Ep. 034 – Carina Modeus - Lessons from death
We talk a lot about how to create a meaningful life and strong connections and relationships, to increase our quality of life, but what happens to our needs and preferences when they are pushed to their extreme? When we know we are about to die do we choose any differently?
With Carina, we explore her observations of people’s last wishes in palliative care and how we can lead, plan and communicate in order to connect with others to create moments that matter - at any point in their life journey.
Listen to full episode :
Available now on
Introduction to Carina
Carina Modéus M.D, specializes in oncology and psychiatry and is head physician for the palliative team in Region Kronoberg (Sweden). On a national level, Carina is part of the steering group for the National Care program for palliative care, and member of the national workgroup for palliative care.
She has long and substantial experience both in caring for people with serious illness and in conversation training for medical professionals within palliative care - always with the goal to create connection, presence and meaning for patients and their families.
Want to connect with Carina:
EP. 034 Transcription
[00:00:00] so this is an extra special conversation, because you are one of the first people I have on the podcast who I know and who has seen me grow up and become an adult. And you're a good friend of my mother's.
[00:00:17] Mm-hmm. .So we've shared a lot of different experiences before. Really. And I've always I've always had a big love for your ability to express things and observe things. Oh, thanks. So I was very excited to be able to invite you to talk with me. Thank you. I'm so honored to be here, really and, uh, a little bit nervous since you want me to speak English and that's not my favorite arena to be in. And uh, I have been, doing some pre-thinking, uh, and I really want to thank you for your questions. Yeah, I loved your questions. I'm glad. So they have made me do some reflection and I have been talking to my friends and to my family about the questions and it's been really very interesting.
[00:01:19] Okay. So I'm glad cuz now we can dive into what's been your process and what have been your reflections. Mm-hmm. . I think just to, to get into a little bit more who you are. Mm-hmm. . So you work with two big difficult topics that a lot of people avoid. Yes. You're a psychiatrist. Mm-hmm. , and you're an oncologist and you work with palliative care.
[00:01:48] Yes. So that's definitely leaning into a lot of spaces, which a lot of people feel a lot of discomfort about, a lot of doubt. Mm-hmm. why did you end up here? What, what made you choose this path? That was the first question, , and I've really been thinking about that. The first is who I am, and then why on earth did I end up here?
[00:02:18] The best answer is that it's, first of all, it's. Amazing grace. Most of what's happened to me is not things that I have deserved or chosen. I'm born in a country, Sweden, in 1964, in a time where all children were allowed to go to school without any costs. And I don't know for how long.
[00:02:49] Back in the centuries, if you look, there are farmers and they all lived in, the southern parts of the Sweden called Småland. It's known for. Its very, very, harsh climate. Both physically and mentally. Uh, and I think that have fostered some persistence to me. Mm-hmm. and to my siblings and most of my relatives immigrated. So , those that are still here, they are earthbound and they're greedy. I try not to be that greedy, uh, but were adapted to restrained resources.
[00:03:33] And that's a part of my, uh, childhood with my parents, both farmers and both from very big families, 10 and 11 children Wow. In the, in the families. So there's always been a lot of people and very little resources. Hmm. And I think that is maybe something that we need to learn now in the world with a changing climate and trying to find, uh, a way to live not using more resources than we can and or than we have.
[00:04:10] More. Than we have. Exactly. So that's one part in where I come from. And then my mom and dad, they fostered us that they always wanted us to take share in the work on the, on the farm.
[00:04:26] So we had chores. Uh, so even from when I was around like four years, I followed down to the cattle and, uh, I had my little two calves that were, I was supposed to give milk. And I, I thought they needed me to do that. That was my feeling. Mm. So they really wanted me to have a feeling about that. I, they wanted me and expected me to contribute.
[00:04:56] And I think that was one of the really, uh, grounding experiences when I was a small child. So there was a system where I was a part of a bigger whole. Mm. I can very much relate . This our common denominator. My mother grew up in a kibbutz in, in Israel. , which is also very much about that. Exactly. Yeah. We've talked about that a lot.
[00:05:22] Yeah. , I can imagine in, in this, you're always part of a bigger picture. Mm-hmm. and whatever you have in terms of abilities to contribute, you will. So if at four you can do one thing, you do it, and at seven you can do more things, you do them. Yeah. Yeah. And that's very important as a part of the climate.
[00:05:46] Mm-hmm. the wit was harsh in many ways. Not much reflection, not much language, but rather more like silence. And it's more about what you do and what you could deliver than about who you are.
[00:06:07] And if I think about myself as a human being and person, I'm highly sensitive and I'm prone to worry and anxiety, and I always felt that was not a very good thing to have in that climate.
[00:06:25] Mm oh, you're so sensitive. I heard. And that was really nothing good to come with. Um, and I have some favorite drugs, and that's contact relations and possibilities. Mm. That's a nice drug though. . Yes. But it's really dangerous in many ways. . And I'm driven by lust and curiosity. That is what always makes me, sets me in motion.
[00:06:55] I don't remember it for myself, but when I talk to my, uh, sister-in-law and she's also one of my oldest friends and my neighbor , uh, she told me that I, when I was around 20, we were talking about what we wanted to do with our lives.
[00:07:12] And I said, I want to make a difference. So in some way, I have my inner compass set on that. I don't remember it, but in some way. And another important part in my history is that I am born in a Christian traditional faith. Uh, so it was an integral part of my childhood. With evening prayers. My mother came, sat on our beds, sang together with us, and morning prayers in school, singing morning hymns so I still sing some of the morning hymns and remember how it was when I was like seven. And the music has been a very important part in my life.
[00:08:00] Uh, this creating music together, singing choirs, and, uh, as a soloist sometimes, uh, the listening, the intonation, the rhythms, the following, the others. Both creating and responding. At the same time. I love that it's magic really? To make music together with another person. It opens up for much more than the ordinary languages.
[00:08:36] But but how did I end up like a medical doctor? Well, I, I started, biology first at university, and, um, then I met my husband and, we married and moved to ,Oskarshamn, that is also a small city. Uh, and we, and when we were there, we suddenly, uh, one evening, my husband, I, we were talking about if I was going to go back and work as a biologist or if we should move somewhere else.
[00:09:07] And then we were talking about what I wanted to do with my work life. He asked me why I didn't become a doctor, because I said I actually, I think I would have wanted to be that. So why didn't you be that? I don't know. I, I felt like it was not for me. And there ended the dis our discussion. And then suddenly I had sent my, application to the university, and I got a.
[00:09:37] Possibility to start. and then I started and I finished. And then I chose to be an oncologist and that was because I had been studying, uh, oncology at the lab when I was a biologist. And I was so fascinated about that kind of diseases. And I always felt, but how about the patients? I always worked with the cells and some mice sometimes, but how about the patients?
[00:10:04] How are they doing? And then in my family, we have had a lot of cancer. And when I was just about to start my oncology training, I had a very sad notion about that. My sister, two years younger, she had a pancreatic
[00:10:28] and uh, when it was detected, she was already in a palliative situation. So we spent one year together that we both knew she was a nurse. We both knew that she was going to die, and she was only 40 years leaving three kids and her husband and all our others.
[00:10:57] and that was extremely painful, of course, but it also showed me that I have the capacity to be there. Together with someone who's going to die. And the reason why I love to spend times with people that are going to die is the quality in the contact. Mm-hmm. , there's something very special, not much to hide anymore.
[00:11:32] There's some honesty and reflections and the choices are so, uh, extremely important. How should I spend my time when I only have like a few months or weeks left? And to see what do people really. . It's exciting. I learn a lot. And in that contact with a person that is going to die, it's very, very, very obvious.
[00:12:09] That's always true. When people get in contact with each other, you have a transformation of both. In palliative care, we use something called tactile. Tactile massage. And it's where you touch the skin of the patient. And the nurses would, that I work with, they have told me that, well, of course you do it because you want the patient to feel safe and secure and, um, calmed.
[00:12:42] But it happens so much to me, they say mm-hmm. and I have been starting to, uh, observing. . Ah. So when we're in contact, it's, I'm not reaching out to you because I want something else to happen to you, but it happens something to me. Mm-hmm. , it's a transformation in that, uh, moment of contact, and it's thrilling really?
[00:13:11] Mm. Lots of things happen to me every day at my work meeting persons and families that are soon going to say farewell to each other, but how do they live them? And can I be inspired in some way in my ordinary life? And I think , I am, I'm, I'm trying to really set my inner inner compass so I don't spend too much time with futile things.
[00:13:42] I love what you're saying. I just listening to you talk about the connection and the mutual thing. Your eyes lights up, . Yes. I love it. And it's, uh, so I, I can, and we can really sense your engagement. And it's interesting is one of the questions that was going through my head before coming into this conversation was just this thing that you talk about, which is when you're at this point towards the end of your life and you know, it's the end, what's important then, and it goes back to your also thinking of possibility, possibilities can be amazing, but they can also be really distracting.
[00:14:23] Mm-hmm. . And in the way we go about life, sometimes we end up doing things that don't really feel, that don't really fulfill us, that don't really connect us. Uh, absolutely. Because we're supposed to do it. Mm. So, yeah, I would love to come back to that question that you, yourself asked. What, what is it that we do then?
[00:14:44] Yes. When we, when we start peeling off the things that aren't important. What, what have been your observations? Well, people do the ordinary things and sometimes with a better presence. Mm-hmm. , I like that they very seldom want to go to some fancy places or buy something or trying to, uh, do things that they never done.
[00:15:20] But they always, almost always wants to spend the time together with their families and, uh, parents or depends on the. Family system, of course, but they want to spend times with their important persons at their important places. So I think it's mainly about the connectedness and meaning, of course.
[00:15:51] Mm-hmm. , uh, it's quite often that they say, I would like to come once more to my summer house by the sea. I want to touch the ocean. I want to taste the canola buts and flowers. I had a person saying, I really want to do that once more, and I have one woman.
[00:16:19] She was so extremely. Could almost not breathe at all. So she needed to have her oxygen with her, and she could only make movements if we really helped her . And when I saw her looking out through the kitchen window, oh, there they are. It was in the spring. I, I have them tattooed on my arm actually. And they're called Winter aconites.
[00:16:53] Winter aconites. And they don't exist. They, I think they're northern hemisphere flowers, but they're little, little yellow flowers that's spring up through the snow and through the dirt and everything right now, outside right now for us. Yes. And when I saw her face shining up from this once more, I saw them and that had been her goal.
[00:17:19] Uh, So it's about small things, often tangible, uh, through bodily sensations, and it's about connectedness, I would say. That's interesting. Mm-hmm. , what do you see? Because as you're saying also then as people then they're surrounded by all of you caretakers in different ways who aren't family. What do you think is the most important thing in your role in helping make that end of their life something meaningful to them?
[00:18:02] Well, well, trying to create safety. Hmm. And trust so that they always know whom they could contact if something happens. So in all different ways trying to create an environment of safety and trust. And then I have one very important thing that I always think about, and that is that I think every time when, uh, when a person is dead and if we could read in their, that salons their eulogy or like in Sweden we also do these ads.
[00:18:40] People who have died. I don't know how that's done in other countries, to be honest. No. Okay. Maybe it's special for Sweden, but Yeah. But if they mention us there, I think we did not do a very good job because I want us to be a part of the room. Mm-hmm. like the walls or the floor or the roof or so mm-hmm.
[00:19:03] And they shouldn't really notice that we are there. , we must try to just create space for them to live their lost life. It's like good leadership. If you have really been, uh, successful in your leadership or your parenthood, then the one that you are parenting or leading, if they said, I did it myself.
[00:19:30] Mm-hmm. Proud. That's good parent thing and good leadership. You are there, but you're just creating space. Mm-hmm. Maybe just on, like you did with me, uh, posing the right questions. Mm. Not taking credits. No, exactly. Yeah. Just asking. So what is important now? I, I, yeah. I just listening to you, I just think it's really interesting because I've had this notion that.
[00:20:04] things come to their very extremity when you're about to die. Mm-hmm. , but then also listening to you, it's all of these things that you're saying. They're also true in everyday life for anybody who is alive. Hmm. And yes or no, close to their death knowingly. If we all, none of us know, of course. But, um, but safety, trust, enablement.
[00:20:37] Yeah. I think, and, and that's maybe the core also of me doing this is just trying to inquire mm-hmm. , because who knows anything. Yeah. What's more human? Yeah. What. , when we get to the core of things, what do we all want? What does it look like? How can we help each other? Create it, be it, get mm-hmm. , those things.
[00:21:01] Mm-hmm. Yes. Feel those sentiments of excitement, fulfillment, presence. Mm-hmm. . Mm-hmm. Mm. Um, and see the difference between what we want and what we need. Yes. Sometimes. That's really interesting. Need versus want, how does that play out? Because I know you also, you also help train people mm-hmm. who go into work in these scenarios. And as we touched on before, not always something that comes naturally to us. No. To know how to hold space. Yeah. And be present with people who are close to the end of their life. People who are suffering.
[00:21:52] What are some of the things that you, some of the core things that you pass on to others as they kind of go into to doing this? I've been thinking a lot about that because I'm doing, uh, some of my time, I, I'm trying to do communication training. Mm-hmm. and, uh, mainly with doctors, but in some, to some part also with nurses, uh, into a concept called serious illness conversations, which is supposed to take place, uh, early in the process for the patient to identify the patient. We use something called surprise question. So you pose a question to yourself, should I be surprised if this patient is dead within a year? Hmm. And if I say, Nope, I would not be surprised, then it's time to have to offer the person and the family a serious illness conversation.
[00:22:56] And we are trying to help people understand what kind of conversation is that mm-hmm. and how are we going to tell the patient what he or she wants to know? Some of them want to know all about what's ahead, and someone doesn't know at all if they, they don't want to know. Really don't tell me, I don't want to talk to you, to you about that.
[00:23:29] They want to just live every day and take it as it comes. Like 75% of them want if you study it in research. And so they want to know, so how are we going to help all this personal in the care to have such a conversation? Uh, and I, that's where I really al also have been thinking a lot about contact.
[00:24:06] It's about the quality of the contact. Uh, see, seeing, listening really gives space for the. And it's not that easy to teach people how to do that. Cause we're so very full in our heads with what we think and what we feel and what we're afraid of. And we don't know what the person is going to say about hope and worries and suffering.
[00:24:38] And so, so I think contact is one of the most, um, grounding parts in this. Uh, and then it's about differentiation. Mm-hmm. . So differentiation is, I'm, I'm trying to use the expression, remember that the other is another. Yeah. It's not you, you don't know anything. Mm-hmm. , you don't know anything. And that's from, um, my psychotherapy training.
[00:25:14] There is a notion about the not knowing position, and that is something that you always should try to put yourself in. Mm-hmm. , the not knowing, I don't know. So I have to ask you. Uh, so that is the, the differentiation, the contact differentiation. And the contact is one part in what you should try to, uh, achieve.
[00:25:40] When you have managed to differentiate, you have to link, so first differentiate, and then link. And when you linking the, you have to have the contact. Uh, and then you have to start asking questions. And there it's very important how you, what question? And I've started to think about the questions as if you had a, a spotlight on your shoulder.
[00:26:11] Mm-hmm. like that. Very strong. . And by choosing the right questions, you could light up parts in the person's life that they have lost sight of. Mm-hmm. . And one of the things that I do always with my patients is that I ask them when they, when is it as best? At what moment is your life best now? And what is it in that that is the best?
[00:26:45] And they always, almost al always, are they surprised by the question? Hmm? Do you want to know when I'm at my best, but I'm dying? Yes. But is there something, is there some small little period in your day when life is a little bit better? Mm. Yes. Well maybe you know in the, not in the morning because I always in pain then.
[00:27:11] And then my wife comes and she gives me my tablets and I can get up and that is really painful. And then I manage to eat a little bit of my breakfast, but then I go to the sofa and the cat comes lying on my stomach. How we put on the radio and listen to the morning news. Then it's okay. Alright, that's beautiful.
[00:27:38] So what is the best in that? If you start continue drilling in the moments of the best quality, you have lots of things happen to people. Instead of asking how is your pain and when are you have the most pain? And in my pills that I gave you, did it help? That is also important questions, but we don't forget them.
[00:28:03] but to ask questions about lighting up the dark corners. Um, and it's about attention. Mm-hmm. . So it's contact, differentiation, linking and attention. I think that is most important. Maybe a lot of more things, but I haven't found out them yet. I mean, there are always things we don't know. Right. But , but you definitely have scenarios that are at the extreme of something where you get to practice. Mm-hmm. . And on the other hand, again, just listening to you, I'm thinking Yeah. There's a lot of similarities just to how you're talking about structuring, about digging, about asking why, about removing your own biases and your own assumptions.
[00:29:00] Mm. that also seem to be quite universal to how you can actually, um, create that human connection and empathize in a way that feels meaningful to both of you. Exactly. And you learn a new, new lot of very interesting things. Mm. When you ask instead of assuming, yeah. Assumption is the mother of most fuck ups
[00:29:29] Yeah. I just heard that from somebody else last week. And I, I think it's very true. And at the same time, it's part of how we function is mm-hmm. , we make sense of complexity and we make assumptions. And we just, this morning I was reading a post by somebody and in the comment section she was saying sometimes we have to lower the bar for ourselves.
[00:29:50] And I felt very, I felt like an exhale when I read it. And she was just saying, we just have to assume that we're not going to do anything perfectly. , we have to assume that we have assumptions. Mm-hmm. , and that we have biases and that we have ideas. And what we get to choose then is practicing how we act without making that the center of our way forward.
[00:30:17] Yeah. Um, I know I reflected, I thought, ah, it's a nice way to take your self-judgment out of the equation mm-hmm. and just go, okay, this is happening. How do I play with this to make it different? Yeah. It was just a very interesting concept and I just, I'm hearing the same you're saying that here.
[00:30:42] And also a thought that I had when you were talking is, and I don't know if that plays out, work with what you do, because a thing that I see a lot is we always, when we see a struggle, when we see a problem, we wanna solve it. Mm-hmm. . and we often skip, skip the step of doing what you say, actually get curious, put this spotlight on and go exploring.
[00:31:04] Mm-hmm. , we skip that step. Mm-hmm. , we go straight into solution mode. Exactly. What are some of the things, because you also then train a lot of people in doing this. What, what are the things that they say, ah, like what, what are the things that they do they feel helps them not rush into this, it's a hard question.
[00:31:29] Um, I think they, the persons that are training, they are often really helped. Uh, and they tell me their help by seeing others practicing. Hmm. And that's very interesting because I think we do it in a little bit different ways, but in one of the settings we use actors. Uh, so they are the patient and then you come in and you act as if you were the doctor and the others.
[00:32:02] We were small group then. So one actor, one trainer, uh, and me as a supervisor and, um, like four or five people sitting as some kind of audience or so, and quite often they say I learn most from looking, listening, and not that much acting. And that's very interesting. Uh, and I think it's about, uh, this, uh, focus of attention that gets really narrow when you are in stress.
[00:32:35] Uh, so the person that is training, uh, is really focused and the others that are just looking, they can be more open and, uh, reflecting during the talk. . And um, that is one of my observations. And the other is that, uh, they often, uh, if, if I manage to see if they could differentiate to remember that the patient is another, they sometimes say, oh, she told me something I didn't know.
[00:33:15] Yes, congratulations. It's because you asked. Uh, and that is quite often. And then we use another technique that is called agenda, uh, and that is to talk about the talks early in the consultation, uh, that you first describe your own wishes. Uh, okay. So today we come to you. Just to see how you're doing and if it's okay with your medicines and if you have any special needs.
[00:33:47] That is an ordinary way of starting the conversation. And then I ask the patient and the family, did you have something special that you wanted us to discuss today? And then sometimes they say one or a few things and then I say, alright, so we are going to talk about the, uh, medicine, your pain and you wanted to talk to me about the sick leave or about the paper too, or whatever.
[00:34:14] And just doing that to get, click some into, um,
[00:34:25] uh, common plan about what, how are we going to use the time together? And then I used to say if it's needed. Alright, so we have about. One hour or 30 minutes or so, the patient know what is the frame timeframe. Uh, and that is quite often also the, that the trainers say, I don't use that agenda. But I think that maybe that's good because otherwise you'd start talking about what you're supposed to do from your point of view.
[00:34:57] And then at the end of the consultation, the patient says, and I wanted to talk to you about this big question. Oh, I should have known that. Mm. Uh, so it gets the trainer into a little bit more of control. Yeah. And that kind of communication is really, uh, about leadership, manage expectations, space. Exactly.
[00:35:25] About expectations to see that we use our time together in a wise way. Mm. . I like that thought that leadership is about setting the scene. Mm-hmm. , but not being the, not being the headline or creating a center stage for somebody else. Mm-hmm. to get what they need to see them act there. How do you, how do you stay grounded with this? Because as much as we can practice and it's a practice to do these things, to connect to, to ask, to differentiate, to see,
[00:36:22] what do you do to maintain your own ability around that? As a part of my daily practice, I, every morning, uh, I go to my yoga mat and I bring a candle and my book of Psalms and a small book about the climate and pilgrims for future.
[00:36:48] Uh, and I have a, a small yoga practice. And the most important part in that is the grounding really through the body, I used to think about it as it is if you were, um, Yeah, you're throwing, uh, it's called throwing. Throwing, yeah. Throwing or turning in English. Turning mm-hmm. When you make ceramics.
[00:37:16] Okay. So it's like when you put that piece of, uh, clay on this, uh, spinning plate. Spinning plate, and in the beginning it's wobbling. Mm. And after a little while, you manage to get it right in the center. Mm. And then it doesn't, doesn't wobble anymore. It doesn't go. It's, and that is something like what happens to me in the morning practice.
[00:37:47] Mm. And it's a lot about the breathing. Mm-hmm. and the breathing is physiologically, it's a very exciting function because it's the only function in your body that is both. Autonomous. Mm-hmm. And under the control of the will. So you, you, you can't decide, or not ordinary people, some Indian gurus know how to, uh, change the pace of the heart, but normally people don't know how to do that.
[00:38:27] But with a breath, you can do that. You can decide when you breathe in and when you breathe out. And that is, I have thought a lot about this breathing thing here. I have it . Uh, so there's an Latin word and that is the same word as respiration and the same word as spirit to breathe. . I think that the breathing, it's like the whole movement in life of receiving and giving, and it's very obvious that you couldn't just pick one of them.
[00:39:26] You have to do the first to be able to do the next. You have to move, you have to breathe in and able to be, breathe out. So that that movement and that exchange between me and my surroundings, that is the essence of life and of staying grounded.
[00:39:51] Mm. and you always in towards the ending of this little practice, I used to lay down on my back with my arms stretched out, and there I practice my trust. Mm-hmm. , I try to feel how it's like in my body when I trust, when I truly trust the gravity that the floor will hold me, and in that moment I can feel that I'm free.
[00:40:33] So there's something about trust and freedom and breathing in and breathing out. And when I lie there on my back, I sometimes think that I'm being breathed. Mm. , then I don't, I don't have to choose. There's something in me, and that is life. Something gives the impulses to my diaphragm, to contract and to let go.
[00:41:05] And that is the whole life rhythm. Mm-hmm. . And I connect to that every morning. And then I, I pray my prayers and I light the candle and I, uh, sing a mourning hymn quite often. The one that I sang in the, uh, classroom when I was a child and then I end with the blessing. Mm. And that gives me a good start for the day. Uh, staying grounded, adding contact with. because I think that is one of the most, uh, grounding prerequisites. Forget it. If you want to come into contact with another person, you have to have contact with yourself first.
[00:41:56] Mm-hmm. . Otherwise you're all over the place. So the presence in contact with yourself, the differentiation and the link. Mm-hmm. . Yeah. That's, I think that's how I do that. And then on my way to work it, I leave a lot of that because things happen and life goes on life. It's not, it's not that easy, but that is my daily practice and I really need it to be, to make it possible to have company with all the pain and the suffering and, uh, families.
[00:42:42] Mm-hmm. that are soon going to say, farewell all the sorrows and the crying and the, I don't want to
[00:42:54] Saying farewell. That's hard. That's hard. And we will all have to do it . Very true. All we know about all that, this is my children. Really tired of hearing all our relations will end with a loss. Mm-hmm. , there are no exceptions. No. I think, yeah, just hearing you say that, and also you talked about trust and I'm thinking about it in relation to relationship and connection. Mm. , but also in relation to this unknown, which is, you know, in whatever context we talk about it in your context of, how long am I gonna live mm-hmm. , or what's the future going to look like?
[00:43:52] We all have different unknowns that are dominant to us, and I think one reflex in that moment can be to go and try and control Definitely. And then be more in that space of not asking questions, but trying to push everything into the things that you want to see. Mm-hmm. . Um, yeah. So I'm curious about the word trust here.
[00:44:19] How much you think that also plays a role in making these interactions Good. . Mm-hmm. , they're really very, very, very utmost important. Mm-hmm. , uh, and in our whole lives, , we, we, we can't live without trust. We could, but it doesn't get any good lives. You have to find something or someone, or someplace where you can foster that trust, I think.
[00:44:58] Um, and in some way, I think, uh, in my life after losing my sister, I've been thinking about all the losses that I'm going to have. And I, uh, I think about not knowing how long life will be. I feel in some way I feel a trust that I will be able to handle whatever happens. Um, and then I have my Christian faith hoping to be met.
[00:45:37] when I'm leaving, when I get out of time, out of this world, uh, I hope that there is something beyond and that builds my trust, but also the possibility of being forgiven for all the things that I don't manage and all the times when I do wrong things. Mm-hmm. That's really building trust. It's okay. It's okay that you're human.
[00:46:11] Yeah. You will do a lot of mistakes. Yeah, we all do that and that is so beautiful. When I, uh, go to church in the evening mass sometimes I love the moment best when you just come to the church late at night, not many candles, quite dark. And then there comes small persons just like me coming there. with their longings and their mistakes and their, uh, need for being met and welcomed and seen.
[00:46:46] And so, and here we all are with our imperfect lives. Mm-hmm. . And we're all human. And we're all human. We have the same needs. Hmm. Uh, and that's, uh, really building trust for me and for them, I think, uh, have a place to go where other people come with the same longings. I think that's interesting cuz you bring up two, two aspects of the, of the trust is mm-hmm.
[00:47:20] one, you talk about fostering this trust in yourself that you can handle things that come your way. Things that don't go as you planned. Surprises. Mm-hmm. , you know, a lot of things happen in life. , but also having that space that can foster the trust and as you were talking about also that you want to create in the facility where you work, is that's a more collective responsibility or a leadership responsibility kind of here's the space we are in together and that makes us feel safe and we all are part in creating it.
[00:47:59] Mm-hmm. , but then we're all, are part, we all have responsibility to ground in our own trusts and learn to trust our own abilities. Mm-hmm. , uh, yeah, I just wanted to relate to that cuz I think that's, um, a balancing act that I see a lot. Mm-hmm. the structures and the spaces versus the personal development .
[00:48:22] and they're not more, one is not worth more or less than the other. They're, they're going on at the same time. Mm-hmm. . Mm-hmm. . And sometimes we, I think sometimes we wait to develop ourselves because we're waiting for something else to happen around us to give us that. And I kind of think, well, it's both right.
[00:48:45] We have to take responsibility for it, or we can't sit and wait either way, . We just have to trust that even if that space isn't good enough for us, we also then know, I'll be fine. I'll be fine here. If it isn't perfect for me, I'll still be okay. The art of doing the possible things in that very moment together with someone.
[00:49:05] But then building trust is also about deserving trust in how you act from one time to another. And uh, uh, in some parts you can do that by, for instance, if I have a patient and a family, where there is much distrust when we start our contact, then we must, uh, use a lot of time in many visits before there is even the first seed of trust.
[00:49:35] Mm-hmm. Then it's my task to endure that. So if the patient don't trust me, I say I come back next week and if I don't come back because something happens, then I have to tell why. And I have to go in a reparation phase saying I'm extremely, not, extremely, I'm sorry for not come coming as I, uh, promised I got sick or my nurse had to go to whatever, uh, doing what you said that you were going to do.
[00:50:15] Mm-hmm. . So building trust is about deserving it. And trying to not promise anything that you don't keep. So I think that is the building of the trust together with the families that are having a person that is soon going to die. Uh, it's very easy in some families because they have the very healthy attachment to each other and they, they have the trust with them.
[00:50:42] I have that from my childhood and some people don't have that. They're not attached to anyone outside. They have another wanted or dared to try to trust another person. And all kinds of people die. I used to say . So therefore, I always also meet persons that are not used to trusting. Mm. Connecting or connecting.
[00:51:12] Mm-hmm. So sometimes I just have to go there and trying to persevere in the moment where I feel they don't trust me. Mm. No. Maybe they have their good reasons. Mm. And then I say, I come back next week, . . You use your grits and your everance. Exactly. Yep. Yes. And trying to deserve a tiny little part of some kind of trust.
[00:51:42] Mm. It's almost always possible. Yeah. Eh, but you should never, ever lose one single part in what you have promised. Mm-hmm. Cause then it's all just like a house of cards. Yeah. So it's very fragile then. Yeah. It's very easy to destroy trust. . Yeah. And it takes a lot time to build it. Mm-hmm. . But what I'm hearing is also that if you're transparent, you have, you can play with the margins Exactly.
[00:52:20] A little. Mm-hmm. , if you're being honest, I'm, I'm seeing that this wasn't good for you and I'm sorry. And here's the reason why I think we missed that part Sometimes Yes. Or quite a lot. And, and we don't realize the consequences. No. It has on the, on the total, because I can say, things that I do are very, it could practically very far away from, from the work that you do, but I still see a lot of the same patterns.
[00:52:49] Mm-hmm. , uh, same being, when you talk about a company culture or a way to take care of your employees, for example, then there's. always this, the communicated promise and then what you deliver in a very practical way, what it looks like. What, what does the support I get with my leadership or my tools or whatever else is surrounding me that's giving me the sense of a consistency with.
[00:53:16] the promise. And I've seen a lot of how much we underestimate the role of that dissonance. Between what we're saying and what we're doing. . And also how much impact it can have if we're being honest about the dissonance. I mean, it makes the whole difference because the end of the day we keep coming back to this, we're human.
[00:53:41] There are going to be inconsistencies, there are going to be mistakes, there are going to be things that don't make sense. Mm-hmm. . And if we can talk about them, then we can also manage the expectations, then we can manage the stress. So I. just, feeling into what you're saying from, from where I'm sitting is Yeah.
[00:53:59] That's how I'm making sense of it. Mm-hmm. . Um, but they place out in all scales, just big. Mm-hmm. organizations, intimate relationships. And I love how you also started to say we're human everywhere. Mm-hmm. , we're not less human because we are in a certain setting because we're the doctor or the patient or the coworker.
[00:54:23] We're, we're human in every space. And I definitely listening to you and the words that you talk about in different ways are the exact same that I see in a lot of other places. Hmm. Which is not surprising, uh, but comforting almost. Mm-hmm. . That's nice. Yeah. There's a sense of comfort just, okay. Hmm. , this is the core humanness.
[00:54:53] One thing I'm curious about, and I wanna come back to when you talk about the link mm-hmm. , what is that? What is, we talked about the differentiation mm-hmm. and the desire to listen, and you talk about the quality of the connection. Mm-hmm. and giving attention. What, how do you know that there's that link?
[00:55:21] Do you just feel it? I think it's, I honestly feel like a lot of people don't know or don't trust No. That, that the link is there, there that the link is there.
[00:55:36] I think it's, um, ah, it's a very subtle interplay. It's about the questions and what I spot on with the attention and so, but we're very good at feeling. I think I am, at least to feel when I'm in contact, the other person is there. Mm-hmm. There's some kind of resonance when it starts to . They react to you? Yes, they react to me and I react to them.
[00:56:13] Mm-hmm. And there's some kind of, it's also about musicality, actually. It's about toning, intonation about what, what kind of person is. , how could I, you have to be very agile in that moment. And really trying to tune in to see what is that other person with the you know, you just have, if you're going to help another person, you really must try to find him where he is.
[00:56:42] Mm-hmm. And start there. And that is what you always have to do after the differentiation is trying to, okay, so where, where are you? What is important for you? And trying to read out, are you afraid of me? Do you trust me? Kind of, uh, projections can I see if I can feel in the air in some way? Uh, and quite often the patient also shows a lot of feelings.
[00:57:22] And that's where many of my trainees used to be quite nervous. Uh, it's hard to come into the, this emotional resonance and being with Mm. The empathies towards that I've learned from your mother. Mm-hmm. , your beautiful mother, being with Mm. I'm here with you. You don't need to fix it. You don't have to do anything.
[00:57:48] No. Don't have to run from here. You don't have to say anything that is going to fix it. You could just stay, stay calm. I'm here with you. Mm-hmm. You're not alone. Mm-hmm. And being with mm-hmm. I like that. And to trust that it's enough, it's enough. It's also that, right. The feeling that things aren't enough.
[00:58:16] Hmm. I like. , and you are born and raised in that beautiful being with, I'm very privileged to have gotten a lot of tools from my mother in that sense, and, and a lot of very positive experiences in terms of being a person. I think. Being treated as a human with respect. With respect at any age.
[00:58:44] Mm-hmm. . Um, I definitely, just on self-reflection, listening to you, I think that, um, it, it's more natural. The differentiation is more natural to me, for example, than the staying with mm-hmm. , because I'm also quite creative and so I don't wanna say Im solution oriented, but I'm a little bit impatient and I see a lot of possibilities and sometimes I, I know that I struggle and so it's, that's a very conscious practice on my end and through this work that we do.
[00:59:17] and that we also encourage people to do in, in a different context, to stay with the problem, just be with the problem or be with whatever is here and then move forward, but spend some time here. And I definitely know that that's something I have to pick myself up on. Um, so it's also this, again, coming back to the trust and acceptance that it's not going to be perfect every time.
[00:59:43] Not every day. I get to remind myself I get to practice. Uh, it also, that's my sentiment, just listening to you, is also, you also have to be human in this interaction. Mm-hmm. , it's not, you're not going to be a machine and every interaction is going to be perfect and connected and straight away people are going to trust you.
[01:00:05] No, sometimes you have to work on the relations. , sometimes you have to work well, you always have to work on yourself if you're working on the connection. I have to say that the feeling that's me is like very comforting to to hear these things. There's something nice about hearing that humanness is always humanness. And it's all, all the imperfection. It's okay. It's okay. We're human. So we've talked about a lot of different things mm-hmm. and we've, I didn't ask the exact questions I sent you, but we still touched on mm-hmm.
[01:00:34] most of the topics in some way. I always like to end on bringing it back to ourselves mm-hmm. , because sometimes when we talk about these very big things mm-hmm. and they can feel really far away and a bit. Scary sometimes to approach. Mm-hmm.
[01:00:59] if we're looking at the things that you are seeing in terms of building that quality, creating that resonance with each other, mutual connections, and what are some things that you would encourage people to do or to start practicing? Very, and doesn't have to be big or complex things, just Mm. Well, I, I would say that I think one of the things that people do too little is to take time in.
[01:01:34] Mm. In the reflective mode, checking in with yourself, breathing. Um, and that's where you calibrate your compass to see, because you have to do that every day. Mm-hmm. . Make room for silence. Put all your gadgets away and just being quiet for a little while. Mm. And reflect on where are you now? Where are you going?
[01:02:12] What kind of day, days? Um, connect with yourself. Yeah, exactly. So connect with yourself because if you're, you have this connection with yourself, you monitor yourself. And when you monitor, you could see if you have to modify in some way, do I need to do something in a different way? And that is something I really learned from working in psychiatry, that if you find a better balance between demands from inside and from outside and your resources,
[01:02:51] If they're calibrated, then you have a much better wellbeing. So trying to find a way of listening to yourself, am I doing the right things? And maybe should I say no to myself, to someone else, to someone at my work? Uh, but also to say yes. And that is, someone said that is the sign of the mature human being to say yes and mean yes to say no and me.
[01:03:33] No. And it's extremely hard. It is really. And then to open to grace is receiving in the breathing to really see being. writing a gratitude journal. I've been doing that for a lot of years. That is very good. I really like that, that you emphasize this. I think we underplay the importance of being able to receive.
[01:04:04] Yes, I think so too. It's easy to end up in just breathing out, giving, perceiving, contributing as a, and you have to also be the one that is receiving. Mm-hmm. Yeah. Especially if you want to establish connection and mutual resonance. Exactly. Has to come, you have to be there for the other one. Mm-hmm.
[01:04:27] Receiving what you want to give me. Mm-hmm. As well. Mm-hmm. Maybe cultivate trust. in the different ways. For me, it works with this lying on my back on the floor. I don't know if it works for anyone else, . It's just my, we all have my way of doing it. Experiment with that. I think I know, uh, a few episodes back I had Maria, I was a neurologist one. Mm-hmm. , we were also talking about, uh, growth and developing and, we were just, we were talking about that, that there's rarely one way that works for everybody.
[01:05:03] And actually a really good thing to do is to just be open to exploring exactly what works for you. Just try, try, try some things out. Maybe lying on the floor will do it, and then you don't have to look anymore. And maybe, and maybe not, maybe, maybe not. And , and then you have to look for, for other solutions.
[01:05:22] Yeah. But, uh, and I really like that. because I feel like we live in a world where we're constantly pushed all these ready made solutions, buy it all in a box and it's gonna fix your life and transform you. And actually everything's a puzzle. Yes. And you have to go pick little pieces from here and little pieces from there and make it make sense to you.
[01:05:43] Build your own. Build your own. Yeah. Yes. But I really like these, I really like your, your pieces of, of advice. Thank you so much for sharing your wisdom. Thanks for having me.
