Grief, Loss, and Wellness Debriefing: Vickie Leff, Matthew Loscalzo, Craig Blinderman

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, who do we have with us today?

Alex: We have a wonderful full house today, Eric. We have Vickie Leff who’s Executive Director of the Advanced Palliative and Hospice Social Work Certification Program and also teaches in the UNC School of Social Work. Welcome to the GeriPal podcast, Vickie.

Vickie: Thank you so much for having me.

Alex: And we have Matt Loscalzo who’s Executive Director of People and Enterprise Transformation and Professor in Population Sciences and Emeritus Professor in Department of Supportive Care Medicine at City of Hope. Welcome to the GeriPal podcast, Matt.

Matthew: Thank you. Happy to be here.

Alex: And we’re delighted to welcome back to the GeriPal podcast, friend of the pod, Craig Blinderman, who’s Director of Adult Palliative Care Services and Associate Professor of Medicine at Columbia University Irving Medical Center. Welcome back to the GeriPal podcast, Craig.

Craig: Thanks so much, Alex and Eric.

Eric: We’re going to be talking about loss and grief and the role of debriefing for healthcare providers. Matt, and others, including Craig, just not too long ago, wrote a book called Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals. And Vickie created a debriefing course for CAPC. What’s the right…

Vickie: Helped them create one?

Eric: Yeah, helped them create one, so we’ve got a lot to talk about on this podcast, but before we dive into this topic, Vickie, I think you’ve got a song request for Alex.

Vickie: I would love to, if you don’t mind, if you could play You’ll Be in My Heart by Phil Collins.

Eric: And why’d you pick that song?

Vickie: It just reminds me of how important collegial support and being with each other is.

Alex: Great choice. (singing)

Eric: Thank you, Alex.All right, let’s jump into the topic at hand, loss and grief. I want to start off by turning to Matt. Matt, tell me about the book that you just published. It’s a collection of personal narratives, right? You have healthcare providers telling stories about loss. You actually did something interesting. It sounds like you met frequently, monthly on this. What was the inspiration to doing this?

Matthew: Well, really, first of all, I really have to say, Alex, thank you for that beautiful music. In the writing of these stories, almost all the authors talked about music in their lives, with Bach being the most popular, but there were many others, just so you know that. So you’ve got me in the mood, Alex, thank you. Thank you, Eric, for letting me share that.

Three years ago, I really went to my colleague, Dr. Susan Block, who you know well, and Craig is good friends with, and we really talked about creating a book that enabled doctors and other healthcare professionals to tell their own stories of loss. And this is a big difference from walking in our patient’s shoes, which is an important way to think, but we knew that our colleagues were deeply suffering with many of their own losses. And what we found, of course, is exactly what you would think, is that we carry these losses with us.

We went to Oxford, immediately said, “Yes, do it.” And we began this edited version of this book. And what we found was it was a real challenge to try to get physicians and other healthcare professionals to write about their own personal losses. When you read the book, you will not really know that because these stories are so profound and are so deeply personal. And at some point in time, because at some point in time Susan was offered a much better option in her actual life to take a step back and to paint and to be with friends, and then we had the real luck to have Dr. Marshall Forstein join us. He’s a psychiatrist at Harvard and a beautiful writer. And also Linda Klein as a co-editor. So we’ve been really fortunate.

Bottom line is this has been a three year saga. It’s probably the hardest book I have ever been involved with, and that’s even as an editor. But it really is about deeply personal stories in your own life about loss. And it’s multiple losses. It’s just not loss of a person, it’s loss of a dream, loss of integrity, loss of really things in your life that you didn’t even realize were so valuable until you lost them. And then making the connection between that loss and that person that you hold onto. So we did focus though, Eric, and then I will stop, we did focus more on loss. There’s a lot written on grief, but so little is written on the loss experience and even a definition of loss is even lacking.

Eric: Tell me, because I think this is the most interesting thing, because usually, I won’t even say usually, 99.99% of the time, loss is a side note. Loss is the thing that triggers grief and then we talk about grief. I don’t think I’ve read a book or a paper on loss and grief. Loss just gets lost. We focus on grief. And here it sounds like you’re very careful that you’re making this distinction between loss and grief and that loss is something more than just the thing that triggers grief, is that right?

Matthew: We’re saying loss is an experience that used to be much more complete and full in our lives. But in the last 100 years, with how much medicine has evolved, loss is not so open to people’s lives anymore. And we don’t talk about it as much. So people are less able to have the language when the loss event actually happens. Loss is different than grief.

If you look at most, if not all of the loss and grief books, one thing you will not be able to find, and I have looked, and our colleagues have looked, and the other authors have looked, surprisingly, is a definition of loss. And so we have loss and grief, but we’re sort of leaving out loss. It’s sort of like all of us in supportive care. We talk about death and dying. Now, we know dying happens before death. Now, come on, but when we take a step back and say, “Let’s look with fresh eyes at this,” it’s the loss aspect where I think we could do a lot more healing right up front than we are doing. And that’s why the 17 authors in this book each talked about that experience in a much deeper way than I think most books do.

Eric: And how would you define loss?

Matthew: Well, I just happen to have a definition here, Eric. I’m glad, we should be working as a team. And this is really something that Susan Block and Marshall and Linda Klein and I worked on after looking at what wasn’t there, but it really is the actualization, the realization of a permanent, uncontrollable, irrevocable and undesirable separation from a highly valued relationship resulting in changes in one’s identity, which is what this book is all about, and sense of place in the universe. The primary loss almost always sets into motion a further cascade of social and emotional consequences. And at its core is a sense of regret. Loss is connected to regret. And I think this is time that we can really think much more deeply about loss and as it is happening. Our sensorium doesn’t shut down because we are experiencing a loss. We aren’t as prepared. We don’t have the language to share that loss as it is happening. And I think that’s not only a personal, psychological, spiritual, but it’s also social as well.

Eric: And how does that differ from grief? What I often hear, grief, that normal, often, and we just had Holly Prigerson on the podcast talk about complicated grief, but grief in itself, that reaction, that is often triggered by loss.

Matthew: Yes, absolutely, absolutely, but it’s the whole meaning you’re giving to loss that drives the grief. And I want to thank you for having Holly on. She wrote a beautiful blurb for the book, actually, and she’s one of my heroes. But really ultimately when you think about loss, loss is an experience. Loss is different than grief as well in that with grief generally over time, the suffering and the pain gets less. With loss, that sense of loss stays with you, that connection, but without always that sense of grief. Loss is its own entity. And we’ve been really private of doing the research of really doing the deeper thinking about what the loss event happens during the loss event and how we can impact how grief is experienced later. But if we go right into, “Okay, now here’s loss.” And many of the textbooks say it’s just something you pass through quickly and then you get into grief. We don’t think so.

Eric: Yeah.

Matthew: We think how you experience and interpret the loss as it is happening impacts that grief and impacts the rest of your life if it’s a serious loss.

Eric: And then you specifically asked the people writing their stories to focus and that distinction between loss and grief. Craig, I’m going to turn to you. What was it like to be an author of this? What was that experience like?

Craig: Yeah, I actually got involved with the project a little bit on the later end of its inception. Susan Block had reached out to me and asked if I could contribute something specifically on the experience during the peak months in New York City and COVID Pandemic in 2020. For me, these groups of authors were meeting fairly regularly to discuss their work and their process. And so I came on a little bit towards the end of that and was realizing that this was really a very unique opportunity to work with, collaborate with and learn from people who are doing this difficult writing.

And so for me, thinking about there were so many losses, first of all, there’s so many losses in our lives in general, just going through life, that’s what we expect. It’s a constant sense of impermanence that we just continue to absorb these losses over time. And then to focus in, to sort of hone in on particular losses during the pandemic really was a bit overwhelming. And it really forced me to ask some deep questions about myself and how was I processing the losses? Was I processing the losses in a way that was meaningful?

And I think it was really through the writing and digging into my reservoir of memories and feelings and with the editing process of pushing to go deeper, to explore a little bit more, to be vulnerable, it was in that space of vulnerability that I was able to tap into some of the profound losses that I had.

And I chose one in particular experience to write about, a trans woman who I call Jamie in the piece, who I had known prior to the pandemic who I was treating as a palliative care consultant for her cancer related pain. And there was just this expectation that I would continue to treat her. She was homeless. She was very vulnerable, African American, spent time in prison system, on the streets of New York City for most of her life.

And then to see her show up in our hospice unit in April of 2020, it just completely broke my heart. And it was the first time I recognized someone. Everyone else were just people I was just meeting for the first time and it was this overwhelming amount of loss and grief and pain that we were all experiencing. And then to see her, it sort of set up this sense of there’s an expectation that we have for the future that what we’re doing in the present moment is somehow going to continue and that we’re going to have an opportunity to maybe deepen a relationship, to provide some healing, to learn more about each other, to form bonds. And that was just ruptured because I knew there was no way out for her.

Eric: Yeah.

Craig: And so that’s what I wrote about and it really just took me to a place of real vulnerability and just being able to go back to that place, those haunting days, and try to peel back myself and what I was holding back and just letting it out through the process of writing.

Eric: There’s one thing, I’ve been to self-care retreats, we write stories about the losses and the grief we’re going through. And probably a lot of our listeners have done that, but it feels very different and much more vulnerable if you were to publish that story. First of all, not even to publish it, now you have to get feedback on your story and potentially edits and then you’re going to open it up to the world. Did that give you pause?

Craig: Yeah, it did. I was trying to be brutally honest and the editors like Matt and Marshall and even Susan in some earlier drafts kept pushing me to just go deeper and just be more honest. One of the things that I realized I think, and maybe just kind of speaks to my own sense of evolution as a physician in how the hierarchies of power that we have as sort the veil, that we have some kind of superiority or hierarchy within a patient-physician relationship, that our patients are allowed to experience loss and grief and pain and we somehow don’t show the sides of our humanity whereby we’re also subject to the same kind of suffering.

And so I felt like I’m just a human being, making it through this world and trying to figure out how to help others, help myself. Yeah, so I’m going to expose myself and show that I was afraid and that I felt fear and that I felt a sense of not doing enough and I felt a kind of shame and all of these things. We probably all have that. We all probably feel that, but how often do we make that known, make something underneath the surface more known and share it with others? So that, to me, felt like a heart opening experience, something that I often don’t do. And that was a nice way to help me also to sort of face the fact that we are not so different after all and there’s no reason why we should pretend that we’re different.

Eric: Well, speaking of differences, Matt, I thought most of these people are highly trained folks who talk with people who are dying. Many of them work in palliative care, they counsel people about loss and grief. And yeah, as you said in your book, when the loss hit home, that didn’t help as much as we thought it would. That was a theme you found in all of these stories?

Matthew: That was a massive theme. As Craig pointed out, these stories were peeling away, and unlike an onion, when you got to the middle, there was something really there. It was our humanity. It wasn’t so self exposing. We had to work at it. We did meet every month. We did go through each other’s stories. There were legal issues so we had to take out some of the information. There was some ethical issues we had to work through. When you’re getting that deep, it gets complex. But one thing, Eric, that you point out really clearly about early on, the professional veneer is not thick enough when it’s your own personal losses and experiences, which is what Craig alluded to earlier. That hit us really early on. And we were really struck by how did we not know that?

Eric: Yeah.

Matthew: And it leads to us thinking about not only ourselves and our sub selves, those many aspects of ourselves, but also our teams, our institutions and society. They all reinforce running away from vulnerability, ignoring the positive aspects of what suffering and loss brings to feeling more deeply connected to each other.

As we were unfolding these stories, every time we brought them back, it was a different story. Because every time we remember a story, it’s changed physically in the brain. And also every time we recount a story, it’s now a new story. There’s the remembering story and there’s the living story and they begin to separate. And just having 18 people on a call at times with different stories and hearing every time their story’s changing.

Eric: Yeah.

Matthew: And it was glorious.

Eric: Yeah. I was reading over Susan Block’s story yesterday. And for those who don’t know Susan, she is a matriarch in palliative care, I think. I remember going to PSAP, her and Annie Billings teaching me about palliative care. And to me, they were the gods of palliative care. And it’s funny, it’s like when you were a child and you look at your dad and they can do no wrong and this person was the epitome of everything right. And over time, you recognize that people are human. And that story that Susan wrote was so open, so many pieces that I’ve never heard of before and so vulnerable, that I don’t think I’ve heard that. Reading these stories, you don’t hear that from physicians. And Susan’s just one example, other examples of another, I forget who, but lost two of their three children. Did everybody who were of those 18 people, did they all agree eventually to publish this or was there some pushback from others saying, “This feels too vulnerable.”

Matthew: It was all of that. Not only that, it’s we had a number of other authors who had to drop out. And the major reason why they dropped out is because they weren’t able to go deep enough and to be able to share their losses in ways that others could understand it. And really getting to anger is a healthy place if that anger’s going to motivate you forward.

Eric: Yeah.

Matthew: But if you’re stuck in anger, there’s no growth there.

Eric: Yeah.

Matthew: And we needed stories where there was reality and where there was growth. We wanted to role model. The bottom line is, we all know this, if the healers are not healthy, what options, what choices do the rest of the population have? We need our doctors and healthcare professionals to role model for us how to deal with loss, how to be healthier.

Eric: Yeah.

Matthew: Because if we don’t do it, who’s going to do it?

Craig: I think I just want to comment on something, Matt, that just raised for me, is the change that actually happens through the process as you’re going deeper. There’s a way in which, it’s something that Hannah Arendt talks about, a philosopher of the 20th century, that we don’t think deeply enough about things, that we often take a view that I kind of know what’s going on under the surface, I have a sense of things, I draw some opinions and some judgments. And then you act in your life.

And I found that through this process, both the writing itself and then the feedback, the editorial, the sharing, there was a way in which things were changing for me, that I was able to think of things differently or more deeply or shifting the emphasis on something. And to me, I’m, first of all, forever grateful for that. And I think as a process and just recognizing, and maybe it’s well known to writers, but recognizing to the extent to which the writing process, and particularly in the way that we frame this, actually allowed for things to unfold in a way that wouldn’t have unfolded without that.And so I think that’s a very specific thing that I think also can lead to therapeutics. I think the process of writing, of getting into it, it’s not too dissimilar from what we do in some narrative medicine workshops where we write to a prompt and we see where it takes us. And 15 minutes prior to that writing, you had no idea where it was going to take you and now you’re in a new space. It’s remarkable.

Eric: So Vickie, how does this differ? Does it differ at all from what you’re doing around debriefing?

Vickie: It is a little bit different. And I’d first like to say I really commend all of the authors for having the courage to challenge the veneer that many healthcare providers have, were taught to have, protect them from a lot of different things, and unveil the truth that we all know, which is that life happens to all of us. And my interest in this is that I think about, having been a clinical social worker for 35 years in the space of palliative and oncology care, is how does that impact how we choose to say what we do with our patients and families? It has to. It just absolutely has to. And what I love about the concept of this book, which is very similar to debriefings, is that it normalizes it. That, of course, we have our own life issues that come up and impact us. To pretend otherwise really keeps us apart.

And I’m sure that the process of telling the stories was very therapeutic in and of itself. I also suspect that the sharing of it as a book will be very profound and normalizing for a lot of other people and kind of sheds that light on it. The debriefings that I’ve been involved with, which have all been in hospital settings, are trying to tend to and give people deliberate and intentional space to talk about the impact of this work on them, which sounds so simple, but it presumes a couple of things. It presumes that it will impact you and to move away from the paradigm that you can’t be impacted by this.

I often say to folks, “I’m very worried about folks for whom this work is not difficult.” I’m way too expensive, but they need therapy. If you’re not reacting to some of what’s going on, and I don’t mean in a cry with them sort of way, I mean having your own issues triggered and so forth. It’s a very natural part of any kind of close work that we do, especially in palliative and hospice care, of course, because we’re seeing people at very dramatic times and often only for a short period of time.

So the debriefings, I think it’s the same construct that they’re using that you all are using for the book on a little bit more granule level. And the debriefings are meant to give people that chance that management approves of, so institutionally supported time, to say, “Yeah, we know this work is hard.” And we’re not talking about a support group, we’re not talking about therapy, I’m not talking about narrative therapy. All of those things, great, by all means. This is not a one off and this is not the be all and end all. It’s one thing. And it seems so simple that I think it gets a bit overlooked and, “Well, debriefing, whatever.”

But the thing that it does, like the book, is to say we’re all human. Isn’t that okay? And let’s just take a moment to process how our experiences are impacted by the work we do and impact the work we do, the things we choose to say, why we maybe don’t go into that room that day, kind of avoiding it a little bit. All entitled and perfectly okay. The debriefings are not meant to be coping 101. They’re peer facilitated specifically so that folks have that sense of trust and know that the person facilitating it as kind of the guardrails gets it. You don’t have to explain what it’s like to work in an ICU or even some of the acronyms and so forth that folks use.

And it can be a half an hour, it can be an hour, it can be 20 minutes, whatever. I know it’s really hard to find time, but what it does optimally is it provides social support. It provides social support and reduces isolation. And we know from evidence that that is kind of the magic sauce. And we’ve missed it a lot, in COVID, it became very clear. Without that, those sidebar conversations and whatever, that it was really hard to do this work even on top of what we already do.

Eric: And you’ve created a curriculum on CAPC for these debriefings, is that right?

Vickie: So what we did, Diane Meier heard about some of the work I was doing with Project Echo and over at Duke and she reached out and said, “You know what? I think that CAPC needs to provide this,” it was in the middle of COVID, “For healthcare providers, right now.” And what a brave thing to do. So no cost to anybody, doesn’t have to be a member.

And so we just designed a couple of workshops to train some facilitators. That’s also available, anybody can download it, it’s free, to give folks an idea of how to do this in their own institution. It sounds simple, and it is, and it’s not rocket science, but there are a couple of things that we can share along the way that make it a little bit easier. So CAPC’s offering the debriefings online virtually for anybody, any healthcare provider. They actually also extended it internationally, particularly around the time of the start of the war in Ukraine. And so you can participate that way or you can download the guide and do it yourself in your own institution. I was so happy to hear that Diane wanted to do this as an institution as opposed to, “Just take a yoga class and you’ll be fine.” Which, of course, no offense to yoga, but not really going to cut it.

Eric: Here’s a $5 gift certificate for Starbucks.

Vickie: Well, there’s a great, I don’t know if you all know Jared Rubenstein who does some comical videos on YouTube, cartoon type videos. And one of them is called Token of Appreciation and it’s a game show. And one of the folks said, “What would you do if your staff is really upset and whatever?” And the right answer is pizza party. So some of those things, well intended, it’s like the hero signs, well intended, but I think that they disenfranchise some of our stress sometimes.

Eric: And for these debriefings, do you just have them open-ended, regular scheduled, once a month? Or are they focused on particular issues like hard ICU deaths or unexpected issues or when people bring it up?

Vickie: Thanks for asking that because it can be whatever you want it to be. If you’re in a culture where you can do all of that in the same institution, so we would do some debriefings for the MICU staff who were experiencing so many more deaths than any place else in the hospital. And the focus was on those difficult deaths. Other places like the oncology unit, sitting with nurses, it would be around not being able to see people when they got well. They only saw them when they were inpatient.

So it can really be whatever you need it to be. It can be interdisciplinary. I find that it works a little bit better when it’s specific to a profession. People feel a little bit safer to share some of their concerns if it’s all nurses, all docs, all fellows, all social workers, whatever, but it depends on your culture. That’s the beauty of it. It’s a blueprint that you can put on and use in your institution however you want with the underlying foundation being the same, which is to give people a chance, that’s a very intentional opportunity, to talk about the impact of this work on them.

Eric: Yeah.

Vickie: Oftentimes folks are like, “Well, it sounds like a support group. You’re going to ask me what happens when I’m five years old.” I’m like, “No, really, I don’t want to know.” But sometimes if folks are nervous, then we’ll do a topic like moral distress, grief, very, very broad topics that always come up in every debriefing anyway.

Eric: Yeah.

Vickie: Just to give people a sense of, “Oh, this is what I can expect.” Sometimes it’s a little scary for folks.

Alex: I’m thinking about the book and thinking about the debriefings and thinking about why did we choose to bring you together for this podcast? And both get at this, the clinical experience in hospice, palliative care, social work, nursing, physicians, it can be deeply wounding to healthcare professionals and we experience loss on an everyday basis in the course of our clinical care. And that loss and those wounds need attention. And that attention might be through writing, through thinking, through debriefing. And through that process, we can grow from those experiences. And that’s sort what makes our profession. We have tremendous privilege and opportunity in our profession to care for people at such sick, vulnerable times. And that also has a tremendous impact on us and opens wounds in us and losses in us. And we have to go to those places in order to process them and grow despite how challenging and difficult those situations are for us.

Vickie: Thanks for saying that, Alex. I couldn’t agree more. And to normalize that for folks, that of course you’re going to have a reaction and have a place to process it, because we know that the idea of self-awareness as a clinician in palliative care or hospice is really, really key. Why? Not because we want to naval gaze, but because it impacts our clinical decisions and the words we say and the things that we do and the choices that we make on behalf of or with families. So the more aware we are of, “Oh, that’s why that was kind of hard for me,” the better we’re able to be exquisitely present and genuine with the folks that we need to be with and then put our other stuff aside, deal with it later over a glass of wine or something. I don’t know if that’s appropriate to say. But to really demystify this idea that this work doesn’t have an impact on you and just make it normal. Of course, it does. Of course, it does.

Craig: And all the losses and wounds in our lives affect who we are and we’re not the first ones to sort of recognize that this has a benefit in a therapeutic space. Carl Jung talked about the wounded healer, that the analysts who him or herself brought their wounds into the therapeutic encounter. There’s a way in which that helps you actually to really deeply connect and to find the space and to empathize in a way or to deeply analyze in a way that you might not have that same level of access if you weren’t aware of the ways in which we’re all wounded and we’ve suffered losses throughout our lives.

So again, it’s this kind of a breaking down of this sort of mistaken thinking that somehow we’re separated from and somehow immune to all the pains of life and that we’re going to sit in our privileged position and care for others. When in fact we have to bring those things into the therapeutic encounter, and vice versa, the therapeutic encounter affects us. And so there’s this kind of way in which that interdependency seems to me to be much more fundamental to our lives than maybe we had previously realized.

Eric: Yeah, I’m going to set up these walls between work and home. And I am so good, I can separate them completely where one doesn’t affect another.

Matthew: One of the things that came up in the book, and I’m glad that you said that, Eric, because I can sort of really connect multiple stories in the books in these stories. And there were 16 of these stories. And it was so obvious that when loss affected a person in a family, that women experienced it very differently. Women do more work than men do in this area. They have children, they have families, they have jobs.

And one of the themes that came out in addition to the veneer that you alluded to, Vickie, thank you. One of the things that came out was clearly looking at, if you look at COVID, and when I think of Craig’s work, the work that he has done needs more than a book. Day after day going in, in the eye of the hurricane during COVID, what he and his team did. And if you read his story, you’ll be so moved by it in terms of the multiple levels of loss. Not just loss of life, but loss of time that you’ll never get back and loss of hope when the environment isn’t supporting you in the way that you can.

And I don’t know any healthcare system that does a really good job in supporting their teams in being mentally healthy. It’s just more work, do it in the less time. And these are losses as well. It’s the loss of the dream of the occupation you thought you were going to have. These are all losses and these are very real. I think connecting with these losses makes us healthier, not avoiding them, making them part of our lives. Making the suffering a connection, a healing connection, can be very powerful.

Eric: And I think the other thing that brings the two groups together for this podcast is that there’s a social connection here too. For the book, it was not just, “Write an article, we’ll publish it.” You were meeting monthly, you were talking about this. You’re probably using a lot of those same things that Vickie is doing around debriefing and facilitation. And for Vickie, it’s not just, “Here’s an hour of your time, sit in an empty room and think about the meaning of this work.” There’s an important part of being with others.

Matthew: Yes.

Vickie: That is the secret sauce. It seems so obvious, but no one wants to hear what a facilitator has to say, the connections that they make with each other. “Oh, you struggled with that too? I’m not the only one who was really upset when Mrs. So-and-So died? Wow.” It’s just so powerful at a basic human level to know that you’re not alone with something, you’re not isolated with it. And that it’s very normal to have those feelings. You’re not crazy. And there’s things that you can do in addition to talking about it that might be useful. And at the same time, understanding how that might influence how you deal with that next patient. And that we’re not perfect, but just having some self-awareness along the way is kind of, to me, the golden goose or holy grail, whatever. But I agree with you, the social support, as we found out in COVID, is everything.

Matthew: But I would push back just a little bit because I think that Vickie didn’t brag enough actually. I think that she should have. I think, and the data shows this, in same and opposite sex relationships, if you are in a supportive, respectful, healthy relationship, you get the benefits of living longer and living better. If you are in a relationship that’s very close and unhealthy, you don’t get that benefit. And it’s the same thing with really what Vickie is doing. She’s lifting people up. She’s giving them a language. She’s giving them an opportunity to get feedback from other people, which is guided by her, making sure it’s therapeutic.

There are bars throughout this country where people go and drink. I don’t think that’s where you should be going. I think you should be going to people like Vickie and people like Craig and people like this podcast that lifts us up. And it’s more than just being part of the crowd, it’s deciding to be a healthier crowd. It’s deciding to demand that hospitals create healthier environments for doctors and nurses and others.

Vickie: Exactly.

Matthew: And knowing that if we don’t get to the system, it’s not going to change.

Vickie: I’m going to push you back even further and say that I feel that it is an institutional obligation to create a moral community where this is okay. And yeah, we’re all busy, but you know what? Make room.

Eric: Yeah.

Vickie: And with no offense to surgeons, I would guess that their answer would be different if I was a surgeon, to say I want an hour a month. As well, to what you were saying, Matt, we know data wise that it will help people stay in their jobs longer because they’ll be able to find more meaning in it. And man, oh man, is that costing hospitals a pretty penny. So it’s just a no brainer in terms of any kind of investment. And debriefings in particular are very inexpensive. But I really think enough of this going to yoga and whatever, the institutions have got to step up to the plate and put their money where their mouth is and do what they say they want, which is for folks to have opportunities to be as healthy as they can and get through the work as best as they can.

Eric: So Vickie, my last question, I know we’re at the end of the hour, go to the song, is that there are people in unhealthy institutions, there are people who are working solo, there are people who don’t have that support. You’ve also created something for them on CAPC.

Vickie: Right. Not me, CAPC, offers debriefings virtually for any healthcare provider anywhere. Whether it’s palliative care, hospice, thoracic surgery, it doesn’t matter. It’s open to anybody. You don’t have to be a CAPC member. They’re usually really small groups of maybe three to 10 people. So they can do that now. Yeah, there are plenty of places, I would say most, would say rah-rah to this idea, but don’t ask me for any money and don’t ask me for any time. So I get it, but the more people that have exposure to it and maybe have a personal experience with it, they say, “You know what? This is really important work.”

Eric: Well, I want to thank you all for joining us on this podcast, but before we end, maybe we, Alex, Phil Collins, is it?

Alex: A bit more music? Yep. A little bit more Phil Collins. Music is another way of processing and thinking through.

Eric: And interesting, in the book…

Alex: Yeah.

Eric: In the citations, I think for maybe most of the stories, there were music citations.

Alex: I’m glad I wasn’t asked to do Bach, [laughter] however, that would’ve been a new one. First time request for this podcast.

Matthew: The Beatles were a close second. The Beatles were a close second.

Alex: Okay, good. We’ve done plenty of Beatles. And thank you to CAPC also for making this content free, you said, Vickie?

Eric: We’ll have all the links on our website both to where to purchase the book and to the CAPC content.

Alex: Yeah. And I sang with Brynn Bowman just two nights ago in San Diego at the Foley NPCRC retreat. We did Bohemian Rhapsody and it was perfect in every way, just as it was on this podcast when we did it three years ago. Here’s a little You’ll Be in My Heart.

(singing)

Eric: Well, Matt, Vickie, Craig, thank you for joining us for this podcast. It was really a pleasure.

Craig: Thank you, guys.

Vickie: Thanks for having me.

Matthew: Thanks everyone.

Eric: And thank you for what you’re doing. Also, thank you to all of our GeriPal listeners for supporting the podcast. If you have a second, like us on YouTube and follow us on YouTube. We could use some more followers. We’re trying to get above 1,000. And with that, thanks everybody.