Love Conquers Alz

BRITTANY LAMB, MD: ER Doctor Helping Dementia Caregivers Make Confident Medical Decisions

November 07, 2022 Susie Singer Carter, Don Priess, Brittany Lamb, MD Season 5 Episode 64
Love Conquers Alz
BRITTANY LAMB, MD: ER Doctor Helping Dementia Caregivers Make Confident Medical Decisions
Show Notes Transcript

In EPISODE 64,  Co-Hosts Susie Singer Carter and Don Priess chat with Dr. Brittany Lamb, an ER Physician, Dementia Family Caregiver, Educator and Advocate.

 In medicine, there is a saying, "You don't know, what you don't know." Dr. Lamb is on a mission to inform Dementia Caregivers so they can make competent medical decisions on their person's behalf through anticipation and planning. Her enlightening services include such matters as advanced directives, planning for medical emergencies, how to talk to your family and determining goals of care just to name a few. So if you are someone's power of attorney, health care proxy, surrogate or default decision maker, Dr. Lamb can help create a plan to help you make informed future medical decisions and focus on spending quality time with your loved one now.

Dr. Lamb openly discusses the challenges and stress doctors and healthcare workers face working within the current healthcare system. You don't want to miss this episode.

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Don Priess:

When the world has gotcha down, and Alzheimer's sucks. It's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is we continue to fight with the most powerful tool in our arsenal. Love. This is Love Conquers Alz - a real and really positive podcast that takes a deep dive into everything. Alzheimer's, The Good, the Bad, and everything in between. And now here are your hosts Susie Singer, Carter, and me, Don Priess.

Susie Singer Carter:

Hi, everybody. I'm Susie Singer Carter.

Don Priess:

And I'm Don Priess and this is Love Conquers Alz. Hello, Susan.

Susie Singer Carter:

Hello, Donald. How are you?

Don Priess:

I'm swell and yourself?

Susie Singer Carter:

Good. All right. Yeah, terrific. Yeah,

Don Priess:

Feelin peppy?

Susie Singer Carter:

Well, I had I yeah, I know. I'm not peppy.

Don Priess:

I ju st thought I'd throw that out there and see if you'd be peppy today.

Susie Singer Carter:

Well, I normally am peppy. But I had my flu shot yesterday, so I don't feel particularly peppy. But I'm trying that thus my my gallon of caffeine, Loaded. Yes.

Don Priess:

I'm gonna wait to get the flu shot till I know I shouldn't wait. Maybe till Monday. I have to play golf in the morning. I have to get up super early. So I'm not going to get my flu shot. Till then. I'm going to ask our guest today if that's a really good idea, a really stupid idea. I know the answer to that.

Susie Singer Carter:

You're very sensitive soul.

Don Priess:

I am. You know, and I feel like I need to be peppy at all times. But while you're you're non peppy is the average person's pappy so we're good to go.

Susie Singer Carter:

Look at that. No one's ever said the word peppy that many times - on air or anywhere.

Don Priess:

I'm bringing peppy back.

Susie Singer Carter:

Yeah. I'm like a real Pippa. Look at that...she's got gams can't see my gams but they're there.

Don Priess:

So anything exciting to report or should we just jump in?

Susie Singer Carter:

We should jump in because we've I've so many questions for our guests.

Don Priess:

And yeah, you have a lot of words to say, don't you

Susie Singer Carter:

I have words to say and words to ask. And I like it. Yeah. So go on and introduce our lovely guests Donald.

Don Priess:

I will do that. Dr. Brittany lamb is an ER physician, dementia family caregiver, educator and advocate. She helps Medical Decision Making caregivers make competent and informed decisions on their person's behalf through anticipation and planning. Her enlightening services include such matters as advanced directives, planning for medical emergencies, how to talk to your family and determining goals of care just to name a few. So if you are someone's power of attorney, health care, proxy surrogate or default decision maker, Dr. Lamb can help create a plan on how you will make your future medical decisions so you can focus on spending quality time with your loved one. And after all, that is what it's all about. Is it not? So? Let's not wait another moment and say hello to Dr. Brittany Lamb. Dr. Or should we be Dr. Brittany?

Dr. Brittany Lamb:

Just call me Brittany. It's totally fine.

Don Priess:

Excellent.

Susie Singer Carter:

Not lamby-pie, Don.

Don Priess:

Yeah, not lamby pie.

Dr. Brittany Lamb:

It would not be the first time that someone told me Lamby pie.

Susie Singer Carter:

So I want to call you Lamby-pie.

Don Priess:

We've been talking about it since yesterday. Yes, we've been we've been talking about it since yesterday, we'd like if we could only call her Lamby Pie

Susie Singer Carter:

Thank you for coming on and what you do and your experience and your perspective of what you do and what you've seen and how you feel changes should be made, so resonate with what I've just been through in the first half of this year. And I'm sure almost everybody that's listening will have have or will have this experience because it's part of life and it's part of it. It's a big part of life that we don't have any idea of until we're deep in it until we're knee deep in it. And like you say that is the worst time to make decisions. So let's get a little background on you first so we can understand that everyone can understand how cool you are and how brighten and awesome you know you started as an ER doctor tell us about that.

Dr. Brittany Lamb:

I always knew I wanted to be a doctor. I had no idea what kind of doctor I was going to be. But I was very interested when I went through all the process in medical school. That's I wound up being an ER doctor so they've been working in the ER for almost a decade now. And I in my personal life I think maybe people would want to know why I got into the dementia space. You know, my grandmother lived with us when I was growing up, she had vascular dementia. She was just with us when I was in high school on my father's mother. And that was my first experience ever being around someone who had dementia. And so it was very eye opening for me seeing how it impacted her life. And then, you know, also the people around her. So her her spouse, my grandfather, and then my dad and my mom, even you know, and the interactions between all of them providing care and making decisions. And, you know, she out they also have the they had seven kids, so you know, all the different children weighing in and everything so, but yeah, so then I went to college, and I did some volunteer work with a community that kind of brought college students are interested in going to medical school together with someone living with dementia. So I hung out with this guy who had dementia, and I hung out with him in his assisted living facility. So that was another experience I had and why.

Susie Singer Carter:

Wait, wait, wait, wait, wait, go back to that. So you hung out with this guy with dementia? Like, like you do? Like you do? Okay. You need to extrapolate that a little bit. Yeah. So

Dr. Brittany Lamb:

Yeah. So, you know, he was actually I honestly, I can't remember his name. It was a really long time ago. But he was an actuary for Geico. And so, so smart, and I would sit with him and we would do crossword puzzles, like at his assisted living on his back porch, you know, that was secure and everything, and I just hung out with him, I got to know his family, I went over their house for dinner, you know, and this was when I was in, this was a Madison College. So before I went to school for medical school, so, um, I just think that, I don't know, I mean, I enjoyed spending time with him and getting to kind of know what it was like, in an assisted living facility. Also, you know, like, I've never even been into Benin, one at that point in my life. So. So a little bit of real world experience there, I really liked hanging out with him, you know, just he taught me a lot. I mean, he was very knowledgeable person. And I always enjoyed spending time with people who are older than me, because, you know, you have so much wisdom and knowledge that you can pass on to people who are younger. And so I always enjoy spending time with people who are aging centrally. But when I, when I was in medical school, I did research on advanced directives. And so the POLST form was something that I was super passionate about, and still am, and worked on that. And it's just always mattered to me that people receive care that they actually want. And I think that if you don't understand the disease's themselves, and if you don't understand the treatment options for them, you can't make informed choices. And so this all these combinations of like my personal experiences kind of limit brought me to this point in my life where I just keep seeing aging people in the emergency department that come in, who are really sick and who cannot speak for themselves, who then need help making choices and their families are very overwhelmed because they were never talked about about what their diseases were like, or what it looked like when they got worse or what the treatment options were. And this is for people who everybody for all comers, not just people living with dementia, it's a huge problem for all aging, folks. But for those who are living with dementia, there's a special opportunity, which I mean, it kind of sounds bad saying it like that, but because you know that that person will lose the ability to make their own choices, it does allow you to plan in advance for the choices that you might make. And you can decrease stress as a caregiver by doing so. So that is like my entire mission and coming online and doing this work is I want to offload the stress from caregivers when it comes to medical decision making and planning for their person's future so that they can really spend that time with their person, like providing day to day care and just enjoying being with them. Because they still have so much to give.

Susie Singer Carter:

Totally, I love it. I love it. I'm applauding you so much because I am I am your poster child for what not to do. And, you know, and and we, you know, we had it. i My mom didn't really have a directive before and it was you know, I really loved my mom a lot. I wish she had a Living Will a trust but but that was that's a different story. I I was her conservatory person. So I was her health, her health surrogate and I had to make a decision on her directive. I didn't even know what a directive was. And I went with my gut which was you know, I wanted her at full code because I thought I wanted to be the one to make that decision. I never wanted her to be taken into a hospital and someone else make that decision for me or make you know a decision that was too important. I needed to see my mom and because she has Alzheimer's and because she can't communicate for herself. Maybe you know she She needed someone else to communicate and look at her and actually be able to communicate with her to see where where she really was at physically and emotionally. So but but still like what you said it's, it's, it changed over the past six months for me, I had to decide do I want to keep it full code because I finally got educated on what full code is, which you talk about, which is, you know, CPR, which is, which is aggressive. And, and I certainly didn't want that. So can you discuss maybe like what the, to the different kinds of directives that are that we have choices to, to make?

Dr. Brittany Lamb:

Let me back up a little bit. So Advanced Directives are document legal documents, and the person who has been diagnosed with dementia has to do those on their own. So living well, deciding who their circuit is, they have, while a person still is able to make their own decisions, and still has capacity, and legally that's called competency, they can fill out those forms and kind of can direct some of their health care in advance through these documents. So and then they're in in each state, there is a process for like, who would become someone's legal healthcare decision maker if they didn't name someone. And so it's different, a little bit different in each state. But normally, it's like a spouse, and then you know, and then a child. And sometimes it's a parent, they're still alive. But anyway, so there is a default decision maker that will happen per state. But so advanced directives have to be done in advance. And they have to be done when a person is still able to make their own decisions. And I have a huge bone to pick with advanced directives, because they do not tell they're not specific, which is this issue. They're not meant to be specific, you know, they're drafted by lawyers, by attorneys by people who do not practice medicine. So they're not they don't tell me what to do in the emergency department. And this is kind of why I jumped into this space is because I do believe that the issues that come up in dementia, I think that what you choose to do, from a medical standpoint, should change should can and should potentially change depending on the actual medical condition that is happening. So in some circumstances, you may want more aggressive care, because perhaps that person is very likely to recover or maintain their current quality of life, like, especially from an infection, like pain, maybe we're going to treat that aggressively. And that's okay. But if they have a significant underlying problem, like a heart problem, or a lung problem that we know is not going to get better, perhaps that person wouldn't want aggressive care in that situation. So anyway, I kind of got off tangent there for a second, but Advanced Directives are legal documents. And then when you come into the hospital, who you're talking about with code status, so code status is basically like, what do you want us to do if you are to die. And so and I'm in I'm being very blunt and direct here, right? So CPR, we only use CPR, if someone is like actively dying, or technically has that they do not have a pulse, and they're not breathing anymore. So CPR is chest compressions, it's medications through the IV, it is controlling someone's airway with intubating, them, putting them on a ventilator in some in some circumstances. And then occasionally, we can actually shock people which people see on TV as shocking people all the time. And that is actually not as common as not being able to shop someone. So that's one, when someone comes into the hospital, we're going to ask you do you want to be full code, and that means that we're going to do CPR, and we're gonna put you on a ventilator. And then each hospital has different designations for what they do after that. So there's full code. And then there's the other opposite side of that is comfort care. And so usually that's going to be labeled as somebody who's going to be a do not resuscitate. So don't do chest compressions, don't do CPR, don't put them on a ventilator, allow natural death. So that's usually what kind of what the language is. And that is somebody who, if that person starts to die, and they're becoming unstable, they're they have unstable vital signs, meaning their blood pressures really low, their hearts really high or really low, they're not getting oxygen, they're not breathing, we're going to keep that person comfortable, but we're not going to do a lot of aggressive measures to try to reverse those things. So that's allowing natural, allow natural death. And then there's people in the middle which the people that do not want to have CPR so they are Do Not Resuscitate. But they're okay with other aggressive treatments and then the hospital will help you differentiate hopefully, which things you are okay with and not but I'll tell you that having that conversation could take half an hour and who has half an hour in the hospitals sit down and have this conversation with you? Nobody does and so it's it's a huge problem because it's it is not complicated. I don't believe that it's complicated to explain this. Have people I think people are very capable of taking in this information and making decisions for themselves. But they have to be given the information in order to make decisions, and we do not have a way to give it to them. Because we don't have enough time in the hospital and primary care, doctors don't have enough time in the like, unless you're seeing a concierge physician. You know, there's just isn't a lot of time.

Don Priess:

And that's the biggest problem is that sometimes they're asking you, what do you want to do? And you have no idea you don't have the education? It's like, Wait, you're the Doctor, tell me what should be done. Yeah. You know, do what, how many times do I have to question what if this was your daughter? What if this, you know, yeah, that to me, is the answer to that? What if this was your loved one? What woould you do?

Dr. Brittany Lamb:

Yeah, and we're trying not to we're trying not to do that. And so when you ask us that question, we're supposed to, we're not supposed to do that. That's, that's a huge, it's a huge problem. Because you're right, it's like, what do you want to do? That's not the right question. The the way that this should be done is, this is what's happening? Do you understand what's happening? Okay, these are the options for what we can do going forward. But I need you to understand, like, what happens if you choose each of those options? Because a lot of times, people will tell me, like, just go ahead and do everything, but then they don't understand, like, what that means going down the line afterwards. And so and it's hard, it's, it's just hard to deliver the information when you have such little time

Susie Singer Carter:

You're right. And also it there's, you know, it's it's not it's not a, it's not a simple decision, because there's so many other factors that play into each of those decisions. So, you know, there's, there's data, and then there's, there's people, so there's data that can give you a sort of general idea of what is happening, what might happen, what could happen, what has happened, maybe, and then there's the reality of that person, and really what they're presenting, what does that mean? So, you know, I don't think there's a caregiver that's that I know, that I've talked to who hasn't felt like they've turned into a CNA, or, you know, has been, you know, taken on those responsibilities of really trying to, to diagnose and to be an interpreter. And, you know, it's, it's a really hard job, and especially when you're emotional, and and especially when you're up against a system that is very rigid, and because of their fear of liability. And that's an issue.

Dr. Brittany Lamb:

Yeah, 100%. I think that I think that caregivers that have more knowledge and have done it before, tend to feel more, I think, once you've done this before, with someone who's been really sick, it doesn't make it easier for you the next time. But caregivers do wind up learning so much about the healthcare system, because they have to advocate for their person because they can't speak for themselves anymore. And there's all kinds of issues that come up and problem solving that that's required in doing this job. It is not easy is 100%. What are very hard job to do that no one wants to do. I mean, exactly, no one wants to be in the situation.

Susie Singer Carter:

And not everybody is a Britney lamb. Not everybody is because No, truly because there's a lot of people in this field that have who maybe should be out of it. But maybe they're maybe they've gotten jaded, hardened. Because they had to because it isn't an easy job. And, and they throw big wide nets over everybody and they forget that there's individual human beings that are there and that everybody doesn't every act the same on on morphine, and everybody doesn't always die, when their pulse, you know, drops to this level or whatever, you know, everybody has a different, you know, we are unique. And and we have to remember that when we're diagnosing that, you know, there are, there's, there's things that happen, I'm not I'm not Uyu girls not saying that, you know, let's pray, and there's going to be a miracle. But I know, you know, just that, that data is only data. And then you have to have you have to be in there as the caregiver to really, really check in and really see is this the base of your person is this, you know, how are they what is the quality of their life? What would they want? And, and I and can I just throw this out here? I mean, as you will probably recognize this question, but I got this question all the time from the palliative doctors in the hospital who didn't know me they were just sent to call it call me and say what would your mom want? When she was in her fully coopersmith disc you know, state when she was you know, before Alzheimer's and everything and I said that's not fair. That's not a fair question. Because that person is not the same person anymore. So the person that would say to me, Susie, don't put me in a place like that, you know, if I get there? Well, no, because that person now says, I say, How are you, mom? And she goes, I'm great. I'm alive. She's happy as a clam. So you have to, you can't you can't make that decision on someone from 20 years ago or 15 years ago? It's not a fair question. It's not because they're different.

Dr. Brittany Lamb:

Yeah, I think that what you're saying makes perfect sense. Um, I think that in palliative care training, people are asked to think about that, like, so they're, you're taught to, to, as the person was when they were fully competent and had capacity, what they say about how they're living right now. But if you recognize in your person, that they still have a good quality of life, and they would still want their life prolonged, then you are able to speak on their behalf, as as bad as their current quality of life. So you know, there, there are some people that are not as I don't know how to say this, like, not as affected with their personality, and from an emotional standpoint, negatively with dementia, you know, some people that can still enjoy, and you can still see that they're, you know, happy and that they have, like, some meaning and purpose, and they're still enjoying life. Like, that's, that's one segment of people. And then there are people that are not that are not like that. And so if people's quality of life is suffering, you know, then, you know, their loved one may choose to do something differently. But I think I think what you're saying makes sense to like, but yeah, I think, I think also like knowing that quality of care are trained, they're trained to come in and ask that question, like, what you're saying is not is not what you should do. And I get both sides of it. Really? Yeah.

Susie Singer Carter:

And it really comes down to the the individual again, that's all I'm saying is that it comes down and you're absolutely right. Set like, you know, one of my other colleagues mother, who had dementia towards the end, she was like, I'm ready to go, mom, they're coming to get me and I'm happy to go. My mom, I don't wasn't ready to go. You know, she was, you know, she just loved life. So whatever was there, you know, if it was a good meal, if it was snuggling with the babies, it was that was a good day, if we were singing a song, it was a good day, if she could see a good looking man walk by. It's a great day. Okay. So I mean, it's just, you're right. And you're right, because it's like, you know, everybody, some people can acclimate to where they're at, to what they have. And and that's, and my mom had that facility. And I know a lot of people that I've met throughout, you know, her journey that were just like her and I met others that weren't, and who, when they were ready to go, they were ready to go. And, you know, it is, you know, and I think if you're, if you're at all intuitive with your person, then you you, you can really they'll communicate that to you, and you'll know it, you will absolutely know it. And no induct, I mean, if you? I mean, what do you think about what I'm saying is because because I think that doctors can only give you the spectrum. And then you they can't make that decision for you.

Don Priess:

They don't know You

Susie Singer Carter:

They don't know.

Dr. Brittany Lamb:

You are 100% Right. And also, I have to check in with myself constantly as physician, like, I have a bias towards less care. Like, I know that I have that because and I tell people that I have a bias towards less care because it people in the hospital do because we see people suffering, right, you just see people coming in coming in, there's they're sick, they don't feel good, they don't want to talk to you. They're confused. You don't know what they're like when they have a good day. And that's why I'm constantly telling myself and my and the nurses that are working with me, like more or more taking care of patients. I'm like, we need to know what this person is like when they're not sick. Like what is their day? Like? Are they? What is their quality of life? Like? Would they be okay with that quality of life like, and that's, that's the struggle. I think that when people work in the ER, and they work in the hospital, nurses, techs, doctors, we all just get so used to seeing people suffer, and we don't want to hurt them, you know, and what we do to treat people it's not comfortable,

Susie Singer Carter:

Np, it's not.

Dr. Brittany Lamb:

And it's it's not comfortable. And they're tough decisions. And you want to make sure what you're doing is what someone would actually want. And, and so there's this balance there, right between like, I don't know what this person is like on a good day. And I have to remind myself that I want to seek out that information, so I can help their decision maker and make the best choice for them in that moment. And I think it's tough. I don't think I think that it's hard for people to do and I think it's easier. I think it's easier just to continue with the standard of care and medicine and to just continue to do things to people and not really question whether or not you should be doing winging it and then send them the palliative care team have a conversation with the family. I think that's what was happening.

Susie Singer Carter:

Right? First I want to just say I want to I just want to say that the best doctors and nurses that I because of what my mom did bounce in and out of the hospital the last six months of her life, and that wasn't because I wanted her to that was because of the of the situation, the facility and it was bad. And that the nurse, but the Emergency Nurses who I became friends with, were like, What is going on Susie? This is your mom's base? Don't they understand? I said no, they do not understand. And I get called like, I'll get a call at two in the morning. Your mom is, you know, breathing a bit fast right now. And I go okay. All right. So what do you want me to do? Well, we don't you know, do we think we should send her to the hospital? You do? Why? Well, you know, they're just so worried and, and most of it comes from liability. Yes. Worried about their own liability, and not the well being of their resident. So my mom would get sent back there for no good reason. You know, being transferred in a in a in an Ambulance, ambulance, the whole thing? It's just it's too much and and if she wasn't sick before she is now.you know,

Dr. Brittany Lamb:

Yea, she's out of her routine. She didn't sleep. She didn't get her medications or whatever. Normal care. I know. It's

Don Priess:

and then I and then intubated three times, she was intubated three times, even against. Yeah, Susie said no more. None. And they still did it.

Susie Singer Carter:

My mom in in January of this year was sent to the hospital with which, unbeknownst to me of level four, pressure wound in her sacrum. You didn't know about that? No, she wasn't bedridden. She was in a wheelchair from and that was from Depakote. But that's a whole nother story. That's what put her in the wheelchair. This all happen during COVID Even though in an all I could do was was zoom with her once once a week, which I did. And I started to notice that she was in bed when I'm zooming with her at three in the afternoon. Right? So then I'm asking why is she in bed? Well, she's tired. Or whatever, you know, so I wasn't getting there. Anyway, she ended up with that which which turned into which, you know, brought her into the hospital because of sepsis. Yeah, and then UTI and then low kidney functioning and, and pneumonia.

Dr. Brittany Lamb:

I listened to your the latest episode that you did. I think I missed that you didn't know that she had that serious of a pressure balloon to now I'm just like, my mind is kind of blown on that what happened germ on like, I see that same situation happening all the time your patients like the same sequence of events. But I cannot believe that they didn't tell you that.

Don Priess:

She didn't know she had any pressure one level, let alone a level four. notification that there was any pressure wound.

Susie Singer Carter:

No, no. And when you know, and Don and I actually done came with me to visit her, like 36 hours before she was taken to the hospital. And I noticed that she was didn't seem right. I mean, she was still responding to me and laughing I told you know, I had this whole video actually of her tell I was doing what I do the dog and pony show to make her laugh and make her happy and at dawn happened to record the whole thing. And, you know, we noticed and and by the end of it, I was like 12 minutes and I was doing the life of Norma you know and making her laugh and, and and then Don noticed that she had something flopping around in her mouth. And it was someone's bridge, not Herman else's bridge with food on it. And I was like, oh my god, like that's why it was flopping around because it didn't it wasn't hers. It didn't fit, right. Yeah, she had like, yeah, so I anyway, so that, and I noticed that she wasn't clean. And she but she was in her chair. So she was sitting in her chair. And still if you look at you know the video, you'll see she's adorable. And she's like, responding to me like I'm going, I'm going right and she's laughing because I'm telling her how all the men love her. And you know, I'm doing all that stuff. And so she was having she was having her life. She was at her base, there was nothing different. And then after once they got her into the hospital and they had to intubate her. First of all was COVID. This was back in January. So it was Omicron. And I wasn't allowed in there. And I got a call that they were going to intubate her because of the pneumonia. I mean, I had no choice. They already did it. And then they when they tried to excavate her, they did it too soon. So they put it back in again. And then they decided to put a G tube in because it had been too long and they needed to give her food and nutrition and then they told and then they told me it was all temporary. That was just a temporary until they excavated her. And then by the end of that that month and a half she came back to the her facility with the Foley catheter with her G tube and the facility, I decided that it was better to keep it in because it was less invasive. And but at the end of the day, it was really just easier for them. Yeah, more convenient. It was much more convenient. Despite the fact that my mom wanted to eat orally wanted to drink orally, wasn't aspirating at all, but they decided she was aspirating.

Don Priess:

Oh, so they would give her nothing, not even liquid on a sponge.

Dr. Brittany Lamb:

That's awful.

Susie Singer Carter:

It's awful.

Dr. Brittany Lamb:

That's horrible. I mean,

Susie Singer Carter:

It's inhumane.

Dr. Brittany Lamb:

Yes, I mean, 100%. That's not a quality of life. That's not called providing comfort, even though especially not if you have if, especially if she had a swallow study, and and there were measures in place to make sure she wasn't aspirating. You know, like, I mean, if she wasn't aspirating, then that doesn't make sense to me. And to do that out of conveniences, like very poor care.

Susie Singer Carter:

Exactly.

Don Priess:

They did it under the guise. They did it under the guise that she would aspirate, even though Susie could go in and give her juices and stuff. And she did it with. Yeah, with the sponges they for they stopped her from doing it said no, no, she will aspirate. And she's like, well, she isn't she doesn't. And they said and then after Suzy finally talked them into finally letting her do what they got.

Susie Singer Carter:

But they had someone come in to assess Finally, after seven weeks her.

Don Priess:

Which was done wrong.

Dr. Brittany Lamb:

Yeah, Yeah, , I'm not a speech language. I

Susie Singer Carter:

They basically did it like this with their fingers just to test if she was swallowing and first of all, my mom was like, What are you doing? Like, I'm not going don't do those studies. But yeah, I mean, I had to swallow with your fingers there. And so I said she's not going to swallow with your fingers there. And, you know, since I found out from from really the true speech to do a barium test, you have to do an x therapist, that that is so antiquated, you don't test swallowing that way. That's as good as a guess. That's as good as I'm not ray.

Dr. Brittany Lamb:

There's things that there's a process in the standard that need to be done in order to know

Susie Singer Carter:

because it's too big of a choice to make its two big a decision.

Dr. Brittany Lamb:

That's that's a huge, huge issue. I mean, a lot of people, I think that we struggle as a society and talking about what quality of life means to us. But there are certain things that we all a lot of us hold equally. And one of them is like the ability to enjoy food, right?

Susie Singer Carter:

It's a basic.

Dr. Brittany Lamb:

Yeah, right, so...

Susie Singer Carter:

It's a basic. And if she and I kept saying if she's going to aspirate and die from that, then let's let her die from that. Because what other quality she have? I don't understand, like, what are what, what this is not comfort care.

Don Priess:

But that's a liability that comes from

Susie Singer Carter:

I have a problem with hospice and palliative and I also have a problem and maybe you can explain what is the difference between palliative and hospice, the difference that I found out and you can, you can, you know, expand on this is that one, Medicare covers and Medicaid covers different things under palliative as opposed to hospice, so they were happy to put her into hospice, when she got back, instead of trying to get her back to the base that she was at

Dr. Brittany Lamb:

Palliative care is, you know, true is is, is caring, it's supposed to help determine what someone's quality of life means and improve their quality of life, maximize it, allowing for every treatment under the sun while doing that. And so it's it is a fabulous service, if you find the right company, right, and so that your person, can anybody with dementia should consider a palliative care evaluation as well, I think, because it will connect you to services and resources that you may not have known that you might need. And you can still pursue all treatment options. Hospice is really more for someone's end of life. Now. Good hospice services can also improve quality of life and people can live on hospice for years. So yeah, but it is it is the question is asked to be approved for hospice, like, would we be surprised if this person passed away within the next six months? And if the answer is no, we wouldn't be surprised. And they, you know, would be more likely to be approved for hospice. But with hospice, the goal is any treatment intervention, anything that you do is to provide comfort, and that's right, a an underlying goal of hospice and palliative is just to maximize quality of life. hospice has to do that as well. But that's the difference between them. But yeah, I mean, how they're paid for and covered. You know, that's, that's a tough, that's a tough thing.

Susie Singer Carter:

If you have a wound, and you're, you know, you need it to be addressed because it doesn't matter how long you're gonna live, if you have a week, or you have a year. It's your week and your year, don't you agree and that in that we all may have just a week. So we who has the right to say that, well, they only have a week to live. So who cares? Let's just put them on morphine and knock them out. That's not fair. That's not fair. It's just not and and there's, there's a disconnect in communication between the surrogates. And the surrogates are often, and I'm not. I hesitate to say it, because it's gonna make me sound that I'm defensive, but I'm not it. I hear it from other professionals that, you know, there's a lot of gaslighting that goes on. And so it becomes, you know, you are the problem, you're being you're overstressed. You're not seeing reality. You're, you're, you're living in it

Don Priess:

You expect too much.

Susie Singer Carter:

You expect too much. You know? And, and you can be and so they can push you into that. Stereotype box. Yeah. And, yeah, and it's not true, because I and it took me so I mean, I found a few allies, but I eventually became, and I'm, I'm a gentle advocate, I have the disease to please. So I am the last person to go and looking at Mother efforts. That's my mom, you know? No, I'm like, um, so if, if it's okay, could you maybe send someone in and my mom has gunk in her mouth? That's like, she can't even breathe, because there's stuff blocking her airway. Just thought you might know how to get it out, you know? So yeah, you know, and I just became the thorn in their, in their heel, because they just didn't want to deal with it. And they're understaffed, and they just don't have the manpower.

Dr. Brittany Lamb:

Yeah, I mean, I think that's like the root of the problem. And in a lot of the care and facilities, I think people have with us, some of the facilities really do have the best intentions, and they just don't have the manpower for it. And that, and that is happening in hospitals as well. So it is it is, yeah, it's, it's, we've, we've lost a lot of workforce, because of COVID. And the stress of health care in providing this care it. I mean, there are people that say that, you know, people working in the ER, in the hospital, that we get PTSD, and we have, you know, it is demoralizing to watch sometimes what happens to humans, and so that, that, that normalization of suffering, and just seeing it over and over again, it can be really hard and people and so I think that might be part of why you by people get gaslit in a way, it's just because, you know, the people that are doing the gaslighting are just like, you know, I don't know what you want me to do in this situation, like, there's nothing I can really do. And you're you're coming at me with reasonable requests, but I can't actually take care of them for you because of XY and Z issue. On my end, we don't know how to we don't know how to provide what the best care for your person because of all these all these variables and issues. So

Susie Singer Carter:

it's true.

Don Priess:

It's systemic.

Susie Singer Carter:

I feel sorry. Yeah, I do feel sorry for for a lot of the health care workers, like yourself, and a lot of doctors who have their hands tied, because it's, it's down to protocol, and it's down to again, liability and things like that, that, that that stand in the way of person centered care, and individualized care. And, you know, and then also there's some care, and then there are caregivers that aren't don't educate themselves and become and do become problems. I know that I understand that too. And that and they and I'm sure there are, I don't doubt that there are people that you know, come out people come at these facilities with with ridiculous expectations. Understood, I understand that. But there's got to be a middle level that we can meet and, and that we need to take care of our health care workers like you, you we need to provide, you know, therapy and, no, seriously just like we

Dr. Brittany Lamb:

I don't disagree

Susie Singer Carter:

to, you know, minimize PTSD, which is really unhealthy, which can cause so many problems, which can, you know, manifest like Alzheimer's, like dementia, because it just takes over. And so, yeah, the fact that we don't a incentivize our are, you know, people to come into the health care system? We don't. And we, and we don't take care of the ones that are there.

Dr. Brittany Lamb:

Yeah, there's definitely more work that needs to be done. I think that also I think things will change. I think that the fact that we can have this conversation virtually and then get this information out into the world and impact people and, you know, the fact that we're a I'm a physician that is has created an online course that that caregivers can take and consume on their own time to educate them. Like the fact that this is now possibility is something that people are a thinker. I just think people are more interested in spreading information and knowledge now and I think a lot of physicians are looking to take back some of their autonomy. Power, like in control of what we're actually doing in the healthcare system, because so many physicians have become employees that it is hard to advocate because you are concerned about losing your job. And so that it's part of it. But I think I think things will change. It's just disseminating information and talking and having conversations and, and shedding light on these issues. So like your documentary is going to be, you know, I think it's, I think it's a fantastic idea and something that is so needed

Susie Singer Carter:

Thank you.Yeah, when someone meets their person, at the ER, what what can they do? What can they how can they best advocate? What

Dr. Brittany Lamb:

Yeah,

Susie Singer Carter:

communicates to you the best, like when someone's in their house, what can they say to you that that, that assures you that they're actually concerned in the right way?

Dr. Brittany Lamb:

I think when caregivers show up physically in the emergency department and ask, you know, hey, can whenever the doctor whoever has like a second come in and talk to my person, because remember, there's nurse practitioners and physician assistants also working in the ER, in conjunction with physicians. You know, I just really would like to talk to them, I want to make sure that we're on the same plane, same page that we're doing care that my person would want, I just want to make sure that we're following their goals and preferences and wishes and I want to provide information so that you understand my person better and kind of know what's normal for them and not. And I think a lot of that you can communicate to the nurses that can then relay that information to physicians, if they're super busy running around doing other things. I did just recently write a blog post I've written, I write a blog, I try to put it out every week. And a lot of it is about how to improve communication in the emergency department and with medical care staff in general. So I did do like a 10 tips for the ER, Oh, no. Yeah, so one of the things is that we really need to know the person has dementia, because if you're there to help them make medical decisions, and we don't know that they have dementia, that's a huge problem. And one of the issues I think people don't realize is that like nurses and techs are not sitting and like digging through your medical record. So they don't always know that the person has dementia, if it's if it's not written in the record, unless someone tells them and so I know it's annoying. When you come into the ER, you tell your story, like six times you tell it in registration, you tell it when they triage you, you then tell it when your nurse actually comes in, you tell it to the tech, you then eventually tell it to the doctor.

Susie Singer Carter:

And then you have that whole next round that come in.

Dr. Brittany Lamb:

Yeah, yes, anybody who's taking care of your patient in the last year person, and you have to tell them to, and I know that it's frustrating, but every time a new person comes in, it's a, it's another, it's another way to advocate for your person. And it's another way to make sure that they're they're getting the care that that they would want. So, um, but I think letting us know is a big thing. And then I kind of also tell people like, it's really important that you have an idea and understanding of your person's overall health, and like what medical problems that they take, what medical problems that they had, what medications that they take, it's really important, because to have a conversation about, you know, what's happening to them, you kind of have an app to have an underlying understanding of what what their medical situation is. And so that's something I tell people to talk about. And then goals of care. Like, I can't talk about goals that care enough. And I teach three goals of care. And it kind of goes in line with what we're talking about with code status. Yeah. And so I teach goals of care, like your person wants every treatment under the sun to continue to prolong their life, because they would be acceptable with their quality of life. Or they're someone who values the length of their life over quality of life, because there are people out there who, who want maximum medical treatment until it fails. And they don't care if their quality of life suffers with that. So that we have to respect that, right? It's not my job to tell you what to do. It's my job to give you the options, and then you make the best decision for yourself. So full treatment. And then on the other side, I teach that there's a goal of care of comfort. So every treatment and intervention that we do should be focused on comfort. And that doesn't mean no care, it means that, you know, if we're going to do a hip fracture, repair surgery, that is for comfort, like if someone falls and fractures their hip, they're never gonna walk again, unless we fix it. And they, they their goal here may be comfort, but that doesn't mean that they can't come to the hospital and have surgery. But that's important to know, because say they have a severe infection and have sepsis and their goal of care is comfort. Well, they should not have maximum medical therapy to treat their sepsis because their goal of care is comfort. And so at any man you talk about the different options there but and then the middle, the middle goal of care is I think, where a lot of people fall is some but not all treatment. And so, you know, not receiving CPR is usually what would drop someone from full treatment into that goal of care category. But then literally, that's why people need a medical treatment plan, which is what I teach in my course. So that you can decide for each medical condition your persons at risk for the most common things. What would you do now

Susie Singer Carter:

So important, so important what your she's saying is so important you guys because I did change it from full code to do not resuscitate, which really only meant for me my definition was, don't do CPR and don't break her ribcage. I don't want her ribcage being broken right to resuscitate her. But that doesn't mean I don't want antibiotics for her sepsis and for her pneumonia. I do. I do want her to be suctioned so she can breathe and doesn't feel like she's suffocating. And there's a there were certain things that I had, that I wanted for her. And I had to fight for that I had to fight for that because their default was she'll be fine. If we give her morphine she won't feel like she she don't worry about it. And I'd say no, no, I Please, you have to listen to me. I know my mother. She and then when I would talk to the respiratory specialist who came in who was who would do the sectioning. I asked him, will morphine help my mom feel like she is not being waterboarded? And he said, No, it won't. It's inhumane. She needs to be suctioned. So you must go with your gut. Do your do your research, and then do what you're saying Brittany's like, you know, do do Brittany's course or do something that we're you do? Where you do really defined definitively, you know, communicate what you want in these cases. And you have to be specific, right?

Dr. Brittany Lamb:

Yeah, yeah. That's the thing is that, I think that the more that you can learn, and the more knowledge you have, then when you're in the moment, you're gonna feel better about the choices that you make, you're not going to feel as guilty for making potentially making the wrong choice, you're going to be less likely to feel regretful and you're going to like sleep better, and just feel like shirred Yeah, yeah. Yeah, you made the best decision that you play with the information that you have, you know, one of the one of the bigger advocating,

Don Priess:

One of the big biggest challenges you talked about, you know, communicating with first with the nurse than to, you know, is the availability of somebody to communicate with, due to staffing shortages, and just just the amount of work that you you are put under, you can't stop and talk to every person's family who comes in? I mean, Suzie, I don't if you're if I'm not mistaken, like the first time your mom went in, you didn't talk to a doctor till the next morning. And she went in early the night before. You were in the dark in the ER,

Susie Singer Carter:

that was the emergency one, that one and

Don Priess:

even then there's a lot of decisions that have to be made in that er, and you didn't have any, you were in the dark, you might have another doctor call a friend of your your nephews, friend's father, who was a doctor call to talk to the doctor directly, because you had no idea what was going on? And have him explain that to you. I mean, it was, that's insanity

Dr. Brittany Lamb:

That is insanity.

Don Priess:

And it's dangerous. And and I think that's due to would you say that's due to staffing shortages? Or is that just the system?

Dr. Brittany Lamb:

Ah, due to both.

Don Priess:

Oh, hard to say? Yeah.

Dr. Brittany Lamb:

You know, just like what happens in living facilities, like, you know, paying for people to be in there and take care of patients is very expensive. And it's the same thing for staffing hospitals with, you know, and I mean, I'm not going to get into I'm not going to get into all the issues that I see in the emergency department, because of what I do, because it's what I do for a living, right. I mean, I can talk to that to talk to you all about that on at a separate time. But yeah, I think that it part of it is staffing. And then it is like there's turnover, right? So a physician may have seen your your mom and put in orders and decided what they were going to do and then said, Oh, I'm gonna go, I'm gonna talk to her loved one later, like, talk to you later. And then something else happened. And then it was the end of their shift, and they left. And then there's a new doctor there now. And they know they really don't know anything about your mom. They just know that your mom is not dying, and that they don't need to actively take care of her right now. Like she's tucked into the hospital and that like so that's just unfortunately, like, that's kind of what's happening on the back end. And I try I personally tried to make a point talk to the caregiver, the person that's making medical decisions for my my patients that are living with dementia, I do that that I know that not every physician does that. It because it matters to me that I start the care that they would want because the care skits started in the emergency department. We start critical care, we can start comfort care, we can leave we set the kind of tone for what the hospital's day looks like in a lot of situations. So I think just being an advocate, being there physically, and I think asking You know, you just have to keep asking, like, Hey, I know they're super busy. But like, is there any way someone could come and just talk to me for like, three minutes about what is going on? And you just, I always tell people, like, kill the staff with kindness, like, and I don't know how else to tell people to do it, but just just keep asking, you know, and being nice and saying, I know that you're busy, I know. But like, I'm here, and I just really want to talk to somebody, or can they call me, you know?

Don Priess:

Yeah, because, you know, there's always the Oh, the squeaky wheel gets, you know, the oil, you know, and some people go with quite the opposite. And, you know, basically go Terms of Endearment on everything. And, and, you know, they think that well, I'll get, but you feel, obviously, and then maybe the person you are, the way better way is to be nice and decent and pleasant. But sometimes I feel like you don't get noticed. Sometimes they're like, Oh, they're nice. I don't have to deal with them. Right now. They're there. You know, so that's a hard decision depends.

Dr. Brittany Lamb:

Yeah, it definitely depends.

Susie Singer Carter:

Yeah, wow, this is a big, this is a big topic. It's a huge conversation. There's, there's a lot to unpack here, because I have been through it. And I know, you know, and it does, and it is it's a it's a person to person situation. I love that you I love your advice about alerting people to the fact that your person has Alzheimer's or dementia, because we forget. And we do. I did think that, you know, well, isn't it in their files? You know, don't you see it? But no, I mean, that's why my mom ended up in a wheelchair because when she went to a doctor's appointment, and she was agitated, they thought she had a mental breakdown and put her in Psych lockup, and gave her Depakote for seven days. And because they didn't know that she had Alzheimer's, at the hospital at the place that was her doc, her regular hospital. So people don't look, people don't look, they often don't have time you can't you I think you're really right in saying you can't assume that anyone knows.

Dr. Brittany Lamb:

No, 100% You can't assume

Don Priess:

So important. I always I always think when I go to the doctor, oh, they've looked at all my files. They know everything. They know, my whole history, and quite the opposite.

Dr. Brittany Lamb:

It's time consuming. And that's like in the doctor's office before they see you for a regular visit, they probably have reviewed your record. But yeah, I would hope you know, but in the hospital, you know, you come into the ER, I skim through the what's in there, but it's not always complete. And I don't always have time to go back and read. You know, some people's charts are like so many pages.

Susie Singer Carter:

for sure. And you have and your goal is to get that person stable.

Dr. Brittany Lamb:

Right? Correct. It's Yeah, exactly. So we look for, you know, what is what is most likely happening based on the symptoms that they're coming in for? And then also like thinking about the worst possible thing that can be and what could what could potentially negatively affect their quality of life and harm them? If we miss it? What testing we need to do? So yeah, it's it's, it's all based on who's sickest? Right, so it's whoever sickest gets seen right then. And we're constantly being interrupted, which, which we all know, like, task switching is not good for our brains. And that's how things get that's how things get forgotten. Like, you get forgotten to bring a blanket to you don't get your pillow. You don't, you know, they say they're gonna come back. And then where are they? They're not back? Well, it's because they probably forgot, because they got distracted doing a bunch of other things. So it's just,

Susie Singer Carter:

it's actually I played music really loud in the in the room when I played my mom's music, and they're like, Wow, who's that? Singing? It's my mom. Any trick I could do to get attention? I mean, people loved it. It worked. No, I'm just making a joke, but in a way, but not really. But the point is, is that you're right, that we have to assume that that everyone is distracted and busy and, and, and gosh, I think what you're saying is like, the best, the best, you know, way to to, to, to avoid these problems is to be prepared.

Dr. Brittany Lamb:

Yeah. Just trying to decrease people's stress by teaching them like what they might not know, like filling in gaps of knowledge ahead of time. And I don't want to tell people what to do. I just want to provide this perspective that we have from the medical side of things so that people are armed with the information so they can make informed choices.

Susie Singer Carter:

So great. I love what you're doing. Brittany, I think what you're doing is no it's so it's so so so important. It really is it's like it's required if you're if you are a caregiver, if you are the the person, conservator of the person's health, you must do that for them and for yourself. That will alleviate So much problems on both sides. And and I wish that I had known that. But you know, now I do. And and now

Don Priess:

there's a place where everyone can go, they can go to your website and find out all about being prepared.

Dr. Brittany Lamb:

Yeah, it's blambmd.com.

Susie Singer Carter:

Well, yeah, it's gonna be in the in the show notes, you'll find it for sure. But I mean, I don't, I don't usually promote, we don't usually promote, we just have conversations. But I think what you're doing is really great. And I think it's important. And I think, you know, having someone that's been in the trenches, like you with an A can speak from experience, can, it can be an invaluable service to all of us. So thank you.

Dr. Brittany Lamb:

Yeah, I'm happy to happy to help. And, you know, people don't have to pay for my course, they can, you know, can read my blog and join my facebook community, and I go live in they're trying to go live in there weekly, and answer questions and things too. So they're

Don Priess:

Go pay for your co pay for a course.

Susie Singer Carter:

People need to get paid you guys

Don Priess:

We want Brittany to have money

Dr. Brittany Lamb:

Yes, but yeah, I mean, I'm happy to happy to help people in the course as well.

Susie Singer Carter:

Well, thank you so much. You're delightful human being. You're a lovely human being, and I love your soul. And I think that what you're doing is, is wonderful and that you're taking the time to, to, you know, multitask, like you're doing because you're doing you're juggling a lot. So thank you.

Dr. Brittany Lamb:

Now it's helped me I honestly feel like being in this space has taught me a lot has helped me better care for my people who are living with dementia, and I'm happy. I'm happy to do it's making me happier at work. So it's a win win.

Susie Singer Carter:

Beautiful. That's so beautiful. We're all about that. Aren't we Don?

Don Priess:

Yeah, absolutely. We are. We're all about that. You know, what I was really excited about today is that I finally got to call a doctor Lamby Pie. Yeah.

Susie Singer Carter:

Who isn't?

Dr. Brittany Lamb:

very excited. I love that.

Susie Singer Carter:

A series, we're gonna develop a series Lamby Pie, MD

Don Priess:

Lamby Piei MD Well, it's we do love what you're doing. And that's what we're all about is love. And there's one reason for that, and that is because love is powerful. Love is contagious, and Love Conquers Alz, and we thank everyone for watching. Please like subscribe, go to Brittany's website. Get yourself all good for the future and we'll be happy to see you

Susie Singer Carter:

Get prepared Kiss your loved one and next time.

Don Priess:

take care everyone.