 I'm Jay Fiedel, this is ThinkDev, we're covering coronavirus as much as we can. We wanna do our part in the community understanding of what's going on. And we are actually covering it pretty well. We probably have 65 shows already about coronavirus and we're having more all the time from various parts of the community. And today the part of the community we're talking to is Larry Grimm. He's a hospice worker, a rehabilitation worker and he's gonna talk to us about the most vulnerable members of our community, that is the Gopuna. And of course this is Aging with Grace, which is the name of the show Larry does, has done with us from time to time. Welcome back Larry, it's nice to see your smiling face to the extent that I can see it under the mask, yeah? Tell us about the mask. So this is a paper mask, this is a simple mask and it used to be available right now. These are provided by my Bristol hospice and we use them when we go into facilities and it says one thing, it's me from aerosol, sending aerosols out to other people when I talk or sneeze or if I cough and that's very important to keep in front of a capuna. It also protects me from aerosols coming in into my face if someone sneezes or coughs at me but also the third thing it does is it says to the facility and to the patients and family that I have a consciousness, what's going on? And I have a console people that I relate to. I'm at home alone right now so I'm going to unveil myself and don't touch your face. Well, yeah, don't touch your face with or without it. So yeah, you're a minister also and there have been some interesting pieces in the paper about prayer, about religious organizations getting together to pray and this is grouping and I guess it depends on exactly how you organize the group and how you pray but it's been a source of contagion and I wonder if you have any thoughts about that? The power of prayer, it works alone individually but it also works in groups may not be the best way to go lately. You got any thoughts about that? Yes, I'm a Presbyterian minister and I'm working as a chaplain. Spiritual care provides a lot of hospice and some of them go through their end-of-life process and martial all the spiritual resources they have. Sometimes those spiritual resources are communities and churches that are praying for them and people who care about them. And this time right now I am very upset about churches and congregations and gather people who gather intimately in a prayer group and violate the social distancing. It is to me, it's akin to the snake handlers, you know, the snake handlers who say, oh yeah, the Bible says we can handle snakes. So let's get a few snakes out and throw them around. Yeah, they're venomous that they won't bite because God will protect me. Well, God didn't give me a mind and give us minds and capable analytical capabilities in order to abandon them and throw them away and call that faith. I disagree with that totally. So yeah, I'm very upset about Liberty University that called students back in to close contact and other churches that are violating this very wise mandate to keep a distance. Okay, let's talk about hospices, the rehabilitations. Let's talk about how life has changed for you as a hospice worker and for the patients in a hospice. There must be some significant changes going on because of the vulnerability of the people in the hospice or the rehabilitation hospital. Yeah, there very much is. In terms of facilities, Jay, the facilities are taking a strong positive policy and practice of some of them barring visitors totally, not even family members are allowed in. And some of them bar our hospice care except for our minister, except for the nurses and the healthcare assistants in order to make sure that the number of contacts are limited. And I think that's again, a very wise thing to do. It's one of the family members because family members may come and from long distance wanna be in contact but can't do that. But that's really precisely the issue. And as 14 day quarantine is on people who arrive on the islands that Governor Igay has put in place, as hard as that is, it's so wise because we don't know who they have been in contact with back at home in Washington or in California or in China or in Asian countries in South Korea. And when they come, they can possibly bring the virus with them and they get around grandma who's dying and they wanna hug her and they wanna hold her and embrace her in their family love and they can impart the virus to them. And before we know it, the virus has left from that person onto a healthcare worker or onto another friend who comes to visit and or onto a chaplain who's sitting by. One of the experiences I had, Jay was with a, one of my Japanese background just there. She has family that travel back and forth in Japan. And she and I usually have no conversation because she doesn't speak. But I sit with her and she looks at me and I look at her and meditate together. Well, I was sitting with her the other day and all of a sudden she sneezed. And I was six feet away, fortunately, but she just let out a huge sneeze, totally unexpected. And it wasn't like she usually sneezes when I go to visit. So I wasn't anticipating that. But in that sneeze, I didn't know what could have been in that sneeze. And I ended the visit immediately, but it was just a kind of microcosm of what healthcare workers face all the time, not knowing what all could be present in that sneeze. So that's part of the care for the healthcare workers and for the community. And I think it's really important. So that's one of the ways in which things have changed dramatically. The other part of that, of course, Jay, is protecting the patient themselves because they are very vulnerable, very vulnerable to the COVID-19. And our purpose in hospitals care, our purpose in all of the facilities, also the care for them, is to make their life comfortable. That's palliative care. To make it comfortable, peaceful, an end that will be better for works as pleasant as this can be. And if we allow someone to come in with COVID-19 and with the patient who is so vulnerable and the patient is bound to have a horrible ending, if it takes root, which it likely will, can I bring up that sheet, Jay? Yeah, let's look at your sheet. Larry's made a sheet of questions for visitors and empowering Kupuna, very important. So Larry, why don't you go through the points on the sheet? I think it's very important you do that. I'd like to thank you, Jay. Well, first of all, my interest here is enabling Kupuna to be empowered. So if you're at home, for instance, and you're in the vulnerable age group, whatever it is, or if you're in the vulnerable situation, as we'll define it a little bit here, you can be able, you have a reason to ask these questions of people. Now, these are the questions that I get asked, Jay. You ask change for us. When I go in to visit somebody, I get my temperature taken, usually. And I was 98.5 this morning, get my temperature taken, and then I am asked these questions. And I think they're questions that anybody can ask of a visitor who comes. Show those back up again, Eric, which please. So who's vulnerable? Well, everybody in a way. One said, I think it was Dr. The physician on the task course said, everybody's vulnerable. This is a novel virus, which means that there is no herd immunity. There's no shared immunity. So everyone in the world is vulnerable. There is no immunity in any human being. Secondly, those who are over 60, they also have certain vulnerability because our bodily function, the end of dwindles sometimes. Also, those who have any kind of respiratory illness, they are vulnerable because this virus attaches the throat and then moves down into the lungs. And one person has had COVID-19 was talking about it on Facebook. Yesterday. And he said, this thing turns your lungs to glass. I mean, that's a lung turning to glass. It's just a horrible image, Jay. Excuse me. So anybody who has those possibilities, those vulnerabilities has a right to ask questions of people coming into their space. And certainly that's what the facilities do to protect the patient. So the question is, let's see, have you been in contact? Have you traveled anywhere? Have you traveled outside of the country to any place? And we changed it here to, have you left the island? Have you even traveled to the mainland? And in the past 14 days, because 14 days is an incubation period, is that the first one? Have you or someone you know? Yeah. And the last 14 days. So if the answer is, if the answer to any of these four main questions is yes, and it's a good reason to say, hey, not now, come back. So this is not theoretical. What you're reading, this is not theoretical to see. You're actually doing this and acting on it, am I right? That's exactly right. That's exactly right. So, and then the next set of questions has to do with your health of the visitor. What's your temperature? I'm a, who are at home, get a thermometer that you can put up to the forehead and brush around the forehead. Take the temperature of anybody who comes to your home who wants to talk with you and have a mask available if you want, if you're able. The N95 masks are just for the health care providers. They shut out in a percent of all incoming virus and such. So you ask about the temperature, you have a headache, that's another indicator. What's the third one there? What's that third one? I mean, you have reading difficulties. All these show up again and again as we're hearing people talk about being in the realm, being assessed as havers. It's a predictable manifestation. It shows up in the temperature, it shows up in breathing, it shows up in coughing, it shows up in headaches, it shows up in not sleeping well. And so if anybody's coming around my kupuna, and I want my kupuna to say, test this out with them. Don't let them come in to your space without knowing positive answers about this or negative answers about this, actually. Yes, yes. Well, so I think that could be able to, so are those all the questions now? Yeah. Suppose one of your kupuna starts experiencing these symptoms. I hope it hasn't happened yet, but suppose it does happen, it's possible certainly in these times. What's your plan? What are you gonna do? Well, that's a good question. And we have one, one of our patients as I understand it today has one, has signs of this. At that point, that's really when the local facility picks well to help them get through it as if they're able to get through it. But... Are you gonna be equipped? Are you gonna be equipped to take care of a sick kupuna who has the virus? Or do you have to refer that person out? Or should you refer that person out? Because you have the possibility of contagion to health workers who may not be as well prepared as in a hospital and to other kupuna who are gonna be, as we have said, very vulnerable. What do you do? We're going to do what we can inside the facility to make the process as easy as it can be and as caring as we can. I'm suspecting that just all of the pattern that everything is, which is have a respirator, have a protective gear, PPPE, we call it, which is the personal protective equipment, which is gown, gloves, face mask. There are some face masks that are shielded across the whole face that are highly protected at that point for people who are close by. And there may be some who in the caring and in our hospice care who say, yeah, I'm not sure if I can do this. I don't wanna be that close to it. And they may back away. Well, that's a risk that all health care workers have and the question is whether it's a risk they undertook when they got in the job and in the situation or whether it's a surprise. And I would imagine that in hospice or rehabilitation hospital circumstances environment, they would be a surprise for them. One of the interesting things in the mayor's conference here an hour ago was Susan Ballard, the chief of police got up and told us that the police were hyperactive and they were giving these citations, people who they thought were breaking the lockdown rules. But also she said that the police are very busy. They're like the first line of action when somebody feels that somebody in the household or in your case in the hospice or the rehabilitation in the hospital has got the disease and they can't manage it. They don't have the PPE, they don't have a ventilator, they don't have staff who's able and willing to take care of this, but it's really not their cup of tea at all. And this individual, this patient has to go to the hospital. So who do they call? I really hadn't thought about this. Who do they call? What are you gonna do? Yeah, you can call your doctor. And I suppose you guys at the hospice have a doctor right there or at least available to you. But what Ballard said was that they call more often than not 911. And the police respond and the police call the ambulance and the police arranged for this patient to be taken into a facility which is gonna be able to treat the person and also which is safer for the community. I find that interesting because I don't think a lot of people have actually thought that through. What do you do when you finally conclude that somebody's got all these symptoms and there's no other conclusion to make? What do they do? Well, maybe one thing to do is just call 911. We still do have hospital facilities here. Yeah, another thing that can be done, Jay, is they can call, first call their PCP, their personal care provider and say to the PCP, this is what's going on. And then you know my history. What do you think I should do? And the PCP will help make some judgment as to whether or not it's severe enough at this time to go in for critical care. And I think the important thing there is that as they talk about flattening the curve, trying to make it so that we don't get overwhelmed, the system doesn't get overwhelmed with all kinds of symptoms. False alarms. Well, false alarms are early on in the stage of development that might be okay later on. Some people might develop an immunity to it and be able to recover very well and much more quickly. But if everybody who gets a sneeze goes to the emergency room, then we're in trouble with being able to support them. Those who are really far along. Yeah. Well, I'm just wondering how it's gonna work going forward. This is gonna be more contagious or at least more people are gonna catch the contagion and people are gonna be more concerned about it. And you run the risk that the hospitals won't be able to handle the intake either by personnel or equipment. And you guys will be tremendously burdened because whatever risk you perceive now today, it'll be worse, not only in the de facto level of risk, but in the fear, the level of concern about the risk. So, and very troublesome as a family. Yeah, yeah. Well, everything is dynamic, isn't it? Everything changes, especially this. So we don't know where it's gonna change to. So you're in a very interesting. Yeah, well, that's another level. That's another issue, Jay, of the anxiety levels. When do we get most anxious? We get most anxious when we can't predict the future. And this is becoming more and more difficult to predict. And as much information as we gather together, it still seems to be feeding the anxiety level. So, and I can feel it, it's an intuitive thing. But when I go into a facility, I feel that anxiety level rising in the staff and how uncomfortable that is for them to live with that anxiety all day long. And yet the best thing for them is, as I see it, is to do the steps that we've done, outlined that are capable of helping us to determine what the virus is doing. Yeah, but one of the things you do, Larry, is you communicate with the patients. And that is, that's an art form of all in itself. People are already under stress. They're obviously worried about what the future is for them. And they're trying to make peace with life in general. And so you have to be very nuanced about how you talk to them about this, about what you say to them. You are the source of information. It's like, you know, I was telling you that my wife took this survey by the National Preparedness Disaster Preparedness Training Center, which will be circulated now. In fact, Think Tech has circulated it. One of the organizations circulating it. And one of the questions is, what else do you recommend? So she said, you know, I don't understand how the people in this community in Hawaii don't speak English or getting their information. They may not be getting information like everyone else because they don't speak English. You don't watch television all day, but if you can't speak English, you know, it doesn't help you much. And in a funny way, it's the same thing in a hospice or rehabilitation center. You know, people are beyond the ordinary streams of information. You Larry and your coworkers, you are their, you know, their information provider. So how do you see that? What do you do about it? What kind of message do you give them? What do you want them to understand and know about? Well, I think the first thing is the limitations on what we know that we don't know everything about it. The second thing is that things are being done to figure it all out and how to best position ourselves for health and well-being in this setting right now. Third is that the virus, as I do when it's external, is really very vulnerable. So these precautions that we're talking about, washing hands, making sure you don't touch your face, being cleaning surfaces all over and keeping those clean, all those precautions, although they're not elaborate, they're very simple, but because the virus is not that healthy, I mean, that strong, it can be, we can, those are good means of protection. These standard procedures, well, let me, let me back up and then my wife was a dental hygienist, is a dental hygienist. And when we, when the HIV came around, she was treating HIV patients. And I said, what do you do? And she said, well, the virus is vulnerable. And after every patient, I do the same alcohol cleansing of my operatory, the whole operatory. And I make sure that I cover every space, every surface. And that's a standard procedure. Of course, she wore a sure mask and she wore gloves and those other barriers between skin and her body and the externals. So I think I would bring some sense of reassurance to Jay that the standard procedures that we have, when practiced and done faithfully and continuously and routinely, they are very protective. Making sure that the surfaces are clean, making sure hands are washed, making sure faces are clean and making sure that we don't expose ourselves unduly. Can I show you? A hypothetical, a hypothetical, Larry. So now you have a patient, patients in the hospice. The patient doesn't have a long time to live. The patient has other issues that are, that are going to be fatal. And somehow the virus gets to that patient. And now we have shortness of breath. We have, you know, a fever. We have an inability to breathe properly, all that. And, you know, all of the touchstones you mentioned are met or at least a number of them are. And any rational person now knowing what we know would conclude, you know, that this is pretty sure this is going to be the virus. And given the fact that this individual is vulnerable, very vulnerable to start with, you know, now we're going to have to, you know, take him to a hospital for her and let them try to save him. But knowing, of course, that you put somebody in a ventilator, this is the national statistic. And about half the people who go in ventilators don't come off ventilators. That's it for that. And for the people you're talking about in the hospital rehabilitation hospital, it's not likely they're going to survive. So you're a hospice worker. You're a kind and gentle man. You're a man who is tremendously empathetic. That's the nature of your life on the planet. What do you say to this patient who's already, you know, in the last chapter? What do you say when you come to the conclusion that this person has the virus and we'll not be able to see his or her family again? What do you say? What do you say? Yeah, yeah. Well, first of all, I want to know how you feel about it. How are you feeling about this disease? What's going on in your own soul about this? How much aware of it? What are you aware of? Are you aware that this is evidence of COVID and does that, I mean, I wouldn't even mention the disease. I would just wonder if they know about it. How much they know and how much they don't know. And then move from there. The feelings of loss begin to set in. It's what's called anticipatory grief, of course. And the patient can then begin to grieve intensely about not being able to see the family, about not being able to recover. And that anticipatory grief is expressed in many ways. Some people press it down, of course. They don't want to bring it out. So my challenge then is, do I try to suggest things that would open that up and say, have you thought about this as bringing you closer to the end of your life? Have you thought about what that means for you and how does that touch you emotionally to think that you might not be able to, to see your family again? So those are the kinds of things that I began to explore, Jay, and try to do it gently. There's always, everyone has a right to deny what's going on in their lives, you know? And so we'll find a lot of denial of people who say, I just don't want to deal with it. Maybe if I can deny it, it'll go away. There's a certain kind of bargaining that sets in. Elizabeth Kugler-Ross has five stages of dying and become evident. And sometimes they can move through those in very quick manner. But to be, to listen to that, what are they gonna discover as they share with the hospice worker what's going on? And it may not be me, it may be the CNA who comes in, cleans their diaper, changes their diaper, cleans that we listen with that kind of compassion so that we're companion rather than trying to teach something else. Yeah, yeah, it's the person who holds hands. Although it's hard to hold anybody's hand with this contagion. The last question I want to ask you, Larry, which is something that has just occurred to me is that you deal with people who are dying all the time, then that's your place in life these days. And then in fact, you're a minister that is part of it. And up till now, up till January, February of 2020, it's been a certain ball of wax for you doing this. Okay, now the ball of wax has changed. Now there's another element in the calculus here that you have another risk that changes it and something you have to watch for, something you have to protect yourself against and something that will be really final as soon as the diagnosis is done because this person really can engage with anybody in the same way, no matter what his or her condition is in the last chapter, it's changed. And my question is, how has it changed for you? You start out empathetic and now you're in this tremendous risk zone and wow, how has it changed for you? Well, it sounds selfish perhaps, but I certainly do want to protect myself because I'm in that Kupuna area. I'm in that vulnerable zone myself. I've had some respiratory issues. I've had my share of those and I have also, of course, I'm 70 one year down next month and children I call them, they call me now because I've introduced them to that beautiful word. So I'm very conscious. I don't, I have to be very conscious of those things that I've described already that are preventing. And so that's the first thing. The second thing for me is that the dying process for my patients may be tremendously sped up, accelerated tremendously if they get this virus because it doesn't last long. It just, if it peaks quickly, it takes, it seems to take them past. So I can be a help to the family at that point. That's probably more important focus than the patient themselves. Am I making sense? Yeah, and a funny way it makes you all the more important. It makes you a part of the process and it makes you, it makes you revisit your whole role here because the stakes have changed. Larry Grimm, Hospice Worker of Parks allows extraordinaire. Thank you so much for joining us here on Aging in Grimm. Very well. This is one hell of a time we live in. Thank you, Larry.