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The History of Hospice with Barbara Karnes

Barbara Karnes is a pioneer of the modern hospice movement in the United States. She got her start as a hospice nurse when medical professionals didn’t know how to pronounce the word hospice, let alone understand what care it could provide their patients. Thirty five years ago when Barbara was helping set the standard of care for people at the end of their lives, she wrote Gone From My Sight. It is a little blue pamphlet that uses simple, straightforward language to explain the dying process. And it is still widely used today by hospice agencies across the country. In this episode, Barbara explains what hospice actually does and how it helps people. We also talk about the dying process – what to expect, what it looks like and sounds like and what you need to know if you’re caring for a loved one who is dying.


You can learn more about Barbara’s advocacy work and buy all of her pamphlets here: https://bkbooks.com/


Transcript:

Sarah Cavanaugh:

Hi. I'm Sarah Cavanaugh and this is Peaceful Exit. Every episode we explore death, dying and grief through stories by authors familiar with the topic. Writers are our translators. They take what is inexpressible, impossible to explain and they translate it into words on a page. My guest today is Barbara Karnes, and she's a force. She's an early pioneer in the hospice movement in the United States, and she helped make it what it is today. 35 years ago, she wrote, Gone From My Sight. It's this humble little blue pamphlet that uses simple, straightforward language to explain the dying process, and it's still widely used today by hospice agencies across the country. I even had a friend the other day say she was given this book and it changed her life. After all these years, Barbara is still working to educate people about end of life care. Most people don't talk to a hospice nurse until they've been given a terminal diagnosis, but she for years has provided this wealth of information to everyone and having this information is so powerful. We talk about the dying process, what to expect, what it looks like, sounds like, and what you need to know if you're caring for a loved one who's dying.

Welcome to Peaceful Exit. Let's start at the beginning. I'm just very curious about how you became a nurse. Was that something you wanted to do from the very beginning?

Barbara Karnes:

No. I graduated from nursing school in 1962, and thought, "Oh goodness, I've made such a mistake. I should have never been a nurse. I should have been a social worker actually." So I didn't work as a nurse. I was actually an interior decorator for a while. And then in the '70s, Elisabeth Kübler-Ross came forward out of Chicago and said Americans are not taking care of their dying. And Dame Cicely Saunders in England came forward at the same time and said here's an idea of how to take care of people who are dying. And that struck me. And I thought, "Yes. This is something I want to do." In hindsight now looking back, the gift was that I never worked in the medical establishment in relationship to death and dying. I came with a whole new perspective and that vision coming through eyes that didn't have any preconceived ideas, allowed me to really see people dying and see that there is a process. That's the gift that not nursing gave me.

Sarah Cavanaugh:

I love that. The gift of not nursing.

Barbara Karnes:

Yeah. Well, the thing is dying is not a medical event. Yes, you do pain management and symptom control, but really it's a social, communal event. And so you need a little bit of medical knowledge, but you need a lot of people skills and understanding the dying process. Because people don't die like they do in the movies. They have a process to it, but most people don't know that because we don't have any role models on what it's like to die.

Sarah Cavanaugh:

And we don't talk about it enough.

Barbara Karnes:

And we don't talk about it hardly at all, which makes us so unprepared for the experience. And that's what dying is. That's what life is. We are born, we experience, and then we die. It's the name of the game. And yet because we bring such fear with us to the end of life that we don't really see what's happening is distorted by the fear we bring. And so end of life education is 90% of end of life work.

Sarah Cavanaugh:

Did you have experiences personally that led you to this work or your curiosity about the dying and being with the dying? It takes a special person, I think, to do this work.

Barbara Karnes:

Well in the late 60s, early 70s, that was self-exploration and that's what most people do during that age group. It's what's the purpose of life? What does it mean? We ask all these questions and I did. And my belief system evolved with everybody dies. It's not something to run away from. And so when Elisabeth ... And I spent a week with her in a workshop in Escondido, California. And I went there thinking she's going to teach me how to work with dying people. And what she taught me was that you have to have your own house in order in order to help others put their house in order. So that was an incredible week experience. And then I just studied everything which wasn't much. My families, my patients, they were my teachers. They're the ones that taught me the end of life process. It wasn't any books.

Sarah Cavanaugh:

So what is hospice for our listeners who may not understand or are familiar with hospice or think that hospice is a death sentence?

Barbara Karnes:

Hospice has a really bad PR image in that hospice says that they take care of people who are dying. But what hospice really does, hospice helps people live the very best that they can within the confines that their body and disease has put them in. So hospice, it's evolved over the years, but the basic premise is Medicare will pay for it. Medicare has its own category of hospice care. So the premise is that you have six months or less to live. I have a problem with that because no one can put a number on how long someone has to live. You can say months, you can say years, you can say weeks, you can even say hours, but you can't be so specific as to put a number on it. And yet that's what the government did. The government said six months or less and that there is no treatment. That treatment has reached a point where it's not working and where the physician has to be able to say, "I am sorry, I can't fix you. So let's help you live the best you can within the confines that your body and disease has put you in."

So hospice is not just about nursing. It's not just about a hospice physician. Hospice has social workers who aren't used enough much to my sadness because if it's not a medical event, then it's a social event and that's where you utilize your social worker who has communication skills and community resources and just are a great listener. And that's what most people need is a listener. Because there aren't really a lot of answers. But hospice listens. Hospice has chaplain services. Again, a listener. They're not there to sell religion. They are there to give support. And home health aides for bathing. They have arrangements with nursing facilities. So if a person is in a nursing facility, you can have hospice care. The ideal is that you come onto the hospice program in the months before death so that they can help you live and hook you up with services and equipment and support. And then as death gets closer, hospice increases the amount of time that they're spending with the family because the goal is the patient's death. Everything leads up to the moment of death and then bereavement and grief support continues and follows through for a year.

Sarah Cavanaugh:

I didn't know that after someone dies that you have bereavement support for a year. That's actually new information for me.

Barbara Karnes:

Hospice is required to offer bereavement services. It varies depending on how you interpret the regulations. But what I think is ideal ... Let's do that. What I think is ideal is that following the death, the primary care nurse, the social worker, and the chaplain that have worked with that family in the first week following the death, I would like them to come and have a final goodbye. Answer any questions. What are you thinking? Thank you for coming into my life. And we're here to help you. So you lay the groundwork.

Then about six weeks, two months following the death, then you offer a bereavement support group. And in grieving, most people are going to go, "No, I'm not going to go." So you need your hospice volunteer who has worked with the family to go with the family member to the bereavement group. There are periodic notes that are sent just as a reminder, as a we're thinking of you. There is a new product called Help Text, which some hospices are subscribing to. And a text is sent to the griever on a periodic basis just with a little sentence here or there. And it helps with that loneliness and the isolation. A big component of grieving is isolation. And so those little help texts really break through that.

Sarah Cavanaugh:

I wish I'd had that support or known about that in hospice before. That is really wonderful. I have a couple of questions I'm curious about. Before the person dies, will the social worker ... I know that they're an incredible listener, but can they also help that person reconcile with family members or reconcile within themselves things that they may regret in their life or relationships that are out of whack? Talk a little bit about how the social worker can help that person who is dying.

Barbara Karnes:

Well, when we've been told we can't be fixed, then we start looking at our life. What have I done? Who have I touched? What has this all been about? Life is like a billion piece jigsaw puzzle. And when we've been told we can't be fixed, we start putting those pieces together and the social worker and the chaplain can help us put those pieces together because we recognize whether we share it or not, that our life is going to end sooner than we want it to be. And those thoughts are going to come through. And it's nice to have a sounding board where you can bounce off your ideas. And we tend to not do that with our family. So we can often talk more openly, more freely with a stranger than we can our own family. And that's the specialness of the social worker.

Sarah Cavanaugh:

How did you start working on Gone From My Sight and how did it come about?

Barbara Karnes:

I was on call, 3:00 in the morning. What I learned is if you're on call and you don't roll out of bed, then you're going to end up with your patient in the hospital in the ER so you go. Well, mom was in the bedroom and she was really in the dying process, but not hours, probably weeks from death. And the family and I are sitting in the living room and I'm explaining to the family that mom's doing a good job. Nothing bad is happening here. This is how you die. And I'm telling them what to look for. And as I was talking, I noticed the daughter was taking notes and I thought, "Oh goodness, she should not be having to take notes." So I went home that weekend ... And this is before computers. This is when you used a yellow legal pad.

I sat down on my sofa and I wrote out what I wanted families to know about the dying process. And the key things that I wanted was it had to be short because people under stress do not have the time or the energy to read a whole book. It had to be large print because a lot of the families are elderly. As well as reading it in not proper lighting. So it had to be large print and it had to be gentle. I wanted that information to soak in gently, not be very clinical and abrupt. And from there I took that book to my director because I was a primary care nurse, and I said, "I wrote this for my families and I am giving it to you. Would you print it and give it to families?" And he looked at it and he said, "No. No, I'm not going to do that." And I said, "Okay." And I was like the little red hen, "Then I'll do it myself." And he basically gave me permission. I printed out a hundred copies and handed it to my patients and it just went around the country. It took a life of its own. And I think that's because the information is so important. It's easy to read and understand at a time when people are so scared about what's happening.

Sarah Cavanaugh:

I just love all the considerations you had in writing it, even low lighting and elderly readers and all of that. It feels like you were one of the originals in terms of the hospice care ethos. You had this understanding of what families needed at a really grief stricken time. And I found in my own life when my father-in-law died, I was with the family and I had been with my own mother and experienced it. So I just shared, this is normal, this is happening, this is going to happen. And we were very fortunate to have him in a hospital bed in the living room and at home. But what conversations were going on at the time you were writing this around dying and hospice? Was it a conversation that anyone was having?

Barbara Karnes:

No. Most people couldn't even say the word. Generally it was hospic is how often people called it. Doctors didn't really understand so getting referrals was difficult. No one knew. It was the new kid on the block. And it was outside of the medical model. And it was oh, that weird thing, that hospic thing. And so getting referrals was challenging, and yet we couldn't really handle a lot of patients because we were the first hospice in Kansas City.

Sarah Cavanaugh:

Oh, wow.

Barbara Karnes:

They hired me as an assistant nurse, and I worked part-time. Jodi worked full-time. Four months later, I was working full-time as well. But it was our community outreach that got referrals. And so over the years we've built hospice. Now, I became the executive director of that hospice eventually.

Sarah Cavanaugh:

Of course you did.

Barbara Karnes:

But it was just a real small operation when we started. We were lucky if we had 12 or 20 patients total for the two of us.

Sarah Cavanaugh:

I love hearing about the origins of hospice and how you being outside the medical field were able to encourage families to consider this conversation at all. So an extension of that question about what's happening with families at home, what was happening in hospitals at the time?

Barbara Karnes:

Well, in hospitals, the person was who was dying was put at the end of the hall and no one paid any attention to them. It was almost like a failure. If you think about how taking care of our dying has evolved, it started in the '50s or maybe '60s. Before that Grandma died at home. She died in the upstairs bedroom and family was there and they watched her die and it was all very normal and natural. And then along came hospitals and then grandma ended up in the hospital and there she died at the end of the hall and generally alone. And from there we started moving dying, unfixable people out of the hospital into nursing facilities. And in nursing facilities they also died at the end of the hall and generally alone. And that's why no one really understood or knew what dying was like except for the movies. Now we have come full circle and people are aware and want grandma back home in the upstairs bedroom.

And so because we have no history of what it's like to die, that's where hospice and the end of life doulas and my materials come in because we understand the dying process and can guide that family into seeing and having this sacred experience. And it is. It is a sacred experience that end of life workers are helping families and the patient create so that family can then have a sacred memory that they will carry with them forever. Instead of that scary, oh my gosh, mama's dying was horrible and horrific, we neutralize the fear. That's the biggest part of our job.

Sarah Cavanaugh:

So people today still get your little blue book. How do you want families to use Gone From My Sight?

Barbara Karnes:

Okay. What I want. In the months before death when a doctor has said, "I can't fix you. Go home. Put your affairs in order.", that's when you need the book. Hospice needs and does, a lot of them give that booklet on admission. It's not enough to just hand it to someone. You need to sit down and read it with them. What I learned is that hospice reached a point where they weren't with families in the hours to days or minutes before death. And so families didn't understand what to do while mom was dying. So then I wrote The Eleventh Hour. And those two booklets in my mind go together. Gone From My Sight says to the family here's what's going to happen. Here's what it's going to look like. And then The Eleventh Hour says here's what you do while it's happening. And I wrote pain management because pain at end of life is different than pain for someone who's going to get better. And you treat it differently. And people don't understand that. And so they're afraid of narcotics. And in our society, yes, I understand why, but there is an appropriate use of narcotics. So every book ... And I've got a whole bunch more. But every one that I've written, I have thought I saw a need that wasn't being met, and so I jumped in there and met it.

Sarah Cavanaugh:

Well, thank you for that. I'm curious about Gone From My Sight because it was published in 1986 and updated for the first time during the pandemic, 2022, and that's an impressive run. And what kept it so evergreen and what then motivated you to update it after nearly 40 years?

Barbara Karnes:

We just changed minute things. And the reason that it hasn't needed to be updated is because the signs of approaching death don't change. It isn't like with diabetics who how you take care of them can change and evolve and medications can make it different. We all die the same way. We either die fast, which is getting hit by a truck out here or a heart attack or suicide, or you die gradually and gradual death has a process and that can be old age with no disease or you die from a disease. And that process doesn't change. Our body was made to die. It has a process that it goes through to let go and end, and that doesn't change. It's never changed and it won't change. We jump in and we mess with it and we try to change, but you die the way your body is meant to die. So I don't have to keep updating the book because that isn't going to change.

Sarah Cavanaugh:

Yeah. That makes sense. That makes sense. Let's talk a little bit about the dying process. You have a lovely metaphor at the beginning of this book about the little chick that works so hard to get out of its shell.

Barbara Karnes:

There is a labor to dying and that process labor does certain things at certain times, but it's hard work. We work to get out of our body. And I was trying to think of fifth grade level, easy, gentle analogies that people could relate to and understand this complicated heart-wrenching process. And so I equate it to two things. One is the little chick that works and works and works to get out of its shell and the driver of our physical body works really, really hard to get out of this vehicle that we use to get around in on this planet. And I also equate birth. We go through labor to get into this world and we go through labor to leave it.

Sarah Cavanaugh:

Yeah. Yeah. So as you say, the death process is not like in the movies. What is it really like? What is that universal process that it makes your book timeless?

Barbara Karnes:

Two to three to four months before death from disease three things start happening. And you don't even have to know the disease or the diagnosis. You look at these three things. One is a person's eating habits change. Months before death they're going to stop eating meat and then on a continuum. Then they don't eat meat and they don't eat fruits or vegetables. And then you're doing good if you can get soft foods. Then Ensure. Ice cream goes a long way. We love our ice cream. But they gradually reach a point over these months of not eating at all because food is the gas we put in our car and that's what our body is. It's a vehicle to get around in on this planet and if the body's preparing to die, it doesn't want the energy. It doesn't want the energy that food gives.

You're going to look at a person's sleeping habits, again, on a continuum two to three to four months before death. Afternoon nap, mourning and an afternoon nap. And gradually one day they don't get out of bed and then they're asleep more than awake. Most of us sleep through the dying process. We can be moving, we can be talking, but really we're asleep when we actually die. The third thing is socialization. Again, we gradually don't have the neighbors come over. Or it starts actually with the favorite football team. Not interested in watching the golf match or whatever. Then it's don't have the neighbors come over. Then it's the family. Because they're going within and that's what they should be doing. They're processing their life on many levels, but it's only work that can be done by one, and that's them.

There are other changes that say when labor begins. Labor takes one to three weeks to get out of our body, and there are significant changes that have not been there up until this moment. The key thing is a person starts sleeping with their eyes partially open, generally their mouth open. They may have hand movements, picking the air, picking their clothes, the bedsheets, just random hand movements. That's when labor begins. And then there are other changes that say we're talking days to hours. And now the person is generally nonresponsive. They're sleeping with their eyes partially open, and as death gets closer, their breathing gets slower and slower and slower. And then a really interesting to me, scary to most people, thing happens. In the moments before death a person's facial expression probably will change. There may be a tear, there may be a yell or bolting movements. And it's really, really scary to families because they think something bad is happening. What I see that, that unusual, all of a sudden movement is that final jerk to release from the physical body. It's the birth into the other world. And nothing bad is happening, but it's scary if you don't know that it's going to happen.

Sarah Cavanaugh:

Yeah. A lot of us have heard about the death rattle. Can you explain what the death rattle is?

Barbara Karnes:

Sure. The body is starting to shut down and so the kidneys aren't working properly, the lungs aren't working properly, the heart's not working properly, and fluid is forming not only in the lungs but in the back of the throat. And you're hearing the breath come through that fluid and it makes a gurgly scary sound. It can go on for days and oftentimes for hours. And it's really, really scary because we think something bad is happening. And when someone is able to understand, yes, this is normal, this is natural, oftentimes turning someone over on their side or moving them around in a different position will affect that sound because it just moves it. But oftentimes you can't make it go away and it's just part of how we die.

Sarah Cavanaugh:

How much do you tell the patient about the process?

Barbara Karnes:

Great question. In the months before death, I let the patient and the family know that I will talk about anything. All you have to do is ask me. I'm not going to go in and say to the patient, "Look, you and I know that you can't be fixed and that you're going to die, and so let's talk about it." But I work at developing a relationship of trust and that I'll talk about anything. So that when they're ready, they will feel comfortable enough with me to ask me questions and bring up the subject. With the family, I am not that lenient. I'm not going to play games with the family. The family needs to know dad can't be fixed. Dad's dying and this is what happens. There's not going to be a miracle. And that's what most people pray for is all of a sudden this is going to be gone. I am direct but gentle with my families, but I tell them the truth and what to expect so that they can see and prepare themselves. And I also give them guidance on how to interact with dad.

And in the hours before death, I will have each individual family member go in alone and talk with dad. Dad's nonresponsive. He may be moving, he may be muttering, but he's nonresponsive. He can still hear. I actually wonder if they can hear in the moments following death. So I encourage before death happens that each significant person go in and talk to the person that's dying. Talk about the good times, talk about the difficult times, the challenging times. Anything they need to say, this is their opportunity. That's individual as death is approaching. Then after death, before I call the funeral home, I again have each person go in alone and talk to dad again and say whatever they want to say because it's not going to be the same at the funeral home, at a visitation in the ... It's not going to be the same. This is your last chance to really have dad to yourself. Say goodbye.

Sarah Cavanaugh:

That's so beautiful. You've created that sacred space so that people can have time, and that's such a gift.

Barbara Karnes:

Well, and that's so important. That's what I want all hospice people, what I want all end of life doulas to treat the dying and their families in this way of creating their sacred memory. In order to have a sacred memory, you got to have a sacred experience.

Sarah Cavanaugh:

Yeah. Are there any stories that come up for you that are in particular really moving when you invite that sacred space?

Barbara Karnes:

There are a handful of patients and families that got into my heart. Most of the people that I took care of, I took care of as children of God, and I did not get emotionally involved with them. But every once in a while, someone got in my heart and filled an empty space that was in me. And I still carry those people in my heart and I grieved for them. I had to learn as a person working with end of life that I had to figure out a way to take care of myself. And what I did was I created closure with every patient that I had that died. I went to their visitations. And now they're not doing visitations as much as I'd like now, but I was in a position where I could encourage the families and teach them how important the visitation is.

Well, I Barbara, would go to the visitation, go up to the coffin, put my hand on the body and say, "Thank you, John, for coming into my life and I wish you well on your journey." That was my symbol within me. That was my closure. Then I said goodbye to the family. I recognize that death for most of us who are working in the field, we must learn to take care of ourselves and that we're the odd ones. We are the ones that the neighbor says, "Oh my God, I don't see how you can do this work." And so whether you keep a journal or whatever you do to take care of yourself, we need to.

Sarah Cavanaugh:

I know one of the beautiful things about the work you do is confidentiality, so I'm very respectful of that. Is there anything within you that you can share that was a story that filled you up and why it touched your heart?

Barbara Karnes:

Okay. I will say there was a gentleman that became the father that I never had. And I took care of him for over a year, and I stayed in contact with his wife until she died, which was maybe 10 years later. We exchanged birthday cards and Christmas. It was like she was family. There was a young ... Yeah. I think I can tell this. During the early years when AIDS was ... No one really knew what it was or what it was about. I took care of a young woman who came home to her mother and father and brought with her her two-year-old son. The husband had died of a mysterious disease that no one really knew what it was. And then by the time she was showing severe symptoms, they knew it was AIDS.

So she came home and I worked with her mother and father, and the little guy was really considered failure to thrive. And so mom died. I stayed in touch with the family and two years later when the little guy was four, grandma called me and said, "It's time for you to come back and take care of him." And we'd been in touch. I knew that the medical establishment said he was born with it. So I was with them when he died. We're talking, this had to be in the '80s. Just this month I got a letter from grandma and she said, "I'm just touching base. Want to see how you are." That's in my heart.

Sarah Cavanaugh:

Let's shift a little bit to thinking about preparation, because Peaceful Exit is a lot about preparation. And if you're healthy today, what's your sage advice? What can you do to prepare maybe even as a young person?

Barbara Karnes:

From 18 on you need to have an advanced directive. Because if you don't have an advanced directive, you will die the way the medical establishment wants you to die. And a 19 or a 20-year old is a legal adult. Some will listen to parents, but they don't have to. And so you need an advanced directive. The thing about an advanced directive that you make when you're 20, when you're 30, when you're 50, when you're 60, you can change it. It's not set in concrete. So put down ahead of time how you want to be treated when it comes time to die. Do you want a whole bunch of medicine? Do you want treatment until your last breath? A lot of people do, but there are others that say, "If the doctor says you can't fix me, then don't put me in the hospital and do CPR. Make me a no code." But you have to have it written down. You also need a durable medical power of attorney. There will be a point where you can't speak for yourself. And even though you have it written down and you've given that advanced directive to your physician and to your family, you want an advocate. You want someone who, when you can't speak for yourself, has the legal ability to speak for you. It's not the same as a power of attorney. This is a medical medical and that only involves medical situations.

Sarah Cavanaugh:

And it's so important for the advocate to have that because I was a medical power of attorney for Jeannie. And when she ended up in the ER, because I had on file a medical power of attorney, I could take her home. And I think that if I had not had that legal paperwork already filed at the hospital, then she would've been admitted to the hospital and probably died there. And so the ability to actually meet her needs and wants depended on it.

Barbara Karnes:

It did. And it's not enough for me to say, "I want you to be my medical power of attorney. Sign these papers." That's not enough. You have to sit down and I have to tell you what I want, what my beliefs are, what I think. It's not enough just to have the paper signed. You have to have the conversation.

Sarah Cavanaugh:

So have you had the conversation? Is it Julia, your daughter?

Barbara Karnes:

Julia is my daughter-in-law, and she is our medical person. She knows all kinds of medical stuff. And so she is my durable medical power of attorney. Yes. She is.

Sarah Cavanaugh:

And she knows all your wishes for your end of life?

Barbara Karnes:

Oh, yes. Yes, she does. She knows me like a book.

Sarah Cavanaugh:

So you've spent your amazing career trying to change what people know about the end of their lives. What more work is there to be done? What do you want to continue to change? What else could be better?

Barbara Karnes:

People's understanding of end of life can still be better. We've come a ways. We've made some progress. But still, most people believe that death is a failure and that we can do everything possible medical and that we will be able to fix someone. Most people operate under that illusion. And so I don't know if we can ever get to a place where everyone understands that death is normal. It's natural. It's not the enemy. It's never going to be okay for someone that I know and love to die. It'll never be okay. I will always want my mom. But I can get to a place where I understand, yeah, she's going to die. And that's what end of life education is about, or my work is.

Sarah Cavanaugh:

So how can I help make things better in these conversations for Peaceful Exit? What would your advice be to me?

Barbara Karnes:

My advice to you is to continue being the voice that deals with end of life, that deals with living until you're not. We tend to put a lot of attention on dying, and we skip over that we need to live until we're not. And you have the microphone and you have the people that will listen, and that to me is what your work is about. It's getting this knowledge out there to the ears that are listening to you.

Sarah Cavanaugh:

Thank you so much. My last question to every one of my guests is, what does a peaceful exit mean to you?

Barbara Karnes:

Well, it would be wonderful if I would just get in bed, close my eyes and not wake up. And I think everybody wants that. That's the peaceful death everyone wants. However, what that does is it deprives you of the opportunity and your loved ones of the opportunity to say goodbye. So I would like a couple of weeks, maybe even a couple of months notice, so that I can say those things that I want left behind. I can wrap up all my loose ends, put my affairs in order. As much I'd like to jump over the actual dying time, I really think the closure for my loved ones is more important than my just not waking up. Because I really would be depriving them. So I'm willing to make that sacrifice.

Sarah Cavanaugh:

That's an enormous gift to those people around you.

Barbara Karnes:

Well, and who knows how it will happen?

Sarah Cavanaugh:

None of us know.

Barbara Karnes:

None of us know.

Sarah Cavanaugh:

I'm so grateful for your time today. Thank you so much. I just really respect your career and what you've brought to the conversation. You are a gifted educator. I always admire when someone can take something that's so complicated and communicate it simply, and I just really appreciate that about you.

Barbara Karnes:

Oh, thank you. Thank you for having me. I appreciate your questions, and our conversation has been really thought-provoking and educational. I think we've done good work, and thank you for allowing me to be part of your work.

Sarah Cavanaugh:

Well, thank you.

Thank you for listening to Peaceful Exit. You can learn more about this podcast and my online course at my website, peacefulexit.net. If you enjoyed this episode, please let us know. You can rate and review this show on Spotify and Apple Podcasts. This episode was produced by Larj media. You can find them lajmedia.com. Special thanks to Ricardo Russell for the original music throughout this podcast. More of his music can be found on Bandcamp. As always, thanks for listening. I'm Sarah Cavanaugh, and this is Peaceful Exit.




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