Ep 57: Know Death, Live Life with Dr. Delia Chiaramonte

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Dr. Delia Chiaramonte and Institute for Integrative Palliative Medicine Resources:

The Institute for Integrative Palliative Medicine
https://integrativepalliative.com/

The Integrative Palliative Podcast
https://integrativepalliativepodcast.com/

Integrative Palliative Medicine Interest Facebook Group
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Dr. Delia Chiaramonte on LinkedIn
https://www.linkedin.com/in/deliachiaramonte/

Dr. Delia Chiaramonte on Twitter
https://twitter.com/DrChiaramonte

Transcript

Dr. Gray, Host: Hi, everybody. Welcome back to another episode of the dare to dream physician podcast. I am so excited that one we're,we're back online, cuz I, I had took a , a little break, when I was going through, this, time with my dad at the end of his life. And and we talked about that in the last couple of episodes, today, we're gonna, we're gonna do a switch.

So Dr. Delia Chiaramonte, had, so graciously interviewed me, for the previous, episodes. And, I'm just so grateful that I went through this experience and she helped me so much through the experience when you know, my dad was when, when I was dealing with, with my dad facing the end of his life and, And, I love our conversation where I got to share about that.

And this time I am inviting her back. And what I wanna talk about is some of her experiences and some of her expertise. So that for any of her listeners, if at all of us, at some point, if there is anybody that you love in your life, if there's anybody that's really important to you in your life, chances are that at some point in our life that we are going to be

Dr. Gray, Host: experiencing, having a loved one, that's going through a serious illness, that may be facing their own mortality. And there are so many emotions and just so many things that come up, when, when we have an experience like that. And so that's what I'm so excited to talk to her about today. and you've already learned a little bit about her, but I'm gonna have her officially introduce herself.

and I'm just, so excited, that she's here because I, I really admire her and I love the work that she's doing. Welcome.

Dr. Chiaramonte, Guest: Thank you so much. I'm so excited to be here.

Dr. Gray, Host: So tell us a little bit about your background, who you are, what you do and, what you've done in the past and what you currently do.

Dr. Chiaramonte, Guest: Sure. So currently I am, I'm the CEO of the Institute for integrative palliative medicine. And I'm gonna explain what that means. Cuz a lot of people don't know what integrative medicine is or palliative medicine and together, most people don't know what it means, but it, it is my heart. It is the kind of practice that it turns out, really feels special and important to me.

And so I wanna share it with other physicians. I want other physicians to know how to use this work with their own patients, but then also in their own lives. So I'll back up a little bit. I was a family doctor first. And I did family medicine, cuz I couldn't decide I wanted to do all the things I wanted to help older patients and children and, women and do gynecology.

And I just wanted to do all of the things. And so for a while I practiced family medicine first in a rural place. And then in a family medicine residency and I loved teaching, I love teaching positions. So I really like being in the residency program. found that my practice moved from regular family medicine towards integrative medicine first because what I found was a lot of patients didn't get better in the way that I expected them to get better.

So I learned in medical school, right? Like we all did that. You find the disease and you use the drug and the person gets better. And then in real life, there were a lot of patients that I had who had headaches were tired, were, had chest pain, but cardiology said it was nothing and they just felt. lousy, yucky. They just felt bad. And so I started using with them, some of the tools I use for myself, the integrative medicine tools like mindfulness and exercise and looking at their life and were they happy with it? And the thoughts that were in their head were there are a lot of negative thoughts or could they transition to a little bit more positive thoughts?

And it turns out that people got better. And so I felt like,oh my gosh, what is that? Turns out there was a whole field called integrative medicine. So that pushed me towards the integrative approach to care. And then I started doing just by accident, hospice work. And what I found in hospice was that the people were happier in general than the people in my family medicine practice, which was the absolute opposite of what I would've expected.

Right. Right. We're taught, make them better and they'll be happy. These were people that nobody was going to be able to make better.

Dr. Gray, Host: Mm.

Dr. Chiaramonte, Guest: So wines, were they happy and not, not everyone was happy, but there was a sense of gratitude of focusing on what's important of families coming together of letting go of stupid things that don't matter.

someone said something that you didn't like, or you're you have traffic, who cares if your loved one is on hospice? It doesn't matter if there was a little traffic, right? You're gonna focus on being with them and focusing on them and being together. And, and I found that the families, not just the patients, but the families who were dealing with end of life conditions were really focused on deep, important things that mattered. And I really liked that. It just was really appealing to me. And so, I became board certified in palliative medicine. And so for a while, I was the associate director of a center for integrative medicine at university of Maryland, did a lot of teaching of physicians there. And then I had the opportunity to do palliative medicine.

Dr. Chiaramonte, Guest: And what became really clear to me is that they are the same thing and they belong together. So the integrative approach to palliative medicine and palliative medicine is the care of people with serious illness. So it includes end of life care, but it's not exclusively end of life care. And so basically that meant caring for the whole person and family, going through a serious illness, using all the regular tools, medicines, et cetera, but then adding other tools, if they're appropriate evidence supported tools like acupuncture, massage, meditation, advanced counseling skills, positive psychology, etcetera, cetera, et cetera.

So just the focus is whole person care of families facing serious illness. Using all of the tools that work are conventional tools and then complimentary tools.

Dr. Gray, Host: Yeah, that's, that's really phenomenal.

Dr. Chiaramonte, Guest: It works. This is what I founded. I, I started a practice that had an inpatient and there was also, there was an outpatient component, also an inpatient component. And the two together really worked best because sometimes people. Who are facing, they have a cancer and they have significant pain.

 Sometimes they need morphine, right? Like they do. Sometimes they need morphine. They need SNRI, they need Gabapentin, but it, but they may also be catastrophizing about their pain. Oh no. Oh no. What if it gets worse? What if it's worse? What if could worse? And if you do that, it does get worse. And so giving them tools to decrease their catastrophizing, to increase their quality of life while you're using medicines.

Also the two things together, really in my experience, helped families thrive even in the face of a really serious and potentially life limiting illness and is more satisfying for the provider to, for the doctor. It was more satisfying for me to practice in this way, both because the patients felt better.

And of course, when patients feel better, they're grateful and then we feel better. But also because you're talking about a lot of things that are meaningful for us too. Right. Being grateful, focusing on what matters, managing our symptoms, making our environment, how we want it to be so that it fulfills us letting go of stupid things that don't matter.

All that stuff that I'm saying out loud to my patients. I can't also not hear it. And it helped me be a happier person too. So that's what I, what I wanna share with you guys today and in general,

Dr. Gray, Host: Yeah. I think that, That's really amazing. And when, when I was in residency, I requested to, I think I was the only anesthesia resident who did a, a rotation in, palliative and hospice medicine. and I, I asked to do that, for the reasons that you stated, I thought, wow, this is a pretty amazing time in someone's life.

And, and we don't really talk about it. I mean that we don't get that much exposure. I remember a medical school, I got, there was like a movie about, someone with heart failure, who, who ended up dying from heart failure. And it was the last days of, of this woman's life and, and there was, hospice that was involved.

And I think that was the, really, the only education that I got that I remember in medical school. and so, yeah, as a resident, I, it was inpatient. so I, I think, one of the things that I remember asking was, why is this only inpatient doesn't make any sense for, for this type of service, to be offered to only people who are an inpatient 

Dr. Chiaramonte, Guest: You are so right about that. We're so right about that.

Dr. Gray, Host: Yeah. And so, but the other thing that I, I ended up cuz I was, one of the fellowship that I could have done out of, anesthesia residency was actually palliative care. And I, I think I gained so much from that rotation, and I saw what you meant about, the people who were there, just the perspective that you got,in the end decided, and I, I think I had a, a conversation with my husband about this.

he's isn't it just really depressing to see people die, all the time and, and so I, I think that for me, that was what made me scared to continue. but I see what you mean. I, I see that part of me, you know, can see that, but the, the other part of me is I feel like this is really reserved for people who really feel called to do that.

Just cuz I even I'm a little, I'd be a little scared of going into this field.

Dr. Chiaramonte, Guest: I, I totally get what you're saying and you are not alone in that feeling. I think the worst thing about palliative medicine is the marketing of the specialty just felt flat. People don't understand what it is. And, and the truth is if you walk around the hospital, the palliative people are often the happiest people, real like they're we're the life affirming kind of people. And in my experience, it is the opposite of depressing, but almost everybody that I say to, that I'm a palliative medicine, doctorate, almost everyone says, oh my God, that must be so depressing. I do that. but it's, it's the opposite of that. It's not that it's not because first of all, it's satisfying because you have deep connections with patients.

when people are facing something intense, you can connect with them in a deeper way. I can, I can be someone's family doctor and prescribe their blood pressure medicines forever. And they like me. Okay. But they're not gonna feel the same connection to me as if we talked about their fears of death.

Dr. Chiaramonte, Guest: First of all. So the human connection is really affirming and special, but also, as I mentioned, Just the idea of seeing other people who are facing their mortality and are making the decision to let go of things they don't care about and intentionally focus their life on things they do care about is a constant reminder to do the same thing for me.

Like there's no way you can do palliative medicine in my opinion, unless your, a sociopath and not learn from it and change in a good way as a person. So just that, making sure that I let go of things that aren't important to me and let go of toxic people and work on my own negative thoughts so that I feel happier as a person, which I am reminded to do every time I talk to someone who's facing their mortality, that literally makes me a happier person, because those things actually work.

So I'm teaching it to other people, but I'm also doing it myself and you really, you can't not be touched by that. It's hard to, to see someone. In their forties who has cancer, who has young children and then go home and be annoyed with your husband that he left to close around, Cause you just see the disconnect between those two realities and it's hard not to feel grateful most of the time.

Dr. Gray, Host: Hmm. That's such a great example. Yeah. And, and that was very much the, what I came away with, after. After going through, seeing my dad die is every time you connect with that reality, that mortality that we all have. is very hard to start. It, it gives you so much perspective, I think perspective is, is there maybe the, the key word here is that perspective of we're only here for a limited period of time.

We're, this is a person who I deeply love and care for and the stuff, that maybe annoyed me once about my dad, I was like, it's really not important because he's really not even gonna be here that much longer. But if you look at the long term, having that perspective and applying it to everybody that I love in my life, it is, is really amazing.

Dr. Chiaramonte, Guest: Yeah . It's very powerful. And the other thing is we all have magical thinking about how long we have, in my magical thinking mind, I can maybe live till 90 or something.

Dr. Gray, Host: Same here.

Dr. Chiaramonte, Guest: Maybe, although I drive cars, and stuff happens, right? Like you don't know none of us know. So we shouldn't even say, I

keep worrying about stupid things until I'm 80 and then I'll really focus on what's important, cuz I know it's short, we really should just do that right now because, because we don't, first of all, we don't know how long we have, but even so how great would it be that I do live till 90, but I've learned the lessons and I focus on things that matter to me now.

And then I have a happier life till I'm 90. That's the best scenario.

Dr. Gray, Host: Yeah, yeah. It's, it's a humility that we, we're not immortal that we, that life is not to be taken for granted.

Dr. Chiaramonte, Guest: Yeah. I, I have had multiple people say to me, which I, I always find it's not funny, but funny, They they'll say, they're, they're facing a serious illness and we're having serious conversation and they'll say, how am I supposed to live now that I know I'm going to die?

Dr. Gray, Host: Mmm,

Dr. Chiaramonte, Guest: And it's funny. you always knew you were going to die. because how many of us are going to die? All of us, right? We are all going to die. And I don't know why it works that way. And nobody really knows why it works that way that we get to come to this planet, fall in love with a bunch of people and with experiences in living here.

And we get to stay some amount of time and then we have to go, that's the rules. And that's just the rules. I don't know why it's just the rules for everybody.

Dr. Gray, Host: We didn't invent them.

Dr. Chiaramonte, Guest: We didn't the rules, but also there's literally nothing we can do about it. Right? One, one day or another day, all of us are leaving this planet.

Dr. Gray, Host: Yeah.

Dr. Chiaramonte, Guest: And so, but because, because our society is so scared of this whole idea, and we can't talk about death and we shield children from it. And we don't say the D word. we live our lives, pretending this isn't true. And that's not good in my opinion, I don't think that's healthy. I'm not saying that every day we should be thinking, oh my God, I'm going to die.

But rather we should just know that that is the reality. People are born. They live for a while. They die and knowing that we should live a life that is good, right. That helps other people that doesn't focus on stupid things that has connection and love that focuses in the moment. The best we can, because we are gonna die at some point.

And we don't have to know when, in order to start living that right now.

Dr. Gray, Host: Mm. Yeah. Yeah. I, I love that. And, and I think that's also part of the, not focusing on the negative thoughts and the catastrophizing. and, and I learned that a lot from my dad because, almost five years ago when he was diagnosed with this, aggressive cancer, That was, what I had focused on, it was like, oh no, he's going to die.

And oh, how is he gonna die? Is he gonna suffer? And I had all this anxiety and, and worry. But yeah every time I saw him, he went through a lot of things, you know, chemo and surgeries and things like that. And he, he just, he was very much in the moment. He's okay, I'm here. It's are you in pain right now?

I'm in pain. if, an hour from now, he's not in pain, he's he doesn't even think about it. And, and then the other thing that I thought was so amazing was there was this short window of time when he was, had, a major surgery. So he couldn't get chemo, cuz he was, recovering from this major surgery and It was actually right before COVID, hit the world.

There was an opportunity for him to go to Antarctica with my mom and at first, and he had just gotten a colostomy. So I think psychologically there was some getting used to, so there was, an opportunity to go and my mom asked my dad's do you wanna go, look, this is an opportunity.

Dr. Gray, Host: And my dad is no, I don't think so. just, you go, no, I'll stay here, stay at home. And then, my mom's no, no, if you don't go, I'm not gonna go . So, so he, so, so my, my dad, kind of went upstairs. I think he went to the bathroom and he came back downstairs, so five minutes or 10 minutes later.

And he told my mom, let's go , we're gonna.

Dr. Chiaramonte, Guest: Thank I was hoping that's what you were going to say.

Dr. Gray, Host: Go. Yeah, so they were, they were, and this was right before the world shut down. Not that anyone really knew that what was gonna happen, but he had this window where his health was good enough. There was an opportunity that presented once in a lifetime opportunity that he recognized and, and he went, you know, myparents, like they took the risk, they went, they had this amazing time.

And they would, text me pictures while when they had wifi service. And I'm like, wow, this is so cool. you here, he is standing right in front of a penguin and...

Dr. Chiaramonte, Guest: Wow. That's amazing. Wow.

Dr. Gray, Host: Yeah. And, and, so, after I saw those pictures and after that trip, I'm like, why am I so worried about my dad dying here? He is, he's living. And,

Dr. Chiaramonte, Guest: That exactly.

Dr. Gray, Host: Yeah. And why don't I just enjoy, you know, I, yeah, like in some ways, of course we're all going to die and, my dad, the cancer is probably gonna be what takes him, and probably sooner than we would've expected if, if he didn't have the cancer, but, but he's living and he's focusing on being alive and the good things about being alive.

And I talked about in the previous episode for him, he didn't wanna think about dying. And so it really worked for him. And, and I thought, you know, what, if this worked for him, I'm gonna think about it that way, too.

Dr. Chiaramonte, Guest: Exactly. exactly. And that, honestly, that is the integrated palliative approach, right. Literally there, because even on hospice, it's the same, this doesn't change if you're on hospice and people sometimes feel like, if I go on hospice, I have to think about dying every minute of every day.

Like now I'm just dying every minute. No, you're not are you still alive today? Okay. If you're still alive today, you're living the same as I'm living the same as everybody's living, we're all just living until we're not. And, and we should do the best we can to make today. The best we can, which is different for all of us.

If you're in college making today, the best you can is maybe not catastrophizing about what if I don't get into grad school years from now. And what if I don't have a great life? Like just, just do your homework today. Okay. and one step at a time you'll get where you'll get. And if you're on hospice, if you have symptoms, a big important of focusing on today is get your symptoms managed the best you can, so you can enjoy your life.

Dr. Chiaramonte, Guest: Like a lot. It blows my mind. A lot of people have pain or constipation or fatigue. Et cetera, et cetera, cetera. And they don't take their medicines. Nausea. They don't take their medicines. They'll say yeah, I have them, but I don't take them. Are you feeling nauseous right now? Oh yeah. Is it stopping you from doing anything you'd like to do?

Oh yeah. I'd like to go, work in my garden, but I feel too nauseous.

Dr. Gray, Host: Mm.

Dr. Chiaramonte, Guest: So they are not living their life the best they can today because they have some idea in their head that you shouldn't take medicines. You should try to be strong and top them not take the medicines for as long as possible or, in our world integrated palliative world, we would say, yeah, take your medicines.

But also maybe how about that pressure point that we talk to you about? And maybe you should do a meditation a little bit because anxiety can cause nausea too. So here's your multi tool treatment plan, but please do all the things, including your medicine, so that you feel better so that you could go out into your garden, which is what you wanna be doing. And then you're just living today, right? You're just living. So the whole value. I've integrated palliative medicine is helping people to feel as good as they possibly can physically, emotionally, spiritually, as good as they possibly can so that they can just live today. The day they ha you have today, you live today.

Tomorrow will be what it will be, but we don't have to be there yet. As my, my younger daughter taught me, that's a tomorrow problem. I love that. that's a next week problem today. Your problem is you're nauseous. Let's do all the things we can do to make you not be nauseous so that you can go out into your garden and enjoy your day.

Dr. Gray, Host: Mm. Yeah. Wow. And I'm really curious, because you work in this field and,as, as a physician you're working with, patients who are going through serious illness, do you have any experience in your own life when you know, you have a loved one, that's going through a serious illness?

Dr. Chiaramonte, Guest: Probably the most profound one that I had was when my younger daughter, when she was 12, fell off a horse and hit her head and had what, was really a life altering at the time experience for her. She had 12 outta 10 pain in her, ice pick behind her eyes and in her head and her neck. Couple years she had to leave school.

She couldn't read for a while. She had some personality changes for a while. Not surprisingly. She got quite, down about the whole thing and was isolated. It was a really difficult time for all of us. And, I think the hardest thing and what I really had to practice myself was not knowing what the, what was going to happen and not getting stuck in the future.

And instead just being in the moment. And I think that's when I really learned it for myself. And that's when I really learned the integrative approach to pain management, which is so important because for pain, that's going to be there for a while. Meds alone are not the answer, but also the integrative approach at the time I was in the integrative medicine world and, and she was told by one integrative physician.

Just don't eat sugar and fix the mold in your basement. All your pain will go away. And we knew that was wrong too. So the, that, that, that really made me feel like, what has to happen is the mix of conventional straight up medicine procedures and the integrative approach together. That's what I, when I really got, that was with her actually, because what, what helped was all the things she got surgery, which helped she had neurofeedback.

She had vision therapy. She had massage. I tried to get her to have acupuncture, but she was afraid of needle. So she wouldn't do it at the time, but she did guided imagery. She used medications for mood disorder. So all of the things work and just the straight conventional approach would not have worked the same way.

And just the straight we call it integrated, but sometimes it's practice more in an alternative way would not have worked. It was really the combination of aggressive, straight up medical and all this big toolbox of complimentary therapies together. That's what worked. And then what I also saw was when I got upset, it made it harder for her.

And so the whole household did worse when I didn't manage my own stuff. And even as a physician, right. Even as a physician. I wasn't sure how to make this right. I didn't know exactly what was going on. None of the other physicians that we were talking to were really taking charge or seemed to be doing the right thing.

And I felt like I had to be in charge, but I wasn't exactly sure what to do. And I think it's what that experience that makes me want to help physicians. It's part of the work that I do is help physicians to guide their own family members who are going through serious illness, because I learned a lot in the process.

And part of it was practical advocacy in the medical system. Part of it was, this focus on wellbeing so that you can get better because you, when you get worse, you get worse, you get worse, you get worse, right? Like the, if doing changing your thinking in a positive way is important. You can't do that if you're depressed.

And so you need to manage the depression, but then you also meds alone are not gonna do it. You also have to work on advanced counseling skills. So seeing how it all fit together. And then also how I had to use the wellbeing tools for myself in order to make the household work better was really meaningful to me.

And so that's, that's part of why I wanna share that with other people. And by the way, she's fine. Now she's in college. She's doing great. Thank goodness. Had I known the end of the story? It would've been easier at the time, but you just, you don't know. Sometimes we don't know how things are gonna go.

Dr. Gray, Host: Yeah. Yeah. Wow. Oh, there's so many things about that. I wanna ask you, but I, I love, I love that the one theme that, that was challenging, that, that you took away with is, the, the uncertainty. Cause I, I think that is such a huge part, whether you're, you are dealing with, serious illness or, or, you're just, your loved one is dealing with a serious illness.

There's so much uncertainty. And even with dying, with my dad, see, seeing how weak he was, there, there's still this so much uncertainty because, then the goal was, I don't want him to suffer, I want him to, to, to feel okay and, is that gonna be the case?

And, and so, yeah, there's all this uncertainty. And can you speak more about that? How do you, how do we embrace that? How do we feel? Okay. in the midst of that.

Dr. Chiaramonte, Guest: Yeah. That's a great question. That is a huge theme for anybody dealing with anything challenging to their health or anything else is uncertainty. And the simple answer is being in the moment is how you deal with it. Because when we say uncertainty, what we really mean is what if that happens? What if that happens?

What if that happens? What if that happens? And that is all future thinking, because that hasn't happened. Right now you're sitting in the living room with your loved one. And if you're thinking, what if the chemo doesn't work? And what if you can't tolerate it? And what if you have to get radiation and what if you have to have surgery and what if they won't let you have surgery?

And what if you, it progresses? And what if you die? All, none of those today, we're literally just sitting in the living room, right? Like none of those things have happened yet. And so the real treatment for that kind of thinking is to refocus your attention in the literal moment that you're in because the next moment will come and you'll deal with that moment.

Whatever is in that moment. And in that moment might be, we have to make a decision or we have to plan something, but that's not the moment you're in yet when you're in that moment, just be in that moment, don't be in the if we decide that, then what if there's another decision? And then what if that one doesn't work.

Just just, if you're in the moment and you have to make that decision, just make that decision. And if you have to research something and to plan in order to make the decision, then just research. Don't say, what if we can't find the answer and then it doesn't work and then we have to go that place. And then they say, no, right?

Like just be in the moment that you're in. And that doesn't mean don't think about it. that moment might be researching. That moment might be planning. That's fine is, but then stay in that moment.

Dr. Gray, Host: Mmm.

Dr. Chiaramonte, Guest: The, the example that I use, that that sometimes is easier to process, cuz no, this is heavy. is a, a medical student.

So a medical student who has an exam coming up, they, and they open their book. If they say, oh my God, why didn't I start studying earlier? I should. I told myself I should have studied last week. I shouldn't have gone to that concert. Probably everybody else started studying two weeks ago. Oh my God. So that's backward thinking, right?

That's not helpful because in the time you did that, did you learn anything? Did you read any of the words in your textbook? No, you did not. and then, so that's the past now, if you're in the future. Oh my God. What if it doesn't work? What if I fail? What if I don't get into dermatology? My parents will be so disappointed in me.

I'll have a terrible life. What if I'm homeless? Right? None of that happened. That's all in the future. And the whole time you did that, did you study anything? Did you learn anything? No. So even if it's true that you should have studied earlier, whatever, right now in the moment your task is to read that textbook.

Dr. Gray, Host: Mm

Dr. Chiaramonte, Guest: Right. Do those questions. That is your task right now in the moment. Don't think about what happened before. Don't think about what could or couldn't happen. Just do the thing in, and when you refocus your life in that way and you try, I'm not perfect for sure. But when you try your best to refocus yourself to the moment that you're in.

Literally your anxiety gets markedly better because in the literal moment, you're in, usually it's not that bad, right? unless someone's actively trying to kill you. It's it's not that bad. Like you have things to worry about. I have things to worry about, but in this moment we're having this lovely conversation.

It's not so bad right now.

Dr. Gray, Host: Mm.

Dr. Chiaramonte, Guest: So that works no matter what is you're up against. Even if you have a, a cancer or other condition that's gonna take your life. It works the same, like today. How are you doing today? Oh, I'm nauseous. Okay. We talked about that. You're gonna take your meds and do your breathing and all that.

So you feel better now? You feel better? Yeah, I feel better. Okay. So what works for you today? Today? I'm gonna go play with my grandkids. Great. Just do that. If tomorrow you have to do chemo. You'll do chemo, cuz that will be your now, but don't go to the future. Until you have to. And if, like I said, if planning is what you're doing, then that's your now it's okay to plan.

I'm not saying don't plan, but don't go in your head to what if the plan doesn't work because you're now is that you're planning. And so the way to deal with uncertainty is to I'll add one thing to it, which is do everything that you can, that you have control over really, and then let go of the rest and be in the moment.

 So, so one example I'll give is my, my other daughter has, life, potentially life threatening food allergies. And so when she was little, I had to send her to school with all these people, with peanut butter, everywhere, and teachers who didn't really get it. Right. So, so you do everything you can, and then you focus in the now and let go of the outcome.

So I send her with an EpiPen and I made her own cupcakes and I taught the teachers and I taught her how to eat my daughter, how to use an EpiPen. And then I send her to school and then I could spend the whole day worrying that she's gonna die. But why do that. Right. I could say I did all the things that I could do now.

I'm just gonna focus on the moment and not allow my mind to go to a scary place because it hasn't happened yet. If it happened, God forbid I would deal with that moment, but don't go to that moment before you have to.

Yeah, there, there, there are two things I wanted to add to that wisdom that you shared. and you talked a little bit about, you talk about future cuz anxiety. A lot of it is future looking oh, what did this happens? What did this happens? I, the other thing that I see often, is like the, the narrative of, what happened.

So the, the past, right? oh, maybe this person, my loved one wouldn't have this problem right now, if X, Y, Z happen. Or if you know this doctor, someone made a different decision and, and just dwelling on that,that narrative of what happened in the past and, and that's what's causing the future problem or the, the present problems.

And, and I would say that that's also not focusing on the moment

Dr. Gray, Host: That marks the end of part one, I encourage you to find Dr. Carti. She will share more about what she does in the future episodes, but you can go right now to our website, www dot integrative, palliative.com. She offers classes in CME and integrative palliative care medicine. She also offer. One on one counseling for physicians with loved ones who are facing a serious or life threatening illness.

And I, I cannot recommend her highly enough. Thank you for tuning into my podcast. I am really excited to share next week's episode with you. So please tune in. I'll see you next week.