Kathryn Mannix
@drkathrynmannix
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Retired palliative care doctor. Writer: 'With the End in Mind', 'Listen.' Wants us to understanding dying more, fear it less, listen better. Rep: @DHAbooks
Northumberland, UK.
Joined April 2018
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Pinned Tweet
This
@bbcideas
video has passed 3m views on Facebook.
@bbc
ideas has confirmed that it is available for people to use by embedding into their own websites: embed code in my tweet below.
#Itstimetotalkaboutdying
IMHO dying is not as bad as you think. Powerful piece from Doctor Kathryn Mannix on why we need to talk about death.
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What can we learn from the death of the
#Queen
?
The world has watched her live through the process of
#OrdinaryDying
, and yet dying went unspoken, un-named.
Let's notice what nobody mentioned: we all saw the Queen going through the stages of ordinary dying.
A 🧵...
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What can we learn?
That dying is inevitable, recognisable, describable, and that we can prepare for it. The Queen had clearly planned ahead.
That at the edge of life, we can still enjoy love, and peace, and companions.
That we need to get familiar with dying.
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#TipsForNewDocs
Some patients are sick enough to die. They may pull through. They might not.
Say 'sick enough to die' to pt & family. Not 'serious.' Not 'critical.' Not 'unstable.' Name death as a possibility, & plan good
#eol
care in parallel with current treatment plan.
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Dying in plain sight, camouflaged by briefings about 'mobility issues' and medical advice to 'rest.' Because like anyone else, the Queen was entitled to some privacy about her health, and to die away from the public gaze.
But we all saw the process.
Rest in peace, Ma'am.
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This moment.
An interval of joy for a family facing the end of Dad's life very soon.
@widow_waiting
is keeping her diary here. Her courage & dignity are astonishing. We can't choose what happens but we can choose how to respond. This account is a lesson in living.
Miracles *do* happen. We’re beyond thrilled to announce the safe arrival of our daughter. Today, I placed her in her daddy’s arms. They may only have a short time together but his love will last her a lifetime.
#TerminalCancer
#AnticipatoryGrief
#EndOfLifeCare
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She has demonstrated the phases of ordinary dying to us all.
How dying is mainly living, after all.
And how, in the end, we can all plan ahead, address the unfinished business in our lives, and die with symptoms well-managed, even in our own bed if circumstances permit.
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😷 I'll still be wearing a mask:
*for those who are vulnerable
*for those who are afraid
*for those awaiting vaccination
*because delta is more transmissable
*yet-to-arise mutations may be more dangerous
*long covid is serious
*it's not a big burden to be kind
#MaskForOthers
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Thanks for inviting me to talk about the very end of life this morning
@BBCBreakfast
.
I'd love you to post a clip of that description of the dying process for people to watch.
It's so important we talk about dying calmly & with understanding.
Love & thanks to
@bowelbabe
.
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I found this profoundly moving.
Japanese transplant surgeons bow to the donor after taking their life-saving organs.
This
@DyingMatters
week, sign up for the
@NHSOrganDonor
register or local equivalent.
#givethegiftoflife
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Oh
@BBC
-
Please use your D-words.
There is dignity in the language of death, used with compassion & kindness.
Let's give that dignity to the Queen.
Those closest to her are not resorting to euphemisms. Neither should you.
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Once at her beloved Balmoral, the break with tradition in asking the outgoing and new Prime Ministers to attend her there was a sign that she was now too tired to travel.
All of us in palliative care recognised what was unfolding.
Yet dying remained un-named.
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A mother's letter in Student BMJ c1981: her leukaemic child died suddenly while she was absent. The doctor who had to tell her apologised for weeping.
'If you aren't with your child as he dies, you'd want him to be with a person who would weep,' she wrote. 'Never apologise.'
Many doctors admit to crying at work. Probably still more have done so but been unwilling to admit it for fear that it could be considered unprofessional. However, it’s increasingly recognised as unhealthy for doctors to bottle up their emotions . . .
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I challenged
@DGlaucomflecken
to add the palliative care rotation to his 'medical student meets specialist' collection.
He smashed it.
I know there is tea brewing somewhere in that room.
Thanks Dr G!
Still laughing.
@APMPostTweets
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Clair's retirement project was to live the end of her life with grace, campaigning for better access to palliative care for all who need it. She has influenced policy. She has won many hearts. She has lived and died well.
Please read her blog.
Clair died today. We are thankful for her life, which she lived well, and for all the happiness we have enjoyed together.
Thank you for being part of Clair’s Dying Well Journey. This final blog post is her Goodbye.
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I'm advising my family to keep shielding our Mum. This means Dad has to live a shielded life with her.
Why would you ease lockdown, open schools and let down shielding all at the same time?
I fear this action isn't based on the science, but on changing the political conversation.
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This book review moved me to tears. For 25 years, this man has carried the trauma of misunderstanding the changes in his mum's breathing as she was dying.
We all need to understand & talk about dying. Nobody should have to carry that unnecessary burden.
#ItsTimeToTalkAboutDying
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She hung on.
Many people do this, living longer than expected in order to see somebody special, celebrate a last important occasion, hear longed-for news.
Something held her, something important to her own heart, waiting.
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Pals in Twitterland, I'm going back to work today. I don't think I will be 'front line' but I'll be supporting those who are.
So my account will probably be quiet.
Look after each other. I know you will.
Sending love to you. Taking it to work, too.
Nothing else really matters.
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Astonishing.
Since
@TEDTalks
posted my talk about 'What Happens As We Die?' to their home page yesterday, it's already clocked up 15k views.
People DO want better information - so please pass it on.
I'm delighted that TED has chosen to spread this idea.
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Christmas gatherings should follow the same rules that cancelled many other family- and faith-centred festivals this year.
Time for some courageous leadership from our government. No festival should take precedence over public protection.
We're all in this together.
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As her body wearied, she needed to ration her energy, reduce her public engagements, delegate some tasks.
Energy runs out faster as the process progresses.
But her mind remained crystal-clear, her famous sense of humour was undimmed.
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Death isn't a medical failure, it's a biological certainty.
But poorly-managed death IS a medical failure. Get advice. Call for any question. That's how you'll learn.
Let's make enabling the best death possible a medical outcome to be proud of.
You can do this. Good luck.
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How can we do better at supporting bereaved friends and colleagues?
Well, here's what bereaved people tell us.
Graphic is by
@mlalanda
based on 'Listen.'
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My talk on
@TEDTalks
has passed 500k views in under 3 weeks.
I'm just getting my head around that.
It seems that when we talk about dying with clarity & truth, the 'taboo' falls away. People really want to know more.
I hope it consoles many more people.
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She began to make clear her wishes.
Charles' wife to be Queen Consort. The 2nd in line, William, to move to Windsor. Her dresser & special friend joined the Royal household as her daily companion.
I wonder what medical wishes she also sorted out.
#AdvanceCarePlanning
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People want to know more about what happens as we die.
My TEDx talk for
@TEDxNewcastle
went live yesterday. It's already been viewed 44,000 times.
Please help it get out into the world: pass it on in any way you can.
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Every party:
'What do you do?'
'I'm a palliative physician.'
'Is that ...dying and stuff?' Frantic eye movements, searches for new topic. Finally, asks
'What does your husband do?'
I smile and walk away. That was a wrong turn, my death-denying inquisitor.
He's a pathologist.
"What do you do?"
I'm a palliative doctor
"What's that?"
Helping people with life limiting illness improve their quality of life and make a bad situation less bad.
"That's so depressing!"
...
@bmj_latest
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Missions all accomplished, arrangements within the family in place, Constitutional duties complete, her energy was spent.
Even as the family was gathering, it was clear that she was in the last stage of dying.
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Hospitals are not designed for the heartbreak that takes place within their walls.
Let us design hospitals with quiet places, space for reflection, privacy for sorrow, access to safe, green outside spaces, room for tender conversations.
@RIBA
@JDDKarchitects
In England, the government has committed to significantly investing in the NHS estate. What is needed though is a shift from thinking about hospitals as sites to cure sickness, to places where humans provide care, says this
#BMJOpinion
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After Prince Philip died she was noticeably more tired, her public appearances less frequent, her energy less reliable.
Losing weight, walking with a stick: changing month by month, a stage that usually indicates life expectancy measured in months.
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Strength fading, she had tasks to complete. She was able to join in some, but not all, of the long-awaited Jubilee celebrations.
The country waited for a new Prime Minister to be appointed by her, with weeks to wait for that election.
She hung on.
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Thank you
@thehuwedwards
for referring to the Queen and 'she,' rather than the coffin and 'it,' throughout your commentary at the
#QueensFuneral
today.
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I think this is called a 'pinch me' moment.
Still can't quite believe it happened.
Thank you,
@TEDxNewcastle
for inviting me, & to that huge, attentive, supportive audience.
Unforgettable chance to talk about the forgotten wisdom of dying & recruit more of us to talk about it.
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Thanks to
@WmCollinsBooks
for generously making
#WithTheEndInMind
FREE to download today, to support those tender conversations being sparked by
#COVID19
.
Download will be free for 7 days. Please spread the word.
#pallicovid
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The changes began slowly.
Initially, we realised that she was less energetic year by year.
This is the stage of dying when life expectancy is usually still measured in years.
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I'm thrilled to tell you that my talk about 'What Happens As We Die' for
@TEDxNewcastle
is now up on
@TEDTalks
YouTube website.
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Look what just arrived!
It's simply astonishing to see a real, actual book emerge from the long process of envisaging, writing, revising & daring to submit a manuscript.
Thanks to everyone who encouraged the writing of 'Listen.'
Publishing in September & can be pre-ordered now!
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Bravo
@WelshAmbulance
Palliative Care Paramedics.
I am cheering - can you hear me?
The Welsh Ambulance Service has appointed its first palliative care paramedics.
The new recruits will deliver care to patients who are nearing the end of life in what's also a UK ambulance service first, in collaboration with
@SwanseabayNHS
.
Full story:
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Sometimes, meeting your heroes is everything you'd hoped for.
I had the enormous pleasure of meeting up with
@MichaelRosenYes
to record this week's edition of
#WordOfMouth
for
@BBCRadio4
.
This is us 'standing strong.'
Listen in tomorrow
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Well done, everyone.
We got here.
That, for many of us, is our top achievement this year.
Rest well, weary ones, and we'll keep on keeping on tomorrow, whatever the date is.
You are enough.
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I love this story. Bravo Hugh Grant!
@Depheruk
is a real example of
#CommunityAction
.
Here's where you can donate. We can't all match
@HackedOffHugh
but our smaller donations all add up.
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This is why I love palliative care.
And this is why I treasure
@doctor_oxford
and all those great-hearted colleagues who look after dying people with love.
Rachel Clarke
@doctor_oxford
on compassion and grief during the pandemic, in conversation with
@DrHenryMarsh
, Andrii Myzak, Yurii Prokhasko and Iryna Tsybukh at Lviv BookForum yesterday.
Watch now →
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Deathbeds. Some thoughts. A thread.
Most of us haven't seen somebody die in real life. We get our inner pictures from TV dramas, cinema screens, media stories. We've had more of those media stories than usual during Covid19. But we haven't been there for real.
1/n
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We saw when
#DoE
was dying that the Royal Family had plans in place to let him prioritise being at home with his beloveds.
I hope our Queen is afforded the same loving choices.
#AdvanceCarePlanning
matters, whoever we are.
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I feel as daunted as the first time round.
Trying to work out how to be most effective.
Meanwhile, reading & reflecting. Drinking tea. Gardening. Writing. Waiting.
Have to admit I'm scared, too. Like everyone else, I imagine.
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#Pallicovid
: in case it's of use, there's a letter template in
#WithTheEndInMind
that might be useful for those tender end of life situations where visiting is limited & patient is awake enough to dictate or even write to loved ones.
Here it is as a single page, with my love.
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I am possibly slightly crying.
This amazing woman is VP elect of the USA.
The world is changing.
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@Rosiecat2
I'm sorry it's upsetting you, but it's helping lots of other people.
There's bound to be lots like this at the death of a figure like the Queen. I hope you can find peace of mind while you're waiting for it all to subside again.
Sending love 🧡
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I'm very pleased & proud to say that the team at
@TEDTalks
has chosen to feature my
@TEDxNewcastle
talk on the main TED website.
This is such an honour, & a great boost in the campaign to promote public understanding of dying.
Thank you,
@TEDTalks
.
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Twitter provided this information for my
#OrdinaryDying
thread about the Queen, which has now reached 2 million people 😲
Forgive me if it takes me a long time to respond.
Lovely to see people advising & consoling each other in the comments. Thank you all.
🧡
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It's
#InternationalNursesDay
Thank you to the nurses who have taught me, believed in me, dried my tears, held me to account, stood beside me, mentored me, befriended me, made me a better doctor & a wiser human.
Every day should be Nurses Day. We'd be lost without you.
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Once upon a time, a long time ago, I ran away from the truth because I was too afraid to admit to a patient that she was dying. I let her down.
We have to learn to use the D-words, & we have to ensure our least experienced staff are supported when they do.
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Thinking today of bereaved people. People who consistently report that friends and colleagues turn away, embarrassed and afraid to 'say the wrong thing.'
There's no right thing. We can't make them better.
Just listen. Let them to tell their story. Be there.
#saytheirname
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Never underestimate where your words might end up.
This story has me weeping quietly on a train. The mum's love. Her daughter's appreciation. The book I was almost too scared to write.
Be brave and share your wisdom. Somebody, somewhere, needs it.
My mum, weeks from dying, read me passages from
@drkathrynmannix
book, With the end in mind. Once over my shock, I realised she was preparing me, mothering me, protecting me. The book became my talisman and yes, death is a social event, a community event, and not medical. Ta Mum.
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#EoL
care staff need to talk about restlessness prior to death, including it in preparation. Although it's not common, it's highly distressing if companions don't understand it.
Here's an edit of my recent public info post on Facebook, where I don't use medical language.
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As I think I may have mentioned, I think we all need to talk more frankly about dying.
Rather an awkward moment as we begin, now, than a lifetime of regret that we didn't, later.
Thanks
@guardian
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Thank you,
@CallTheMidwife1
, for tackling the isolation & distress felt by bereaved people when friends & neighbours feel too awkward to make contact.
What beautiful modelling of a tender conversation.
It's ok to to say 'I'm here, but I don't know what to say.'
#grief
#courage
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When someone who was 'sick enough to die' gets better, everyone is delighted. That's a win.
When they don't, the mental preparation time for families can make a big difference to their bereavement. That's also important.
#onechancetogetitright
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I'm so glad Prince Phillip was able to die peacefully at home with his beloved wife nearby.
No matter who we are in life, love is all that matters in the end.
Condolences to all who loved and will mourn him.
It is with deep sorrow that Her Majesty The Queen has announced the death of her beloved husband, His Royal Highness The Prince Philip, Duke of Edinburgh.
His Royal Highness passed away peacefully this morning at Windsor Castle.
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Gentle & sensitive assistance by the young staff
@sainsburys
Ponteland just now. You enabled an elderly customer to maintain pride and independence. I saw you help her multiple times, always showing courteous respect. Well done.
#YoungPeopleTheseDays
#kindness
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Again, a bit louder, for the people at the back...
Relief of suffering is part of good care. It's not only for dying people.
If your patient has unrelieved symptoms, consult palliative care. It's what we do.
@APMPostTweets
@RCPLondon
@rcgp
@RCPCHtweets
@RCSEd
@RCSnews
@theRCN
Palliative care is often misunderstood as only being for people who are dying. Yet relieving suffering is an essential part of care for all patients with life threatening illness. How can the palliative approach be used in patients with severe covid-19?
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This is extraordinary.
300k views in so short a time.
The world wants a better understanding of dying. Let's share what we know.
Please pass it on. If you have time, look at the comments.
This information really matters.
@TEDxNewcastle
, thank you.
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A common complaint from families when patient dies is 'we didn't realise s/he might die!'
They are told about sepsis/low oxygen sats/hypotension/poor blood supply to vital organ(s) but this doesn't communicate 'sick enough to die.'
Use your D-words.
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OK, UK voters. This will be my only
#GE2109
tweet.
Think of the most vulnerable people you know.
Vote for the manifesto that will make things better for them.
We can't go on like this.
Thank you for using your vote to try to make a difference.
That's all anyone can do.
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There are days when I feel overwhelmed and encouraged by a sense of compassionate connection around the world.
This has been one of those days.
As I go to sleep, I thank you all for being with me today.
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...and relax...
It is finished.
Listen: how to find the words for tender conversations is due Sept 16th. It will look a lot snappier by then!
I really hope it's a book to help people talk more confidently about those things that matter most to them.
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What an astonishing journey this tiny film has been on, all around the world.
How we die.
Usually gently.
Please help everyone to know more to become less afraid.
Thank you for this platform,
@bbcideas
.
“We've lost the rich wisdom of normal human dying, and it's time for us to talk about dying and reclaim the wisdom” - Palliative care expert
@DrKathrynMannix
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Wishing us all contentment in 2021: the peace of ordinary things, the joy of gathering together, the comfort of hugging our dear ones, the consolation of weeping together for our losses.
Thank you all for your company and kindness in a year of perplexity and loss.
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Here's my
@TEDxNewcastle
talk about 'What Happens As We Die.'
80k views in such a short time tells me that people want to know - we have to get better at talking about dying.
Thanks to everyone who's shared and commented.
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Aged 6 I thought we went to school to 'learn everything.'
Aged 16 I realised it may take a little longer than that.
In elderhood I learn every day how little I know, that curiosity is the antidote to ignorance, and that wisdom rather than knowledge is the treasure.
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The phenomenon of our beloved people dying while we're out of the room is so common in palliative care that we warn families it can happen.
Some dying people seem to need permission; others seem to wait for specific news; some wait for their dearest to leave.
So many questions...
@Peeler_45
Keep talking/typing/venting there is support here 💙 I sat with my dad for days as his body slowly shut down. I left one night as had an important meeting for my younger sister the following morning - he died that night- I missed his last hours & will never forgive myself.
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Over my career I've been nurtured, supervised, mentored, terrified, comforted, held to account, accompanied & made a better doctor by nurses.
Yesterday I had a chance to thank some of them back at my medical school.
Nurses everywhere, thank you. Please keep training your docs.
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Share my excitement!
My
@ted
talk has passed 1 million views.
The wonderful messages of appreciation fill me with gratitude for this opportunity.
Take a look.
Share it.
This is about all of us*.
*not relevant to immortals, obviously. Don't show them.
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Thanks
@BBCBreakfast
for sending me this clip, & to Charlie Stayt for allowing me to describe the process of dying on national TV over breakfast!
Huge thanks & love to Dame
@bowelbabe
for getting the nation talking, & to everyone joining in.
via
@YouTube
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Don't mistake our tenderness for weakness: it is based on courage and determination, honed to a skill by practise and experience, and delivered with grace.
#TenderConversations
matter.
Step up, not back.
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Dear Tweeps
Your response to this has been so huge I can't keep up. I can see some personal stories, so I'm sorry it's taking longer than I'd like to respond to you all.
Thanks, as always, for looking after each other here. I love this compassionate community 🧡
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What can we learn from the death of the
#Queen
?
The world has watched her live through the process of
#OrdinaryDying
, and yet dying went unspoken, un-named.
Let's notice what nobody mentioned: we all saw the Queen going through the stages of ordinary dying.
A 🧵...
1/
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This is what can happen when we explain dying.
Thank you for sharing this precious moment,
@CathyWinfield
🧡
When you make end of life something not to be frightened of
@drkathrynmannix
- reading to her grandma, not frightened by the fact she is “sleeping” not disturbed by noisy secretions, just a little girl, her “mannie” and the love and bond between them 💕
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In response to recent
#EoL
conversations about whether we should focus on nutrition or on comfort when dying people lose their appetites:
It's normal to lose interest in food during dying.
Here's a thread about it ⬇️
With thanks to
@richardodurrant
for permission to share our DMs.
Worries about lack of nutrition at the end of life are very common, & should always be taken seriously.
I'm talking here about dying from an illness, & how dying impacts appetite & gut function.
cc
@APMPostTweets
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A reminder that people around us are grieving - not just during a memorial week, but every day.
#NationalGriefAwarenessWeek
invites us to think about how we show up for them. Look out for ideas to help & support via
@goodgrieftrust
-
@DrAmirKhanGP
is one of their Ambassadors.
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This is why I do what I do.
🧡
@drkathrynmannix
I've just used this with a resident at the care home who said she was frightened at how quickly the Queen died.
When I'd taken her through this she said it made so much sense and she's not as scared of dying anymore.
Big thank you
@drkathrynmannix
❤️
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Before the end of
#FlorenceNightingale
's birthday:
Thank you to all those nurses who taught me, supported me, told me off, mopped me up, trusted me, guided me & made me a better doctor.
Nurses everywhere, please keep training your doctors.
Happy
#InternationalNursesDay
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#MedicalTwitter
, this is not OK.
Please look at this story, & the responses, to see the uphill struggle we have to talk with compassion about CPR to people who are sick, frightened & not accompanied by their loved ones during this time of covid.
Some comments:
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Slightly angry to learn that upon arrival on Friday FIL was told by a young Dr, "You could have a heart attack while you're here. Do you want to be resuscitated if you do?" Answering, "Yes", was told, "But you might not be the same. You might need a lot of care." Fucking wankers
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@dubyacko
I am crying on a train.
This is so moving, and I feel tearfully proud to have been part of your Mum's library of love for you.
I wasn't sure I was brave enough to write that book. I'm very glad I dared.
🧡
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As a doctor who used the NHS practitioner health programme when I had a profound depression, I am astonished to think funding for this essential service is being cut.
I've signed this open letter to the Health Secretary & the NHS CEO.
It takes a few seconds.
It may save lives.
⬇️
💥 NHS STAFF 💥
Please consider signing this open letter to
@VictoriaAtkins
&
@AmandaPritchard
at
@NHSEngland
expressing your dismay at their extraordinary decision to cut
@NHSPracHealth
funding for hospital staff.
Please share widely 🙏
Letter here:
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We always think there will be more time.
Even when our heads know the truth, our hearts stumble to keep up.
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A truly remarkable interview between Dame
@bowelbabe
and her friend,
@youmebigc
Producer
@MikeHolt12
as Debs considers the journey she's been on, and what matters in the end.
Do listen in.
Support
@BowelbabeF
if you can.
Love your life.
Bravo, Mike. Thank you, Debs.
⭐
#YouMeBigC
's Deborah James [
@bowelbabe
] has stopped receiving active treatment for her cancer and speaks to producer Mike [
@MikeHolt12
] one last time ⭐
You, Me and the Big C | Listen on
@BBCSounds
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If your patient is sick enough to die, get support from your seniors &/or pall care team.
Patients who see the pall care team are not obliged to die.
Pall care can help you with parallel planning, support pt/family/staff (you!), in ER, wards or ICU.
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Timely CPR saved Chris Eriksen's life.
The match footage shows
-how immediate collapse is after
#CardiacArrest
-how quickly we need to respond
In Cardiac Arrest the heart stops while other organs are healthy: rapid CPR response saves lives.
Learn CPR: see
@ResusCouncilUK
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I have had patients die while families sought a parking space. There are designated maternity spaces: we know how to do this.
#EoL
parking should be similarly easy to access.
Agreed!
I have had situations where a family member is circling the parking lot during a
#palliative
clinic appointment. 😰😰😰
Many patients suffer financially due to their illness itself or are already low income- this just makes it worse!
#financialtoxicity
#sdoh
#hpm
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This doesn't happen to me every day, so it simply has to be retweeted.
😊
@drkathrynmannix
@Philippa_Perry
It was an honour to read it. It’s such a wonderful and important book
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You can tell I have a big writing deadline.
The house is unusually tidy.
Surfaces gleaming.
Ironing basket empty.
And I made marmalade...
#AmWriting
#ShouldBeWriting
#ThiefOfTime
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The toxicity of parliamentary 'debate' is so demoralising that I'm off to spend two days talking about death, dying and end of life care to cheer myself up.
Maybe it takes
#dying
to bring living into proper focus.
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@DrEmHenderson
@lucypgeridoc
She's given us a wonderful, national story.
Let's die like the Queen. Well-planned. Well-managed. In our own bed.
With loved ones.
Possibly corgies.
#AdvanceCarePlanning
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How carefully we prepare for a birth.
How careless we are not to honour death in a similar way.
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It's
#WorldBookDay
& this year I have taken impersonating an author to a new level: I've finally submitted the manuscript of my second book.
Sending thanks to all writers & illustrators, to the many supporters who bring our books to the world, & to readers everywhere.
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#tipsfornewdoctors
Manage anyone sick enough to die with two outcomes in mind:
1. What can we do the reverse the dying?
2. What can we do to soothe the dying?
Do both, if appropriate. Ask for help.
Death isn't medical failure - but a bad death often is.
#onechancetogetitright
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16k!
Thanks to followers old & new; welcome to new people. It seems there are now 16,000 people in our bubble, discussing death, dying & living well, kindness & curiosity.
I was wary of the Twittersphere when I joined, but you've all made it a pleasure. I love learning from you.
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The bad news: there are no 'right words.'
The good news: there are words that will do.
It's your compassion, not your vocabulary, that makes
#TenderConversations
happen.
The biggest difference comes from how carefully we
#Listen
.
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