Caitlin Whyte (Host): Welcome to In Their Words, a podcast from the UPMC Pinnacle Foundation and UPMC in Central PA, where we share the personal stories behind healthcare and the people whose lives have been touched by it.

For many people, palliative care is something they don't fully understand until they need it. But behind every diagnosis and every difficult decision is a team dedicated to providing comfort, compassion, and dignity for both patients and their families.

In this episode, you'll hear from Angela Miller, a lead LPN at UPMC with more than four decades of nursing experience. After spending her career caring for others, Angela found herself on the other side of healthcare as her father faced advanced heart failure. She shares how her family's experience with the palliative care team changed the way she views end-of-life care, the extraordinary compassion showed by the caregivers who walked beside them, and why those final days became filled not only with grief, but with peace, gratitude, and love.

Angela Miller: So, my name is Angela Miller. I am a lead LPN. And I have technically been with the organization for five years, although I came over with a group. So, I mean, I've been a nurse since I was 18, and I'm 60, so it's been quite a while. But I've been with UPMC for about five years.

I guess I have to rewind all the whole way back to when I was seven. I had actually six, I had open heart surgery, which doesn't sound like a big deal nowadays. But back at the time in 1971 when I had it, there wasn't a whole lot of six-year-olds who were undergoing open heart surgery. And I think that whole experience and the exposure to the medical world really just kind of embedded that seed within me.

And I had talked about it a couple times in school, and approaching my junior year in high school, senior year, the guidance counselor asked me what my plans were, what I wanted to do when I graduated as far as a career. And I said I wanted to be a nurse. And her response to me was "I think you would be academically better suited to be a secretary. I don't think you have the strengths to become a nurse academically." And I just kind of said, "Okay. Well, thanks for your opinion, but that's what I want to do." So, I went and interviewed at LPN school, which no longer is in existence. It was Harrisburg Steelton Highspire Technical School of Practical Nursing in Harrisburg. And the head of the school came out to my mom and said, "This girl is exactly the type of person that nursing needs." And I did have to work hard for it. And there's nothing wrong with having to work hard for something.

And I did take a break because shortly after starting the program, my grandfather on my mom's side, who was much like a father figure to me was diagnosed with pancreatic cancer. And emotionally, I just wasn't ready to handle all of that and try to do nursing school as well, so I took a break and spent that time with him and got a job, a part-time job and saved up so I could pay my tuition back. And the day before he passed, he was not verbally responsive at all, but we each had moments that we could spend time with him to say goodbye. And while I was with him, I took his hand and said how much I loved him and that I was going to go back to nursing school and make him proud and be the best nurse I could be in honor of him, and he squeezed my hand. And the next day, he passed away.

And all that money that I had saved up working part-time, I had to repay my tuition. And my parents, you know, they were very supportive, but they were like, "If you're going to take this break, you're going to need to pay the tuition that goes to the next program." So, I did that and I graduated and have been a nurse since I was 18.

And actually in my office during COVID I developed a relationship through TikTok of all things with another nurse in North Carolina, and she was a fantastic painter and her thing was to document stories about nurses, how you became a nurse, tell you a little bit about the background. And then, I shared with her and she asked if she could commission, if I would be interested in commissioning her to paint a painting of my portrait. And I said, "Well, sure." She said, "I just want to document," you know, and of course we had our mask on, you know, it was all that premise of COVID. And she said, "Do you have a picture of your grandfather?" And I was like, "I'm not sure why you're asking, but yeah, I can send you a picture." And I couldn't see it until she was finished and she sent it to me. But when I opened it up, it's a picture of me but in the background very subtly, and most people don't notice it until I point it out to them, is my grandfather's profile looking over my shoulder. It's a testimony to so many things.

And I actually had it done at Harrisburg. And it was Saperstein and Travisano who are no longer practicing. I don't even think they're around alive anymore. But they were the ones who did my surgery. It was something that they knew I had when I was born, and they kept wanting to just stretch it as much as they could because they didn't want to do surgery, open heart surgery on a child. You know, just keep stretching it.

So at age six, it was finally like, "We need to do this." And even that experience, like I said, I don't have a lot of memories, but some of the memories I have are kind of funny. Like, remember there was an African American girl that was going through open heart surgery at the same timeline. And her and I would constantly be in the hospital at the same time getting our heart caths. and I would recognize her right away, and we became pals. And I wish I would have kept her name because I would love to follow up and see where she's at nowadays, but I did not. But I remember when she had her surgery, she ended up having to have a pacemaker in. So, I pushed her out in a wheelchair out to the nurse's station at night so we could get ice cream.

So I think, a lot of nurses and healthcare providers, the basis of us is that we're just driven to help people. They come to you at the most vulnerable of times. And especially now, I mean, healthcare has changed.

It's become a different animal, so to speak. And it's important to have that advocate. And nursing is much bigger. And when I say nursing, I'm not just meaning an RN or an LPN. I'm talking about all of healthcare. I look at us as all an intricate team.It is not just one person. It is us as a team coming together to help that patient. And it's very humbling, and it's very satisfying to know that you can help someone who is scared or unsure, and you can give them that reassurance of, like, "I've got you. And you really do. You give every patient 110%. And it's satisfying to see them go through the entire process. And even if the end of the process isn't the result that you wanted, that you have given them what they needed at the moment they needed it. And I think that sums up what we do and why we do it. It's just a caring for humanity.

To tell the story, you know, my dad was a mechanic by trade. He was a manager. He was the guy that everybody brought their vehicles to to say, "Hey, can you listen to it and tell me what's going on with it?" And he took a lot of pride in just being able to do that. And he had a very significant family history of heart disease. He had lost two brothers before the age of 50 to massive heart attacks. His mother had passed before the age of 50 to a massive heart attack. So, there was a lot of heart disease in the family. And at age 50, he was experiencing some chest pain, so they did a heart cath and found incidentally a widow-maker or a left main blockage. So, he had that repaired, but he struggled a lot cardiac-wise, his heart health. We used to call him the bionic man. He had 12 stents put in. He went to Washington, had radiation seeds implanted into his heart. You know, you name it, he basically had it. He had a pacemaker, and he also had gotten struck by a neurological spastic disease, which meant that he drug his feet and he was no longer able to walk as easily as he could in the past. So, my mom became his main caregiver. He also then developed symptoms of heart failure which became much more apparent and much more significant as he aged.

And I would say over the past year we noticed that it had much more significant impacts on his ability to breathe and everything. And became 100% reliant on his pacemaker. So, he was hospitalized in May. And at that point, they told us, you know, basically his heart failure was going to really become worse. And he had gone to rehab, he had come home, and he ended up going back in rather emergently because he had fallen.

And it was at that time that they kind of said to us, "Look, his heart failure numbers, his labs were so high that, in all reality, we can never put a timeline on anything. You know, it's always in God's hands. It's never something that we can say, you know, this is going to be this long. But we would be surprised with the advancement of this that he would be able to even last six months." And it was just kind of a hard hit for my dad and to know that the way he was, he would not be able to come home because we wouldn't be able to get him in the house, the stairs, et cetera. So, my dad kind of talked it over and he said, "What are my options?" And at that point was when palliative care came into the conversation.

When I think of palliative care my mind first goes to cancer patients. But palliative care is much bigger and much broader than that. It is basically when you are faced with a situation that things are not going to get better, they're going to demise. And palliative care enables us to have control in an environment where we don't have control. And enables us to make decisions that can make those ending days or that ending time not only comfortable for the patient, which is always the utmost important thing. But it can also help comfort the family as they're transitioning through facing the loss of the loved one. And I really didn't understand the full depths of what they do and how amazing they are until I walked through it. The whole entire team was incredible. And Dad started out on the fifth floor, which is more of a cardiac floor. And when he became palliative care, they did change him down to the third floor.

But I would be remiss if I did not mention the nurses and everyone, all the staff on the fifth floor, because they were amazing as well. But when we came down to the third floor and palliative and hospice became involved, everybody was outstanding. There were a few, though, that really touched our hearts. And the one was Dr. Gregory Kohler, who was one of the hospitalists. There was a support person, Elaine. Some of the nurses were Holly and Giovanni and Thalia. I just cannot express how much they went above and beyond to just bring us a sense of peace that we didn't have to worry about things. They were constantly talking to us. "If you notice that he's in pain, if you think he needs anything, please don't hesitate." They were in to check every hour, not only on him, but, "Do you need anything? Can I do anything for you or your mom?"

Because my mom and I had stayed there for that period of time that he was in palliative care, and they made sure that we acknowledged that you can order something to eat. You don't want to leave because granted you need to take a moment to take a breath. Because being in that room 24/7 for seven or 10 days, however long it takes for transition, you need to take a breath. But they wanted to make sure that we knew, you can order anything from the menu. It will be brought to the room. it's part of our care. It is part of everything. Do you need a toothbrush? The little things like that. They brought snacks to the rooms. They brought drinks. They made sure when the granddaughters were there, that we had snacks that we could give to them as well. And they brought brochures from hospice on how to help the grandchildren transition through death. This was their first experience, and they were very close to my dad. So, helping them to transition through, helping my sons who have never really lost someone as well.

Just helping us on how to help as a family, how to help each other get through this. And they were just completely on it. And when my dad seemed to be uncomfortable and the medicine wasn't quite covering him, Holly was like, "I'm reaching out. We're going to get something increased." There was never a hesitation. Their main goal was to make sure that my dad was comfortable, that he was attended to, and that we were tucked in as well, which meant that we could focus on him. We could relax and take the time that we were given to say our goodbyes, to talk about memories. Just be able to have that closure in those last days.

If we had our way, we would have our people with us the rest of our lives. Like, we never want to say goodbye to someone. And it is difficult. And surprisingly enough, I will say I guess I thought that as a nurse I would handle it better. But I don't think it really matters what you are, who you are, what you do. It's still losing someone that you love. And it brought such a sense of peace and comfort to know that, they had everything under control. It didn't matter if every 20 minutes we were pressing the button saying, "I think he's uncomfortable." They didn't ever question. They were like, "Okay, we're going to get him some meds." They trusted that we knew him well enough to know.

You know, sometimes we get too rushed in healthcare, where we've got so much on our plate, that I think that we don't give credit to the fact that while we see this patient before us, the family that's sitting in the chair has been surrounded by this person perhaps their entire life. And they know them in a much deeper level than what we could ever begin to know them. And we need to give credit to that and that input as to, "I think there's something wrong here, or He's uncomfortable," because they know them well, and I think that needs to be a much integrated part of taking care of a patient, and they definitely made that very apparent that they valued our opinion as to what we felt he needed or what could be done to help him.

I think that it's really important to take a step back and just look at the whole picture. I have much more respect and just awe for anyone in the palliative care. I respect the challenges that the floor nurses have in juggling time. I just really respect that and became much more aware of that.

And I think it just even strengthened more my resolve to do what I do as a nurse and deepen my compassion and my drive for that. Because we often don't know the whole picture. We just get a small glimpse, but we don't know the whole picture. And there's a great video out that doesn't speak a word through the entire video. But it goes through a hospital and people that you pass in the hospital and person getting on the elevator, and how we often come to a very quick judgment of someone that we're passing. But then, it gives you a blip of what's going on in the background in that person's life. We don't know the whole picture. So, that patient that's ringing their bell 50 times, you know, and you're like, "Oh my goodness, I can't go in that room one more time."

There might be a background picture that we don't know. So, I would hope that this has taught me to be much more compassionate on a deeper level. I would like to think I was already compassionate, but it's definitely deepened it and my resolve, like I said, to why I do what I do.

Caitlin Whyte (Host): Angela's story is a powerful reminder that while medicine cannot always change an outcome, compassion can transform an experience. To the physicians, nurses, support staff, hospice team, and every and every caregiver who helped Angela's family navigate one of life's most difficult moments, thank you for providing comfort, guidance, and dignity when it mattered most.

Your care allowed one family to spend less time worrying and more time simply being together. Thank you for listening to In Their Words, a podcast from the UPMC Pinnacle Foundation and UPMC in Central PA. If this story inspired you, please subscribe, share this episode, and join us next time as we continue highlighting the people, programs, and moments that make compassionate care possible.