You're at the Coaching Inn 3D Coaching's Virtual Pub where we enjoy conversations with people who are engaged in the world of coaching. Welcome to this edition of the Coaching Inn. I'm Claire Pedrick. And today it is my absolute pleasure to be in the good company of Dr Katherine Mannix, author of Listen and End in Mind and also the TED speaker who's done this amazing thing that we've been sharing on socials. What happens as we die, Catherine? Welcome, Claire. Thank you so much for inviting me.
Great to be with you. Can I just confess, I am known in the coaching profession for saying, don't guru me and I don't guru anybody except for you. Oh, no, I can't be a guru. Um Oh, hang on. Look, you see this. Um the my phone is alarming. Not, not that, it's terrifying. It's simply telling me to make sure that I'm I'm here, but we're already here. No, I can't like I, I can't be anybody's guru. I mean, I can barely run my own life really.
And, and, and you will know that thing where there's um the person who goes to work, who's the kind of public facing client facing person and then there's the person who actually lives your life in all its chaotic glory. Yeah. Absolutely. Absolutely. So, what I need to tell you is that I don't recommend very many books to coaches. And one of the books that I recommend is your book. Listen, because I think it's one of the best book, probably the best book out there about listening. Goodness.
Well, that's, that is such a compliment coming from somebody with your experience and wisdom, Claire. Thank you. I'm, I, I'm really honored and I've been surprised, delighted, but, but surprised at the new, um, readership that this book has picked up compared with, uh, with the end in mind very much is, is talking to people about dying and it's largely been picked up by the public or organizations that deal with dying and death and bereavement.
But listen, has a whole different, uh, new, new groups of readers and that I, I didn't foresee it coaches is one of them. Um, and it's being used in, in training of, I've discovered, uh police officers and prison officers and, and, and as these new groups declare themselves, you think actually, yes.
How could you possibly do that job if you weren't able to find a way to listen to what's going on to the people who uh II I, I'm torn between saying the people who you serve, which I think is the right model and the people who are in your charge, which is also part of the model that they're working to listening is absolutely paramount, isn't it? Yeah, absolutely.
And yeah, I was talking to a nurse yesterday who's using coaching in palliative care actually, um, and I was recommending your books to her. Uh, and uh she was saying that when she has conversations in coaching, she talks about the guest, we are a guest in the conversation, which I love because that's really what you're getting at and listen. Isn't it that we are a guest in somebody else's life for a bit of time? Yeah. Absolutely. Right.
Don't, don't make the mistake of thinking that, you know, the answers or that you're in charge. Exactly. Exactly. Um, I've got a new book coming out in the autumn and I almost called it. We offer, they choose pictures, a line which you've probably forgotten. But I, I talk about that line from listen all the time we offer and they choose because it, it, maybe I like your book because I agree with it. You're so just saying, and it's always good to read something you agree with. Right.
Yeah. So what title did you come up with in the end? It's called The Human Behind the Coach. Oh, nice. And it's out when, uh, November good. We can look out for it. But, but it's it. Y yeah, I mean, II, I was listening to listen on audible and I had to get a copy and go through and highlight all the pages because there's so much in there about, about human to human encounter. Um, and then you launched your TED Talk. Yeah, I've had, I've had an interesting, uh, autumn really.
Um, because I've always thought it would be interesting, although I knew it would also be terrifying to give a talk at a, at a TED event. And then over the course of the autumn, I had two invitations in quick succession. One of which actually was to two events back to back an ordinary if you like TEDX event in Dun Laoghaire followed the the next day by a youth event.
And actually, the youth event was absolutely superb that the young people's talks were fantastic and they've been brilliantly coached and supported by the organizer and her team. Um just bringing out the best in them, bringing out their confidence and their ability to, you know, stand up and give an account of something that they were knowledgeable about and passionate about. Absolutely superb coaching. And I was invited to um cheer everybody up by talking about dying afterwards.
And, you know, it was, it was a really remarkable event. So now there are three talks up from the, the, the ted's platform which goodness me a year ago, I wouldn't have thought that that could happen even once, let alone three times. It's so important, isn't it to be, to be normal about everything? Yeah, one of the things that I get told a lot is what people find helpful about what I'm doing because I'm not doing anything extraordinary. Really.
I'm just talking about stuff that people don't usually talk about. Exactly. Um, but the thing that people seem to appreciate about it is, first of all, obviously I'm speaking about, um, dying or communication from a very, very long experience of working with dying people or facilitating communication in families or training people to communicate or, or being in conversations that matter, either therapeutic conversations or just, you know, being a human being.
Um, but the thing that people seem to like is the fact that there isn't a special voice for it. Now, in fact, there is a special voice for it because what I'm doing is I'm using the voice that I practiced for years as a mom, which is, although we're talking about something quite serious here, I'm not using a very serious voice voice. And my kids recognize that voice with horror because it means they're in really big trouble. I love that.
So when they listen to things that are recorded online, they, they, they go, oh, mum, I can't believe you're using the voice, but actually I think it's probably the same voice that I use when I'm trying to make sure that I order the right vegetables at Christmas, you know, and I go into the green grocers and I go through my list it, we're just talking about something and we're, it, it matters, but we're not going to get all kind of emotional and drippy and to my head.
So I have a very special sad voice because that just al al already that's changing the agenda isn't, it's making assumptions about the way the conversation's gonna go. You've just validated my dislike of the diagonal head. It's a really interesting thing. We, we laugh about it a lot in palliative care. Um, and there are people who call it the, the, the Macmillan tilt.
But actually when you're just in a human to human contact with somebody and they're telling you something that makes you feel, oh, I just, I ache for you listening to you telling me this, you will notice that your head tips and it's not, it's not a thing that we do to signal reciprocal emotional something. It's a thing that happens automatically. And I'll quite often find myself in the middle of a conversation with my head over here.
And I suddenly think, ok, I've got to get back up to upright without looking as though that's what I'm doing. I, I gradually, you know, adjusting by a couple of degrees every few seconds to try and get my head back up to 12 o'clock. So we kept ourselves doing it. And the problem is of course that the people who we're talking to find it very, very irritating because they interpret it as pity. But actually, empathy and compassion will move your head in exactly the same direction.
So, it's about bodily awareness, isn't it? It's trying to all that spinning plates of communication. What is my voice doing? What words am I choosing? What are you saying? What are you really saying? And also what body position have I adopted all at the same time. It's really tough to take notice of all those plates and keep them all spinning. Absolutely. Absolutely. So I listened, I read your thing on Twitter. I think it was about listening to your, what happens as we die ted thing.
So I listened to it for many reasons, partly because I'm very interested in, in conversations around dying, which is a kind of personal interest as well as a professional interest. Um I then shared it with my dad who's 90 all sorts of other people s kind of straight away. But the thing that really struck me from it, Catherine is that my definition of coaching is a conversation where somebody feels heard and gets new insights into their own stuff.
And as you were describing the conversation with that lady about what dying looked like. That's what was happening. She was right. She was feeling hurt and getting new insights. Yeah, I never really thought that the job is deaf coaching before, but it actually is. And well, we already ii, I very often compare the, the parallels between what happens at the very beginning of life and what happens at the very end of life. I it's not hard at all to accept that midwives are doing birth coaching.
That's exactly what the job is, isn't it? It's about the health of the pregnant person. It's about the health of the baby or baby's and it's about how to do giving birth. It's coaching in order to not exhaust yourself discovering at the last minute stuff that you could have known about mentally rehearsed, physically rehearsed in advance. And actually now, ok, so now, now you've moved my, my head with that explosion of insight.
The other thing I realize that we do that's very helpful, which is another type of rehearsal is for families who are looking after a person who they hope will be able to die in the place where they're currently living, might be their own home, it might be in a family member's home, it might be residential care where they're really happily settled.
And what they don't want is for them to be lifted out at the last minute through a crisis into an ambulance and, and off to a hospital where they haven't got familiar people and sounds around them. And one of the things that I very often used to do would be to do a kind of, I would call it a cognitive rehearsal with the family. So we've talked about what dying is probably going to be like.
And that gradual onset of tiredness and increasing tendency to sleep, eventually not being asleep, but being unconscious, breathing changes, that can sound a bit disconcerting and then talk to the family about. So let's say we get to the stage where the breathing sounds noisy. And you might be wondering, is this, is this the thing that they told us about or is this not OK? Is this different from the thing that they told us about? How will you deal with that? Let's practice.
Now, let's do a kind of mental run through of what will you do? So the minute they, I 9999, ok. What's going to happen if you dial 999 and the algorithm that the person's following at the other end of the phone will almost certainly dispatch an ambulance because the person isn't responsive, isn't replying to you and we're expecting that they're perfectly safe. They're doing ordinary dying. So let's think about what are the other responses we could make.
Where's the other sources of help that we could turn to? Um And it's the same thing again that midwives are doing with birth partners. Um It's the reason that um birth dealers can be so helpful and end of life dealers now are, are a growing thing. I'm a patron of the U K's organization End of Life. Do the UK. Just that wise person, usually a woman but not always a woman who's saying, yeah, this is normal, this is OK, this is safe. This is what we're expecting.
Yes, this, this is what usually happens or this is one of the patterns that usually happens. But who's also able to say, oh, hang on? No, this is not ok. Now, this thing's unusual, I think this might be distress. We need to get this checked out. We don't want this person to be distressed.
You know, pain, for example, is not part of the process of dying, dying only causes you to lose consciousness and the pain will be coming from whatever the illness is that the person has had probably has painkillers in the house. We probably know the right dose of painkillers. Maybe they haven't been able to swallow for a little while and their pain is coming back, maybe they're overdue an injection, whatever. So there's a person who's able to normalize that which is normal.
And then also say, oh no, hang on this, this now is unusual. And if this is the first time you've accompanied a dying person, why on earth would you know that? And that's why I'm so keen that we all know and understand and recognize and talk about ordinary dying. Because between us, even if we've only seen one or two deaths, each, if there are 30 people in a, in a supportive community, then that will be between 30 60 deaths between them that they can call upon.
And if somebody has been an end of life worker, you know, a a care worker in residential care, community care worker, uh somebody who's worked in hospitals or hospices or whatever, they may have seen hundreds or even thousands of deaths and it's a library of resources to be able to call on. Mm, not beautiful. The beginning, the birth and the death and the normal cycle of life. Yeah. And the coaching of people. I love that Claire. That's great.
And there are end of life coaches who work with people from diagnosis uh to actually say given that you've got three or six months or whatever left or an unknown amount of time left. What are the things that you want to be doing in this time that are going to be the most life giving for you and the, and the people that you love, which is such a different model, isn't it from the? Oh, no. Oh dear. Oh help version which does need to be managed as you say, but it is slightly different.
Well, I think a a again, you know, when you have a positive pregnancy test, there's a whole load of emotions there and then not all joyful because every change is a loss as well. Isn't it a loss of what was before and so again, birth and death so much in parallel, but that shift after doing the adjustment? Oh, ok. So this is what is happening now in my life, right? Ok. Are we going to do the the Oh no or are we going to have a conversation about? Ok. So what really matters most?
And that's such a great question, isn't it? What, what matters most to you? Because those are the places now to absolutely put focus when time is precious and there's not a lot of time left. How could, how could we use that time best? And what are the things that are happening that just, you know, you've got the absolute note to school to get out of pe now, haven't you, you, you just, you choose you, you be the captain of this ship and we can come along, we can crew it for you.
We can help you to navigate it, but you have to stay in charge. Yeah, you have to stay in charge and yet the, the, the, the desire to help somebody accidentally often changes who's in charge of the ship, doesn't it by mistake? Isn't it hard not to help? Isn't it just so hard? Don't you find yourself? You know, even even as a really experienced practitioner sitting there thinking, oh, if you could only do this or think about that or try this out.
And it's really interesting when I'm training new healthcare professionals and I'm teaching them to listen. Um and I'm teaching them to use curiosity and questions rather than advice and suggestions. I hear them cheating and doing that thing. That's so tempting, which is, oh, I've got to ask a question, but I'll bury my advice in a question.
Yeah. Have you ever thought about the possibility that you could, is still giving advice and it's hilarious as you watch, people realize that they're doing it. Yeah. Yes. Yeah. We're not taught to ask questions. Are we as humans? No, we, we, yeah, we, we, it's interesting. It's almost like we're trained out of asking questions, isn't it? Children are just so curious. They are so filled with curiosity and they, it, it's all questions.
And somehow we take that curiosity and we start to tell them that there are places where you know, this is a classroom. Now, your questions are not welcome here. Your, your silence is required here. And to some extent, everybody else in the classroom can only benefit if what's going on can be heard. But of course, the teachers that we all remember are the teachers who encouraged our curiosity.
The teachers who managed to look fascinated by our question as though it was the first time anybody had ever asked them such a fascinating question. And yeah, we need somehow to, to re reinvigorate curiosity and hold on to it for the whole of life. Yes and enco yeah, encourage.
I'm, I'm just thinking about school where the people in the classroom who ask the question is the teacher, but the teacher asks a question with an expectation of a particular answer because it's the educative process, isn't it? So who knows what this is? Or there's there's always a right answer rather than it being about exploring. Yeah. So, what was your hope for? Listen, when you wrote it, Catherine? That's a, that's a really good question. You would think.
I would know the answer, wouldn't you? But the thing was I hadn't really intended to write a second book. I'd, um, I came along to just help people to understand ordinary dying by telling stories of the way people live during ordinary dying. And that, and my hope in some way was that just as my grandmother would have understood dying by just being there.
Um Looking after people dying at home and having what was going on explained to her by the older, again, mainly women, probably not only women, but mainly women who themselves had been trained by the previous generation. Um And so she knew it by knowing the people and watching what was happening to those people as they died. So when I was trying to think, how would, how could you give that back to the public now that they don't have that experience of looking after people at home?
It has to be by them, meeting people in the place that they are doing their living as they're doing their dying, telling a story in a way that makes the person really care about what happens to this person. And that's why I use stories and I thought that that was it, it would go out there. It would be in some libraries, some of my friends would probably use it.
Um, but I kind of done what I came to do and I hadn't anticipated at all how successful the book would be my, my publishers had and II, I didn't really believe them if I'm honest. Um, and then there was this huge response from people partly, um, about the education about dying, which is kind of the correspondence I was expecting, But also this other correspondence that was ok, you've convinced me this is something we absolutely have to talk about.
But I've got no idea how to start that conversation, whether or not to pick up that conversation. Um What would happen if I made the person sad? What would happen if I made the person cross, what would happen if I made their family cross, healthcare professionals say, well, you know, I might get into trouble. I might get sued and then dying people writing to me saying I am desperate to have this conversation with my family and they keep closing me down and I don't know how to open it up.
And I thought, do you know what I've got quite a lot to say about these conversations? So I went back to my publishers and said, look, I think I've got a book in me that's about communication. And what's really obvious from most of these letters is the tone of if I could just give this person a really good talking to, we could thrash this thing out and sort it, which is absolutely the cart before the horse because the key thing is shutting up and listening.
So I'd like to write a book about communication and it will be called, listen. And they never argued about the title. What they did argue about was they came back and said, well, yes, that would be marvelous. We'd love you to write another book, but it mustn't just be about dying. We don't want another death book. And I thought, oh, that's a bit awkward. Really? Isn't it? Because that is what I know best.
And then I stopped and thought about it and thought, no, it's not the only thing I know, of course, because I had a cognitive therapy practice. That was largely but not exclusively palliative care. And, you know, I've, I've lived a life, been a trainer, I've managed services and people and, um, run a home and live in a family and have friends and all those times when there are conversations where you think, oh, I really shouldn't tiptoe around this. This thing really needs to be talked about.
But I do wish somebody else would start the conversation and not me or I wonder if that person even realizes the effect of the way they're behaving on everybody else. I wish somebody would mention it to them, those kinds of things, those daunting conversations. So I think in the end they were right. That it is a better book for being across life span.
And my hope for it really was that it would do the thing that I've been asked to do, which was help people who were daunted by conversations about serious illness, dying, death, grief, bereavement to navigate those conversations.
But even as I was writing it, I could feel that the premise was growing that although I was describing a skill set that I had witnessed, and I had used principally for those sorts of conversations that actually what was happening was a distillation of why conversations work in the first place. And I was really helped by um conversation analysis expertise. So I got the contract to write the book in January of 2020 with 12 months to deliver the book and it was 2020.
So although I'd written the proposal, I just then wasn't, I was completely unable to write as I was watching what was happening across China, it was starting to happen in Italy, COVID cases are rising. We were hearing from our colleagues in Italy about the health service overwhelm. We knew it was coming. And I just thought I can't, I can't sit at home and write a book and sit on, you know, 30 years of experience of helping people who are sick enough to die. So I went back to work.
And so first of all, I volunteered for NHS England and that brought me back into contact with Professor Ruth Parry from Loughrey University as a conversations analysis expert who helped a small group of us doing a project for NHS England to develop a training package. A very quick, easy to digest training package for those daunting conversations. How do you break unwelcome news? How do you discuss, um, when cardiopulmonary resuscitation and CPR isn't going to be helpful for someone?
So you make a certificate to protect them from that. How do you have that conversation? So people don't think that they're having, they're being deprived of treatment that would help rather than protected from treatment that won't help. And so we devised a training package. I then went back into the NHS because I was over 60. They wouldn't let me be patient facing, which was an interesting emotional response of being really disappointed and incredibly relieved at the same time.
But doing staff support and running a communication skills training for newly qualified doctors, newly qualified nurses about these tender conversations, explaining about dying, breaking unwelcome news. And by the time we'd run this training three or four times, we were having requests from all over the place to run it for them.
And eventually we had, you know, very senior intensive care unit, staff, um respiratory professionals, people who I wouldn't have thought would need that training, but who felt that they could benefit maybe just from having a structure around it because they were having to do it so often and it was, it was such an emotional burden for them. So I stayed doing that until our first wave had passed locally, which is probably July or August. So now I've only got five months to deliver a book.
It was going to take a year to write. But I've been doing the practical for months. I've been thinking about what makes these conversations work and coaching people in small groups around conversations and observing the things that they do well, and the things they struggle with and the messages that they struggle to hear from the coach. And so actually, the book was so much richer for having that expertise distilled into it than it would have been if I just sat down to write it from January.
Thank you. I notice that watching other people having conversations is a huge source of learning for me. It's, it's very, very interesting, isn't it? And, and some of the time it's startling that they don't take the very obvious route in front of them that they kind of embroider their way into a very difficult backwater.
Um And it's really interesting trying to unravel what was happening for them that, that seemed like the obvious route for them when there was something that was as wide as an open barn door that I could see and either they couldn't or they didn't like the dark that was on the other side of that. So they weren't going to go there even they, they could see it was open.
Fascinating. And I think there's something isn't there about the time delay between seeing what you describe as the open barn door. So we see the open dander and we think, oh, no, I need to say something here. That's about listening. Now, let me think about what that might be and, and all that creates a big time delay. So by the time we offer back our invitation, it's half a second.
One second, two seconds, three seconds, five seconds after the door was opened and now we're not, now we're slightly out of sync. And I think that's why it sounds weird. That's interesting.
Yeah, I have to go away and think about that because one of the things that was really interesting about teaching the theory as proper practical practice and then meeting those practitioners again afterwards and then reflecting on how their conversations were going after having attended the training was t teaching them.
The thing we were talking about before that we're not taught to ask questions and to encourage them to understand that this isn't like a pain assessment where you've got seven questions in a row and whatever the answer to question one is, question two will still be question two. This is a completely different model of communication.
Your opening question is the only question that you will dream up from inside your own head that after that your next question explores what the person told you in response to your first question. So you don't know what the question is. You have to think about what they've said to work out what you need to further understand. Do you need to take it wider? Do you need to go in a bit deeper?
And that means there will be a delay between when they stop talking and when you start talking again and you call that silence. In fact, you call that awkward silence.
And what they observe is you thinking about what they just said, what they observe is that you are listening, that you are participating if they observe it at all because we know, don't we from audio tapes and video tapes, um, practice sessions that we, we'll have AAA person who's being trained to come out this, oh, there was that terrible silence or, you know, I just, I, I, she said that thing and I just, I couldn't even think what to say next. Um, and how long do you think the silence was?
00, it was forever. It, it must have been, I don't know, it felt like half a minute. So now we replayed the tape and there is a silence and it is five seconds maybe, which feels like a very long time, doesn't it? And then the patient will say I didn't even notice that silence. I was absolutely caught up with thinking about what it was that you'd made me think about. And asked me about, I didn't notice that silence at all. So helping people to understand that silence is your friend.
That silence is thinking time that this person isn't sitting looking at you thinking they're too stupid to say anything. They are still in their own head thinking about, have I given them everything that I should have done here? Is there anything else I could say? Or they're joining dots? Because you've helped them to say something out loud that they've never said out loud before? And now they're thinking, oh, and maybe that is because of this, which is related to that.
They are not attending to your silence. They are doing their own work in a space that you are providing by holding a silence for them. That's such a new concept to clinicians who've been trained to always know the answers and to use questions only as assessment tools for a medical model of a problem. I think I agree with you about medical people. But I think it goes way beyond Catherine because what I observe is that people don't look when the silence is happening.
So they lose connection with what the silence is doing, which is, which I think is really interesting. So one of the things that we teach coaches is to watch and I was doing a supervision the other day and um, it's a group supervision and we do what the person who's brought their thing needs most and what they needed most in the 20 minutes they had was that nobody else spoke at all. But what I observed was that the, that as a group, most of the participants in the group were not watching them.
Most participants in the group were, were thinking about their own question or working out what they needed to say next or thinking about being useful or helpful or whatever and, and then wanted to offer it without looking back to see whether the person who was holding the space as it were was ready for the next thing. So I think timing is a huge lesson that we need to learn as a society.
Yeah. And I love the idea that we're observing the person we're supporting because if we don't observe them, we, we will walk all over them completely inadvertently, won't we? Yeah. So I think helping people to be comfortable that silence is a tool. So you don't need to be uncomfortable when there's silence in a conversation, but silence doesn't mean that nothing is happening that the person we're supporting is doing a lot of work in this silence.
And if you haven't got something particular to say or to offer or to ask right now, you are still working because you are observing and what you know, just teaching people to notice the tiny little bits of body language that tell us that the person we're talking to is still thinking is remembering is synthesizing, is starting to feel anxious about the silence. Now, that kind of look towards you with their eyes, that's expectant. Are you going to say something now?
And how, how you can indicate by your response to that eye flick of leaning forward as though to speak or to lean back and to look down and, and basically say I'm conceding the floor to you. You, I know it's my turn in this conversation, but actually I'm not going to throw the dice this time.
I'm giving it back to you and it's up to you, whether you speak or are silent, but I'm going to wait until you're ready and you can't do any of that, which is really nuanced, often unspoken body language between two people if you're not absolutely observing the person and we have this, I don't know whether it's a British thing or whether it's a human thing of tending to look away from a person who's looking distressed when actually,
that's the very point where we do need to be literally keeping an eye on them. It helps you all day. Um There are so many things that, that are so similar in the work that you're doing and the work that I'm doing. It's, it's, it's really exciting. Thank you, Catherine so much for coming and opening up the conversation about listening. Well, thank you so much for inviting me. Lovely to meet you and a great honor to join you in your virtual bar. Thank you for coming.
So, listeners, if you want to read Catherine's book, it's called listen uh by Katherine Mannix, published by William Collins. And the TED Talk is what happens as we die and it's on youtube. Um Thank you, Catherine and thank you for listening, everyone. Bye bye. If you've enjoyed what you've heard today, we'd love you to share the podcast with a friend or leave a comment on social media.
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