The Caregiver Cup Podcast

Mastering Hospitalization For Your Loved Ones with Dr. Monique Nugent

• Cathy VandenHeuvel • Episode 202

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Discover the keys to navigating the complex waters of hospitalization as we sit down with Dr. Monique Nugent, an experienced hospitalist and the author of "Prescription for Admission: A Doctor’s Guide for Navigating the Hospital, Advocating for Yourself, and Having a Better Hospitalization." Through our enlightening conversation, you'll learn how to be an effective advocate for your loved ones, uncover the pivotal role that hospitalists play, and grasp the significance of aligning with your loved one's values. Dr. Nugent's wisdom is invaluable, providing an list of strategies to de-stress and improve the overall experience during these trying times.

We dive into the essentials of personal health information management and the game-changing advantages of electronic medical records. Imagine the peace of mind knowing that your medication lists and specialists' contact information are just a touch away, especially during emergencies.

In our final segments, we tackle the emotional roller coaster of caregiving and how to enhance interactions with hospital staff. It's all about setting the right communication expectations, appointing a primary family contact, and acknowledging the crucial role of caregiver emotional health. Dr. Nugent's passion is palpable as she guides us through strategies to improve these interactions, emphasizing the power of a community that supports one another. Don't miss out on the wealth of knowledge and resources that Dr. Nugent shares, designed to fortify you with comfort, communication, and compassion in healthcare settings.   

In addition to her book, you can find resource on her website at drmoniquenugent.com/

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Cathy:

Well, my friend, I am excited for you to hear this podcast episode because I had the pleasure of interviewing Dr Monique Nugent. She's a practicing hospitalist and she'll explain what that is in the interview and associate director for the division of hospital medicine and South Shore Hospital in Massachusetts. But what I'm most excited about is she's the author of a great resource book. It's called the Prescription for Admission a doctor's guide for navigating the hospital, advocating for yourself and having a better hospitalization. It is really a complete guide providing the critical information you need to navigate the hospital. With her advice, readers can stay calm, feel confident and focus on healing after healthcare. She is so passionate and you're going to hear it in her voice about advocating for every patient by working to make healthcare safe and high quality.

Cathy:

In this episode, really, it is for anyone that's going to be hospitalized, and especially you, the caregiver, who has to take care of our loved one and navigate this complex healthcare system. But also, I want you to also think about potentially you might be hospitalized and this might be a great guide for you as well. Dr Monique breaks down what the role of a hospitalist is, how communication is so very important, having discussions with your loved one and understanding their values and really what they want from an expectation perspective. Having your loved one hospitalized is a very stressful time, and Monique, dr Monique talks about this In an emotional time. If you're going in prepared, though, and knowledgeable, it can actually decrease your stress and make it much more a positive experience.

Cathy:

So sit back and listen to this great episode. I will go ahead and put the author, the book, the name of the book and the link and Dr Monique's website information in the podcast notes as well. Well, caregiver cup listeners, we are in for a huge treat. Today I have Dr Monique Nugent on the podcast episode today. Dr Monique, you are like the very first doctor I've formally had on the episode. I've had some different expertise, but never somebody with your vast knowledge, and so I'm excited to talk about your passion, your expertise and, most importantly, helping us, as caregivers, navigate this world of hospitalization, especially with aging parents and aging loved ones. So, without further ado, let's go ahead and have you introduce yourself and tell us what you're all about.

Dr Monique:

Thank you so much. I really, really appreciate your time getting a chance to spend some time with your audience. So I am a hospitalist and I know a lot of times people hear that phrase. It may be the first time that they've heard that, but not the first time they've come across someone in my specialty. I am a board certified internist, which means I treat adults and only adults, but I have chosen to focus my practice on patients who are hospitalized. So I don't have an office where I go to the hospital. I'm the doctor who, when you come into the hospital, if you're too sick to leave from the emergency department, I'm going to be the doctor who do your admission and care for you throughout your hospitalization plan, your discharge and help get you out of the hospital.

Dr Monique:

It's like a essentially like the primary care in the hospital. Years ago it was that primary care doctors see their own patients in the hospital, but as time has gone on you've really come to understand that the care of acutely hospitalized patients is really its own specialty. It comes with its own set of expectations and complications, but also the hospital itself needs to be supported by having clinicians available kind of all the time to be able to patient care, improve flow through the system and help people get what they need. Safety wise, right, you need someone who can always respond in a hospital setting if someone has an emergency, and so that model of practice of being in your clinic and then going to the hospital in the afternoon really doesn't work that well anymore, right? And so it's the rare patient who will see their same primary care doctor in the hospital and in their clinic. You might see your cardiologist, you might see your oncologist, right? People who have a lot of business in the hospital, but really the primary set of people who are going to care for your hospital-based decision.

Dr Monique:

And so us, as adult professional internists, we're called hospitalists, but this type of practice is really kind of seen across medicine. There are pediatric hospitalists, right? So people who just take care of children in the hospital. You have acute care surgeons who are surgeons who just see cases in the hospital. You have laborists who are obstetricians, who just see patients who are in labor.

Dr Monique:

They would just work in the hospital, because we're coming to understand that the need of people in that acute illness time or that acute time of hospitalization is kind of different from what we originally thought that we could do as physicians is kind of split our time here, there and kind of everywhere. So I think I'm very flattered when patients ask me for my card to see, oh, can I see you in clinic? And I say no, unfortunately this is the only place, or fortunately this is for me. The only place that I work is a hospital, and so I've really taken it as my mission to help people understand the hospital and how interfacing with that system is a system within a system within a system and everything that you're kind of up against. So thank you so much for your time. I appreciate it.

Cathy:

Yeah, and it's definitely. You definitely have different people all the time and new challenges all the time when you're when you're that hospitalist and it's like that has to be very unique and different. You know, and I think about it, you're seeing people with acute conditions and I asked you today if you could speak about the aging population to help us caregivers through this stressful time and understanding how stressful it is and really what our role is, and so, and what does it take to go ahead and play that role? So can you help me? Can you help me understand, or help caregivers understand, when their loved one gets admitted to the hospital and they're the caregiver? What can we do to help you as the hospitalist to make that stay helpful for you? Gather the nuggets. I know you wrote a beautiful book on creating a checklist and all that kind of stuff, but if we're just all of a sudden our way to the hospital, what can we do to play an active role and help you?

Dr Monique:

Yeah, so I think the elderly population and people who are caregivers not just of their elders, but sometimes we're caregivers of medically frail loved ones and other types of relationships I think that there's actually a lot more preparation that people can do than they expect. So most of us will sometime in our life hospitalize for one reason or another. Most women in this country give birth in a hospital. That's one reason women may come in contact with the hospital. Slips and falls kind of an unexpected thing, and we just came through a pandemic not long ago where lots of people now were in the hospital, kind of unexpectedly. But if you're caring for someone, there's actually a decent amount that you can do to prepare you for a hospitalization. And, just like you alluded to, a hospitalization is extremely disruptive. It's not only going to disrupt the life of the hospitalized, but if you're a caregiver, your regular routine is also disrupted. What you're normally doing to care for your loved one now switches very different, and so being prepared actually is going to help you. And this is when I really encourage people to have open and honest conversations for your caring for around their wishes, their goals for their overall care. Why are they hospitalized and what are they trying to accomplish with that hospitalization. Each hospitalization may be very different. Some may be planned you may be going in for a planned chemo and say in the hospital, or it may be a slip and fall and a hip is broken and now we're here and we have a whole bunch of decisions. So the first thing is having conversations about values, goals and wishes, writing those things down and having the legal framework to support who's ever going to be able to be the caretaker or the decision Right. So and I have this conversation with adult children all the time Just because mom and dad is of a certain age, it doesn't mean they don't get to make their own medical research. And so, yes, you may be the person taking care of them, but if you don't present to the bedside and they never tell me to call you and they're alert and they're oriented and they're making their own decisions, I may never know.

Dr Monique:

Paul, I may say when you call your daughter, sharon, the conversation usually goes Sharon's so busy, she has the kids, I don't wanna bother her. I'll give her a call later, doc, don't worry about it. And then the next day Sharon says you never call me. I'm the one who cares for my mom, you never call me right. So setting up that framework by having healthcare pox filled out, advanced directives filled out, most form filled out and I talk about all of these in my book and have links in the plug through QRS quotes to take some of this form and then having them ready with your patient, the person you're caring for saying when they check into the hospital, here is a healthcare box with my contact information and meet with the doc on admission Hi, I'm Sharon.

Dr Monique:

Even though my mom's making her own decisions and she is alert oriented, we work together. I would appreciate a phone call, right. And now that conversation's had, the expectation is set in front of your mom, which helps a lot so that when I call it's not as high, but then also I have contact information. I have her wishes in case I'm not able to get in contact with you. You are supported by the conversation and the documents. You know if something happens and you have to make a more complicated decision, you're in line with that person's goals and values, right? So really, one of the two things you can do to prepare for a hospitalization is just that have open, honest conversations and set up a legal framework to support the caretaker when they come into the hospital. And I say to people the biggest gift you can give your children or your spouse, whoever's caring for you, is the directions that they know, that they're aligned and they're upholding your wishes and your values through the entire process, whatever the outcome.

Cathy:

Yeah, because we don't think about that and I'm sitting here feeling that way with now. I've been thinking about this, dr Monique, with my husband, my husband's going through. He's in his six plus year of chemotherapy, had a stem cell transplant, but we should probably be planned in just in case another hospitalization is needed and have further discussion because things have changed over the years.

Dr Monique:

Yeah, it's interesting. Yes, yeah, I always tell patients the best time to have these conversations is when you don't need to have them. If I'm looking at you to make a decision, it's usually because there's very few decisions to be made. And so have the conversation. And I know these are hard conversations, these are uncomfortable conversations. No one has ever like hey, pass the Brady. So let me ask you about your end of life wishes, right, but these are conversations that you need to have and they are nothing but support for the caregiving, because in all of the years that I've done this, I've been I think I counted seven different hospitals in, you know, across the both coasts. I will tell you that I have seen over and over again people say I don't feel like I can make this decision, and if you're giving your caretaker your wishes, they're not making that decision, they're carrying out your wishes, and that is a big relief, because a lot of people carry a lot of guilt if they feel like they're put in a position to make a decision that they don't know what.

Cathy:

Yeah, especially when there's multiple children or multiple family members. And, yeah, I dealt with my mom and dad both going through hospice care and being the primary caregiver and having to talk to them about mom's wishes and dad's wishes and yeah, we should have definitely had those conversations sooner, because you kind of carry the weight on your shoulder then about this is what mom had asked from me and there was no other discussion with the other two. Yeah, that can be very difficult.

Dr Monique:

Yes, and the second thing I say is to be the owner of information right. So knowing the medications that somebody takes and if you don't know them exactly, knowing where to get that information right, this is 2024. And so CVS, ball Greens, they all have electronic records that hospitals are able to tap into. So if you don't know all of it, say hey, can you call the pharmacy down the street. They have my list right. But the more information that you could own about your loved one and about yourself, that's gonna be a big boost for safety, and this is really the thing that I drive home.

Cathy:

Yeah, allergies as well, and all of that. Yes, okay.

Dr Monique:

Right, new medications that may be prescribed, we need to make sure they're not going to interact Medications that you chronically take that we wanna make sure you don't miss. Like anti-seizure medicines, right? I have seen several times where someone kind of comes off of the street. Nobody knows anything about them. A couple of days later they have a seizure, going to find out that, oh, they have a known seizure disorder, they were taking seizure medicines but we didn't have any information. So, like, these are vital things. So I always talk about be the owner of your information, know your medicines or where to get that list.

Dr Monique:

If you're cared for by a specialist like your husband, right, who is my specialist and how do I contact that specialist? Great, because hospital-based physicians sometimes it may all be within the same system so I have access to their notes. I may know them really well. Oh, I see Dr Jones, oh, I know Jim and I shoot him a message and we have this collegial relationship. Or you may be on vacation somewhere and your specialist is really far away. Are not tapped into that system and so having access to that person where I can call and say, hey, I have your patient here, is this something that would be consistent with your care plan or tell me what you know about them. Mrs Peacock, I'm seeing those things can be really, really helpful.

Cathy:

Yeah, definitely, definitely. I can see how somebody could be prepared coming in for surgery or coming in for a planned one, but then not being prepared when they come in. Otherwise I can share just a story with you, dr Monique. When my mom was midway through she was probably about a year and a half before she passed she was taking her own medication out of her pill boxes and she had bottles as well, and she couldn't remember if she took her last medication or not.

Cathy:

She ended up overdosing herself on medications and I was not the prepared primary caregiver that I should have been. But I said did you take your medication today, mom? She was, I don't know, and well, and I looked at it and it didn't look like she took it, gave it to her she was hallucinating and she was overdosing on her medications went into the emergency room and was so distraught that I didn't take anything with me. I have no idea what she was taking. So obviously we had to tap into that. But again, that was the last time I didn't do that and we worked through other avenues of care and got her one of those pill box pouches where you push them out looks like contraceptives almost, and we're all situated. So she never overdosed again on her medications because she was able to go ahead and take them correctly. But it took probably two and a half days to figure all that out.

Dr Monique:

Yeah, yeah, and so I'm sorry you guys went through all that and it sounds like having information is really the safety issue is important and the more information you can give your doctors and it doesn't mean it always happens or, like I said, there are lots of times people are kind of found down or have an accident or maybe your loved one isn't near and you can't get to them and it will get figured out. But if you can come in with more information than not, you're only going to be adding to the safety factor that we can look at the whole picture and say like, oh, maybe this kind of presents, like someone who took two doses of the infection, so let me not put it on the medication list for a PM dose in the hospital tonight, something like that.

Cathy:

Right, and one of the things that we should do as caregivers, then, is to have that information available and maybe even have that in some sort of area so that we can grab and give it to the doctors or know where it's from. What other advice would you have for that caregiver if your loved one is in the hospital? What else can we do to help the hospitalist be more efficient, get things communicated better or perform their responsibilities better?

Dr Monique:

So you use a really great word communication. So one of the biggest dissatisfiers that I see when I talk to families who are upset about a hospitalization tends to be around communication. People can often feel like they're not hearing from the doctor, they're not hearing from a specialist, they don't know what the plan is, and so I spend a lot of time in my book talking about how to communicate with your team, and the biggest thing is setting an expectation that is reasonable and achievable for communication. So that does require some work on your part. I once had a gentleman come to me very angrily at a talk saying you know, my mother was hospitalized and if I didn't sit at the hospital from 8am to 5pm, I never would have heard from physical therapy, Never would have met the XYZ person, no specialist would have ever called me and assist in that, and I think my answer to him was really kind of disappointing where I said well, if that is your expectation and that is how you felt the expectations met, then you do what you need to do, and if you feel that you need to sit there from 8am to 5pm, then it seems that that's the thing you needed to do. So when I talk about clear communication goals that are reasonable and achievable.

Dr Monique:

Understand and this is kind of the part where I don't want people to feel like I'm making excuses for the health care system but the people who work at a hospital are kind of overwhelmed. There are lots and lots of questions and right now particularly, we're seeing a huge amount of numbers in hospitals across the country. There are some people who are very unlikely to reach out to caretakers like physical therapy. So expecting to meet with a physical therapist or expecting to get a phone call from a physical therapist after they see your mom is kind of not really a common expectation and that is your expectation and setting that expectation to the nurse because maybe you have a specific question, right? Oh, when you see this physical therapist, he's asked a physical therapist if she qualifies for a walk-on, right. That type of communication is very different. But if you expect that everyone who comes in to see your loved one is going to call you, that is unfortunately not going to happen and you're going to be really upset and kind of disappointed.

Cathy:

Yes, that would not be humanly possible. That could be with hundreds and thousands of patients.

Dr Monique:

Well, I've come across a lot of different expectations and the thing is that none of these are in a vacuum, right. So they usually happen, like people tend to say. Like I had one family years ago who wanted the nurse to call every time they ate any medication to their loved one, and it really stemmed from years before that they had a bad medication interaction, they had fears around that. So, rather than what I did was rather than saying like because of MedPass, it's a really high safety time for a nurse and the nurse really has to pay attention, and so it's not really feasible for a nurse to call every time she goes to the medicine, what I would do is go over the list of all the medicine patients subscribed. This is what's on the list for today, right? So that was my way of meeting that experience.

Dr Monique:

But meeting with the team and introducing yourself, having one person as the point person for communication, right. So if there are three sisters calling and no one knows which sister they spoke to, the message may not get to the person that is looking for it, right? Because I speak to one person and I say, oh, I spoke to Sharon, I feel good about that and I didn't know it was actually like Claudia was looking to have the conversation. So meet with the team early or the hospice, right. Pick one person for communication and have that one person set a regular communication goal with the team or, I'm sorry, with the hospice. That the hospice community. So hi, I'm Sharon, I'm her caretaker, I'm the mom. I would really like to hear from you after you speak with the cardiologist. I would really like to talk about the care plan tomorrow at 2.00. Are you available? Right? So a clear, specific and that's something that's achievable, instead of kind of saying like no one spoke to me.

Cathy:

Yeah.

Dr Monique:

Go out there and you set the expectation, because then you can say you know, doc, I expected to hear from you after you spoke to the cardiologist and that didn't happen. Why not? What's going on, you know? And it puts things in the open, right, having that one person is key, because it is very difficult to make multiple phone calls and what ends up happening is, like I said messages do not get to who's.

Cathy:

Yeah.

Dr Monique:

Right. And the other thing is do not be afraid to call for a family. A family meeting is usually a time where big decisions are made or big communication is set out so that people know what's going on. And it's usually that I, as a physician, say, okay, I think we need a family meeting, and then we all kind of case managers will reach out and we kind of work together. But that's usually driven by the physician saying I have this big piece of information that I need a decision made on, or I feel like communications are very sticky here and we're trying to recalibrate.

Dr Monique:

Family members should feel motivated and encouraged to call family meetings themselves. You know, doc, me and my sisters don't feel like we're getting the full story here. Can we have a family meeting? And then this way you get everybody who is a stakeholder, who you feel needs to be there, on your side, there, and that also gives the medical team time to get everything that they need together to sit down and have good conversation.

Dr Monique:

Now I would say don't particularly expect the specialist can always be there, right?

Dr Monique:

Unless, like you're being cared for by the surgical team, it may not be feasible to find a time that the consultant, the surgeons, the cardiologists, can always be there, but your hospitals is supposed to know the thing that's going on, right, and if they don't know, their job is to be able to get you and it's okay to say that. Say, like you know, I don't feel like we have a really good plan for his oncology plan right now and I kind of expected that. Can we circle back to this? And you know, either you have the oncologist reach out to me directly or we come back and we talk about this plan when it's, you know, tomorrow, when you have got all the pieces Sure, sure, right. I mean, there's nothing wrong with having these conversations and making sure that you've set the expectation of the tone, and I do always encourage people to try and do those things in like a collegial and professional manner as well, because you want to be working together and having like tension and that therapeutic relationship be strained can make the whole hospitalization difficult.

Cathy:

Does a patient usually attend that as well? If a patient is a decision maker, a patient should definitely be Absolutely, because, yeah, you don't want a patient feel uncomfortable as well.

Dr Monique:

Right and I talk about that too in the book the setting of the meeting. Maybe we meet in the room to include the patient, or maybe the patient isn't the decision maker. There are little issues or things like that. There are a lot of pain and we don't want to be upsetting them, so we move meeting somewhere else. Right, I feel empowered to use the tools in my book and on my website or whatever tools you have, to call a family meeting and direct that meeting something that's productive.

Cathy:

Yeah, the questions were very, very helpful. I think the big things were being able to ask the questions, but ask them in the right way and be as specific as you possibly can. I think that's the big piece for me. That was a huge takeaway too. And to team together. I think when you had said the words team, we're a team, you're leading the care, but we can be that team member, that extra I, that extra word that we hear from your patient, that maybe the patient because I know taking care of my family members sometimes they, oh, we don't need to tell the doctor this or we don't need to tell the doctor that. And sometimes those golden nuggets are just what the doctor needs to hear and convincing, for example, my mom to tell the doctor. She sometimes would get kind of sassy back at me and I'm like, no, but that's good information for them to go ahead and take it and if it's not, they're okay with that. You probably heard it all.

Dr Monique:

Yeah, there's very few times where I'd say there's no information. Pictures of stool is one that I pass on and, you believe or not, people take pictures of their stool to show to me more than you think.

Dr Monique:

That's the one that I'm kind of like okay, but most of the time, you know you're right. Most information, more information, is really good and and we really do depend on you as caretakers. A lot of my conversations with caretakers start with hey, you know, this is the first time I'm meeting your mom how far away from her baseline, how close to her usual selfish. You know, as the caretaker, you know this person best. So who I may think is you know, someone who is, you know, doing well. You may say like oh no, she's a lot slower than usual. You know, no, usually she's a lot more jovial and and joking. So I don't think we're going.

Cathy:

Yeah.

Dr Monique:

Right, and so we really depend on you as caretakers.

Cathy:

Yeah, another question I have is what is like the biggest barrier you have when it comes to that caregiver? We talked about that caregiver that wants to stay there all day and doing that. Are there other things that a caregiver does that may I don't even know what the word is impede or slow down or stay? Kind of put that wall between you and the hospitalist or you and the patient Can you elaborate on that?

Dr Monique:

That's a great question. No one's asked me that before. So I think that I've found over the years caretakers who are scared and there's lots of reasons behind it, right and a lot of times people have had really negative experiences and hospitals I always say all the time hospitals are not fun places Right, like nobody wants to be there. I jokingly say they, they paid me to show up today and you came here, great, right. But I think that sometimes, when people put up their own emotional walls, Okay.

Dr Monique:

And they are not emotionally accessible, or they may be. You know, I think in this country we have an idea that aggression is the only thing that gets things accomplished Right, sometimes bringing that fear, that anger, those barriers into an interaction. I can't tell you how many times I've met family members and as soon as I walk in their hands, across their chest, their lips are cursed and they're ready to fight. They expect that this interaction is going to be Right, and I now have to spend some portion of my time disarming that person and bringing their arms down across their chest so that we can have this conversation Right. And so I would say, just kind of think about what are you emotionally bringing into the space? Yeah, what are your own fears, your own expectations, your own goals for your, for your loved one, right? And? And how, how can we work together to achieve those? Because the truth is, if you're a caretaker, you're coming there from love, right? And so, really, the thing that you want isn't going to be harmful. You're not. You're not wanting to hurt them, you're wanting to help and you're wanting to. You know, see the one love either go back to the person they were, or not being paid, or come home or something Right. And so just think about what are you emotionally bringing into that space and how can you maybe open yourself up a little bit to be part of the team, your own vulnerability, your own emotions to you know, partner, because sometimes bringing fear and anger, it just makes that interaction kind of difficult.

Dr Monique:

And I say that knowing that, and I've said it, hospitals are not easy. People have had really hard times in hospitals, you know, like there's there's reasons people don't like doctors. There's there's reasons that people say did you call my primary care because they have faith and trust in that person. Just met me, you don't know me, and so there's a lot Right, but the therapeutic relationship for me in a hospital, as a hospitalist, isn't just patient, it's what their support system. And so if I can, if we can build that bridge and we can get along and you can help me see your point of view and eye to eye and we can have a easy, flowing conversation, that would that. That would be gang clusters.

Cathy:

Yeah, yeah, definitely, cause you're building a team. I mean, yeah, and as a care, as, as a caregiver myself, going ahead and saying this is my team now, this is, this is who I need to help, so and so, get better, yeah. So, what advice, dr Monique, would you have for a caregiver when it comes to their self care when their loved one is in the hospital? This is the time for them I'm selfishly thinking about this. This is the time for them. They have the extra hands, they have the extra people taking care of them. Most caregivers don't want to leave, but in the long run, they're going to eventually have to take care of their loved one in a positive situation when they leave and be ready to go ahead and, you know, take on that major role again. What, what is the job? Yeah.

Dr Monique:

Yeah, all all of the conversations are. They're an active process. They're very active process, right, and so as much as the patient is there getting tests done and meeting with your specialists and getting symptoms managed and medicines and wound care and all that stuff, the caretaker is running around getting information, calling all the different family members, talking to the specialists themselves, making sure they have extra stuff at home or if a hospitalization is kind of leading more towards comfort care and end of life care, emotionally getting to that place and a lot of times you're bringing family members and loved ones along with you on that emotional journey You've been talking about that.

Dr Monique:

Okay, hospitalizations are not respite care. Respite care is where say, hey, I'm gonna go away from the weekend, I'm handing over the care of my loved one to someone who is ready to take this stable situation. But a hospitalization is, something is happening, things are not stable, and so if you, as a caretaker, burn yourself out, how are you going to pick up the ball to the rest of the journey? A hospitalization in this country is average five days. Okay, right, and those are five hard days, but the rest of the time is at home, going in and out of doctor's office, so you can't kill yourself on those five days. And this is where your community comes in.

Dr Monique:

Reach out to people, love and support you as a caretaker. Right, call your best friend. Unload mom's back in the hospital. Can't believe this is happening again. And she's like I'm gonna come over with my crock pot. Let her come over with her crock pot, right, find some time for yourself. Which sounds easy and kind of horrible at the same time.

Dr Monique:

I'm a Niki mom. My first daughter is in the Niki and the neonatologist very lovingly held my hand and told me do not come here tonight, go home, lay down, see your bed with your husband, your children. Your child is with a professional, but if you keep coming here, you will have nothing to give her when she leaves Perfect. So if that means asking people to sit at the bedside while you go home and take a shower, do that. You can't do everything.

Dr Monique:

Reach out to your community. Whatever community holds you up Is it your church community? Do you have sorority sisters? Is it your neighbors? Whoever it is holds you up, let them know you need care as well, because those four and a half five days, that's a journey. That is active time. That's active planning and worrying and calling. And so sleep at night. Let someone buy you dinner. Take your own medicines. I can't tell you how many times I've responded to medical emergencies in an obstetric unit because the father forgot to take his medicine Right, because he's there and not caring for it. So take your own medicines. Take care of yourself with whatever moments you can't, because this is hard. And whoever holds you up, let them hold you up. Let them hold you up Because what you're doing for your person, you're caring for, is a lot.

Cathy:

Well said, dr Monique. Well said because I never really you created a better picture for me, because right away we all think we're wearing these capes and we're super woman and everything's going to work out. But it's not sustainable to go ahead and go at that pace all the time, and I'm sure you see it all the time. So good, good, well, this has been very helpful. Do you have any other advice that we did not cover, that maybe you've answered in a different previous interview or something you said? I got to take care of this.

Dr Monique:

Something that I always tell people to do is we talked about talking about your goals and values before hospitalization, but I don't think that we enough debrief after hospitalization. Because and I'm finding what I'm talking to people as a fairly new concept because a lot of the times you get home, you're just happy to be home and so you may not want to revisit the thing that just happened, right. Or you're home and now there's a new diagnosis and new specialists, a new this and new that, and you're just taking that ball and just dribbling, just continue, never put it down right. But there has to be a process, unpacked the things that happened, and so, if you can maybe try and find that time to sit down with your loved one who you hear for, and yourself, or and sometimes it may be in the primary care doctor's office where you go for your post hospitalization visit. So, like what just happened, Like for real, like what just happened, we were in the supermarket and you clashed your chest. You said you had chest pain and now you have like a whole bunch of new like hardware and your chest ate medicines.

Dr Monique:

Like, oh my God, what just happened to us? Right, Like decompress that and say, like this is what we went through and how does that change the conversation of goals and values? Do we now have a new diagnosis and what do we think around that? What does that value mean to me in my I'm sorry that new diagnosis mean to me in how I'm gonna live my life and expectations around pain and suffering and end of life here? Or did I just want you to have a heart attack in this middle of the supermarket? Okay, I guess this is how we change our diet. This is the things that we're gonna do together as a family. We need to have conversations with mom and dad around most forms. Most forms are mobile orders for licensing treatment which is like are like shock infections right, Because I didn't know what to say about hospitalized. So find some space, and that may take many conversations, but find some space. Unpack the hospitalization.

Dr Monique:

What happened, and what does that mean to you now?

Cathy:

Yeah, and all the lessons that you learned along the way and discussions that, yeah, it's a lot to process. It is a lot to process I think about it when my husband has a stem cell transplant back in 2022, and he spent six weeks. We spent six weeks away from our home and went through it because he has Hodgkin's and non-Hodgkin's lymphoma and we laughed, we were so excited to be home. And then we got home and I was so afraid. I was so afraid and they prepared us enough, but we didn't process either, because I mean, you have to clean everything down, you can't have guests you can't have, you can't eat off the deli or a buffet for a year and all that kind of stuff, and it's like Everything has changed. Everything has changed and, yeah, that's a really, really good point because it is scary, but it also is an important step that a lot of us think, oh, we're fixed, we're gonna go home and things are gonna be back to normal. They're not.

Dr Monique:

Homes might look very different. They come home with new equipment. They come home with new pain, right Like you make them home with new wounds. You make them home with new doctors names. They like oh, now I have to meet an oncologist, what does that mean? Now I have to find a dermatologist within our healthcare. Things are insurance, which finding dermatologists very difficult, right Like home, unless you're like 22 years old and you broke your arm playing tennis. Right, and even that person goes home with a different home because they have a cast. The hospitalizations for the elderly are, I should say, our older family members. They come home with a whole new set of equipment and expectations and fears and appointments. Right, if they can go home because they may have to go to rehab, they may not be safe enough, that's true. So home. You know, there's many times where people will look at me and say, like we have eight stairs to go up. There is no way mom can make it up the stairs right and then to convince them.

Cathy:

Sometimes the loved one they can't go home is another.

Dr Monique:

That's another one. They're like oh, going home, going home yeah, Well so yeah, home can be anywhere.

Cathy:

This is a book, and can you tell everybody the name of your book? Because this is a book that I think that you don't just buy when you need it. I think, as a caregiver, this should be something that you put on yourself and keep and have it there as a resource. Now Do some of the things to be proactive now, but also have it when the time is needed. So can you tell us about the book and how it all evolved for us?

Dr Monique:

Yeah, thank you. So the book is entitled Prescription for Admission a doctor's guide to navigating the hospital, advocating for yourself and having a better hospital. And so you're right. I've written this book to be used. It has places for you to fill in. I talk about trying to encourage people to have these conversations around their values involved, so I've got questions and places for people to write their thoughts in. I've got QRS codes to take you to your state's most form, because every state has their own most form.

Dr Monique:

I've got a QRS code for us, a quick guide that you can keep on your cell phone and kind of have easy access to. This book is meant to be used, and so this really came out of the thought process that, like I said, I worked on the East Coast the West Coast about seven different hospitals in my career so far, and there's nothing new under the sun when it comes to the same frustrations people have had over and over and over and over. And so I really thought during COVID, when people were learning how to crochet and make sourdough bread, I thought to myself when I wasn't patient at the hospital, I got to put pencil paper and I'm gonna write this down and I'm going really hard to make sure that people have the tools, because I love the hospital as a place to work, I love the energy of it, I love my colleagues and the great conversations that we have and the way we work together to help patients. I've seen amazing things happen. I've seen people diagnosed with things and treated so quickly and live safe. But I've also seen really horrible things happen and I've seen people really struggle. I've seen bad outcomes. I've seen medication errors. I've seen communication problems. I've seen people leave feeling as if they were put through a boxing match and they came out with nothing good and I don't want that to be the story that people have.

Dr Monique:

And that's hard because every hospital is so different and every person has their expectations. But there are some skills you can learn. There are some expectations that you can set early. There's some things you may not know. There's. So. Many times I hear people are frustrated with the fact, like urgent care didn't XYZ me. I'm like urgent care is not an emergency department and they're like what is the difference? What is a stroke center? What is a cancer center? What are the levels of trauma center? Like I thought this was a trauma center. Why are we sent to another place? You know so there's the hospital system in this country is extremely complicated and the system built to support it is extremely complicated, and there's no class in high school need how to win at hospitals, and so I thought I'd put pen to paper and try to help people out.

Cathy:

Yeah, the statement that got me the most was a positive experience to for comfort, communication and compassion, and I love that you have have that somewhere I don't know if that was. Somebody wrote the review or something but because it is understanding how stressful hospitalization can be, but the ultimate goal and values are making it a positive experience. I mean that's the big thing. And if we as a patient or if we as a caretaker or caregiver, if we can be a little more proactive and you give us this resource, I think this is just one thing that as caregivers and as you're listening caregiver couple listeners you can go ahead and utilize. I mean I think it was Dr Monique you have it so cheap. I think it's $15. I am sorry it's not. It's not like it's this huge expense, but it can be this major resource when and if you need it.

Dr Monique:

Yeah, I've got some free downloads on my website. Dr MoniqueNujikcom downloads around knowing your medications. There's one about family meetings planning the family meeting, because I think that's a really big one, and if you sign up on the website, I'm gonna start a blog in February.

Dr Monique:

I'm gonna start getting things out more, I should say, more regularly. I haven't done it at all, but I'm gonna start getting little blogs out regularly. I've spent the past year kind of listening to the community about what their questions are and what is really out there as a need, and I'm gonna try and get some writing out on a regular basis. So please check out the website, dr MoniqueNujikcom. Check out the book Prescription for Admission. It's on Amazon, barnes, nobles, anywhere that you buy books online and I'm gonna build this community and really care to support people who are caring for others who come into hospitals, which could be any one of us. You're a 23 year old playing tennis, right, and so let's be a part of a team, see how we can get all this information out and support each other so we can feel a little bit more comfortable in the hospital.

Cathy:

Well, yeah, and thank you for being the pilot or the navigator for us, because this is just a huge, huge service that you're providing to us. I can't thank you enough for being a guest today on the Caregiver Cup podcast Listeners. I will put the book name and the link out there. I will put Dr Monique's website out there so that you can check out her resources that she has available to you. So thank you for taking the time out of your busy day and, as always, Caregiver Cup listeners, here's another great resource for you.

Dr Monique:

Thank you so much. Let me just.

Cathy:

Wasn't that a great interview. I really could have talked to Dr Monique for hours, but hearing that she understands care from the patient and the caregiver side gives me a bit of peace, especially when she provided this great book and even further resources on her website to help us. As she said, this book is available at many locations. I bought mine off of Amazon for less than $15, and the scan codes are helpful as well. My hope is that this will give you a plan and hopefully will reduce your stress if you ever have to be in this situation, and I hope you take her advice on finding your team and letting them help you in the stressful times, especially when you are needing it the most.

Cathy:

If you like this episode, please take a moment and tell us, tell Dr Monique, tell me by giving us a review on your podcast application or sending an email. I'm at Kathy at KathyElvanncom, or take us on your favorite social media site like Instagram or LinkedIn or Facebook. Tell us your key takeaways, because we wanna hear those, because there's so many in this episode. Thank you again for listening to the CaregiverCup podcast. Until we meet again next week, have a good rest of your day. Bye for now.