Julie Young

When patients who are dying are reaching up, when they're seeing people that you can't see, when they're talking to loved ones who've already passed, and they may have been completely confused before that, but you can hear some things clear as a bell. I mean, it makes everybody in the room's hair stand up on their arms, you know? You feel like there's more than just what we know, and that I find very comforting.

Aryana Misaghi

I'm Aryana Misaghi and this is Appalachian Care Chronicles, a podcast bringing you stories from every corner of West Virginia's health sector. Join me as we journey alongside a variety of problem solvers, change makers and daily helpers, who are all working behind the scenes and on the front lines to care for our communities. Together, we'll explore what they do day-to-day, the steps that got them there, and the why’s that continue to draw them back. How in the face of some of the most challenging situations possible, do they manage to keep themselves and the rest of us from falling apart? Far from predictable, the paths they've walked are full of twists and surprises, discovery and purpose. This podcast is for anyone who's ever even thought about going into the healthcare field or has a passion for caring for others in times of need.

Aryana Misaghi

Let me introduce myself, your host. I'm Ariana Misaghi, and since you last heard from me in Season Two, I've been working full time as a psychiatrist in residency training. After I graduated from medical school at Marshall University in Huntington, West Virginia, I've been using that education I got there to actually help people. And it's been extremely rewarding. I'm also so excited to welcome you to Season Three of the Appalachian Care Chronicles. This season, we explore hospice care, peer recovery support, medical imaging, and even how healthcare providers can shape legislation. We also have some exciting news, Appalachian Care Chronicles has been renewed for a fourth season! That means we'll be back in 2025 with four brand new episodes featuring unique pathways into healthcare careers.

Julie Young

Okay, so right now we're driving to go visit a palliative care patient who has requested social work assistance with completing her medical power of attorney and her living will and so on her medical…

Aryana Misaghi

In this episode, we meet Julie Osborne Young, a licensed independent clinical social worker and Director of Social Services at HospiceCare in Charleston.

Julie Young (to Patient on the phone)

Hi there! This is Julie the palliative care social worker. Hey, dear. We don't see 31. All right. Tell me more about that?

Patient (to Julie Young)

Okay I’ve got someone coming out to the road…

Aryana Misaghi

Hospice agencies work with people in the last six months of their lives, and their team of providers help them manage their symptoms and in some cases, offer spiritual guidance. One day this spring, we came along with her to visit a new patient. A 56 year old woman who asked for help with her Advanced Directives.

Julie Young (to Patient)

How are you feeling today?

(Cell phone ring interrupts conversation)

Patient (to Julie Young)

My granddaughter came up with that ringtone, that's her saying it.

Julie Young

(Laughs)

Patient (to Julie Young)

I'm having one of my better days today. I had a really great treatment this morning…

Aryana Misaghi

Agencies like hospice care also attend to those dealing with a serious illness who need support but might not be imminently dying. Someone with cancer might, for example, receive what's known as palliative care along with treatment like chemotherapy.

Patient (to Julie Young)

Oh, my goodness, I don't even know where to start…

Julie Young (to Patient)

Yeah.

Patient (to Julie Young)

End stage kidney failure. Dialysis four days a week, three hours at a time.

Julie Young (to Patient)

Wow. So has dialysis been, what has it been like for you?

Patient (to Julie Young)

It’s been a struggle. It has, it has been a hard struggle. We have to do all kinds of things to try to get me through a full treatment. And half the time it's not been a full treatment. This past Friday, we tried for over an hour ended up going straight to CAMC to have surgery, and I was back there Tuesday. I have the surgery again.

Julie Young (to Patient)

Goodness. I bet you’re exhausted.

Patient (to Julie Young)

Absolutely. Absolutely.

Aryana Misaghi

Julie explained that all of her patients are experiencing grief to some level, especially the ones living with illness. Patients often experience a cascade of grief events, patients have a lot to unpack, and behavioral health and social service workers serve as non judgmental witnesses to anything patients are experiencing. That kind of care goes a long way.

Patient (to Julie Young)

… I met my husband…

Julie Young (to Patient)

How long you been married?

Patient (to Julie Young)

31 years.

Julie Young (to Patient)

Wow. What's it like to be married 31 years?

Patient (to Julie Young)

At times, a lot of fun.

Julie Young (to Patient)

Oh, awesome.

Patient (to Julie Young)

A lot of patience.

Julie Young (to Patient)

Well said. Well said. Yeah, I heard somebody say, you know, marriage is about forgiveness.

Patient (to Julie Young)

It is! On both sides.

Julie Young (to Patient)

Yes, yes. So I just wrote on here, and I'll fill the rest in, but I've got you and Richard as your primary, and then it's got a little place where you can write any additional directives. If you want to say, I wish to be cremated, or I don't want to be cremated, or something like that? Do you want me to write anything there?

Patient (to Julie Young)

Okay. I'm donating my body to science.

Julie Young (to Patient)

Okay.

Aryana Misaghi

By documenting wishes early and clearly, behavioral health and social service workers help reduce the stress and anxiety that patients feel as illness progresses. Documentation also helps families understand and respect those patients' wishes. While it might seem like common sense, most people aren't exactly eager to think about end of life scenarios, let alone write them down. Having a knowledgeable third party to guide the process makes a world of difference.

Patient (to Julie Young)

…short term unconscious, dialysis, yes.

Julie Young (to Patient)

What does short term mean to you?

Patient (to Julie Young)

Um, a week.

Julie Young (to Patient)

Okay, very good.

Patient (to Julie Young)

I think that covers everything.

Julie Young (to Patient)

Yeah, okay, very good. All right, so we'll do a living will, and that's basically what that says. And then I put those additional directives on there, and then if you want to sign in these two places, then I'll take it back to the office and notarize it, and I'll make a couple copies and mail it back to you. Does that sound good? And you've already talked with your family about what you just said about feeding tubes…

Patient (to Julie Young)

They know everything. Absolutely everything.

Julie Young (to Patient)

Okay, great. Good job. You think you're gonna try to do anything today on your good day, eat something. You want something? Well,

Patient (to Julie Young)

Well, I had Tutor’s.

Julie Young (to Patient)

Okay that's it! That has a lasting feeling, you know, that sticks with this a little bit. Yes, 100%! Yeah, very good. Well, I'm glad you got to have some.

Julie Young

So in a typical day, I'm usually just learning a lot about what other people are experiencing and being a witness to their resilience. And I'm always in awe at the capacity to which the individuals and families that we serve are able to adjust and adapt to so many you know what we would see as hardships, and they often will see them as hardships as well, but, but it's just amazing to see the strength of the human spirit, and you know, particularly the West Virginian.

Aryana Misaghi

Lots of people don't really understand what a hospice agency does until they need their services for themselves or for a loved one. Even though the end of life may be a difficult thing to think about, it's always best to be familiar with all the resources and options out there. Julie works on a team that includes a nurse, nurse assistant and a chaplain. Together, they meet with a medical doctor every week to discuss the plan of care for each patient on the roster.

Julie Young

We are going out in the field. We're meeting patients and families where they live, we go to long term care facilities to see patients, and we're really just working with them to assess what their needs are, and we determine what their needs are by finding out what their wishes are, basically, and where there's gaps between what they wish they had, what they want and what they actually have. So when we go to assess patients, we don't go in there with expectations or ideals of what we think they should have. You know, they really guide their plan of care, and they determine what their needs are by communicating with us and we help patients with a variety of issues that they may be facing. For a lot of us, illness is very isolating, so folks may need their social safety net strengthened. They may need caregivers. If they don't have family members who are able to provide care, and even folks that do have family members that are able to provide care, you know, they still may need additional assistance, as many of us do, you know. Really, we all need a village the whole way out, and some of us have a very much smaller village than others.

Aryana Misaghi

Julie’s work has put her in the privileged position of caring for others dealing with severe illness and those nearing death. That could be a little unsettling to some, but Julie finds comfort in witnessing others during their time of need.

Julie Young

I think it's very humbling to get to be involved in anyone's end of life event. You know, sometimes I feel selfish, because I just feel like all I'm doing is learning from everybody else and what they're experiencing, and I hope that I can take what I'm learning here to help, you know, my family, and to help prepare myself for when it's my time to die.

Aryana Misaghi (Show Information Break)

Appalachian Care Chronicles is made possible thanks to the West Virginia Higher Education Policy Commission. West Virginia Invests is the state's tuition free community college program covering tuition and mandatory fees for certificate or associate's degrees in in demand fields, including nursing and other healthcare careers. Find out if you qualify and apply at collegeforwv.com. That's College For WV dot com.

Aryana Misaghi

Growing up in Charleston and Hurricane, Julie only had a vague idea of what she wanted in a career. She was certain she wanted to help people, and a counselor suggested social work, which made perfect sense for her. She got her bachelor's from Marshall University and her master's from West Virginia University's campus in Charleston. She worked for the state's Child Protective Services for a few years after college, and then moved to Georgia, where she found her calling in hospice care.

Julie Young

I made a friend down there who was a hospice social worker, and they had a position open, so I took that position, and that was the first experience I'd ever had, you know, in a hospice setting or even with that population. But it just really hit home to me. I was really excited by the field, and I thought, this is kind of what I want to do.

When I was mentoring with a seasoned hospice social worker there, and we went on one of our first visits, and I just went there to observe what she was doing and how she did a hospice social work visit. And we went to a long term care facility, and there was a patient who had advanced stage dementia, and the patient was laying in her hospital bed. She was totally bed-fast. And turns out she was non verbal as well. So speaking to her sometimes caused frustration for her, and the social worker was aware of that, you know, before she came to visit. So when she came to visit, I just kind of stood in the back and, you know, was observing, and she just put her hand on the patient's forehead and looked at her, you know, in the eyes, very contently. And they shared a moment. And it seemed like it went on for a little while, and I'm just like, “Huh, are they going to speak? Are they going to do something?” And that was it, you know, that was the social work visit, and it was such a peaceful moment. It was a calming presence. It was comforting. It was all the patient needed. That just had me hooked! Just being able to tailor your visit towards whatever a patient needed at that time, or or doing your best to find out how to show up for somebody in a way that they might need you.

Julie Young

I'm starting to learn now that it's been, you know, several, many years past high school, that the best way you can show up to help somebody else is really to be, is to help yourself, to keep learning, keep working on yourself, so that you can show up for people in a way that's open and caring and empathetic. I think a lot of people in healthcare fields, particularly in probably every field, sometimes can experience, you know, some level of burnout, as they call it, and compassion fatigue for the most part. So if you're not doing things that you enjoy and trying to find out, you know, what lights you up as a person, it's hard to have much really to share, and we really have to combat that, that burnout at every stage, so that we can show up empathetically for people.

Aryana Misaghi

Burnout is always on our minds as healthcare professionals, and this isn't the first time we've talked about it on the podcast. As Julie has learned through experience, you gotta fill your own cup first, before you give to others. Figuring out what it is that does fill your cup and then actually doing those things is crucial to managing burnout. Julie eventually moved back to Charleston and took a job in hospice care. A few years later, she started working on her Advanced Social Work License, which social workers can start pursuing two years after getting a master's degree.

Julie Young

West Virginia gives us a really unique opportunity as a social worker to kind of be able to serve patients in such a unique way. We have patients who live rurally, which can bring about its own set of circumstances. And also, you know, here closer to town, you know, there's some resource differences and that sort of thing. So I see just huge opportunities for social work in West Virginia. And I love West Virginia, and I love the people of West Virginia. I just get to see, pretty much every day, the resilience of the West Virginian that I find to be so inspiring.

Aryana Misaghi

Social work can fall into a little bit of a gray area involving both problem solving and powers of empathy. The most important part of solving any kind of social problem is figuring out what the needs of the individual and the community are first. Julie is keenly aware of the needs, attitudes and resources specific to West Virginia and its people, and she uses them strategically to help people exactly where they are.

Julie Young

I believe that being able to see and meet people who are going through sometimes very sensitive times in their lives, to be able to approach that non judgmentally, you know, and to empower people and to believe in people's right to self determination. I mean, none of that is black and white. That has nothing to do with any quantitative research or anything like that. That's all, that's matters of the heart. You know that's who you are, that's what's important to you. You know, soul matters, all that, all that is not black and white, and it's so individual to the person and to their family system. And that's the voice that we want to represent, would be the voice of the patient.

Aryana Misaghi

Julie remembers a patient of hers who had ALS and was unable to leave her bed, walk or feed herself. The woman's husband worked during the day and sometimes into the evenings, and they had two school-aged children given her limitations and the fact that she couldn't even get out of her home by herself if there was an emergency, her medical providers thought moving to a facility might be a better option. The woman insisted on staying at home so she could see her two kids when they got off the school bus.

Julie Young

That is what the family identified was working for them, and the patient was in her right mind. She was able to state that that's what her wishes were. And she had a very caring medical team, and their, you know, hopes for her was that she would be placed in a long term care facility because they couldn't afford round the clock caregivers or caregivers every time that were needed. And she didn't qualify for the Medicaid program that would have sent a caregiver or something like that, or even if she would, it would have taken a number of months to actually get the help. So that seemed like the only alternative would be for her to go to a long term care facility, but that was not what she wanted. She wouldn't have gotten to see her kids every day after school. So, our job as a social worker was, of course, to look for all community resources that could have been available to help. And they did end up coming up with a church family that would come and provide some volunteering there. But ultimately, it was her choice to risk not being able to leave in case of an emergency. So our role as a social worker was to help the medical team understand that even if it wasn't okay with us, it was okay with her. And that's what was important. So that was our role at that time.

Julie Young

Social workers are kind of seen as people who come in with a clipboard and they are looking to see maybe what you're not doing right, or, you know, are you abusing someone or something like that? And sure, there are adult protective services workers and child protective services workers and so, you know, they're social workers, but even ultimately, their goal is to try to help people get what they need so that they can live the way that they need to live. You know, like, I say, our goal is what the family members goal is. So we have no agenda other than making sure that we're doing everything we can to help them get what they feel like they need.

We come to learn when we become social workers that we can't eliminate all human suffering. You know that it still happens. People are still going to have needs that are unmet because we all have boundaries and limitations. And to some things, there's no solutions. Some things can't be fixed, but what we can do is talk about it, process it, and be a witness. And sometimes that can go a really long way. And I think there's satisfaction in knowing, even when things don't seem like they work out, there's satisfaction in knowing that you tried. And I think people deserve somebody who's going to try.

Aryana Misaghi

March was Social Work Month, and we stopped in for a meeting being led by Julie.

Julie Young (to Colleagues and Staff)

Alright guys, good morning and happy Social Work Month! I have an agenda. I'm just going to pass it around. And guys, I just kind of wanted it to be pretty laid back for you all. So I'm going to kind of hit some areas of conversation that people have talked about with me over the last month or two, since we've had our last meeting. And I just want us all to know the same stuff for the most part. And a lot of this, you know, if you already know it, awesome. And the theme of Social Work Month this year is empowering social workers. And I thought that was kind of neat, because social workers also need empowering in order to empower anybody. And it's kind of been a heavy, I mean, the year is almost a quarter the way over, but we've heard a lot of sad stories and had some frustrating stuff kind of go on around us where we wanted to try to make some change, but kind of weren't able to. And a couple of us know some things I'm talking about, we kind of carry it with us all the time. But anyhow, so I'm gonna start talking about some shop talk that is not so emotional.

If a patient or a family member are not receptive to social work visits, we want to just all be on the same page on how we document that in the chart. So 100% of the patients, their first care plan item is, Plan For Services. If you scroll down, it has the Social Work Visit Frequency and that sort of thing under Plan For services. And then we can type in there what the plan will be to continue seeing that patient, if not at all. We can say, you know, “Family requests phone calls, PRN only, no visits,” something like that patient. Family does not and that's very rare. Typically, they just love their social work, all right, very good, okay, and this is…

Aryana Misaghi

One of the most exciting aspects of medicine is seeing how technology can advance access and treatment in all different fields. Telehealth took a huge step forward with COVID 19, and now we're seeing brand new therapies emerge from biotech companies. Recently, Julie's colleagues have introduced virtual reality technology, digital headsets that allow users to experience the thrill of travel without leaving home. Some studies have shown it can help with memory loss and loneliness, and one tech company is even developing a headset geared towards seniors.

Julie Young

So say, if they physically aren't able, maybe to go to the beach, we can try to bring them that experience, or if they've always wanted to go, you know, to Colorado or somewhere, we can try to bring that to them. And we've had some really great results, and some people that really enjoyed it.

Aryana Misaghi

The transition from living a healthy life to being terminally ill—the transition from life to inevitable death—it's going to be hard for most of us. This transition ends up being one of the most challenging times of our lives, and we need people who care to help us through. Julie shows up and is present for her patients, and sometimes that's all they really need.

Julie Young

I have experiences that make me feel like I'm in the job that I want to be in, frequently. Sometimes when I'm at our Memorial Hospice Unit, and I get to greet patients, families as they come, and I'm the first person that they see, and I get to—and it's rare, because I'm not there all the time—but when I get to kind of greet them in a way that is soft and understanding, it makes me feel proud that, you know, because I treat people the way I want to be treated, if you know as much as possible, obviously, but, but there's times when I've had patients that I was counseling, I can think of one woman in particular that just really benefited from my visits and me coming, and sometimes you're the only person that someone sees in a day, you know. What an important role that is. You don't have to be something great, you know, you just have to care. And that comes easily for most of us, truly. And so I just think it's a very humbling experience just to get to show up and meet people who are open, which is a beautiful experience.

Aryana Misaghi

Appalachian Care Chronicles is a production of the West Virginia Higher Education Policy Commission, Health Sciences Division, which is solely responsible for its content. Guest opinions are their own.

Special thanks to HospiceCare and the Palliative Care Center.

For more information about educational opportunities related to healthcare in West Virginia, visit appcarepod.com that's A PP Care Pod dot com.

I'm Aryana Misaghi and you’ve been listening to Appalachian Care Chronicles.

In our next conversation, we'll sit down with Dr. Tom Takubo, a pulmonary critical care physician whose journey in healthcare took him from the southern coalfields to the halls of the West Virginia State Capitol.

See you then!