Full Transcript
[00:00:07] Dr Monika Wieliczko: Welcome to Guide to Afterlife, your go to podcast for young widows. I'm your host, Dr Monika Wieliczko, a psychologist, and your fellow widow. Each episode brings you insights from world renowned grief experts and authors discussing complex grief issues and their personal experiences of loss. My aim is to challenge the way you think, empower you to face your feelings, and help you develop resilient ways to grieve. Move beyond surviving each day and visit guidetoafterlife.com to take part in the grief MOT, your first aid program for grief.
[00:00:52] Dr Ali Ross: Welcome to Go to Afterlife.
[00:00:54] Speaker 3: Thank you.
[00:00:55] Dr Ali Ross: What I really want to talk to you is about your experiences of working with grief and palliative care. Mhmm. And your experiences of working with men and being a man. I don't often get to speak to men on this podcast for some reason. They're much difficult to
[00:01:13] Dr Monika Wieliczko: connect with or to reach or to maybe see people
[00:01:16] Dr Ali Ross: who are involved in the field. For some reason I end up speaking to women so I thought it would be really interesting to do that. So maybe introduce yourself to start with. Yeah. And say what you do and what put you into working with grief.
[00:01:36] Speaker 3: So I'm Ali, Ali Ross. I'm an existential phenomenological psychotherapist, which is the worst thing to Wikipedia in the world. And I have been practicing since 2011. And what got me into working in palliative care, I mean really when I was four I remember saying to my mum that I was just sort fascinated about the concept of death. I wasn't particularly harrowed by it, but I felt like no one around me was acknowledging death.
[00:02:09] Dr Ali Ross: And
[00:02:11] Speaker 3: it didn't make sense to me. You know, I'm trying to make sense of the world as a little boy and everybody's living their life as if they're not going to die and it just really confused me. And my mum is Finnish, but I grew up in England. So my mum, from a sort of quite straight talking and also treating children like little adults sort of educational like cultural point of view, just would talk straight to me about it. And we weren't raised with any religious practice either so she could be unambiguous about not knowing and how her concept of death, well also shaped our family life but also how it's shaping the way that she lives her life. So I feel like I had a very different relationship with mortality in general, the concept of death, than any of my peers. And then, you know, various things led me to want to become a therapist. Not least, actually a friend of mine's dad, he walked in and he found his dad dead when we were about 14. And he called me up while he was waiting for the ambulance to arrive. And we just talked on the phone for an hour. His parents had divorced and his dad lived alone. And yeah, we just talked and then the paramedics attended and just before we ended the call I said to him, why did you call me? Because we weren't particularly close friends. We were, he was sort of, we were both fond of each other but on sort of peripheral friendship circles and he just said you felt like the right person to call. And sort of one thing led to another there. I ended up working at Nightline, which is a student counselling service at Childline while I was at university. I also studied English and philosophy. I didn't just want to study sort of hardcore theoretical philosophy, I liked the complement of the way, you know, novels, you know, really give us lived experience through the characters, through the narratives. And I wanted to live a meaningful life because I was inspired to make the most of my life before I die. And then when it came to when I graduated and I remember it was, you know, July time and everybody was just out having fun. Everybody graduated. I lived in halls at Leeds University and that halls happened to be at the end of the Career Centre on the same road. And I'd never been into the Career Centre and I just wanted to sort of walk past my halls one more time before I left. And I went into the Career Centre and I, you know, dusted some of the folders off the shelf and the careers adviser said can I help with anything? And I said I think I want to do that job where you sit opposite someone and you ask them how they are and you tell them and they tell you how you are. He said I think I might be counselling. So I pulled a folder there was a level three certificate at Leeds. I stayed up working in Leeds. I did a stint working for social care. I worked with children who'd been abused and neglected. And then I worked in a drug treatment service and both of those were also, there was a lot of death around the drug use and leads. So that came up a lot for the children that I was working with. And then in the drug treatment service again, a lot of death. You know, we would literally be running courses on how to help someone if they're overdosing and how to keep them alive. I mean, you know, death is ever present, right? But these are settings where it was more very close to everybody's existences because, yeah, I mean the depravity that was around in the areas and needs that I was working in. And then it came to finishing my level three certificate, wanting to take on the doctorate and I was thinking of where to practice. And then I saw that my former colleague's wife happened to live around the corner from me and she'd written a book very much about death and palliative care. And when death enters the therapy room, by which she meant someone is all of a sudden bereaved when they weren't expecting to, or it's just the dominant presence in the therapy. And I'm very grateful that she was my first therapist and combination of things helped me realise that I was an existential person before I even knew what existentialism Then I got more into the philosophy of it. And you put all that together and I was raring to go to work in anything where I was able to name how death shapes life.
[00:06:46] Dr Ali Ross: So it was there from the very very beginning culturally through your family, the approach to death and living, but also that awareness really early on that something wasn't quite right in the way people were thinking or interacting with death that kind of got your interest. I like how he's how he just knew what he wanted to do but he didn't know the name.
[00:07:12] Speaker 3: Yeah yeah yeah.
[00:07:13] Dr Ali Ross: It's just so fascinating you know. I think it's very common for us therapists, psychologists, counselors to know without knowing what we're to do. It's a bit like being a teacher.
[00:07:29] Speaker 3: Yeah, it's definitely the vocation of it.
[00:07:31] Dr Ali Ross: Yeah, so you kind of end up going. And I'm not surprised you ended up working in palliative care. Can you say a bit more about that?
[00:07:41] Speaker 3: So I was a student on the Existential Doctorate and there's a Society of Existential Analysis and they run an annual conference. And I was in my final year, my fourth year, and this incredible person stood up and delivered a talk. Her name's Marianne Steele and the talk was on Baba Yaga. And it was about how this witch figure of folklore is sort of mysteriously hidden in the woods. But if you find her or really she finds you, then what can happen essentially if you can confront her and sort of meet her with honesty, then you might come back out of the woods alive. But some people never return. And she just used Baba Yaga as an analogy for living towards death and how we as therapists can model living towards death to help our clients tolerate confronting death. And it was such a powerful talk and I practically said out loud, may even have said out loud in the sort of auditorium like I have to spend time with this person. You know, literally that evening I cold contacted her and she was working at the hospital, ended up working at Guy's and St Thomas' at the time. And I said, know, I heard you talk, thought it was brilliant. Just wondering if there's any opportunities to practice under you in any way. And it turned out they had a placement and I just actually missed out on the intake by like a month, so I had to wait another year. And then met her in the interview and they say don't meet your heroes but I couldn't be happier that I met her and and you know, we continue to have a relationship to this day. So I practised there on placement for a year and then a job came up perfectly. My placement ended and then the next month there was a job and I went through it and I got it and I worked there for the next nine years. I mean, we'll say more, but in a nutshell what I loved about palliative care as an existential psychotherapist, mean the NHS had no idea what an existential, I mean what a psychotherapist was, what an existential psychotherapist was, what an existential phenomenological psychotherapist was, the NHS had no idea. And incidentally like I would almost never say to patients or any of my non therapeutic colleagues that I was existential because it generally didn't sort of mean anything to them. But I would sort of almost describe it that we would get wheeled out or wheeled into the room when all other sort of treatment options were expired. You know, we can't, we don't know if there's anything to do for this person. We don't really understand what's happening dynamically. Can you go in and try and figure out what's going on here? Or we can't do anything for this person, is there anything you can do?
[00:10:29] Dr Ali Ross: Last resort.
[00:10:30] Speaker 3: Yes. Nothing else works.
[00:10:32] Dr Ali Ross: Yeah. Having an existential therapist.
[00:10:34] Speaker 3: Wieliczyn and I loved that. And if anybody asks me what is existential psychotherapy? Like I said it's the worst thing to Wikipedia, but in its maybe simplest form it is helping people understand their being against their doing. So if you like, the hospital staff would run out of ideas of what to do and then they'd send us in and we would help the patient be. Towards either death or being bereaved. So my main specialism was work with imminently dying people, or work with people that were anticipating being bereaved, or where one of the partnership was terminal. Not always, but that was often what I would get referred. And then we'd work towards the death of the partner and then I'd continue to work with the surviving partner. So it would transform from couples work to individual work. Which is very very powerful obviously.
[00:11:38] Dr Ali Ross: To know the story, to know both.
[00:11:40] Speaker 3: The power of it happened almost every time that there would normally be a rhythm to the therapy of sorts. Obviously the sort of ill person's physical capacity to attend would affect the rhythm of therapy sometimes, but generally there'd be some quality of rhythm. And then when they died, there'd be a period of time normally where the surviving partner wouldn't be able to attend or wouldn't want to attend therapy. And then when they were able to reconnect, it was so important that I had known.
[00:12:12] Dr Ali Ross: They were holding the story.
[00:12:14] Speaker 3: Yeah.
[00:12:14] Dr Ali Ross: Experience.
[00:12:15] Speaker 3: They didn't have to relate what they were like because I had met them and worked very intimately with them.
[00:12:21] Dr Ali Ross: Much easier to connect once you've got that connection established. I mean in some ways it very much mirrors my experiences of loss with my husband where I was in psychoanalysis before he died and throughout that kind of build up of illness and approaching death and then I had to pause for a few months because I just couldn't understand the idea of talking about him. It wouldn't have been helpful.
[00:12:47] Speaker 3: Yeah.
[00:12:47] Dr Ali Ross: Think it just having that time away and travelling was what I really needed to go to the basics, know, to eat, to sleep, to regulate my body. And then similarly to what you were saying, coming back a few months later and somehow with the capacity to think and process what happened, but this whole experience of coming and going in and out of grief, It's not like you go away and you stop grieving but at least you're not talking about it every day to someone. So it was kind of, I can kind of relate to this experience. I think it was much easier to then come back and actually yeah, in a funny way I think that my analysis became before he died. It was about him and me and then obviously as he died in some ways even though it was just me coming to see my analyst, I was always bringing my old dying husband with me. Yeah. So it was a kind of a couple
[00:13:56] Speaker 3: Yeah.
[00:13:57] Dr Ali Ross: Couple triangle therapy. I can see, yeah, similarities.
[00:14:02] Speaker 3: I can well imagine the sort of the value of that transition as well of having your husband as a, as almost a physical presence before he died. And then feeling that presence not being there after he died, even though he was never in the analysis room.
[00:14:18] Dr Ali Ross: Mhmm.
[00:14:18] Speaker 3: But I mean I also do want to add to that because I think, I mean I'm sure this has come up countless times across your podcasts, is that there were some people who needed to step out and some people who know I'll be there next session. Some people wanted to book something in when it was getting closer to and pretty obvious that their partner was imminently dying. And others would say I just can't, I can't think past next hour. And the full spectrum of some people not coming back for a year, some people like I say wanting a session. I did work with some people who would work with me on the day that their partner died and then would continue in that rhythm.
[00:14:59] Dr Ali Ross: Yeah. And
[00:15:00] Speaker 3: partly that was because they'd been anticipating it for such a long time. Generally that was sort of a graph you could plot sort of length of anticipation of grief to how quickly they'd want to resume therapy after the death of their loved one.
[00:15:14] Dr Ali Ross: What their experience was like for you before and after being with them throughout that experience.
[00:15:21] Speaker 3: Yeah. Yeah. I like that sort of catch. It's certainly not a guiding. And yet I have expertise, but it's it's expertise in not knowing really. So I suppose it's guiding people to you don't need to know, there isn't a guide. Just one of those, I'm not quite answering your question but it occurs to me as you speak that I was called into intensive care once and it's quite rare for somebody to die completely lucid. And this person for various reasons had a condition that was causing their death where they would basically, very painlessly just close their eyes and die at some point. But until that point they'd be speaking just as you and I are right now. There was
[00:16:04] Dr Ali Ross: shift when the progression where you withdraw quite gradually.
[00:16:09] Speaker 3: Yeah, so basically no decline. Wow. But they were old and they were absolutely ready to die. And we had a sort of individual bit of time together where they then just conferred to me like, I'm really fine to die, I'm ready. And they had a very peaceful death. But sort of a few hours before that I was again sort of wheeled in the intensive care stuff like we don't really, this doesn't happen hardly ever, we don't really know how to gauge this. We don't know if they're fine and they're ready to die or they're, you know, really masking something and saying they're fine in that very English way, you know, stiff upper lip. They were certainly of a generation where you're more likely to expect that, you know, don't worry about me kind of thing.
[00:16:51] Dr Ali Ross: I'm just dying.
[00:16:51] Speaker 3: Yeah, yeah, yeah. I'll fine, be fine. There are two children right beside me, sort of children in their fifties. And they were the panicked ones.
[00:17:04] Dr Ali Ross: Right.
[00:17:05] Speaker 3: And they had no idea what to do and they sort of looked at me and I really remember it fondly that the son said to me, You're not a priest are you? And I said, No, I'm not a priest. You know, good you can come in then.
[00:17:17] Dr Ali Ross: Oh.
[00:17:18] Speaker 3: And then he sort of didn't really care what I was.
[00:17:20] Dr Ali Ross: As long as he wasn't.
[00:17:22] Speaker 3: As long as I wasn't a priest, yeah. Because his parent was very much not a religious person. It was sort of like, you know, I am here to protect. If I can do anything else I want to do Yeah yeah. And then I sort of said, look I'm just here to help you figure out how you want to say goodbye. And they were just really stiff next to their parent like by the side on hospital bed. And it just felt really natural. They were sort of all looking at me like what do I do? And they were very much looking for my guidance. But really it was just I felt like they wanted to touch each other but they didn't think that they could. So I just offered the permission of like, you can, you know, you can hold hands if you want to. And then they instantly like all clung, clung in and held hands. And the tension in the room just melted and they all started talking. And it was mostly that if nothing else it was It
[00:18:13] Dr Ali Ross: was about facilitating connection, and allowing for things to flow.
[00:18:18] Speaker 3: Because death is not talked about, because people are terrified of what to say when somebody dies and it's the same people are terrified to say before someone dies, they don't want to upset them. Yeah, and a slight extension from that. A lot of the family work that I ended up doing, so again that was a good example, I would turn up, be told I'm here to see this patient on a ward. The patient might not even be there, they might be having a scan and it might just be the family or they're sat waiting. Or they might be the patient with the family, it might be their friend, it might be any combination of friends and family. So you really have to sort of work on the fly. It sort of certainly helped that I didn't know what I was doing and didn't need to know. But so much of that work was everybody is so scared of upsetting anybody when death is imminent that everybody seems to tread on eggshells and nobody says that they're struggling.
[00:19:12] Dr Ali Ross: Yeah.
[00:19:13] Speaker 3: So most of the sort of family group friends facilitation was checking how they all were and everybody saying I'm fine, I'm I'm I'm fine, I'm fine, including the patient and yet they'd asked for me to come. So it was basically saying, so everybody's fine and yet you've requested me. So it's probable that none of you are fine or some of you aren't fine and you just don't know how to say that. And again it's giving people permission to say I'm struggling, I'm scared, I don't know what to say, I don't want lose you, you know, and start acknowledging their location in what's happening. And once you have that, then what is otherwise chaos, you find the ground and then from there you can step with much more sort of intuition and confidence. That's mostly what I did. You know, facilitated.
[00:20:07] Dr Ali Ross: Yes, facilitation is the word that comes to mind as I listen to you talk about how puzzling and in some ways confusing the experience of loss is in our culture but also going back to what you were saying at the beginning is the fact that we don't have the language, we don't have the tools to understand and process what's happening. I think that's what makes death so traumatic for so many people is that we just somehow engage in this illusion that I've got the best kept secret in the world and everyone knows about that we're gonna die. Yeah.
[00:20:47] Speaker 3: And
[00:20:47] Dr Ali Ross: eventually it's gonna happen to every single one of us. Yeah. And I think there's such an easy way to dismiss it and to say, well, I mean in some ways you have to live your life ignoring it to some extent, but there are times when you really have to confront yourself with the fact that time's limited. And I think that's when this palliative moment, the palliative care concept comes in where people are suddenly thrown into a space where well no one's medicating anyone, no one's fighting for life. It's a very different set up. I mean, can only relate to my experience of being in a hospice, St. Christopher's hospice. And thinking, gosh, I felt so liberating. Fact, you didn't have to fight. I was just it's only going to prolong suffering. And it's obviously not the case for everyone but for some people it is.
[00:21:50] Speaker 3: And
[00:21:51] Dr Ali Ross: that was the case with my husband that, you know, it was just pain and it was all about managing pain and what kind of quality of life is that? And these are the questions I think that often come to my mind. As I look back we also think about how we relate to death in medical profession, in general society, how we see death as something that has to be avoided at all costs.
[00:22:20] Speaker 3: Yeah, and really not weighing up what those costs are. I mean it certainly feels like I am in a culture that has come out of a sort of Abrahamic religious grounding where, you know, life is this deeply precious thing that should be preserved at all costs. I mean the fact that, you know, assisted dying is who knows what's going to happen.
[00:22:44] Dr Ali Ross: With the bill.
[00:22:45] Speaker 3: Yeah. But that, again what would enter the therapy room so often, that you know the door is closed, it is now a confidential space. You can basically say what you like and still people are desperately tentative to sort of not say something where the swap team is going to come in and put them in a straight jacket and take away their rights because they might express that maybe I don't want to get treatment. You know, I've been told that I could have aggressive chemotherapy for ten months and that will extend my life potentially by twelve months. But then ten months of those I'll be literally poisoned and in a massive amount of pain. So maybe I don't want any of that chemotherapy and I'll live for three months, but I won't be in horrendous pain and my quality of life will be good, my quantity of life will be poorer for it. Again, if you have some of the family, because I think as soon as you have an understanding whether or not there's a network around that patient, it's so important to understand if there is any implicit or explicit pressure there of, you know, you have to fight this for the kids or, you know, you have to live a few more years for your life insurance to pay out or because people, yeah, that language of fighting, there's a lot out there if people want to look into it about the narrative of fighting and how detrimental it is to the quality of a lot of palliative patients' lives enduring intense pain for long periods where they don't feel permitted to say 'I actually don't want to do this' and that isn't like letting your family down necessarily. I mean it's not for me to say, but at least for their individual point of view, you're not letting yourself down if you don't want to live the next one, three, five years in constant pain. And I do think chronic pain is grossly misunderstood as well, you know, it's quite an easy experiment if you say to someone, if they know what a plank is, just do a plank for three minutes and then tell me how you find chronic pain. Most people can't do a plank for any more than forty five seconds. And if you have to do that plank for three minutes, then you tell me what it's like that you don't have a choice to drop that plank now and you just have to endure that and how much that completely changes your everyday living experience. And then it's a legitimate question like, and do you want to live that way for any length of time more than you have to? And it's okay to invite a choice of like, I don't, I'm not going to do some treatment that may extend my life but will be a violence in my body in the meantime. And then also what it's like for the family to witness that violence entering into your, the person you love. Is that necessarily a good thing just to extend your life?
[00:25:42] Dr Ali Ross: But also it costs for the family of enduring something incredibly traumatic. I mean I'm always surprised when I look back and sometimes I question myself, but my genuine feeling is that there are worse things than death.
[00:26:01] Speaker 3: Yeah.
[00:26:01] Dr Ali Ross: And actually wrote a poem on that and that was something I've read out loud on the funeral. Mhmm. Know, there are worse things than death and now I know. But it was this kind of, I think, accumulation. There was this long period of time where it was all about fighting, was all about keeping his body alive. And I mean it as essentially keeping his body alive because there wasn't much of him I think that wanted wanted to stay alive but he also didn't want to die. I think he just was in this kind of state of being numbed by drugs and just waiting for death really. Mhmm. If I'm absolutely honest, you know, about what that felt like. So, yes, it was much more traumatic than the actual death, which was peaceful Mhmm. In some ways because he just stopped breathing at some point. But I think this whole experience really opened my eyes to how we perceive death and the stories we tell ourselves and medics tell us, you know, about surviving stage four bowel cancer. Or you know, does it mean, the survival rate these days? Survival rate means, are you still alive two years later?
[00:27:22] Speaker 3: Yeah, I think a huge part of what I learned the more I got involved in hospital work is how hard it is. I mean if you think about why medics become medics, it's mostly, at least as they're starting out, because they want to help people get better. So there aren't that many that choose palliative care because you're not helping somebody get better, you're helping them as best as possible juggle the very tricky pain management so that they can have as pain free and also the sort of social side of it like where they want to die and but it's very different from almost every other kind of medical care because you know that you can't make somebody better and they'll walk out the door most of the time.
[00:28:11] Dr Ali Ross: So it's about accepting your limitations. And
[00:28:14] Speaker 3: then what does jar then is particularly younger people, and certainly some of the staff support I did in hospital work is that the staff members would struggle most when there was someone in the same age or they could see themselves appear with this person. And then their determination to like, we're going to do everything we can to save your life. And then those medics finding it very, very difficult to say we're out of treatment options or I'm not sure we're going to be able to do anything here or just have that straight conversation of I don't think you've got long to live. And it's so hard to take that position, it's absolutely not to criticism. And frankly that there isn't much training or support out there for menace having those difficult conversations and we're in a culture where that you're really fighting against that culture.
[00:29:04] Dr Ali Ross: Yes, a culture that doesn't accept death, know, so what options do you have?
[00:29:08] Speaker 3: But so that's then this more implicit pressure of like, oh okay, well they're saying I've got a good chance and that could happen even if they, you know, people find it very hard to say, yeah there's not much I can do.
[00:29:19] Dr Ali Ross: Yeah. But also I think in some ways how people die or how we approach the whole subject has such a profound impact on how we're going to deal with our grief afterwards. I think in some ways I think I'm always surprised that people often don't really register the fact that someone's already dying. It comes as a surprise. And I wonder whether you've had any experiences of that. Specifically think about men, the men group that you were running, if you can say a bit more about that.
[00:29:57] Speaker 3: Yeah, I mean something you said just a second ago about your husband, parts of your relationship with him or your experience of him dying before he literally died. I mean absolutely that happened. I suppose again there's that spectra of the patient I mentioned who just went from being exactly as you and I to death. And then people that go from, you know, like a three year gradual decline. Maybe motor neuron disease is the most tangible example of parts of someone's physicality shutting down before they then die. And that's obviously from the physical side of things and then there's a sort of, if you like, psychological side of things, particularly because of like a brain tumour and somebody's personality changing quite aggressively before they die and that experience for their loved ones to be, oh they're not them anymore' or you know, dementia, Alzheimer's, that sort of stuff. But on the men's group in particular I made a choice, the group that we ran, and that was myself and a social worker who'd also done some counselling training. So it was a men's group for anybody on the cancer pathway. So that could be somebody in remission but just receiving sort of monitoring care.
[00:31:12] Dr Ali Ross: Yeah.
[00:31:13] Speaker 3: And everything from that to, you know, new diagnosis, actively in treatment on the palliative pathway. I mean imminently dying was sort of rarer in the sense that if you're imminently dying you're probably not going to be able to attend an in person group. So it was a group of up to 12 by virtue of those numbers and the spectrum of potential cancers that that group would have. Some would attend every session from start to finish. Others would, because it was fortnightly sessions in two blocks of six I think it was. Yeah, there'd be some people that you know would attend and then couldn't attend because they were sort of throwing up or they just had surgery and needed to recover. And sometimes you didn't know if they'd died. And sometimes you know they would die and then we'd have to work on the fact that I would be introducing to the group, to the group. I'm really sorry to say that you know, xx can't isn't coming today, they died you know a few days ago. So it couldn't have been more in the room that way. And other times not knowing because sometimes it would take a while, particularly let's say they had gone to a different part of the country and maybe collapsed somewhere and then for the stream of their care to be integrated in between sessions, we wouldn't necessarily have a full update on what was happening with them. So I wouldn't know what was going on. Couldn't tell them they were just absent.
[00:32:39] Dr Ali Ross: So much uncertainty.
[00:32:41] Speaker 3: But then they might turn up the next week. Yeah. But that was such a visceral example of when does the loss happen? Because we didn't know if the death had happened. We are now, you know, this person is absent, but we don't know if has the grief started? Or are they just away? Or are they very sick right now? Or what? So it really blows open the notion of like, you know, death happens at the point where the last breath is taken.
[00:33:11] Dr Ali Ross: And that's so powerful actually what you just said that you know this image of concept of death is something static or a point of time but actually it's always there. But also that we're constantly dying from the day we're being born, you know. Something that we don't really register that cells in our body start dying the moment we've been born. And you know, it's the you can't separate life from death. We put so much effort and money into creating this illusion you somehow can stop yourself from dying, getting old, getting ill. It's fascinating to listen to that and then this extreme environment, I mean extreme in terms of it's in your face all the time as you're saying when you walk into that room with this group of men and you don't know how many of them will still be alive and who's gonna turn up, who's gonna be gone by then. You might not know. I mean how I'm just kind of thinking what what that was like for you. I mean in some ways sounds like that's part of your, the way you practise.
[00:34:29] Speaker 3: Well it's part of the way I live to be honest. There's not much of a distinction there between practise and living, it's one and the same really. And one thing I'll say as well, like after working in palliative care I'm not at all as invested sort of materialistically as I previously was. Because unsurprisingly, absolutely zero of the people that I worked with said I wish I'd, you know, renovated my kitchen or you know, I wish I
[00:34:55] Dr Ali Ross: Save my money.
[00:34:56] Speaker 3: Yeah, exactly. I'm grateful for it literally daily for the way it helps me appreciate the life that I have. I think I take my life far less for granted. I still take my life for granted of course, but far less for granted now than I did before I worked in death and dying.
[00:35:13] Dr Ali Ross: And which is why I think for some people it might sound unimaginable that someone might want to work in palliative care or be confronted by death. And it's so hard I think to get to the bottom of it what you actually are able to take from it and how much you gain from it in terms of life
[00:35:35] Speaker 3: but I mean I think of really easy shortcut to the people that are baffled, at least conceptually. I mean what I'd love genuinely is to just stick everybody on a on some sort of instant transport system and take them all to Oaxaca in Mexico for three days of Day of the Dead. I mean anywhere in Mexico really. But those three days where the graveyards in Mexico become party central, but it isn't just the sort of frivolous, you know, just completely letting go, it is intentionally celebrating the people that you love to have died and gravestones being adorned with beautiful flowers and food memorabilia of, you know, this is what my dad used to love. You know, he loved whatever smoking this brand of cigarettes or he he loved this like mountain range, so sticking a postcard of the mountain range or something. And then everybody's being around in this graveyard just telling stories about the people that they loved and lost and what that does for the families who might be hearing about their grandma talking about their grandma's grandma. The sort of the family narrative, the fact that you're literally in a graveyard where, you know, if you said to an English person or practically anybody in the Western world, let's go and hang out in a graveyard for then either you're going to be wearing a long duck trench coat and you're going to be into gothic metal or people are just going to be freaked out like why would I ever do that? I've got to say by the way, I have a lot of time for the show afterlife that Ricky Gervais put together. Whatever you think of Ricky Gervais in general. The fact that there are scenes where he is sat on a bench with another grieving wife in her case. And that it's a very warm, warmly shot environment and it normalises, you know, people sharing in their grief the sort of weekly or daily, I don't know what it is from the show, like daily ritual maybe as of going to the grave. And then that sort of shift, I mean, you know, Mexicans are great at talking about death.
[00:37:50] Dr Ali Ross: They live with death. I mean one of the things I've definitely got from Mexico when I won her last year was this feeling that death is always on your mind somehow you know living on the edge. And something about especially in Mexico City, you never quite know when you're gonna die. Yeah. Someone's gonna shoot you. Yeah. You know, there's that side of things which is a bit mad. But there's also this liveliness, this energy that comes with it which is fascinating. And the culture is so rich in so many references to living with Beth. So much playfulness. So yeah, I think it's all rooted in there. And just thinking about Jager and you know, that first story you brought in and this fearful figure that no one dares to confront or you know, you're trying to hide from. I mean, I've got this very distinct memory from my childhood of those stories and being threatened by you know, adults, know. You know, come and get you. So that's what comes to my mind. Yeah. That's this, you know, something you should be afraid of. Mhmm. Something you should avoid at all cost.
[00:39:06] Speaker 3: Yeah. And
[00:39:07] Dr Ali Ross: if we listen to those stories throughout our lives, you know, it's really hard then to know what to do when the death knocks at your door and you are actually having to confront yourself with this approaching loss and you know, what do you do then? You know, the paradox is I think in some cultures where we are exposed to death daily, when we see people die, it becomes such a normal, not normal, it's always normal experience to be expected because you do this, you know, you see this every day almost. But I suppose that in societies where everything's done to hide it, to pretend it doesn't exist, you don't talk to children about death and what it means, it's much harder than to just know what to do with it. Yeah. The concept of palliative care is that there's actually an end, you know.
[00:40:05] Speaker 3: So I've I've got two children and both talk about death quite a lot. My daughter talks about death. I guess she might talk about it more than some more of her peers. But it's quite short lived. You know she'll name it and we'll just acknowledge it and that's the end, it's really lovely.
[00:40:24] Dr Ali Ross: Like anything else.
[00:40:25] Speaker 3: Yeah yeah yeah. You know? Yeah she'll ask me like what's that? And it could be I don't know like a yak or something and I'll say yak and she'll be like okay and then move on. What's that? Sort of basically like death and she'll be okay, move on you know.
[00:40:35] Dr Ali Ross: But there's language, know, you start from the beginning that you introduce something that is just normal, like you know, you look at dead bird, you know.
[00:40:46] Speaker 3: I mean it's everywhere if you want. But it doesn't have to be everywhere in this like overwhelming way, it's just part of an integrated life if you can allow it to be.
[00:40:56] Dr Ali Ross: Exactly, and I think I just wish we had more places where these conversations could actually just bring up those questions and uncertainties and prepare not necessarily not like you can prepare for death because you never know when it's gonna happen, but mentally make room for the fact that it is going to happen. Just really baffles me now. But when I look back at myself maybe ten years ago, I think I lived in a very naive way in terms of how I approached death, like I knew it was going to happen at one point, but I never quite captured it can happen so quickly to someone so close to me in such an unpredictable way. So that confrontation with death really quite dramatically changed my approach to life and my approach to living, practising and similarly to what you're saying about your experiences of palliative care, just you know, how much you can take from death is kind of one of those things that we almost felt we don't have permission to talk about.
[00:42:09] Speaker 3: Yeah.
[00:42:09] Dr Ali Ross: That death also brings up good things in you. It doesn't mean that losing my husband was a good thing but it means that I took something very powerful from it that maybe if I didn't experience that at the time I would have never got to where I am now in terms of my approach to life and how I want to live my life in the remaining time I've got.
[00:42:34] Speaker 3: That really well captures again what I see myself offering as a therapist is very literally opening the room up to people and saying you have permission to talk about death in here. And beyond that it doesn't take that much to explicitly give people that permission. If they are then prepared to walk through the door then they quickly realise that oh I can talk about death and everything around it and survive it and tolerate it actually much better than I thought I could. And there's so much understanding to be garnered from there. And now my life feels more intentional, richer somehow. And there's an irony that when people cross that threshold and start to bring death into their life, they are not only mourning those that have died, but they're mourning the life that they had before they let death in.
[00:43:31] Dr Ali Ross: And that's a huge loss. That I think explains why we're so invested in pushing this away, you know, not wanting technology. Because when you look back, which is actually the basis of any therapy, any kind of more in-depth experience or therapeutic experience, is that you have to at the very foundational level prepare yourself for the end. Yeah. And that means the earlier we get that, the more we can take from life. It's something that we constantly feel in conflict with, I think in our society, is that you know, let's not think about it, let's not talk about it, everything's fine, no one gets ill, you know.
[00:44:16] Speaker 3: But I think you can spot quite easily, I think it's one of the reasons why I identify as a sort of more relaxed person in the world is that I'm not in that tension. It wouldn't be fair to say I haven't got that tension at all. I mean I'm afraid of death in the sense that I don't want to not exist right now. I love my life. But I can sort of acknowledge that non existence will come to pass. Yeah.
[00:44:40] Dr Ali Ross: One does not exclude the other.
[00:44:41] Speaker 3: You can
[00:44:42] Dr Ali Ross: be in touch with your fear and that could enrich your life rather than destabilise your life which is often, you know, you know, let's not think about the pink elephant.
[00:44:52] Speaker 3: Yeah, yeah. As I normally think about pink elephants. Yeah.
[00:44:57] Dr Ali Ross: But it's the thing that if you can actually confront yourself with it, know, suddenly this enormous kind of fear that surrounds death kind of starts to dissolve. You know, I think I remember before Wieliczko died imagining what that's going to look like and I was worried, so so worried about, you know, actually finding him dead in bed. Mhmm. Or something kind of unpredictable happening like that, which you can never prepare for anything like that. But actually, when you experience death, you suddenly realise that it's not what you were imagining. And I think that realisation can only come through the experience of witnessing that.
[00:45:47] Speaker 3: I think that's probably one of the culminating things about confronting death that helps people with the rest of their life. Is that this is an ultimate, the ultimate thing that we are, I am, you are not in control of. So people struggle if they've a) not experienced death around them and they don't know what it is in any way for them personally, and if they are very much in control of their lives. So particularly the sort of more privileged, more capable people who haven't been protected from death and dying, but also being protected from not being in control, get confronted by something that is so profoundly out of their control. And then if you can embrace that, it then again opens up to there's loads of things that you're not in control of and that's okay. And then you're not swimming upstream anymore. Neither are you giving in. You're living more in flow.
[00:46:47] Dr Ali Ross: It's so powerful and I think you know just I'm mindful that we are sitting here talking face to face which is not always a possibility to have this kind of real life experiences on the podcast. But I'm also mindful that we're sitting in the center that you've developed, that kind of a lot of vast centers around working with people. I mean I know that there's a group of psychologists, psychotherapists, counsellors working with you. Could you say a bit more about how that concept came about and say maybe a few things about the groups you run-in what happens here. Yeah. So you're based in Peckham.
[00:47:29] Speaker 3: We are indeed, yes. The practice is called Come As You Are or QIA for short. And it's because I think that's such a fundamental message about what therapy can be. People often, often but sometimes say like do I need to bring anything to my first session? Do you need to do anything? And the genuine message is like no, you can just come as you are and then we'll find out how you are and we'll go from there. That's not easy by any stretch. In fact that's very hard, sort of very exposing and stripped back for all of us.
[00:48:02] Dr Ali Ross: You can't prepare. Yeah. You're back for the death.
[00:48:04] Speaker 3: Yeah, exactly. And also I love that this practice has a real range of practitioners. So as you say it's counsellors, psychologists, psychotherapists, there's also speech and language therapists here. And that we don't have a hierarchy on psychologists are the best or you know, existential psychotherapists. There's a full range of modalities but what brings us together is that the people here are committed to relating with. You're not going to get treated here and that's certainly something I want to perpetuate in the therapy world is that, you know, if you want a treatment for a phobia or something then, you know, there are treatment clinics for that. But I don't want Kaya to be a place where people get treated. Want it to be a place where we can be with each other. As I say, extended Like
[00:48:53] Dr Ali Ross: your analogy between medical world and palliative care world. Because
[00:48:57] Speaker 3: not everything in life is a problem to be fixed. Not everything in life is something that we're out of control of that we just need to find a way to take control of. Frankly most of life is what we're not in control of, what can't be fixed, but how can we be together in that that melee and still find each other? And there is understanding to be be found there and if you can find that that's profound. So that's what the inception of this place is and yeah, we run various groups as well. And we have a grief group which I'm deeply fond of, which is also specifically a grief group not exclusively a bereavement group because we experience grief when you know our best friend relocates to the other side of the world or we had an identity as engineer and then we get made redundant and we don't know who we are without our professional identity. Grief takes many different shapes. But again if you can understand these things with more nuance, breadth and depth, then that's part of, as you say, or as we've been saying, normalising the culture around grief.
[00:50:04] Dr Ali Ross: And the most kind of relatable experience paradoxically because we all have experience of loss. We might not have lost a loved one
[00:50:14] Speaker 3: but And we might not have realised that we have lost or grieved.
[00:50:17] Dr Ali Ross: Exactly. Or sometimes we haven't grieved.
[00:50:20] Speaker 3: Exactly.
[00:50:20] Dr Ali Ross: It happened really early long time ago and there was never a space to grieve. There are all forms of grief and loss and can be anticipatory grief.
[00:50:29] Speaker 3: Yeah.
[00:50:31] Dr Ali Ross: Expecting someone to die at some point in the future and you know that all brings us together and I think one of the things that I really liked about your group is the fact that you're not trying to separate people out into different specific groups. You're actually saying well, maybe there's we are more alike and there is more to share and to learn from each other and then it separates us, which is often the narrative that you see. Only a person who've lost a husband or wife can understand what I'm going through. Losing a parent or a grandparent isn't not going to be good enough or something like that, which is often the narrative that I think I'm trying to engage people in and thinking that actually maybe there's another way of thinking about your experiences that will be less isolating and will help you connect with other people and find a common language.
[00:51:24] Speaker 3: And I love that about groups as well, that I think if a group is going particularly well then we as the facilitators, Anna and I, don't have to step in much. And it's a good model of, again, I'm okay with being an expert but I'm not such an expert that you must come to me to understand grief. Actually there's deep wisdom in this room with people that don't even necessarily realise they're grieving. And the group is where the understanding comes, not necessarily from Anna or I.
[00:51:59] Dr Ali Ross: And it's such an important thing I think from this conversation as well, it's just this, that will really stays with me and I'm hoping that our listeners will take from it at least. Know, things is about this kind of acceptance of things we can't control, things we can't change, and and how to be more open and maybe going towards death doesn't mean that you want to die. But it means that you're we're accepting of what's coming. And and I think there's something really incredibly valuable about what you're saying, what you're sharing, is this idea of being kind of grounded in the present moment in your life when you're embracing the fact that you're going to die. You're gonna lose it all and, you know, something that no one really wants to talk about. So I don't know if there's anything you wanted to share from you.
[00:52:54] Speaker 3: There is one book recommendation actually. Okay. I mean it's a classic but it's Leo Tolstoy's Death of Ivan Ilyich. Right. It's maybe 40 pages, you know, written whatever it is like one hundred and ten years ago or something. But if ever there's a masterpiece in that 40 pages, somebody going from not being at all aware of their mortality to being so aware of their mortality. It's a deeply powerful message and yeah, it's 40 pages that I think is worth your time.
[00:53:26] Dr Ali Ross: We'll put it in the show notes alongside ways how you can people can connect with you, with Kaya, with the practice. I don't know if you were on social media at all.
[00:53:36] Speaker 3: Yeah. We're on Instagram.
[00:53:37] Dr Ali Ross: Yeah. So we'll put some links in on the Instagram and and thank you hosting
[00:53:42] Speaker 3: Oh, pleasure.
[00:53:43] Dr Ali Ross: Meeting today and and for your time.
[00:53:45] Speaker 3: And just to talk about it as well. Just lovely for me to be here talking with you about it.
[00:53:50] Dr Monika Wieliczko: Thank you for joining us. I hope you found it useful. Connect with me on Facebook and Instagram under guide to afterlife for more brief tips and resources. Visit guide to afterlife.com to send me your questions and to take part in the grief MOT, your free first aid program for grief. See you next Tuesday for yet another stimulating conversation.
