Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.158 The Truth About Dying: What Hospice Nurse Julie Wants Every Family to Know

• Michele Henning Folan • Episode 158

Share episode

How Understanding Death Can Help You Live More Fully — with Hospice Nurse Julie

This episode of Asking for a Friend is sponsored by Better Help. https://betterhelp.com/askingforafriend

What if facing the realities of death could actually help you live with more intention, gratitude, and peace—right now?

In this powerful episode of Asking for a Friend, I sit down with Julie McFadden, better known as Hospice Nurse Julie, a former ICU nurse turned nationally recognized hospice educator with over 15 years of experience and millions of followers online. Julie’s mission? To normalize conversations around death and provide comfort, clarity, and dignity at the end of life.

We explore:

  • The most common experiences people have at the end of life—many of which are rarely talked about
  • How Julie transitioned from ICU to hospice, and what she learned about life in the process
  • Practical advice for midlife women navigating aging parents and caregiving responsibilities
  • How to prepare emotionally and logistically for end-of-life situations—with grace and self-compassion
  • Why contemplating our mortality might be the greatest gift for living more meaningfully

Julie’s new Nothing to Fear Journal offers a compassionate guide for reflection, planning, and healing—and this episode delivers the heart and honesty that midlife listeners crave.

✨ If you’re supporting aging parents, feeling overwhelmed, or simply curious about what a peaceful end-of-life journey can look like—this episode is a must-listen.

📘 Find Julie at https://www.hospicenursejulie.com/ and grab the Nothing to Fear Journal, available mid-June.

This episode of Asking for a Friend is sponsored by Better Help. Get 10% off your first month of therapy. https://betterhelp.com/askingforafriend

_________________________________________
Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling run-down. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan

Have questions about Faster Way? Please email me at:
mfolanfasterway@gmail.com

After trying countless products that overpromised and underdelivered, RIMAN skincare finally gave me real, visible results—restoring my glow, firmness, and confidence in my skin at 61. RIMAN Korea's #1 Skincare Line - https://michelefolan.riman.com

*Transcripts are done with AI and may not be perfectly accurate.

**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.

Michele Folan:

Let's be honest, midlife can feel like a lot shifting roles, changing bodies, aging parents and sometimes you just need a safe space to talk it all through. That's where therapy comes in. It's not a sign of weakness, it's an investment in your well-being and with BetterHelp, getting started is easier than ever. Betterhelp is entirely online, so it works with your schedule. You fill out a brief questionnaire and get matched with a licensed therapist in as little as 48 hours and if it's not the right fit, you can switch. No awkward breakup required. Give yourself permission to feel better. Visit BetterHelpcom forward slash. Asking for a friend to get 10% off your first month of therapy. That's BetterHelpcom forward slash asking for a friend. Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife.

Michele Folan:

I'm your host, Michele Folan, and this is Asking for a Friend. For many of us in midlife, the reality of aging parents, shifting roles and our own mortality starts to feel very real. Yet it's still one of the most avoided conversations, whether you're supporting aging family members, facing big questions about your own future or simply curious how to talk about death without dread. This episode is honest, empowering and full of heart. Welcome to the show everyone. On this week's episode of Asking for a Friend, I'm joined by the incredible Julie McFadden, a hospice and palliative care nurse with over 15 years of experience, known to millions online as Hospice Nurse, Julie. Julie's mission is clear to replace fear with understanding, denial with peace and silence with meaningful dialogue. She's the New York Times bestselling author of Nothing to Fear and her newest project, the Nothing to Fear Journal, offers a deeply personal, compassionate guide for exploring what really matters at the end of life and how we can prepare, emotionally and practically, starting now. Julie McFadden, welcome to Asking for a Friend.

Julie McFadden:

Thank you so much for having me.

Michele Folan:

I'm excited to be here. So, okay, first of all, before I roll into this conversation because this conversation is very meaty please share some personal details about you, like where you're from, and anything you want to share about your family, like where you're from and anything you want to share about your family.

Julie McFadden:

Okay, so yeah, my name is Julie. I live in Los Angeles. Now I've been here for about 13 years, but I grew up in Pennsylvania. I'm 42. My sister is also in California with me, so her and I both live in Los Angeles together. The rest of my family's back in Erie, Pennsylvania. I'm a nurse. I've been a nurse for 15, I think 16 years now and I'm also a content creator. Like you said, I go by Hospice Nurse Julie online and an author. Now I mean, wow, all these things have kind of unfolded in the past few years and it's been really exciting and kind of mind-blowing that people want to learn about death and dying and hospice and palliative care, what that means, so it's been really cool.

Michele Folan:

Well, so first of all, congratulations. You know New York Times bestseller and with the popularity that you've gained on social media. So kudos for all of that, thank you. That's fantastic.

Julie McFadden:

Thank you.

Michele Folan:

But you know, you're in a career that, first of all, anyone like myself who has known someone that has gone through the hospice process, you all are angels, incredible, incredible people. So again, just a little pat on the back there for you, for what you're doing, and and and not just for the patients but for the families, because there's that interconnectedness there that you have with them as well. Yeah, yeah. So take us back to the beginning. I'm I would love to know what led you to becoming a nurse and then, specifically, hospice and palliative care.

Julie McFadden:

Yeah, I mean the journey to becoming a nurse to me is like kind of immature, if I'm honest. In my early 20s I was a little lost. I had a degree in psychology. I was working in a hospital as something called a behavioral tech, so I was working in like a mental health floor where people were going to get help because of whatever mental health issues were going on right and I was like running groups and talking to people individually and just doing different things that someone with a undergrad in psychology would do right. And one day a woman had a seizure right in front of me and she fell and cracked her head open and there was like blood everywhere and really like it was so shocking to my system in the moment when it happened and I ran away, I yelled and I ran opposite of this.

Michele Folan:

I didn't help this woman.

Julie McFadden:

I ran and I went to get the nurses. So I did get help for her but I did not help her. And I remember being so shook up and having this image of all these nurses running down the hallway to this woman and I remember thinking it was like in slow motion. I remember thinking like I want to be like that, like how come they can do that? How did they?

Michele Folan:

do that, running to danger instead of running away from it.

Julie McFadden:

They had to sit me down, other people had to sit me down in a chair because I was about ready to be the second patient, because I was so shook up by what I saw. But that made me be like I want to be that. I want to know up by what I saw. But that made me be like I want to be that, I want to know how to do those things. And the woman ended up being fine. I saw her the next day. I went to go visit her the next day. She ended up being fine, so that all was great. That kind of made me think would I want to be a nurse, like? Instead of thinking like, oh, I could never be a nurse, I thought I want to learn how to like run towards that when that happens.

Julie McFadden:

And then my friend was in a nursing program. So the school we went to had an accelerated nursing program where you could get your bachelor's degree in three months. So it was this really intense accelerated program and at the time, because I had already gone through school, like four years of school, I was like I could not do another four. I could not do another four years. No, but this three semester thing where you bust your butt for three semesters. I could maybe do so through a bunch of. It took a really long time and it was actually really hard to get into the program, but I eventually did. And then I got my bachelor's degree in nursing and that started my career out.

Michele Folan:

But your background in psychology I can see being super helpful, though Totally, in what you're doing now. So, even though your career path wasn't linear, necessarily, there was a purpose in all of this that you're now discovering.

Julie McFadden:

Yes, of course I can look back on my life now and be like, wow, look how it does all seem to flow. It's like when you're in it it doesn't feel like that, but looking back it's easy to see like, wow, I met this person and this happened and because of that I did this and it feels really cool.

Michele Folan:

Yeah, yeah. And then when did you transition into hospice?

Julie McFadden:

I think it took me about eight years of being a ICU nurse, which do not do that, folks.

Julie McFadden:

It was probably after two years of being an ICU nurse, I was like I hate this. I hate this. I hate nursing. I made the wrong choice. This is not for me. I can't do this anymore.

Julie McFadden:

So it was probably like four years just strictly in the ICU and then maybe another four years like being a travel ICU nurse, then being an agency nurse and just trying to like find my way in nursing, because it was like I worked so hard to get this degree and here I am like really not enjoying it. And then finally, through my experience of being an ICU nurse, I finally was like you know what? The thing that's lacking here is this idea of not discussing that people will have an end of life. And I saw we did many wonderful things to keep people alive and they did survive in the ICU, but there were many patients where we took way too long to say something to the family about. You know, this is probably the end. This is, they are not going to get better. And I just saw that.

Julie McFadden:

You know, it took a while, but I finally saw that I could be an advocate for people like that and even though the advocacy was them eventually dying, it felt better than trying to keep them alive, like that, felt like we were causing more pain and suffering than anything. So I thought I remember having this thought, like if people are going to die, we all are eventually from one thing or another. You know there has to be a better way to do this, and that's what got me thinking about hospice, and it basically just took me a million years to take the plunge and change and change. So don't do that If you have it in your heart already. I probably had it in my heart like three or four years into my ICU setting, but then I took another four to actually take the plunge.

Michele Folan:

Yeah, but some of that is that we just lack some of that confidence to say, okay, because you're learning, you're learning something new again, right, and you feel like you're starting over in a sense. So, yeah, and then so you do hospice, and then you decide to take your message online. Did you ever expect to become, I mean, really a social media sensation? I mean, I'm going to call you what you are with over.

Julie McFadden:

I honestly can't even. It's so hard for me to take that serious. But thank you, I'm definitely just a normal. I'm a normal girl over here. I don't know what I'm doing. That's the truth, but thank you yes go ahead.

Michele Folan:

Yeah, but you know many of my listeners they're 50 plus. They are navigating aging parents and caregiving. What advice would you give them as they step into that role?

Julie McFadden:

Oh my gosh, there's so many avenues to take there. There's so many avenues, so one. I think it's really important to just talk about how hard it is, because I think about it as like new parents, right, when new parents have babies and they're like whoa, why didn't someone tell us like this is super hard? Why do I feel like I'm constantly failing? Why does it feel like there's nothing out here to help support me? How is anyone doing this?

Julie McFadden:

I'm not a parent, but all of my friends are parents and they all tell me this. They all say we have a dual income, we plan for children, we did all the things and it still seems so hard. Right, how is everyone doing this? And I equate that to taking care of aging loved ones or someone who's terminally ill or has a life-limiting disease. It feels like that because that's what I hear from my families on hospice and palliative care. Like no one told me I was going to be in charge of everything. No one told me I was going to have to act like a nurse, somewhat right, like no one told me this.

Julie McFadden:

This is so hard. How does anyone do this? And, honestly, I don't fully have answers to make it less hard. I have some tips and tricks, but also, like I like to just normalize that you're not losing your mind here. It's actually that hard and there are missing links in our healthcare system and this is one of them. So I like to just bring a voice to that so people know that they're not alone.

Julie McFadden:

Everyone's thinking this You're doing the best you can, and that's the thing I want to drive home is like whatever you're doing, you're doing the best you can. And if you need more help, be the squeaky wheel right, be the advocate to the doctors you're working with, to the nurses you're working with, to be like listen, I need help, I need help. What else is there for me and my loved one or my loved one needs help. And the last thing I'll say is to try your best to prepare as much as you can, which it's really hard to prepare. If you don't know what to prepare for, you're like but how, what, what do I need to prepare?

Julie McFadden:

I think that's where my videos come in, my book comes in, the journal comes in. I hate to sound salesy, right, it's not about that. It's about you do need someone else who knows how to do it, to guide you through it. Hence how the social media thing developed. I realized there isn't much out there to support people. So, yeah, you got to plan and you got to know what to plan. It'll help you.

Michele Folan:

Hey, Julie, we're going to take a quick break and when we come back I'm going to talk a little bit about the sandwich generation and some of that preparing that we need to do. You listen to the podcast. You might even see my reels on Instagram. Perhaps you've even clicked a link or two, but you still haven't made a move. You're still waiting for the right time to start.

Michele Folan:

But here's the truth. There's no perfect time, but there is today, and if you're feeling stuck, low on energy and like your body isn't responding the way it used to, you are not alone. That's why I coach women through Faster Way. We start with the basics fueling your body with real food, building strength and finally learning how to support your metabolism instead of fighting it. No extremes, no restriction, just a support your metabolism instead of fighting it. No extremes, no restriction, just a smarter, proven approach for women over 50.

Michele Folan:

If you're even a little curious, click the link in the show notes or shoot me an email. I'm happy to chat with no pressure, but maybe it's time to stop watching and start doing. Let's do this together. Okay, we are back Before we went on break. I wanted to bring this up about the sandwich generation because so many women my age are taking care of their aging parents and they may even still have kids at home. And you know we talk about being prepared and it's like I don't think anyone ever prepares you for what this hospice journey can be like, because it can last a very, very long time, right.

Julie McFadden:

Right, they can be on hospice. I mean, depending on the disease, right? A lot of aging people are on hospice for dementia or Alzheimer's or Parkinson's disease or congestive heart failure, which is a long-lasting, life-limiting disease, so you can kind of be on hospice, be off hospice. There's definitely a period of time and this is the hardest time, I think when you don't really qualify for hospice but you need help and there's not easy answers for that. This is what I mean by missing links in our healthcare system. This, okay, this Aging people who need extra help they don't quite qualify for hospice. Even if they did, hospice does provide things, but they still don't really provide the custodial care, which is like the day-to-day care of someone, just to be there, to kind of like watch them, make sure they're safe, make sure they're getting the food they need, right? That's not provided by hospice. So it's the families that have to step up, and most people don't know that and most people aren't prepared for that.

Michele Folan:

Yeah, because it's maybe not a nursing home type of situation, right? So a friend of mine has a brother who has had some serious health issues and he is in hospice now. He's in his late 50s, I think, but he's in hospice now because his weight got down to a certain place where they just made him eligible for hospice. Is that state?

Julie McFadden:

by state. No, all hospices in the US should be acting under the same guidelines because Medicare is the one that funds hospice. So, depending on what disease you have, what disease you're coming onto hospice with, there are certain criteria for specific diseases. Now, every once in a while there's like strange outliers. I'm not sure what disease he has, but there's like I say strange because it's like there are little outliers of well, they have this specific disease that's not technically terminal, but they might be because they're so malnutritioned.

Julie McFadden:

We basically have to prove to Medicare that they will likely die in six months. That's the main thing the hospice has to prove to Medicare to make someone eligible. So sometimes we'll look at factors like malnutrition. We'll look at their albumin level. If it's below a certain number malnutrition We'll look at their albumin level. If it's below a certain number, that tells Medicare that this person will likely die within six months. Now will they? That's who knows right and maybe they'll be able to stay on hospice for a year or two years if we can continue to tell Medicare. Hey look, they are still showing signs that this might happen and some hospices are better at following guidelines than others. So there are some more lenient hospices that will take people on, even though they may not technically meet criteria. So it just depends.

Michele Folan:

Okay, so we're looking at organ function basically, so like kidney, liver, that kind of thing, then in determining how much longer somebody may live.

Julie McFadden:

No. So the way I would look at it is like there's and again this is general, but generally speaking there's two types of patients. There's patients with metastatic cancer, meaning cancer, like a cancer diagnosis. They are a little more quote unquote easier to get onto hospice because it's a little more obvious. We know this type of cancer, we know where they are in the progression of this cancer. We're used to seeing it. There's weight loss, there's functional loss, there's pain, there's shortness of breath, all these different things that we're looking at. So it's a little more obvious.

Julie McFadden:

Then there's the other type of patient that has life-limiting chronic illnesses like COPD, which is a lung disease, chf, heart disease, a stroke, with different symptoms, and they've been living with these symptoms for a long time and now they're not doing well. Dementia, alzheimer's Dementia and Alzheimer's are really actually difficult. It's difficult for people to get onto hospice because you can live a long time with those diseases Parkinson's, ALS, things like that. Those people with those diseases. We have specific criteria and I won't go through every single one because it's just it's like mind-numbing. That's like a mind-numbing thing for a hospice nurse, right, you have to like know all these things to know if they meet the technical criteria to be on hospice and that criteria is supposed to gauge how close this person truly is to death. Because it's really hard to know with those diseases, because they ebb and flow so much. Does that make sense?

Michele Folan:

Yeah, so are you partnering with the doctor to make that full assessment of that patient Correct?

Julie McFadden:

Yes, we're always partnering with the doctor and all of us who work in this field. If you work long enough, you kind of know the criteria like the back of your hand. They give you booklets in the beginning so you can kind of learn. But you and the doctor know the specific criteria. And of course there's times when I see someone who's 98, right, and they technically don't have a terminal diagnosis. But here they are, they're not eating, they're not waking up, they look very, very close to death and I have to work with the doctor and work with the family to kind of get a diagnosis on our own so they can meet criteria for hospice. Because clearly they're 98, they're not eating, they're barely drinking, they've been sleeping 24 hours a day for three days straight. We can put them on hospice. But technically, per Medicare guidelines, we have to have some kind of diagnosis that shows this Right. So there's a gray area certainly.

Michele Folan:

Julie, I've always kind of wondered about this, because when my mom was ill she went downhill pretty quickly and we knew she was in a hospice situation, but we had to leave her in the hospital. She was too frail to be moved. We had to leave her in the hospital. She was too frail to be moved. So we did hospice in the hospital. No one, including me, ever said Mom, we are moving you to hospice. I didn't have the heart to have that conversation with her and that has haunted me since she passed away. And I'm wondering how much do we tell our loved one when it comes to that time?

Julie McFadden:

I think if they're alert and oriented, like fully alert and oriented. We be honest, as honest. That's what I think you know and we're not used to doing that. We're not used to. We never learned how to do that.

Julie McFadden:

I have had, like. One of my best friends really says that his mom would do better not knowing, and I'd have to believe them. So if a family member does tell me that, like I am telling you, I know my mom or I know my dad, and they will not, they don't have it in them to know these things right, it makes it a little difficult because we have to have them sign paperwork, like saying they're going on to hospice. So there's a little bit like well, how are we supposed to do this? So I usually try to talk to like the way I usually do it is say like what do you think is going on here? Like, how do you feel? How do you feel about your body? What do you think is going on? And usually nine times out of 10, the person will say I'm dying. So I do think people know they may just not be saying it, but generally speaking I also try to go with what the family says.

Julie McFadden:

The family knows their loved one the best, but I would say we do need to work on just being able to talk about it a little more, and that's the whole reason why I'm here. I'm doing these things. It's not your fault, I mean, I get it. Many people don't know how to bring it up or say it, or will it make it better or will it make it worse? And it's a little easier for me because I'm the hospice nurse. That's what I'm supposed to do. When you're the daughter, it feels harder and no one taught you how to do it and I don't know, was your mom alert and oriented, or did she? Oh yeah.

Michele Folan:

She was alert and I think she knew it was happening. But I still feel like I owed that to her, to have that conversation with her, and that's what's bothered me. Yeah, cause she, she was very alert and that was the hard part. It was her lungs that were giving out on her, and so it's. It was just one of those things where, yeah, you always wonder like what, what should I have said?

Julie McFadden:

I do want to reassure you not, and I really mean this. I mean I feel like you did the best you could at the time. I mean it's easy to look back it's always for anyone it's easy to look back and say, oh, I should have done that, but at the time you did the best you could with who you were at that time and yeah.

Michele Folan:

Okay, I feel a little better now. Your book Nothing to Fear was a huge success. What inspired you then to follow up with your fear journal, Because you have that coming out here very soon.

Julie McFadden:

Yes, so the book to me was absolutely insane because I just never knew I would write a book. So to write a book and then have it be so well received was amazing. And the journal came about one because I'm a journaler, so I love journaling. I've journaled ever since I've been a little girl. I talk about it on my channel. It's really, really helped me throughout my life. So when my publishing company said, hey, we're thinking about doing a sister book to your book as a journal, I'm more excited about that than the book, because I just love, I just think journaling can be so helpful and I think you could read my book and it's definitely very helpful.

Julie McFadden:

But it also could be like okay, now that I know all these things, where do I start? How do I start? What do I do? What questions do I ask? Where can I put all of these things that I need to keep in order? And that's what the journal is for.

Julie McFadden:

So it's broken up into sections where the first part's a little bit about getting you comfortable with exploring death, exploring your own death, exploring immortality in general, kind of like all the existential stuff that can come along with it, and then, as it goes along, it gets into more of the practical things where I love that. I'm a girl who, if I feel out of control which a lot of people do when someone's ill or when you yourself are ill I want to know what can Like practical things. So I feel in control and that is what the back of the journal is for. The back of the journal is like the practical things like start here, do this, here's how you do it, who do you call? Like things like that. So that to me is like chef's kiss, cause I know that's what I want.

Michele Folan:

So and I think a lot of people like that as well- yeah, and because we talked about the plan right and so many of us know this time is coming Some don't, but many do so I see where there would be a real benefit in kind of getting the house in order in terms of your head, your thoughts. And then also there's the other stuff. The stuff that we hate having to deal with is just all the practical household things that can be so daunting.

Julie McFadden:

Yes, and you don't know what you don't know. You know what I mean. You forget, oh, I don't have the password to the bank statement, so I don't know who the beneficiary is. I don't know what you know. So it's things, it's all the little things like that that I know, cause I'm around it all the time and I know what people need to get an order. That, um, it kind of helps you just cue into things. You need to check off the box before it all goes down. Now, if it's already gone down, it'll still help you because you'll know what to do, like how to get things in order, who to contact, what kind of lawyer do you need? If you do need a lawyer, how to get in touch with the mortuary, things like that.

Michele Folan:

You know, and then this brings up you did touch on it just a little bit but there is this moment where we're going to have to confront our own mortality, right? Yes, and maybe the mortality of a spouse? Yes, and some of my friends have already been through that. Yeah, how do you hope the journal will support that reflection?

Julie McFadden:

I would say that's the beginning part of the journal, the whole existential things. I feel like it sounds to me it's even hearing me say what I'm about to say sounds cheesy, but I mean it with my whole heart and I can't believe that I'm this person now. But my job and my work has kind of changed me. I know for my own life that contemplating my own mortality or my loved one's mortality, as morbid as that sounds, has truly helped me live in today and appreciate today. That is one of my greatest gifts that I've gotten from working in this field, the greatest gifts. And that's what the beginning of the journal is all about.

Julie McFadden:

I'm trying to get people to also be able to tap into the things that I feel like I have tapped into because I can and I practice. It's literally a practice of me really trying to understand that, like this isn't always going to be, my health is not always going to be, my sister will not always be here and I know even when I say it it sounds like oh God, thinking about that, but there's something about it that helps me see it in a light of like. But that's not today. I am here today, my sister is here today I can walk on these legs today, I can drink this coffee and feel the sunlight today, and I'm getting chills just thinking about it because it brings me so much peace and joy and brings me to the moment of now. To the moment of now. That's the greatest gift I can have. So that's what I hope the journal brings to people. I hope that's what is kind of portrayed in that first part of the journal to get people there, because it's been one of my greatest gifts.

Michele Folan:

That's the gratitude piece that we're always told in the morning we should be finding something to be grateful for, and you're just giving people a platform to actually put it down on paper, which I think is really nice, yeah.

Julie McFadden:

Yeah.

Michele Folan:

Before we started recording I asked you if we could talk about this a little bit, because I know there are life after death type of moments that you have with these patients as they transition and pass through. That's the best way I can put it. Can you tell me some stories that you've experienced with patients and how that has affected your belief in life after death?

Julie McFadden:

Yeah, so just to generally, I'll generally talk about it and then I'll give a couple stories. So my chapter six in my book is all about deathbed phenomena, which is the longest chapter, because it happens so much in this end of life realm which really surprised me as a critical thinker, icu nurse. It was like a huge shift for me and the only reason why I kind of came around to the fact that it happens is because I kept seeing it all the time. So it's like undeniable, you can't really deny it, because it just happens all the time. We don't know why it happens, but it does. And so deathbed visions happen with almost everybody and it doesn't happen right before they die, it happens a few weeks before they die, where they start seeing dead relatives, dead loved ones, old pets that have died.

Julie McFadden:

And the story that always sticks out to me for this is a family called me in because their loved one was confused. A loved one who was on hospice was confused. They were saying some crazy things. We need to come over and medicate them. And I come over and the patient's like seems totally fine in bed, totally alert and oriented, and I'm like a little confused and they're like well, he's not doing it now, but he was really confused earlier and I was like, okay, well, how do you feel now? Right, and he was like I feel fine and I'm asking dates and making sure he was oriented and he seemed great. So they left for a second, the family left and the patient grabbed my arm and goes listen, I'm seeing my parents. I'm seeing my parents, they're coming to me and they told me that they're not coming yet, but they're coming soon and, not to be afraid, they'll take care of me. And that's why they think I'm crazy. But I'm not crazy. I don't know why it's happening, but it is.

Julie McFadden:

And I'm like I know and honestly, by this time I have seen it so much that it actually wasn't even surprising to me I just sort of laughed and I was like I know, listen, you're not crazy, this is something that happens at the end of life. We don't know why it happens, we don't know why it's called deathbed visioning. It happens across all cultures, all faiths around the world. We don't know why, but it does. And as long as it's not scaring you and as long as you're okay, it's okay. And he was like well, can you tell my family that? Right, because he's whispering, he's afraid, he's afraid to say can you tell my family that, because they think I'm crazy, they're trying to knock me out? I'm like I'll talk to him, it's okay, right? So then I go and then, of course, I leave there and the family grabs me whispering. Listen, he's saying he's seeing his parents, he's hallucinating. Something's really wrong, you know, and I'm like you guys, well, and I kind of just giggle and I'm like it's okay, this is something called death bed visioning. It's very normal, it happens in, like most of our patients. A lot of our patients don't even talk about it, hence why we don't know that it's even happening, but as long as he is comfortable, it is okay. Now, if he starts screaming and yelling and is agitated and is going to hurt himself or something, yes, that is a time we may want to medicate somebody, which I never actually I would never consider bad visions.

Julie McFadden:

Visioning Visions are a beautiful, comforting thing and they look very different than something like delirium or confusion or agitation. They look very different. The person is usually like this man is very calm, very collected, very alert and oriented and knows who they saw and what they saw. And I mean I literally have countless stories like that People who have seen Jesus, people who have seen other deities, like it depends on what you believe in, right? So like, if you're a Christian, like people can see Jesus but they will see other deities. If they're not Christian, they'll see what is true to them, right? People seeing different types of angels, people reaching up and smiling and saying hi, mom, you know you can just, and it's wild to see.

Julie McFadden:

It never really gets old, but I do see it. I do see it often, often and now that I educate about it with my families, because I think it's really important we don't run into this mess of like you need to get over here and medicate my loved one because they're going nuts. I try to educate, and when I educate, that's when people start already telling me stories. Oh, they're already doing that. They've already been talking to our next door neighbor who died a couple of years ago. So it's fascinating. So it's fascinating, it's comforting to me. Whether it's real or not real, it's still comforting to me.

Michele Folan:

Yeah, because it's comforting to them. Does it comfort you when you think about dying yourself?

Julie McFadden:

Yes, yes, I mean. There's so many things that comfort me about dying, Like even just the biological aspect of dying and how our bodies are built to do it and know how to do it, and takes care of us at the end of life, and our bodies are biologically built to systematically shut down and help us be not hungry and thirsty and help us sleep more. That's comforting to me too. These things that are unexplainable are comforting, but the things that are explainable, like the biology of death, is also comforting to me.

Michele Folan:

Can you talk about that a little bit, the biology of death? So you know, we all know when someone has gotten very compromised and they always say, oh yeah, you know he's shutting down, what does that really mean, though?

Julie McFadden:

It usually means the organs, like you said, that are kind of systematically shutting down.

Julie McFadden:

So there's probably multiple organs shutting down.

Julie McFadden:

I do believe if someone is because I've seen it in the ICU and it's not bad, it's just different If someone has been kept alive in the ICU for many months, their shutting down will look a little different than someone who's on hospice and who has been naturally kind of shutting down over weeks at a time, just because they have already been kind of pumped full of fluid and then diuresed and then on this machine and that machine.

Julie McFadden:

So it's still very peaceful because we have medications to make it peaceful. But I don't think it doesn't give the body enough time to truly shut down. Whereas in hospice what I saw over and over and over again when the body has time to really systematically go through it, it helps you shut down the hunger and thirst mechanism that purposely makes the person dehydrated because they actually feel better. The more dehydrated they are, and dehydrated because they actually feel better, the more dehydrated they are, it kicks in, usually higher levels of calcium, so you sleep all the time and it's a slower, more natural process that really creates for a peaceful death. But when someone says they're shutting down. That's what they mean. All of the organs in the body are systematically shutting down.

Michele Folan:

Okay, that little burst of life that people get at the end. And I'll give you a specific example. My father-in-law was in memory care and we had seen him earlier that evening and he sometime around maybe midnight, maybe 11 o'clock, he got in his wheelchair and kind of scooted down to the nurse's desk and was flirting, probably, with the nurses, saying hello and chatting with them, and then he went back to his room and at about 2 am we got a phone call saying that he had passed. What the heck.

Julie McFadden:

I know.

Michele Folan:

Yeah.

Julie McFadden:

Right, yeah, so that is called terminal lucidity and it happens in one third of all people dying. So one in three people will experience something like that, and we don't know why it happens Another mystery, we don't know. There's always theories. People always say, oh, it's DMT being released, it's a bunch of hormones being released. All of that is fun to think about, but we don't really know. It's never been actually studied. We just know. Again, we just know what happens.

Julie McFadden:

And the thing that makes it very distinct is that and I don't know if you're I think you said it was your father-in-law yeah, I don't know if he was looking ill or was ill, but usually someone is like ill and looking like they're going to die soon and then suddenly, boom, they have this moment maybe a day, maybe two days at max, where they look like they're doing things they haven't done in so long Getting in a wheelchair, going down, flirting with people asking for a cheeseburger. My grandma, a few days before she died, woke up, got out of bed she hadn't walked in days had Thanksgiving dinner, you know, complained to my mom that the food was too hot, which is like her personality you know like this is the hotter and then was like boop got back into bed and died a couple of days later.

Julie McFadden:

So it's the distinction was like boop got back into bed and died a couple days later. So the distinction is like someone's very ill boom, this like distinct burst of energy, and then they die shortly after. So that's the distinction is that they have to die shortly after. If they don't die shortly after, it's not terminal lucidity, it's just them. You know their disease, waxing and waiting. But if they die shortly after that burst, that was terminal lucidity, all right.

Michele Folan:

Yeah, because, yeah, I mean he had lost a lot of weight. You know, because when they have dementia, food isn't as interesting to them and you know whatever. But yeah, that was my example, that I was like I got to ask her about this one because I know I've talked to so many people that have had that same experience as well. Yeah, yeah.

Julie McFadden:

Okay, and it sounds to you a little bit like he may have he sort of just said maybe his body just said I'm done, this is enough, I'm done, this is enough. Whenever someone dies, whenever it's not really that slow progression, they just sort of do it. I'm like I feel now this is just my opinion, there's no scientific reasoning for this, but it just feels like their body declares itself and just says I'm done.

Michele Folan:

Yeah, that is perplexing, but so interesting, right, how our body just knows. Does that come from the brain? Does the brain direct traffic there that tells the organs that it's time? That's a great question.

Julie McFadden:

I mean, I think they're finding that all the organs are kind of talking to each other the spinal cord because the spinal cord too is a big part of of working our body and our gut talks to our brain, our brain talks to our gut. So you know, uh, because I've been a nurse for so long, I I feel comfortable going. I don't know. I think probably. Yes, there's definitely some of that, but I think there's more. There's still mystery to like, what's running the show? Is it the brain? Is it the gut? Is it all together? The brain does a lot of things. That's why, if you have disease to the brain, it can be hard for the rest of the body.

Michele Folan:

But I don't know. Okay, one other question. I had this just popped in my head. Yeah, how do we make the decision whether to do in-home hospice or to do hospice in a facility?

Julie McFadden:

Oh, great question. I would say only do in-home hospice if you are able to be there you or someone, or you pay someone else to be there most of the time. So at first, when you sign up for hospice, your loved one who is on hospice may not need 24-hour care, right. They may be able to have someone just pop in at night or pop in in the morning or whatever, right, but eventually that person's going to need 24-hour care and hospice will not provide that. So if you or your family can work a system where you guys can be there and your loved one wants to be home, then do that. Or if you have the money to pay for a caregiver who can be there, then do that. But if you don't, I would recommend a hospice, either in a hospice home, if your city has that, or like a skilled nursing facility, and then hospice will go there.

Michele Folan:

Got it Okay, yeah. Yeah, I wasn't sure how that actually worked, but that's the family's, up to the family and their decision how they do that. Okay, what are some of the small mindset shifts you think that we need to make today, or should make today, to embrace aging and the natural transitions of life? Because when you, when it comes to losing a parent or maybe a spouse, that accepting piece is just not there.

Julie McFadden:

Not there.

Michele Folan:

It's got to be a horrible, dire situation for you to say, okay, yeah, I'm okay with this, right, yeah?

Julie McFadden:

I think there's not a quick and easy answer for that. I think there is. It takes time, it's gray, it's not black and white in the sense of like I can't give you like a, do this and do this and then you'll equal this. I think it's like learning to live in the uncomfortability of like not knowing and feeling grief, before someone even dies, just knowing, like your friend who's in his late 50s, I think you said like his loved ones are grieving now. I mean they'll grieve later too, but like there's grief and like this idea that, like I'm not living this life that I thought I was going to be living, like this isn't what I planned for here. So I think the first thing I would say is if you can talk about it, and talk about it honestly, don't give some frilly thing of like well, I accept that it's like no, I mean the people that I see that die well, live well and die well.

Julie McFadden:

Are my patients who are willing to be like this. Can I swear? Are we swearing? Yeah, oh, yeah, no, yeah. Patients who are completely to be like this Can I swear? Are we swearing?

Michele Folan:

Yeah, yeah, no yeah.

Julie McFadden:

Patients who are completely like this fucking sucks, I'm so angry, I'm so angry this shouldn't be happening. I'm scared, like all of the stuff. Just say honest things and there is something about that that I have found that kind of helps release that grief, that sadness, that anger, even for that moment. Right, and then you connect with the person you're talking with. So, if you're the person saying it, say the truth, the truth as you understand it in that moment. If you're the person listening, let them say their truth. Right, don't go no, no, no, don't say that You're going to be fine. You don't need to make anyone feel better. It's about trying to connect honestly.

Julie McFadden:

If there's a thing, there's a prayer that I say every day, that really helps me, and if you're not like into prayer, you can call it something else. Whatever you want to call it, but it's God or whatever you call God. Help me set aside everything I think I know about blank, whatever that is, for an open mind and new experience. Please, let me see the truth, and I love that because it just helps me kind of release it a little bit and hopefully see the truth of it all. And sometimes the truth is this is wildly uncomfortable and period. Yeah, you know.

Michele Folan:

You know, I knew this was going to be a really heavy topic, but again we got to face this stuff head on. We can't sugarcoat it, it's life. Can't sugarcoat it, it's life. And if this podcast can help one person kind of navigate this very, very difficult and sad situation, I am happy, right, I mean, that's one of those things. So, on a little brighter, more maybe personal note what is one of your self-care non-negotiables, the thing that grounds you, no matter what?

Julie McFadden:

Well, I am sober, so I'm sober and I'm in a 12-step recovery program and non-negotiables for me are things I do in that recovery program to keep me grounded and keep me sober physically and emotionally. Fantastic, and that's like non-negotiable.

Michele Folan:

How long have you been sober to keep me grounded and keep me sober physically and emotionally. Fantastic, and that's like non-negotiable. How long have you been sober? Nine years, congratulations. Yeah, thank you. We talk about alcohol all the time on this podcast. It comes up oh my gosh will we?

Julie McFadden:

I'll come back. I'll come back, girl, because I can. That's a whole other book I want to write about the disease of alcoholism and what it means to me. And I mean, my recovery has completely changed my life and it's changed everything about my life, including how I work, and I think, yeah, it's been amazing. So that's the non-negotiable. I do it every day. I do something to maintain my sobriety, and not just my physical sobriety, but my emotional sobriety, so I can be free in the day that I'm in.

Michele Folan:

Yeah, do you still go to meetings? Yeah, okay, yeah, fantastic, yeah, yeah, you know it comes up all the time because this is a health and wellness podcast and we've all heard the data. And I know my my listeners are rolling their eyes because they're like God. She is talking about alcohol again, but I am sorry. Yeah, so I I still have occasional cocktails, so it, but but I don't drink every night. I don't like polish off a bottle of wine. I did during COVID, all that stuff. So that is in the rear view mirror, that life, and I am so, so grateful. But what made you decide to get sober?

Julie McFadden:

Oh my gosh, I mean so many things. I always knew I had something a little bit of an issue with alcohol. Mine to me was a little confusing because I was quote unquote like high functioning. You know, I think a lot of people misunderstand what alcoholism is. You know, I still had a job, I still maintained friendships, I never got DUIs, I never went to jail, like nothing like that.

Julie McFadden:

My bottom with alcohol was an emotional bottom where I would just thought I was getting in the way of what I wanted to do with my life. It just felt like I was too hungover to do stuff. And then I would say I'm not going to drink tonight because I was too hungover this morning and I got to do stuff tonight. I got to get out there and whatever. The stuff is right. But then by the end of the day I'd be like, nah, it's fine, and I'd just open a bottle. And then next thing, you know, I'm drinking a bottle of wine, maybe a bottle and a half, depending on if I'm still awake, and the cycle was all over again. Right, and I didn't do that every day, but I did start doing it most days. And what was really eye-opening to me was I eventually only to spare. This is still going to be long, but I'll try to make it shorter, you know, to spare the length of the story.

Julie McFadden:

I eventually stopped drinking on my own. I didn't call myself an alcoholic because I didn't think I was, but that's when I really started seeing that I was an alcoholic, because if you want to know if you're an alcoholic, try quit, quite, try stop stopping alcohol. Right, and I could do it. I did it. I did not drink and I didn't drink for 11 months, which is a long time, almost a year. That is a long time, yeah, for almost a year.

Julie McFadden:

And my life, my internal life and my external life got worse and worse and worse. I didn't do the things I thought I would do, I didn't meet the friends I thought I would meet, my life got smaller, my anxiety got higher, my inner world was insane and I got much more lost and confused in sobriety. And that really got me to my bottom because I thought, wow, I did the thing. I thought I, I did the thing, I stopped the thing and I thought I was going to like fly, and I didn't fly. Yeah, I like sank, sank, sank, sank, sank. And, through different circumstances, I ended up meeting a friend who took me to a meeting and that just started me on this journey of learning about alcoholism and getting help for what I would call alcoholism. And yeah, it just helped me so much when I got into a recovery program and it helped me so quickly that I was kind of like sold. I was like this is kind of all I wanted. I wanted to learn how to live sober and that's what it taught me.

Michele Folan:

That's awesome and you hit. It's that community, it's that connectedness. Yeah, exactly I'm not alone, there are other people just like me. I mean, that's beautiful I love it.

Julie McFadden:

Yeah, yeah, thanks for sharing that.

Michele Folan:

We didn't know we were going to go down that road. Yeah it.

Julie McFadden:

Thanks for sharing that we didn't know we were going to go down that road. Yeah, it's my greatest gift. It's my greatest gift of my life. It's your superpower. Yeah.

Michele Folan:

Yeah, yeah, and to be able to share that with other people, to share your journey with other people, is a gift, I think.

Julie McFadden:

Thank, you, thank you. I'm passionate about that too. Two things I'm passionate about sobriety and death. That sounds so crazy, but I could talk about those things forever.

Michele Folan:

Oh, she's a wild one.

Julie McFadden:

Yeah right, everyone's like yikes.

Michele Folan:

Oh, julie's coming tonight. Oh, geez Great. Oh, that's so funny. All right, Julie McFadden, where can the listeners find you, your work? You have a YouTube channel as well.

Julie McFadden:

Yes, Thank you for bringing that up, because I feel like, because TikTok is where I got started and that's where I have my most followers. I always talk about that, but really my love is my YouTube channel. I love my YouTube channel. I go live every Thursday there, so like we have a. I'm all about community, as you know, so we have a community there. All the same people show up. It's just so beautiful. So I have a YouTube channel. All my channels are same name Hospice Nurse Julie. So wherever you get your like social media, you can find me on Facebook, instagram, tiktok, youtube same name Hospice Nurse Julie. And if you're interested in either my book or my workbook, it's called Nothing to Fear and you can get it really anywhere you get books. I think the easiest place to look is on my website, hospicenursejuliecom, but it doesn't help me more. If you order it there or wherever you get, it will help me, but that's just an easy place to start HospiceNurseJuliecom.

Michele Folan:

Okay, and and the Nothing to Fear journal comes out in June, in June.

Julie McFadden:

Yes, okay, yes, I think mid June. I should know the exact date, but I think it's somewhere around mid June, perfect.

Michele Folan:

Wonderful Julie McFadden, or Hospice Nurse Julie, thank you for being here today.

Julie McFadden:

Thank you so much for having me.

Michele Folan:

You've been great. Hey, thanks for tuning in. Please rate and review the show where you listen to the podcast. And did you know that Asking for a Friend is available now to listen on YouTube? You can subscribe to the podcast there as well. Your support is appreciated and it helps others find the show. Thank you.