B (3:20)

It'S me, Steve Burns. And I'm so glad you're here because you and I go way back, right? Yeah. And look at us now, like, we're all grown up. We've got this new podcast where we talk about all this grown up stuff and there's special guests like Jamie Lee Curtis and Bill Nye, but for the most part, it's about you. I mean, it's always been about you. From Lemonada Media, Alive with Steve Burns is coming September 17th. Wherever you get your podcasts or you can watch every episode on YouTube. Alive with Steve Burns. There you are. Come on in, come on in, come on in. Welcome to Alive. I'm very glad you're here. You look great, by the way. Anyway, so thanks for coming today. I kind of want to talk about something kind of big. Like real big. Can I ask you, do you ever think about death? Yeah. Okay. Do you ever think about dying? Like what? Like, what is that? Like, what is the experience of someone who is physically dying? Yeah, yeah, yeah. That is something that I think about, like, all the time, actually. I'm making tea. Do you want tea? There's tea. It's actually a thing that I feel like I was kind of forced to think about a lot back in the day, kind of against my will because there was, like, this Internet rumor going around that I was dead, that I had died and was not alive. Yeah. And it was always some weird way, right? Like I. Like I died in a car crash or a heroin overdose or, like, suicide. That was one of them. And it was nuts. And no matter what we did, we couldn't get rid of the rumor, Right? Like, it didn't matter. No matter how many talk shows I went on and said, oh, I feel fine, or how many new episodes of Blue's Clues we made, it didn't matter. It was like this indelible Internet rumor that I died. And I actually would get into arguments with people on the street, like, arguing whether or not I was, in fact, alive. It was crazy. And this was also when the Internet was just beginning to Internet. So it was like millions of people online all telling me that I had died. Imagine that. It went on for, like, five years, then it went on for, like, 10 years, then it went on for 15 years. And I'll tell you, it started to feel like a cultural preference. Does that make sense? Here you go. If I'm being honest, it actually. It kind of messed me up. It did. I'm older now, and I've experienced some death and dying. I lost my dog. I lost my dad. And those were painful and profound experiences, and they changed me. Right. And they reminded me that death is a fact of living. Right. Of course it is. It is. The inevitable fact of our death is the one certainty we hold while we're alive. And that got me thinking, why not confront that? Right? I mean, why not talk about it? You know? I mean. Cause if you think about it, we're all gonna die. We're all dying while we're living. So why not ask the question, what is that? What is dying? Yes. Yes. This is what I'm saying. I'm fascinated by this, and I'm actually super excited to talk to our guest today about this. She knows so much about death, so much about the process of dying. I can't wait to talk to her. Come on, let's go. Let's go. Okay. All righty. Okay, so our guest today is Julie McFadden, and I'm super excited to talk to her. She has been a hospice and palliative care nurse for, like, 15 years. She has a new book coming out on June 11, and it's called Nothing to Fear Demystifying Death to Live More Fully. I could not be more excited to read that and to talk to her. I found her through TikTok and her TikTok page. I'm not kidding. It's important, I think, and it's profound. And it's all about demystifying death and dying, and it's a little scary in places, but it's also, like, super beautiful and super amazing and. Oh, she's. She's here. Hang on. Hey.

C (9:18)

Hello.

B (9:19)

Hi. Julie McFadden. Thank you so much for coming by. We're so excited to talk to you. I really, truly, truly am a fan of what you do.

C (9:26)

Thank you. It is such an honor.

B (9:28)

So I was thinking maybe we should just start kind of simply, like, tell us, what is hospice? What is palliative care? What do you do?

C (9:38)

Okay, so those are big questions that I'm going to try to generally answer. So we're not here all day because there is a lot of things that can go into that. So what is hospice? I mean this with all sincerity. Hospice is about living. People think it's about dying. People die on hospice. You go there at the end of your life, but it is for people who want to live out the rest of their lives, you know, wherever that may be. Most people choose home, especially in the United States. There are like hospital homes and places you can go. But most people choose to be in home hospice, which means they're in their home and then a team of people comes to care for them, to help manage symptoms of their disease that they're dying from.

B (10:26)

Yes.

C (10:26)

So palliative care is more about managing your symptoms. So a team of people that looks at you like as a whole person and manages your symptoms while you go through treatment of a disease or you have some kind of chronic illness. For me, I have a big soapbox that I wish everyone could be on palliative care the second they got diagnosed with any kind of like life limiting, terminal or chronic illness. I feel like everyone should just get a palliative care team right away, can't they?

B (10:56)

Is there a reason why they can't? I mean, it's just a choice. Is that a choice that people can make?

C (11:02)

They can. Ish. Many doctors aren't fully aware of, like what palliative care actually is and what it's for. So they won't refer early enough. And there is criteria to get onto palliative care. And sometimes those people, when you first get diagnosed, they don't meet criteria. I see more debilitated, which I think is ridiculous. You shouldn't have to be more debilitated. You should just get it because everyone needs it, I think.

B (11:30)

Yeah, yeah, yeah. I remember I was, you know, I was a caregiver for my father. When my father passed. He died of lung cancer. And it was a very gradual process. You know, he didn't, he didn't die all at once. You know, there. It was just. It was a subtractive process, if that makes sense. Like things were being taken. You know, things were taken forever and gone. His strength was taken forever and gone. I remember his beard was taken forever and gone. And it occurred to me that I had never seen my father's face until he was dying of cancer, you know, and it was such a gradual dimming is how it felt. And I was right there with him, you know, when he passed, I was right there. It was hard to talk about. It's years ago, but I knew he was there and I knew he was gone. But I never saw it happen.

C (12:34)

Yeah.

B (12:35)

You know, and I was inches from his face, you know, and I never saw it happen. I couldn't. I couldn't identify the moment. You know what I mean? So I guess that's why I'm asking, like, is there, is there a hard line somewhere, you know, where they're like, okay, there now it happened. The, the whatever has left and now this person is gone forever.

C (12:56)

I think it depends on who you talk to.

B (12:58)

Okay, okay.

C (12:59)

And I will say, I mean, I could talk about this topic forever and ever. And there really is a biological, physiological, metabolic thing that is going on when someone's dying. And our bodies are built to die.

B (13:14)

I'm looking for a pen. I'm writing that down. Our bodies are built to die.

C (13:19)

Oh, baby. There's a whole chapter in my book about it.

B (13:22)

I'm reading your book for 100% sure.

C (13:25)

Thank you. Thank you.

A (13:35)

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D (15:21)

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A (17:12)

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C (18:33)

Yeah, I mean, that's the first thing I noticed as, as a hospice nurse. Within my first year being a hospice nurse, you know, I was an experienced ICU nurse. I had nine, eight or nine years under my belt at a large hospital where I felt like I, you know, I learned it all. And then that first year of hospice nursing, my mind was blown by what the body did on its own without us doing anything. Your body knows what's going on and will help the process along if we let it. We meaning the medical, medical people. If we, if we just sort of let things happen.

B (19:12)

Well, tell me more about that. How does, how does, how does our body help us die? You know, I would assume that our body would be enormously concerned with keeping us alive.

C (19:23)

There is a threshold. There is a threshold where, you know, our body will fight to survive and live. And when, when the body kind of knows, hey, this is, this is happening, like, like the cancer is taking over whatever we want to call it, whatever however we want to word it, the body will eventually hit a threshold where it understands that this is the end. And your calcium levels will go up. So your body will allow you to sleep all the time. And your hunger and thirst mechanism that, that part of you that like, makes you hungry and thirsty shuts off. So you don't really feel hungry and thirsty.

B (19:59)

Right.

C (20:00)

Your body actually feels better physically the drier it is. So at the end of life, dehydration actually feels better than being hydrated. Then you're in Ketosis, you actually get endorphins released. That helps dull pain.

B (20:21)

Interesting.

C (20:22)

And feel a little euphoric.

B (20:24)

Really? Wait a minute. So there's mercy in that somewhere. You know what I mean? That's actually really amazing, that opposite.

C (20:35)

Just so everyone, if anyone's listening. And it's like, what. Because I've seen that in the ICU where we're not letting people die. And we pump people full of fluid because we. Because that's what's going to keep their blood pressure up. So we pump them full of fluid, whether it's blood products or just regular, like, normal saline fluid. Because their body is dying, the body is not keeping that fluid where it should be in. Helping the body stay hydrated.

B (21:02)

It.

C (21:02)

It expands and starts causing edema going back into. Going into the lungs. Because the body's saying, hey, I thought I was dying here. Why are we floating with fluid? I can't handle this. And then they go into respiratory distress. And then you have to intubate them, put them on a breathing machine. Then their body is swollen, and then we have to diurese the body again, which means take off that fluid to try to get it back to, like, homeostasis. When the body is naturally doing something. Yes, we can try to intervene, but we have to do all these things to. To make it work, right?

B (21:38)

Yeah, yeah, yeah, yeah, yeah. When my dad got to that point where he was sleeping all the time, you know, and he felt far away, you know, what are they concerned with? What do we know about what they're experiencing? Are they full of regrets? Are they expressing things? What are dying people concerned with?

C (21:57)

From what I have witnessed, people die the way they lived.

B (22:01)

Oh.

C (22:03)

I know.

B (22:04)

Bald and neurotic. I'm gonna die bald and neurotic. Yes, yes.

C (22:10)

Listen, I take that heart because I think about that all the time. I always go, I'm so neurotic. How am I going to do this? Because. Okay, so truth. Truth for real. This is a good lesson for us, because I'm the same. I'm the same. I'm not bald, but I'm neurotic, so I really mean that. People die the way they lived.

B (22:32)

Wow.

C (22:32)

If your family didn't have a great family dynamic, you're not going to suddenly have this amazing family dynamic just because someone's dying. Sometimes the drama of it all or something can kind of bring people together. But most of the time, it's like, if you guys weren't talking before, you're probably not going to start talking. If they are willing to discuss the fact of that, with their loved ones around, even if that discussion is something like that sounds negative, like, I don't want this to be happening. I'm angry. This is happening. I'm sad, I'm pissed off. I'm. Whatever it is. Those people tend to live better and die more peacefully just because they were willing to acknowledge the fact that they understand it's happening. That is half the reason why I decided to get on social media, because I was like, people need to understand that talking about their death, talking about death and dying, even if it feels like in a negative connotation, it still helps.

B (23:30)

Oh, that's amazing. That actually, that reminds me of what you were saying. From a biological standpoint, from a medical standpoint, we die the way we live. That is one of the hugest things anyone ever said to me, that it reminds me of so much other stuff that I've read all the old Stoics, Seneca and those guys, Marcus Aurelius, they would practice death, right? Which I always thought was ridiculous, right. But they would wake up and say, what will it be like when I die? When it is hurt? When I'm eaten by a bear? What will that pain feel like? And they would practice that every day. But it's actually an amazing practice to accommodate that fact. Has to change the way you live, right?

C (24:14)

Yes.

B (24:15)

And because we die how we live. That's beautiful. I've already really liked talking to you. You're great. Okay. We're great. All right. So I found you through TikTok, right? And you had me bawling. A lot of what I was seeing there was hard to look at, but. But also very beautiful and extremely important. And I love that you're doing that because you're talking about the hard stuff. And I think one of the things you said was, are they safe? Are they clean? Are they comfortable? If so, you're doing fine, you know, but my instinct was like, no, I have to invent a camera system, and I have to get this special chair, and I have to do a million zillion things to fight back, to fight, you know, to struggle against this process that's happening. And I do wish that I had been more present, because the. The moments where I was present with that were the most important moments I've ever had.

C (25:27)

Yeah.

A (25:34)

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E (27:10)

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A (28:37)

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B (30:34)

Okay, I'm gonna ask you some questions. Did my dog know that my dad was dying in hospice? Because it looked like he did.

C (30:43)

I was gonna say yes.

B (30:45)

Oh wow. Okay.

C (30:46)

So I think so again, like, I think it depends on who, who you talk to. Right? But from my experience, animals know what's up.

B (30:54)

Yeah.

C (30:54)

I mean, time. Big time. Big time.

B (30:56)

Yeah. I walked into the room and I was like, ooh, this looks different. Things look different today. And then the hospice nurse was like, yeah, yeah, this is happening. And I said, oh, what do you think? Like, you know, days, hours, you know, like what do you think? She's like, I don't Know, watch the dog. The dog will know. And apparently just two hours before he passed, my dog woke up up as if he had heard something and went over and nuzzled my dad's hand. And my dad hadn't moved in days. And my dad, his hand woke up and pet my dog. Gosh, it's that story even now. But it seemed like he knew. Yeah, I like to think he did. I like to think he said goodbye, you know?

C (31:42)

Yeah. I've seen so many amazing things with, with dogs and cats, with the, with the owners where like they'll take off symptoms, they'll protect the, the, their loved one. They'll sleep under the bed. They'll sleep on the bed continuously. They'll howl when someone dies. Like, it's just intense. It's just intense. I just feel like dogs.

B (32:07)

I love dogs now. What do you think our healthcare system gets wrong about dying and death?

C (32:21)

A big sigh over here. So long to go. I mean, you know, in hospice specifically, the thing we get wrong is one, we don't provide. 24 hour caregiving for families.

B (32:36)

Oh, God. Yeah. That is so. It's impossible to get that. That's something you can never get.

C (32:41)

It's impossible to get it. Impossible because Medicare is our boss and Medicare says no working class families, which is most of Americ. They can't do it because they have to work. I mean, it's just insane.

B (32:52)

You have to be a billionaire. You have to be a billionaire to have someone 247 helping you die. You have to.

C (32:59)

I have made a video that says in order to die well in America, you have to be rich. I get sad watching people try to die well in our health care system and it's nearly impossible. Damn, you got me fired up, girl. Oh my God, Steve. I get so angry. Yeah, that's because it's so unfair. And there's nothing I can do. There's nothing I can do.

B (33:25)

I've seen this problem, but I'm less afraid of the moment of death than I am of the process of dying for some of these reasons. Like, I just imagine an ugly room with a linoleum floor and fluorescent lights and a hallway that smells like pee. And I'm like worried probably about what I'm leaving behind for other people to deal with.

A (33:50)

And.

B (33:50)

Right.

C (33:51)

Can I hopefully ease some people's fears and your fears after I gave that whole spiel of like, there's no hope. There is hope. There is hope.

B (33:58)

Okay.

C (33:59)

There is hope.

B (34:00)

Please really ease my fear of dying?

C (34:02)

Yes. Well, I can do that too, but. But Think. So the whole spiel I gave you have to be rich to die. Well, in America that is, that is the reality right now. And we have a chance to somewhat change that in when we plan for our death. At least have one person point of contact that knows what you want and don't want. So at least family members can know what you want and don't want. If you can't talk about it because you're not cognitively there, people need to know.

B (34:36)

It's hard to do. I mean, it's hard to talk to your family about death and dying. You know, it's hard to parent your parents. It's hard to, to do those things. You know, I'm also guilty of only kind of half planning my estate right now. And like, because I don't want to do it. I don't wanna. I don't want to do that. I don't want to think about that. I don't wanna, you know, But I, I think it is, I think it is really important. Oh yeah, wait, one more thing. Challenge accepted. You said you could ease my fear of death. That'd be great.

C (35:07)

Yeah.

B (35:08)

If you can.

C (35:09)

Okay, so your, your fear of death. 1 guess what, Steve.

B (35:14)

What?

C (35:15)

You are so normal for being afraid of death. Okay, so just because you fear death doesn't necessarily mean that it's going to be awful or like, there's nothing wrong with fearing death. I think there is something to like, fighting the resistance. Like, I can't fear it when really it's like, I can fear it. So please acknowledge that, take a deep breath and like, accept that, like, doesn't necessarily mean that like anything bad is going to happen just because you still fear it. So that's 1, 2. I really do think education helps decrease fear. So I don't know how much you've watched my videos or when you read my book, but education around death and dying can really, really ease fear because our bodies, like I said, are built to die. And there's really amazing things that can happen that will help us. And then three, I don't know if you want to go there here with this or not. But like, I don't know if you have fear of like. Well, we don't have to go there. I was just going to talk about like, because there's a reason why there's like, reasons why I don't fear death too. It happens to be because I believe there's like life after death. It's not a religious thing. It's. And I truly understand that it's A belief of mine. So, like, I never like to push my belief on people, but that's also another reason why I personally don't fear death, because I feel like when we die, we go to a place more like home than here ever could be.

B (36:39)

Really?

C (36:40)

Yeah. I've always felt homesick for a place that I can't remember.

B (36:45)

Oh, yeah. I can relate to that, actually.

C (36:49)

Yeah.

B (36:49)

Yeah.

C (36:50)

I feel like I've really been shown through other people's deaths that, like, that's. That's. That's what it is, that feeling of homesickness. I feel like when I die, I'm going to wake up in a place that I've always known, and it's like, oh, my God, how'd I ever forget this? And when I see babies. So another thing I always talk about is when I see babies being born, which is few and far between, but I have seen babies being born, and everyone there is like, oh, you know, it's like, oh, my God, there's a baby now. It's here, and it's crying. And I can weep because it's so overwhelming, this powerful feeling of, like, and now there's life here. And I can look at a baby, and I always think, like, where did you come from, baby? Right. And it feels like the baby knows something that I used to know. And it's that same homesick feeling, but it's good and it's bad because it's, like, nostalgic. But it's like, I miss it. I get that same feeling when I see people take their last breath.

B (37:50)

Death. Wow.

C (37:52)

I get that same feeling.

B (37:54)

Wow. So you're saying as someone who spends so much time with the dying and the moment of death, you feel a continuity from that moment and also the moment of birth.

C (38:07)

Yes.

B (38:08)

That's something you, as a skeptic and a realist perceive.

C (38:11)

Yes. And I think because it's not my grief, I'm not losing the mom, I'm not losing the dad at that moment anyway. I will eventually, someday, but the grief isn't there. So I feel like I can be present in the moment for what it is.

B (38:26)

That's so interesting. You're not seeing death through the distorted lens of pain and grief. You have a sort of, if I could say, privileged position of experiencing all of this death objectively. And that is something I never considered. This has been a very deep and awesome and meaningful conversation. Julie McFadden and I so appreciate you having this with us. And I think I need a minute to think about everything that you have said and to go contemplate my own life.

C (39:02)

Yeah, I hit you with a lot. I hit you with a lot.

B (39:05)

I can't wait to read your book. And you are an absolute delight and a treasure. So thank you so much for being here with us. This has been wonderful. Thank you, Julie McFadden. Bye.

C (39:15)

Bye.

B (39:23)

Right. I mean, that part where she said, what was it? Our bodies are built to die. Because our bodies do all these things to, like, sort of comfort and accommodate our death when we're dying. That I don't know. I don't know why, but that just does a little to make it less scary for me, I guess, you know? Oh. And it sounds kind of like maybe my dog and my dad got to say goodbye. For real. For real. That makes me feel very good. Yeah. But. But for me, it was when she said, we die how we lived. Yeah. Let's go outside. Okay. Wow. Yeah. That is definitely a lot to think about, huh? You know, the question that's that I'm thinking about now is if we die, how we live, and we know we're gonna die, but we don't know when. How. How do we live? Seems pretty big. You know, actually, I think I'm gonna just stop talking about this and take a minute in silence and just kinda think about that one. You're welcome to join me if you want. Well, I'm super glad we did this one. That one felt big. Anyway, sincerely, thank you so much for doing this with me. It really does mean a lot. Until next time. That is so pretty. It Alive with Steve Burns is a Lemonada Media original. If you haven't subscribed to Lemonada Premium yet, now's the perfect time. You can listen to the show completely ad free, plus you'll unlock exclusive bonus content from me as I reflect on this episode. Just press subscribe on Apple podcasts. Head to lemonadapremium.com to subscribe on any other app or listen ad free on Amazon music with your prime membership. That's lemonadapremium Alive is hosted by me, Steve Burns, and produced by Jeremy Slutskin. Our editor is Christopher Champion Morgan. Our associate producer is Akshaz Tharabailu. Audio engineering by James Sparber. Lemonada's SVP of weekly programming is Steve Nelson. Executive producers are Jessica Cordova Kramer, Stephanie Whittles, Wax and me. We'll see you next week. And you look great, by the way.

C (44:08)

Want to listen to your favorite Lemonada shows without the ads? Subscribe to Lemonada Premium on Apple Podcasts. You'll get ad free episodes and exclusive bonus content from shows like Wiser Than Me with Julia Louis Dreyfus, Fail Better with David Duchovny, the Sarah Silverman Podcast, and so many more. It's a great way to support the work we do and treat yourself to a smoother, uninterrupted listening experience. Just head to any Lemonada show, feed on Apple Podcasts and hit subscribe. Make Life Suck Less with Fewer Ads with Lemonada Premium. Are you looking for ways to make your everyday life happier, healthier, more productive, and more creative? I'm Gretchen Rubin, the number one bestselling author of the Happiness Project, bringing you fresh insights and practical solutions in the Happier with Gretchen Rubin podcast. My co host and happiness guinea pig is my sister, Elizabeth Craft. That's me, Elizabeth Craft, a TV writer and producer in Hollywood.

E (45:03)

Join us as we explore ideas and.

C (45:05)

Hacks about cultivating happiness and good habits. Check out Happier was Gretchen Rubin from Lemonada Media.