Episode 4: End of Life Care

Cara Lunsford, RN (01:15.473)
Perfect. All right. Well

Let's get this, let's get this going, man. Let's get this going. Okay. So all right. this it doesn't matter how many of these we we've done because we are kind of putting them in different orders. So even if we say, this is the fifth, you know, video that you and I or podcast that you and I have done, it doesn't matter because people might hear it on the sixth time. Who knows?

Joscel James (01:24.046)
Let's get this going. I'm just so excited.

Joscel James (01:50.284)
Yeah.

Cara Lunsford, RN (01:51.143)
But it is the fifth time that you and I have gotten together and this time we are remote. We're not in the same place.

Joscel James (01:55.724)
Yeah. We're remote. Yeah, sadly.

Cara Lunsford, RN (02:00.485)
I know, it is a little sad.

Joscel James (02:02.082)
It is a little sad, but that's okay. I I miss you. But it feels like I'm right next to you.

Cara Lunsford, RN (02:03.749)
I miss you.

Cara Lunsford, RN (02:09.039)
It does feel like that. Why?

Joscel James (02:10.338)
Right. It's like this is the technology amazing.

Cara Lunsford, RN (02:13.637)
Yes, yes. I mean thank gosh. That we like all the way f three thousand miles away, I can be in like North Carolina, you can be in LA, and here we are getting together to talk about dying.

Joscel James (02:25.688)
We're talking about dying. Wow. Okay. Just jumping right into it. Talking about dying.

Cara Lunsford, RN (02:32.133)
Well, we're gonna talk about death and dying. Death and dying. I know. It's

Joscel James (02:34.626)
Death and dying. Okay.

Cara Lunsford, RN (02:40.335)
Okay, I'm just gonna I'm throw it out there really quickly though. So for me personally, I've done end of life nursing for I would say better part of twenty years. So it's it's kinda my thing.

Joscel James (02:41.582)
So

Joscel James (02:53.918)
Mm.

Joscel James (02:58.41)
Okay. so this is why you chose it?

Cara Lunsford, RN (03:01.797)
Well, yeah, kind of, but also because I just had an experience where I did module two of death midwifery. So basically adding this to my practice as a nurse, learning more about how can we be more ceremonial, how can we make meaning out of the dying process and out of death.

for patients and their families. And this is the section second module, which was really more focused on ceremonial bathing of the body and shrouding and and we'll get into that a little bit more. But that was why I it felt so relevant to me and I've had some recent experiences that I think you know I can definitely share here.

Joscel James (03:42.445)
Mm-hmm.

Cara Lunsford, RN (03:57.851)
And and so I was curious though from your perspective, like I wanted to know more and learn more from you about your experience with dying, death and dying, either personally and professionally.

Joscel James (04:13.518)
Yeah. I think it's super I I love the topic. I love that you chose this topic. Personally, well, I'll start off professionally. We see death and dying all the time in the hospital. And w I don't think we talk about it enough. I don't think there is a right way to talk about it, but I do think we do need to talk about it, especially after seeing my first death or my first expiration.

in in the E or in the ICU, like no one could have ever prepared me. Yes. Yeah.

Cara Lunsford, RN (04:44.783)
Isn't it interesting that we call it expired? I just wanna like call it out really quick. Like is that we actually use that word expired.

Joscel James (04:52.642)
Yeah, so we can talk about that. Like we even have a separate name for it, right? Expiration in the hospital. Because do you think it's because I think it's because dying has so much emotional weight to it that we have to use something a little further removed. Like we have to emotionally detach ourselves in order to complete the job, right? It's all about objectivity in in medicine, right? You gotta be objective, you gotta not put any personal emotions into it.

Cara Lunsford, RN (04:54.235)
Yeah, like go ahead.

Joscel James (05:22.102)
So I guess it's not a surprise that we don't even use the word dying, that we have a separate term for it, expiration, when it comes to death. We do say time of death. Yeah. Yeah. Yeah. But yeah, I think even that term, time of death, I think it's so it's so scientific and removed, right? There's not much emotion left to time of death. Versus you you'll say,

Cara Lunsford, RN (05:29.711)
we say time of death, right? Like so it's like, did you call time of death, right? Like did you call what was the time of death? Did you call time of death? but

Joscel James (05:51.906)
This patient died, right? I think that's a little more has more weight to it.

Cara Lunsford, RN (05:56.955)
Yeah, it feels heavy. It feels heavy to say that someone died. it's the reason why we use all kinds of and not to like get off on the tangent, but you you said something so important, which is the words we use. We use passed away. we we have a really hard time. I lost someone. I've lost

Joscel James (05:58.562)
Yeah, heavy. Yeah.

Joscel James (06:13.228)
Yeah. Mm.

Cara Lunsford, RN (06:22.843)
You know, I've lost this member of my family, I this person has passed away. But we have a really difficult time saying, My husband died.

Child died. It there's some interesting finality to that also. but you know, just even exploring what you said about expiration, not to like go down a rabbit hole, but I think that this like brings us back and starts us off actually really nicely about like how we address death even in healthcare.

Joscel James (06:58.284)
Yeah. Well, I think espe well, healthcare, obviously, because we're both in healthcare. But I think death is something we need to constantly remind ourselves that, you know, that's the final destination. Like whether we like it or not, it's gonna happen. And I don't think we think about it enough. And there's a stoic there's a stoic phrase, memento mori. You've heard of that, right? You've never heard of memento mori? So the stoics is like philosophers in ancient Rome, they had this

Cara Lunsford, RN (07:20.379)
I have not actually. No, what is that?

Joscel James (07:28.3)
phrase called memento mori, which is Latin for remember you are mortal or remember death. And the reason for that is to remind yourself that you're gonna die and whatever you're focused on, is it really important? Is it really important the th the your anxieties, your fears, what you're stressed out about, other people's opinions, what you're working on right this second. Is it really that important if you're gonna die? So it really brings our life

Cara Lunsford, RN (07:34.426)
Mm.

Joscel James (07:58.23)
into focus to really think about what matters most. The now exactly the now, which is why I I personally love the topic. And speaking of that phrase, I got it. It's my first tattoo. I don't know if you can see memento mori. I have it tatted.

Cara Lunsford, RN (08:02.663)
The now.

Cara Lunsford, RN (08:13.819)
That's amazing. I didn't even know that like you had that.

Joscel James (08:18.028)
Yeah. and super important to me, just a reminder.

Cara Lunsford, RN (08:20.667)
Yeah, I think.

Yes. I w you're right. We we are all going to do it, right? We're all going to die. And and we use I I you know, I've I d distinctly remember the first time I printed out a pass for a family that that it was like a parking pass so that they could get free parking because their child had expired. And it actually

Joscel James (08:28.13)
Yeah. Yeah.

Joscel James (08:48.598)
Cara Lunsford, RN (08:52.397)
said that and I was like

Joscel James (08:54.146)
Wow. The past said that?

Cara Lunsford, RN (08:56.527)
I it said it in the computer. I don't remember if it said it on the on the pass. I hope it didn't. but I remember thinking, expiration. Patient expired. And I'm like, like milk in the fridge? Like that you know, that's it it's like that's how that's the language, you know, like we don't say milk died and we but yet we say that a patient expired.

Joscel James (09:09.196)
Yeah. Yeah. Yeah.

Joscel James (09:18.008)
Yeah. Like a can.

Cara Lunsford, RN (09:25.243)
Like they're no good anymore. Right? There's so much like meaning to the language we choose. And so so this this is all something that I've really started learning in this in these modules that I've been taking. It started off with the sacred art of conscious dying, and that was module one, and then I moved into module two, which was kind of more about, like I said, the ritual.

Joscel James (09:47.79)
Mm-hmm.

Cara Lunsford, RN (09:54.545)
kind of ceremonial bathing of the body, cleansing of the body, and shrouding. So

Joscel James (09:58.272)
Right. What are you taking these modules for?

Cara Lunsford, RN (10:02.023)
I I'm I'm doing it because I want to add this to my practice as an end of life nurse. I and I'll get into a little bit more about like just my own

trauma that I've had around death, and and why this is so important to me. But I wanna go back because I know we went off on a tangent a little bit 'cause you said expiration and I was like, that we gotta talk about that. But let's go back really quickly and like talk a little bit about you were saying professionally we've all experienced, you know, well not everyone's experienced it actually. That's you know, some people can work their whole career as a nurse.

Joscel James (10:27.16)
Yeah.

Joscel James (10:45.048)
That's true.

Cara Lunsford, RN (10:46.489)
And never have someone die.

But did you have those experiences in

Joscel James (10:56.118)
In nursing? absolutely. my God. Yeah. I mean, especially during COVID. well, my first death was the in the ICU, first code, and obviously we didn't get him get him back, but I remember just being kind of traumatized about it and just looking around and how people just kept going. People just kept going. It's like, on to the next. And I was like, and we were working we were working on this patient till like six AM and then at

Cara Lunsford, RN (10:56.995)
Yeah, when you were in the E R? Yeah, okay.

Joscel James (11:24.948)
change the shift that they coded and then we didn't, you know, we couldn't get them back. But no one could have ever prepared me for that. But I wish people we we talked about it more. And then in the ER, it just becomes so it just becomes so routine. Unfortunately, especially when it comes to code comes in, they didn't make it, on to the next. And it was just like that messes with you.

Cara Lunsford, RN (11:36.743)
Mm.

Joscel James (11:51.894)
And I think this is kind of why I I love the ER. I you know, the ER is my favorite specialty work in because of the high adrenaline, but that much death and dying kind of kinda messes with you because you you bag bodies and then on to the next. And we don't talk about that enough. Because when you face that in front of you, then you start thinking about your own mortality. You start thinking about, you know, how time our time's limited, you know, we have

Cara Lunsford, RN (11:52.164)
Mm-hmm.

Joscel James (12:20.472)
I've seen twenty year olds up to nine year olds pass away right in front of me. And it's kinda like there's really no guarantee that any of this is guaranteed, you know?

So it's

Cara Lunsford, RN (12:35.815)
We're not promised even a second from now. Right. We're we're we're not promised any of this time and and this whole concept of the this person died before their time. You know, I I don't you know, this is kind of an interesting phrase that we say because I don't know when our when when the the magic time is. but

Joscel James (12:40.31)
Yeah. Yeah. Yeah.

Cara Lunsford, RN (13:05.957)
We say, they died too young, or they you know, they didn't realize their full potential. Or they, you know, there's all these things that that we say I think mainly because we have our own fear. I think it it comes from our own fear of dying before we have been able to do the things that we wanna do in our life, or see the things that we wanna see, or watch our children grow up.

Joscel James (13:28.682)
Yeah, for sure.

Cara Lunsford, RN (13:35.879)
and and so we're grieving that. So I think when we see someone who is maybe our age or younger or even someone who's younger than our parents and we say, Wow, guy they died and it it's such a tragedy before before their time.

Joscel James (13:41.25)
Mm-hmm.

Joscel James (13:55.138)
Yeah. Yeah. And I don't think we're allowed the space to really think about it and talk about it in a way that is beneficial for us to move on. I know they they offer that, but I don't think we do it enough in healthcare, especially in fast pace fast paced environments, ERICU.

Where it where it it it does happen often. Like exactly what you were just saying that right now, like when we see someone our age or younger, we get this slew of emotions and thoughts and we almost personalize because how can we not personalize it, right? It's kinda like, that could have been my family member, that could have been me, that could have been my mom. And if we don't process it, we just what do we do? Just put it under the rug and just like kind of ignore it.

and I don't think I don't think we should just ignore it.

Cara Lunsford, RN (14:50.031)
No, no, I I don't think that there's any benefit to that. when for you working in this kind of fast pace, because I I mean I can say for me, working in oncology and working in pediatric oncology, even though it's not fast paced and sometimes we know that a child is going to die from their disease and

Joscel James (15:15.48)
Mm-hmm.

Cara Lunsford, RN (15:19.015)
We are anticipating it and sometimes we're anticipating it for a week or two weeks. It could you know, it could be a while and there's lots of preparing or planning.

Once it happens it's still very like you could still say say to the parents like well you you know you have four hours. We can give you four hours with your child, with your child's body. And then after that and and you know that can vary a little bit, but for the most part it's not a lot of time.

Joscel James (15:51.052)
Yeah. Wow.

Cara Lunsford, RN (16:02.531)
And sometimes people have been trying to make it to the hospital to see their loved one. Sometimes they their family has been holding vigil at the bedside for you know a very long period of time. But for the nurse who's caring for that family and caring for that patient, once that that completion has happened.

Then it's it feels very sterile and and then we are, you know, yes, we can do bathing, and I have done bathing with families. not the same type of bathing I just learned, which was much more ceremonial in nature, but but intentional, kind of intentional, like how do we make meaning out of this, out of this moment together?

Joscel James (16:43.821)
Mm-hmm.

Cara Lunsford, RN (17:01.627)
But then then we shroud, which is n for me was never a a process that I wanted to do. I really hated shrouding.

Joscel James (17:16.846)
Can you tell me a little bit more what you mean by shrouding?

Cara Lunsford, RN (17:18.885)
Yeah, yeah. So you know, earlier when you said like, well, you throw in a body bag, right? Like, you know, take downstairs to more. toe tag them, you know, put a tag on very similarly, you know, we would ha we would have to wrap the body in plastic. and

Joscel James (17:28.642)
Yeah, man.

Joscel James (17:39.414)
Mm.

Cara Lunsford, RN (17:42.949)
That was something I never did with parents because personally I felt like it was hard. I couldn't even imagine doing this with a family and with parents. Yeah. Yeah. Yeah, this was on us to do this. And so we would shroud these patients, children. And

Joscel James (17:53.58)
You have to do this. Wow.

Cara Lunsford, RN (18:07.739)
We would have to tie and we'd have ties and we'd have to tie around the ankles and we'd have to tie around the legs and and we'd have to tie around the neck and that always really bothered me. and then the thing that always bothered me the most was covering their face with plastic. I it I can't begin to tell you how much it would get to me. And then, you know, we would have the body transported down and

You know, and and at that point it's kind of like, okay, did you finish your paperwork? Your patient expired. Okay, so now you gotta like finish your paperwork, patient expired. you have to tell one legacy who, you know, one legacy is like organ donation, like this patient is not does not qualify does not qualify, right, because of cancer.

Joscel James (18:57.587)
I know. I know I know one legacy, yeah.

Yeah.

Cara Lunsford, RN (19:02.773)
so they're not they don't qualify, so we would have to like, you know, do that. And and then once that bed was free, it's like, okay, well, admission, you can get an admission.

Joscel James (19:17.474)
Yeah.

Cara Lunsford, RN (19:20.257)
And yeah.

Joscel James (19:22.018)
That the speed of that of that emotional swing is yeah, I can't even begin to say and like shrouding shrouding kids, that's that's so heavy. I can't even imagine, like you said, what you what that would feel like.

Cara Lunsford, RN (19:39.321)
It it felt to me like in my heart it felt wrong. Even though I knew like this is what we have to do and why we do it and this is the process and you're not really ever taught that there's any other way or that there's anything else to offer.

Joscel James (19:45.966)
Mm-hmm.

Joscel James (19:58.083)
Yeah.

Cara Lunsford, RN (20:01.943)
And which is kind of what I've been learning more recently is that we can do things differently. There are other options. and that as long as you advocate and you know what the rights are, that you can ask for those things. I I just, you know, didn't know.

Joscel James (20:19.918)
Can you can you tell me what it sounds like you've been learning a lot about it? So can you tell me what those other options are?

Cara Lunsford, RN (20:27.995)
Yeah, yeah, sure. so one of the things that I learned recently, back in January I took care of a a woman who was dying from dementia, and had dementia and was in the process of dying, had stopped eating, etc. And the family had a certain religious faith.

And that religious faith was not going to allow them to practice the things that they felt they needed to practice because their mother was in a s you know, skilled nursing facility and there was like s five other people in that room, right? And there would be a a limit to how long

their mother's body could be in that space. And that was very counter to what this family needed from a religious and spiritual perspective. I ended up actually bringing that woman to my house and she's a friend of a friend's mother, brought her to our house and we did hospice at home.

so got hospice on board, brought the the bed and the oxygen concentrators and the meds and everything like that. And she was with us for three days and then she she died. and then her family was able to

Forward in this practice, this this practice of their faith that also included ceremonial bathing and shrouding. And, you know, there was prayer, there was music, but there was also like it was kind of a prolonged period of time, not anything that was outside of what you you can do from a hospice perspective, but I was able to see how they were.

Cara Lunsford, RN (22:49.703)
taking care of her body and how the women kind of came together to bathe and and and then the the shroud that they used was this beautiful like she had this you know beautiful cream colored dress and then they like wrapped her in like almost like a muslin and and then you know you can have

You know, she was able to have some of her things with her and and I saw her in a very different way. I I was surprised because I had never seen anyone any I had never seen anyone's body cared for in that way. Almost to the point where I was like, Wow, look how beautiful she looks. Look at how peaceful she looks. Look at the fact that this family is able to

Grieve and mourn in a way that is different than I've ever seen in a hospital setting. And it kind of made me question, like, well, could we be doing this? Like, could we do this in the hospital? And the more questions I asked, and the more I learned, I was like, well, actually, yes, we can. We can bathe this way, we can shroud this way, we can actually say.

No, we'd rather not have plastic. We can actually advocate for some of these things. And and, you know, especially if you say like from a religious perspective, spiritual perspective, this is something that's important to us, you can definitely advocate for those things. You can also keep as long as the body is not being transported in a public place, like from like an apartment.

For example, like if you take the body out of an apartment and the mortuary comes, the face has to be covered. Now you can cover with the muslin, or you can have a little flap of muslin that comes over the face. Does not have to be plastic. and even when it comes to tying, the tying can be, first of all, not around the neck. It can be like around the shoulders. It can be, you know, kind of holding in, holding the

Joscel James (24:48.738)
Yeah. Yeah.

Joscel James (24:58.413)
Yeah.

Cara Lunsford, RN (25:13.573)
the elbows in so that if you're have your hands crossed you know across your chest, you know, you can have the tie around like the elbows to keep that in place. around just above the knees and then kind of right like around where like the the calves are and then right above the ankles. And so this is kind of like where you can

how how you can tie and you can tie with like ribbon, you can tie like there's it doesn't have to be, you know, like you're zip tying or something, not that you're using zip ties in this setting, but like but you know, there it doesn't have to be plastic or, you know, whatever, twine or something like that. It can be something really beautiful. And then the practice of tying is really

can be also very intentional and meaningful for the families. Like you can have one person on one side of the body, another person on the other side of the body, and they are like coming together and tying kind of together, which is also like can be really beautiful. That is something I would have wanted my families that I cared for to be involved in. I never wanted them to be involved in just the plastic, you know, collection

wearing of a of of of a body.

Joscel James (26:36.738)
That sounds a lot more ev everything you just described, like you said, sounds more intentional and more meaningful when it comes to death, instead of just, okay, bag and tag, send them off, right? It's just there's it's not as abrupt and they're more involved.

Cara Lunsford, RN (26:48.721)
Yeah.

Cara Lunsford, RN (26:56.155)
Yeah. And and no, I mean not every not every death can be kind of prolonged in a way, like where meaning like not the death, but the the after they're dead, after the person has died, that how you keep a body and how long you can keep a body

Joscel James (26:57.688)
So I'm

Cara Lunsford, RN (27:20.217)
is also very interesting because sometimes it's based on state by state, but really like three days you can. And in a lot of countries people have home funerals. Like though their loved ones die and then there is pretty much a viewing and that's where that word parlor comes from. You know, funeral parlor. People had parlors in their home.

Joscel James (27:32.366)
Mm.

Cara Lunsford, RN (27:45.381)
And parlors were that room. It's a little bit like that room that you look at when you go into someone's house and you you're like, does anyone ever go in this room? Because it's got the piano, it's got the nice chairs, it looks like no one ever sits here. Yeah, that's but that's the parlor. In old in old houses, that was that was the parlor. And people would actually have viewings of their loved ones and their bodies out for people to come and visit.

Joscel James (27:57.186)
Right. A little creepy.

Cara Lunsford, RN (28:15.181)
and and pay their respects before they were ever taken for burial.

So it it's really and and also for for me in the in in a more recent case that I was working, they were they put all kinds of flowers all over the shroud and they put flowers all around her head, like a crown of roses and and all kinds of different flowers, baby's breath and

Joscel James (28:46.2)
Yeah. Yeah.

Cara Lunsford, RN (28:53.561)
I have to say it was absolutely beautiful and the patient's mother was like, I'm so grateful. I mean, when do you ever hear the words I'm so grateful that I get to participate in this?

Joscel James (29:08.046)
Mm-hmm.

Joscel James (29:11.948)
Yeah. You don't hear that often.

Cara Lunsford, RN (29:15.001)
No, no. I mean gratitude is definitely yeah, gratitude is not something people oftentimes are saying when when it comes to death and dying. so the fact that I was able to see that integrated into my practice, I brought in a death doula, a death midwife to that that case in particular and learned so much from her.

Joscel James (29:16.59)
Especially in the hospital. Yeah.

When it comes to death and dying.

Cara Lunsford, RN (29:43.673)
And then was like I I have to learn more about this.

Joscel James (29:47.34)
Yeah. That's good. That's good. You saw something and then now you're taking lessons and modules to better incorporate it into what you currently do. And you said you're a hospice nurse currently still.

Cara Lunsford, RN (30:02.651)
So yeah, I mean I still I I don't work f specifically for a hospice anymore, but I was a director of nursing for a hospice for a little while and I've worked in hospice for a while. and then for many years before that I in the hospital I worked with patients, many of whom did die, because I did pediatric oncology. So I've been in this space for a long time. Now I tend to do a little bit more private work.

Joscel James (30:31.912)
okay.

Cara Lunsford, RN (30:32.495)
where I'm kind of called in by a physician or a family member who has received my name from someone. So I but I still do it, but I tend to help families to navigate end of life, whether it's setting up hospice, you know, kind of getting certain things in order, even in terms of like what are your, you know, what are your wishes? And that was actually something I was gonna ask you.

Joscel James (31:01.602)
Mm-hmm.

Cara Lunsford, RN (31:01.861)
Because if we're talking about death and dying, let's talk about it for ourselves.

Joscel James (31:08.334)
Okay. Ourselves. Wow. Okay.

Cara Lunsford, RN (31:09.667)
So yeah, let's talk about for ourselves. Right? Yeah, it's hard. I know. I'm gonna just like throw it at you. when you think about how you what you want your death, if you could write down the way that you hope that you could experience your you know, your own death and dying.

Joscel James (31:14.826)
Yeah, okay.

Cara Lunsford, RN (31:36.015)
And how maybe you would want your family to experience your death?

Joscel James (31:40.99)
Wow. That is loaded. That is a loaded question. death and dying. I think I mean I've definitely given it some thought, but for me personally, I would like to obviously not obviously, but I would like to pass away peacefully in a bed. And I I'd I'd like to be at home. I'd for sure want to be in my bed, my bed at home.

Cara Lunsford, RN (31:42.855)
Yeah, sorry to put you on the spot there, Joseph. Come on, J J.

Cara Lunsford, RN (32:02.887)
Okay. So you'd like to be at home or you wanna be in your bed or any bed?

Joscel James (32:11.758)
And I think I would want my

I would want to be cognitively there, if I you know, if we're having preferences, right? I want to be cognitively there. And I w I'd want my loved ones to have a certain level of acceptance, but I would also would like to meet it with open arms. And you know, kind of approach it in a way where this is this is happening. I'm in this moment now. And I I wouldn't want

Cara Lunsford, RN (32:36.305)
Mm.

Joscel James (32:48.876)
I don't think I would want any sadness around me. And I wouldn't want people to go out of their way to just

Cara Lunsford, RN (32:51.751)
Mm.

Joscel James (33:00.066)
Be with me. Like

А вон вон терв'ясь то сто.

Come visit me, you know? Like I of course I'd like I'd like visitors, but

Cara Lunsford, RN (33:14.299)
Like you would be okay if somebody was like, I can't get there, but I'd love to face time with you.

Joscel James (33:18.518)
Yeah, yeah. And I d I totally yeah, I want to

Cara Lunsford, RN (33:20.709)
And you would be okay with that. You wouldn't feel like they didn't make the effort.

Joscel James (33:25.676)
No, because I would want that level of peace with myself that

This is gonna happen and this is where I'm at. But no, of course, I would not hold that against anyone. they didn't make the effort. I I wouldn't not hold that upon anyone. I would want people to still live their lives as fully as they can because it's you know at the end of my life. And I I think I'd wanna be surrounded by by more joy than sorrow and a lot of a lot of looking back on the things I've done and accomplished and the experiences I've experienced.

And the people I've I've met, I think I would want it to be joyful. Storytelling. Yeah, and I'd love to.

Cara Lunsford, RN (34:04.655)
And storytelling. It sounds like you would love storytelling.

Joscel James (34:11.266)
Give back in in in a way, you know, whatever time I have left and just impart wisdom if I have any wisdom to share. But that's a it's a good question. That was I didn't expect that.

Cara Lunsford, RN (34:21.905)
That's right. I know. I like to just kind of wing it sometimes. But it well, I'm not done asking you questions yet. Hold on. You're not off the you're you're not off the hot seat yet, JJ. Sorry. You you don't get to pass the buck yet.

Joscel James (34:26.004)
Yeah. W what about you?

Joscel James (34:40.839)
okay. All right. No passing the buck. That was on my N CLEX. No passing the buck.

Cara Lunsford, RN (34:45.575)
No pass the buck. so all right, so so joy, laughter. if someone is sad, you feel like, okay, I understand that you're sad, I understand that you you know, you're grieving. Would you rather people like grieve away from you? Like go into the living room.

Joscel James (34:55.853)
Yes.

Cara Lunsford, RN (35:13.987)
And, you know, if they feel like they need to have that kind of emotion or do you feel like, okay, I no, I think maybe I I think maybe I could hold space for that. What what are your thoughts?

Joscel James (35:28.45)
I think I would be able to hold space for it. I would love to hold space for it and kind of of course I wouldn't tell anyone to not feel their feelings 'cause people will feel how they feel. I definitely would not want any sympathy, right? Especially if

Cara Lunsford, RN (35:41.391)
Mm.

Joscel James (35:45.784)
You know, if I get disabled and I can't, you know, can't use my arms or my legs. I wouldn't, I would try to accept it and just be like, this is this is what it is, you know, especially if I'm I'm disabled in some sort of way. And just not have I wouldn't want any shame. I think there's it. I would not want any shame about my condition, whatever that condition would look like. I would not want, no. And I would not want anyone to feel sorry for me. Right.

Cara Lunsford, RN (36:06.299)
You wouldn't want to feel a shame, like it shame. Yeah.

Cara Lunsford, RN (36:13.177)
Okay. Yeah.

Joscel James (36:15.106)
I've been reading a book called

Tuesdays Tuesdays Yes, Tuesdays with Maury.

Cara Lunsford, RN (36:19.878)
With Maureen?

My grandmother loved that book.

Joscel James (36:24.118)
Yeah, it's a great book and it sometimes it's uncomfortable because it really puts you face to face face to face with death and dying. And the way I don't know if it's a re true story, the way he handles how he's dying, I think, is the way I would love to handle how I would die.

Cara Lunsford, RN (36:42.823)
Hmm. There's a there's a book called The Tibetan Book of Death. And there's also the Tibetan Book of Death and Dying. Or Living and Dying, sorry. Tibetan Book of Living and Dying. And then the Tibetan Book of I don't know if it's the of the dead or of death. I'd have to look. I can't remember. but that that's also, I guess, like if we're kind of recommending some reading to the listeners.

Joscel James (37:02.478)
Mm-hmm.

Joscel James (37:09.528)
Yeah. Yeah. Well, I think the the the b the best book I've ever written or written. I haven't written any books. The best book I've ever read s since we're on the topic of books, and I'd love to go into this a little bit later too. Well, we've talked a lot about death and the the finality of death and expiration and di death itself. But I feel like I also want to talk about the dying part of it and the best part of the best book I've read on.

Dying is being mortal by Atul Gawandi. He's a surgeon. Have you read that book? I think you would love it. it's called Being Mortal, but it talks about the dying process and how we just don't handle the aging population well at all in nursing homes, especially people who are alone, who don't have any family, and just how they're treated, just the dying part, not necessarily the deaf part, but the dying part. And some people are dying for a long time.

We don't talk about that enough and I think yeah, that's a whole other talk. But I'd love to get into that a little bit later. But being mortal is a book recommendation.

Cara Lunsford, RN (38:17.713)
Yeah. I we we do everything we can to avoid death. Right. And and then once it kind of gets to be too too much or or you know, we're like, okay, now this person's suffering. Okay, well now we gotta like it it's we don't we just don't do this well. I don't really have any other way to say it. We just don't do it well. And

Joscel James (38:39.062)
Yeah. We don't. We really don't.

Cara Lunsford, RN (38:45.219)
If there's anything, and I'm just so new, I'm not new to death and dying, but I am new to looking at it through a different lens and seeing it done differently and being curious and asking questions and saying, okay, well, what does it look like if we don't

You know, if if we choose not to do artificial feeds, if we choose not to do NG tube feeds because this person is no longer willing to feed themselves or swallow food because they have end stage dementia. And their body is actually telling us that it's done.

And they're telling us that they're done, you know, in a way by saying, I don't w, you know, they shake their head, they don't want food, or they close their mouth and they don't allow the spoon to go in. or it but then in healthcare we offer, right? We offer to the patients, families, and we say, Well, we could do an NG tube.

Joscel James (40:05.004)
Yeah. Yeah.

Cara Lunsford, RN (40:12.037)
And we could put feeds in.

Joscel James (40:13.902)
і

Cara Lunsford, RN (40:16.067)
And we're just so we're just so uncomfortable with the idea that

Maybe it's time. Maybe it's okay to not do anything to prolong this like what are we bringing this person back to? What are we keeping them here for?

Joscel James (40:31.342)
Yeah. I

Joscel James (40:41.582)
Quality of life.

Cara Lunsford, RN (40:43.355)
Right?

Joscel James (40:44.31)
Yeah. I think there this goes into the ethical part of death and dying, ethical part of healthcare. Like what are we doing here? And this also makes me feel

Joscel James (40:58.38)
What when when I don't know me and my friends say this, when we don't know what the feeling is, we say we feel some type of way. But it Yeah, it's like I feel some type of way, like exactly that scenario you laid out where a patient refuses to eat, they're like, I don't want to do this anymore. And then we then then we start think talking about NG tubes and invasive procedures and the family will say yes because that's what they want. And we see it on the opposite end as the ones doing the cares.

Cara Lunsford, RN (41:05.041)
Mm-hmm.

Joscel James (41:25.9)
And the patient suffering and patient not wanting it anymore, it just puts you in this ethically gray area of.

What am I doing? This this is my job? Like some t there's some some experiences in healthcare which just like there's no amount of money that justifies what I'm doing here with the emotional and ethical gray areas. I'm like, this is it's just I I some some type of way. I have no words. Yeah.

Cara Lunsford, RN (41:53.937)
Yeah. Some type of way. And and and I think to ha you know, I th I I do have compassion for the fact that not all healthcare

Professionals feel comfortable having these conversations. And so what feels like an a low lift or an easy lift for them in the moment to just get through it and to not have to have the conversation to say, Well, she's not eating. We could do an NG tube. And immediately now the family has something to grab onto. You feel like you've done something.

Joscel James (42:30.638)
Mm-hmm.

Yeah.

Cara Lunsford, RN (42:35.303)
Provided a potential solution, but you have avoided a conversation, a necessary conversation, that allows the family to start to wrap their brains around what is happening. Because at some point in time, the next thing that personally I would say in that situation is: I would say, yes, we can put in an NG tube. However, at some point in time,

We're going to have to decide do you want to remove it? Is it time to remove the NG tube? Now you're putting the family in a position to remove nutrition, to take away. Right? And that's also where we get into issues of extubating. Now it's on the family. They have to quote unquote pull the plug as they put.

Joscel James (43:09.782)
Mm.

Joscel James (43:16.638)
Mm. I never thought of it that way. Yeah.

Joscel James (43:28.362)
no.

Cara Lunsford, RN (43:31.451)
Right, but we say extubating, or we have to opt to say, okay, well, you know, we're gonna turn off the ventilator or we're gonna extubate. That's a burden that we are placing onto the family that they are left with, they are imprinted with, right? And there's a burden there. How are we how are we not

Joscel James (43:46.55)
Yeah. Yeah. Yeah.

Cara Lunsford, RN (43:58.555)
thinking sometimes of what the burden is we're placing.

Joscel James (44:02.328)
Yeah. Well, I think that also speaks to the fact that we were talking about earlier, culturally, societally, we just don't talk about death and dying enough. So even if you say things like, What are you bringing this patient back to? What is their quality of life gonna be like? People people don't hear that. And especially we talked about this in our

With emotional intelligence, people are so heightened emotionally that they don't even they don't even think about that. At that point they're only thinking of literally life and death. And it it's kinda like, well, it's not really my place to have that conversation, I guess. I don't know. It's it's so like ethically gray. I d I don't know. That's hard.

Cara Lunsford, RN (44:49.851)
Yeah, and and as nurses, I I've had those conversations with patients and families. I've but I've also made the choice to be uncomfortable. Cause sometimes it's uncomfortable. You have to be willing to sit in your discomfort. And we're not great at that. We're not great at sitting with discomfort.

Joscel James (45:05.974)
It's super uncomfortable.

Joscel James (45:11.854)
No.

Cara Lunsford, RN (45:15.971)
So for me, I the first step towards having these difficult conversations is getting comfortable being uncomfortable. And sitting across from someone and being okay with silence. Are you okay with silence? Because maybe the person doesn't know just yet. I mean, what about when I just asked you, JJ, like what what you wanted, right?

It took you a second. You had to like there was you were trying not to be quiet 'cause we're on a podcast and you're trying to fill air, right? Like but you don't want, you know, dead air. Right. But I could tell that, you know, if we were in any other type of place or scenario, probably would have sat with that a little bit longer than you did.

Right? I mean like you it you it it catches you.

Joscel James (46:07.276)
Yeah.

Joscel James (46:14.592)
It's it's just it's a heavy topic. And when I mean that was talking about myself, but when patients or the patients' families, I feel like it's a skill to talk about death and dying as a bedside nurse. And it's not a skill like, you know, that you go to Skills Day for and say this is how you talk about death and dying with the family. Like you have to to to sit there.

and talk to their family member about what's going on when it comes to death and dying, it's there's no right thing to say. There's no right thing to say and

It is uncomfortable. And I I I wouldn't even know how to approach it.

Cara Lunsford, RN (46:56.519)
So maybe we start with people. Yeah. So maybe we start with people we know, right? Like maybe we have our friends come over and we say, I'm gonna ask you some questions about what are your wishes? What do you want? What do you what do you I I started having these conversations now because I've been to these modules and I now have a certain

Joscel James (47:13.274)
yeah. Yeah.

Cara Lunsford, RN (47:24.931)
I I learned stuff about cremation and aquamation. You know, you can like actually have in sort of instead of a cremation, you can have what's called an aquamation, where it's like it's basically they dissolve your body with water and lie and its alkaline state and then the bones are left and that's kind of what's ground up and given back to the family. That's their remains. But there's green burials where you can actually be buried.

Joscel James (47:34.754)
I didn't know that.

Joscel James (47:46.346)
Mm. I didn't know that.

Cara Lunsford, RN (47:54.639)
on like conservation land, land that's been actually designated for this, and you can have a green burial where it's just your body kind of back into the earth, three to six feet down depending on the state you live in. And and there you're going right right back into the earth, you know, no casket, no nothing, like just maybe your shroud. You're just in a shroud and lowered onto

bed of flowers, you know, at the bottom of this this burial site. And then there's and then I learned and I had no idea this was happening in the South, in Louisiana, look up extreme embalming.

Joscel James (48:39.466)
Extreme embalming.

Cara Lunsford, RN (48:41.581)
I had no idea this was happening. Where they do this what's called extreme embalming and they literally did you ever see that movie Weekend at Bernie's? Where they like prop him up and he like carrying him around and putting him in the car. Literally, we have people in in our country who will put their friend at the poker table and they'll just have a poker game with their buddy Sal.

Joscel James (48:51.777)
yeah, yeah, yeah. When I was a kid. Yeah.

Joscel James (49:09.272)
So it's like weekend at Bernie's?

Cara Lunsford, RN (49:10.925)
It is. And that is happening today. I had no idea. I I I had I was some kind of feeling, right? I I felt some kind of way. I felt some kind of way. But totally non-judgmental. I was like, that's a thing. I did not know.

Joscel James (49:15.758)
I don't know how I feel about

Joscel James (49:21.06)
Some some type of way, yeah.

Joscel James (49:31.222)
Well, I feel I feel like there would there could be I can definitely see a healthy way of doing that, but I can also see it going the other way, right? An unhealthy way, of doing that. I I can see both. Hopefully it's the healthy way.

Cara Lunsford, RN (49:40.559)
In other countries, in Indonesia, there's a there is an island in Indonesia where it's a very like indigenous tribal, you know, community in Indonesia and they keep the body, they they use salts and things like that to try and preserve and dry out, but they keep the body with them sometimes for weeks. and

They spend that time grieving, crying, doing whatever it is. And sometimes they just have them kind of propped up there. then they bury the body, but then I can't remember how many years later, they exhum the body and they bring the body back out. And they were putting a hat on this guy, they were putting glasses on this guy. He still had hair, like like a mustache, he still had a little bit of chin hair, like legit

put him in clothes, like a suit, propped him up, people were taking pictures with him. This is a thing. I know. Yeah. It's wild, right? So yeah. Yeah. So you know, there's definitely different ways to do it all over the world. But then there are different ways that we can do it even here. And understanding even the environmental impact.

Joscel James (50:43.544)
Wow. I think I've heard of that one. That one's pretty wild. I mean, I think it's the cultural differences around death and dying, right?

Joscel James (50:56.462)
Mm-hmm.

Joscel James (51:02.147)
Mm-hmm.

Cara Lunsford, RN (51:05.347)
of different choices that we make. You know, there's now you can actually create like fertilizer compost. You can compost your body in certain states. There's certain states where they've created these giant composting like they're like giant composting machines. And they put you in there with like hey alfalfa, like some you know materials.

Joscel James (51:20.236)
I didn't know that.

Cara Lunsford, RN (51:34.521)
And in three to four months, your soil.

That can be that you know. I kind of liked it, but then I'm always thinking about I so what I'm always thinking about is the scalability of something. Like if like if we all decided that we wanted to be composted, how many of these places would we have to have? And it takes three to four months to compost your body and you know, how is that a scalable thing? Could we

Joscel James (51:43.278)
I I think I would be okay with that.

I would be okay with that.

Cara Lunsford, RN (52:08.151)
ha is there enough room on the planet? Is there enough energy to keep Well it actually yes because not scalability from like a commercialized like capitalist approach, right? Like how much money can we make? You know, but like yeah, I know, I know. But like scalability from like could we do this? If every person in the United States wanted to be composted, could we do it?

Joscel James (52:13.74)
That's interesting. That's the first thing you think of when it the scalability.

Joscel James (52:24.14)
Right. No right. I didn't think that.

Cara Lunsford, RN (52:37.711)
Right? Like and it'd be hard. Right. It'd be hard because there's only so much room and space to put these places. And I mean, maybe you can build upwards, you know. I guess you can you can build up. and I think the practicality of it being Yeah. And then it's like what are you really trying to do? You're trying to go back into the earth, right? You want things to be

Joscel James (52:38.392)
I don't yeah, I think the feasibility of it, yeah. It'd be hard.

Joscel James (52:50.232)
Yeah. Yeah. I think you're it sounds like you're thinking of the practicality of it being mainstream in a way.

Cara Lunsford, RN (53:08.271)
You want maybe stuff to grow from your remains. Well then I guess aren't we just doing a green burial? 'Cause then isn't it just a green burial?

Joscel James (53:17.131)
Ooh, that's a good that's a good point. Yeah, I guess green burial would be okay with me.

Cara Lunsford, RN (53:19.449)
Right. People like Yeah, but people like remains, right? So like this is where it comes into like you can't if you do a green barrel, you can't share your remains with multiple people, right? Like you know, if you have compost, you know, Aunt Mary can have s you know, can have some of your compost and your sister can have some of your compost and your, you know

Joscel James (53:32.75)
Joscel James (53:41.218)
I didn't think about it that way. I would rather be I would rather do green burial. But I like the idea of being compost to give back to nature. Cause the first thing I think of go ahead. Yeah, yeah.

Cara Lunsford, RN (53:44.719)
Yeah, I I I lean.

Cara Lunsford, RN (53:49.285)
Yeah. Yeah. And it's really better for the environment than than cremation. Cremation creates a lot of smoke and stuff like that, but

Joscel James (54:00.566)
The the first thing I think of is 'cause I think about this all the time when I look up in the night sky, is we come from the stars, right? The we are literally made of the same elements that are made from the stars. And it's like what better way to end your life by becoming part of the earth again in that compost or green barrel way?

Cara Lunsford, RN (54:22.841)
I agree. I love the I personally, I love the idea of that. There's not there's a lot of legality around, you know, where you can do it and how you can do it. And sometimes it's not feasible for every person, right? 'Cause if it's not if there's not a conservation area near you, you have to arrange to have your body transported.

Joscel James (54:37.526)
Right.

Cara Lunsford, RN (54:45.413)
you know, across maybe a state line or you have to like so you have to arrange for transportation. There's money involved in that. But the interesting thing about the green burial that I thought was really very cool is that if your family is willing to d dig the grave, it's pretty much free. Yeah. I mean then a I mean, aside from maybe having to transport the body from one place to another because you're not close to one of these conservation places. But

Joscel James (55:03.176)
yeah.

Cara Lunsford, RN (55:15.249)
But it's also a way to keep more land as conservation land because once bodies are buried there, then it's you there's all these laws around like bear you know, building on top of burial sites. So, so that's that's also a way to kind of give back and a you know, to create more confor conservation land. so it's it's just interesting. It's just like an interesting thing to talk about. And so I think like

Joscel James (55:19.982)
Yeah.

Cara Lunsford, RN (55:44.859)
When we talk about getting comfortable, being uncomfortable, I think it starts with like ourselves, right? Like start asking yourself those questions. What would you want? Yeah, what would you want? How do you want it? Maybe get super detailed about it.

Joscel James (55:53.452)
Yes, one hundred percent.

Joscel James (55:59.916)
Yeah, as detailed as you can.

Cara Lunsford, RN (56:01.635)
As detailed as you can, get curious, ask questions, do research.

Joscel James (56:06.05)
Yeah. And then the next step after that, after you know how you would want, well, how you would feel about your own death and dying. But the second part would be definitely talk to your loved ones about it, right? As soon as I read that book that I mentioned to you, Being Mortal, Atul Gwandi, I talked to my mom. Like, it's I'm an only child, she's a single mom, so it's just me and her. I'm like, if I am no longer there to make my own decisions, what this is what I want done. I need to know exactly what you want done when you cannot make your

decisions, whether it's th through cognitive disease or you're in an accident, you're intubated. I need to know what you want done because if we don't talk about it, I can't be guessing. And you know, I would rather have these uncomfortable conversations now because I've seen too much in the hospital where it's just like they never talk about death and dying. And

Cara Lunsford, RN (56:54.747)
Yeah, and then the families don't know. You ask them what would what what would this person have wanted? and they say, I don't know, we never talked about.

Joscel James (57:00.67)
Y yeah, and then you can see the weight of the world and I understand it is the weight of the world on their shoulders making that decision where had you just spoken to your loved one, uncomfortable fifteen, twenty, thirty minutes, I think, would literally make all the difference.

Cara Lunsford, RN (57:19.559)
Yeah, and writing it down, like just saying, you know, let's all take a second to write down there's a there's a there's a game that the the women who were the midwives, the death midwives, death doulos who were running these modules, named Birgitta and Chessere are the names of their names. but they were they told me about a game called Go Wish.

Joscel James (57:50.094)
Go ish. Yeah. huh.

Cara Lunsford, RN (57:50.213)
So like go fish. It's like go wish. So it's like, what are your wishes? And so you kind of like have to like take cards and then you put them out in terms of like, yes, this is I would want to be at home. I do want my family to touch me. I want to be touched. You know, I and then like you kind of keep taking ones away. You're only allowed, I think, to have three.

Joscel James (58:08.607)
Cara Lunsford, RN (58:16.943)
in front of you and it helps you distill down what your real wishes are. Like what is the most important thing to you? and so it it it really helps you distill down to the most important things. and mm-hmm.

Joscel James (58:23.948)
Mm-hmm.

Joscel James (58:30.988)
Yeah. And that's what death and dying does. It boils down what is the most important thing.

Cara Lunsford, RN (58:38.257)
Yep. Yeah. So it's a great yeah, it's a great game. Go wish. Go wish. I'm sure you can find it on Amazon or somewhere. but I definitely recommend it. And and yeah, just start talking about it. There's places like endwell dot org. they're great. That's a great resource if you're looking for more information about how to talk about dying.

Joscel James (58:41.555)
wish.

Joscel James (58:45.133)
Amazon.

Cara Lunsford, RN (59:05.926)
And what to expect. It's kind of like what to expect when you're expecting. It's like that book. Yeah, but the other what to expect when you're dying or when your loved one is dying.

Joscel James (59:12.93)
But the other way. What do you expect?

Yeah. But the difference is we're all gonna die, right? Like we're I'm not gonna be pregnant ever, right? But like it's like our common theme, it's a common thread.

Cara Lunsford, RN (59:24.773)
Yeah. Yep.

Cara Lunsford, RN (59:30.203)
Yeah. And and look, do we all know that we're gonna have an opportunity to be laying in our bed and connecting with our loved ones before we die and be able to have meaningful conversations and for them to be able to have, you know, to be able to make meaning after my death in a in a way that's maybe very ceremonial or ritual. Sometimes we don't. Sometimes people die suddenly, very suddenly.

in an accident or something like that. There's still ways to bring ritual and ceremony in, even when you don't have an opportunity to say goodbye the way maybe you thought, or the way you planned, because we it's you know, it's very hard to plan for exactly how we're going to die, but we can have wishes. We can have we can say how ideally if we you know, if we could

Joscel James (01:00:10.808)
Mm-hmm.

Cara Lunsford, RN (01:00:27.675)
be the architect of our death and our dying, what would that look like? and at the very least that's a great place to start.

Joscel James (01:00:37.07)
Yeah. Agreed.

Cara Lunsford, RN (01:00:38.895)
So I di you know, I I didn't really I I I told you I wasn't gonna talk about my my own well, I I when you when you tossed it back at me, I was like, Wait, I'm not done with you yet. But I will say that I I like you would like to be at home. I would like the opportunity to be able to connect and tell people what they have meant to me.

Joscel James (01:00:51.534)
Yeah.

Joscel James (01:01:07.502)
Mm.

Cara Lunsford, RN (01:01:08.781)
I would like the opportunity to feel love from people, what I have meant to them. Like I I'm I I want to be a space where people can share the love they have for me and a place where I can share the love I have for for others. I would also like for there to be laughter and storytelling. I'm a very communal person, so I I think the way I

Joscel James (01:01:32.078)
Mm.

Cara Lunsford, RN (01:01:37.637)
Lived is probably the way I would want to die. It's just people coming and going and you know, a revolving door of people staying for as long as they want and leaving when they when they want. I love the idea of the vessel, my body, being cared for by the people that care for me and love me. And because I feel

like that is a gift to them in terms of grieving and having their time to to grieve. So I would want to make myself like my body available to to do that. And I think that that's also self love, right? Is to say, I want my body to be cared for in a loving way. it housed my soul, you know, and it allowed me to live yeah, it allowed me to live this beautiful life.

Joscel James (01:02:30.274)
Yeah.

Cara Lunsford, RN (01:02:35.215)
And to have these beautiful experiences and you know, I brought a child into the world with this body. You know? So Yeah, I brought another life into the world with this body. So that is meaningful to me and and I love the idea of being shrouded and then and then, you know, being placed in some conservation land where, you know, my body goes back into the earth and feeds the earth and

Joscel James (01:02:41.908)
Mm-hmm. Another life.

Cara Lunsford, RN (01:03:03.407)
And hopefully I didn't take anything in terms of like energy. Like I don't want to take from the earth. I you know, I think that that's my big my big thing. At at death, I I don't wanna take from the earth. Energetically, resource wise or others other.

Joscel James (01:03:19.448)
Yeah.

Cara Lunsford, RN (01:03:21.105)
So that's mine.

Joscel James (01:03:22.496)
It's beautiful. I could tell you value your community and your loved ones.

Cara Lunsford, RN (01:03:26.321)
I value my community, yeah, and I val I value nature. and I I think that that's that's what I would want to leave.

behind. so but it's been really great having the opportunity to talk with other people and be in a space with other people where this is a conversation that is welcomed, that there's an invitation to talk about it. and so that's why I felt really like, this this is what I want to talk about. I want to invite JJ to talk about this with me.

Joscel James (01:04:04.568)
Yeah. Yeah, I love this topic. I'm glad that you chose this topic. And I could tell it's meaningful to you and you have a lot to say. And honestly, I think we can talk for another hour about it. To be honest, there's so much there might there might need to be a part two for this because we didn't we didn't even talk about the dying part of it. like the hospice part and nursing homes.

Cara Lunsford, RN (01:04:14.438)
yeah. There could have been like a part two to this for sure. Well we might

I know, I know what

Cara Lunsford, RN (01:04:27.409)
There's so much. There's so much to to to to dig into. But I think that if we start with being uncomfortable and having uncomfortable conversations with ourselves and with others, then I think we get there. I think we'll get there. and then we can have more conversations about the dying process and how you how you lead up to this. Like how do you lead up to conversations about death? So

Joscel James (01:04:37.955)
Be uncomfortable.

Cara Lunsford, RN (01:04:56.915)
I'm I'm just so grateful. I'm so grateful to have had this conversation with you and thank you for sharing your wishes with me, J J.

Joscel James (01:05:05.794)
Yeah. Thank you for the questions and thank you for giving me that space to talk to you about it. I'm grateful for you as well. I'm grateful for this topic. And and thank you for sharing with me your wishes as well.

Cara Lunsford, RN (01:05:19.417)
Absolutely. Well if anyone is interested in learning more, like I said before, there's definitely well throughout this podcast episode we dropped some names of books and things like that. there are you know, there's there's

Joscel James (01:05:32.301)
Mm-hmm.

Joscel James (01:05:36.802)
The websites.

Cara Lunsford, RN (01:05:38.213)
Yes, yes. Nurse Hadley, she's amazing. She she really she's written a book and she she talks about end of life in a re she's been a hospice nurse for many, many years. So kind of a shout out to her. And

And like I said, endwell.org. And you know, we'll also if you have questions, you can always put it down in the comments when we post into social. If you have more questions or you want more resources, we can always provide you with those.

Joscel James (01:06:02.606)
Mm-hmm. Yeah.

Joscel James (01:06:10.146)
Yeah. Reach out and we'll comment back.

Cara Lunsford, RN (01:06:15.579)
I loved it. Thank you so much, JJ. I loved having this conversation with you.

Joscel James (01:06:19.512)
Thank you, Kara. I loved it too. And thank you to our audience for listening. Reach out to us anytime.

Cara Lunsford, RN (01:06:26.587)
Absolutely. Peace out. Peace.

Joscel James (01:06:29.026)
Peace.