Reimagining How We Navigate Change and Loss: A Conversation with Sonya Dolan and Bridget Sumser of Mettle Health

This transcript has been auto generated

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Meg Pekarske

Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever-changing world of hospice and palliative care. Reimagining How We Navigate Change and Loss. A Conversation with Sonya Dolan and Bridget Sumser of Mettle Health. Bridget, Sonya, thank you so much for being here.

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Sonya Dolan

Oh my gosh. Thank you for having us.

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Meg Pekarske

Yeah.

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Bridget Sumser

Yeah, it's such an honor.

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Meg Pekarske

This is such a special, podcast for me because I think you guys are awesome and the work you do is awesome. And also, I felt like there was no fitting way to end my podcast hosting responsibilities on Hospice Insights then to have you on it. So you are my last podcast. Our podcast is going to live on, through Bryan Nowicki’s

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Meg Pekarske

going to host it. But so this is my last hosting gig. Hopefully that was like, you know.

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Sonya Dolan

Even more honored now. Very cool.

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Meg Pekarske

Yeah. But yeah. So and that's why, I guess when I was coming up with the title and thinking about the things I wanted to talk about on this last episode, because I think as someone working in hospice for all these years, I mean, obviously death is is loss and change. And what the changes sickness brings. But I think that there are like me not doing this anymore.

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Meg Pekarske

Endings and how we do endings are really important too. And I think it's a skill like anything else, than how do we build those skills. And I mean, I don't think that there's a lot of resources out there for people. And I just think that what you're doing is so remarkable because, yes, it is helping people with illness, but it's also helping people with aging.

00;02;06;13 - 00;02;33;11

Meg Pekarske

It's also helping caregivers. And so just to to be fully transparent, you all helped me through, the terminal illness of my mom and her death. And it was extraordinary because I have no idea where I would have turned. I just knew that I needed help. I needed someone to help support me, how I could be the best version of myself during this time.

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Meg Pekarske

So thank you for your work. But I've also been able to see firsthand how remarkable it really can be to have that accompaniment during, you know, change. So anyway, long intro to to how you've impacted my life. But but for those listening who aren't really familiar with Mettle Health, do you want to talk about who you are and what you do and why you do it?

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Sonya Dolan

Yeah. Yeah, absolutely. And Meg, thank you for, you know, trusting us with you and with your mom's death. And we're every time we get to talk to people who have used our service, I feel incredibly honored and grateful that we get to be part of their lives and your life. So thank you also from us to you for for trusting us with those tender moments.

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Sonya Dolan

That's no no small thing. And I'm really glad to hear that we.

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Sonya Dolan

were that we were helpful.

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Sonya Dolan

So I my name is Sonya. I am a co-founder of Mettle Health, along with B.J. Miller, and we created this service in order to help, people, individuals. And that can be someone who is living with an illness, that can be someone who is caring for someone with an illness, that can be someone who is dying, that can be someone who is caring for someone who is dying

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Sonya Dolan

navigate that experience. And each of us have our own lived reality, and we have different things that are going on. We have different relationships, we have different living experiences. And we wanted to create a service that, really created relational relationships between the person who was navigating that new reality that changed that ending, whatever that might be, and the practitioner on this side.

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Sonya Dolan

So how can we tend to the life that is being led outside of the treatments, outside of the things that happen in the hospital? Or how can we support people to utilize the health care system? How can we help them? Think about the care for themselves, think about care for others, how to communicate with each other, how to think about what's happening, how to cope with it.

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Sonya Dolan

There's there's so much that goes into being a human being living with change. And that's where we want to be with people in that moment.

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Meg Pekarske

Yes. So, Bridget, what's your role on the team?

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Bridget Sumser

Yeah. I joined Mettle pretty close to its inception in 2020 as a counselor and stepped into the role of Director of Counseling and Practices or Programs, this fall. So, have been along the journey since the beginning. And, I'm now here as you know, more steady part of the team to to build what comes next and support our incredible practitioners that provide the support and space for people out in the world.

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Bridget Sumser

And. Yeah.

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Meg Pekarske

So and you said something about the complexity of being human. And I think that the gap that I see in and I don't know if this speaks to the why you did this, but the whole concept of wholeness, and we very much compartmentalize things. Right? It's like our mental health and our physical health and our intellectual health and these different things.

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Meg Pekarske

And, you know, I think it's getting more mainstream that there's because and maybe we have less stigma over mental health. And now that's just like smart living, right, is to and to our emotional well-being. And so but you really don't at least my experience working with you, it's not like, I don't know, it's it's different in what you're doing in that it's not just it is like tending to your humanness and like, who being.

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Meg Pekarske

I mean, it's present because there is no solution here, right? I mean, it's just helping you trust yourself and asking probing questions. I don't know, but I have never found that in anyone else because most things are about problem solving. And obviously you provide a very different approach. Then there is a problem that needs to be solved. There's like the tending to and I know you use the word emotional accompaniment, which I think has a lot of wisdom to that.

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Bridget Sumser

But yeah, I mean, well, you know, I'm just so humbled by like, wholeness, whole people and whole lives. And we are so committed to a stance that is not oriented towards fixing. Right, but oriented towards being with and in the being with. Are there things that we can help with that actually turns down some of the volume? So not to fix it, but can we get clear on really practical or concrete things so that stress level gets turned down so that then there's more energy and more reserved for some of the unanswerable stuff that that is involved in being a mortal human being.

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Bridget Sumser

Right? Our mortal human being that loves other mortal human beings or is responsible for people they don't love. Right? So we we really do this dance, which is that we can't fix, being human and having human experiences of the body. And there are definitely things where we can turn down the volume. So there's more space or a little bit of respite to build our capacities to approach what is challenging differently.

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Bridget Sumser

Right? To build build skills. It's really hard to build new skills or new capacities. If all of the stress levels and all of the buckets are on fire, right? So we don't shy away from helping with concrete things in service to people having more of their own internal resource to tend to the stuff that's really important to them.

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Meg Pekarske

Yeah. Well, I think like at least for me, like making things small is helpful. Right? So I mean, Natalie, who I know is on your team and she's an occupational therapist, and that at first I was like, what does an occupational therapist do? But then you have these great little videos on your website, and just about helping people break down the things that you need to do, like she even talked about, I can make this phone call with you, like these barriers we have because there is doing that needs to happen and like support in that doing.

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Meg Pekarske

And so I mean, I think it's you know, it can be big sort of emotional work and presence, but it's also like those concrete like I need to do this. And there are barriers to me doing that, you know, mentally or you know, whatever. And I think people even see that as a thing that needs to be tended to, I think is, is just incredible right there.

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Meg Pekarske

So and I guess when I was confronted with, my mom's illness, I knew I needed something and I, because I admired her work, knew that you guys were cool and doing interesting things. But I didn't know that while I'm not the direct caregiver for my mom, so maybe they can't help me because I don't think my family's going to want, like, some family meeting.

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Meg Pekarske

So how can I, as a 50 now one year old woman, like, how can these people help me? And because I knew this was going to be, you know, very difficult and many different levels. And so can you talk about how you support patients and then how you support caregivers? And what does that, I guess, look like? Because you can help a caregiver when you're not helping the whole unit.

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Meg Pekarske

Right. And so which is a little bit different than hospice, which is very much like I'm the unit of care is the patient and their family. And here people may just individually seek out your your support. So yeah.

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Sonya Dolan

Yeah. Bridget I think can definitely speak to like the care that is provided. And I just want to add a little note of what you just said about I wasn't the direct caregiver, which I think is something we think about a lot and run into a lot is like health care is kind of designated. There's a patient and there's a caregiver and everyone else outside of that, we don't really have words for you.

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Sonya Dolan

We don't really have help for you or support. And like, I think a big thing for us is opening this up of like there are friends, there are other people outside of this, there are other dynamics that need to be tended to and that those dynamics deserve attention and time. So we run into this a lot of just like word choice of how are we describing the people that we're tending to?

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Sonya Dolan

Are they a caregiver? Do they see themselves as a caregiver, or do they see themselves as something separate? There's so many ways in which each of us can interact with this type of experience, and we want to open it up and say, like, whatever your experiences make to your point of like, I don't know what I need, but I know I need something that we're there for that, that you don't have to be in this like very defined bucket of I am the caregiver, I am living with this patient and I am doing this on a daily basis.

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Sonya Dolan

There's so much more beyond those two people. And and we want to be there for all of that. So this I think is also it's the redefining of who deserves care in these systems. It's a re it's an expansion of. And it will of course, take time and energy for us to get to people and say, no, you deserve this to like you deserve this.

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Sonya Dolan

You need it. We're here to support you. So that's just a bigger note on like the expansion of where this care can be given. And I can kind of talk more about like what it is.

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Bridget Sumser

We do for these people. I mean, I think the hospice movement and palliative care as it followed suit was really revolutionary in this idea of patient and family as the unit of care. We need that model really desperately. We need it throughout the health care system, really desperately. And it frames caregiver well-being as important as in service to patient experience and patient well-being.

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Bridget Sumser

And I think a fundamental sort of position we take is that caregiver, family, care partner, whoever you may be in constellation to someone else who is sick and in your own potential to be sick, or the potential of people in your life to be sick one day, like your experience, your well-being, care for you. You are entitled to care just because you are a person, right?

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Bridget Sumser

Not because we're going to help you cope better so that you can support your patient better, if that. If that happens and that's something you want, that's a beautiful thing. But simple and profoundly because you are a person having human experiences, you are entitled to this type of care and that's a hard thing to articulate and help people feel, because we've got so much stuff about like, am I close enough to this to have these, this big of feelings about it?

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Bridget Sumser

And, and have somebody listened to me for an hour about it? And it's like, honestly, you just have to open up the newspaper, read a few headlines. And as a person as sensitive or feeling or even whatever, just as a person, you're entitled to support, to process the things that you are exposed to. And that's many degrees away.

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Bridget Sumser

But there's grief and change and loss impacting all of us all of the time. And we really want to create spaces for people to get care, to get loved up, to be seen with no prerequisite of like, I'm one degree out. This is happening in my body. So therefore I'm entitled, right? It's like, you know, it's like just because you are a person, you're entitled to this kind of accompaniment and seeing and orientation and support.

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Meg Pekarske

Yeah. Well, that's I think, pretty radical even saying that as a person who considers myself like I'm very independent, I don't need help. Like that's been one of like the midlife learning of actually the wisdom is asking for help. Like, no, I don't have this. And for most people know that I do a lot of drawing and art.

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Meg Pekarske

And so I even this morning I was I was drawing these figures and they're like doing wild things, like, this woman is surfing, I don't surf, but I'm it was like, I don't got this. I'm getting to do it anyway. Like I'm doing sort of these, I'm on a skateboard and like jumping off and I, you know, in my old, younger years, I probably would have said, I got this.

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Meg Pekarske

I don't need anything. I'm just going to do this. And now this sort of weird circle of, yeah, I'm doing this, but I don't have it. And so it was interesting as I was drawing this because but there's sort of felt like a freedom, like, I don't have this because there's going to be other things around me to like, deport me.

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Meg Pekarske

And then what's the worst that can happen? Right. Like, is, you know, then then you sort of fall apart and then you come back together in different ways. But so, so anyway, I think that that and again, I think this is getting normalized more. And one of the things I wanted to explore is just your insight into how generationally things are changing, because I think there is just a sense that you should be.

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Meg Pekarske

I there was an article in the New York Times about people saying, and this is probably millennials, like, I won't date someone who's not in therapy. Like that's like the new thing, like because it's that normal like you, that means you're not reflective and you're not thinking about yourself and all this, which is pretty full circle from, you know, like maybe my parents generation and, you know, not wanting to do grief support even or whatever.

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Meg Pekarske

And so I think something is afoot where as this becomes more normal that it's okay to ask for help and maybe you don't have that, and that's not failure. That's not you're not competent enough to do this. This is just like hard. And you need someone to walk the path with you. And it doesn't mean burdening. I think all of your other relationships.

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Meg Pekarske

It's not that friends can't be supportive, but I think people who do work just in this space and grief and loss and what you do is different than even like a regular therapist, because, I mean, there is just a lot out there. And so but I guess what challenges do you see to what it is you're doing? I mean, both there is like the big health care system and what challenges are there and interfacing with that, but challenges with people being open to doing this, that it's somehow when you ask for help, it doesn't mean you don't.

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Meg Pekarske

There's something wrong with you.

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Sonya Dolan

Yeah, no, it's definitely a challenge. And what you mentioned about I don't need help. I've got this. I have been in that exact similar situation with my mom years ago when she was dying of cancer. Like, I, I think to myself, would I have accepted help if it had been given to me in a certain way? And I'm not sure that I would have.

00;18;54;03 - 00;19;29;03

Sonya Dolan

And I think that's real. There's something that I think we experienced that is you have to get to your personal kind of level and for people, for everyone, it's a little bit different of like, okay, I'm here and now I do need help. And a lot of the time we end up in that zone with people. I think what feels too late, there's so much work now that we want to do with them that we think is important around processing and getting right and having conversations, and now it's all shoved into a tiny little space, and we would love the opportunity to really work with people months, years in advance so that we can open

00;19;29;03 - 00;19;50;10

Sonya Dolan

this up. And to your point, you know, kind of therapy is the wrong word, but like open this up and discuss it. So then we get to these scarier moments. You can just be with your person and you can be each other with your people, and you can have the conversations that you want to have versus living in a really terrifying, distressed place where you're making decisions and you're just freaked out about those decisions and what's going to happen.

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Sonya Dolan

So I would love for us to, you know, as we move through this world and people grow and change and we grow and change that, we're hopefully working with people much farther upstream to talk about this stuff. And then when they get to those places, they feel more prepared, and less here. But that's real. Like independence is like, oh, especially in America, like we are.

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Sonya Dolan

I am my own person. I will do this alone. I do not need help. Or maybe like my family is my unit, but still there is a very help is a four letter word to a lot of people. And I. I can understand why because it's kind of been given to like, you pull yourself up by your bootstraps, you do this thing, you go forward, you are successful.

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Sonya Dolan

You are the person who makes it happen. It is not a tribe around you. And so I understand where we got that idea. And it's definitely something that, I think we are trying to navigate with people is to gently suggest that it's a, it's okay, like to get the support. There's nothing bad about this and it will do nothing but good things for you.

00;20;52;19 - 00;21;12;13

Sonya Dolan

But it's it's real. Yeah. For sure. And I think the health care system on top of it creates even more of an idea of like, okay, you're going to do this alone, and you are going to try all of the things in order to extend your life, because that's how that system is working, is to cure or to fix.

00;21;12;13 - 00;21;42;23

Sonya Dolan

Meg to your point like this is not something necessarily that we can cure or fix. So we have that system that's saying there's always something else to try, and until there isn't, we will keep going. And you are an independent human being who does not need help, that those two things together create, you know, a few barriers for us to get together and hopeful that, you know, to your question about like how people are changing, I see it in my friends’ kids who are ten and eight and talking about their feelings in ways that feel so mature and advanced.

00;21;42;25 - 00;22;00;21

Sonya Dolan

And I'm so impressed with them. And I'm like, wow, when you're an adult, you're going to be really processing this stuff and like, open to talking about things in a way that I never was. So I'm super hopeful for, for the future of that. But yeah. Bridge what else, what else are we up against here as far as what we do?

00;22;00;23 - 00;22;38;25

Bridget Sumser

Yeah, I think so. I think individualism has some really significant pain points when your body stops working in the way that you've known it to work, or your family system stops working in the way that you've known it to work, or, something's changing and somebody that you're close to, right? And I think we hold very dearly this idea of interdependence, even you can be fiercely, independent and also interdependent, like we need each other.

00;22;38;27 - 00;23;03;14

Bridget Sumser

I think one of the ways in which we're different from some modes of traditional therapy, and it's really hard to just talk about therapy in a blanketed way, because there's a million types. But, you know, all of our counselors come with really deep bench experience with the health care system, with accompanying and companioning and helping people facing serious illness and end of life.

00;23;03;14 - 00;23;36;17

Bridget Sumser

And we are people sitting with people. And that sort of changes the helping dynamic right there. There can be a lot of power and I need help. I'm going to go to an expert for help. Right. That can be the sort of a power base transactional thing. And we really look to kind of flatten that in some ways, not to not own what we know or what we've experienced or, you know, bring clarity where where there can be clarity because that's just so important.

00;23;36;17 - 00;23;59;09

Bridget Sumser

But we are humans that also sit with uncertainty, that also sit with the vulnerability of needing others, of the confrontation that happens when life is not manageable. And our main mode is to manage. Right. And there's something that's sort of softening, I think, in receiving help in that way, because I'm not the expert of your life. Natalie was not the expert of your life.

00;23;59;09 - 00;24;26;00

Bridget Sumser

Natalie was expert in creating a space that invited as much of your life into the conversation as you were ready and willing and interested to . Right. And it's one of the beautiful things I think about the work for us. It's so sustaining on the practitioner side, which is every single hour I spend with people, I learn. So it serves my life.

00;24;26;03 - 00;24;46;12

Bridget Sumser

I learn so much. This is not like taking out of my bank, taking out of my cup. This is very much like usually I do on some level of like how people show up and face such extraordinarily challenging circumstances.

00;24;46;14 - 00;24;48;01

Sonya Dolan

And we don't think, oh yeah.

00;24;48;03 - 00;24;48;20

Bridget Sumser

It's no, no, no.

00;24;48;26 - 00;25;06;27

Sonya Dolan

What I love about what Bridget and the other practitioners do is that they're curious about the person in front of them. They're curious about what they don't know. They're open to finding out more and letting that then involve their next conversation and so on and so on. It's never a I have the answer for you, and here is the answer.

00;25;06;27 - 00;25;19;09

Sonya Dolan

And go do it and fix it. It's open to not knowing, which I just love very much, because it creates the dynamic of like, we're figuring this out together versus you've come to me and I'm going to tell you the answer. Sorry. Sorry Bridget.

00;25;19;11 - 00;25;43;07

Meg Pekarske

Yeah. That's the not knowing that's like become my life philosophy and curiosity. So you use like two tag words for me right there. Curiosity. And that just actually I don't want to like being in the not knowing because I mean, how can you really grow if you're just always doubtful? Well, this is what this means. And I have it all worked out and whatever.

00;25;43;07 - 00;26;27;15

Meg Pekarske

And so I guess I how do you because I want to talk about your model of care. Because it's a challenge. Because were a bit more like direct to consumer or at least the way we are right now. And I think, and when we were prepping for this, I said it's sort of like the menopause movement for middle age women, where it's become democratized through social media and other things that people are talking about, like the taboo thing that, you know, half the population goes through, because it got information out and people talking.

00;26;27;15 - 00;27;00;29

Meg Pekarske

And then you have different companies who have sort of filled this gap, because wherever you live, you might not have someone who is the menopause expert or whatever. And same I think in this space that you're doing is there is not someone with your skills and experience and openness. Because what you're doing and we'll talk about this little bit is it's not hospice, it's not what you know, traditional health care is doing it sort of something else.

00;27;00;29 - 00;27;26;28

Meg Pekarske

And so I guess this direct to consumer model, which is a fancy way of saying people have to pay you, right? I mean, this has been the real challenge to the growth of non hospice palliative care is just those limits. People don't want to charge people, but you can't not not charge people because you know with fraud and abuse laws you can have beneficiary inducement because if they do go on hospice.

00;27;26;28 - 00;27;52;18

Meg Pekarske

And so there's just been real challenges with wanting to charge people for things. And I guess you were there standing strong and being like, if you provide a valuable service, people will pay for that, you know, and I do think things are changing a little bit. And so but tell me, how do you how do you deal with that?

00;27;52;18 - 00;28;18;12

Meg Pekarske

What is it like? You know, building there is no payment model right now. Now there's opportunities and I think pairs are getting more open minded about stuff. And again, you look at the menopause movement, what's happening there and insurance companies paying for things. Maybe they didn't before. But tell me a little bit more from a business standpoint. What does that look like.

00;28;18;12 - 00;28;40;14

Meg Pekarske

And and how are you trying to to navigate that. Because the push pull is, you know, hospice was all volunteer and before the Medicare benefit. And it was like and then we got the Medicare benefit. And some people would say, did that sort of ruin what we were doing in some way because there's now like big business and I don't think it's ruined it.

00;28;40;17 - 00;29;01;29

Meg Pekarske

But it's also step. Yeah, changed it a lot. And so when you get a payment model that then defines what it is you're doing, and then in, you know, then there becomes like you know now 6000 people doing that. So just share your thoughts a little bit about that.

00;29;02;02 - 00;29;22;23

Sonya Dolan

Yeah. Oh gosh I know Bridget and I can talk about this for like hours because just just to start like the the bedrock of this, I think that there is an idea in this country about the value of caregiving, the value of caring for someone. It is traditionally a woman's work. It happens with children. It happens with older adults, it happens with family.

00;29;22;26 - 00;29;45;12

Sonya Dolan

So there's already this idea that this shouldn't just be done and it should be done quietly, it should be done without compensation. And that if there is compensation, I don't really think it should be that valued. It should be pretty low. The person who is cleaning someone's body, who is taking care of their physical self, those people are paid very little money.

00;29;45;12 - 00;30;02;16

Sonya Dolan

So there is a signal that is sent that this is not worthy of like our capitalist society, which is also something that I think we're trying to interrupt a teeny bit here and say, this type of care is super valuable and we want to provide that value. I'm not saying that you should just pay us just because you should.

00;30;02;19 - 00;30;20;04

Sonya Dolan

You. We want to give you something that feels equal to the value of what you are giving us, that this should be e, this should be felt. And so there's just that entire thing like I think in hospice and palliative care especially, there's this idea of like, you should just give of yourself, but you I think the doctors run into this a lot.

00;30;20;05 - 00;30;36;17

Sonya Dolan

Nurses social workers which I can probably talk about this. You are the person who is the go to. They will call you in the middle of the night, ask for advice about something you are never. I don't know many lawyers who get called without saying like actually, no, you can book some time with me and we'll figure this out.

00;30;36;17 - 00;31;03;28

Sonya Dolan

So there's a there's an idea that one should give of oneself in a way without that. So that's kind of where we're coming up from. And like money is real. Finances are real. It can be hard to pay for things. And that's a reality that we recognize too. And we have always, since our inception to now to moving forward, wanting to figure out ways to make whatever we call care accessible to everybody.

00;31;03;28 - 00;31;20;01

Sonya Dolan

So, you know, right now we have this one on one type of care that is one, to your point, direct to consumer people pay us for this. And we do sliding scale where people need it. And how can we care for people in a way that maybe isn't one on one, but provides in the same type of thinking?

00;31;20;01 - 00;31;41;17

Sonya Dolan

How can we do content journeys or videos or recordings or worksheets or whatever, or combination of all of those things that maybe also gives the same hit of okay, I feel a little bit more confident about this. I know new things to think about. Or maybe I can go to a group support session in which I discuss this with our practitioner and get a hit of support that way.

00;31;41;24 - 00;32;10;17

Sonya Dolan

So we're thinking about what comes next after this one on one piece that can still provide care to people navigating these situations at a different price point because price is totally, totally real. And, hopefully, to your point, like insurers recognizing that this is real, you know, can we do something with those groups as well to say, hey, we can help your, HR

00;32;10;17 - 00;32;28;18

Sonya Dolan

populations. We can provide some type of benefit to your HR groups so that then you can provide it to working caregivers. And is there a partnership here that could happen so that we are, in fact, providing care in another way. So I think that those are also in the future and in this moment it is direct to consumer.

00;32;28;25 - 00;32;50;04

Sonya Dolan

And I also always love that because there's no referrals, there's no nothing. You can just come on in and talk to us about the next day or next week. There is no something that has to be processed. There's not an insurance that has to be run. None of those things are in place. And we wanted to get rid of a lot of that red flag, you know, stuff that stops you from getting access.

00;32;50;04 - 00;32;52;04

Sonya Dolan

So that was also important to be like, okay.

00;32;52;04 - 00;32;53;00

Meg Pekarske

Yeah, yeah.

00;32;53;02 - 00;32;55;01

Sonya Dolan

Come on in. We'll see you tomorrow and we'll talk about this.

00;32;55;03 - 00;33;26;10

Bridget Sumser

And you know, I think Sonya correct any of this that doesn't feel resonant to you, but I think it's it's a fundamental reason why why Mettle is created outside of the health care system, right, is that we want to be a place that is sort of forever expansive, where no conversation is unwelcome and no conversation is directed by what the money that is sourcing the connection or fueling the connection, fueling the time together says it should produce.

00;33;26;16 - 00;33;52;03

Bridget Sumser

Right? Because that starts to make up the space, right? If we need to be delivering advance care plans, if we need to be delivering sort of bulleted goals of care. Summary is, that doesn't necessarily let us go to the places that are most true in this person and sitting in front of us live. So that distinction and that separation has been really important.

00;33;52;05 - 00;34;20;18

Bridget Sumser

I think a couple of other things just about the model, is that we really work to create impactful experiences so someone could come and sit with us once and sort of have enough fodder, enough of a sense of like connection, support that maybe they don't need to come back to us for a while, right? Or they come three times, or they come every week for six months, right?

00;34;20;18 - 00;34;45;18

Bridget Sumser

Like we we are really quite flexible in adapting to what people need. And we are not trying to build dependance on us. Quite the opposite. Right. We are trying to, or we are, we are looking to sort of help stabilize and ground folks in their life, not on telehealth, in their community in real time. Right. And so we're not setting up.

00;34;45;19 - 00;35;03;24

Bridget Sumser

We're not setting out to find, thousands of people that will come to us every week, you know, endlessly. You'll want to come every week, like, we're so down the hang with you. And there's the we're not looking to create a system that that does that kind of fosters that kind of dependance.

00;35;03;27 - 00;35;26;00

Sonya Dolan

Yeah. Yeah. We want you to, you know, come learn what you need to learn. And we have this word like, hopefully you'll graduate and hopefully you'll come to us and be like, hey, I am feeling so much better than I was. And I feel like I've got this and great. Okay, wonderful. And and how can we at Mettle create spaces that then continue to hold you that person versus just like, okay, well we're done.

00;35;26;00 - 00;35;53;26

Sonya Dolan

So goodbye. Like we would love to create some kind of community catchment, something where there is always a place for someone to go. Because we also recognize that as we move through these moments, grief is present in weird ways. Moments of needing something else comes up in weird ways. It's a sporadic it's not on a schedule. So how can we continue to care for people in those little moments that pop up, even when we may not be engaging with them on a daily basis anymore?

00;35;53;26 - 00;36;09;29

Sonya Dolan

So that's a big goal for us too, is like creating something a little bit bigger that says, you're this one on one time might be done with us, but we're still here in this capacity, and you can check in and get a hit of something that feels good for you in this moment, as you move through these other phases of your life.

00;36;10;01 - 00;36;40;07

Bridget Sumser

I also just love that you've mentioned sort of the menopause movement a few times because, you know, the caregiver movement is not separate from the menopause movement. And this generation generations show women 40 to 65 that are sort of sandwiched between responsibilities and, are creating major cultural change in terms of women's health care. Like, I would not be surprised.

00;36;40;09 - 00;37;07;23

Bridget Sumser

You know, I sort of felt like one day I woke up in menopause. Perimenopause care was everywhere. I would not be surprised if we felt the same way about caregiver care and well-being, because there's so much work happening in that space nationally to build language around it, to build community around it, to build the literature around it. And, you know, the health care system historically has not been able or interested because there's no payment source there.

00;37;07;23 - 00;37;33;04

Bridget Sumser

So it's gonna happen in on the consumer side that's going to push change across all of the institutions. But it I think is very possible. The same group that's pushed menopause care is going to push major change in this space for everybody across generations in the, in the coming years, you know, like now.

00;37;33;06 - 00;37;59;10

Meg Pekarske

Exactly. It's beginning. And as you say, it's like the overlapping group. I'd imagine a lot of the people who seek your help could also be women, but that are like getting okay with asking for for help. And, and maybe this is, typical, but I remember when I was meeting with Natalie, it was like, can I keep seeing you?

00;37;59;10 - 00;38;27;27

Meg Pekarske

Because it was like, over, like three times because it's like, well, I don't want to burden you. I don't want to take you away from other people. And so I think that's something that I really appreciated is there's not like some package you have to, like, sign up for because as you say, you know, this work is like sort of up and down and sometimes you feel like you have it and then something happens and you feel like, oh yeah, I really don't have that.

00;38;27;27 - 00;39;02;03

Meg Pekarske

And and like, that's okay. And being in a space that doesn't sort of have, you know, judgment and again, just to because I want to, as we wrap up here, talk about, how you can partner and collaborate with others. And I guess to start that my own like, personal experience, you know, I was seeing Natalie a little bit before it was like right after my mom got diagnosed.

00;39;02;03 - 00;39;31;19

Meg Pekarske

And then my mom ended up dying fairly quickly. And so it was good to have a relationship established before my mom actually died. Because there, you know, it's it's hard to, like, walk into someone's life and sort of this sort of crisis. So to your point, and then we were able to, to go on to hospice.

00;39;31;22 - 00;40;05;21

Meg Pekarske

But she was only on hospice for like a day, and I thought she was going to live like a week or something. But it happened very quickly, and tremendous hospice experience. I feel like the karma of the world brought back to me after 26 years of doing this, because we had like five visits and this 24 hour span and like a really amazing, like, admission nurse who just a super skill to ask the right staff to get to it and build a safe space for my mom to be real.

00;40;05;21 - 00;40;36;21

Meg Pekarske

And we had this amazing chaplain who's all wonderful and but it's like none of that. Even if my mom would have been on hospice for six months, it wouldn't have filled the need that I had. Despite be having very good hospice team like the chaplains. Wonderful. The chaplains still, you know, checks in with me, asked me how I'm doing, but it's not the same.

00;40;36;21 - 00;40;59;29

Meg Pekarske

And so I see what you're doing is complementary. It's not competitive. I see it as really complementary because, you know, again, the unit of care is the patient and the family. And they, you know, there's just limits of what, you know, even the best of hospice teams can really do because they're not designed not nor is what they're paid to do.

00;40;59;29 - 00;41;26;14

Meg Pekarske

I guess what you're doing. So can you talk a little bit more about how you can collaborate and partner with people? I know you talked a little bit about the HR function, but just how is it I don't even really think about what you're doing as palliative care, even though it all sort of in that bucket, because it isn't like I'm doing this advance care planning.

00;41;26;14 - 00;42;08;25

Meg Pekarske

And you know, my clinical now meets the 99252 billing code or whatever. Yes. Yes. And so I think that there's opportunities for you to work with other parts of the health care system because I guess my two observations of working in health care for as long as I have, we have the silo, which I mean, hospice has got to be its own silo, even though the whole idea when we started was we were going to get integrated so there wouldn't need to be hospice because that would just change health care.

00;42;08;25 - 00;42;35;15

Meg Pekarske

And then the other thing is I need to own it, right? So hospitals will do this. And the pendulum swings back and forth like hospitals start up their own hospices, their home health. And then they realized, that's not my core business. I'm not good at. And then they sell it and the pendulum keeps swinging back and so I don't think the silo is good, but I also don't think people can do everything well.

00;42;35;15 - 00;43;08;17

Meg Pekarske

And so this like, well, I'm just going to do the whole continuum and whatever. And so, if we're not going to have either one of those models, we need to complement and collaborate partner and like, so tell me how your vision is, is how you might interface with hospice. Because grief support and hospice varies, you know, dramatically because there's not a lot of, rules defining what the 13 months of bereavement support after death really looks like.

00;43;08;19 - 00;43;34;01

Meg Pekarske

And most hospices don't do like therapy, grief support. It's more like grief support groups or staff. So tell me how you envision, because a lot of our listeners are going to be health care providers. And I guess I want people to see how you can complement what they're doing and feel something that's essential but not being met, not because people don't want to, but.

00;43;34;03 - 00;43;37;25

Meg Pekarske

Right. It's really not what you're getting paid to do. And so.

00;43;37;28 - 00;43;39;07

Bridget Sumser

Right. Yeah.

00;43;39;09 - 00;44;01;26

Sonya Dolan

Well, hello. People who are listening practitioners out there. So how we this I love this because this is how we see ourselves as a partner. We are not doing something better than you. We're just doing something a little bit different. And I would love all working clinicians to view us as a helpful partner, not just to them, but to the patients and families that they are serving.

00;44;01;26 - 00;44;24;09

Sonya Dolan

So you are working within a system that has turned your activities into like metrics. So therefore, I don't believe that there is time in the day for a lot of the stuff that needs to happen. And I think a lot of clinicians know that. And to your point, Meg, it's not that they don't want to do it, it's just that the system is not set up to support those types of longer conversations, bigger ideas.

00;44;24;09 - 00;44;44;20

Sonya Dolan

How do we manage this? How do we think about communication, etc.. So we want to come in and be like, hey, hey oncology nurse, this is so we can support your person and tend to all of the stuff that you just don't have the time to do. And then hopefully when this patient's family unit, whatever it is, comes in and sees you, they're better users of you as a health care provider.

00;44;44;20 - 00;45;16;01

Sonya Dolan

They know what questions to ask. They understand things a little bit differently, hopefully better. And they're engaged in a way that feels different to that provider as well. So I would love us to be seen as this helpful person partner, organization for a hospice, palliative care, hospital systems, ER, ICU like we understand the difference of working within the system and outside and want to remove some of that burden and say we can have this bigger conversation.

00;45;16;01 - 00;45;37;28

Sonya Dolan

So you know that this person is tended to in this way, and you can do the job that you're there to do, maybe that surgery, maybe that's chemo, oncology, that kind of stuff. You do that job and we'll do this other piece and together we're going to be able to tend to this person in a bigger, better way, which I do believe most, if not the majority of clinicians want want for their people.

00;45;37;28 - 00;45;40;26

Sonya Dolan

So hopefully I think, Mike, yeah, I think.

00;45;40;26 - 00;46;08;22

Bridget Sumser

You set it up for us though also, which is that it's grief and grief is not right, right. All every single person listening here knows that grief is not just bereavement. Grief is the feeling, the feelings that start to percolate when your body starts to change, when you start to notice changes in your spouse, when you're sitting at the Thanksgiving table and your mom has just told you the same story two times in a row, right?

00;46;08;29 - 00;46;41;21

Bridget Sumser

Grief is the emotional experience along the entire trajectory that does not have a home, and we are deeply indebted to the hospice movement in making grief a part of the discussion at all. And to your point, grief offerings. Bereavement offerings are hugely variable and often really underutilized, even when there are robust systems, because grief is snarly and it's intensive.

00;46;41;21 - 00;47;00;23

Bridget Sumser

And I need to talk to somebody twice in one week. And I don't want to touch this for six months and then like, oh my God, I'm going to get my wedding dress and my mom is not here and I need to talk to someone now. And that kind of ride does not fit into big systems. And that is not a critique of the big system.

00;47;00;23 - 00;47;35;05

Bridget Sumser

It's just to say, like, it doesn't happen in those spaces. It doesn't happen in the same rooms where anxiety is being pumped through the air. You know, the air ducts where everybody's executive function is already hit because there's you're asked to do so much in health care spaces. And so we can really be a partner in the learning to live with and be with and adapt and adjust to the grief that is forever present or that is forever present, long after 13 months.

00;47;35;07 - 00;48;11;02

Bridget Sumser

But people face decades later that they're face when their own illness presents itself. Right? Grief finds other grief. So, like, you know, we are often tending to grief in most conversations, even if it's never named as such. And like we can be your partners in that, including practitioner grief. The grief of the moral injury, or the moral distress that goes into caring for so many people day in and day out that our whole complex human beings coping very differently with similar circumstances.

00;48;11;02 - 00;48;21;22

Bridget Sumser

So like, you know, that one encapsulation of how to think of us is, is really in partners for that the snarly space of grief.

00;48;21;24 - 00;48;59;17

Meg Pekarske

Yeah, I there's just that I think there's just so much opportunity there because I think that there's so much and I think we're on the precipice, as you say, of of change. I hope I'm not being overly optimistic, but like people want resources. And again, it's not that I won't pay for it, but like, all of my friends, you know, all of our parents are older and it's like, how can I find someone who's going to adapt my parents house, which is, you know, a 1930s house with some grab bars.

00;48;59;17 - 00;49;24;19

Meg Pekarske

And this is my dad's getting a hip replacement and and this and that. And it's like, who does that? Like, and who's reputable and, like, you know, how do you find people that help you? Because everyone wants to get care at home, right? That's ideally where most people want to be served. And obviously you're using technology to to do that.

00;49;24;21 - 00;49;57;05

Meg Pekarske

But I think there's just so many things as you start dealing with illness, that people need help with. And it's like, yeah, I want to pay a handyman who knows the right products to use. That can be life changing. And so hopefully as humans and, and, health care systems, we see the value, even if I don't do where there is a value in connecting people to resources that help them.

00;49;57;08 - 00;50;05;00

Meg Pekarske

And, and you being one of those resources because we don't do that. But it's really important, you know. And so I just think that I think there's.

00;50;05;00 - 00;50;13;23

Bridget Sumser

A, I think there's a piece there and, and it's not true for every person. And we don't assume that anything is true for every person. But why do the.

00;50;13;23 - 00;50;23;07

Meg Pekarske

Grandma sit on this? Well, that's it for today's episode of hospice. And some love on Beyond. It's thank you for joining the conversation them and to subscribe to our podcast.

00;50;23;07 - 00;50;26;05

Bridget Sumser

Visit our website. On some level is really.

00;50;26;05 - 00;50;27;16

Meg Pekarske

Or sign out when you get to.

00;50;27;16 - 00;50;28;13

Bridget Sumser

Add the list and.

00;50;28;13 - 00;50;30;06

Meg Pekarske

See till next time. May the when it.

00;50;30;06 - 00;50;53;07

Bridget Sumser

Makes that arrow. It reminds me that I can't in the ways that I could. It makes me feel like I'm insulting my mom's ability to take care of herself. This is that. This is the grief stuff around all of the logistic, practical things. And then people come in feeling so much shame, being like, why can't I just call the handyman to install the grab bars?

00;50;53;07 - 00;51;17;10

Bridget Sumser

And it's like, because it's painful and it's okay that it is. It is a significant symbol of how things are changing. No shame that that feels hard. We can help you do it. And part of why it will be more easy to do it is because we say like, yeah, this sucks is super hard. Those are ugly. This is a beautiful bathroom and those bars are really ugly.

00;51;17;12 - 00;51;23;02

Bridget Sumser

Like, yeah, let's rage against the bars for a second and then let's figure out how to put them in, you know.

00;51;23;04 - 00;51;46;23

Sonya Dolan

Yeah. Exactly. Thing. And to your point, earlier like that's a practical administrative thing. But to bridge's Point has huge emotional existential implications. So when we are tending to something that feels administrative or practical, we're actually talking about coping emotionally and like, you know, for me, when my mom and I was taking her to the toilet and I was like, oh my God, like, we have fully shifted.

00;51;46;23 - 00;52;03;22

Sonya Dolan

Like, this is never going to go back to the way it was. And that was that was a moment of toileting. It's just physical bodily care. Yeah. But it had a huge, huge emotional impact. So that's where I think that we kind of step in and say each of these things is connected to each of these other things.

00;52;03;22 - 00;52;31;11

Sonya Dolan

So it's not that someone's just coming in for this one part of it. You start talking about the grab bars and all of a sudden we're talking about, I used to shower in there with my mom when I was little, and now it's all changed and it's totally different. And you're in multiple spaces at the same time. And I think that's kind of the beauty of what we get to do is we get to tend to each of these different places and not just the physical aspects are not just the treatment is we now get to have this beautiful conversation about like, why is that grab are so hard?

00;52;31;13 - 00;52;32;18

Sonya Dolan

Let's let's talk about it.

00;52;32;18 - 00;53;02;26

Meg Pekarske

Yeah. Yes. Needs to be like what that represents. Because like my mom was very esthetically minded. I get my like sense of art and fashion and like everything that's beautiful from my mom and so like her and she's very she's a minimalist and I'm a little bit not a minimalist. But anyway, she it was like the recliner for her, like, so my mom's bedroom was a safe space for her.

00;53;02;26 - 00;53;31;11

Meg Pekarske

But like, she's having a hard time getting up. And I was like, she needs to get a recliner. Like, we talked about that and it didn't happen. And as you're relaying the story about the grandpa, like, cause visually that is not would not be my mom's, chair of choice. And so but we finally get the recliner and I was, you know, very prepared that she was going to call the day it was delivered.

00;53;31;11 - 00;53;56;02

Meg Pekarske

It's like, this is horrible what? You know, and she didn't. And that was also a sign to, you know, like because she's passed the point. But I lost story about my mom, which is this is the last thing she said before she died. We're taking her to the bathroom. And my sister said, we have the commode in the basement.

00;53;56;02 - 00;54;17;23

Meg Pekarske

And she said, not yet. And then she's walking back. We're walking. Her issues have a very hard time, you know, breathing. She had lung cancer on the toilet, and she's walking back. She ends up collapsing and must have had a heart attack, but it was like the final words was, I don't want to be going to the bathroom in my bedroom.

00;54;17;23 - 00;54;42;27

Meg Pekarske

And I feel out and my family all feels the same way. Like that was like I in some way she willed herself or whatever. But like there was something like, I'm ready to go, but you can't. There's a lot of mystery that happens at the end. That's pretty wild. But I mean, I just think that's so powerful. What you said is it's not really about the grab bar.

00;54;42;27 - 00;55;16;05

Meg Pekarske

It's like what that represents and that sort of everything you do, right? It's not really about this thing. It's like all of the other baggage or memories and its connection to everything, and someone that appreciates and can define that and also say that is hard. Like to see my mom's bedroom with a recliner in it that she would never want, even though I picked out that the most esthetically minded recliner it is not what she would choose to have and like why that can be, you know, difficult.

00;55;16;05 - 00;55;47;29

Meg Pekarske

But how can we do that to to not, not do what's important, which is the grab bar’s important. The recliner is important. So like coming over that that barrier is super important. And so but well what you do is amazing. And walking the path is, is really hard. But I guess that as we close up here, what's on the horizon for you?

00;55;47;29 - 00;55;50;05

Meg Pekarske

What are you guys excited about?

00;55;50;07 - 00;55;51;13

Sonya Dolan

Oh, my gosh, we

00;55;51;13 - 00;55;51;25

Bridget Sumser

Have so

00;55;51;25 - 00;56;14;00

Sonya Dolan

many things. We have so much to be excited about. This coming year, you know, with Bridget coming on in a, in a, in this role that she's now in, of director of our practitioners and our program, she can really put time and energy into like what it is we're providing to the people who come to us and expanding that beyond this one on one offering, which is so beautiful and wonderful.

00;56;14;00 - 00;56;36;04

Sonya Dolan

And we want to keep that forever because we love that. And how are the what are the other ways that we can utilize technology, information, static stuff to help people? For the reasons that we talked about earlier of like, maybe there's a barrier to independence or maybe it's just we're not right there just yet. But I know we need some things that we're really excited to figure out.

00;56;36;06 - 00;56;55;16

Sonya Dolan

How can we provide what we consider to be the Mettle brand of care through other modes of interaction with people? That gets me really, really lit up. So I am really excited to explore that and do more around that so that we can we can in fact, say this is accessible to so many more people. Like, that's really, really important to us.

00;56;55;19 - 00;57;31;04

Sonya Dolan

Everyone gets sick, everyone dies. This is something each of us will experience, and therefore it needs to be pretty democratized. And we would love a system where everyone can say, yeah, I have access to that, I can get this information. I feel better about this. So being able to utilize technology, what's already out there to start to build on that is something that we're doing in the next few years that we're really, really excited about and just expanding what we do beyond this one-on-one piece of like, okay, I'm with you for this hour, but like really thinking about what it is that we're creating together or what it is we're working through, what

00;57;31;04 - 00;57;49;02

Sonya Dolan

we want you to have at the end of it. So being more mindful about what it is that we provide to the people that we're serving as well. And that kind of goes back to the curiosity word I used earlier, is that we want to always be curious about what makes sense next. What else can we do? And never just say like, okay, we're done.

00;57;49;08 - 00;57;57;22

Sonya Dolan

Great. We're set. Like we want to be an ongoing place of curiosity about what we what we can do differently or change or make make different.

00;57;57;22 - 00;58;10;07

Meg Pekarske

Yeah, yeah. You know, hopefully it will be the same wish hospice had. Like, we won't need Mettle because the whole world is now doing that, right?

00;58;10;07 - 00;58;12;00

Bridget Sumser

Yeah.

00;58;12;03 - 00;58;37;09

Meg Pekarske

But, until then, yeah. You know, , just an amazing conversation. And thank you so much for the work you do. It's really amazing. And we're linking to your website so people can check that out. And you have all these amazing videos and webinars to record and whatever. And there's like oodles of information on there. So we'll we'll link to that.

00;58;37;09 - 00;58;39;13

Meg Pekarske

And again, thank you so much for your time.

00;58;39;16 - 00;58;49;08

Sonya Dolan

Thank you.

Bridget Sumser

Thank you. Wonderful to be here with you today in particular.

Meg Pekarske

Yeah

Bridget Sumser

Congratulations. Yay.

Sonya Dolan

Congratulations. Celebrate.

00;58;49;10 - 00;58;53;11

Meg Pekarske

Thank you. Thank you. Take care.