acting as a nurse but but because I am a nurse and I have all of this knowledge um I I am just able to identify where death duelist need a little bit more help so it was you know quickly and trying to meet people and just you know networking with other death duas um people were looking for help you know like I don’t really know where to go from here or how do I really start my own business um and then I was able to identify also there’s um you know a lack of Education regarding hospice okay so death duas and hospice are very different you know we work in the same Realm but we don’t step on each other’s toes you know we work side by side but uh death duas need to know fully what hospice is they need to know that they need to understand that what they can do what they can’t do what they should be doing so that they can best help their family their clients their people you know whoever it is that they’re trying to help um and then also there’s not a lot of knowledge around the medical aspect of dying with death douas because it is non-medical by trade but um it’s my belief that if you could understand a little bit more more about what’s happening as the body’s dying that just will make a death duela better um so I started offering education surrounding these things how do you open your own company as a death duel how do you Market yourself how do you get clients um you know how to learn about hospice how to work with them proactively because sometimes hospice you know can be nervous about death duelist because they don’t really know what we are either so for just like labor and deliver is nervous about birth duelist there you go so for me like it was very important for me to get in front of hospice because I’m an advocate for hospice I know everything they do and I’ve seen people die with and without hospice and it is not ever my choice to see somebody die without hospice um so I wanted to get in front of them right away and make sure they know like I’m here and I’m working in this realm but I’m Pro hospice I’m working together with you you know we’re friends um so I do have a great relationship with most of the hospice companies in the area for that reason but um but yeah so these are the trainings that I’ve started offering death duas and I am actually in the process of opening my own death doua training program uh my hope is to have a virtual program and an in-person program that would have some Hands-On training which would be really great wow that’s great and what you said about getting in front of hospice so you’re also trying to have a drama free death uh which sounds like a silly term but I make up a lot of silly terms on this show but that that’s true a lot of times the best and worst of families all come out during the same time and sometimes that spills over into the caregivers and the caregivers are impacted I saw this a lot uh both in the ICU and often pre- and postsurgical right so that does make a sense not even peacekeeping but peacemaking since there is a difference between those two terms there is definitely yes yes and I do like you know hospice and I work really well together I mean we really compliment Each Other Well since I’m a nurse and I’m usually working with nurses in hospice you know that obviously you know what a nurse to nurse relationships like you know you can kind of talk nurse lingo to another nurse and so you know we work great together um but you’re right it is great for us to be able to work together not only with the client but in all of the drama that can be surrounded with a death uh that is kind of part of my goal is to reduce as much drama as possible and a lot of times I find that drama surrounding deaths comes from a lack of knowledge of knowing what people want right so maybe the medical POA has made a choice um but everybody else doesn’t agree but if there was a conversation beforehand you know so that everybody understood like this is what I want um then when the medical POA makes that choice you know maybe it wouldn’t be such a drama thing so I’m just a really big advocate for like let’s not only plan for everything but let’s talk to everyone about it um because just a little conversation can really prevent so much of that drama I know you’ve seen that you know fighting at the end of life and siblings and all of this stuff and I I try so hard to make sure there’s none of that right because again what we’re talking about is a good death good grief because we know there are complic griefs in life where things didn’t go the way that you wanted and it’s hard to get over it rather than a clean grief which I suppose I can Define better but then we’ll go off on another tangent we will yes but it still is the idea that sometimes when people die there’s riffs afterwards because with all that sorrow of a brother didn’t act the way that they should have or the sister made this decision right and so it makes the grief process so much more difficult mhm so and and that depends on cultures too some cultures are better or worse or um have different philosophies of it I mean again here in America like nobody wants to die everyone wants to spend all their money not dying it’s a very strange thing right um and so you have to be culturally sensitive well at the same time I guess you’re also saying like no we have to kind of fight against the way this usually goes CU it’s not working for anyone right yeah usually my clients um the clients that I work with the most they’ve gotten a terminal diagnosis so usually cancer um so they kind of bring me in knowing you know they’ve been given this timeline or whatever it is um and so I’m kind of the starter point where it’s like all right well I guess I got to start exploring what could or couldn’t happen and a lot of it is kind of acceptance getting them to accept things you know sometimes people can repeat back to me stuff that the doctor said to them but I can tell that they don’t really understand what that meant you know so it’s kind of like working through that now what I hear the doctor saying is you know maybe there isn’t any more treatments that are going to work for this or you know whatever sometimes people really just need help with um you know working through all of that sure absolutely okay so is there a type of client that isn’t a good fit for you or a type of patient that really a death duel that isn’t really that useful um honestly no I can’t picture a scenario where I wouldn’t be able to be helpful I do know that some you know death duers are different like everybody kind of does their own thing and some people do choose to not work with certain illnesses for certain reasons um some people don’t want to work with children understandably um I personally have not ever worked with a child um I would try it but I don’t know how you know I would have to see how that would go just because I’ve never done it you know I’ve always only worked with adults but um I’ve worked with clients that were in their 20s their 30s 40s 50s all the way up to into their hundreds um wow you know I’m really great in situations where people are aging out uh CU I have a lot of nursing experience there but I find that I can be extraordinarily helpful in you know somebody’s gotten a cancer diagnosis and you know now it’s just jarring for everybody most of my clients are younger they’ve got children they’ve got a spouse you know so there’s all of these different aspects to the fact that now you know their their Lifeline is a little shorter than they thought right and that’s a lot of times where we the two of us can work together and where mental health comes in um because it it is important to have counseling as you’re working through that uh and not only for a lot of times we again the way the Western medicine works it’s like okay let’s give this person all these resources but I’m like well no wait they they live in a family system we’re not just treating one person here let’s make sure that everyone has the counseling that they need the Psychiatry that they need yeah and I’m not saying that hey you’re going to die let’s give everybody allof but what I am saying is let’s look at what the needs are get down to really what the root causes are and what each person really needs and treat it not in a extensive way where you’re spending your last days talking to a stranger about your childhood honestly uh but still like what are these threads that have never been pulled that need to be or what is still missing or what do we need to have some closure on right and not only like you said it’s for the whole family right so sometimes the dying person themselves can be really at ease with what’s happening like they understand but maybe they’ve got a spouse and a young child and the spouse and the young child are really really really struggling so sometimes it’s those people that I’m like you know a young girl who’s going to lose her mom you know maybe we could preemptively throw her into some counseling to kind of you know what’s this going to look like and just to kind of get her prepared um but I definitely am all about that and working through that and trying to keep people as healthy as possible um you know death is always so sad everybody says that death is so sad right but for the person who dies it’s usually not sad for them it’s usually pretty comfortable for them if we’re working together it’s only sad for the people that are left you know so I try to do everything I can to uh make them remember it in more of like a beautiful and tender type way as opposed to like a sad and sorrowful type of situation right yeah like that movie is it inside out where the girl is finally growing enough that she has memories that are both happy and sad and she doesn’t know what to do with them yes I love that so you’re saying if we can make death a Bittersweet experience um it’s still bitter like there’s no disguising it but there can be some sweetness in it then it’s not something where the survivors are like no I don’t want to think about mom’s death I I don’t want to remember this it’s something that can be treasured and uh kind of place where it needs to be honestly in their brains yeah absolutely I mean imagine if you were a kid you were younger and you were losing a parent I mean that’s so hard but you know imagine if you look back at it and are able to picture it being beautiful or more of a celebration as opposed to just everybody moping around and so sad um I also like to help people do stuff like that like let’s have a celebration of life while you’re here you know enjoy absolutely I help people write their obituaries right like nobody likes writing an obituary so like let’s just do it if we know that it’s coming up like let’s get that thing written and get it out of the way and then your family doesn’t have to worry about it um but also I like to work on uh Legacy projects with my clients so um they say everyone dies two deaths once when you die and once when you’re spoken of for the last time so what type of Legacy do you want to leave behind for those that you’re leaving behind so like I mentioned a lot of my people are dying younger than they probably thought they would be so they have family that they’re leaving behind so we kind of work together to create something tangible um that I can give to their people after they’re gone and so you know not only do they have these memories great memories hopefully but also you know something that they person actually made for them that they can kind of hold on to forever so that’s great yeah and I think too um one thing you’re trying to do is find these little pockets of Joy even in a difficult situation yeah absolutely I I mean I’m not saying that you have to write in obituary was actually a superhero this is the only time that we’re admitting what her powers were but so it doesn’t have to be ridiculous obviously but where you can find pockets of Joy or humor yeah yeah I’m definitely a humor girl so I will try to slip humor in there all along the way and keep people laughing and keep it light-hearted and fun I mean I see death differently than most people in the world do so you know most people hear the word death and they clam up and they get nervous and they get anxious but for me I know this is what I’m supposed to do I’m like meant to do this and I’m good at this and I know that when I work with somebody even though I lose them at the end um like it’s almost a little rewarding because I know I did a good job you know I lost them but I lost them in a beautiful way and it was great for them and for their people um I always stay in contact with all of the family members because I kind of become a member of the family you know someone dying is a really really intimate thing um and so to kind of let me into their moment like that I’m always is grateful um but also I do really kind of build bonds with people and become like a member of the family so I do keep in touch with everybody afterwards just to kind of make sure that um everything’s okay you know and if I do I’m again I am absolutely not a counselor so we can talk things out but if I feel like somebody needs a grief counselor or needs more than what I can offer I always kind of um you know have great great people to fish them out to right just like we’re not death duelas out of sense we send to you and again it is a lot about the people left behind because so much of our culture let’s do everything for dead and then well what are you doing for yourselves and it the death is easier for the person if everyone else is being taken care of if they’re tuned up I mean we do that with surgeries when I have one of my patients who’s going to have surgery I’m like okay let’s come in for ketamine treatment either like right before right after let’s make this in such a way because we deal with addiction too I have patient are like I don’t want to take any narcotics after surgery and so by building a safety net then they can go into the surgery more comfortable cuz a lot of times with my patients I’ll make them laugh right before they fall asleep and they wake up much better too yeah so it doesn’t even take huge things but if you can just uh tweak little details as you said death itself in some cases is not beautiful but if you can tweak some of those details and you end up with a much better result for sure yeah I totally agree that’s great so if somebody wants to become a death Dua is there any certification or experience that they need yeah so there are death death Dua training programs um and it is there’s training and then there’s a certification program that you can go through as well there’s many different schools out there um so I personally like to recommend Doula givers if anybody likes that um that one is run by a nurse a registered nurse and I think that she does a really good job at uh diving into the medical stuff that people really need to know um but I also am trying to open my own school so I mean if anyone’s looking to get into it right away definitely you know check out du givers they’re great I hope to be up and running after after the first of the year so um you know if it’s not something where someone’s in a hurry they can always just reach out to me I have a list of people that I’m going to get a hold of as soon as it’s opened and get them signed up and all of that so right and and I asked about the certification too because it can be so challenging uh in today’s world of marketing and social media uh to find out like well who’s actually the the person that I need for this I mean that’s honestly one reason why I do these shows it’s as simple as some people will listen to me be like oh that’s that guy’s a little weird I don’t want to go to ascend it’s it’s perfectly fine we both saved ourselves some time and effort and you might have saved yourself a copay that’s great but at the same time it is uh you know you do need to hear testimonials you do need to find a personal touch some of it is aligning and again death is so personal the spiritual aspects of how we deal with death are so complicated in this country because you know it’s this mix between death douas and chaplain and hospice and how do they all fit and how do we like look back at this person’s life so it can be very comp yeah it definitely can and you’re right I feel like a lot of times people just don’t even know who they need like I think that in end of life situations everyone’s panicked and stressed and there’s all this stuff going on but it’s like who who do I even call who’s going to help me you know right so that’s why I’m out here being noisy and letting everybody know I’m the one you can give me a call I’ll help and if I can I’ll find someone else who can right and I think in these cases too you have to push to the discomfort I mean it’s the same with um mental health a lot of times people are like oh wait what’s going on that there’s a stigma with with it and it’s one of those things it’s like okay now now it’s time to talk about it so I always like to say choose your hard right so people are like I can’t talk to my mom about when she’s going to die that’s so hard it is super hard you know to talk to your mom about that or as a mom to talk to your kids about that but you know it’s even harder is when you don’t talk about it and then you die then that’s even harder so you know you you really get the choice to choose to have these hard conversations and I really implore people to do it cuz it’s much less hard than not doing it in the end mhm no absolutely and again some that’s cultural like in Greek culture I think my mom probably started talking about her death as soon as I came out of the womb at age 30 just kind of a thing that Greek women do they just they’re going to die all the time but at the same time um a lot of times it’s like okay well let’s go a level deeper like how do you want to die yeah and and what do you want to see cuz a lot of times we talk about like well this was you know the final wish of uh this person and there’s a part in my big fat week wedding 3 where the woman’s like this is what my dad wanted and her brother was like you know dad wanted a lot of things and he asked you for stuff all the time this is just one of the things that he wanted right so there is uh I do this with the ketamine infusions a lot when patients are using them to kind of get over a death of like let’s put this in a place of honor this memory but let’s put it where it belongs let’s not put it in the Forefront of your brain where the way you see the world from now on is through this filter of this trauma or this loss at the same time let’s not forget it where it’s churning up emotions and reactions that you don’t understand because it’s in your subconscious let’s just put it in a place of honor where it belongs put it in your memories almost shove it and then move on with your life so it’s a place of honor it’s a place that you remember and as you said with Bittersweet Memories but at the same time it’s not a place where it’s continual pain or continual like let’s talk about this to everyone that we see or this is who I am now right yeah no that’s very smart to kind of like shove it like you said like it’s there it’s going to be there it’s never going to go away but you got to figure out how to make it fit and still be you right absolutely yeah well thanks for being on the show today this great for having me I love it this was fun all right so if anyone wants to reach you it’s your website again is you can find me it’s Casey gon.com you’ll probably have to look up the spelling but that’s okay um also on all social media you can find me at death dla Casey so Facebook Instagram Tik Tok YouTube um you can find me anywhere and I’ve got lots of content out there so please take a look if if you want absolutely and for us it’s asent healthc center.com so thanks for watching