S1E13: Purpose At The End Of Life with Brandi Combs

In this episode of Purpose Project, host Leslie Pagel welcomes Brandi Combs, a social worker with extensive experience in hospice care. They explore the concept of purpose at the end of life through Brandi's compassionate lens. Brandi shares her personal journey, and the significance of connections and resources in end-of-life care. She also discusses the role of a life review in helping patients and families reflect on their legacy. The episode underscores the value of learning from seniors.

00:00 Introduction to Purpose Project

00:39 Meet Brandi Combs: A Journey in Hospice Care

02:17 Exploring Life's Purpose

04:17 Dying Well: Insights from Hospice Care

05:56 The Role of Resources and Connections

09:20 Living with Intention and Purpose

17:21 Understanding Hospice Care

23:02 Life Review and Legacy

26:12 Advice for Dying Well

31:15 Volunteering and Learning from Seniors

34:34 Conclusion and Reflections

Purpose Project is a research study on the topic of life's purpose. You can follow along in the making of Purpose Project:
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Captions are auto-generated.

Transcript

Leslie: 0:05

Welcome to Purpose Project. My name is Leslie Pagel and I am so glad that you found us today. I knew when I started Purpose Project that I wanted someone on the show who has experience working with individuals at the end of their lives. And I found the perfect person. Her name is Brandi Combs, and she has spent a portion of her career as a social worker in hospice care. On the show today, she talks about how purpose comes up at the end of life. Let's take a listen. Brandi. Thank you so much for being here with me today. I am looking forward to exploring this topic of purpose with you and learning from you.

Brandi: 0:52

Thank you.

Leslie: 0:53

I think a good place to start is to start with you. Who is Brandi Combs?

Brandi: 1:00

Thank you so much. Well, first and foremost, I am a mother of two children. I have a four and a seven year old. I live just outside of Austin, Texas, and I have been a Texas girl my entire life. so I grew up in Texas. I have a love for the outdoors. Anything from fly fishing to camping, which most of the time is camping these days, don't get out as much with the kiddos. and I have had a career, a very interesting career, actually. I am a licensed social worker. and I worked for the last 15 years in hospice care, and had the privilege,at bedside with probably, I was thinking about it before this podcast, a couple hundred patients. And so, getting to hear their stories and learn a lot about life. Um, so that's, I think what's brought me here today and I'm excited to talk about it.

Leslie: 2:01

You were the first person that came to mind when I thought I need to speak with someone who has been in hostess care, who's been around people at the end of their life to understand what comes up in the conversation. But before we get there, Brandi, we'd love to explore your purpose in life. Would you say you have? A purpose in in your life?

Brandi: 2:30

I think that's a really good question. you know, I, I do feel that there are individuals who have purpose. and I do feel that in life, you know, each phase of life brings a really unique purpose, to, for each of us. And so, I, I do feel that I found my purpose in my career, maybe in a different phase in life, when I was, in hospice care. currently I would say my, this phase of life, my purpose is to provide the best life for my family. However, that be by being a great example, and, and connecting with others and teaching them how to connect with others in their life. but I do, I do think that through my journey in hospice care, that I really did find the purpose. For me is ultimately those relationships, that we build throughout life and how I want to leave this world is actually something that I've thought about. and I want to be able to have those relationships and I do feel a calling, towards supporting, supporting people at that time of life. Um, but I think my purpose is always evolving.

Leslie: 3:44

Yeah, it sounds that way. It sounds like as you. Gone through your life that there are times where you've connected to what you're doing for, for a sense of purpose. and right now, where you're at your stage of life, that connection is to your family and to your role as a mother and being there for your kids and providing the best support that you can for them.

Brandi: 4:13

Absolutely.

Leslie: 4:15

Absolutely. Yeah. You're the first to say, I've thought a lot about the end of life. Um, and I think that would be natural, you know, given your experience in hospice, but when you've thought about that, what are some of the things that you've asked yourself and how have you thought about that?

Brandi: 4:39

Yeah, I think it's very interesting in that stage of life to when I've gotten to walk that journey with patients and families. Um, you know, we use the term dying well in hospice care, and that is my goal when I would walk into a situation with a family is to help them figure out how to die well. And, it looks very different for every patient and every family. Um, what that means to them, different goals, things they want to accomplish during that time. You know, there's a lot of things that a lot of that families may not be aware of that is going to have to happen in order to take care of their loved one. And so we want to be able to provide as much dignity. As is possible for, for that patient who is passing away.,but I do see common themes, that we can definitely dig into that I saw across all the families and all the patients, and that was, Really, again, those connections, resources, I was talking with a good friend of mine, a colleague before this, to get her, her insight on what, how she felt patients and what their purpose was. and she and I were talking about resources and I think everyone comes to, we all are going to die. We're all going to get to that. Um, that's something we don't get away from. And what kind of resources do we have around us? And that's not just financial, there's, of course, financial resources are very helpful. but I would say that, I've seen families without resources that do it so well. Because they've talked about it. They've figured out how they've had those connections. They've made this lasting impression and and have a legacy, with people around them in a community. And so I think it's really that that is something, that I think is so important, in life and getting and that those are the things that I've thought about, is how when I get to that stage of life, will I have those connections? Will I have prepared my family enough for what to expect? Um, and I think, you know, it's interesting that I've thought about those things so much, I guess, at my age. but I think it's such an important we come into this world and we plan so much for the birth of our children and how is that going to look, but we don't do a lot of discussing or talking about how do we want to leave this world. So, given that quite a bit of thought and just, you can only hope that things turn out well.

Leslie: 7:19

Yeah. Well, and, thinking about it in terms of Kind of those resources at the end of life, that you have, is a new way of thinking about it. For me, I hadn't thought of it that way. I, part of the reason why Purpose Project started is because I was thinking about. When my life is all said and done, did I do everything that I could to contribute the way that I want to contribute or to have the impact that I feel like I'm supposed to have? And the answer to that was no. And, and I didn't know what to work on. I didn't know what I was supposed to do. And so it was. I want, I'm going to study this. I'm going to study purpose and really understand how do people find their purpose in life and then how do they realize it. And, this idea of at the end of life, having those resources around you, whether it's financial is important, but really those connections is. is something that people at the end of their life find valuable and meaningful for them.

Brandi: 8:41

And I think, when you're saying making an impact, and how do you make an impact, I think how that translates at the end of life is in those people who are there. for you and who are available for your family. and so I think too, that we don't always know the impact that we're making. it's hard to, it's hard to define that. but it is, it is, it is all about how you make others feel.

Leslie: 9:11

Which you had talked about, as a core part of your purpose now is building relationships and the relationships with your kids. What are some of the things that you're doing that you do to live out that part of your purpose with where you are? Today.

Brandi: 9:31

I, I, you know, I think I'm a work in progress for sure. There's intentions that I have. But I think what's most important in the lessons that I'm teaching is how to treat other people. How to treat other people with respect. And so. I'm still in the early stages, even though it feels like the kids are growing so fast, of what I want to accomplish as far as what I want to teach them. I do. Interestingly enough, I, you know, we've had a couple of family members pass away and I want them to be able to see that. Experience. I think a lot of times children are sheltered from that, but I think it's important that we show, what it looks like to die, because I think that's something we're missing as a, as, culturally is mm-Hmm, how do, how do you do this and how do you take care of, others? And so, there's been people in our life, that I want them to be able to see that. And I, you know, I. Definitely am in no way, um, saying that I do that. I do that. Well, I think it's something that I want to do well and live out. so

Leslie: 10:37

how does that pursuits? with your family and and your kids. How does that make you feel?

Brandi: 10:48

How does that make me feel? I think that I think that's a good question. I'm just such a person who who never feels like I have done enough. And so it does make me a little anxious that I haven't done enough. To really do really accomplish those things, which I think is what we're talking about today is, how do you discover your life purpose? And I was even just saying that a little earlier is that we don't really truly know the impact we're making. So, I think it's a very, it's a great ambition and I think it's always an ambition to strive for is to make this impact and to do things with intention. But I also, uh, I always feel like I could be doing a little bit more if

Leslie: 11:33

that makes sense. Well, I appreciate you sharing that because I do think that. When I talked with people about the topic of purpose, that it can seem like, oh, it just makes me feel so good and I'm motivated and, but there's another side of purpose and you, you talked about. Anxious, it makes me feel anxious. I feel like I'm not doing enough or, I could be doing more. And, there are some, negative side effects of purpose. I, that's not the right language to use, but some uncomfortable feelings that arise as well.

Brandi: 12:17

Yeah, I think we're just, we're all always striving. And if you're not keeping your eyes open for opportunities to live with intention, then you're missing. And if you're so closed minded to think that there's just one thing that you're supposed to be doing, then you may miss out on other opportunities in life.

Leslie: 12:37

And

Brandi: 12:38

that's a personal opinion, I guess.

Leslie: 12:41

Yeah. Yeah. You talked about the feeling of anxiousness, but what is the most challenging as you set out to be the best mom that you can for your kids and as, the purpose that you're living right now?

Brandi: 12:58

The most challenging. It always feels like time, you know, just having that time to be able to do those things. And I'm sure, everyone is busy. Everyone has time. And I do think, going back to what we were talking about earlier, those human connections, finding the time and the space, and to be able to really make heartfelt. Connections sometimes feels almost impossible and that's outside of family. Cause I feel like my world is my world is work and my world is my kids. And, so then making sure that you're making those connections and being of support to others when they need that support is challenging.

Leslie: 13:43

Yeah, yeah, absolutely. Yeah. As you, you talked about how your purpose. Has evolved through stages of your life, and you've also talked about thinking about your end of life when you look forward, let's say, 10, 15, 20 years, have you considered what your purpose might be? Then that is it a version of what it is now? Does it change evolve? What do you see as you look out in the horizon?

Brandi: 14:20

Yeah, I like to keep my mind open to what that might be. I think family is always going to be very important as far as my purpose. But then, I know things will change. Like you said, in 15 years, I've started to dabble in, how can I support other women? And in health and wellness actually is actually a passion of mine. So that is something that I, I would love to see my life take that, take that route. And how can I support others, on their health journey? So that's, a vague thought, but again, I'm just trying to keep my mind open to what we're talking about, and opening my mind to opportunities to connect and talk with people and, see where life takes me. So,

Leslie: 15:11

yeah, I love that. Like being open and accepting of what comes your way. And then you also talked about you use the word passion to describe, connecting with women and helping them and their health and wellness. And I've often wondered. If passion and purpose are one of the same, I don't know if you have thoughts on that or not.

Brandi: 15:40

I, I, I do think so. I mean, I think that what we spend time thinking about learning about is a passion and that does translate into purpose, but I do think we also have some purpose that, we don't necessarily. That we don't, we can't exactly vocalize. I do think that there is more to this life than what we think we're passionate about and what we think we're doing well. Um, I do think that life has a purpose that we may not be able to see right in front of us. And the opportunities that we have to, keep our mind open to and just do the best we can. So I, that's my belief.

Leslie: 16:24

Yeah, yeah, and when you say, the purpose right in front of us, or is that because what you talk, you talked earlier about how we might not always know the impact that we're having. Is that is that what you're referring to when we might not see it in front of us because we're having this impact. That's unknown. Absolutely.

Brandi: 16:49

Absolutely. Yeah, you just don't know. You don't know the people who you've touched and I think that's 1 thing that you see and end of life is, is, is the, is the people that actually do come out and support. Um, and you just don't know who you've touched. But we're all trying to just do the best we can. And that stage of life is very telling and how much of an impact or how much we've lived our life with intention and purpose.

Leslie: 17:20

Yeah. Yeah. Let's talk about that. This is shifting into your professional experience, in hospice, but first, could you just, so you're a social worker working in hospice care, what, what does a social worker and hospice care do?

Brandi: 17:39

So the social worker is there for. psychosocial well being. So the whole premise around hospice care is it is an all encompassing care of somebody at that stage of life. So in order to if you want me to go into what hospice care is because I think there's some misconceptions. I can definitely go there. Go there. Okay. So hospice care is meant for people at the last stage of life. And medically, what that means is the last six months of life. It's hard to determine if you have six months to live. But is, is this going to be, is your disease going to end up Is your life going to end because of this specific diagnosis? And is it expected that it will be potentially in the next six months? We always, the doctors would say, would you be surprised if they were still with us in the next six months? So it's kind of a vague. guideline, but it is medically necessary. And so the idea around hospice care is that we are supporting the whole person. So that's not just physical, but what is pain, at the end of life? Is it social pain? Is it spiritual pain? Is it physical pain? And so we have professions, that surround the individual and their family to help address, maybe what might be causing pain or some, or need symptom management. And so the role of the social worker is to, a lot of times what I was doing was really supporting the families. And so I talked about how when you come in to meet with a family, is asking the question, how could we help you do this stage of life? Well, and what does that mean to you? What are your, is it caregiving? Do we, is it, is it talking through maybe, their life's purpose and, and like what we're talking about talking review and helping them talk through that. Is it getting, advanced directives in place? It's addressing the psychosocial needs. And then we lean on, we work as a team to be able to address the patient's needs and the family's needs so that they can die. well

Leslie: 20:03

are you, you mentioned that a lot of this is focused on the family versus the patient. Is there a difference between the family and the patient or

Brandi: 20:18

I think a lot of that more has to do with care. And so how do you help them understand the resources that are available to them? How do you help them understand how to take care of the end of it, of the patient who is dying? And also help them support them emotionally with the path they're walking. Because as I had mentioned earlier, there's so much that goes into taking care of a patient. That a lot of times there's a misunderstanding from the beginning of what all that's going to entail. And it's, they need that support.

Leslie: 21:01

And you mentioned these categories of care, um, is there a category that is more common than others?

Brandi: 21:13

So, um, there is, I know, I think we all go, we all experience at that time of life, All aspects of ourselves. So we experienced dying from a physical perspective. We've we experience it from an emotional and psychosocial and spiritual perspective. And so that's the reason for a team, um, is to be able to surround that the patient and family and help them to walk through those different aspects so that the patient dies symptom free. With all, what, considering all of those aspects.

Leslie: 21:51

Yeah.

Brandi: 21:53

And what is psychosocial? So that would be more, in line with the social worker's role. So that is how they are coping, with the situation, how they are, coping what it entails as far as caregiving and resources. So psychosocial more has to deal with how an individual is coping.

Leslie: 22:13

Okay, and so you are working with families and patients at the end of life to understand how can they die well and what care across the different aspects do they need so that the team can appropriately serve the patient and the family. Right. And I imagine there's. a lot under there. I'm curious about the role of purpose. I don't imagine that that word purpose comes up. I don't know. It might. But how might the topic of purpose come up at the end of life, whether from the family or the patient or both?

Brandi: 23:02

So one aspect of my role was, life review with the patients and family. And that is therapeutic in and of itself, to be able to share your story, to share the impact you've made on others in your life. And it helps. It helps not only, take care of the patient, but also the family to be able to share and, and to feel, feel heard and to feel, be able to express what you want others to remember about you. So I think that that correlates with purpose. You, ideally for every single patient that I had, we had the opportunity to do life review, but I think A lot of times, there's so much going on at that stage of life that it's hard to get to that, that piece. And so it goes back to all of everything we've talked about is being able to be prepared for that time of life. So that you can reflect on these memories and be able to give your family, that gift of talking through everything that's happened in your life and how you want to be remembered. Symptom management is the point behind hospice care. And, When there are other symptoms like lack of resources, lack of caregiving needs, physical pain, we don't get the opportunity to do this in very important step.

Leslie: 24:35

Okay. Okay. So let me make sure I understand. So there's a part of the process where, there's a life review that you do with the family. And, depending on the situation, that piece. Might not always happen or is it that it is happening, but the families have a hard time doing that.

Brandi: 25:04

I think,

Leslie: 25:06

yeah,

Brandi: 25:08

I think both, I think we want our families and we want everybody to understand maybe what we feel our legacy and our purpose has been. But I do also think, you know, as we talked about, and this is my perspective, as we talked about, that purpose changes, throughout our life, I think when you are facing end of life and what you want to be remembered for may change from what you thought your whole life purpose was. Um, and it really becomes about those people that are around you. Um, yeah, yeah. And, um, you know, it's such an important time that we can spend with family and that we can spend, and we can do dying well. And I hope that for all the people that I meet and, we have to, I think we have to talk about it before we get to that stage. Right.

Leslie: 26:11

Yeah. What advice do you have for those who are listening on what they can do To die well and, and to equip their family with this life review conversation.

Brandi: 26:30

Yeah. Advanced directives are so important. So important. What is that? What's advanced directives? is actually putting in writing what you, your wishes are. And that's not just financial, it's medical. And I think there's a misconception out there that to do these advanced directives, you have to have a lawyer present, but you really don't to be able to express what your wishes are. Um, there's, um, directives that are in place that you can actually even just pull off of the internet and be able to express what's so important to you and how you want to die. And so that addresses the medical piece of it. I do think it's important to talk about how you want to be remembered. So have you talked about, have you made arrangements as far as your final arrangements? Have you talked about what you want your If it's important to you, what does your funeral look like? Um, you know, I, this always ends up being our topic of conversation at the Thanksgiving table, but it's so important to be able to talk about these things. And so, when you have those things in place and people are very clear on what your wishes are, then there's not the burden of maybe somebody else having to make these decisions for you. Cause at that stage, you may not be able to communicate. There may be that piece of it. But there's still opportunities to be able to connect, with, so. All the way through. Yeah.

Leslie: 28:03

Yeah. Yeah. So write down your wishes, not just medical, but also how you want to be remembered and have those conversations with your family around the Thanksgiving dinner table. If you want. That's right. Just have the conversation.

Brandi: 28:23

That's right. Actually, we had a grant funded program that we were going out and talking about. This is called the gift program. And it was, we would go talk about how at after the age of 18, you really should start talking about what your wishes are. Um, and any life change you have, you need to look back and make sure that the people in your life know what you want to happen? Yeah.

Leslie: 28:52

Well, and in my head thinking of what's the connection to purpose here? Like, why are we talking about this? And this, you said a big part of it is how you want to be remembered and, as someone who is searching for my life's purpose. Um, thinking and answering that question now about how do I want to be remembered can help me uncover. How do I want to spend my life? What do I want to spend my life doing? What purpose and meaning do I give to it right now? So that, afterlife I can be remembered in that way.

Brandi: 29:36

That's absolutely. Yeah, and I know that this is, you know, talking through advanced directives and funeral planning is not anything anybody wants to think about when we're talking about purpose. Um, but it is so important because part of how you're remembered is, is how you took care of other people in your life. And by being able to. Take care of life's business, and be able to relieve that burden from your loved ones, can really help you leave a legacy where the people who you love the most are in a good place,

Leslie: 30:14

right? Yeah. You just put an idea in my head, Brandi. I'm envisioning having this conversation with my family about, how I want to be remembered and me asking them, what can I do this year to be remembered in this way, it's a way of living as well. Yeah,

Brandi: 30:38

absolutely. I, I think that's so important. And just like we were talking about my kids in the beginning, you know, that's me talking about this. Like I said, I'm a work in progress, but how do I make sure that they will remember me in the right way? Even now, even with young children, right?

Leslie: 30:58

Yeah, absolutely. It's good. Purpose Project exists to help people discover and realize their purpose in life. Is there anything else that comes to mind as, advice or tips based on your experience?

Brandi: 31:15

So for me, I've been fortunate in that my career has afforded me the opportunity to spend time with others who are Who have lived their life, who are maybe reflecting on their life. And I think that has helped me learn, learn a lot and I'm still learning, but I think spending time if you can, in any way, with seniors, with people who are facing end of life, if there's a way to volunteer, I think the, what you will get from that is, is. immeasurable compared to what even they will receive from you helping them out. And not that you are trying to do something for yourself, but I think the way that we learn in this life and we discover our purpose is through our connections and, learning from seniors is something that I think we all should do, because that generation, I always say it was just the generation that is currently seniors, there's so much to learn from them. So any way you can get involved in your community and learn from those, I think is going to, Ultimately just, um, help you live a very fulfilled life. And that's something I know personally, I hope to continue to get to do.

Leslie: 32:41

Yeah. Are there places for people that are listening to this? Where might they go to find volunteer opportunities?

Brandi: 32:52

I would definitely recommend looking into any non profit hospice in your area. There's always volunteer opportunities with non profit hospices. There also are, for profit hospices as well, but I would start with your local nonprofit. And then I think at any of the communities, any assisted living communities in your area, finding out ways to help support them. And what they're, just being able to support their daily operations. You're going to get to be, you're going to get to involve yourself and experience other people. Um, and I think that's, what's most important.

Leslie: 33:28

Yeah. Awesome. Okay. So, parting advice from Brandi is let's learn from the generation that has a life lived. Go out, find the nonprofit hospice care in your area and see, how you might be able to, support them and know that you're going to get far more out of it, as well. I heard that from you that there's so much that you're going to gain in doing that, volunteer work for others. Absolutely.

Brandi: 34:03

Absolutely. As well as supporting them. Being able to help others in that space is is so needed. And there's such a void there that needs to be filled by people who, Want to help.

Leslie: 34:15

Yeah. Yeah. Brandi. Thank you so much for being on Purpose Project. I am taking a lot away from our conversation. And I know those that are listening are as well. Thank you for being here with us today. Thank you so much. It's a pleasure. As I reflect on this conversation with Brandi, one thing is clear to me. And that is we need to have conversations with our loved ones about the end of our lives. But those conversations don't need to be about death. They're really about living. They're about living the life that we want to live so that we're remembered in the way that we want to be remembered. Brandi, thank you for highlighting that for us. Thanks to all of you for tuning in. I hope you have a wonderful day. Purpose Project is brought to you for education and for entertainment purposes. This podcast is not intended to replace the advice that you would receive from a licensed therapist or doctor or any other qualified professional.