Inner Peace w/ Dr. Reese
May 15, 2022

Watching Death Slowly w/ Keysha Rowe

In episode # 139, Dr. Reese sits down with Keysha Rowe, a veteran hospice nurse who shares amazing stories of transitioning. In this talk they discuss the difference between a peaceful transition and one filled with turbulence. Plus - families in denial, the main fear of dying, what happens at the time of death, and patients that wish to not wait for death to happen. 


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Dr. Reese (00:51):
Keysha, welcome back to the podcast.

Nurse Keysha (01:51):
Hi, how are you?

Dr. Reese (01:53):
So yesterday I texted you and you were like, hold on a second. I gotta do a pronouncement

Nurse Keysha (02:00):
Mm-hmm <affirmative>

Dr. Reese (02:01):
And it's like, that's something you don't hear from another human being very often. <laugh> And of course you're referring to, you have to call the death

Nurse Keysha (02:14):

Dr. Reese (02:15):
Of another human being because you're working in hospice, right?

Nurse Keysha (02:18):

Dr. Reese (02:19):
So what was that like yesterday?

Nurse Keysha (02:22):
You know, just had to give a lot of support to the family. Cause it wasn't my patient that I had to pronounce. Actually it was someone else's patient that I had to pronounce, but I was just in the area close by, so I was able to do it. Um, you know, it, it makes it harder when you don't know the family mm-hmm <affirmative> um, but you still can give the same empathy and the same kind of support and comfort for the family. But, um, but they did require a lot of support. Um, they, this family actually had a really hard time coming to terms with, um, their family, um, passing away. So

Dr. Reese (02:57):
Why, because in my mind I'm like death happens

Nurse Keysha (03:04):
Mm-hmm <affirmative>

Dr. Reese (03:05):
And you've certainly seen enough of it.

Nurse Keysha (03:07):

Dr. Reese (03:09):
But what do you mean that they have trouble coming to terms? Are they in denial?

Nurse Keysha (03:14):
They're in denial a lot. Um, a lot of them, a lot of you have a lot of patient family members that don't, um, even though the FA the, the patient themselves have already accepted, um, their prognosis or accepted their, that they're gonna die. Um, a lot of the family members do not accept that the death is coming, the death is near, or even the death even happened, which is what, um, transpired yesterday. Um, it was the family, just some family members were just like, no, you know, check the pulse again or check this again, you know? Um, wow. They, they didn't even want me to even take the oxygen off, um, either, so,

Dr. Reese (03:55):
Oh, wow. Mm-hmm,

Nurse Keysha (03:56):
<affirmative>, it just, it takes a lot of, just a lot of handholding, you know, and talking to them and, you know, and, and everything, and kind of like, just explaining to them that they're, you know, no longer suffering. I know that we selfishly want them to stay here, you know, and we want them to be here, you know, for us and be here with us, you know, however, you know, this is, this was their time and, you know, we have no control over this. There's, there's no playbook in this. There's no playbook on how, and there's no playbook on how people are going to react, or there's no playbook of how people are gonna cope with, um, their loved one dying either. You know, it's just kind of like, you, you, you just take the, you, you actually just meet people where they are in their grieving process. So

Dr. Reese (04:47):
Sounds very dramatic.

Nurse Keysha (04:48):
It can be at times.

Dr. Reese (04:50):
And, and you ha and you have to do this all the time.

Nurse Keysha (04:53):
Yes. I have to do it all the time. Sometimes, you know, you have families that are accepting of it. Um, I think sometimes it, it, it helps more when the patient has accepted, um, when the patient is alert and oriented and has accepted it accepted of it. But you have, I have patients that aren't alert and oriented. Like my patients that have dementia, you know, they're not alert and oriented, you know, they, they, you know, so the family is, is making all the decisions, not them making the decisions for them. And so it's kind of, it makes it difficult sometimes when the family has not accepted the death and dying process thing. So

Dr. Reese (05:31):
For, for those that may recognize your voice, you were on the first 12 episodes of this podcast. Yes. Just two over two years ago now.

Nurse Keysha (05:40):
Right. <laugh>

Dr. Reese (05:42):
And, you know, you were engaging along with Tina and conversations with me. And so here we are again, and I remember one of those conversations that we had, you told me, or the audience about a situation where this woman died so peacefully and she like totally ACC accept. She was totally an acceptance of it. Yes. And it was like this beautiful process.

Nurse Keysha (06:10):
It was, it was, I had never seen anything like it before. Um, she had, she was my patient. This was prior to the company that I work for now. She was so accepting of it. Um, it was so beautiful. She, um, she did a lot of yoga and meditation in her and her, um, time before. And, um, the daughters were saying she doesn't want to be medicated. She wants to feel it all. She wants to feel it. Yeah. And, um, you know, and at that time, when I was a hospice nurse, then I couldn't in my head. I couldn't understand that. I couldn't wrap my head around him. Like, why doesn't, why doesn't she want the morphine fee? What doesn't she want the anatomy, what does she want this? You know, this is, that's the things that we use to keep our patients comfortable when they are actively or trans, actively dying or transitioning as we call it transitioning.

Nurse Keysha (07:05):
And, um, I had never seen anyone pass away that way. So peacefully, no meds, just all she kept doing was breathing through the entire time, just taking all these deep breaths. And I didn't interrupt her. I just sat by side her and just sat there with her. Didn't didn't speak to her. Cuz she told, she actually told her family don't talk to her when she's going through this process because she asked them to say everything that they needed to say to her before she goes under, I guess, in her trans in her transition. And um, that morning she was just breathing very peacefully, very deep breathing, like a lot of deep breathing. And it was then all of a sudden, you know, you could see the breaths getting slower and slower and then she was gone. Hmm. No. And I didn't see any in, in a lot of cases that I, that I see. You see a lot of people having respiratory elevated respirations, pulses elevated. Um,

Dr. Reese (08:18):
Well, because of anxiety.

Nurse Keysha (08:19):
Yeah. Anxiety. Yeah. And because of, sometimes it could be also cuz of pain as well. Um, whether she had pain or not, she, the type of condition she was in, she should have had pain, but she didn't show it. Her all, everything was, her vitals were normal. They were, they were normal. Um, I, I, the only thing I took was a heart rate and her respirations and that was it. And her heart rate, you know, throughout the process, you know, it, it you'll see it, you know, slowing down a little bit, you know, but just, just in her breathing was slowing too, but it never was never did she show any signs of distress?

Dr. Reese (09:07):
That's awesome. Mm-hmm <affirmative> yeah. That's a role model.

Nurse Keysha (09:11):
Yeah, definitely. If I'm gonna die, that's how I wanna <laugh> that's how

Dr. Reese (09:17):
I wanna die. Right. And that's, that's, that's why it's so important to practice meditation. That's how I rationalize getting into meditation in the first place. Okay. 13, 14 years ago. Maybe, even like, I remember rationalizing as this would be a great skill to have when my time comes

Nurse Keysha (09:39):
Mm-hmm <affirmative>

Dr. Reese (09:41):
Yeah. And, and here I am all these years later doing all this practice and doing this podcast and I, I can definitely say that, that my, my little download was correct.

Nurse Keysha (09:52):
Mm-hmm <affirmative>

Dr. Reese (09:53):
Mm-hmm <affirmative> if, if we don't practice how to die, which is meditation, then we're either gonna go very painfully or very scared.

Nurse Keysha (10:03):
Yes, yes. And you do have people that they are afraid or they are, um, they say that they're not afraid, but you do sense the anxiety, but most of the time, they're, it's not that they're afraid of dying. They're afraid of the people that they're leaving behind. They're afraid for them. Right. Um, they have anxiety about, um, about what's gonna happen to the people when I pass and which is why I always talk to the families and tell them, you know, when I have a good rapport with them, I say to them, you know, um, let him or her know that it's okay. That you're gonna be okay. It doesn't mean that you don't have to mean it. You know? Cause we know that it, you know, you're gonna go through these ups and downs, but I have to also talk to the family, say so, but you are gonna be okay. Like, I, I have this, I have to, they be like, I'm not gonna be okay though. I can't tell her if I'm not. And I'm like, yes, you can because you are going to be okay. Eventually you will be okay.

Dr. Reese (11:08):
Sure. Yeah. Everywhere we look, especially in the social media era. There's death. Mm-hmm <affirmative> this person's mother died. This person's aunt died. This person's uncle died. And it just, if you scroll through your Instagram or Facebook enough, you're gonna run into it almost every day.

Nurse Keysha (11:26):
Every day.

Dr. Reese (11:27):
It's a topic I talk about in my new book where if life is a school, death is your final exam.

Nurse Keysha (11:35):
Yeah. Mm-hmm

Dr. Reese (11:36):
<affirmative> and you don't wanna fail.

Nurse Keysha (11:39):

Dr. Reese (11:40):
Cause if you're passing, okay. The word passing comes from you, your spirit or soul leaving your body. Right. It's a passing, right? Mm-hmm <affirmative> so you don't want to quote unquote pass and fear.

Nurse Keysha (11:57):

Dr. Reese (11:57):
And anxiety

Nurse Keysha (11:59):

Dr. Reese (11:59):
<affirmative> you wanna pass away and joyfulness and peacefulness, right? Just like this woman that you talked about a few minutes ago. Mm-hmm <affirmative>, that's what we want. That's the final exam.

Nurse Keysha (12:11):
Yeah. I know that. Um, I wasn't there for my dad's passing. My sister actually was and she, her reaction to it was she, she cried, but it was like a cry of joy for her. Cuz she said, she kept saying, you should have seen it. It was so beautiful. That's all she kept saying. It was so beautiful. Wow. Cause you, she said you kind of the person that, that sees it happening, it's it kind of like, and I think you have to be connected to it in order for you to like really see it and understand there's some kind of light that happens. Yes. It's like, it's like, um, their face, their eyes, everything just gets bright. Like it's like a light it's like almost like an aura, I guess you see around this person. And I don't, I, I know when it's happening, like our, I know when the passing is happening because I can see that light.

Nurse Keysha (13:16):
Mm. I can see that, that, and it's not like a, it's not a literal light, but it's just like, you know, you, you can't, I can't explain it, but it's just you, I know it's happening. And I'll because it happened with my grandmother. I was there for my grandmother's passing and I said it, I said, I was, I called everyone into the room. I said, she's, that's everybody she's passing. She's transitioning over. Everybody came running into the room, you know? And I could see it. And then even like, my family was like, how did you know, how did you know what's happening? I said, I can't explain it. I just know. I just know you just, you just see this. It's just this light you see, and everyone has it, everyone, everyone. It happens to everyone. Yeah. Every passing that I've seen, that I've always seen that I've always witnessed and I was there for it. You, I always see that light and I always know that it's happening.

Dr. Reese (14:06):
Right. Do you feel like being around so much death actually positively affects your life or

Nurse Keysha (14:15):
When I first became a hospice nurse? No. <laugh> and didn't, it was like very depressing, but I was just doing it. Um, because at the time it was a, it was a nursing job. I was gonna do it, you know, but then I started really getting into it and um, EV but every time I, every time I leave hospice, I always come back. I always go back to it. Cuz it's it's, it's not, it's not anything that I chose. Hospice chose me. I didn't choose hospice. Mm-hmm <affirmative> um, so now it now, because I'm in it now, I'm not afraid of death. Right. And that's the first time I've ever like, said that out loud. Nice. I'm not afraid. <laugh> I'm not afraid of dying. You know, my, my only things is just worries about my family and, and me leaving the same as up, like, you know, as everyone else. But as far as dying, I'm not afraid to die.

Dr. Reese (15:15):
We're born to die.

Nurse Keysha (15:16):
Yeah. It's not like I'm gonna be going out there doing stuff reckless, cuz I'm like, oh yeah, I'm free. I'm not, I'm not afraid of death. You know? It's not that it's just more like, you know, it's my time. It's my time. And I'm smiling about it. <laugh>, I'm smiling about it because it's like, it's almost like, I'm like, again, I'm worried about my family and I'm worried about, you know, how people are gonna be, but it's almost, it's almost like you, like, I can't wait to die, but in a smiling way. Yeah. You know, like not like not and I'm, and, and people may look at it like, oh, she's depressed. She had no, it's not that it's, it's, it's just getting to that side, that other side so that I can live.

Dr. Reese (16:00):
Right. Yeah. Just a few weeks ago I was holding a newborn in my arms. Oh, buddy of mine had a baby

Nurse Keysha (16:07):

Dr. Reese (16:08):
<affirmative> and I'm holding the child. It's gotta be like three weeks old, you know, small head boggling all over the place. And I'm just looking,

Nurse Keysha (16:17):
Were you, were you properly supporting the head?

Dr. Reese (16:19):
Yes, <laugh>. And, and I'm looking at this little baby and I'm like, you're gonna have to die. Mm. Like this little child is gonna die.

Nurse Keysha (16:34):

Dr. Reese (16:34):
<affirmative>, you know, hopefully not to her eighties or nineties, but you know, it's like the journey has begun.

Nurse Keysha (16:42):

Dr. Reese (16:43):
And it's going to end mm-hmm <affirmative> and it's the only guarantee.

Nurse Keysha (16:49):

Dr. Reese (16:51):
And there's something, there's something to be said about that, you know,

Nurse Keysha (16:54):
Mm-hmm <affirmative>

Dr. Reese (16:56):
And so I'm reminded of the story of Socrates who, you know, he was convicted by the government and sentenced to death. Mm-hmm <affirmative>, you know, similar situation is Jesus.

Nurse Keysha (17:09):

Dr. Reese (17:10):
Um, but they, uh, they did poison mm-hmm <affirmative> and the night before his disciples all got together and they figured out a way how to break 'em out of the jail and he declined.

Nurse Keysha (17:22):

Dr. Reese (17:23):
He said, I'm good. I'm ready to die. Mm-hmm <affirmative>. And the next day they injected the poison and, you know, it's a slow, slow process. And he was like, very mindful mm-hmm <affirmative> and he was observing his feet and his legs and then his torso. And then, you know, like he was like, oh, this is a, like, he was, he had a curious, he had a curiosity about it. Mm-hmm <affirmative> he was ready.

Nurse Keysha (17:51):

Dr. Reese (17:52):
And I feel like if we all take that approach, just like the woman you talked about mm-hmm <affirmative>, this can be a really beautiful thing.

Nurse Keysha (18:00):
Yeah. Yeah. And I think part of it too, she, um, fam it's cultural with some patients and families that I have. Um, definitely culture plays a huge part in the death and dying process and accepting, um, them going through all the different stages of grief with bargaining and denial and sadness and accepting. I mean, it, they go back and forth. No one really stays in the grieving process, you know, no one agrees at the same time. And sometimes you go through, you go through several stages of grief at different times, you could be accepting and then go back down to like grieving again, you know, <laugh> right. So it's like, it it's kind of, you know, its it's cultural. I, I definitely see that it's cultural or what their upbringing was, um, in, in accepting the death and dying process and you know, and the steps and everything.

Nurse Keysha (18:57):
But, you know, I'm, I feel like I'm like, um, the person here for them right. To, to show them that whatever feelings that they're having, as far as the family goes, whatever feelings that they're having, it's all normal. Yeah. The feelings that they're having is normal are normal. Yeah. I know. They're not gonna be people around are gonna be like, oh, they're, you know, they're gonna always accept it. You know, you're not gonna always have those people. Um, and you know, those can be difficult cases, but you know, I, I find myself that I'm able to work through them with the, with the families and um, eventually they get there, you know, and sometimes I don't see the case through. I have, you know, I, if sometimes I don't, I'm unable to see the case all the way follow through because I'm not the primary case manager, um, on some of the cases. But later on I find out, oh, you know, they're, they're starting their bereavement, um, classes. They're going to, you know, classes with, you know, dealing with loss and everything. Um, but you know, it's because you, they haven't accepted death, you know, um, they know that the person is gone, but it's very hard for them to work through sometimes the, the grief.

Dr. Reese (20:18):
Sure. There's a bond, a bond, right? Yeah. Mm-hmm <affirmative> so tell me a story that stands out,

Nurse Keysha (20:26):
You know, what's so funny, this story that I'm about to tell you is the story that made me quit hospice the first time. <laugh>

Dr. Reese (20:34):
Right. This is your second stint.

Nurse Keysha (20:36):
Yeah. So, um, so the, the call that I received was that he was having uncontrolled symptoms and he was at home at the time. And he was at home, not in a facility. I don't worry so much about patients when they're in the facility, because there's always someone there to take care of them. You know, especially in the daytime, there's certain things going on, you're able to get the APRN, but you're also able to get the on call MD, you know, at nighttime as well. However, when they're at home, it's not like that. It's the family who is taking care of their loved one. So with that being said, I was, I had this one patient and military family everybody's military. So I can, you could just, I'm just trying to put that personality out there. Um, the military family, they very strong. The, the patient was very stoic, just, you know, um, but he was having, um, uncontrolled symptoms and I walked into the room and you can hear the respiratory stuff going on. It was like all of the, um, secretions. And it was just a lot of loud breathing in the room and he had so much anxiety and he was just like all over the place. Like it was like, as he could be, he could crawl outta his skin if he, if he needed to. Okay. But it's it's as if he, like he was reaching and grabbing because he couldn't take what was happening to his body at the time.

Dr. Reese (22:22):
Was it a psychological response or was it physi it's psychological, right.

Nurse Keysha (22:27):
It's psychological and physical response. Okay. To, because when you start pH, so when he start, you feel something physical, you get scared. So now it's in your mind. So now it makes the symptoms worse with what's happening to you because you can't control what is going on. And if you're someone and the reason why I explained to you that he was in a military background, he he's in a military, you know, of military men, they're strong men, you know, they can take anything. So we, you know, so you think, but then in this situation it was just like, he had no control, like none about what was happening to him. And what was happening to him was that he was having a flash pulmonary edema.

Dr. Reese (23:11):
Okay. He's filling up with water.

Nurse Keysha (23:13):
Yes. And so when he, anyone knows in the medical field, usually when they have this happening, it should, it should be dealt with in the hospital. Um, because it's, it's a, it's a very, um, uncomfortable, um, meaning, meaning them needing a bunch of medications to keep them, you know, comfortable like morphine. And Avan just, you know, a lot of stuff. So now we're at home dealing with all of this. And the only thing you have is sublingual medication, um, trying to combat this. And no matter what I did, no matter how much I was hitting him with it, wasn't doing anything. Mm. So, but something in me told me, pick him up, like, as if he's a baby and cradle him in your arms. So he was laying on the bed. So I just kind of scooped him up and brought him close to my chest. And I kept rocking with him. And then he actually grabbed me around my waist And <affirmative>, and as he did that, I could feel him. I could feel him dying in my arms.

Dr. Reese (24:32):

Nurse Keysha (24:33):
Um, I could feel, it was almost if I could feel his soul, like move away.

Dr. Reese (24:45):

Nurse Keysha (24:47):
It like separated from his body. I can feel it separate from his body. It was like, I could feel it pulled through my hands, like, cuz I had, I was holding him like this, but I could feel like this rush pulling through my hands and my arms. And he passed away in my arms.

Dr. Reese (25:10):

Nurse Keysha (25:12):
Yeah. With his family around the bed with me, his, his entire family was on the bed with me. And um, when he passed away, when he was gone, I laid him down, back on the bed and I told them, you know, that he was gone and the wife said to me, how did you know that he was religious? I said, what? She's like, how do you know he was religious? I said, what do you mean? She was like, you were praying the entire time. I don't remember that.

Dr. Reese (25:50):

Nurse Keysha (25:50):
I don't remember the prayer. I don't remember anything. I don't remember what I said. All I remember is holding him and feeling that. Cool.

Dr. Reese (26:01):
So here's how I'm interpreting it. Mm-hmm <affirmative> it sounds like two instincts coming together. His and yours mm-hmm <affirmative> because we all have this inner child mm-hmm <affirmative> and it gets scared and he was scared mm-hmm <affirmative> and you holding him. It was equivalent to

Nurse Keysha (26:28):
His mom

Dr. Reese (26:29):
Being a mother, holding the, a baby mm-hmm <affirmative> and so like a motherly instinct, you know? And that's what it sounds like to me and

Nurse Keysha (26:41):

Dr. Reese (26:43):
You know, O OSHA says in his book, the art of living and dying that he says, you're fortunate if you're in the room with somebody dying

Nurse Keysha (26:52):
Mm-hmm <affirmative>

Dr. Reese (26:54):

Nurse Keysha (26:54):
Well, I, that, that means I'm fortunate all the time, because

Dr. Reese (26:57):
Right. And this experience that you're <laugh> that you're, that you're talking about right now is mm-hmm <affirmative> is one of those type of situations. That's why he calmed down when you did that, right? Yeah.

Nurse Keysha (27:10):
He, he completely calmed down when I did that. Right. He just held, he held onto me. He did it. Wasn't like he had a good, he didn't have like a tight grip on me. It was more like a relief that someone was holding him. But at that same moment, you know, after I finished, you know, and I put him back down in the bed, you know, you know, I said, you know, I told the family, my condolences says, and I'm sorry. And then I walked out of the room cuz I wanted them to have their time, but I needed my time. <laugh>

Dr. Reese (27:45):
Oh bet.

Nurse Keysha (27:45):
I bet. I walked out the room, walked outside, got in my car, called my boss and I was like, I'm quitting right now. I'm gonna quit. Wow. I was like, I don't wanna do this anymore. I can't do this anymore. You know, I could, I was, I was crying and stuff because I didn't, I couldn't explain what happened to me, you know? And I mean, I knew what happened to him. He died, you know, but the, it was the experience. I couldn't explain. And I, I think I was, I, I thought about him for weeks. Like after that, and I still think about him from time to time. I think about the moments, um, that happened. But I at least in those moments now, when I think about him is not, I'm gonna quit. It was like, it's more like I'm relieved that I was there for him.

Dr. Reese (28:41):

Nurse Keysha (28:41):
And I'm happy that I was the one that was there for him. Cuz I don't know if, cause even one of the nurses that was, um, that I had discussed this with, she said, I don't know if I could have done that. Ah, she was like, he he's he needed you there that night.

Dr. Reese (28:55):
Yeah. Yeah. That's heavy. That's beautiful. Mm-hmm <affirmative> can you share another one?

Nurse Keysha (29:04):
Yes. Um,

Dr. Reese (29:05):
There's many. I would imagine

Nurse Keysha (29:07):
There's many, many stories. Um, patient in a facility, actively dying patient, obvious signs of the stress and the daughter refusing to provide any type of comfort for her mom.

Dr. Reese (29:28):
What is it? What do you mean?

Nurse Keysha (29:29):
Um, death and dying without meds. But this is me I'm I was taught meds. Give them meds, start them every hour on meds. Um, the mom was actively dying. She has secretions. She would only allow us to put the oxygen on, but she obviously was in a lot of distress. I, I, the daughter was just like, so like stubborn. She did not wanna give meds at all. And she just kept saying, Nope, I'm just, I'm not, but, but not only was she not giving meds, but she wasn't providing like the comfort for her mom. She wasn't sitting at her mom's bedside and holding her hand or you know, or trying to walk her through it, you know, or trying to talk her through it. She wasn't doing any of that. She was just was like just pacing back and forth. Just watching her, just going through the dying process.

Dr. Reese (30:24):
There was no tenderness,

Nurse Keysha (30:26):
Right? There was no tenderness and no empathy or no. And then when she passed, it was like, she almost celebrated it. But then I realized to me at that point, I thought she was being heartless. You know, how are you celebrating your mom's death? Like what are you doing? You know, that's how I felt. But she said, I'm not celebrating my mom's death. I'm celebrating her life.

Dr. Reese (30:56):

Nurse Keysha (30:57):
In my mind, I was so angry with her. You know? Like I couldn't even, I couldn't even hear it, you know? And I walked away from it. And then one of my nurse, friends said to me, she said, you cannot be angry with the way she start with the way she decided to do her plan. This was the, this is the plan she had in place for her mother. She wanted her mother to die naturally. Hmm. And I said, but, but she didn't die peacefully. She was like, who, how do you know? She didn't die peacefully? She said, were you there? Were you in? She said, were, she said you were there. She said, but you weren't in her body. So you don't know what was going on with her. You know? I mean obviously respiratory symptoms when they're, you know, breathing heavy is not comfortable, but we're also taught that there's certain things that they're not even aware of when they're going through the transition. So who knows if they're even aware of their respirations elevating during this time?

Dr. Reese (32:01):
Well, is it possible that the mother and daughter talked about it in advance

Nurse Keysha (32:06):
And it could have been, but no one will. We will never know because that wasn't disclosed to us. So

Dr. Reese (32:13):
When people, but

Nurse Keysha (32:14):
I just, I just thought that she was, I just thought in my mind that this here's this heartless daughter, like right.

Dr. Reese (32:21):
<laugh> when, when people die are, is the lungs the last to go?

Nurse Keysha (32:25):
No, it's um, it's

Dr. Reese (32:27):
Actually your, some, a lot of people die from kidney failure,

Nurse Keysha (32:29):
Right? It's actually your hearing that goes last.

Dr. Reese (32:33):
Oh wow.

Nurse Keysha (32:34):
You can hear. Which is why to go back to my first story of my lady. She told him, don't talk her while she, while she was transitioning, cuz she wanted to be focused. Cuz you can hear you, your, your hearing is your last thing to go when you die.

Dr. Reese (32:49):

Nurse Keysha (32:50):
They can hear everything that's happening and what's going on.

Dr. Reese (32:53):
But it sounds like the breathing is the

Nurse Keysha (32:57):
It, the breathing is just a SI just a symptom that happens. Like if they're having any type of respiratory issues and things, it's just your body going into cuz your body goes into like a fight or flight mode. Cuz the brain is the brain. The brain is trying to, the brain is doing what it's supposed to be doing. It's trying to compensate because your brain is meant for you for it to keep you alive. Your brain is the one that works. Everything, you know in your body. It it's the one that controls. It's the central nerve. It's the central nervous system. It's the one that controls everything that's in your body to

Dr. Reese (33:34):
Work. So the woman you told me about the first story with her breathing and her meditation, she got her mind to calm down.

Nurse Keysha (33:43):
Yep. She told her brain, this is how we're going to work. You know? Yeah. We're not gonna, we're not going into that fight or flight mode. You're not you're you're you're not gonna go. You're not gonna fight we're. This is what we're about to do.

Dr. Reese (34:03):
Hmm. And what a difference between her and the gentleman you had to hold?

Nurse Keysha (34:10):

Dr. Reese (34:12):
Now what about someone dying from kidney failure? Is that typically a painful thing?

Nurse Keysha (34:18):
It can be painful. Um, most of the, the pain is not so much. Is there kidneys per se? I mean it can be, but it's more, that depends on, it depends on why the failure is happening. Like some people will have now if you're talking about someone who's on dialysis and they cuz they're on kidney failure and they're on dialysis and they have to get their, you know, it's, it's more like they're, it's the edema that cuz they can't filter out any of the water because they, you know, out their system. So it's the edema that causes them to swell up. They have, then they end up with high levels of, of, um, pneumonia that eventually gets into their brain causing them confusion and, and everything. Um, so I mean there's a lot of things that happens when you're, someone's in kidney failure as opposed to someone who's in kidney failure because there's an obstruction there, um, such as cancer or you know, some kind of blockage or something like that. Um, it, it is the same, the same thing happens to them as well. But the cancer is what at times caused them a lot of the pain. Um, I've never known anyone with kidney failure who was on dialysis that say that they were in pain. It's more of it's the edema, it's the, it's the swelling and the, the pneumonia levels that happens when they are confused and, and everything. So

Dr. Reese (35:46):
Is there medication that can neutralize that at all

Nurse Keysha (35:50):
To make

Dr. Reese (35:50):
It more comfortable?

Nurse Keysha (35:51):
Keep them comfortable? Yes. Um, you know, usually they start the morphine at five milligrams at every hour or 10 milligrams every hour, depending upon the symptoms, cuz basically the medication is for symptom control. Um, if they're having uncontrolled symptoms and they can't, I guess ed through meditate through it, but yeah, but it's, it's it's the medications is for symptom control. And I know that there's a lot of, um, myths about hospice, not myths, but like a lot of people are very apprehensive and hospice has a lot of, it's a bad rap from people because they think that, oh, once they go on hospice, they can start. They you're gonna start them on morphine. And then they're dead in like three days. And that's not the case, you know? Um, with hospice it's you, it just means that you have enough comorbidities or enough illnesses on there to, to make you qualify for hospice. But you don't, you don't have to be on morphine. You don't have to be on, you don't have to be on those meds case in point my first story, she was not on any meds

Dr. Reese (37:05):
And that she was probably in pain, but she, she chose peace over pain.

Nurse Keysha (37:09):
She chose peace of. Okay. Yep.

Dr. Reese (37:12):
Yep. So there's gotta be all sorts of stories of, of, of people that you meet, who aren't comatose they're you know, they're, they're going through the process. It takes weeks. If not months, you know, you told me of recently you had a patient who was like a hundred years old.

Nurse Keysha (37:33):
Yeah. <laugh>

Dr. Reese (37:34):
And he's all messed up and he's just like wants to die.

Nurse Keysha (37:37):
Yeah. He wants to die. He uh <laugh> he's um, he's like, why am I still here? Like that? That's he's like this grumpy grumpy man. He's like, why am I still here? You know? I'm like, I don't know why you're still here. <laugh>, you know, everybody's gone, you know, that he's was close with.

Dr. Reese (37:56):

Nurse Keysha (37:57):
And so it's like,

Dr. Reese (37:58):
Even, even his doctors are dead

Nurse Keysha (38:00):
Probably. Right, right. And he has a brand new doctor who's like probably old enough to be, you know, like young enough to be his grandchild or something, you know? Yeah. Yeah. But yeah, he, yeah, he's um, he only has, um, a few family members left, you know? And it's, he, it is kind of, you know, he gets, I know it's cuz he's lonely, you know, and I know that's what it is. And we're like the highlights of his day coming in there to visit him.

Dr. Reese (38:26):
Sure, sure. Yeah.

Nurse Keysha (38:27):
Yeah. But yeah, but he, he struggles with, he struggles with living on the earth. When I go there to visit him, he's always like, why am I not dead yet? You know why I wanna die? And it's not even like, he's

Dr. Reese (38:41):
Depressed. He's not joking either.

Nurse Keysha (38:42):
No, he's not joking, but he's depressed about not dying. You know what I mean? But not, it's not like he, he, and, and I don't want people to, to take it as, oh, he has some suicidal thoughts or, and no, he's just ready to go. Like, he's been his, heart's been beating on this earth for over a hundred years. Like, and he, all he does is basically sleep, you know? And, and he's just like, and he says that all I do is sleep. And you know, all I do is sleep. I said, well, you

Dr. Reese (39:14):
Have me. Is he capable of walking around and stuff?

Nurse Keysha (39:16):
No. Nope. Not on his own. Now on his own, he has to be transferred all the time. Transferred. You know, his body's old, he's not a young 100 year old man. He's a pretty old 100 year old man. Hmm. So I mean, he's, you know, he, he has issues with, you know, but there was one thing that he said to me, he, he says that he, he wants to, he calls dying, getting on with life.

Dr. Reese (39:49):
Right. Nice.

Nurse Keysha (39:51):
<laugh> I'm just, I just wanna get on with my life. And I, he used to say that to me, I was like, you hundred years old, what do you need to get on? He goes, I'm talking about dying. I wanna die. I wanna just, I just, you know, he says, I'm, I'm tired of being stuck in this chair. I wanna, I wanna, I wanna walk again. So in his mind, because he's on this earth right now, he's not walking, but he feels like when he dies, he's gonna be able to walk and he won't have to depend on anyone.

Dr. Reese (40:22):
I think, I think it's a lesson of impermanence because like you said, he, he, all the people that he had years and years with are gone.

Nurse Keysha (40:35):
Mm-hmm <affirmative>

Dr. Reese (40:36):
And that just shows you how dare I use the word futile. Everything is it's like, and I, I say this all the time. Like I use Alexander the great as an example. I mean, the guy accomplished more than probably any human being who ever walked earth and his empires are gone. You know what I mean? Like, right. You're not, <laugh>

Nurse Keysha (41:05):

Dr. Reese (41:05):
They're gone.

Nurse Keysha (41:07):

Dr. Reese (41:07):
All that work to conquer almost the whole world. Yep. It's gone.

Nurse Keysha (41:13):
It's gone.

Dr. Reese (41:14):
And then many years later, Rome came mm-hmm <affirmative> and Rome ruled and it's gone and now it's the United States. And you have to assume at some point it'll be gone,

Nurse Keysha (41:27):
It'll be gone. Mm-hmm <affirmative>.

Dr. Reese (41:29):
And so these are empires that last centuries, and we're just humans that last a hundred years, if we're lucky,

Nurse Keysha (41:37):

Dr. Reese (41:38):
<affirmative> and it's like, everything passes us by.

Nurse Keysha (41:42):

Dr. Reese (41:43):
And we're, you know, it's like, who's gonna remember you. Your kids are gonna remember you, your friends are gonna remember you, but in a second, they're gonna be gone too.

Nurse Keysha (41:52):
Right. And then anyone after them is they're they may have some memory of you, but they're not.

Dr. Reese (41:58):

Nurse Keysha (41:59):
And then after that, no one will ever remember who you're.

Dr. Reese (42:02):
No, I, I, you know, my last grandparent died when I was 17. I don't have clear memories of my grandparents.

Nurse Keysha (42:12):
Wow. Yeah.

Dr. Reese (42:13):
You know, and definitely not their parents.

Nurse Keysha (42:18):

Dr. Reese (42:18):
And so everything fades away and it's like, we're creating sand castles. Mm-hmm <affirmative> and the wind and the sea is gonna come and wipe that out.

Nurse Keysha (42:31):
Mm-hmm <affirmative>

Dr. Reese (42:33):
It's pretty cool.

Nurse Keysha (42:35):
Yeah. <laugh>

Dr. Reese (42:39):
So what's another story.

Nurse Keysha (42:41):
She was in her nineties and she couldn't understand how she went all those years and then hit age 90 and end up with cancer. It was doctors wanted her to do treatment for it and all that stuff. And she was like, no, she says I'm 90 years old. She says, and I'm looking for quality of life, not quantity.

Dr. Reese (43:13):

Nurse Keysha (43:16):
Because she would rather live out her days, you know, feeling pretty. Okay. You know, rather than her going through treatments and feeling sick all the time, just to get those few extra years. But those few extra years she's gonna be sick. And she felt like the treatments would've killed her. Anyway. She was like, I'm 90 somebody years old. Of course the treatments are gonna kill me.

Dr. Reese (43:49):
So what happened? So

Nurse Keysha (43:50):
She opted for quality, not quantity.

Dr. Reese (43:53):
Did she get real sick?

Nurse Keysha (43:56):
Um, she did. And her only thing that she wanted to do was that summer. She wanted to go to the beach and eat lobster Andraka margarita.

Dr. Reese (44:10):

Nurse Keysha (44:11):
And we made that happen.

Dr. Reese (44:13):

Nurse Keysha (44:14):
And she thought that that was the best thing ever. That happened to her that year.

Dr. Reese (44:21):

Nurse Keysha (44:22):
Eating lo eating. All she wanted to do was eat a lobster on the beach with a margarita.

Dr. Reese (44:28):

Nurse Keysha (44:29):
So we took a field trip.

Dr. Reese (44:32):
How long did it take for her to die? After that beach? Not

Nurse Keysha (44:35):
Long. She was gone in a week. And now let me tell you, she was walking when we got her to the beach, she was walking and then the next day she couldn't get out of bed.

Dr. Reese (44:50):
Wow. And so how, how was her transition?

Nurse Keysha (44:55):
Um, her transition was okay. It wasn't, it wasn't bad. Um, she pretty much was stayed in. She, her, her family opted to give her meds. And so she stayed pretty much in control, but they didn't have to, she, she didn't have to get medicated every hour though. Every few hours that she was, that they medicated her, that they thought that she was in pain or they thought that she was her respirations were getting, you know, a little elevated. So they would, but they, they, they barely used the bottle

Dr. Reese (45:26):
Of oxygen

Nurse Keysha (45:28):
Of morphine

Dr. Reese (45:29):
Morphine. Gotcha. Yeah.

Nurse Keysha (45:31):
Okay. She didn't actually, she didn't even actually go on oxygen. She didn't need it.

Dr. Reese (45:35):
When you say the oxygen levels get elevated.

Nurse Keysha (45:39):
No. So it'd be like, not the oxygen levels. It'd be like the other vital signs that gets elevated, like blood pressure respirations. It's the respirations that get elevated.

Dr. Reese (45:49):

Nurse Keysha (45:50):
Yeah. And respirations is the number of breaths you take per minute.

Dr. Reese (45:55):

Nurse Keysha (45:56):

Dr. Reese (45:57):
The, the, the finger monitor, right?

Nurse Keysha (45:59):
Yeah. The pulse <laugh>. Yeah. So pulse oximeter, you can have rapid deep breaths,

Dr. Reese (46:07):
Like a hyperventilation.

Nurse Keysha (46:09):

Dr. Reese (46:10):
And that's an automatic body response.

Nurse Keysha (46:12):
That's the automatic that automatic body response. That's what your brain is telling your body that you have to do in order for you to survive. Cause it's, it's now starting to starve for oxygen

Dr. Reese (46:25):
And you can do something to medicate,

Nurse Keysha (46:28):
Alleviate mm-hmm <affirmative> alleviate the, the elevator respirations. Yeah.

Dr. Reese (46:33):
And that just makes them more comfortable.

Nurse Keysha (46:36):
Yep. So we think, I could say it makes their respirations go down suppressed

Dr. Reese (46:47):
When they're, which is what we look for when they're transitioning. Like, I mean that minute, that moment does the breath do

Nurse Keysha (46:55):
Something? No, not all the time. Like, so when they're transitioning, when we say someone is transitioning, that means that person becomes unresponsive. They're not, they're no longer eating, no longer talking. The active, dying phases is all the symptoms that we see in the actively dying person. Like the respirations sometimes are elevated. They're shallow. Um, if they're comfortable, they can be slow and shallow. So though, that's, it goes from transition to actively dying. There's like, there's a difference. Some people use it interchangeably. I don't okay. Transitioning to me is they, their, the body per is preparing itself for the actively dying phase.

Dr. Reese (47:38):

Nurse Keysha (47:39):
So I, the body has to rest first because it takes a lot of energy to start act. It takes a lot of energy to actively die, which is why the respirations get elevated. Sometimes the heart rate is elevated. Sometimes they're sweating.

Dr. Reese (47:55):
So how do you go on with your regular life when you have to deal with this all the time,

Nurse Keysha (48:01):
<laugh>, you know,

Dr. Reese (48:03):
Someone dies, you come home, watch Netflix. I mean, how is kind

Nurse Keysha (48:06):
Of like that? It's kind of like that, like, you know, I, I, you know, every day when I see my, on my patients, I I'm watching them die slowly. I see the changes. I see the decline, you know, I have to tell them, but sometimes they know it. They can feel it, they can see it. You know, the family members can see it sometimes. Um, the, the patients themselves can feel it. They can see it too. Mm. You know, but I watch them. And then I come home and I have my kids. Sometimes I just watch my shows or clean up my house. I, I, I, I have a regular life <laugh> outside of hospice. You know, I still have to, I still have to live on this earth until I'm no longer needed here.

Dr. Reese (48:57):

Nurse Keysha (48:58):
So I still have to take care of my responsibility to honor.

Dr. Reese (49:02):

Nurse Keysha (49:02):

Dr. Reese (49:03):
Well, I, I hope that listeners are motivated to take up meditation if they haven't yet.

Nurse Keysha (49:11):
Mm-hmm, <affirmative>, it's definite, it's something that definitely, I think everyone should do it. I'm, I'm guilty of not, um, consistently doing it. Um, I honestly wish that I started earlier in my life, um, doing it, like, at least in my thirties and my twenties so mean maybe late, maybe mid thirties. I wish that I could have started it then, you know, right now I'm like creeping up to the big five. Oh. So I'm like, <laugh>, I'm like, so now it's like, you know, then I have an 11 year old that I have to chase behind. So she, they, they, that don't make it any easier for me to be able to sit back and meditate. Right. So, but I know now that I have times and spaces in between,

Dr. Reese (50:02):
So, all right, Keisha, this, this has been a good talk. Yeah. Where can somebody stop in to say hello to you? Uh, Instagram perhaps,

Nurse Keysha (50:11):
Yes. They can stop it on my Instagram page. Um, my Instagram page is actually, it is open to the public. It's not closed off. So, and my handle is at <laugh> a unicorn among courses.

Dr. Reese (50:25):
Wonder where you got that from?

Nurse Keysha (50:27):
<laugh> <laugh>,

Dr. Reese (50:29):
That's in my first book, diet, stress

Nurse Keysha (50:32):
Touch. I know. I love, I, I, um, I took a liking to it, so I, I took it and I've been should

Dr. Reese (50:38):
I should have trademarked it.

Nurse Keysha (50:40):
<laugh> I know you should have, but it's okay. Yeah. But at least it's somebody, you know, right. That has the theme.

Dr. Reese (50:45):

Nurse Keysha (50:46):
Right. It's not some random person that never unicorn met you. I never saw you. Yeah. Right. So, yes. So it's at a unicorn among horses.

Dr. Reese (50:56):
All right, Keisha, thank you.

Nurse Keysha (50:57):
All right. Thank you.

Speaker 2 (50:59):
Thanks for listening to inner peace with Dr. Reese. If this episode opened your heart, feel free to share on social media and tell your loved ones. Also be sure to subscribe. So you never miss an episode until next time may peace be with you.