Was my volume okay as well? Yeah, it's great. Not too loud? No, I think you're good. Okay. Hi, everyone. Good morning, everyone. Welcome, everyone. Oh, we need that Dr. Mama K smile. There it is. If anyone thought I was exaggerating before. Good to see everyone. I need this village. We're glad you're here. I'm just the jester. We'll get started in just a moment, everyone. All right. Just a moment. We'll let a few more people come in and then we'll get started. All right. Well, let's get started if we can. It's a couple of minutes after the hour so we'll get started. Thanks to everyone for being with us for our December coffee chat. We appreciate you being here. Looks like right now we're going to be a small, intimate crowd for today. But we did have lots of people register. So my plan or my thought will be that we'll have folks joining us as we go along here. I'm Bruce Hammond. I serve as HMDCB's Executive Director. And really pleased to welcome you and provide a couple of reminders before turning it over to our moderators for today's chat. First, next week is our final webinar of the years of our webinar series for the year that we've put together. We are planning to put together one for 2022 as well. But we encourage you to register if you haven't already for our webinar next week on the changing role of HMDs. And it's being led by three hospice leaders. Ron Krosno, who it looks like is here today, which is fantastic. And as well as Bethany Snyder and Ed Martin. They did this session at the Annual Assembly of Hospice and Palliative Care earlier this year and have made a few updates to it and are excited to share it with our group next week on Thursday. So I think Gina could probably put in the chat the link to be able to register for that if you haven't already. So look forward to hopefully seeing some of you there. I also want to give you a quick reminder before turning it over to our moderators that January 11th, our initial certification application window opens. So your help in spreading the word to those physicians that you know who aren't yet certified but should be would be greatly appreciated. We know how much physician to physician encouragement certainly helps in these kinds of situations. So we encourage you to help spread the word about our initial application window opening in early January. Like I mentioned, we are putting together another webinar series for 2022. And we will also be planning several more of these coffee chats into 2022 as well. We feel like we've heard loud and clear from you all that building a community and connecting the community of hospice physicians and those who are certified by HMDCB is important to you. And so we're going to continue doing that as we head into 2022. So without further ado, I'll turn it over to today's moderators. These two gentlemen each recently received word that they passed the 2021 Continuing Certification Program exam, which is fantastic. They're recertified for six more years and good thing for Tommy Farrell to pass because he's our president of HMDCB. That would have been fun trying to find a new president and figure out what's going on. So glad he passed. And Alan Rosen is our other moderator for today. So we're excited to have them moderate the conversation and guys turn it over to you. I'm going to let Alan do our opening comments. You're on mute, Alan. You know, practice, practice, practice. So welcome, everyone. I'm glad that you're here. I want to emphasize that I'm here as a facilitator and a little bit of background. I've been doing hospice palliative care more than 20 years. Originally a family physician, private practice. In the course of switching practices, it was taking longer. Ended up moonlighting doing hospice palliative care in Chattanooga. Loved it. Declined to go back into private practice. I've been doing this ever since. Lived in Tennessee. Lived in greater Chicago area. Now in Florida after my parents lied to me. They said it was only hot two months out of the year. And stay tuned. We'll see where I end up from here. That being said, one of the things that they reached out to me is what is it that we could be as a community and be support? What else could we do given the unique year that we've had? And I have been in a few different settings. Some of you may have seen my name through the hospice and palliative care chat on Twitter. I'm now the lead organizer. It's been going on for 12 years. Wednesdays, last Wednesday of the month. Some of the themes that have come up in that chat or in the medical humanities for Med Hum chat is looking at what we're going through. The comments and there was even some of the questions and preparing for the HMDCB exam about team well-being, self well-being. I know Lauren, for example, on the call and some others in a prior conference have brought this up. And it's a challenge I'm sure all of us can relate to. There have been some aspects that in national dialogues I've had weekly with other people that have been helpful. And in the course of conversation with Bruce and then Tommy, it might be helpful to think about this. Before beginning, I'd also like to say we need to validate. We need to understand the context of what we've encountered. None of us has the same experience. All of us in some way have been affected. And it's had ripple effects. And whether it's in the medical community, whether it's within our organizations, a term I've used before is organizational capacity. If everyone is so fried, if everyone is so frazzled. On Wednesday, gosh, it blurs. Yesterday, I was on this conversation and we talked about as a group of colleagues for us and all of you on this call obviously are leaders. Whether it's in the field, whether it's in your organization, whether it's in your discipline or as a person in your community. All of us are getting buffeted by these challenges. And to some, if this resonates, it's almost like a PTSD. Okay, what number wave are we going through? Which part of the country? Are we talking professionally or family? What about our family members there? What about friends? I have a childhood friend. He was in my wedding. You know what? Love him like a brother. Argue with him like a brother too. He doesn't believe in vaccines. How to help bridge that and have that conversation. All of these things when our staff can be burned out. And so I want to recognize that. I also want to hear your input. What are the challenges you've encountered? And to put it in perspective, we're going to move through a few things. Not only to exchange and have this empathy. How do we cope and connect? And then let's build on that. Because I have proof that there's hope, joy, and optimism ahead. Tommy and Bruce don't know it. But there was an email today from National Quality Forum. So you don't have to take my word for it. With that being said, anyone able to identify what have been your challenges? What are your concerns? I'll go. I really appreciate the intro and the invitation for the dialogue, Ellen. I think that's exactly right. I think HMDCs, this community, has so much to offer. And it's somewhat circular and related to what we've talked about before. And I think individually and collectively, we just maybe need to get out of our comfort zone and be a little more assertive. Because your comment, and I agree with that, as HMDCs, we are leaders. But there's still a hierarchy. And I think we've made tremendous strides in the recognition of the value of the certification. But almost by saying, hey, this is what we can bring to the table. That might indirectly help improve that dynamic as well, if that makes sense. Very much. Thanks for sharing, Jerry. And can you remind us, where are you? I'm in Northwest Missouri. Mosaic Life Care is a regional to Missouri healthcare organization. Maryville, St. Joseph, Missouri. Thank you. Other challenges, concerns people have faced? I think to me, one of the things that was interesting in our organization, I was asked to help or volunteer to do some debriefings for our nursing teams in the hospital. And we did it at a time, it was in July and August of this year, when we were thinking we were coming out of that surge. And we were. But it was interesting that the new surge was starting right back up. And I think that's been one of the challenges is kind of surges that we should expect in a pandemic also create this. When you start coming down, you start getting this false sense of security, maybe. And then so when the next one starts showing up, it's like, oh, my goodness, this again. And I think we've been seeing that one because the turnaround between the last surge, at least here for us locally in Texas. The turnaround between the last surge and this surge that feels like it's about to come seems to be a very short time period. And so I think when you compared it to PTSD, it also kind of reminds me of the multi-trauma that you get, like for the patients I had with HIV that had multiple people dying in their life. We're having multiple hits of this disease on our teams. Great points, Tommy. Thank you. Other people, whether it's things or even feelings, you can contribute. I think really just, and Alan, I will reiterate, thank you for opening the dialogue, because I'll say I had some form of PTSD, moral injury. I mean, I went from full time to part time in my clinical position. I never anticipated that happening at this point in my career. But saying things out loud really is so helpful. And it's funny because Tommy and I gave this presentation at Texas, New Mexico, their regional conference. And we, I mean, we talked together all the time. So when we created that presentation, we really just took notes on a PowerPoint and said, oh, I'll talk about this. You talk about this. Standing in front of this room, speaking about it with him and kind of talking about what we had gone through, more from him inpatient palliative and me primarily hospice. And just hearing it from his perspective and my perspective and just saying it out loud. Tommy, I don't know if you felt the same thing. It was like a turning point for me, just verbalizing it. It's okay that it was awful. And it is. It gets awful. The time commitment, the stress, the multilevel trauma of personal, your colleagues, and then the people that you're trying to take care of and patients and families. I think just the more we speak out loud and normalize that this is something that the entire healthcare community is facing, lets us process and cope as we continue to wave five, wave six, wave seven. And that this is unfortunately a new normal for us and how we're going to navigate all of this. Thank you, Lauren. Entirely so. And not only what we do as leaders, but as clinicians for ourselves, as family members. All of us wear many hats. You know, we're friends, family, parents. You know, there are all these other layers. What else have people encountered? Any feelings? Because I'll share one that surprised me that was difficult. Like Lauren was mentioning, not only the PTSD and some of the depression, but some of my colleagues yesterday around the country were also feeling a little conflicted. Having guilt and also raw anger. Not even anger. You know what? Rage. Here we are again. We're overwhelmed. We're doing this. This is preventable. This is science. And it was a conflict because we want to help and comfort people. Yet, you know, part of what we do is validate feelings. Well, it's valid to be angry. Have any of you experienced that? And anything you can share that may be helpful insight you've come to? I don't know that I have any insight. But certainly anger. I work as a hospice medical director, also as an inpatient hospitalist. So in August and September, when we were seeing the Delta surge, I was going to the hospital and seeing my patients die. And then going to the office and dealing with hospice nurses who said it was personally insulting that I suggested they should get vaccinated. Things like that. You know, with the mandate now, we no longer have any unvaccinated staff. And the office is a much more pleasant place. I hear you. Thanks, Daniel. I think I saw someone else take themselves off mute. They were gonna help us with some insider comment. I forget who it was. Hi, I did. Dr. Rajaram, I'm from Orange County, California. Thanks for recognizing. I retired end of June as the Senior Medical Director from hospice. However, I'm still on faculty with UCI on the Palliative Department. So I'm contributing to some of the teachings still of the Palliative Fellows. I took part in the recent interviewing and the final list came out of the match for the Palliative Fellows. So, and one of the faculty has used me in doing some spirituality and medicine education for medical students. So that's a really wonderful blessing. My thoughts about the rage and the anger and how we should approach it. Yes, UCI themselves had a recent, well, there's a lot of things going on with ethics as well as with many other integrative medicine webinars that they had. And the nurses were able to express many of their discomfort and anger, mostly at the physician community because the physicians were able to come in and out of the hospitals, making rounds and giving suggestions, whereas the nurses spend most of the time at the bedside with the patients. So there was some of that and how we approached, you know, there were many, and I faced some of this and I felt guilty sometimes that I was lucky that I was able to kind of come in and out of the ICUs or from the floors and all go to hospice visits, whereas the nurses were there all the time, but we were very empathetic. I didn't realize there was all this pent up emotions and anger against the physician community as well. So there's a lot of healing to be done by all of us. It's easy to point out, but my approach is mainly listening even now to my colleagues, to the nurses, not to give my opinion, but be there because it's still happening. And I go to nursing homes as well. And one of my practices being in the nursing home, and I went there yesterday and, you know, because of these unvaccinated patients now coming from the hospitals to nursing homes, face, I mean, we have to face, I mean, wear kind of eye protection and masks and everything that we didn't have to before, but that's a part of reality. And I'm not complaining, I'll do it because it's the right thing to do. Thank you. Oh, thank you. That was very valuable. And you brought up something we hadn't touched on that I wanna make sure we magnify in that is in education. And whether it's in health education for people that are training, or whether it is our own direct reports or organizational capacity that I mentioned, but as individuals, education has changed. And we'll get to the section a little later about resources, but I think that's an important dimension to highlight. I've also noticed one other thing that surprised me, I heard, and that was some tension within our field and tension between hospice and palliative. And there were times that palliative care teams were trying to move patients out of hospitals and into community settings. The communities were saying, our facilities are overwhelmed, we don't have the proper precautions. And it became challenging navigating those inter-organizational challenges. Have any of you been in that or experienced it or can share some insight? I just want to add one more thing is that I promoted one of the palliative fellows that I had hired as an attending to become the medical director. And I mentored him for six months from January till June. He got his HMDC and the other two palliative doctors that we hired also got it. So in a way, I'm happy that me having my HMDC and I recertified recently that it started a wave and I've become one of the ambassadors for hospice medical director. So is there anything I can do in spreading more education, getting more people involved in this? I just wanted to add that piece and then I'll- That is great. Congratulations, we're all clapping. And at this point, I'm gonna give a special recognition and full disclosure, I consider her a friend, but I also wanna praise Kai. Dr. Mama Kai, who in her description has her HMDC credential. I don't know why mine didn't show up. It may have been my last meeting was more of a community thing and I didn't have it on, but she's the only one of us. Here we are part of an HMDC group. And I was chagrined and we had already started and I didn't wanna be so vain as to change mine, but in following her example, including what Charlotte, if I pronounce that right, just shared using, way to go, Mindy, having our credential and be valued and that's a great turning point to talk about our value. What do we bring, not only in our field and I'm curious, what have you found helpful or what has changed? Because as horrible as the pandemic has been and I don't wish it on anyone, there have been some positives. I would not have met and interacted with all of you. I would not have had some of the other connections and it's another tool. It's not that every patient visit should be virtual, but it's another tool in our kit, just like not every medication works for every person. Some things have changed and what has changed that has been helpful or changed your perspective? Can you share that with us? I'll share there. I'm gonna go back to talking about those debriefings because I saw the nurses saying something that I think was true for me and my team as well. When we got to the parts where they were talking about what we're getting on through, what was making them part of the survivors of COVID as a profession, I saw two themes arise. And one was, was that team, the fact that no matter what they were going through and how much they felt misunderstood and angry about what other people were saying about us, they knew that team they worked with every day, knew what they were going through. And they felt like a, kind of like a, there was a closing in of the ranks to say, let's take care of each other. So I saw a lot of, and I saw that in my own team, a lot of self-care in our own team. And when you mentioned the tension between palliative and hospice, I'm very, very blessed here that as you, as we keep showing on the phone here, that Dr. Templeton and I are both in the same practice group. It's really nice when your colleagues, when I mainly am on the palliative side and she's mainly on the hospice side, and it's nice that we do consider ourselves one team. So as much as you can make sure anybody, palli is welcome and anybody hospice is welcome if you're on the palli side to remember that we really are, I don't know if the right analogy is two sides of the same coin or what, but we're all, we're all partners. So anyway, that team being, you know, being, having that safe place for me, my team especially is helpful for being that place that I can express my anger without looking like a bad person. Because if I express in the wrong circles, it could be misunderstood. But among my teammates, they know I can, I can be a little bit less proper as I'm going to be on this phone call or on this Zoom and stuff. But then also people identifying down to their core purpose. You know, I had heard a lot of people saying, but this is what I am. I am a nurse. So this is what I am. And I, as I think about it, I've seen that a lot in our resilience groups that this is what we are. We're palliative care. We know how to live among suffering and even feel that suffering and still know that this is where we belong. And so that, I feel like those are two key things that helped evoke me personally. And I saw that theme for others. Thanks, Tommy. Others? I think on the hospice side, well, and kind of to reiterate what Tommy was saying, I'm just so spoiled that our programs are connected to work with them all the time. But in the very beginning, our inpatient unit was not accepting COVID positive. And I saw my palliative care colleagues getting overrun with what was happening in the hospital. And we were trying to figure out how are we going to provide this level of care? Where, when, what, with what? And I, you know, just had to cross cover and palliative one day to help out. And it was incredible to try and see things from both perspectives, what's going on in his shoes, that team's shoes, what's going on in our shoes. And just kind of reinforce the idea of open communication amongst our colleagues about what your struggles and what your needs are, changes in policies and procedures. Tommy and I were on the phone an hour ago about, okay, so what are we doing with BIPAP and these situations and whatever? And just that ongoing talking through and communication. I think the use of Zoom and phone calls for IDG and all of that just made balance easier, not easy, but easier. So now you can start from home and do this work-life balancing that has become, I think, a common workplace conversation, which was not common two or three years ago. I don't know, it's just been a good thing. But to piggyback on Tommy saying that people, we are used to dealing with suffering, I think that was one of the tipping points that I saw in a lot of hospice nurses that I would hear these statements of, I know I'm used to people dying, but this is my eighth death in this location in 14 days. And just like, what do I, I'm supposed to be able to handle this. I'm supposed to be able to be tough. And why can I not get it together for this family? And I think that was a real concern for people that I worked with, including myself, of why can't we tough this out? We're supposed to be able to show empathy and not necessarily sympathy and be able to disconnect from how it affects us personally, but engage in an appropriate manner. And it was a struggle. So I think talking through a lot of that was helpful, but identifying it in the moment was very hard. And I think led to a lot of trauma in our team until people realized that it was okay, that we weren't the tough guys that could handle all the death and dying and burden of illness. It's okay to be sad. So I think that was a big hurdle that our team faced and hopefully makes us stronger coming into the winter. That's really insightful. And like Jerry's commented that the comments as a group, what we're contributing is not only helpful, like Lauren said in her earlier statement, just talking about it helps. You know, it's almost like an abscess that, you know what, in order to drain it or help an empyema or whatever else, we sometimes need to lance, we need to poke the issue. We need to, and sorry for the non-clinicians, we need to sort of, you know, delve into this. But I also wanna capture when she mentioned perspectives, what's it like in someone else's shoes? What are they experiencing? That's been helpful sometimes for the hospice people that are going, why are we getting this admission at 2 a.m.? You know, we're not as staffed as during the day, whatever. Well, do you know that the ICU's on divert and they had a car accident and there's however many people, you know, there's a bigger picture to help in the community. Any other specific ideas, other things, how do you keep perspective? How have you managed this period that might benefit others? Anyone we haven't heard from so far? So I'm mostly at a large nonprofit. We do have a couple inpatient hospice units and our palliative care team, it's not, we have just outpatient kind of home-based consultative services for palliative care. So the palliative care groups in the hospitals are not part of our hospice agency. So I've had to keep in mind everybody's different pressures, right? And everybody's different kind of agendas, whether that's the agendas that they hold in themselves or the agendas that are foisted upon them by whoever they're working for. And I think what I've seen at our inpatient hospice where I spend most of my time is trying to bring people, oftentimes who quite aren't ready maybe to switch to a full comfort mode because the hospital can't use that space for them anymore. So it's not just COVID patients, but it's anybody who may have been in the ICU, there's more of a pressure to bring them over to our facility. And sometimes families choosing to do hospice just so they can visit or patients choosing to come into our unit so they can have visitors. So we're getting a different mix of patients, which was initially kind of confusing and a little frustrating. And I think I just have to remind myself a lot that we all just have to try to walk a mile in the other shoes. Thank you, Mindy. That's really helpful. And it also implies that this is a process. It's not a couple of steps. So, it's like, I don't know if any of you do this too, but on palliative care consults, when they're like, oh, there's this symptom and there's this, and well, it didn't start overnight. We may not fix it overnight. Let's put things in context. What's the biggest priority? How do we do it? But it's a process. We're not satisfied until we get to what is that person-centered important point. One of the things that I'm curious, I'd like to make this a little bit more personal. What activities have each of you done? And I'll be the first to admit I've been hypocritical. You know, work-life balance, do this, do other things. You know, all hypocrites, please raise your hand and I'm raising two for those on the phone. But what specific activities have helped in your connections, whether for sanity or positivity? Thank you. Again, it was referenced in a different context and I think I'm sure everybody were just kind of quiet today, but we all have that and not to sound trite, but for me it's revisiting I guess because I've had a spiritual practice most of my life and career and when things are going good, I don't know if that's the rest of you, sometimes that kind of falls by the wayside, but in times like these, I've found it helpful for my own sanity if you will to revisit that, the daily meditation or prayer, however individuals define them, but for me that's been pretty important. I want to express how important it's been for me just the, is the community and I actually posted in the chat that picture that we got from our AHPM quarterly, last I was part of the AHPM, hopefully everyone's a member of AHPM, but the AHPM quarterly was kind of, it's just neat that this field, I guess I remain proud of just being a part of this field, sorry, where we have people that are, how accessible the leadership and everybody is, when I see some of the people on this phone call and with Dr. Crosno being one of them on there, these are people that mentored me when I was just starting into the field and the fact that there's past presidents and current people in charge of committees and big things that are all so accessible to each other, I'm just very grateful that we have that type of field and then seeing that understanding that we all have the same insights and so when Dr. Templeton was sharing her thoughts about how, why aren't we handling things that we've handled before and I enjoyed that AHPM had that cartoon, just that simple little cartoon made me feel better when I saw that because I was like, oh yeah, I guess I do have a good reason why I was a little bit more sad than I should have been or more upset about a situation than I should be or felt more moral outrage than I should have in a certain situation, so anyway, I just really want to keep expressing my appreciation to everyone else because there's a part of me that, part of what keeps me going is just being a part of the group of people that I'm around, so I don't know if that was coherent enough or not. Yeah. That was excellent. So, sorry guys, I was kind of multitasking, I'm on call here as you know, but I just also want to reiterate that this group is just so valuable because we have the common burden that we carry for our organizations and our patients and still having to do the work that we do. So the word fried really resonated, Alan, and so during this time, we talked about it on the HAPC chat on Twitter, just making self-care, like it's not optional anymore, like if we're all fried all the time and we're also vulnerable to this virus, actually a year ago today I found out I had it, thankfully I didn't give it to my family, but we've lost so many friends and family members and patients who were our regular patients, not the hospice patients, you know, we expect our hospice patients to die, but not the regular patients. And so all the death, all the loss, all the having to continue to go, having to educate people who don't want to be educated, like you guys mentioned, and all the behind the scenes stuff, I have a very low tolerance for all the stuff that we used to be okay with, you know, the administrative things. So I'd rather work from home than go into the office because I just can't, like that extra little bit is just too much. And so I need to go to my patients' houses and come home, you know, just go to the office once a week to sign things because I just can't take too much of that extra stuff because I need to save the fresh compassion for my patients and I won't compromise that. So that's where I am. Beautiful, because it's also something that we have to renew. How do we rejuvenate that? And these moments and sparks of joy for ourselves. And I don't know about you guys, I'm sure you've encountered, like me, friends and family that call, I just read this, I'm worried about this, what's happening? So how do we also help, you know, not just maintain spirits, but infuse positivity? I'm going to do an audible here and probably shock Gina, Bruce and Tommy, but you know, this really is a valuable group. And I'd like to invite and encourage everyone to send Gina your ideas, resources. There were some things I wrote down in advance. Some of which people have mentioned, the HAPC chat, the academy. We have our upcoming annual assembly coming up. If people are not members or engaged with the connect feature, it's a great sounding board for, and I'm not paid, I'm not in any position this year with the academy, but you know what? I'm a big proponent of not reinventing the wheel. So if someone has figured something else out, there were great dialogues on COVID. There were dialogues on treatment. And so I'd encourage people, whether it's with that, but maybe here at HMDC, we can have a repository for more links, what is helpful. And it's not that we have to create all of them, but if some of you find great resources, for example, how many of you are aware of the Chaplaincy Innovation Lab out of Brandeis? They've done phenomenal webinars on telechaplaincy and extending your team in other ways to leverage. I'll share some of the links with Gina, and if Bruce and Tommy like that, perhaps all of us might be able to learn from each other. What else has helped for you? For those interested in the humanities, the medical humanities chat, Med Hum Chat, that's been very instrumental finding out what connections, because if you think of the word humanity, it includes human, and whether we're providers, whether we are clinicians, we're part of a bigger community, and that can be fortifying. I'd like to, in some of the time we have left, also go over for hope and joy, because I think as Lauren mentioned, Jerry, and earlier, Charlotte, some others, in our perspective is maintaining vision towards the future. What are you looking forward to? What brings you a smile, other than my corny jokes? I'll go into the humanities, but I really enjoyed, in a way, the COVID was an eye-opener for me to look into myself, and my daily walks now, I don't take my phone, so I just introspect, and I'm always going to myself, and that 30 minutes is such a joy, and that helps me with so many ways of approaching things, and with kindness, so I think the kindness aspect of it also, there are ways to connect with, and again, my own involvement with spirituality and medicine. I think those are the things. I think what we can make a difference as a hospice community, hospice medical director community, to engage the vaster community that we all live in, and maybe get ideas from each other, how we can contribute, so that's my short thought. Thank you again. Others? What have you found? What I would say is that because of the kind of restrictions, we've been encouraged to not come into the office to do work, and we've been encouraged to work remotely, so for me, the unanticipated blessing is that I am doing about 50% of my work in the home of my grandchildren in Northern Virginia. I live in Lynchburg, so I am having just unprecedented and unanticipated amounts of time being with lovely little tiny human beings who jump up and down with joy when you show up after not being there for a few days, and so that's been probably something that I would not have anticipated to come out of this. I would say that also just talking with my colleagues on the phone at the end of the day intermittently has just been hugely helpful. I have two really good physician partners and a nurse practitioner that I've worked with for years, and just talking with them, but the thing that's been hard is not seeing the nurses at the same level that we used to see. We don't have IDT in person. I don't know. We've had enough new nurses during the course of the pandemic, but I don't know what some of them look like, and that's really not a good feeling either. I've looked them up on Central People to see what their pictures were, and yeah, people are not using their cameras on our IDT meetings, which is probably not a good thing, but anyway, so yeah, it's that, and then I feel that COVID kind of pushed hospice to decide that the big important thing was COVID, and we were doing our inpatient care actually at a nursing home that was owned by the hospital system, and they wanted to use where we were as a COVID recovery unit, so they moved us to a community hospital 20 miles away and just said we could use some beds there, only if they're full of their own patients, they don't want, I mean, we can't admit a patient there, so we've had a hard time doing our GIP service, and if we do get a patient there, it's a 40-minute drive to go out and admit them and to round on them daily, and so I feel like we're not considered very valuable to the organization because everything's been so COVID-centric. Those are kind of the pluses and minuses that I've experienced. Thank you. Thank you, Pat, that's excellent, and anyone else, because not just what has brought you joy, what are you looking forward to? We're in December, there are all these reflections, you're going to hear movie lists, song lists, other things that are looking backwards. I'm curious, what are you looking forwards to, and as a corollary, as a leader, what are you doing for those around you, whether family and colleagues, for that excitement? I'll share next. First, just on another piece that keeps me connected, or I think keeps me grounded, and this goes to, I'm forgetting one of our, and I feel bad I'm forgetting, I could scroll through the list and I'll see his picture and remember who was talking, but that might take too much time, but the, it was actually Dr. Wilms, when he was mentioning that connecting to the spiritual side of things, I like songs and spiritual poetry and prayers, and so one that, you know, just like when I've been watching this week is St. Bridget's prayer, her mealtime prayer, and just an excerpt of that where she talks about, I should welcome the poor to my feast, for they are God's children. I should welcome the sick to my feast, for they are God's joy. Let the poor sit with Jesus at the highest place. I should welcome the sick to my feast, for they are God's joy. Let the poor sit with Jesus at the highest place, and the sick dance with the angels. Just those things that make me feel like when I'm helping the people that are sick and poor, that I'm there with a price that's, you know, connecting me together. So that always brings me extra comfort and peace. And when I think about the things looking forward to, is I do think even though we're gonna have more COVID waves to come, we're all smarter now. I remember that first, going back to, Dr. Chamberlain gets picked on a lot with me here, cause we're right here next to each other. But I remember that first phone call, that very first month of March of 2019, and there was a lot more not knowing and tension and worry that we were both having to figure out what was gonna happen next. And now, now we've got a vaccine, now we still have lots of, yes, there's all these tensions and stuff out there, but we even know how to navigate those conversations better. I think, I feel like, and maybe this is me just being too much of an optimist, that there's a lot, things are cooling down, the battle lines don't have to be there as strongly, everyone can kind of settle into the place that they're at and meet people at the place that they're at. And I'm looking forward to being even more of a peacemaker in 2022, and doing better at listening and understanding, and be better at not letting myself be disconnected, as our one person was sharing, there's nurses I haven't seen, and I'm gonna be better at picking up the phone and talking to people more, because every time I get on the phone with a colleague, I enjoy the phone call. I might have a bad text exchange, but I don't seem to have bad phone calls. And I think that's just because there's a difference when we're talking with each other. So I plan on 2022 being less fear-driven and being more connection-driven. That's what I look forward to in 2022. Hallelujah, that's great. On several points, whether it's community, whether we define it by faith, by connection, colleagues, and how are we proactive, with some of the time we have left, if people don't object, I want to make sure I can validate why I have optimism for our field and for 2022. And Tommy alluded to it, several people, Pat and others, but I think there has been some good that's come from the pandemic. And I don't wish it on anyone, but it's highlighted where there have been gaps. When those gaps in our systems have been fractured, we've been told for how long we can't do telemedicine, telehealth, virtual care. A colleague yesterday had said, we've done 10 years of change in less than four months when all this started. And when you look at the progress and you look what's happening, you know what? Palliative care got a lot more respect. And Sean Morrison with Capsy and Mount Sinai said this early on in the pandemic, not just to be relegated with palliative care as, okay, you guys are the advanced directives, go get them to be realistic. They also saw the interdisciplinary care. I've heard from colleagues that the chaplains have become essential, not just for patients, their families, the staff. And here we are in the holidays. And I think there's an even greater recognition. To be honest, to be blunt, it's about darn time the rest of medicine's catching up with our field. Hospice has been around for decades. For eons before that, it may not have been formalized. Interdisciplinary person-centered care. And look at the new reimbursement models. Someone incidentally had submitted a question about coding. I don't see that person currently attending, but we even were talking about doing a separate type of event for coding resources, other things, and not do it on the fly. That can be more challenging. But when we look going forward, there's new reimbursement models, shared risk. You know what? Let's get credit and compensation for the advantages that we bring. Look at the ROI, the return on investment and benefit in the community when there are more social workers engaged with families in their homes. There's now this hospital at home movement. I don't know if your systems have experienced this, but I've been involved in discussions. They're trying to put more layered on palliative care. Well, you're going into the home, or your hospice nurses are doing this. Can you also go somewhere and grab labs? Well, okay, let's reimagine these things, but let's also do it respectfully, and let's be inclusive. So I am optimistic. Another thing that I wanna give people time to talk about, but if you haven't seen, I'll pass it along to Gina. National Quality Forum today, 10 a.m. I had nothing to do with it, but they're emphasizing person-centered metrics. They're looking at measuring quality outcomes in reimbursement, what we expect as a baseline. This type of coordination of care. How many people today have mentioned IDGs? How many people have talked about interacting with colleagues? Forget the discipline, they're colleagues. And we miss our colleagues, our nurses, the respiratory therapists, the others involved. And by the way, for this on the top, looking at well-being. The fact that this has become a national mantra, and this drives reimbursement and policy coordination, these, I think, are opportunities for us going forward. All of you are the ambassadors, representatives in your communities, and please share what you're doing. Let's learn from each other, and let's revel and enjoy what lies ahead. Any other thoughts? We're nearing the top of the hour. I want to respect your time. Other thoughts people can contribute and help? The only other thing I would say is, and I've said this in, I think, every single one of these in one way, shape, or form, and everyone has reinforced that, the value of this community, and let's just be in touch in between the coffee chats and the webinars and every other interaction we've described, and really reach out to one another on an individual basis, as well as a more formalized, systematic community that we've talked about. Thank you, Jerry. Go ahead, now. Okay. Hi, hello, everyone. This is my first coffee chat, and I'm recently certified, so I'm very happy to participate in this. I know time is important, but I'll go briefly about myself. I did my internal medicine residency, then I took a job at VA Hospital as a hospice director, so I did both palliative and hospice there, but at that point, I don't know about this hospice medical director certification. Three years, it took me three years to find it, but now I think the word is more. I encouraged all my attendings to take that test, because we do a part of the palliative and hospice there. I'm also recently board-certified oncology and hematology, too, so I took the job in Indiana, Terre Haute, as a palliative medical director, and here, they have very preliminary palliative care, so my responsibility is to develop the palliative care here in the hospital, so that, you know, educate all the hospitalists and the intensivists to get the consults at appropriate time, all that. So I have, like, you know, a plan for that, but I don't have any guidance yet. I don't think we have any data collection also to do the patient service and all that, so I need a big help from the community to initiate the program, and how can I do this, you know, in the proper way? Is there any resources that I can use? There are lots of resources, and very excited for you speaking up, and like we said, not reinventing the wheel. A lot of people have experience on this call. I think there are ways that I know I've discussed in the past with the board. For us, it's very important that we have a plan for what we're going to do, and that's what we're going to do, and that's what we're going to do, as a board, for us to improve and deepen these connections and help in disseminating where are some of the resources, whether it's for people new in their career, and if any of you have encountered sometimes people that are in mid-career. If you've been a physician, how do you become a leader? How do you become an advocate and shift your hat for an organization or a region or more population specialties and others that, again, can be effective? And you are the very example of the optimism for our field. Look at what you're doing and bringing, not only to your community, but to ours. You're bridging disciplines, and this is exciting. This is a way forward, and I hope the rest of you, again, not to be a Pollyanna, not to minimize the difficulties, but this is exciting. And so, you know, whether it's myself and others, and you bring up another point that as we conclude, think about what you're going to do, not just for your own joy, but if you're involved, you're a leader. What about your teammates? Are they using their vacation? I want to use mine. You know what? I want to cover for other people, so they'll cover for me. What about their goals for next year and their optimism? You know, if all of us could have contagious smiles like Dr. Kai, we will be a much happier place. I want to thank everyone. Any final comments? I turn it over. Thank you all. Thank you. I put my email on the link, Dr. Kuri. If I said your name close, correct? Yes. Yes, that's correct. Thank you so much. Start emailing some of us and we'll get you some ideas. Okay. Thank you. I appreciate it. Gina and Bruce, we're getting it back to you. Just very quickly to say thank you all so much for the, for the great conversation and hope you all have a great holiday season. This is December. I can't believe it's December. I don't know if any of you can believe it's December. It has flown by, it seems. So, so hope you have the great rest of the, of the, of the week this week and the rest of the month. And we'll hopefully catch up with you after the first of the year. So thanks again for being with us. And, and oh, Alan, one more thing. Remember the early bird discount for the annual assembly, which you can go to in person in February in Nashville or virtual, the early bird discount ends January 5th. So is you're looking at what to do. And if your budgets, you know, they're just overflowing with money and whatever, but if you're going to lose your education funds by the end of the year, that may be something to put it towards. And I get no compensation, unfortunately, for saying that. I warned you earlier about the bad jokes. That's informed consent. You're still on. You wish you wish you did get some, didn't you there, Alan? Thank you very much, everyone. Have a great one. See you later. Bye-bye.

COVID-19 pandemic

healthcare professionals

burnout

self-care

community

support

telehealth

palliative care

optimism