Session 131: Living Well In Order to Die Well

Dr. Joy: 00:11 Welcome to the therapy for black girls podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Harden Bradford, a licensed psychologist in Atlanta, Georgia. For more information or to find a therapist in your area, visit our website@therapyforblackgirls.com. While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for relationship with a licensed mental health professional.

Dr. Joy: 00:56 Hey y'all, thanks so much for joining me for Session 131 of the therapy for black girls podcast. This week I'm sharing a conversation I had with Ashley McGirt, a clinical social worker based out of Seattle, Washington about living well based on her experiences as a hospice therapist. Ashley is passionate about teaching individuals how to live well so they can die well. Her work in hospice has helped her to really stress the importance of living will in her private practice where she treats primarily millennials of color suffering from racial trauma, anxiety and depression. Ashley and I chatted about the kinds of concerns her clients discuss while in hospice, how family members of those in hospice can take care of themselves. The impact that race related stress is having on the mortality rate of black people and her tips for living a life without regret. If you hear something while listening that really speaks to you, please be sure to share it with us on social media using the hashtag #TBGInSession. Here's our conversation.

Dr. Joy: 02:05 Thank you so much for joining us today, Ashley.

Ashley McGirt: 02:07 Thanks for having me. I'm excited to be here.

Dr. Joy: 02:10 Yeah, so I want to talk with you more about your work. So you have I think a very unique field that not a lot of us are working in. You work a lot with hospice clients. So can you tell us a little bit about your work, what you do there?

Ashley McGirt: 02:23 Yes, so as a hospice therapist, my role is really to provide emotional support to those who are dying. I sometimes work with the families as well, but for the most part after my patient dies, we refer the family members to grief support services. So my role is really just to have a conversation with patients about their terminal illness, their thoughts around death, really how they live, whatever they want to talk about. Because oftentimes people do have the misconception that I'm coming just to talk about death, which that's not the only thing I talk about its really making sure that they're comfortable, they're emotionally prepared, that they're not depressed or anxious. Around their illness and around their desks so that they have for the sort of preparation and can feel more comfortable given what's going on.

Dr. Joy: 03:17 Hmm. So can you talk a little bit more about what that preparation looks like? Like what kinds of things are you talking about?

Ashley McGirt: 03:22 We're really talking about the life that they lived, any fears that they have circulating around death. Cause oftentimes the fears that individuals have are things that they didn't finish, things that they didn't accomplish, things that they still want to do. So if there's any way that I can still incorporate that into their lives at the end of life, that's something that I work with my team to try and do. There's some things that we can't necessarily do. Like I had one patient who always went to Palm Springs and she wanted to go to Palm Springs one last time. That wasn't possible, but we brought in kind of like the mock Palm trees, some sun, just like beach atmosphere and we really brought a Palm Springs vibe to her home here in Seattle where she was living. So things like that or some of the conversations that I have, I also talk a lot about religion and faith because sometimes that's why individuals have certain fears. Our hope. We also have a chaplain who also is there for spirituality purposes, but it comes up a lot in my conversations during end of life. I learn a lot about different belief systems and just thoughts that people have about the dying process.

Dr. Joy: 04:34 [inaudible] okay. And I know we often see like lots of memes or lots of like, what do you call them? Like [inaudible] information or motivational quotes. Talking about like at the end of life, nobody is thinking about how many hours you worked but more about like who you were to your family and the impact that you made. So I'm wondering if things like that come up, like are there conversations around regrets?

Ashley McGirt: 04:58 Yes there is. And that meme is so accurate because at the end of life I've learned so much and sitting at the bedside of the dying, it really is about the things that they regretted, those who are in their life, on the people that they love. And there was actually a palliative care nurse who compiled all of the different conversations that she had with those who are dying and she created what's called the five regrets of the dying. And that's actually something that I hear amongst so many of my patients. And then on the bright side, I do have patients who actually don't have any regret. They're happy with the life that they live and they're really ready. I have patients who tell me like, look, I'm ready to meet Jesus. This is my time. I know what I did here on earth was good. And then there was those other individuals who really do regret and they're sad at this stage in life, especially with my black patients because I am seeing an experiencing, so black patients dying a lot earlier than they should. Whereas my white patients there well in there hundreds. So at that point they feel like their life is complete and they can now take on the next stage of life, whatever that may be for them.

Dr. Joy: 06:12 Hmm. So I would imagine if you're seeing people dying, you know, much earlier in life there would maybe be some regrets, but also probably some confusion and maybe frustration and anger about the fact that they didn't have more time so to speak.

Ashley McGirt: 06:26 Exactly. And lots of confusion. Some of the top regrets are just really that they didn't live the life that they wanted to, that they spent so much time working, not enough time with their family. A lot of things like, well, if I worked so hard or if I didn't do this, sudden things of what I call a destructive thinking. So a lot of should of, could of, would of's.[Inaudible]. I really try to deter my hospice patients from that pattern because it can cause a lot of depression, anxiety. So I really try to focus on the positive aspects of their lives. But there's also a time just to allow them to vent and get out everything that they wanted too, because I learned so much in their regrets. And then there's also potential upon the possibility for them to maybe make those things come true. Like, okay, well you couldn't do with them, but what can you do now who can show up in your life at this moment for you? How can you be happier even right in this stage of end of life? Because that's one of the biggest regrets is also that, you know, I wish I let myself be happier.

Dr. Joy: 07:30 Mmm [inaudible] so you said that you do work some with the families and I know we often hear about, you know, how death or end of life can really just cause a family to unravel and lots of different ways. So I'm wondering if there's work that you have had to do just around kind of helping the family to take care of themselves while they're trying to support their loved one.

Ashley McGirt: 07:52 Yeah, so my work with the family is really focused around caregiver burnout. So what I see is a family member will want to spend all of their time with the family member that is dying. They oftentimes won't even shower, wanting to take care of their own personal hygiene because there's this fear that if they leave, they're gonna miss the moment and their family member's going to die. And we have a whole care team that comes with hospice. So I really try to emphasize that to the caregivers and let them know like, Hey, it's important for you to take a break. You need to take a break. I still encourage them to do the things that they used to do prior to taking care of a relative with a terminal illness. And that's important, especially so that they can still continue to have that rhythm. So once that person dies, they're still going on their daily walks because that was something they consistently did even well.

Ashley McGirt: 08:48 They're taking care of the person and I do things like helping them get a caregiver to release for respite and just letting them know that it's okay. And sometimes I've even seen my patients where they actually won't die until that person leaves because they don't necessarily want that family members to experience them dying. We'll have the patient who will be holding on for a long time and we're like, okay, what are they holding on for? And then we'll ask the family members like, well, maybe if you kind of step out of the room or go to Starbucks, take a break or do something, go see a movie. And then we'll see that once they do actually leave, it allows the person to actually transition on, which is sometimes necessary, especially if they're in pain and they're suffering. We do want them to let go. Or I'll tell the family members to have a conversation with them and let them know that is okay, that you love them, that you're here and that they, you know, they can transition on out of this world. So I have a lot of those conversations about, you know, do you need to step out of the room? You need to stay, what is it going to be like? Right? Watching your family member who you love die

Dr. Joy: 10:02 [inaudible] and can you talk more about the whole idea of like, you can smell that they're holding on.

Ashley McGirt: 10:07 There are certain signs of symptoms that we can tell. Oftentimes people want to know like, well, when is my family member going to die? Well, no one knows the exact day nor the hour. What the body tells us a lot. So there's things such as aspirated breathing, the body stops making bowel movements, they become incontinent. So as we're seeing that the body is literally dying and going through these stages, but the patient hasn't actually let go themselves. We as a team just in doing this work can tell like, okay, maybe they're holding on because there's someone that they want to see before they actually die. Or then I start asking the family questions. Um, and I usually do this before that stage even gets there. Like is there someone that they would want to know that they were dying? Is there a family member who may be live on the other side of the country?

Ashley McGirt: 10:57 Who should come? They want to see? And often times I do see patients where they're waiting it out and if they're able to verbalize that, sometimes they've actually told us like, yeah, I would like for my son to be here. Most of the times at this stage they can't talk, but they're not letting go. But their body shutting down and they're holding on for that last, last bit of something that they need before they can actually go onto the next phase. And so it's really the thing, attention to the body and then thinking, okay, if the body is shutting down, but mentally like they're holding on aspects of them is still here. So what else could it be? And that's when we start asking questions. And going back to some of the earlier questions I may have asked when they first came onto my caseload.

Dr. Joy: 11:42 And are there other kinds of questions that you're asking to kind of get at some of this information?

Ashley McGirt: 11:46 Yeah, so I'm asking about the life that they lived. Who was there, who was important to them, what types of things brought them joy. And so when I hear those stories and if I know like, okay, they spent a lot of time with their best friend or their children, those are people who are really important to them that they wouldn't want with them, uh, in this life. And I also have family members who really don't want anyone around. I had one particular patient, I remember she had two twin boys and she loved her son so much that she didn't want them to know that she was dying. So she actually went through the dying process alone. I would encourage her a lot when we talk to her so that she didn't have to go through it alone because I was really the only person that she had who she could talk to and she could vent to and provided her emotional support at the end. She actually did agreed to let our students know what was happening, but unfortunately she died prior to even being able to communicate that. So I was the person who they call their son and let her know like, Hey, she loves you so much, and she was planning. She just didn't want you to carry, carry that stress or have to put your life on hold because oftentimes that's what caregivers are doing. They have to take time away from work or whatever they're doing to show up in a family member who is sick.

Dr. Joy: 13:09 Got you. Okay. And I know a lot of your work, Ashley is also related to kind of going back to your earlier comment about how many more black clients you're seeing kind of dying earlier in life. And so you do a lot of work around racism and how chronic stress is leading to higher mortality rates. Can you talk a little bit about that?

Ashley McGirt: 13:29 Yes. So in addition to doing hospice therapy, I also have my own private practice where I focus predominantly on millennials of color. And I also focus a lot on racial trauma. So really just healing from somatic symptoms are those physical symptoms that manifest themselves in the body. Because I see a lot of my black and Brown hospice patients dying as a result of chronic illnesses that are stressed and do things like high blood pressure, stroke, heart attack, certain cancers, diabetes, obesity. Because oftentimes in the black community we're stressed either. So we're taking on a lot of weight. Um, African Americans, I literally die earlier from all causes across the board no matter what it is. We see this in even, yeah, maternal rights. So things of that nature. So in my practice I'm really looking at the body and healing from that stress and that trauma that's taken its place.

Ashley McGirt: 14:31 A lot of things that we really misplace cause we're resilient people, we don't often see it. It's like no I'm just going to power through. I'm fine. But then our body says no I have a headache. I've got these neck pains or other things like that. But through progressive muscle relaxation, [inaudible] and other tools and also education, just really sure that the clients I serve in my private practice are really aware of what's going on. I screen everybody for their ACE score. So adverse childhood experiences because we know that childhood toxic stress leads to [inaudible] early mortality rate. If you have an ACE score of six or higher, your license automatically decreased by 20 years. So a lot of my work is really bringing in like some resilience training, doing something to really [inaudible] counter that so that they don't have to be on my hoster caseload at 50 years old.

Dr. Joy: 15:26 [inaudible] And so I'm also really curious Ashley, how are you taking care of yourself doing this work?

Ashley McGirt: 15:31 Really just leaning in on my support system who really understand the work that I do. My mom's a registered nurse. She's worked in hospice, so she understand the medical system, especially when it comes to treating people of color. Taking vacations, taking breaks. Yeah. My hospice organization, they're really good in that they have support meetings, especially when we have really hard cases or super young patients and because of the zip code that I serve, I get a lot of the really young patients. So my patients who are black and brown are typically ages like 30 to 55 on hospice, which is wait too young to be on hospice. So they recognize that and they understand that, Hey look, you are serving a population that is dying, extremely dung. So they step in to really make sure that they're offering support. They have massage therapists who come in for us weekly so we can get a massage if we wanted. Different things of that and just recognizing what's going on in my own body. So modeling a lot of the things that I'm doing with my clients, whether they be on hospice patients or my private practice, really just making sure I'm doing the same things to care for myself so I don't end up one half early.

Dr. Joy: 16:52 Yeah. Yeah. That it sounds like it is really important. I mean, of course as therapists it's important for us to be taking care of ourselves no matter what I feel. But I think it is particularly difficult working with this kind of client population should be making sure that you're taking care of yourself.

Ashley McGirt: 17:06 Yeah, we have to. It is so necessary. So anytime that I have something that's extremely triggering or hard for me, you know, I take a break and if that mean not going to work or relying on my team. And the good thing about hospice is I do have a team that I can lean on for support and my private practice is a little different because it's just me. But that work also is really sort of self care because I realized that I'm getting clients at an early stage so that I can really do the work. To prevent them from Indiana hospice.

Dr. Joy: 17:40 You talked about also really learning some great things about like how to live well from working with your hospice clients. So what of things would you share with us about how we can do a better job of living [inaudible]

Ashley McGirt: 17:53 Going to therapy is definitely the number one thing I've really learned from working with hospice patients, especially my minority ones because most of them are dying from chronic stress related illnesses. So when we think about stress, one way to relieve stress is going to therapy as well as you know, eating right, exercising. So all of these things have really helped me to live better in my own life, but I'm mindful of what's going on in my body, what am I taking on so that I don't end up on hospice at an early age. I also really shocked with my private practice plan. Everyone in my family, whoever will listen, I'm always stressing like we have to live well so we can die well because the reality is people of color, black people especially are not dying well. We see this all across the board, no matter what the illness, we see all the statistics. We know we have high ACE scores. So those high ACE scores are related to childhood stress. So we have to heal from our childhood trauma. And one way to do that is really through going to therapy.

Dr. Joy: 19:02 And I'm curious about how you talk with your clients about, you know, so many of the things that are out of our control, right? So a lot of would lead to the chronic stress where black people is racism and discrimination and so what kinds of things are you talking with your clients about related to those kinds of issues?

Ashley McGirt: 19:19 Yeah, when it comes to races, but that's definitely a little bit more challenging because we know racism isn't going to end tomorrow, but there's things that we can do to still live well and take [inaudible] care of ourselves. Like we could still eat well even though there's racism out there, we know that there may not be a grocery store in neighborhoods of color, but doing what we can that in our power. Also checking out. We don't always have to watch every new story. We don't have to watch every video read every article because that take an immense toll on the body, that vicarious trauma, secondary trauma of just hearing these stories, it can be incredibly, incredibly toxic. So I'm always talking to my clients to be mindful. It's like we want to be aware but not so much so that it becomes debilitating because we know the stories, the stories are the same.

Ashley McGirt: 20:14 Um, so which stories can we take in? Which stories can we take out? And also adding in some self care practices after we do hear those stories, like after we heard about Tatyana Jefferson, I really stressed to my clients who brought that up in session to make sure they went on a walk. It's been progressive muscle relaxation because muscle memory is so real. And as we share these stories, our muscles tense up and tighten and it takes an incredible toll on the body that is killing us sooner than should be expected. So just being mindful of our body, checking in like, you know, how is my head feeling? I do head to toe assessment with my clients to really make sure that their body's okay and sometimes that even means referring them to a primary care provider who can actually do some tests outside of session to make sure that everything's okay just so that we can ensure we're living well.

Dr. Joy: 21:11 So what are some of your favorite resources? Ashley, you already gave us a, which sounds like a great one. In terms of the five regrets of the dying, are there other books or resources that you find yourself recommending frequently?

Ashley McGirt: 21:24 Dr Joy DeGruy book, she's actually one of my mentors. She wrote "Post Traumatic Slave Syndrome" and rest. My Americans, my grandma, my grandmother's hands. His book really talks a lot about the impact of stress in our body and how we can heal through that. He focuses on sematic experiencing, which is what most of what I do with my clients in my private practice. I even do these things with my hospice patients, even though they're dying, they're not dead in the moment. So if they have the ability to physically do some of these exercises with me, we do it. And I've actually noticed in some of my clients, which it doesn't happen all the time, but there's been some patients where we have actually discharged from hospice because they no longer showed any signs of dying. And so oftentimes people feel like, okay, if you're going on hos this, you're automatically dying.

Speaker 3: 22:16 But that's not the case. I currently have a patient who's been on hospice for three years, hospice just means you have a terminal illness and you could die within six months or less. Um, and the goal is really to keep you comfortable and as long as your body is showing signs of decline, you still qualify to continue to be on hospice. So this particular person's body is still declining, but they haven't died, it's been three years. So that's one of the big misconceptions. Um, so really just reading that book, "My Grandmother's Hands" you can learn so much, especially about the impact of racial trauma and how race related stress takes a toll on the body in ways that we can heal from it.

Dr. Joy: 23:00 Wonderful. These sound like great resources. And where can people find you, Ashley? What is your website as well as any social media handles you want to share?

Speaker 3: 23:09 Um, for my website, really simple. My name Ashley Mcgirt.com. You can find me on Instagram @therapywithAsh. Also. Um, the Ashley McGirt LinkedIn. It's pretty much all just my name.

Dr. Joy: 23:23 Perfect. And of course all of that will be included in the show notes for people to find easily. Well thank you so much for sharing with us today, Ashley. I really appreciate it.

Ashley McGirt: 23:31 Thank you so much for having me and shedding light on this important topic of death dying in hospice.

Dr. Joy: 23:37 Absolutely thanks.

Ashley McGirt: 23:38 Welcome, welcome

Dr. Joy: 23:42 I'm so glad Ashley was able to share her expertise with us today to find out more information about her in her practice or the resources she shared. Check out the show notes@therapyforblackgirls.com slash session one 31 please remember to share this episode with two people in your circle and don't forget to share your takeaways with us either on Twitter or in your IgE stories using the hashtag TBG in session. If you're searching for a therapist in your area, be sure to check out our therapist directory at therapyforblackgirls.com slash directory and if you want to continue digging into this topic and meet some other sisters in your area, come on over and join us in the yellow couch collective where we take a deeper dive into this topic from the podcast and just about everything else you can join us at therapyforblackgirls.com/YCC thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take care.

Speaker 1: 24:58 [inaudible].