Navigating Hospital Stays with Dr. Monique Nugent

SPEAKER_02 0:00

Welcome to Ask Dr. Mia Answers on Dementia Caregiving. I am your pocket geriatrician and memory specialist. When I was helping my mom with her cancer journey, I knew I wanted to be her advocate and her care partner, but I didn't expect to have to rehash old patterns of communication like a teenager. Combining my knowledge as a specialist for older adults and my own experience as a sandwich generation care partner, I am here to empower you to take practical steps to not only care for the older adult in your life, but also take good care of yourself. Welcome.

SPEAKER_03 0:46

Welcome back to Ask Dr. Mia. I am very excited to bring you this conversation with Dr. Monique Nugent today. And if you're tuning in for the first time, I also want to let you know that this is going to be my last episode before I take a summer break for 2026. I will be uh taking a trip to London to the attend the Alzheimer's Association International Conference and uh a little time off with my family, but I will be back again in late August, early September in terms of the new academic year. But I am very excited to talk with Dr. Nugent again. She has been a prior guest on this podcast. We were talking earlier before the recording that it's almost been exactly two years since she came onto the podcast. She's a practicing hospitalist and the author of Prescription for Admission, a doctor's guide for navigating the hospital, advocating for yourself, and having a better hospitalization. So welcome back, Monique. Thank you so much for having me. It's great to be back. Absolutely. And I know that we both see folks who are in the hospital, and particularly from the perspective of care partners who want to be there to advocate from their loved ones' perspective, but don't necessarily know how. What would be your suggestion?

SPEAKER_00 2:26

So the things that I really tell people is number one, you are important, right? You as a caregiver, you as the care partner, you are a vital source of information, you're a vital source of support, and you are going to be a huge part of planning for their success after discharge. So don't ever discount your presence, your input, and your questions, right? So I want you to first feel like, yes, I'm important. I should be here, right? And I think the conversation around adults and caregivers hasn't really gotten to that point yet of all of us always seeing caregivers as a partner. You know, when we talk about kids, we say trust mom, trust dad. Parents know the kids best, right? But that doesn't fully translate yet. And this is the message that I'm trying to get out to care partners, to caregivers, to family members, and then also to providers, to physicians. Like this is a really important person. Reach out, let's partner, right? So that's the first thing. I want you to feel like, yes, I should be here. Yes, I'm important, and yes, I'm going to participate, right?

SPEAKER_03 3:32

Absolutely.

SPEAKER_00 3:33

So after after that, like good pep talk to yourself, right? Um, the things that's important to understand about communication in a hospital setting is that there is a little bit of a imbalance of power when you come into the hospital, right? The way things were done at home fit your schedule, fit your lifestyle, fit your comfort. And suddenly now you're in the hospital and everything's going to be on the hospital schedule. And the hospital does run on a schedule, right? A schedule that has to do with change of shifts for nursing, when supplies are available, when phlebotomists are available, when the OR is open, right? So the hospital is its own ecosystem and it has its own schedule. And it has also its own stakeholders. At home, you are the main stakeholders, you and your loved ones. That's that that's the group that's working together. But suddenly you come into the hospital. Now I, as a hospitalist, I'm involved, right? I'm a stakeholder. The case managers are. They have their own schedule, the insurance agency, hospital administration, the nursing staff. So now the stakeholders have changed, right? And so you go from this comfort level where I know the turf, I determine the rules, to suddenly all of that is gone. I'm on somebody else's turf. There's a whole bunch of people involved, whether or not I want them involved, and the rules have changed. And so when you start to fight that, it becomes really antagonistic. So there has to be an understanding that this is not home. Things are not going to run the way they were run at home. What I need to do is transition the things that I know and the things that I need to this environment. So as a caregiver, you are the owner of information. And information is safety in a hospital. The more I know your medications, the safer you are. The more I know the past that you've had, the safer you are. The more I know the phone numbers for your specialists, for your primary care doctor, the safer you are. The more I know your allergies. And you as the caregiver, you are the owner of that information. So you have to be able to bring that information to every conversation. And the other thing you're going to bring is an expectation, right? So I come with information, and the expectation is you give me information and a plan back. And that's really what this conversation should be. What sometimes I think happens is this I'll get a phone call, you know, such and such is Marge's daughter wants to talk to you. I'm on the phone and say, hey, you know, how you doing, Marge's daughter? And she says, Well, how's it going today? That is such a vague and like not useful question to drive the conversation forward around care. And what happens is there's sometimes this idea or expectation that like I should get daily check-ins when what you should be getting is conversations that lead to plans and changes. Whether or not that happens every day, whether or not that happens two times a day, right? There are tons of times where I'm on the phone with family members multiple times a day because we are moving care forward. Things are changing. We're getting new information. So we need to make decisions. And there's other times where I don't have much to say for the day because the care plan hasn't changed. We're still waiting for authorization from your insurance. We're on day five of seven of antibiotics, right? Right. So I I empower people that every conversation should be a conversation about information sharing and planning. Don't waste a conversation with kind of just a social business. And I know that doesn't sound fluffy. It does, it doesn't.

SPEAKER_03 7:12

But it's realistic. It's realistic because the time in the hospital environment is so much more condensed, I feel like, for everyone involved, not just a patient, but the care partner, the doctors, the nurses. There's a shortage of time all around. And so I think what you're saying is absolutely essential as someone who's been both for in the role of a care partner for a loved one in a hospital, as well as on the other end, you know, as the doctor taking care of someone in a hospital. I think the best care partners offer really helpful information about their loved one's baseline, what their usual mentation is like. Is this normal? Is this not normal? Have they always been a night owl? Do they always, you know, have this complaint, or is this something brand new? And especially when it comes to older adults and people who have memory problems, really that care partner is so just want to double-click on what you said that information is safety. That is such a key and important thing to remember. And not having that information or um not knowing who is the right person to talk to to get that information, I think is where care plans feel and are incomplete.

SPEAKER_00 8:35

Yes, 100%. I I tell this story all the time about a patient who, you know, was admitted. We thought he knew everything about it. We thought he knew all his medications. And then on day three, he has a seizure and suddenly everybody is panicked, right? That's a big thing. And now we're getting imaging and we're talking to neurology. And uh a family member who we hadn't seen before comes by and we're all talking about the things that happen and mentions seizure, and this person says, Well, did you give them a seizure medicine? It's like, Whoa that wasn't on the list of medications that we received. No, you know, and it was like, Well, he doesn't he doesn't always like go to that same pharmacy. It was like, oh, no, we did not give him a seizure medication, right? Um and yeah, we we thought we had a complete list. He told us this was a complete list. The pharmacy that we spoke to said it was a complete list, but like he doesn't always go to that pharmacy.

SPEAKER_01 9:32

Right.

SPEAKER_00 9:34

And and so it really is a safety issue when it comes to to information. And that's why I always like also tell people if you go to one hospital, um, that hospital is building your story, right? That medical record is telling your story over and over again. So if you just show up at another hospital, and it's not it's not I'm not saying you are stuck in one place, and some people do have specific insurance agencies that do require them to go to one place, but like it's not that easy. There's no such thing as the record, right? Here in the United States, we do not have this a general centralized record.

SPEAKER_01 10:08

Yeah, yeah, people think that.

SPEAKER_03 10:11

Yeah, people say, Oh, it's in the system. I'm like, well, the system is oftentimes wrong, which is why you get asked over and over by different people.

SPEAKER_00 10:21

And like I my system may not speak to your system because people also you know forget that these are financial institutions, right? So they have to have contracts to share information. It doesn't just, it's not just for fun where you know they're like, I'm a hospital and you're a hospital, so we'll be hospitals together. Like, no, so we may not always have access to information. And that's why when I say caregivers, you know the truth. You are vital, you have that information. And that's really what the the conversation should be. I have a piece of information, you have a piece of information. We're sharing information and we're planning. I teach something called the ear method. It's very cheesy. I came up with it myself, which is why it's extremely cheesy. It's a way to get the ear of your physician, right? Very nice. I told you, very cheesy. But I want you to to think of these things, these three very easy things when you think about how to set expectations around communication in a hospital. One, you want to set expectations early. And when I say early, I mean day one of a hospital's day, right?

SPEAKER_03 11:22

What do you mean by expectation?

SPEAKER_00 11:23

Like who do who are we speaking to? Identify yourself. Tell me who needs to be called. If it's not you, who is the person who needs to be called? Right. And this is what we're gonna talk about when we do calls. You need to make that connection and set that expectation around who it it is gonna be early because all of us who practice in hospitals will tell you this is how it goes. Marge gets admitted. Marge, you want me to call your daughter? No, you know, she's really busy with the kids today. And after that, they have practice and then she's gonna go to cost. I'll call her. I'll call her and I'll let you I'll let her know. Okay. Uh Marge, did you call your daughter? You know, I didn't I didn't get to it. I'll call her. No, you don't you don't worry about it because you know on Tuesdays, she has this thing and that thing. And then the third day, somebody calls and says, Hey, I am her daughter. No one has called me for three days, right? So not every patient who's in the hospital can't make their own decisions. And there are privacy issues around sharing information. So if you're if your loved one is able to make their own decisions, I can't just pick up the phone and call anybody and everybody, right? I do have to get their permission. Right. And so this is why I say show up early. Hey, you know, I'm her daughter. I help mom, I'm her care partner, help her make decisions, I'm gonna be your contact. She's gonna tell you not to call me. Don't worry, I'm here. Here's my number. Do you have my number? Is my most favorite question that a family can ask me. Do you have my contact information? Because that means that you're clarifying to me who I need to call and you're double checking that I have the number so you know I know that I can contact with you, right? So early. The second thing is I want you to tie conversations to actions and actionable issues. Can you call me after the CT scan? Give me a call after you've spoken to cardiology, right? Tie them to actions so that you have something to talk about and you can make a plan. I want you to get away from the how's it going question. Right? It should be what did neurology say, right? Tied you you knew something was gonna happen. That thing happened, how did that go? What are we doing about that thing for the next steps? Every conversation should be driving actions forward. And the third thing is reasonable, and this is a very hard one for people because you want the doctor to call every day, and that might not be reasonable. Like I said, if the plan isn't changing, they may not call, they may not have much to talk about. Can you call my three sisters? That's also very difficult for people to fit in. Can you call me every day at this time? Also kind of difficult to plan around, right? I once had a patient who wanted to be called by the nurse every time her mother was given a medication. Oh my. That's a really hard ask, right? Why nurses giving medication that's a high time for safety? They don't want to interrupt that process. Right. And then also, like, depending on what's going on, it may be multiple times a day, the nurse is not going to have time to spy and call every single time you were given a medication. So what does that do? That sets up everyone for disappointment, right? Now I said you need to call me every time you give my mother medication. I cannot call. Now we're we're both upset, right? Yeah. Has to be reasonable. One person, one time, around one action. If you feel like there are more people who need to be brought into the conversation, and that is appropriate, right? If you feel like you're lost, that's the time for a family meeting. Get everybody in the room together, all three sisters. So everybody is hearing the same thing at the same time and they're asking questions and everyone is sharing information. Because let's say I do call your three sisters. Each of them is going to ask me something different. Each of them is going to interpret it differently. And then no one knows the truth at the end of the day. And then everybody says, that's not what the doctor said. That's not what the doctor said. So if there are a ton of people, I shouldn't say a ton, but if if you feel like there are more people who need to be pulled into this conversation, right? We have more questions than we can sit down and ask at once. Or if you as the healthcare proxy, if you as the caregiver, if you as the care partner have someone who supports you in decision making. Right. And you want to bring that person in. Again, totally appropriate. No decisions made in a vacuum. No person is an island, right? Caregiving is a hard thing. You have your own support system. You have people who are helping you. But if that information needs to be shared, that's time for a family meeting, which is a totally different tool, my favorite tool for communication in a hospital, but totally different from the everyday call or the regular expectation call.

SPEAKER_03 16:08

Is it I I know we're talking mainly about sort of a medicine type of hospital admission? I know surgeons oftentimes come by super early in the morning at 5 a.m. and then you never see them again. Is it what is reasonable in terms of getting the doctor or someone on the care team to call you to discuss actionable steps?

SPEAKER_00 16:33

First, you have to set that expectation, like either in person or or on the phone immediately. And it has to be verbalized, right? Believe it or not, your team likes clear discussions and clear expectations. Like doctors are also very good used to getting gold stars. It makes them feel good when they make someone happy, right? So if you say to the team, I want to discuss this thing at this time, if they can't get the specific time, but they get that specific information, they at least know to reach out when they have this information, which is why it's so important to tie things to something actionable, tie the conversation around something you are going to act on or needs to be acted on, right? So the surgeons, they come by at, you know, an ungodly hour, like 6:30 in the morning. Lots of people don't want to be called at that hour, right? But if you say, um, I need to speak to you after the surgery, I need to speak to you for wound checks. Let's like, what is the plan for wound care? Call me after you've seen the wound so that we can make a plan or I know what the plan is, right? Again, you're tying it to that action. It's not an easy thing to help someone in the hospital, right? You are gonna get called at all sorts of hours. There and you you're gonna get called with good things, you're gonna get called with bad things, but you want to be called, right? The last thing you want is to show up and something happened and you didn't know. You know, and the things that I think about off the top of my head are like falls overnight, right? If somebody falls out the bed, which is a thing that happens in hospitals as much as we try to avoid it, but you want to be called. You you want to know that information. You don't want to come in and visit mom and then be like, hey, you look like you fell out the bed. Like, what is that bump on your head, right? Right. So you want that information. And so you have to set that expectation that I am the person you need to speak to. And these are the things that I want to know about, right? You might have to give up something else, right? You might have to give up knowing about like that I'm caregiver every medication, right? If that's it, then you have to figure out something else out. What I ended up doing with that woman was realizing it was really about control and fear. There was a medication issue in a previous hospital stay that left her feeling very shaken. And so what we would do is we would go over the list of active meds on a regular basis. Right. So that was our middle ground. The nurse can't call you every time, but when I speak to you, I'll go over the list of active medications. Right.

SPEAKER_03 19:10

Right. Right. And that takes time because there's a lot of medications. Yeah. Yeah. Yeah. Yeah. You know. Yeah. Yeah.

SPEAKER_00 19:18

And so it's hard. I don't ever want to paint a rosier picture than it's going to be. I once had a gentleman who came to one of my community talks, and he grabbed me at the end and he said, you know, when my mother was hospitalized, I had to sit at her bedside from 8 a.m. to 5 p.m. Otherwise, I don't feel like I got all the information. So really, he said, Yeah, I wouldn't have gotten a chance to speak to the physical therapist. And I wouldn't get a chance to speak to the speech therapist. And who knows what time the case manager would call me, you know, because I work and it would be between meetings. And and the way that he figured it out was that if he sat there, people came in the room and he got to have these conversations. Um, and he's like, that's the only thing that worked. That is the thing that worked for him. And I asked him that. I said, Did you feel better about communication at the end? Did you get the the outcome you were looking for? He said, Yes. I was like, Well, sounds like you did the thing you needed to do. Like you figured out that for you, I I don't know a lot of physical therapists and speech therapists who call after every time they see a patient.

SPEAKER_01 20:22

Yeah.

SPEAKER_00 20:23

It's just not part of their workflow, right? If he felt the need that he needed to speak to them, he found a way to achieve that. Is it easy? No. Is it fun? No. Did it work? For him, yeah.

SPEAKER_03 20:35

Yeah. Yeah. And when my mom was hospitalized, I did end up doing something similar, except showing up even before eight. Because sometimes sometimes people came by real early. But yeah, I mean, I think, and I see this a lot, especially for family caregivers, for older adults, where it's hard to even leave because it's that lack of understanding of what's happening. And you know, my mom will tell me, Oh, it's time for you to go. I'm like, Well, we're still waiting on this imaging test, or we're still I know you're supposed to get this tonight. And, you know, you know, could I get that information tomorrow? Probably, but I would like to get that information as soon as you get it done. And so it makes, I mean, it makes a hospitalization really challenging for the whole family because that is kind of we are fitting ourselves into, like you said, the hospital and that ecosystem's world and that ecosystem schedule, which is oftentimes not very pleasant because it's constantly interrupted and no one gets any sleep and we oftentimes it's not a great experience. What kind of advice would you have in terms of improving that loved one's hospital experience, besides, you know, trying to be there as much as one can?

SPEAKER_00 21:55

Yeah. So depending on the reason that they're hospitalized, one of the things that I Do suggest is talk to the nursing staff about nighttime vitals. A lot of hospitals have protocols where they can cut down on nighttime interruptions by not checking things as often if patients are stable and appropriate to opt out of nighttime vitals, right? Because sleep is a huge thing. It's a huge problem in hospitals. And so if you can cut down on things, and it's the same thing, ask the physician the same thing. Can we schedule medications to all happen before a certain hour so that they're not getting like IV antibiotics at 2 a.m.?

SPEAKER_01 22:32

Right.

SPEAKER_00 22:34

And you you would be surprised how often that happens because all the time. It started at 2 a.m. in the emergency department and then it's listed as every 24 hours. So then it just gets followed up as 2 a.m. on the floor, right? So one of the main things you can do is just try and see how you can keep evening time a little bit more calm to allow them to get some sleep. There are going to be tests you can't change. One of the things that people don't realize is like MRIs. They may schedule stable MRIs to happen at the off hours because patients who need emergency MRIs they accommodate as they come in and through the day, right? So that might not be totally avoidable, but if you can, you can help avoid that, you know. And then as much familiarity as you can. Hospitals isolating, you're taking people out of their environment, you're taking people away from their schedule. One person was telling me that, you know, it really helps when people do this FaceTimes. Like people don't have to come in, but at least they're seeing people, they're interacting and they're being part of their community still. Like include them in the things that they're uh that they can be included in as much as possible. And plan for discharge. This is the last one, and people may not like this one, but plan for discharge as soon as they're getting admitted. Planning for discharge starts at admission. What does that mean? You should know the things that you need to be at home safely and successfully. And sometimes people come in and they say, We can't go home again. Love it. That is planning for discharge. Because it's telling me that I need to work with the case management team on where the next steps are. Right. So start thinking about all the things that you're gonna need to get them back into their environment, if their environment is gonna be the safe place for them to go next. So that when it comes to discharge, you're not feeling rushed, things aren't being left out, and then you're not going home in an unsafe situation. I can't tell you how many times I'm like, okay, you're ready to go. You know, physical therapy says you walked up and down the hall. And then the daughter will look and say, Well, did you tell them you have five stairs to get in the house? And they'll say, Nope. And I'm like, Did anybody test him on stairs? No. Okay, back to the drawing board. Right? So this is what I mean by you're important. You have the information, right? You know how many stairs there are. You have the information. You are part of the planning, right? And so that's why planning for discharge on admission, like if he's gonna come home, he's gotta be able to walk. He's gotta be able to go upstairs. Yeah. Right. It doesn't mean that you're planning for discharge on admission doesn't mean that you're thinking immediately about how to leave. What you're thinking about is what does safety look like when it is time to leave? And how can you achieve those things?

SPEAKER_03 25:26

What are the steps that needs to happen before we can get there? Yeah. Yeah. And that's another topic of discussion during your A part of year framework.

SPEAKER_01 25:39

Everything is on the actions.

SPEAKER_00 25:42

You know, it's it's funny when I have patients who have tests like a colonoscopy, always say, I will see you after that. Otherwise, it's just a social visit.

SPEAKER_01 25:51

Right.

SPEAKER_00 25:52

Right. And and if it means that you don't get the colonoscopy until 3 30, then you'll see me at 4 30. Yes, it's late in the day, but we have now something to talk about, now something to act on. And that's really important.

SPEAKER_03 26:06

Right. I know um, and and this certainly comes up a lot in the hospital, especially for people who are living with dementia, is this additional period of confusion that oftentimes happens called delirium, where people's mentation gets super confused. Day and night may be totally reversed. People might have new behaviors and new symptoms that have never happened before, like hallucination, seeing things in the room, hearing people in the room who are not there, agitation or behaviors that are totally out of the norm compared to their usual selves. And I think this is where lots of things can go into what causes people to have delirium, one of them being out of their routine and just that hospital environment. And I know in in my previous experience working in the hospital, sometimes when people are so confused, it is so hard to convince the family that staying in the hospital longer is not going to help them.

SPEAKER_00 27:09

That is a really hard one. That is a really hard one because I will say that I spend a good portion of my career begging people to no longer be hospitalized or to not get hospitalized. Um, I actually had one time I still remember a really lovely son uh whose mother had a stroke and we're meeting in the emergency department, and he's like, Well, what are you gonna do? And I'm like, Okay, we're gonna get an MRI, we're gonna get an echo, you know, and he's like, No, like what are you gonna do? It's like aspirin, statin, you know, like nothing, we're not poking at things, you know.

SPEAKER_03 27:44

We're not going into removing the clock, you know, from her brain.

SPEAKER_00 27:47

Yeah, we're like it's you know, but we're gonna do the tests. And he's like, Okay, she gets really confused in the hospital. I can get her an MRI and we can get her an echo. And you prescribe the aspirin and the statin, we can go home because to me that is the more dangerous thing, right? He's like, and but they they had specific goals, right? They had goals about like avoiding hospital stays. He had goals about being home. It was a more complete picture, but he knew he was like, the more distressing thing is not gonna be the like TIA stroke situation that is improving. The more distressing thing is gonna be the delirium, the confusion, possibility of falling out the bed, the possibility of getting agitated. And it's so hard because, as you said, it's hard to convince family members that going home and leaving the hospital is actually a lot better than staying here and getting worse. And then if people stay, it's very hard for people to understand that same thing. When I hearken back to the first part of my conversation, you're still going to be on the hospital's root turf. And people really are unhappy and they come back and they're like, oh, dad got restrained, dad got a medication overnight, dad got sedated. And then you find out maybe dad was swinging at nurses, he was unsafe to himself. You know, and people say, Well, you didn't call me. I could talk him down. Unfortunately, like the nursing staff is not going to call to talk someone down who is unsafe and who's making other people unsafe too, right? And so it's so hard because that's what I'm talking about. Stakeholders. The stakeholders are different. At home, you could talk him down. Yeah. At home, you had time and space. If he got a little bit more confused than usual, you had things you did, you didn't feel unsafe. But the nurse who doesn't know him might feel unsafe if he starts batting at her.

SPEAKER_03 29:31

Yeah.

SPEAKER_00 29:32

Right.

SPEAKER_03 29:32

And it's not his fault. He's in an environment where he's confused because it's not his usual environment. Right.

SPEAKER_00 29:39

It's so hard. It is so hard. And it's so distressing to tell people it's gonna take a long time to clear. It doesn't take a lot to become delirious, but it will take a long time to clear. And I can't always guarantee they're gonna come back right to where they were.

SPEAKER_03 29:55

Yeah.

SPEAKER_00 29:55

You know, yeah. And so yeah, that's why hospitalizing older adults, it's it's such a scary thing to me. I've been treating I am not a geriatrician by training in theory.

SPEAKER_03 30:06

But I you're an honorary geriatrician. Honorary geriatrician.

SPEAKER_00 30:09

I I trained at Lomalinda School of Medicine in Southern California. Why is that important? That's like the only blue zone in the United States.

SPEAKER_03 30:16

In the United States, yeah.

SPEAKER_00 30:18

People live to well over 100. I had like visiting professors who were like over a hundred who would sit in the anatomy lab, you know? And so I've been treating patients who are in their 90s, hundreds, eighties since I was a medical student. I've I'm very used to this, and I will tell you, it is to me still very scary when I think about hospitalizing people who are older, who have dementia, or any other cognitive issue who may be a little bit more medically frail. I fell in love with the hospital at home or home hospital programs. I only did a few shifts with them before my hospital uh phased that out. But I always tell people if you have that option, ask about it. It doesn't mean everyone is comfortable with it or everyone qualifies for it. But if the hospital has the option to deliver care at home, ask. I have seen our older patients really do well. It's not just like being at home. They're with their food that they like. Yeah, you know, like hospital cafeteria. Yeah. And it may not be culturally appropriate, right? A patient family that I watched when I was learning about home hospital, he did not speak any English at all. The the father did not speak any English. He spoke a specific dialect from India. And can I tell you, being at home with people who can speak to him keeps him oriented. Coming into the hospital where somebody may or may not use the iPad. Um, and even if they have the iPad, now you're like yelling at an iPad, not actually talking to a person. You know, uh, and so when I saw this in the program, I was like, this is a huge win. This is a huge win for safety, this is a huge win for this older person, this is a huge win for health equity. This is a huge win to be able to care for people where they are comfortable and they have the things that they need to be a whole person rather than like plugged down in a hospital where you're eating. My hospital serves something called American chopsue. I have never seen this before. I moved to New England. My parents are from Jamaica, they would never eat it.

SPEAKER_03 32:22

I don't even know what what it is.

SPEAKER_00 32:25

It's like it's like um elbow macaroni with meats. I don't shouldn't say meats. I'm imagining it's one meat, but it's a meat sauce situation. Oh my. My parents would parents, you know, my parents are immigrants, they're from Jamaica. They would look at this like cross-eyed and would never eat it.

SPEAKER_03 32:42

My my dad literally brought in Chinese food to my mom when she was in the hospital every day because it was like the hospital food was pretty much unedible. I mean, she didn't want to eat it, so it's not right, yeah.

SPEAKER_00 32:56

Yeah, sometimes it's not recognizable. Some some people love it though. Some people love it. And that's hey, good for you. That's the idea that they'll eat, right? Right. But yeah, it's it's hard. It's hospitalizing our older adults is is hard. And I'm still trying to figure out how to be as helpful as I can to caregivers and families because the hospital is like I call it the DMV of healthcare. We all show up there. Everyone's gotta go. Sometime you're gonna be there. You're not gonna be excited about it. You're gonna want to leave as soon as you walk in. And the people who work there don't want to be there either. So, like, you know, let's how can I help make this experience a little bit better?

SPEAKER_03 33:36

Yeah. Well, I think having this information and having the framework in terms of how to communicate within an environment that oftentimes people don't really think about when they're at home is really helpful in terms of, you know, knowledge. Knowledge is safety. Information is safety in the sense that, you know, the more that you know about what is typical of a hospital environment, the more you can have the right expectations and the right discussions before you go in, even maybe even in an emergency room, like that son did, in terms of saying, hey, maybe this doesn't have to be. I love it. I love it when families are um so attuned to the person that they're caring for. And uh more surprising than not, it's is that I I say the the healthcare system is a train that will keep you alive for as long as possible, even if you don't want to be in the state that you are at the end of life. That is the train that is moving forward. And unless you tell me to stop or I ask you and you give me permission to get off the train and do something slightly different that has perhap potentially more dignity and more comfort in your own home, like that train's gonna keep going.

SPEAKER_00 34:54

Yeah, wholeheartedly. Something else that I do is spending a a lot of time talking to people about like how do they want to get off? You know, like what does that look like? I think we as I I think it's an easy cob out to say we as medicine. I think it's we as an American society need to reevaluate our expectations around what medicine should look like at the end of your life.

SPEAKER_03 35:19

Well, we're a very death phobic society. You know, we don't we don't like to talk about it, we don't even like to think about it.

SPEAKER_00 35:26

I had a death doula on my podcast. It was just the most interesting conversation. And she says she spends a lot of her time not with the patient, but with their families. The patient already knows what they want.

SPEAKER_01 35:38

Right.

SPEAKER_00 35:39

And you know, she spends a lot of time really relaying that to families. And yeah, um, yeah, it's that's a whole I'll invite you on my podcast so we'll have that conversation.

SPEAKER_03 35:49

Well, tell the audience where can people listen more to Dr. Monique Nugent? What is the name of your podcast?

SPEAKER_00 35:57

Well, I uh I name my podcast after my book, Prescription for Admission. Some people call it branding. I say that I lack imagination and I just really like the title. But uh Prescription for Admission, the podcast is on anywhere where you listen to podcasts. So Spotify or Apple Podcasts, places like that. I do two episodes a week, uh, which is kind of different. One is a 10-minute short quick tip. What do I think you should know? You know, something coming from a hospitalist. And then the other one is, you know, an episode where I may speak for my with myself, with myself, but spy by myself, or have a great guest on to give a little bit more information more in depth.

SPEAKER_03 36:37

Absolutely. Well, I look forward to talking to you more on your podcast, Monique. And thank you for thank you so much for joining me on my podcast again. It's always great having you on here. I know we can talk for a long time, but thank you for coming. And for those of you who enjoyed this episode, please share it with other people in your life who would might enjoy it as well. And feel free to leave me a review on the podcast platform of your choosing. You may have to scroll to the bottom. Lots of people have asked me, how do I leave a review? Um, that's one way, or you can go onto my website, which is all listed in the show notes. Thank you all, and talk to you after the summer. Bye now.