Nancy El-Miski - Grief, Empathy & Patient-Centred Care

CONTENT NOTE 
This episode includes an open discussion of terminal illness, the death of a parent, and end-of-life and palliative care, with a brief reference to pregnancy loss. Support for pharmacists is available through the Pharmacists’ Support Service, 1300 244 910.

In Part 2 of this conversation, we welcome back Nancy El-Miski, registered pharmacist and Credentialled Diabetes Educator at SparrowHub, for a conversation she asked to have: grief, and what it means for how we practise.

This is one of the most personal episodes we've shared.

Nancy reflects on supporting her father through cancer, balancing the roles of daughter and pharmacist, and how grief changed the way she practises pharmacy.

Rather than seeing empathy as simply being kind, Nancy explains why understanding a patient's lived experience is one of the most important clinical skills a pharmacist can develop.

In this episode:

• Holding the roles of daughter and pharmacist during her father's palliative care
• Why she chose to stock and train her team on end-of-life medications
• How understanding grief changed the way she designs patient services
• A simple habit that helps you notice when a patient or colleague is struggling

"Empathy is one of our best tools in pharmacy." - Nancy El-Miski

Whether you're early in your career or have been practising for decades, this conversation is a powerful reminder that the care pharmacists provide extends far beyond dispensing medicines.

You can find Nancy El-Miski on LinkedIn.

About Your Pharmacy Career Podcast

Welcome to Your Pharmacy Career Podcast, proudly produced by Raven’s Recruitment - the experts in pharmacy career and locum services for over 30 years!

Hosted by Pharmacist, Krysti-Lee Patterson, every episode is your gateway to new opportunities in the pharmacy profession. From expert advice to inspiring success stories, we’re here to spark ideas, guide your career, and help you achieve your goals. Whether you're a student, an early-career pharmacist, or a seasoned professional, this podcast is designed to keep you informed and inspired.

Proudly brought to you by the Pharmaceutical Society of Australia. The PSA is committed to empowering pharmacists through advocacy, innovation, and industry-leading professional development. To become a member or learn more about how the PSA can support your career, visit www.psa.org.au.

Pharmacy Daily is a proud supporter of Your Pharmacy Career Podcast. If you're in the pharmacy world, it's a great resource to stay up to date with the latest industry news. To subscribe, just head to pharmacydaily.com.au to get the newsletter delivered straight to your inbox

Transcript

Narrator (00:00.302)

Welcome to Your Pharmacy Career Podcast, proudly produced by Raven’s Recruitment, the experts in pharmacy career and locum services for over 30 years.

Every episode is your gateway to new opportunities in the pharmacy profession. From expert advice to inspiring success stories, we’re here to spark ideas, guide your career and help you achieve your goals.

Stay tuned. The next step in your pharmacy journey starts here.

Krysti-Lee Patterson

Welcome back to Your Pharmacy Career Podcast. I’m your host, Krysti-Lee Patterson, and today’s episode is a little different from our usual conversations.

We’re joined again by Nancy El-Miski, registered pharmacist and in-house pharmacist at SparrowHub, for a follow-up conversation. But this time, we’re not necessarily talking about career milestones. We’re talking about something almost every pharmacist will face, and very few of us are trained for.

That topic is grief.

Nancy chose this topic herself, and by the end of this episode, I think it will make sense why this is an important topic to discuss, especially in relation to a pharmacy career.

Nancy, welcome back to the podcast.

Nancy El-Miski

Thank you for having me. This topic is a little different, but I think it is just as important.

Krysti-Lee Patterson (01:21.226)

Absolutely. Nancy, grief is not something most pharmacists would immediately connect to their pharmacy career. What made you feel this was an important topic to bring into the conversation?

Nancy El-Miski

Grief is definitely an uncomfortable topic sometimes, and I think that is exactly why we need to talk about it. We tend to shy away from it because we do not always know how to deal with it when we are faced with it.

In reality, we will probably all experience grief at some point in our lives. As healthcare professionals, we have people walking through our doors every day who are dealing with a new diagnosis, caring for someone they love, or trying to hold everything together while their world falls apart because someone has passed away.

Grief is all around us in pharmacy, whether we recognise it or not.

For me personally, it started with my own grief after losing my dad. During that journey, I wanted to understand the stages of grief. By doing that, I began to see my patients completely differently.

It gave me more patience and more empathy. More importantly, it gave me a better approach to my day-to-day care.

I started asking better questions and thinking about how I could help within my scope of practice as a pharmacist. How could I educate people? What access could I provide? What services could I offer to ease their journey and their family’s journey?

After experiencing it through my dad and the journey we went through, I knew this was an important topic to discuss.

Krysti-Lee Patterson

Absolutely. To be honest, I think it is very brave of you to do this. Not only is it a topic that is important to you and has affected your life as a health professional, but it is also deeply personal.

It is very difficult to talk about things we hold so close to us.

The other aspect of this story is that it has been with you throughout your entire pharmacy career.

Krysti-Lee Patterson (03:53.942)

You were around 21 or 22 years old when you were first accepted into pharmacy school. That should have been a wonderful time to celebrate with your family - going to university and being accepted into pharmacy school.

However, your family received some difficult news a few months later. Would you like to talk about what that news was?

Nancy El-Miski

Yes. As I mentioned in the previous episode, my dad was the person who really wanted me to attend pharmacy school. He was so happy that I had been accepted and that we were starting that journey.

A few months into pharmacy school, my dad was diagnosed with metastatic bladder cancer.

It felt as though the carpet had been pulled out from under us because, of course, we were not expecting it. All the questions began to appear: What does this mean? How long is Dad going to be here? What can we do?

The journey began with surgery, radiation therapy and then chemotherapy.

The hardest part was watching someone who had been so strong and funny - someone who had been there your whole life - become weaker and more withdrawn because of the treatment and the diagnosis.

That was when I realised grief can begin before someone dies. You start grieving what was, who that person was and the life you had previously.

As I said, I was Dad’s little girl. At that time, anything felt possible and everything was amazing. Then this hit our family, and it hit us hard.

My dad was one of the major pillars of our family’s foundation. When that pillar falls or becomes weakened, the entire environment changes. The way the household operates changes. The family dynamics change. What you talk about and what you do not talk about changes.

You begin to grieve all of that.

After a year of treatment, he went into remission.

Nancy El-Miski (06:16.716)

We felt an enormous sense of relief, but there was always a constant worry: How long is it going to last? When is it going to come back?

Four years passed. I completed my internship, became a pharmacist and was offered a management role. We celebrated, but then the cancer returned.

It had spread throughout his body. Chemotherapy was no longer an option, and palliative care was the only path.

It was around Christmas when we were told he had approximately one month to live.

Krysti-Lee Patterson

That is huge.

I want to touch on the timeframe because I know doctors generally avoid giving specific timeframes. To receive that news must have been devastating.

Nancy El-Miski

It definitely was.

I remember being in denial. I kept saying, “No, that’s fine. We’ll take him home, I’ll care for him, I’ll feed him and make sure he puts the weight back on.”

You go through every possible thought. I was very much in denial.

We had to try to make it work. You cannot simply accept that outcome.

I could see that my dad had accepted it. You could see that he was beginning to let go, while I was saying, “No, we’ve got this. We can do this.”

We hired all the equipment we needed to make him comfortable at home. It was a devastating time. It was actually the worst time of my life.

We established 24-hour care at home, and the palliative care nurses visited every day. They were amazing. They kept me calm and helped me through the process.

At the same time, I was navigating morphine and midazolam injections. My family relied on me to manage those things because I was the pharmacist - the healthcare professional.

But at the same time, I was his daughter.

It was difficult to wear both hats. Sometimes I just wanted to sit with my dad, be his daughter and enjoy the moments we had together, but I also had to be the pharmacist.

Nancy El-Miski (08:36.226)

While I was navigating the healthcare side of everything, including the injections, I would call the pharmacy and ask them to order the morphine in the correct strength, the midazolam and anything else we needed.

I knew when to speak with the doctor and how the Schedule 8 prescriptions needed to be written correctly. I knew how to navigate the whole system.

Then it hit me: How does someone without my background or knowledge manage this during such an urgent and devastating time for their family?

That changed everything for me.

Krysti-Lee Patterson

That is such an important point.

I’m reflecting on some of the pharmacies I have worked in throughout my career. Some of them had those medications ready to go, generally because they serviced residential aged-care facilities.

However, I’m sure there have also been times when people presented prescriptions for those medications and we had to order them.

Of course, it always seems to happen on a weekend or after the order cut-off. In a rural area, the next order might not arrive until Tuesday, even though it is only Saturday.

You are right. People outside the healthcare system should not have to worry about those things. Even healthcare professionals should not have to manage those concerns while they are also trying to be a son, daughter, partner or family member.

I’m sure this affected your career and your views on stocking these medications and supporting people through the process. Did that change for you?

Nancy El-Miski

Definitely.

After losing Dad, I threw myself back into work. In reality, that was how I tried to grieve. I was completely in denial.

Krysti-Lee Patterson (10:54.452)

Why does that not surprise me, after getting to know you a little?

Nancy El-Miski

Exactly.

Work became an escape because it felt stable. I knew I needed to go in, do my job and be there for my patients and staff. At work, I felt as though I had control.

When I was at home dealing with my thoughts, that was where grief really took hold.

That is why you might see someone and think, “They are so strong. They have everything together.” But you do not know what is happening behind the curtain or what happens when they are home alone, thinking about everything that has occurred.

Work was my escape, which was helpful in some ways but harmful in others because grief eventually catches up with you.

I felt as though all the stages of grief collided in one enormous hit. It was like a roller-coaster.

When patients came in with palliative care prescriptions, I would think, “My goodness, this again.” I would run to the patient and say, “I’m here for you. I know what you are going to go through. I know there will be many things you need to manage. What do you need?”

I felt I had a duty of care to support someone who was experiencing what I had experienced. I wanted to help them navigate the process more easily.

I decided we needed to approach it properly.

I contacted the palliative care clinic across the road from the pharmacy and asked, “What do you need? What are the main medications? What over-the-counter products are required?”

That included bicarbonate mouthwashes and compounded preparations. With chemotherapy, for example, people can experience itchy skin, and doctors may prescribe specific compounded treatments.

Because we were a 24-hour pharmacy, it made sense for us to stock what was necessary for urgent situations such as palliative care.

I began making sure we had the required supplies.

Krysti-Lee Patterson (13:14.946)

I had not considered all the non-Schedule 8 medications and products.

When you think about palliative care medicines, you think about midazolam, morphine and ondansetron. But there is so much more involved in palliative care.

It is just as important to ensure those other products are in stock. Because they are not drugs of addiction, the family or patient may assume they can simply walk in and buy them, but that is not always the case.

Nancy El-Miski

Exactly.

You want to make sure you can provide everything the doctor has requested because the family may not know what is needed.

That could include juice boxes, nutritional formula for someone who cannot eat properly, mouthwashes, creams or anything else they require.

Even when you do not have a product, you should at least know where to refer the person. You should not simply say, “Sorry, we don’t have it,” and send them away.

That was the difference I wanted to make. It is an approach I tried to apply to every service I implemented.

We need to have enough knowledge to refer someone appropriately when we cannot provide something ourselves.

Krysti-Lee Patterson

That is very important.

It is frustrating that there is not one clear database showing where everything is available. Perhaps there is one that I do not know about, or perhaps technology may help us access that information more easily now.

Reaching out to your local palliative care team could be a good place to start. You were fortunate to have one in such close proximity, but local health services should be able to help pharmacies better understand what is required.

Nancy El-Miski

Exactly. Then you need to train your team.

Nancy El-Miski (15:10.698)

Make sure everyone understands the journey.

Because we were a day-and-night pharmacy, anyone could arrive at any time with a prescription or concern.

I realised I needed to ensure our pharmacists and the wider team understood palliative care.

Before my dad’s journey, I did not really understand what palliative care was. I knew it occurred, but I did not understand what was actually involved.

Krysti-Lee Patterson

For many people, their understanding probably comes from what they have seen on television or in medical dramas.

Nancy El-Miski

Exactly.

Some people receive palliative care in a centre or hospital, while others receive palliative care at home. Pharmacy teams need to understand that.

When you understand the journey of someone receiving palliative care and the journey their family is experiencing, you can help them more effectively.

Teaching our pharmacists and team about the stages of grief gave them greater understanding. They became more patient and gave people more space.

You stop rushing someone who is already overwhelmed.

You can serve the person better when you understand what they are experiencing.

Krysti-Lee Patterson

That is a good point about urgency and patience.

I know the pharmacy you worked in was very busy, so it must have been difficult to manage that balance. It is an important reminder.

Nancy El-Miski

Definitely.

I wanted the pharmacists to understand that if they saw a palliative care prescription, particularly for a Schedule 8 medicine, and it had been written incorrectly, they should not place the burden back onto the person presenting it.

Nancy El-Miski (17:32.482)

That person is probably already exhausted and distressed.

Rather than bluntly saying, “There is something wrong with this prescription,” you need to word it differently so you do not create more anxiety.

Resolve the issue quickly and urgently. Contact the prescriber and arrange the medication as soon as possible.

That was the level of urgency I wanted the team to understand, especially when supporting palliative care patients and their carers.

It may be as simple as correcting a Schedule 8 prescription, but it needs to be managed in the right way. Reduce the person’s anxiety, arrange delivery, take payment over the phone if necessary and do whatever is reasonably required to get it done.

Krysti-Lee Patterson

Exactly.

Something else I was thinking about is that you had recently received this devastating news while also starting a new management position.

Managing people as a young pharmacist is difficult enough.

In my first management role, I found that you almost became a quasi-counsellor for many staff members. You never know what someone else is dealing with at home.

You would have needed to put on a brave face and support your team. Looking back, what did you do well, or perhaps not so well, to manage yourself and be at your best for your team?

Did you tell your team what was happening?

Nancy El-Miski

Yes, they knew. After everything that happened, I wanted them to understand palliative care and what someone undergoing cancer treatment may experience.

I also discovered that other staff members had family members who had experienced cancer. Some had experienced grief themselves or were currently going through it.

It helped open those conversations.

I think that because I was vulnerable, it allowed my team to be vulnerable and open up to me as well.

It also allowed me to become more empathetic and understanding.

If someone was having a bad day or did not feel able to come to work because of a personal situation, I could see them as a human being.

It was not simply a matter of saying, “This is work, and you have to be here.”

We all need to work, but we also have personal lives and personal issues that need to be managed appropriately.

My vulnerability allowed the team to see a different side of me.

Nancy El-Miski (19:54.200)

They often thought I had everything together.

Krysti-Lee Patterson

Yes.

Nancy El-Miski

I did not feel that way, but they were a great support, and I really appreciated the team I had.

When people know your vulnerabilities, they begin to understand you as a person and become more empathetic.

We developed an empathetic and understanding team that was willing to support one another.

If I was not at my best, they would give 110 per cent. If they were not at their best, I would give 110 per cent. We could balance the day and lean on each other.

Being a 24-hour pharmacy, we needed to be empathetic and understanding. We could not behave like robots or simply say, “My job is done.”

We would stay behind during shift changes to help the next team get into place and prepare for the shift.

We did not complain about staying an extra 10, 15 or 20 minutes. Patients were waiting, and we did not want the next pharmacist to be overwhelmed.

We knew that if we allowed that stress to continue, it would escalate later.

I think the experience brought us together.

Krysti-Lee Patterson

I think that is wonderful.

I am a strong advocate for showing some vulnerability as a team leader, manager or pharmacist.

Some pharmacists say, “I’m not a manager. I’m just a pharmacist.” But even without the title, a pharmacist is a leader. Pharmacy assistants, junior staff, students and dispensary technicians look to you for guidance.

It is valuable to have a team culture where people can share some of their vulnerabilities and support a colleague when they are not at 100 per cent.

It can be helpful to say, “I’m coming in today, but I’m not at 100 per cent.”

That communication allows the team to work together.

When I started my first job, the culture was very much, “Leave your problems at the door when you come in.”

We now understand that is physically impossible.

Nancy El-Miski

That is so true.

Narrator

Pharmacy Daily is a proud supporter of Your Pharmacy Career Podcast.

If you are in the pharmacy world, it is a great resource for staying up to date with the latest industry news.

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Nancy El-Miski (23:42.090)

A workplace is not separate from your life because you probably spend more time there than you do in your own home.

Your colleagues become like family. If people are not understanding of each other, it will not work.

Patients can feel the dynamics when they enter a pharmacy. They can tell when everyone is looking out only for themselves or when the team is disconnected.

Krysti-Lee Patterson

They certainly can.

When I walk into a pharmacy, retail environment or any other business, I can sense when something is not right and the team is not working together.

Nancy El-Miski

That empathy also affected how I interacted with patients.

I was not afraid to speak with my patients about my own journey.

There were days when they would look at me and ask, “Nancy, are you okay?”

I would say, “No,” and start crying. I received hugs from my customers, and I realised it was okay to cry with them. That was part of my grieving process.

I remember a young woman who came into the pharmacy. Her doctor had prescribed an antidepressant after her grandmother passed away.

I explained that it was okay to cry and feel those emotions. She started to cry, and I gave her that space.

It is important to let people know that it is okay to be vulnerable and to experience the stages of grief.

It is okay to cry, feel angry or upset, isolate yourself for a time and move through the journey.

Some people think grief is the same as depression, but it is not necessarily the same. It is a journey a person may need to move through.

Krysti-Lee Patterson (26:03.202)

Absolutely.

Grief can also extend beyond palliative care.

A memory came to mind when you were talking about a patient crying with you.

I was supporting a patient who had been prescribed MS-2 Step. For listeners who are not familiar with it, it is a medicine used for medical termination of pregnancy.

There had been some discussion in the pharmacy about which pharmacist would speak with her because some pharmacists did not feel comfortable supplying the medication, which is their right.

I spoke with her in a private area. During the discussion, I discovered that it had not been her choice to end the pregnancy. She had experienced a miscarriage, and this was not what she had wanted.

I asked her, “Are you okay?”

She said, “No,” and began to cry.

I do not remember exactly what I said afterwards. I may have told her it was okay to cry, and I may have started crying as well because I tend to cry when I see someone else crying.

It was not exactly the same situation, but it showed the importance of giving a patient a safe space to share what is really happening.

Sometimes you receive a prescription and assume it is for one situation, but there is much more to the story.

That probably happens frequently with palliative care prescriptions, but it can occur with many other medicines as well.

Nancy El-Miski

Exactly.

That is why it is important to ask appropriate questions in the right way, allowing the person to open up.

You gave her privacy and made her feel it was safe to express what she was grieving.

That is powerful and is part of our scope in pharmacy. It is also how we can counsel patients effectively.

If you had gone directly into standard counselling, you might never have understood what she was experiencing. You might have simply explained how to take the medicine, handed her the Consumer Medicine Information and sent her on her way.

When we take the time to understand someone, see them as a human being and look more deeply, we gain so much more.

I’m sure that woman appreciated the support and may have returned to you because of the space you created for her.

Krysti-Lee Patterson

It also made me rethink how we approach counselling.

As a student, you are trained to perform these processes quickly. You see a medicine, immediately associate it with a particular indication, counsel the person and move on.

To your point, we need patience and time.

It may sound naive, but I had never considered what happens when a pregnancy has ended in utero following a miscarriage. I had never thought about the physical process involved or why someone might need to take that medication.

It reminded me that there is often more to the story.

Training the wider pharmacy team is also important because team members receive prescriptions, hand out medicines and speak with patients.

Did you apply these principles to other pharmacy services?

Nancy El-Miski (29:47.180)

Definitely.

As I began to understand this approach, we started building services around the patient rather than the pharmacy’s convenience.

When pharmacies develop services, team members may say, “We can’t offer it on that day,” “This person isn’t here,” or “We can’t do it at that time.”

Eventually, the service does not work.

Instead, we thought about the patient’s journey from diagnosis.

When we developed a sleep apnoea service, diabetes service or weight-management program, we considered what the patient was experiencing.

For example, a patient has just been diagnosed with sleep apnoea. Their entire relationship with sleep is about to change.

How are they feeling? What happens when they walk into the pharmacy with a prescription or referral related to sleep apnoea?

Are they left waiting? Are they pushed aside? Are they told to return tomorrow?

What does their journey through the service feel like? Do they feel connected with the pharmacy team? Are we providing a complete solution?

We designed services by examining the patient’s journey from diagnosis, through what happens at home and through their experience within the pharmacy.

You need to identify the pain points a person may encounter to develop a successful service.

We also recognised the sense of urgency.

When someone receives a diagnosis, it feels urgent to them. They want information.

When my dad was diagnosed, we wanted to know everything. What did he need to do? What did we need to do? What could we do immediately? What appointments did we need to book?

People want answers.

Nancy El-Miski (32:08.192)

If your pharmacy offers a service, but no one can help because one particular team member is absent, the patient may leave angry, upset and confused.

When you do not respect a person’s needs within a service, and instead make the process slow, complicated or impersonal, you lose them.

More importantly, you lose the opportunity to help them.

When a pharmacy gets it right, the patient feels seen. They feel as though someone is in their corner.

The service moves at the pace of their needs, not at the pace of the pharmacy’s convenience.

When it goes wrong, it is usually because the service has been built around what is easy for the store. The patient feels that and begins to feel like a transaction.

When someone comes to you in a moment of need and leaves feeling more alone than when they arrived, we have got it completely wrong.

My experience of grief changed how I thought about almost any diagnosis or major change a person might experience.

We need to understand their journey and apply that understanding to our services.

That means responding with urgency, providing the right advice and ensuring the whole team understands why the service exists, how to explain it and how it operates.

Krysti-Lee Patterson

That is so important.

I have worked in pharmacies and also walked into my local pharmacy as a customer. When the one person who runs a service is not present, it can be difficult.

You might ask, “Can I book a flu vaccination?” and no one knows how to arrange it.

Nancy El-Miski

Exactly.

Krysti-Lee Patterson

We know staffing is difficult, but even when the key person is absent, other staff should at least know what is available.

One of my pet hates is when a team member yells across the pharmacy, “Do we do this?”

Nancy El-Miski

Exactly, because it makes you lose trust. You start to wonder whether the team knows what they are doing.

Krysti-Lee Patterson (35:04.342)

Even the way you communicate uncertainty makes a difference.

I have worked as a locum pharmacist, and it can be difficult because you may not know everything that is happening in the pharmacy.

Rather than appearing dismissive or uninformed, I would say, “This is my first day here, and I am still learning how everything operates. I’m going to find the correct information for you.”

Wording it that way is often enough to reassure the person.

Even when you do not know the answer, you can communicate it differently.

Nancy El-Miski

Exactly.

I became a locum pharmacist after many years, and when you are locuming, you do not necessarily know what services each pharmacy provides.

Even if the pharmacy did not offer the service, I would look it up and find somewhere appropriate to refer the person.

Through my locum experience and knowledge of other pharmacies, I could often refer them to another pharmacy and tell them who to ask for.

I did not want someone to leave with me simply saying, “I don’t know.”

I wanted to give them something practical to work with.

Pharmacists are often the first healthcare professionals patients approach, and we are well placed to help them navigate the health system and make appropriate referrals.

Pharmacists are very resourceful.

We need to educate ourselves about other healthcare professionals, including podiatrists, exercise physiologists and others.

We should have a general understanding of which providers are available in the local area so we can help our customers navigate the health system.

Krysti-Lee Patterson

Absolutely.

Nancy, I feel as though this topic could become a series in itself. There are so many aspects of grief we could explore.

Before we finish, I want to bring the conversation back to the person listening right now.

Perhaps they are listening during their lunch break and are about to walk back into the pharmacy. Perhaps they are listening on the drive home and will be back at the counter tomorrow.

If that pharmacist is carrying grief, or someone in their team or one of their patients is experiencing grief, what is one thing they can implement immediately?

Nancy El-Miski (37:13.602)

Start by noticing it more.

First, learn about the stages of grief.

Grief does not always announce itself. You cannot always see it clearly.

However, you may notice that a regular customer or staff member who usually comes in every morning and says, “Good morning,” has not been themselves for the past week.

That is a sign to check in with them.

You might notice that Mrs Smith seems quieter than usual and ask, “How are you going?”

It can be as simple as genuinely asking, “Are you okay? Is everything okay?”

That may be enough for the person to feel seen and create an opportunity for them to open up.

They may say, “I’m not feeling my best.”

You can then ask whether they want to talk about it. If they do not want to talk, that is fine.

You may be able to offer practical relief. Do they need time off? Do they need space? Is there another way you can support them?

That applies to both staff and customers.

A customer may have just left hospital or received difficult news from their doctor. They may be sitting quietly in the pharmacy and behaving differently from usual.

A customer who normally greets you enthusiastically may instead sit silently.

You can approach them and ask, “Is everything okay?”

They may tell you the doctor has just given them difficult news and they feel overwhelmed.

That gives you an opportunity to ask how you can help.

Perhaps you can arrange medication delivery or organise a Dose Administration Aid, such as a Webster-pak, for their partner.

You can identify a practical way, within your scope of practice, to make their journey easier.

Nancy El-Miski (39:36.566)

By doing that, we build better rapport with customers and create continuity of care.

We also create opportunities to provide education.

These questions and genuine engagement with customers are very important.

As we discussed earlier, grief is not only associated with someone dying.

Grief can result from a divorce, children leaving home or another major life change.

A woman may come into the pharmacy feeling sad because she has raised her children and now finds herself alone at home. She may be grieving the life she had before and trying to build a new life.

In pharmacy, we encounter many forms of grief among our patients.

If we do not understand grief or know how to respond to it, we will struggle to connect with our customers.

Krysti-Lee Patterson

That is so true.

I also appreciate your point that grief is not only related to death. It can follow a relationship breakdown, a job change or another major transition.

It is a response to change, and the emotional response does not necessarily differentiate between the causes.

My husband has spoken about the grief he experienced following his divorce. He had been married before, which some listeners may not know.

He described it as grieving the loss of his child.

His daughter had not died, but suddenly she was no longer with him every day. He had to learn how to live with that change.

After hearing everything you have discussed, I can see that he was moving through a grieving process.

Nancy El-Miski

Exactly.

When you understand that, you can hold more space for someone and respond with greater understanding.

Otherwise, you might wonder why they are so angry or why they cannot accept the situation.

You might think, “He can still see his daughter on the weekend,” and make excuses for why he should not feel the way he does.

But it is a grieving process.

Understanding grief also meant I did not become as upset with patients if they were angry or impatient on a particular day.

It made those interactions easier to understand.

I remember a patient who came from the hospital and wanted to return a pair of opened insoles.

He had purchased them for his wife. They had been opened and used, but he was adamant that we should accept the return.

He became very angry with the first staff member he spoke to.

When I joined the conversation, I asked, “Who are these for?”

He explained that they were for his wife, who was unwell in hospital, and he began to break down.

He was angry about what was happening to his wife. His anger was not really about our inability to return the insoles.

We found a way to help him.

Once he opened up and we understood the situation, I could hold more space for him.

Without that understanding, the instinct might be to ask him to leave the store.

Krysti-Lee Patterson

I have probably thought that at some point.

Nancy El-Miski

Sometimes you need to slow everything down and ask whether the issue is really about the insoles or whether there is more to the story.

That is what grief taught me. There is often a story behind anger, frustration or distress.

I always want to understand what that story is with my patients.

Krysti-Lee Patterson

That is beautiful.

Nancy, thank you so much for your time today and for sharing such a personal experience.

I know it cannot be easy to discuss, and you have done very well to hold everything together throughout the conversation.

Nancy El-Miski

This is the first time I have opened up about it publicly. Usually, I have only spoken about it with people in my immediate circle.

You have made me feel very comfortable sharing it today.

Over the years, I have been able to accept and understand it more. I think it is important to share, and it is also part of my healing journey.

The more you talk about it, the more you process it.

As I told you at the beginning, I cried while thinking about this podcast, writing things down and considering how to present the story. All the memories began to return, and it took me back to that time.

But I also saw the strength that came from it, which was amazing for me.

Thank you for that.

Krysti-Lee Patterson (45:21.816)

That is completely okay.

I feel privileged to be in a position to help you share your story because I know it will have an impact on everyone listening.

Nancy, thank you again for joining us for a second episode. It has been lovely getting to know you more.

Are there any final words you would like to share before we finish?

Nancy El-Miski

Always keep the patient in mind.

Remember that empathy is a very powerful tool, and it is one of our best tools in pharmacy.

Be empathetic. Be understanding. Create space for your customers to open up, and you will see them flourish.

Always remember that there is another side to everyone’s story. Every person has a personal journey they are going through.

Krysti-Lee Patterson

Absolutely.

Thank you, Nancy. This has been a very important conversation.

That is all for today’s episode of Your Pharmacy Career Podcast.

If this episode has raised anything difficult for our listeners, we will include a link to the Pharmacists’ Support Service in the show notes.

If anyone has been affected by this conversation and would like to contact Nancy, we will also include her LinkedIn details in the show notes. I’m sure she would not mind people reaching out.

Nancy El-Miski

Not at all.

Krysti-Lee Patterson

Thank you so much, Nancy.

Nancy El-Miski

Thank you.

Narrator

Thanks for tuning in to Your Pharmacy Career Podcast, proudly sponsored by the Pharmaceutical Society of Australia.

The PSA is committed to empowering pharmacists through advocacy, innovation and industry-leading professional development.

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