Episode Summary
In the inaugural episode of Palliative Talks, we flip the script as Jennifer Mossop introduces and interviews our host, Kath Murray. Kath, a hospice palliative care nurse and founder of Life and Death Matters, shares her journey and passion for palliative care and bringing a palliative approach to long-term care, emphasizing how it improves the quality of life for residents, supports families, and empowers staff.
As the first guest in this new series, Kath sets the stage for future conversations by highlighting the importance of normalizing discussions about death and fostering compassionate, holistic care. Her insights offer a thoughtful foundation for understanding how palliative care enhances living fully until the end.
Episode Guest
A hospice palliative care nurse and a thanatologist, Kath is passionate about improving care of the dying person and their family through education, resources and courses. She is the founder and CEO of Life and Death Matters, an organization with a mission to improve care for the dying through delivery of comprehensive palliative resources, training, and support for healthcare workers and individuals.
Kath is grateful for those she has cared with and those she has care for over the years. When Kath is not working, she plays with grandkids, swims year-round in the ocean, loves to be with family, friends, colleagues and faith community, and she is pretty in love with Ted.
Transcript
Jennifer Mossop: Welcome to Hospice Palliative Care Ontario’s podcast, a palliative care podcast called Palliative Talks. My name is Jennifer Mossop, and I’m a longtime advocate for Hospice Palliative Care Ontario and the long term care clinicians in Ontario. And we’ve put together a podcast tapping into some of the most experienced and passionate people in the palliative care and palliative approach to care space.
The idea of this podcast is to provide you with empowerment, inspiration, and some good, solid tips, ideas and examples of how to employ and integrate the palliative approach to care in whatever setting you’re working in, including very demanding ones like long term care, where you’re looking after a lot of residents and it’s highly regulated. I am here to introduce the host of the podcast and that is a very passionate and compassionate person.
Kath Murray joining us from Victoria, B.C.. Good morning. Good afternoon and hello, Kath.
Kath Murray: Hello. Good to be here with you. Thank you so much.
Jennifer Mossop: Kath is a hospice palliative care nurse and she is also the founder of Life and Death Matters, a Canadian palliative care education company. Your mission is to develop resources that help health care teams integrate a palliative approach to care in all care settings and improve the care that people receive who are living with serious illness, and also their families and their loved ones. And you believe that education and resources should be delicious and digestible, engaging and user friendly. And every encounter I’ve ever had with Kath has been delicious and digestible. So this is the goal of this. That pretty much sums up you and what we’re going to be doing with this series of podcasts.
Now I’m going to start off, Kath, with the same question that basically you start off asking each of our guests in this podcast series, and that is what to you is a palliative approach to care.
Kath Murray: Thank you. Over the last 20 years, as we have started to look at palliative care for people with non-cancer or diagnosis, and then as we have looked and realized that palliative care should and must be integrated in all care settings and earlier in the disease, then I just coined what to me is a really simple, definition, but I think it’s profound and great also, and that is that integrating a palliative approach is to integrate the principles and practices of palliative care early in the disease process for people with any serious life limiting illness and across all care settings.
Jennifer Mossop: So you said life limiting illness. That’s something that challenges people sometimes.
Kath Murray: Yeah. Yeah it is. And people talk about, well, is it life limiting or is it life threatening or is it serious? And I started to use more and more just the words serious and life limiting. But in fact, Ben Robert, who we’re going to be talking to, in one of the podcasts, he says, you know, it doesn’t have to be an illness. Somebody can be 177 years old and declining with a healthy, declining body. We’re all mortal. And so they’re not they don’t have an illness as such, but they’re declining and dying. So how does a palliative approach to care help those people help people with life limiting illness or who are very frail and elderly? Well, I think that there’s like three prongs. And my my thoughts today are in particular about our, our more senior population are people with more longer term chronic type illnesses. And so I think of them I think of their families as defined by them. And I think of the staff. So 35 years ago when I started in hospice, and it seems that if you’re 40 years old and you have three kids and you’re dying, that everyone wants to be on your team.
Yeah, community pharmacists, the homecare nurses, the the physio, the social worker, the hospice. If you’ve got a hospice in your community, everyone is there and wants to serve you and and so and how wonderful. And so they should. But if you’re 90 and dying slowly over a long period of time with ups and downs, it just feels to me that as a society we’re not as attentive.
And so I’m so glad over the last bunch of years we have we have seen an increase push to this whole idea of integrating a palliative approach in any care setting. So then I think, how would this affect a resident? So I need to be transparent, as they say. And I’d say that the majority of my clinical background is in, hospice palliative care setting, working with a most amazing team and looking specifically at how helping people be more comfortable and attended to and have quality of life in the dying process.
But I’ve also had the privilege of working with people over long term care settings, mostly as an external person. But I have I have just grown to who all I’ve loved and admired that community for years just never felt qualified that I could work in one and carry the load. But I had a dear colleague and she used to say to me, I’d been asked to develop this course on on that palliative care for people dying with dementia.
And she has just said, well, we can’t use the term palliative because at our facility palliative, it’s like the last few days. And I’d say, well, no, well aged care needs to be moved earlier. But that was kind of before we used that lingo. This was back in about 2007, 2008. And finally I said to her, look, how many people do you discharge from? From your facility? And she said, oh, in the last year, I think maybe one person. And I said, well, I’ve discharged more people from hospice in the last, you know, few months and from our program than you have. And finally she said to me, okay, we just need to change our culture. So then what would it look like?
So to her, it became things like, Bob was dying or looked like he was dying. So he prepared Bob’s wife, and they made sure that Bob had all the care that he needed. And Bob got better. So the good thing for Bob was Bob got good care, Bob got better. And and my colleague asked the wife, would you have rather me not talked about death and about him dying?
And the wife said, oh no, this was really helpful. And then they were able to talk to Bob and say, Bob, this is going to happen again at some point, and what do you want and what’s important to you? And what other things do you want to do? And this is, you know, palliative care is all about living.
It’s not just about the moments of death. So what else do you want to do? What do we need to know to that we would say, now Harvey charging us, what do we need to know about you? To provide you the best care possible? Because we hadn’t had those conversations before. So I think for Bob and for everyone else like him, I think that receiving palliative care early can open up the doors to not only person centered as in, rehab sense, but also person centered, as in knowing and accepting that life is is limited and that we’re all mortal.
And that changes the perspective of it and also focuses on that living. I think it is an incredibly challenging thing to be in working in long term care and and the amount of tasks and regulations. And so I, I need to give credit to people who are carrying huge loads and yet are also striving to meet the needs of the one.
But I think that when we we carry life and death together, it’s like you have if you only look at living and rehabilitation and strengthening, you look through a certain lens. And if you only look at death and dying, you look at it through a different lens. But if you look at life and death, and you hold both of them together, and the lens of both of them are together, in fact you can see clearly and and I think that with the residents, we can do a better job of touching base with them, their hearts and who they are often as the residents who are absolutely fine to talk.
Jennifer Mossop: I was just going to say that I’ve heard that, yes, I’ve heard exactly that. It’s the residents who are relieved when finally they’re allowed to talk about it.
Kath Murray: Yeah, yeah, yeah.
Jennifer Mossop: And the families?
Kath Murray: Well, just imagine I talked with the geriatrician once. Lovely guy did provide a beautiful service in so many ways to the long term care home where he was, working.
But he said to me, oh, I don’t talk to the families about dying. It would upset them. But I think about I think about the times that people have those experiences, and we’ve all heard about them, where someone goes to see the oncologist, and the oncologist says in terms of acute treatment, we’re not going to reverse this illness. And palliative care, hospice and palliative care as much as we don’t have further acute treatment and disease curing treatment, hospice and palliative care, if only just begun. And so you leave the office that day and the family can either decide to get on the person and the family can either go, okay, so time is limited or they can maybe maybe they didn’t hear anything that was said, but they go home and as they mull on it, they start to realize what what was said.
But they can choose. They can make a choice. But if we don’t talk to families and we don’t use the D word and we don’t talk about death, then they don’t have that choice. So, I’ve got an analogy on that one. And and that is if you’re, if you’re on the road from I live in B.C., if you’re on the road from this northern town terrace and you’re driving to Stuart, B.C., in the winter, you’re going to Stuart, B.C., the the the walls are like, are like ten, 15, I don’t know, 20ft high, however high they are with snow on either side.
You’re on that road. You know where you’re going. You might pretend or you might say, once I get to terrace, I’m going on to Mexico. I’m flying to Mexico. But you’re on that road. If you think of being on this, one of those wonderful, windy, curvy roads and you go around, it’s beautiful fall day and you go around a corner and then you’re in the midst and the and you can’t see where you’re going.
And then you come around the corner again and it’s beautiful out. And you think, oh, it was just a foggy day. And, and you go through that good weather and poor weather and good weather or poor weather, it’s really easy to start to think, oh, well, I’m going to hit nice weather again. And when people are dying in long term care, they end with chronic illness.
They often have these periods and they look like they’re dying. Oh, and they get better. They look like they’re dying and they get better. Oh, they look like they’re dying. They get better. But the reality is they usually don’t get as better as they were here. And the overall slope is a decline. But if we don’t explain that to family, then they may just be going, oh, he was sick.
Oh he was sick. Oh he was sick. So then when death comes then you hear something like it’s it’s the obituary. Mom died. Died suddenly on the weekend, at 98 with COPD and CHF and diabetes and and and and and and whatever else. But she died suddenly, and it was a surprise. Why was that a surprise? It was a surprise because these other, hills and valleys hadn’t been used to teach them. So that’s one example. And I could go on. But I think integrating a positive approach, putting death on the table, makes it easier for a family.
Jennifer Mossop: Right. And what about what about for the staff? Because I hear repeatedly that being allowed to bring yourself to the work, to bring a palliative approach to care, to the work, to make those human connections, makes the work more rewarding.
Kath Murray: Isn’t that funny when we can really work with our hearts? And if in fact, life and death ups and downs are both happening to the people we’re caring for, if we can embrace both of those. So if you go to work in long term care and you think your job is to feed people, then when people can’t eat anymore, then you think you’re not doing your job very well.
But what if you think that your job is to take best care of them, to offer them options? And if your your job includes the fact that you’re going to care for this person right the way through to death, then that changes things. It changes things remarkably. And there’s a term called disenfranchised grief. And that’s what happens when we experience a loss that society doesn’t recognize, doesn’t value.
And so when you when you think that someone’s working in long term care and people don’t realize how hard it is, I say I work in palliative care. People say, oh, what a saint. Oh, how do you do that is so hard? And that’s not necessarily true. I mean, the fact is, I’ve never laughed so much in a in a job as I have in, in my hospice palliative care jobs. Same with people working in long term care. This is hard work. And when we acknowledge that, I think it’s easier for staff.
Jennifer Mossop: You talk about loss though for staff and regardless of what setting you’re in, but perhaps maybe more so in long term care because of the long term relationships that are developed, it’s got to be very, very difficult. There’s they they go home from work and then they come back the next day in that bed is empty. Or maybe there’s somebody new there
Kath Murray: And that is huge and it is hard. And different homes do different things to address some of those issues. So if I know that my colleague is really close to Mr. M and Mr. M dies, I might do something to let them know, be well, they’re off or before they come to work or when they arrive on the unit that morning.
As a, as a team, we might do things like put a butterfly on the door, or we might put notes, or we might put a little light with the name of the person, in a central place. So we can we can all know, maybe we can do something up there that their table where they normally eat, we can, put a flower there or something to acknowledge the person who’s been there.
Jennifer Mossop: And you mentioned team. It is a team sport. It is a team. And Balfour Mount once said we provide whole person care. And until a whole person shows up, we work as a team. And I think there’s lots of whole people, but I think it’s a fun description. But Balfour Mount also said, if you work on a team show, maybe your battle scars and oh my goodness, I know communities across Canada and the United States and it is hard being team.
And sometimes I hear real frustration and how important it is for us to develop healthy practices, healthy ways of being a team, how important it is that we learn to hear one another. And for me, I am so passionate about personal support workers and the phenomenal job that they do. I mean, they do, Jennifer. They work in places they go, places they stay, places that no one else on the team wants to go and stay.
And they do such incredible work. They gather information. And sometimes I’ve heard people say, oh, personal support workers aren’t supposed to assess. And then a personal support worker says, we don’t assess. We just gather information and how important to have them gather information and to come to care conferences and to share that information. How many times I’ve heard someone say, if we had known what the personal support worker knew, this whole crisis would not have occurred because we would have been better prepared.
Jennifer Mossop: So we’re going to be hearing during this podcast series from different members of the team, including nurses, doctors, chief medical officers, and some really wonderful, warm, compassionate people like yourself. We have been asking them or you’ve been asking them for some concrete examples or tips or things that that they’ve seen that really make a difference. And so I’m going to ask you that question too. What about you? What are something you can share that’s an easy, adaptable for people to employ the palliative approach to care in their work. So what would be an example?
Kath Murray: An example would be being helping somebody eat their meal and having a family member sitting nearby and the family members, somebody being concerned about the volume of what’s not being eaten and being able to talk about. Isn’t that interesting how our intake changes over a lifetime? And isn’t it interesting how our intake changes and our last weeks, months, years of life and and our body needs different things? Or we’re talking about Thanksgiving dinner last week at the fit with the family and how everybody eats different things. And just those little things help to normalize.
When somebody has been to a funeral or a family member being able to ask them about it, just digging a little bit, you I think you use the term digging sometimes when you talk about exploring things with people, just taking opportunities to talk about some of the heard stuff in ways that isn’t necessarily so hard just because we can just do it gently, gently.
Jennifer Mossop: Lovely. Thank you. Kath. And thank you for everybody who’s listening, watching maybe and joining us today. Please go to HPCO.ca. For the full range of educational opportunities and resources that are offered by HPCO This podcast is part of Hospice Palliative Care Ontario’s Educational Resources and Series, and we want to thank you very much, Kath, for agreeing to host this series and for bringing all your wonderful compassion and energy to make them delicious and digestible.
We have some exciting people that we have been interviewing and I think that people will enjoy, enjoy listening to these wonderful, care providers. Thank you so much. And join us for Palliative Talks, a palliative care podcast.
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