Hospice Nurse, Cydney Alvarado

[00:00] Michelle: I was eager to talk to Cydney Alvarado because I've always been curious to know what a hospice nurse does. I mean, I was reading Elizabeth Kubler Ross's, On Death and Dying at age 13. I never said I was normal. As a float nurse. Cydney got exposure to many different specialties, which helped her tremendously in her role as a hospice nurse, which she says has become her favorite nursing specialty. She explains the details about the people she cares for, opening a case, symptom management, her autonomy, and some very common misconceptions. She is acutely aware of her empathic nature and tells us how she guards against compassion fatigue while practicing what she says is her heartbreaking joy. In the five-minute snippet: Baby Shark, doo doo, doo, doo, doo doo. Here is Cydney Alvarado.
Well, good morning, Cydney, welcome to the podcast
[01:17] Cydney: Morning.
[01:22] Michelle: We're in the closet and it's nice and cozy.
[01:27] Cydney: Yes, it is. And it's bigger than I thought it was going to be.
[01:31] Michelle: And it's a Saturday morning, and you're all relaxed and ready to have a good day. I'm going to run to the farmer's market after this.
[01:42] Cydney: Nice, I love the farmer's market.
[01:43] Michelle: Right?
[01:43] Cydney: Haven't been there in a while.
[01:45] Michelle: And we're finally getting some nice, sunny, kind of warmer weather.
[01:50] Cydney: Looks like maybe spring is coming now. Maybe. Yay.
[01:54] Michelle: Well, I first just want to thank you so much for being here today, and taking your time on your Saturday. I'm excited because you have a lot of experience in your whole nursing career and we'll talk about that. But you're also a hospice nurse and you've been doing that for a few years now. And to me, that's a superpower. I think nurses, we deal with death kind of frequently if we work in a hospital.  And then we think about hospice and we're just like, oh, no, I could never do that. But it's like, why is there this disconnect? And I think probably more nurses could do it and would be really fulfilled doing it than not. So we'll talk about that too. But I kind of like to just jump in and I'm going to just have you talk about how you got started in nursing.
[02:56] Cydney: Well, it's funny because it was not my first choice. Right. I went to high school to be a marine, I went to college, forgive me, to be a marine biologist.
[03:04] Michelle: That's cool.
[03:05] Cydney: That was like, I'm going to be on a boat with sharks and this is my thing, and then life and came back home and I was like, okay, I'll be a math or a science teacher. And my mom was like, probably not. You don't have that kind of patience. Love the honesty.
[03:21] Michelle: Yeah, she knows you for sure.
[03:24] Cydney: And she said, why don't you be a nurse? And I was like, no, I don't like blood. I don't like to be around sickness. No. And she said, Be a CNA. If you can be a CNA, you might find that you enjoy nursing. Said, okay. So I went to a local community college, did the CNA course, and fell in love with being a CNA.
[03:47] Michelle: Wow.
[03:47] Cydney: Never knew that that would be something I would enjoy. And from there, just started pursuing the classes and getting things done so that I could become a nurse.
[03:56] Michelle: I've interviewed quite a few nurses now and talked to a lot of nurses, and I'm always surprised at how so many great nurses never started out saying, I want to be a nurse. A lot of them like you were like, no, I could never do that. Then end up taking some course or some start in the medical profession and then just really, like you said, falling in love with it. And there you go. So I saw in your bio, and of course, I know you, too, that you've worked in a lot of different areas and a lot of different specialties. So talk about some of those during your journey to hospice nursing.
[04:40] Cydney: Well, I think because I started in the float pool, it gave me this wide array of opportunities. One day I'm on a floor that's for your kidneys, the next day I'm on a floor for critical care. And so I got to see just the body mechanics in all the different areas and the medicine specific and the disease processes, and so it just helped me. I couldn't find a specialty because I loved it all. I was very fascinated by the critical care thing. So after a few years, it was like, oh, you need to take these critical care courses. And then I became a critical care float pool nurse.
[05:20] Michelle: Oh, wow.
[05:21] Cydney: Yeah.
[05:22] Michelle: So I'm remembering back to the float pool. And were you one of the first nurses on the float pool? I feel like it was really new when you started it.
[05:33] Cydney: I think I was the second generation.
[05:35] Michelle: Okay.
[05:35] Cydney: So I had the cream of the crop mentorship.
[05:39] Michelle: That's awesome.
[05:40] Cydney: Yeah, I had the best of the best.
[05:42] Michelle: So you worked a lot of critical care. I know you worked some postpartum briefly.
[05:50] Cydney: But just when I got floated to but definitely not my area of expertise. More like, okay, I'll go there today.
[05:58] Michelle: With a smile on your face. Well, you always did awesome. And that's my environment. NICU, labor & delivery, postpartum. And so I remember seeing you there and always just doing very well and never looking uncomfortable or anything like that.
[06:18] Cydney: I appreciate that.
[06:19] Michelle: Yeah.
[06:20] Cydney: I'm a duck. You don't know what's going on underneath the water.
[06:26] Michelle: Most nurses, right.
[06:27] Cydney: You have to be.
[06:28] Michelle: Yeah. How do you think your experience in the float pool, being exposed to all those different patient demographics and different levels of care, how did prepare you for hospice?
[06:46] Cydney: Oh, tremendously, because I was exposed to so many different disease processes. So when I have a cardiac patient that has congestive heart failure, I remember being on the cardiac unit and experiencing those disease processes and medications. And I could really explain in simple terms where we are at this end stage or being on oncology and dealing with different cancers and really just being able to go, I know what this looked like in the beginning and now I can show you how this progression has got us to this space here. It's been so helpful. I pull from those experiences all the time when I'm speaking to different patients and families.
[07:31] Michelle: That's great experience. And then what made you say hospice?
[07:39] Cydney: I think I was working at a surgery center and I was kind of like I kind of called myself a barista because I just asked the same questions over and over because I was assessing. I was the pre-op assessment nurse prior to the surgery. That was my last role there. And I just started saying, this is a job when you're kind of done with patient care, right, this is a job. It was fun, but it just wasn't the excitement and the things that I wanted. And I had a friend who was a hospice nurse and she used to talk about it all the time and it used to kind of just tug at me like, oh, I would love to do that, but I'm a crier and I'm very much an empath. And so because of that, I'm like, they're going to spend more time comforting me, watching their family die, right? Who wants to deal with comforting the nurse when the nurse is supposed to be there to comfort and support the family and the patient? And so I really felt like I would have done them a disservice. And so I kind of stayed away from it for a while and just kind of prayed about it and was just like, okay, if this is what's supposed to happen, then the door will open.
[08:51] Michelle: Wow. Again, talked to so many nurses that moved specialties and the reason why was like, I had a really good friend who said you would be a really good labor and delivery nurse or you would really love critical care, why don't you think about it? And I think that speaks really highly of our nurse colleagues because we know what it takes to do the job and for another nurse to recognize that in us is really valuable and touching. Absolutely. Yeah. Wow, that's really cool. Okay, so now you're a hospice nurse and what kind of patients are you seeing in hospice?
[09:42] Cydney: It's a wide array. So I do adult hospice and when I was a case manager, which is where I would have my own team of patients that I would care for, it can range anywhere from somebody even younger than me, like in their twenties and thirties. It's really hard to do whatever. And we see everything from what people basically talk about hospice, cancer or end-stage lung disease or end-stage heart disease, but then we see like, crazy diseases that I've never seen before, genetic things or chromosomal things. And everyone is so unique and different. And just because this person who's at end-stage lung disease doesn't mean that the next person I have at end-stage lung disease has that same journey. Everybody is completely different.
[10:36] Michelle: Like people, right, we're all unique and we all have our own stories. And I think that's a really good point. I think that's what I really loved about when I was an Admit nurse and I was going to deliveries, they were all different. Some women were screaming at the top of their lungs, some were super quiet and didn't make a peep. And just the reaction of the family and that whole dynamic. We like variety in nursing. Absolutely. I don't think we like to get bored. So, yeah, that is something that's really important to us. So some of their diagnoses you said cancer. That's a big one. Do you have like, end-stage renal disease?
[11:26] Cydney: Yes.
[11:26] Michelle: Okay. Where they're just entering hospice.
[11:29] Cydney: That's a hard one because that's one of the few where you can really give a clear picture of the time frame because that's the magic question. Everybody asks how long? And most of the time we have our little sayings of like, only God knows, or I can give you like days to week or weeks to month, but when it comes to end-stage renal, unfortunately, we can pretty much give you a much clear time frame.
[11:59] Michelle: Yeah, that's going to be very difficult. Well, let's talk about the differences between hospice and palliative care because I think a lot of laypeople and maybe a lot of medical people don't really know the differences. So talk about that for a moment.
[12:19] Cydney: So actually, even for myself, it can be challenging because depending on who's speaking towards palliative or hospice care, the definition, it's fluid, it's very bizarre. So palliative care, the way I understand it, is more of a selective treatment. So full care or full medical care is like all the bells and whistles I say. I explain to my families everything. You want it all. And then palliative is more of that selective. So you're not going to be as aggressive. Maybe you'll do like, some IV fluids or IV antibiotics, maybe some palliative radiation where it's just to shrink a tumor, but you're not doing aggressive things. And then hospice is where we just completely move away from the medical and we do symptom management for comfort and quality of life. So families struggle with like, well, what if they stop eating, what if they stop drinking? And so it's this turning away from they're not going to go back to the hospital, they're not going to go back to the doctor's office. And we try to phrase it as you're not losing things, you're actually gaining them because you're gaining quality of life and you're gaining this comfort. But it can be really difficult for people. But hospice is definitely looking it's a completely different shift from what people I've experienced look at, like medicine. Right. We're not treating to improve the disease processes anymore. We're treating to improve the quality of life for however long that is.
[14:01] Michelle: I think that's such a good definition and explanation. And I learned a lot just from what you said right now. That was an awesome description.
[14:13] Cydney: Awesome, I'm glad.
[14:13] Michelle: I'm still thinking about it. So let's talk about opening a case. They say, Cydney, we have a new case for you. What's involved in that?
[14:27] Cydney: So I'm actually in a role right now where I am the beginning part. I am the intake nurse at the hospice. So I get the phone call, the referral from the hospital or the community, and then it's running the insurance piece, just making sure. And then it's communicating with the family about what hospice looks like, what basic expectations are, and delivering appropriate equipment. We always try to get equipment out there prior to the patient's arrival if they're discharging from the hospital. It's so important to come from the hospital and have a hospital bed, if you're oxygen dependent, to come to the house and have the oxygen or suction or whatever the needs are. And we have such an amazing DME company. They're on ball with that. That's great. So once the patient arrives at the house, it's kind of like walking into that critical care situation or like that birthing situation. It's chaotic, right? Because you have emotions and questions and assumptions and sometimes symptom management. So really the admitting nurse is such a warrior, right? They're like balancing twelve different things at the same time. And our first goal is always in all of nursing is the patient. So I used to tell families, and still do, I'm going to get them tucked in first and then I always reassure them, I'm not going anywhere. Right. You don't have to worry. After this, I'm hitting the road. So I'll tell them, let me get them situated first and then once they're comfortable, then I can kind of get this family's attention again. Sure. So then it becomes, let's talk about the medicines. Because that is so overwhelming and there are so many assumptions with the medicines. People hear morphine or now you hear fentanyl. I can't tell you how many times it's like, well, I heard that in the news. And this I don't want to overdose. Yes. Oh, that's such a huge part of overdose. We come with like the pharmacy delivers this giant bag of meds and they're like our I call them in case of emergency, break glass meds. Right. Or like the visual.
[16:53] Michelle: Right.
[16:54] Cydney: So we put these all out. The majority of these meds they've never heard of. And I always break them up into pieces. Like this is for comfort. We try not to say pain management because pain is subjective, but comfort we can understand a little bit more across cultures. So I'll break it up into comfort management and then constipation, anxiety, and all the other pieces. And then we give them so much information and by the time we're done, I always tell them, I'm like, I know your eyes are full. I know it's above your head now. Right. But we are in your back pocket. The biggest benefit of hospice is we are 24/7, 02:00 in the morning, something goes awry, you have a question? This med isn't working. All you need to do is call us. We'll walk you through anything over the phone. We can also come out and make a visit. You're not going to wake us up. You're not bothering us. This is our job and just really leaving the family at the end of that conversation with just the reassurance that even if you didn't get anything we said today, just pick up the phone and call us. This is our joy. This is what we want to do to help support you. And we just recognize how overwhelming this is.
[18:17] Michelle: It is overwhelming. And they have to be ready to kind of accept in a way what you're telling them. You know, when you're having that conversation like you said, you can see they're like deer in the headlight.
[18:34] Cydney: Absolutely.
[18:35] Michelle: And they're just trying to process everything that you're saying. I can totally relate to that in terms of NICU and a new little 25-week coming in and the Neo is in there and the nurse and the respiratory therapist and we're trying to provide as much education as we can. This is the ventilator. This is why your baby needs this. This is the PICC line. And we see that for just days on end where they are just in shock and they need that time and for you guys to be so comforting. I like the verbiage that you used. I think the words that we use are so important and they can connotate so many different feelings. Just I'm going to get your father or whoever it is tucked in. That's comforting,  who doesn't want to be tucked in, right? And just the verbiage you use about the pain instead of pain management, comfort, those things really bring down the anxiety level that families are feeling. So that's amazing. You talked a little bit about pain management, but what meds, in particular, do you use really frequently? Would you say so?
[20:04] Cydney: I think our key players are oxycodone, morphine, and fentanyl. We don't on rare occasions do anything IV, and it typically is in our cancer patients that have ports.
[20:20] Michelle: Okay.
[20:21] Cydney: Every once in a blue moon we'll do like sub-Q infusions which that was really intimidating. The first time I saw that I didn't know that was a thing. And the needle is like a sub-Q needle. Like, think of insulin. It's super tiny, and it's just in the fat, in a fat area.
[20:40] Michelle: Does it look like, does the needle look like when you access the porticaths?
[20:46] Cydney: You know how they're, like, angled?
[20:48] Michelle: Yeah.
[20:48] Cydney: Yes.
[20:49] Michelle: Okay.
[20:49] Cydney: Yeah. So you really can't mess it up, right? They make it like, for no brainers, I think of, like, the Dummies book, right?
[20:59] Michelle: That's my style. Pain management for Dummies. Okay.
[21:03] Cydney: I wasn't in the bathroom with a YouTube video beforehand. That didn't happen at all.
[21:09] Michelle: Oh, my gosh.
[21:11] Cydney: But those are our key players, morphine, Fentanyl, and Oxycodone. And they all come with their own assumptions and biases and concerns.
[21:23] Michelle: Well, I told you that I interviewed Monty Anderson, and he's a pediatric hospice and palliative care complex care nurse. And we talked about all the misconceptions around pain medication, especially for kids like their parents, saying, well, I don't want him to get addicted to this, and Monty trying to explain this is the least of his problems, and talking about all that. But that has to be a lot of pushback until you actually explain everything and then are they better with it, coming to terms with it?
[22:06] Cydney: I would love to say, oh, yeah, 100%, but no, not at all. So I find the addiction one is a big one, and so we have conversations about you being addicted to a medication when you take it for the incorrect reason. So that's usually one of the things that I say to people, is, like, if you're taking this for pain or for shortness of breath and those are the symptoms you're having, then this isn't an addiction problem, this is needed. But I find, like, a lot of elderly people, they have the addiction mentality, and then they don't understand the quantity. So with hospice, I always tell them we're starting at the lowest possible dose. It's sublingual, it's liquid, and it dissolves under your tongue or in your cheek pocket. And showing them, it's like this super tiny syringe and they're getting this really moisture. It's nothing. And then a lot of times we try to give it to the patient in the beginning, and then we just sit. So we'll medicate the patient, and then we'll just sit with the patient, with the family, and just say, we're just going to see how it works with them. We're going to see if it gives them benefit. If they feel more comfortable, that tends to ease it a little bit better. Or we'll pre-fill a few syringes for them so they don't have to. Well, if I drop the wrong amount, am I going to you're not going to cause them to pass yes? The disease process and what's going on, or I tell them they're dying no matter what. You just get to be part of if they do it comfortably or not. And so when you empower somebody, that tends to spark, the light goes on a little bit and oh, I can help, because nobody wants their family member to suffer.
[24:07] Michelle: Right.
[24:08] Cydney: So when they realize, oh, I can help, and it's not like the movies and the TV and other things like, this is not Kevorkian, right? This is not like, this is not the way it is.
[24:19] Michelle: Yeah, but you have to spell that out 100 times just because there's so much anxiety around that and nobody wants to be responsible for giving pain medicine and then their loved one dying and feeling like, oh, my gosh, I did that. Monty explained really well in terms of what he called terminal agitation.
[24:42] Cydney: Oh, it's hard.
[24:43] Michelle: Yeah. And I wasn't familiar with that term, not being in your neck of the woods and talking about how when they get the agitation under control, many times the patient will pass, but it's not because of the medication. It's because they were able to come down from that agitation and be in a place of comfort and have what I have always referred to as a good death. Yes.
[25:15] Cydney: That's the goal. Right. A good death.
[25:18] Michelle: A good death.
[25:19] Cydney: Yeah.
[25:20] Michelle: Well, let's talk for a moment about patients and families and their misconceptions about hospice. Because being a nurse and being in a family of nurses and having you be the intake nurse for when my dad entered hospice for lung cancer. And just remembering back to that time of you sitting in our living room, so overwhelming, surrounded by nurses, and you were so calm and so kind and so loving and so patient, and we were so scared and sad and anxious. And we had a lot of our own misconceptions about hospice, and you were so good at clearing that up and so forever we'll be grateful to you for that. But talk about some of the misconceptions that families and patients have about entering hospice.
[26:36] Cydney: Sure. I think one of the big ones is this is not morphine and death. I hear that a lot. Like you're just going to drug them and then they're just going to lay there in bed till they die or they're going to starve to death. Or we have this idea of we don't eat, we don't drink, and we're going to die, so why wouldn't I want to feed my loved one and give them something to drink? And it's finding out where they're at. So nutrition is probably the biggest misconception, and it's trying to find a way to phrase it to where they can relate to it. So I say things like our body was designed in a specific way that as we want to grow and get stronger, our body tells us it's hungry and so we want to eat and drink to sustain us. When we get to the end of life, our body is again so beautifully designed and lets us know that we need something that we lose that desire to eat and we lose that desire to drink. And then our body starts to shut down. And I'll talk about I'll listen to their stomach and be like, see, now their bowel sounds, which for you and I make, they're more for them, it's quieter now. Things are starting to shut down. They're not making as much urine anymore, different things like that to kind of let them know that, see, they don't need that food and fluid. We also say if they want it, if they're asking, by all means, we'll never tell you you can leave the house. We don't know what you do. Right, but it's so important, especially culturally. There are some cultures that we can say it till we're blue in the face, but at the end of the day, they're going to do it. And that's how they love. At the end of the day, it's not for us to say that's wrong or how could you? It's how can I best support you through this? So it's the education and the availability of our team and then monitoring symptoms. But yeah, food is a huge issue and then just their brains around the medications and so and so was addicted to this medicine. Or I had a friend that took this or even I had somebody on hospice and this is what it looked like. And then trying to like we talked about earlier that everybody is different, every hospice experience. I personally had family on hospice and each one looked completely different.
[29:31] Michelle: And I imagine there's different teams and all of that too. One of the things that I really was impressed with, with the whole hospice situation was they came, I think it was a couple of days after my dad entered hospice that we realized that he was going to need a hospital bed and it was like it was there in hours.
[29:57] Cydney: Yes, for sure.
[29:59] Michelle: I was so impressed. I was like, wow, things don't even happen that fast in the hospital right now. Your team was just amazing with whatever we said we needed. It was just like boom, it's there. So that was really comforting.
[30:17] Cydney: Yeah, people really, I hear that a lot. They're like the bed's coming today, the oxygen is coming today. Because on different services, home health and different things like that, you're going through all these insurances and whenever but gratefully. We have our own DME company and so we just put in the order and then it's either that day or the next day. It's so nice to be able to tell the family it'll be there in 3 hours.
[30:44] Michelle: I don't know if you realize how I think you do, but just the anxiety. That patient that families go through all these details because they're trying to deal with their loved one dying. They're trying to come to terms with that. And then they're thinking about hospital beds and oxygen and medications. And many of them, our family of nurses, we had some uncomfortable moments, and we are health literate.
[31:18] Cydney: Right.
[31:19] Michelle: And I can just imagine families that have no frame of reference in the medical field at all and how much anxiety they would be feeling and how much your care and attention and information and education, just everything you do, it just brings it down a notch. And it brings it down another notch because you want the family also to experience their loved one having a good death. Yeah. So that's the goal. But talk about, do some patients actually graduate from hospice? Does that happen?
[32:02] Cydney: Absolutely.
[32:03] Michelle: Okay.
[32:04] Cydney: And sometimes it really throws people for a loop, right? Imagine they're like, wait, hold on, I was dying or so and so was dying yesterday. And now when you qualify for hospice, it's six months or less life expectancy. That's the basic definition. But depending on the disease process and what's going on, a lot of times with dementia, and Alzheimer's patients, have this up and down and up and down. And then sometimes there's just such an upward swoop for a while that it's like, okay, you don't really need our services right now, so we'll graduate them. And then with the conversation of if you start seeing more decline or you feel like you need our services again, just let us know. It's great when we admit a patient and we let them know. Our goal, of course, is a good death, but our goal is your comfort. And if you're doing great and you don't need us, that's totally fine too. Or if you want to pursue additional treatment and want to revoke hospice, it's a paper. It's not a big ordeal and waiting for certain things to be approved. It's literally sign here. Insurance is already reactivated for medical and go. But yeah, we see sometimes in cancer patients and sometimes in our, like, Alzheimer's dementia patients or even sometimes stroke patients, they may improve to the point of not really needing hospice or improving enough and feeling like maybe I do need that second opinion and go with our graces. We're happy for you.
[33:51] Michelle: You guys just make it so easy. You make it effortless, which is exactly what you need at that time in your life.
[34:00] Cydney: Absolutely.
[34:01] Michelle: You need something easy, automatic. Don't have to think about it. Let me just focus on my loved one. Yeah, that's such a blessing. One of the things that came up in your bio that caused me to kind of get very emotional was how you described hospice. And I just love it. You said that it's your heartbreaking joy. Can you talk about that?
[34:36] Cydney: Probably not without crying.
[34:39] Michelle: That's okay.
[34:45] Cydney: Well, I think a big part of it is because of my faith also. And so because I truly feel like God uses me in this area and I take it as such a privilege. This is like the most fragile parts of people, and I'm invited in and you build relationship. You get to know the families and the family dynamics. Oh, goodness. I get to sit on the floor with their dog, right? Like, we become part of their family. And so there's joy in the fact that I know every time I leave a situation, I've given them a bit of peace, a bit more understanding, a bit more empowerment, a bit more permission to feel. Grief is such a crazy thing that makes no sense. And I think that it's so easy to push past it because you have to take care of your loved one or take care of other family members, or you're still working or just taking care of your home or whatever the case may be that we don't give ourselves enough space and permission to grieve this. And it's like, it's okay. Grief is okay. It's part of the process. It's okay to be angry. It's okay to be angry at God. It's okay, or whatever is your higher power, right? It's okay to be angry at the disease. It's okay to say, I don't want my loved one to give up. And this feels like they're giving up. All these things are okay to feel, but then what are we going to do with it? So that's the joy that I get to come in and I get to just be invited into this really personal space and leave them better, I hope. But then the heartbreaking piece is that eventually, they do die. And I've had some really amazing relationships with people, and I've had to really find boundaries because a good portion of them become my family, at least for that time being on service. But it's like it was like my grandpa died, but he wasn't my grandpa. And I would feel all these emotions, and then it's like, who am I to be this attached to this person when you had, like, 30 years with them and I've had three weeks, and yes, I was in this really precious moment with you, but at the end of the day, they're your family. I just had the gift of being there for a short period, so it takes a piece of me each time, but I'm so grateful for just the overall experience and how God uses me in each of these moments. There's some really cool moments where we share the same faith and, oh, it's so powerful. And then there's moments where we never talk about faith, and it's equally powerful because it's just humans loving humans, and you're just made into more.
[38:22] Michelle: They are, absolutely. Yeah. And I love how you talked about grief. And our culture here in America is grief aversive. We don't want to have any part of it. It's like it doesn't happen. And for you to have the sensitivity and just the knowledge of the stages that they're going through is so important in helping them come to realize their own grief and that it is okay. And anger, like you said, people feel shameful for having those feelings. And for you to say as a nurse, it's okay, this is normal. To normalize these feelings and allow them in that short period of time to come to the realization of I'm not strange. All these things I'm feeling are normal. This is what I want from my loved one. That is so powerful. It's so powerful and anyone just can't do it. I feel like there are special people that that role is reserved for. And you're certainly one of them.
[39:56] Cydney: I feel like God gives us all in different ways. Right? Because I hear you talk about the NICU stuff and I'm like, oh, no, that scares me to death. Right? I was like, I would love three grumpy old men intubated on 1000 drips before one NICU baby, right? I think we're just gifted in different ways. And, like, I shared with you even before I'm an empath. I feel and I love to sit and listen. And I'm not good with small talk. I like the deeper stuff. So this niche hospice, if I'm allowed to get a little deeper with people and I can spend the time with them, that's such an awesome place to be.
[40:39] Michelle: Yeah. And I feel like people at that stage of their life when they're dying, they're the most authentic.
[40:49] Cydney: 100%, yeah.
[40:49] Michelle: It's like, I don't have to put up a front anymore. I can be myself. I don't care what you all think of me. And that's really a special place to be in with them as a nurse. I think nurses are all kind of I don't know if this is the right word. Like voyeurs in a way, of people watching. Yes, we very much enjoy that. We go to Disneyland and we're just, like, assessing it. Like, oh, yeah, Disneyland is great, but, oh, man, watching all these people, that's so much better. And I love how you say invited in, because you are. And they have to come to the point where they say, we need you. We want you. And that's different than being forced on someone. There's a whole different feeling. So I like how you delineated that when you lose a patient. Have you gone to their service or their funeral? How do you feel about that?
[42:02] Cydney: So I have in some of the patients when I was case managing a few of them that they became family, right? I did. And I knew the family and it was precious, but it was weird. It's very lonely.
[42:18] Michelle: Right?
[42:19] Cydney: It's not like I'm sitting there with my whole family and then I'm introduced as oh, this is so and so's hospice nurse. And they all go, oh, I need a hoodie that just says oh. Because that is the universal response when someone finds out I'm a hospice nurse. I'm like, It's not like that, I promise.
[42:40] Michelle: But I think that, oh, it's like you're this fluffy kitten that just makes you feel good. It's that kind of like oh, my gosh, like like you're an angel. I think that's where it would come from, at least for me, if I was like, oh, but that has to be special for the families and also for you to have that closure and to celebrate their loved one with them as being a part of their life for like you said, this period of time.
[43:18] Cydney: But it's hard also. I actually haven't gone to very many for me personally, and everybody's different, I have to have boundaries. And it sounds cold, but I think as a nurse, people would understand other nurses, right, that when they pass, my job is done. And there's another patient now. Yeah, it's hard because I love people and I'm a people person, and I want all the people and all the conversations and all this great thing. It takes a lot of energy, and it takes a lot out of us. But when they've passed, I've done my job, and now there's someone else. And so there has to be like, that detachment. And in the beginning, I didn't do that well, and I'm not sure I still do it well because I kind of went I swung to the other pendulum, and it's just like, okay, it's done. But I can't be in everybody's life forever, and it takes a lot. So it's about really good boundaries, and I'm still working on it, and some of them still they cross over those boundaries and just tug at your heart too much. And you're like, all of me, just take all of me, whatever you need. This is killing me, and I'm here for all of it.
[44:43] Michelle: Yeah. I love that you can recognize that in yourself, what you need, and be able to give it to yourself. It's so important for the work that we do. So we're going to take that as a segue into talking about some of the nursing specifics. And that was my first question, how do you protect yourself, guard yourself against compassion fatigue? You already talked about being an empath, which I feel many nurses are and we have to be really careful to keep those boundaries. And how do you do it? How do you protect yourself?
[45:23] Cydney: You don't get my personal cell phone, for one. I have a work phone, and when I'm off, I'm off. My phone is off. It's in the drawer. I'll come visit you on the weekend. I did that a couple of times in the beginning, and it's like, no, I need my space. I have a family. I have other things. So those boundaries, those were pretty quick to come up when they were crossed. Exercise is huge. I didn't realize what I was coming home with until well over a year into hospice, that I was just defeated, exhausted, and I would try to share with my family what I experienced, but none of them could relate. So I would call my mom, right? She's the nurse of the nurse. I would call her on my way home from work and just kind of decompress. But I would still find myself just exhausted and empty and defeated. And I joined a gym a while back and I'm trying to get back consistent with it again, but half of it is like high-intensity interval training. The other half of it is boxing. And I never knew how cathartic and fantastic boxing can be. And it's not anger, it's just all this stuff in me and just pounding this bag. And I've boxed and cried. I've boxed and laughed. But I leave every time, just like I left all of it there like, I'm so good right now. So that has been phenomenal for me.
[47:17] Michelle: I think we have to find outlets, whatever it is. When you were describing that, I could just see it. It was like just physically unblocking everything and just letting the emotions flow. And that has to be, like you said, so cathartic. And everyone has every nurse, every physician, anybody that's in medical care, they have all that pent-up stuff, whatever it is. And it's not always just with the patient. There are things behind the patient that you have to call this physician or you have to do this and just dealing with all those things too.
[48:03] Cydney: Yes.
[48:04] Michelle: And now your CEUs are due and now you take this course for comp fair.
[48:09] Cydney: And you need my fingerprints again.
[48:13] Michelle: And then just your life in general and your child sick and you and your husband are quarreling and life, you have to have an outlet. So I'm glad that you know what that is. For me, it's like I go into my craft room and I just create. I just make cards or I paint or I color, and it gets you in this different frame of mind that you need. So that's really good.
[48:47] Cydney: I also write that's a big thing I do. I write constantly.
[48:52] Michelle: Like journaling?
[48:54] Cydney: Yeah, I journal. Most of my stuff probably would be in a journal versus like social media posting and stuff like that. But just things that strike me, I'm always writing about because my brain is just constant and I got to find a way to get it out. And if I tried to get it out with conversation, you would be exhausted with me.
[49:14] Michelle: Yeah.
[49:15] Cydney: And I think it comes out better on paper because if there's just freedom, I don't have to think about it.
[49:20] Michelle: It just comes and then it's there and you can go back and reflect on it. And I'm a big fan of journaling. You can probably see down there. I have journals over the years and it is something that I'm not really good at, saying the things I need to say to people. I'm a people pleaser. But on paper, I can write it out and I can get it out.
[49:52] Cydney: Those real feelings.
[49:53] Michelle: Yes, very helpful. And I feel like every nurse should write a book, should journal what they're going through, and it would just be so valuable to the nursing community and just the community, in general, to just read what's on everybody's mind. Can you imagine?
[50:15] Cydney: Right. Or the things that you experience that happened? Yes. All the time. And you wouldn't think so, for sure.
[50:25] Michelle: Yeah, I love that. Well, hospice is not for everyone, as you so eloquently have shown us. You're an exceptional person. And what qualities do you think I would need as a nurse to really be effective as a hospice nurse? Any special qualities?
[50:48] Cydney: I think you have to be compassionate, right? You have to have empathy. You have to be critical thinking. Things can change very quickly. You have to know how to handle your stress. You have to in the moment. You have to not be afraid to say hard things. Death is a really scary word. And sometimes it's like they're declining and it's like, no, they're dying. I think more people can do it than they think they can. I think they just have to get their toe wet and realize because I think a lot of people, even in the nursing profession, have a lot of misconceptions as we talked about. But I really think that you have to just want to serve, truly just want to be there for them and be flexible. Oh, my gosh. I mean, nursing in general, you always have to be flexible because you're dealing with people, and people are people. But flexibility is so important, especially in the field, because you could be one on one with a patient, but then your phone rings with another patient or there's a benefit to hospice as it's one patient at a time, as opposed to floor nursing, where call lights and all these things. But in any given moment, one of your other patients could also need something. So it's a lot of, like, prioritizing and quick thinking and stuff. So a lot of the skills that all nurses have, you just have to have the compassion to just want to be there for whatever comes.
[52:42] Michelle: I like what you said about again, I go back to the words are important, and I have a tendency and I've realized this in myself, being a NICU nurse for a long time. When I talk to people, patients, and families, I use a lot of the big words because I like them.
[53:14] Cydney: Yeah. They sound cool, right?
[53:19] Michelle: Right, selfish, and not patient-centered. And it took me a while to realize as they're looking at me with these deer in the headlights, like, what the hell are you talking about?
[53:30] Cydney: They're googling it. And how do you spell that?
[53:33] Michelle: Yes. So then I did go to the other extreme where I just geared everything to like, a third grader, and somewhere in there, I found a happy medium. Because our patients are not third graders, many of them did read at a third-grade level and stuff like that, but many of them were right up there, and they could understand even some of the big words that I was talking about. But I think you just have to find what works and be very perceptive about how you're coming across and how you're being received. And if you're being received and you have to check for verification, tell me what you just understood about this conversation.  Because they could be on one page and you're on a total another page. Yeah. So that's a definite skill that nurses have and that we can hone.
[54:36] Cydney: There's this silly saying going around our office right now that someone said, and it was like, read the room. And we roll our eyes about it. Like, of course, we know how to read the room, but there's so much truth to it, right? Am I there for me, or am I here for you? So if I'm here for you, then my job is to make sure that you understand. And I'm leaving you with tools because it does me no good. I mean, you're going to keep calling me back anyways if you don't understand.
[55:06] Michelle: Exactly.
[55:07] Cydney: It does me no good if I just come off great. But you've comprehended zero. Yes. Right. So we have to read. Are you ready for this conversation? Yeah. What do you understand? A lot of times we'll start with what do you understand of what's going on? So then I have a baseline.
[55:26] Michelle: Yeah. Lots of parents looking at me with eyes like I'm dead inside. You're killing me.
[55:34] Cydney: Right. And they're so concerned with this little itty bitty one, and they're like, you're making no sense to me right now. I just need to know where they going to live.
[55:42] Michelle: Yeah. And being receptive to what you're teaching or trying to teach is so important because with your postpartum experience, you know, those first few hours after you have your baby, you're engrossed in that whole experience, as you should be. And you're not open to this nurse in your ear talking about something that's going to happen next week or next month.
[56:10] Cydney: Right.
[56:11] Michelle: You're like, I'm all about this baby right now, as you should be. So you have to pick when you want to talk about those kinds of things. Well, you touched on a little bit about critical thinking, and so one of my questions was in the field, do you have autonomy with your decision-making? Like, do you follow protocols? How does that work?
[56:33] Cydney: We have great autonomy, and I love that we have such a great trusting relationship with our physician. And of course, it's within clear boundaries. We do have protocols, but our physician is also available 24/7, so sometimes it takes a little bit longer for us to get a hold of him. So because of that, he and some of the nurses created this symptom management protocol as far as if the baseline isn't working and this is what they're exhibiting. Symptom-wise, move up this way. So with all of our comfort meds, so we have a little bit of freedom of telling the family, okay, if the five milligrams doesn't work, then we can go ahead and double that and do the ten. And we know that's a safe thing to do. We have such autonomy and that we're in your home, we're in the facility, and we do all this teaching that, yes, we have the basic knowledge, but we also have all this experience and so we get to impart these just different ways of dealing with things or giving them meds. Like, I never knew with sublingual meds, you rub the cheeks and all that stuff. So then I teach people that and that's so great. But we're out in the field, we're not on a hospital floor. Sometimes we have to get really creative. Foley comes out in the hospital, you go get another Foley from the room or whatever. Foley comes out in hospice and you're like, what do I got in my trunk? Did I grab an extra Foley? Do I have a syringe? Can I place this back in? Do they need it? Sometimes reception doesn't work very well, so we're not able to look up things depending on the environment that we're in. And so you have to get really creative and pull out your resources. So there are dressings. What do you have available that we can use in the meantime before I can get we're not looking at this wound needs to heal because your focus changes. So I'm not as freaked out about this going to cause an infection and all this kind of stuff. I'm like, how can we solve this problem right now? Yeah, and then I'll go back and figure it out later.
[58:59] Michelle: Yeah, you have to have that shift too, within you, because as nurses, we're always thinking about those things. Oh my gosh, an open wound, it's going to get infected. And it's just like thinking about those things in terms of he's going to get addicted to the medication. It's like, no, that's not a concern. But yeah, wow. Just when you said that, it was like, oh, yeah, you would have to shift. And if fully coming out, do they need it? Can we put chucks under them instead?
[59:34] Cydney: Or a diaper or whatever?
[59:38] Michelle: What resources do you use on a daily basis to help you in your job?
[59:43] Cydney: So we have a Medicare guideline, Flipbook, that is our hospice qualifying diagnoses, because not everything qualifies for hospice. So there are very specific things. And then within that Flipbook, we have certain symptoms, weight loss or confusion, just different things depending on the disease process. So that flipbook is gold. That is our gold standard. This is how we can when we communicate with the physician, this is the disease process. That's their primary diagnosis. These are the symptoms that they're exhibiting and this is what we want to admit them. Okay. It's kind of like that SBAR report, right? But it's our flipbook. It's how we communicate with the physician. So that all the time. I think the other thing is probably our pamphlet that's gone from my site that was written by a hospice nurse when she cared for a family member. And it's very simple language of what to expect. Generally over like a six-month decline. So you can start saying they're losing weight, they're sleeping more, these different things around this time frame. And then like maybe two weeks, you're an output appetite, just different things. And what I find is when we present that to the family and they read it that later on when we go out for a visit, they'll refer to it. Oh, yeah, because the book said that their urine output wouldn't be as much or the book said that their breathing was going to change, which is a great reference that they have. I always tell them it's good for the kids, too. Like younger, even like junior high and depending, elementary, depending. But it's just very basic language, but it just helps slightly prepare. We're always preparing them every assessment, but it's just this beautiful thing that they can keep with them. What did that nurse say? And they pull out the little pamphlet.
[01:01:45] Michelle: And those kinds of resources are great. Yeah. What disciplines do you work with?
[01:01:53] Cydney: So we have our hospice team. Every patient has a primary care nurse, the case manager. They have a social worker assigned to them. They're gold. Oh my gosh, they're amazing. Social workers in general. Like my hats off, like, I can't do that.
[01:02:10] Michelle: I agree.
[01:02:10] Cydney: I can't do it. They're amazing. And then we have our chaplain, and the chaplain is great because a lot of times people already have their religious preference or nothing at all. And so we're just able to say, this is just for resources and support that's nondenominational, and we can connect you with whatever religious preference or service you want. This is just to start the conversation and then that seems to be less intimidating.
[01:02:39] Michelle: Sure.
[01:02:40] Cydney: Yeah. And then we have our home health aide. So basically like a CNA in the hospital. But they're the best CNAs ever. They have tricks of the trade that I never knew as a CNA. And I'm like, that's amazing.
[01:02:59] Michelle: Where were you when I was a CNA?
[01:03:01] Cydney: Yes. That has been really helpful to turn that 300-pound person really needed that trick. Because in a home setting, you're not calling the lift team.
[01:03:11] Michelle: It's not a Hoyer lift.
[01:03:12] Cydney: Yeah, we do have those, but not very often. And then we have our pharmacy. And we're so fortunate that's a 24/7 pharmacy. So if we need a new Med or a refill in an emergent situation, pharmacists on-call can come in, couriers can come in, and everything is delivered. That's so huge for people. Everything is delivered to the home, to the facility. So we just have an amazing team. And then after the patient passes, or even before, because there's what we call anticipatory grief. So just preparing for the passing, we have our bereavement coordinator and he just has such a phenomenal role after everything. The hospice team has done their part, but he's so integral in that he's just that checkup that offers additional support and resources. And it's a range from the smallest of children to the elderly because we do grief camp for kids and that's powerful. I was fortunate enough to participate in this last year, and it's like five different art projects through half a day where they just get to kind of celebrate their VIP, their loved one, and then it's just kind of talking about and processing a little bit of the grief. But in this really cool, there are other people here feeling and experiencing this and they get to share about mom, dad, grandma, grandpa, brother, and sister. And then the last piece, which I thought was phenomenal, is they take chalk and they write their emotions on like the sidewalk and then we give them water balloons and they get to smash their emotions. That's like as grown-ups, like, we need more of that. So, yeah, our bereavement coordinator, he's awesome and does music therapy and all kinds of stuff. So we just have such an awesome team.
[01:05:18] Michelle: Yeah, you have such a well-rounded program, too. It's like you've thought of everything just from beginning to end and then after and that's amazing. What does your schedule look like and do you have to take call?
[01:05:36] Cydney: So the bummer, right? I was a floor nurse for a long time, so it was 3-12's. And we love three days a week and four days off with hospice nursing in order to be twenty-four, seven, five days a week. Yeah.
[01:05:53] Michelle: Thumbs down.
[01:05:54] Cydney: Yeah.
[01:05:54] Michelle: Did that for ten years.
[01:05:57] Cydney: Yeah. It is kind of a bummer just because I love those extra days off and then when you got to shove everything into the weekend and everyone else.
[01:06:07] Michelle: Is shoving everything into the weekend too.
[01:06:10] Cydney: Yeah. So that part is difficult, but doable. I still get home at a decent time? So 8-5 is not bad. And then, yes, there's call and then there's also weekends. So because we're 24/7, it means twenty-four, seven, and holidays. Oh, it's nursing. There's no such thing as a holiday. Like, let's be real. If you're patient care and we are a 24/7 thing, we all take our turns.
[01:06:43] Michelle: We've all had Christmas on December 22 before cafeteria Thanksgiving. Oh, man, that brings back memories. That's true.
[01:06:56] Cydney: We all take turns and do our part. And at the end of the day, if you got to move a holiday a day before or after, it's okay.
[01:07:05] Michelle: What would a typical, like, say you're on tonight for call? Could you get a lot of calls? Or could you get zero calls?
[01:07:15] Cydney: Yes. Okay. Yeah. So it's kind of like that. No whammies. No whammies.
[01:07:24] Michelle: Especially on call.
[01:07:26] Cydney: Because it's one thing if I'm working that shift and I have to be awake for those 12 hours because night shift and weekends is 12 hours.
[01:07:35] Michelle: Okay.
[01:07:36] Cydney: We split it that way. But during the week, Monday through Friday, it's 8-5. So if I'm on call, then I don't have to be in the office. I don't have to be in my scrubs, but I have to keep my phone with me, which kind of gives me anxiety, and I don't sleep well because I have those dreams that I miss the call, you know?
[01:07:55] Michelle: Yeah.
[01:07:56] Cydney: That freaks me out, but yeah, on call, it's its own little animal. But sometimes there's not a single call. Or maybe it's just calls that you can do where you don't have to make visits.
[01:08:10] Michelle: There is a call that they need you to come out there.
[01:08:13] Cydney: Yes.
[01:08:13] Michelle: Oh, God. And you got to get up at zero dark 30 to try to function.
[01:08:19] Cydney: Yes. Not wake up. My household scrubs are already in the bathroom. Everything's ready to go.
[01:08:24] Michelle: Yeah. You got to be organized. Well, all right. So we're getting ready to just wrap it up. And you've told me and our listeners like, so much information, and you've given us so much education and insight, and I'm like, man, I think I want to be a hospice nurse, so what can I do right now if I want to do that?
[01:08:51] Cydney: I would really encourage you to shadow a hospice nurse. I think that's the best way to dip your toe in. You can read things. Absolutely. I think there are other podcasts and Instagram. I think there's, like, a hospice nurse, Julie, I used to follow on Instagram, and she kind of gives, like, little videos and snippets and kind of talks about the things that we did. But I think the best way, because I'm a hands-on learner and I feel like most nurses are sure, is to shadow.
[01:09:23] Michelle: Okay.
[01:09:24] Cydney: Yeah. It's just to follow a nurse for a day and get to experience the ins and outs of an admission or just regular patient care, just so you can kind of get a feel for what it looks like. Because not every day is an emotional roller coaster.
[01:09:40] Michelle: Right. And I think that's the misconception is like, every day is someone's dying and there's crying, and you've shown us that it's not like that. And that's a great gift that you've given us. Thank you.
[01:09:58] Cydney: Thank you.
[01:09:59] Michelle: Yeah. I really appreciate you being here today. You know, at the end, we do the five-minute snippet.
[01:10:06] Cydney: Yes. Been nervous about this one.
[01:10:08] Michelle: It's so much fun. Cydney, you're going to have so much fun.
Best advice your mom has given you.
[01:10:20] Cydney: Oh, my gosh.
[01:10:22] Michelle: And they're hard. Yeah.
[01:10:26] Cydney: She's always giving me advice, but not like, you need to do this. More like just her life experiences. Man, I feel so bad.
[01:10:36] Michelle: Can you pick one thing?
[01:10:43] Cydney: I love my mom. She's my best friend.
[01:10:46] Michelle: Your mom is amazing. She's a rather amazing nurse, right?
[01:10:50] Cydney: You should have her on this. Oh, my gosh. You have to filter her so much. I need a retired nurse, right? There you go. There you go.
[01:10:57] Michelle: I'd have to filter her.
[01:10:58] Cydney: You would so have to filter her.
[01:11:01] Michelle: Okay, my least favorite and most favorite nursing task. What do you hate doing and what do you love doing?
[01:11:12] Cydney: Okay, so why, when you said my least favorite, did I think about disempacting?
[01:11:18] Michelle: That's probably everybody's least favorite.
[01:11:22] Cydney: You do that in hospice! You do that occasionally. Occasionally in hospice. My favorite nursing task. Man, I used to love putting in IVs. I miss that. In a hospice, we don't do that. And I used to love that. That was so much fun.
[01:11:41] Michelle: Bing stick that thing.
[01:11:43] Cydney: It's very instantly rewarding.
[01:11:45] Michelle: Instant gratification. Yes. Favorite beach activity?
[01:11:49] Cydney: Beach activity. Honestly, I just love with my feet in the sand and looking at the water or taking walks. Love the beach. The beach is, like, my favorite place. It makes me so happy. Even just when you drive over to Pismo, you get that first glimpse.
[01:12:07] Michelle: Stress level, down.
[01:12:08] Cydney: Yes.
[01:12:09] Michelle: Immediately.
[01:12:10] Cydney: My husband even knows. He's like, babe, look. And I'm like.
[01:12:16] Michelle: It's great. Strangest thing you've seen in the middle of the road.
[01:12:23] Cydney: I think. Just dead animals like roadkill. Yeah, just disgusting. Roadkill absolutely.
[01:12:31] Michelle: The main quality that makes you a great grandparent.
[01:12:40] Cydney: Creativity. Yeah. I don't want to sit and watch TV, right? So let's just go for a walk.
[01:12:49] Michelle: Go out.
[01:12:49] Cydney: Yeah, let's be outside, I think, yeah.
[01:12:51] Michelle: A big nature hike.
[01:12:53] Cydney: We haven't done that yet. I took one of my grandsons I got to take to the zoo a while back. Just him, I, and my other son, and it was so much fun.
[01:13:03] Michelle: Magical. Yeah, I love that. What do you think people complain too much about?
[01:13:12] Cydney: Being tired.
[01:13:14] Michelle: Wow, that's true. I didn't even think of that because we complain about it so much. It's like, not even yeah.
[01:13:22] Cydney: Just being exhausted all the time.
[01:13:24] Michelle: I'm just tired. What do you keep on your desk or in your workspace that just boosts your mood? Every time.
[01:13:37] Cydney: Man. So I just recently inherited this desk space, so a friend of mine gave me a little plaque from Marshalls, and gosh, I can't remember exactly what it says, but it's something about nurses do things from the heart, and it was just, like, really sweet.
[01:13:57] Michelle: I'm feeling it.
[01:13:59] Cydney: I was like, oh, okay. That makes me feel good.
[01:14:02] Michelle: That would boost my mood.
[01:14:04] Cydney: Yeah.
[01:14:04] Michelle: Number one thing on your bucket list.
[01:14:10] Cydney: Oh, I want to go to Australia and go to the Great Barrier Reef, and I want to swim with sharks, like, in a cage. I'm obsessed with sharks. I love all things sharks.
[01:14:22] Michelle: Yeah, I do too. I'm not scared of them at all.
[01:14:24] Cydney: No. I had an opportunity to swim with sharks once before. They were like the black-tip reef sharks, and I was like a small child on Christmas morning. I was just like, the whole time is amazing.
[01:14:37] Michelle: Oh, my gosh. What is a surefire way to grab your attention? 22 seconds.
[01:14:45] Cydney: Grab my attention?
[01:14:47] Michelle: What is just going to make you turn and you got my attention?
[01:14:52] Cydney: If you quote movies that I know. If we can connect with a movie like Steel Magnolias or Deadpool Society, whatever, anything like that. If you start talking movies, I'll just be like, oh, we're best friends, and we can talk movies.
[01:15:09] Michelle: Oh, my God. I love that. That's great. I'm horrible at quoting any kind of movies. Yeah. I remember in the moment, and then five minutes later, I forget about it, but I know it was either funny or touching or scary, but I don't remember what they said. I can't quote it at all. Was that fun or not?
[01:15:31] Cydney: That was fun. It's still a little nerve-wracking, right? I see you are still a little nervous.
[01:15:36] Michelle: Yeah.
[01:15:36] Cydney: But no, it was cool.
[01:15:38] Michelle: Yeah, they're thought provoking, and they're not something that's always just on the tip of your tongue, you've got to dig a little bit, but you did well. You had your coffee this morning. Thank you so much for being here.
[01:15:53] Cydney: Thank you. I really appreciate it.
[01:15:55] Michelle: It has been really a joy.
[01:15:57] Cydney: Oh, thank you.
[01:15:59] Michelle: You enjoy the rest of your Saturday.
[01:16:02] Cydney: You too.
[01:16:02] Michelle: Thank you.