Listeners, we have to have "The Talk": Cracking the Code Status Discussion

In this episode of Not Another Medical Podcast, we’re “Cracking the Code” on one of the most challenging and important conversations in healthcare: code status. Join Josh, James, and Brodie as they break down what code status means, why these discussions matter, and how patients and families can navigate decisions about CPR, life support, and end-of-life care. With real stories, candid humor, and practical advice, this episode empowers listeners to have meaningful conversations about their wishes—before a crisis hits.

Episode Transcript

(00:01):
Imagine three different scenarios.
Number one, you and your wife just had a child.
You decide it's time to do your whim.
Some of the questions ask if you'd like to have things like CPR or life support machines.
If something happens to you, of course you say, I'm young.
Why wouldn't I wanna do that? Scenario two, you're sick in hospital, but relatively stable.
A physician comes up to you and says, if you get really sick and your heart stops, would you like us to do everything? You look at them with a mix of fear, surprise, and confusion.

(00:28):
Am I dying? And I don't know it? Why wouldn't I want everything so much goes through your mind.
Scenario three.
Your loved one with multiple medical issues is in the hospital quite sick.
A doctor talks to you about the current situation and how if things get worse, invasive measures like CPR would just hurt them without helping.
They don't recommend doing life support.

(00:49):
And if the time came to let your loved one die peacefully without those interventions, you're not sure what to think, but understand that it is time to truly consider this.
The reality is whether you're young or old, sick or not sick or thinking about it at all, conversations around your wishes when you are critically ill are everywhere.
These talks are fraught with tension, can shock you, but can truly be used to honor you or your loved ones.

(01:13):
Wishes.
Today on Not Another medical podcast will talk about the code status discussion and what makes it one of the most difficult, but possibly rewarding conversations you will ever have. 18 00:01:35,537.136231546 --> 00:01:42,167.13623155 Views and opinions expressed this podcast are those of the hosts and guests do not reflect the official policies or positions of any deleted institutions or organizations. 19 00:01:42,527.13623155 --> 00:01:49,67.13623155 This podcast for informational, educational, and entertainment purposes only, and it's not intended to provide medical advice, diagnosis, or treatment. 20 00:01:49,577.13623155 --> 00:01:51,947.13623155 Listeners should consult their own health professionals for any medical concerns. 21 00:01:52,652.13623155 --> 00:01:54,482.13623155 I'm James Jung, a general surgeon. 22 00:01:54,932.13623155 --> 00:01:57,122.13623155 I'm Brody Nolan, I'm an emergency doctor. 23 00:01:57,512.13623155 --> 00:01:58,412.13623155 And I'm Josh Levitz. 24 00:01:58,412.13623155 --> 00:02:01,772.13623155 I'm an internal medicine physician and this is not another medical podcast. 25 00:02:02,302.13745301 --> 00:02:03,444.53766438 Then we're back. 26 00:02:04,673.64856458 --> 00:02:06,83.64856458 Hey, hey, boys. 27 00:02:06,631.14856458 --> 00:02:10,32.64856458 How you guys been? I think I stole that from something, now that I said it. 28 00:02:10,812.64856458 --> 00:02:15,691.14856458 We might have just copyrighted, infringed I think of Chance Rapper, but I don't know. 29 00:02:15,721.14856458 --> 00:02:20,11.14856458 That's a yeahs a tough phrase to To trademark. 30 00:02:20,161.4076912 --> 00:02:21,531.4076912 more of the, more of the intonation. 31 00:02:22,793.64856458 --> 00:02:23,153.64856458 that. 32 00:02:24,705.32839143 --> 00:02:25,275.32839143 Okay, good. 33 00:02:25,405.32839143 --> 00:02:25,915.32839143 We're safe. 34 00:02:26,611.43351588 --> 00:02:33,811.14856458 so this is the first recording after we've our episodes, right? Mm-hmm. 35 00:02:34,433.64856458 --> 00:02:35,311.14856458 I don't know Yeah. 36 00:02:35,333.64856458 --> 00:02:40,35.60946516 a chance to listen to our, uh, body of work. 37 00:02:40,301.16993203 --> 00:02:45,147.19882745 Wait, us like as in like Josh and I? Well, I mean, like collectively here. 38 00:02:45,784.69882745 --> 00:02:46,54.69882745 Yeah. 39 00:02:46,167.19882745 --> 00:02:48,634.69882745 certainly listened to our recording Yeah. 40 00:02:48,634.69882745 --> 00:02:49,324.69882745 I think. 41 00:02:49,347.19882745 --> 00:02:50,187.19882745 or three times. 42 00:02:50,481.90281464 --> 00:02:53,481.90281464 I think all 10 downloads are from me and one from my dad. 43 00:02:55,739.40281464 --> 00:02:56,279.40281464 Yeah. 44 00:02:57,980.75035082 --> 00:02:58,430.75035082 Dennis. 45 00:02:58,640.75035082 --> 00:03:01,430.75035082 Dennis, we love Dennis. 46 00:03:01,430.75035082 --> 00:03:02,900.75035082 We don't know you, but we love you. 47 00:03:04,310.75035082 --> 00:03:09,179.76935193 Yeah, my, uh, my mom said, you know, it sounds like a good idea for a podcast, but I'm not interested. 48 00:03:09,239.76935193 --> 00:03:10,799.76935193 So guys. 49 00:03:11,845.76935193 --> 00:03:12,115.76935193 Yeah. 50 00:03:12,115.76935193 --> 00:03:12,974.76935193 I Just joking. 51 00:03:13,169.76935193 --> 00:03:14,519.76935193 Mom, she's listening. 52 00:03:16,285.78662567 --> 00:03:17,575.78662567 that's a legitimate point. 53 00:03:18,53.28662567 --> 00:03:18,343.28662567 Yeah. 54 00:03:18,348.28662567 --> 00:03:18,498.28662567 Yeah. 55 00:03:19,8.28662567 --> 00:03:20,268.28662567 We've all made a terrible mistake. 56 00:03:20,429.78662567 --> 00:03:21,449.78662567 to do in this world. 57 00:03:21,514.78662567 --> 00:03:21,804.78662567 Yeah. 58 00:03:21,805.78662567 --> 00:03:22,375.78662567 Yeah. 59 00:03:22,465.78662567 --> 00:03:22,915.78662567 Yeah. 60 00:03:23,635.78662567 --> 00:03:28,855.78662567 Well, we really appreciate the, the five people who listened one person who commented. 61 00:03:30,145.78662567 --> 00:03:36,835.78662567 but know, I think, uh, yeah, I think it was, uh, and, and kudos to all of us for great job editing. 62 00:03:36,955.78662567 --> 00:03:39,505.78662567 You know, preed and post edit. 63 00:03:39,535.78662567 --> 00:03:41,433.28662567 Huge difference Yeah. 64 00:03:41,433.28662567 --> 00:03:46,83.28662567 I don't know if anyone knows, but we, uh, are not well spoken. 65 00:03:46,773.28662567 --> 00:03:49,323.28662567 There's a lot of magic going on behind the scene. 66 00:03:49,533.28662567 --> 00:03:50,103.28662567 Sorry, Josh. 67 00:03:50,103.28662567 --> 00:03:50,703.28662567 I see your face. 68 00:03:50,703.28662567 --> 00:03:51,453.28662567 Let's be honest. 69 00:03:52,634.78662567 --> 00:03:54,524.78662567 No, no, I, I'm, I'm with you. 70 00:03:54,554.78662567 --> 00:03:57,933.28662567 Uh, we're also, we're also amateur editors now, Mm-hmm. 71 00:03:58,394.78662567 --> 00:03:59,703.28662567 hopefully, Yeah. 72 00:03:59,744.78662567 --> 00:04:00,824.78662567 it sounds good to me. 73 00:04:01,83.28662567 --> 00:04:02,643.28662567 Add that to the resume for skillset. 74 00:04:02,823.28662567 --> 00:04:03,123.28662567 Yeah. 75 00:04:03,494.78662567 --> 00:04:04,274.78662567 I already have. 76 00:04:04,448.28662567 --> 00:04:04,738.28662567 Yeah. 77 00:04:05,414.78662567 --> 00:04:07,604.78662567 Amateur podcaster, amateur editor. 78 00:04:07,694.78662567 --> 00:04:09,674.78662567 I got a lot of amateurs in my, in my resume. 79 00:04:09,940.78662567 --> 00:04:11,50.78662567 Amateur producer. 80 00:04:11,984.78662567 --> 00:04:13,484.78662567 I, you know what? Yes. 81 00:04:13,484.78662567 --> 00:04:16,34.78662567 Amateur grip, you I think it's called. 82 00:04:17,73.28662567 --> 00:04:17,133.28662567 Hmm. 83 00:04:17,133.28662567 --> 00:04:17,143.28662567 Yeah. 84 00:04:17,230.78662567 --> 00:04:17,738.28662567 you Yep. 85 00:04:17,950.78662567 --> 00:04:18,370.78662567 you go. 86 00:04:18,543.8044752 --> 00:04:23,292.8044752 Oh, Oh, what have we done? have you guys been up to? I know we had a little Uh. 87 00:04:23,583.8044752 --> 00:04:24,363.8044752 hiatus. 88 00:04:25,582.8044752 --> 00:04:28,792.8044752 I was, uh, I was just telling Brody work has been bonkers. 89 00:04:28,792.8044752 --> 00:04:37,462.8044752 It's like winter time in the middle of the summer in terms of volumes and for listeners at the hospital, winter gets busy 'cause of all the viruses and stuff. 90 00:04:37,522.8044752 --> 00:04:40,792.8044752 And I don't know, the summer is just, um, it's blown up. 91 00:04:41,172.58225001 --> 00:04:47,802.58225001 And, uh, my, my wife and kids, were sick of me working so much, so they went up north for a few days. 92 00:04:48,282.58225001 --> 00:04:50,472.58225001 Um, so I'm, I'm home alone right now. 93 00:04:50,616.08225001 --> 00:04:51,316.08225001 Nice. 94 00:04:51,316.08225001 --> 00:04:51,946.08225001 Mm-hmm. 95 00:04:52,62.58225001 --> 00:04:52,572.58225001 actually sick. 96 00:04:52,572.58225001 --> 00:04:53,262.58225001 It was planned. 97 00:04:53,412.58225001 --> 00:04:56,802.58225001 They love me 80% of the time. 98 00:04:56,813.58225001 --> 00:04:59,66.08225001 Is, is planned yesterday, Yeah. 99 00:04:59,142.58225001 --> 00:04:59,532.58225001 exactly. 100 00:05:00,212.70243142 --> 00:05:04,52.70243142 But I was, I was just, uh, saying to Brody, it's like my house is quiet. 101 00:05:04,52.70243142 --> 00:05:05,372.70243142 It is the weirdest thing. 102 00:05:05,852.70243142 --> 00:05:06,786.20243142 It is Mm-hmm. 103 00:05:07,472.70243142 --> 00:05:08,192.70243142 I miss them. 104 00:05:08,192.70243142 --> 00:05:09,242.70243142 It is all of the above. 105 00:05:09,272.70243142 --> 00:05:11,1.20243142 It's weird, Yeah. 106 00:05:11,181.20243142 --> 00:05:14,271.20243142 I still get like a bit scared being in the house alone. 107 00:05:14,271.20243142 --> 00:05:19,281.20243142 Like if there's no one here, it's kind of like, and we got like, we've got like a super old house. 108 00:05:19,281.20243142 --> 00:05:25,821.20243142 Like there's no way anyone is like creeping in the house without me knowing, but there's still a degree of like, I know Jules is gone, girls are gone. 109 00:05:26,341.20243142 --> 00:05:27,511.20243142 So quiet. 110 00:05:27,627.03576475 --> 00:05:31,977.03576475 You some creaking sound when there shouldn't be any creaking sound. 111 00:05:32,104.53576475 --> 00:05:33,4.53576475 Yeah, exactly. 112 00:05:33,147.03576475 --> 00:05:33,627.03576475 scares you. 113 00:05:34,114.53576475 --> 00:05:34,924.53576475 Oh, that's just ghost. 114 00:05:34,984.53576475 --> 00:05:35,524.53576475 She's fine. 115 00:05:35,997.03576475 --> 00:05:36,387.03576475 Yeah. 116 00:05:39,433.70243142 --> 00:05:40,753.70243142 the, the plumbing issues. 117 00:05:41,91.20243142 --> 00:05:41,301.20243142 Yeah. 118 00:05:41,361.20243142 --> 00:05:43,431.20243142 Oh my God, we just had the back again. 119 00:05:43,521.20243142 --> 00:05:48,351.20243142 Uh, I give like a whole podcast on the challenges of plumbing in a hundred year old house. 120 00:05:48,403.70243142 --> 00:05:49,123.70243142 the pipes. 121 00:05:50,68.14317238 --> 00:05:57,320.86242831 Why won't you drain, just drain? who thought clay pipes and tree roots would be a good mix? Just saying, Uh. 122 00:05:57,398.36242831 --> 00:05:58,122.36242831 what's durable Yeah. 123 00:06:00,223.36242831 --> 00:06:00,960.86242831 Not Yeah. 124 00:06:01,482.36242831 --> 00:06:02,832.36242831 Make mixes well with water. 125 00:06:02,832.36242831 --> 00:06:04,212.36242831 I hear it's perfect. 126 00:06:04,217.36242831 --> 00:06:04,437.36242831 Yeah. 127 00:06:04,590.86242831 --> 00:06:05,10.86242831 Totally. 128 00:06:05,100.86242831 --> 00:06:05,520.86242831 Yeah. 129 00:06:05,700.86242831 --> 00:06:06,60.86242831 Yeah. 130 00:06:06,150.86242831 --> 00:06:08,310.86242831 Maybe like a Play-Doh consistency would be perfect. 131 00:06:08,430.86242831 --> 00:06:08,565.84557004 Yeah. 132 00:06:09,387.45302685 --> 00:06:11,187.45302685 Oh, now we're clay pipe experts. 133 00:06:13,458.9967775 --> 00:06:16,968.9967775 I was in, uh, I was back home in, in Canada. 134 00:06:17,28.9967775 --> 00:06:21,497.9967775 I mean, although not in, in my hometown of Toronto, but, oh yeah, right. 135 00:06:22,567.9967775 --> 00:06:22,857.9967775 Yeah. 136 00:06:22,938.9967775 --> 00:06:23,778.9967775 was really nice. 137 00:06:23,808.9967775 --> 00:06:25,177.9967775 Uh, it out to Calgary. 138 00:06:25,938.9967775 --> 00:06:26,958.9967775 Yeah, shout out to Calgary. 139 00:06:26,963.9967775 --> 00:06:30,408.9967775 It, it was good to escape the, uh, the heat for a bit. 140 00:06:31,248.9967775 --> 00:06:32,118.9967775 and cool. 141 00:06:33,48.9967775 --> 00:06:36,738.9967775 mountains, beautiful lakes, you know, it's just amazing place. 142 00:06:37,197.9967775 --> 00:06:37,487.9967775 Yeah. 143 00:06:37,938.9967775 --> 00:06:42,558.9967775 Banff and you know, the Lake Louise and all of it is just beautiful. 144 00:06:42,927.83825929 --> 00:06:43,197.83825929 Yeah. 145 00:06:43,302.14533621 --> 00:06:45,912.14533621 Winter skiing is just incredible there. 146 00:06:45,972.14533621 --> 00:06:51,27.14533621 Summer is beautiful, but you know, I'm a Canadian, so the winter sports, take it all. 147 00:06:51,908.14533621 --> 00:06:52,448.14533621 Oh yeah. 148 00:06:52,635.64533621 --> 00:06:58,485.64533621 we're keeping tabs, though, I think this is like nine of 10 episodes that James has gone somewhere since we recorded last. 149 00:07:00,297.14533621 --> 00:07:01,257.14533621 Wow. 150 00:07:02,63.14533621 --> 00:07:04,185.64533621 I have a lot of trips coming up actually Yeah. 151 00:07:04,275.64533621 --> 00:07:04,285.64533621 Yeah. 152 00:07:04,463.14533621 --> 00:07:05,93.14533621 of the year. 153 00:07:05,93.14533621 --> 00:07:09,872.31200287 So It's, it's half medical and half James. 154 00:07:09,872.31200287 --> 00:07:10,142.31200287 Yeah. 155 00:07:10,142.31200287 --> 00:07:11,222.31200287 James' Travel Journey. 156 00:07:11,222.31200287 --> 00:07:11,587.31200287 That's it. 157 00:07:12,669.81200287 --> 00:07:14,709.81200287 yeah, my geotag locations. 158 00:07:15,553.81200287 --> 00:07:16,453.81200287 Oh, that's awesome. 159 00:07:16,453.81200287 --> 00:07:17,203.81200287 Good for you. 160 00:07:17,263.81200287 --> 00:07:18,373.81200287 You should travel. 161 00:07:19,153.81200287 --> 00:07:21,129.81200287 Yeah, Maybe we should do a travel show. 162 00:07:22,333.81200287 --> 00:07:25,393.81200287 no, I'm just, I'm just gonna say no. 163 00:07:25,412.31200287 --> 00:07:26,42.31200287 Just know. 164 00:07:26,203.81200287 --> 00:07:28,183.81200287 that's like the last, you're not in improv. 165 00:07:28,183.81200287 --> 00:07:30,493.81200287 You're always supposed to say yes, but I'm just gonna shut this down. 166 00:07:30,812.31200287 --> 00:07:31,22.31200287 Mm-hmm. 167 00:07:31,772.31200287 --> 00:07:31,952.31200287 Yeah. 168 00:07:31,952.31200287 --> 00:07:33,17.31200287 That'd be a very tough sell. 169 00:07:33,229.81200287 --> 00:07:35,389.81200287 Yeah, sure where I was gonna go with that yeah. 170 00:07:35,835.81200287 --> 00:07:36,705.81200287 Good call Josh. 171 00:07:36,979.81200287 --> 00:07:38,299.81200287 yes, yes. 172 00:07:38,629.81200287 --> 00:07:40,219.81200287 My improv class did not pay off. 173 00:07:40,662.47866954 --> 00:07:42,522.47866954 I thought you were supposed to say, and Yes. 174 00:07:42,612.47866954 --> 00:07:43,2.47866954 And. 175 00:07:43,6.47866954 --> 00:07:43,696.47866954 Exactly. 176 00:07:43,876.47866954 --> 00:07:44,356.47866954 Yeah. 177 00:07:44,361.47866954 --> 00:07:44,456.73943755 Yeah. 178 00:07:44,868.14533621 --> 00:07:47,549.14533621 is, but I said no, so I'm, you learned. 179 00:07:47,886.47866954 --> 00:07:48,836.47866954 don't constrain me. 180 00:07:49,158.14433517 --> 00:07:49,448.14433517 Yeah. 181 00:07:49,493.14433517 --> 00:07:59,242.92210998 So speaking of, staying home, so you guys may or may not remember, but, um, Julia, my wife really likes, um, reality TV shows. 182 00:07:59,345.42210998 --> 00:08:00,285.42210998 animal dead guy. 183 00:08:00,425.42210998 --> 00:08:00,965.42210998 No, sorry. 184 00:08:01,12.92210998 --> 00:08:02,782.92210998 Yeah, yeah. 185 00:08:03,547.92210998 --> 00:08:05,512.92210998 And, and, uh, hot animal guy. 186 00:08:05,902.92210998 --> 00:08:19,372.92210998 Uh, so, uh, anyway, she'd been watching Love Island recently, um, specifically Love Island, USA, And my, uh, oldest daughter will often, uh, decide she doesn't wanna sleep anymore and come down into the basement and then just kind of watch episodes of whatever happens to be on tv. 187 00:08:19,732.92210998 --> 00:08:21,682.92210998 So advance a few days ago. 188 00:08:22,132.92210998 --> 00:08:28,762.92210998 Um, and, uh, my daughter comes into the room and just like, you know, kind of gives like a morning cuddle, like she often does. 189 00:08:29,827.92210998 --> 00:08:36,187.92210998 And then, um, uh, goes in, uh, to gimme a kiss and all of a sudden there is an aggressive tongue in my mouth. 190 00:08:36,187.92210998 --> 00:08:42,307.92210998 And I was like, oh God, Oh is, what is happening? And I was like, okay. 191 00:08:42,307.92210998 --> 00:08:43,237.92210998 Like, play it cool. 192 00:08:43,237.92210998 --> 00:08:44,587.92210998 I was like, uh. 193 00:08:44,982.92210998 --> 00:08:45,882.92210998 Uh, okay. 194 00:08:46,32.92210998 --> 00:08:56,622.92210998 And then I'm chatting with, with Jules later, like, I think we got like rain in the love island watching, like, I think she's picking up some stuff that she probably wouldn't have picked up otherwise. 195 00:08:57,222.92210998 --> 00:08:59,412.92210998 And Julie's like, no, no, no, it is totally fine. 196 00:08:59,622.92210998 --> 00:09:12,732.92210998 And then sure enough, like that afternoon, the same thing happened to her and so And she said, and so we're now limiting any sort of, uh, love island, uh, watching with her daughter around, but quite funny. 197 00:09:13,35.42210998 --> 00:09:13,875.42210998 pro tips. 198 00:09:14,175.42210998 --> 00:09:15,409.42210998 Pro Yeah. 199 00:09:15,739.42210998 --> 00:09:23,221.25544332 I don't, I don't want to make any jokes just 'cause a lot of dicey area here, It was pretty funny. 200 00:09:23,221.25544332 --> 00:09:24,1.25544332 We're all gonna be okay. 201 00:09:25,148.75544332 --> 00:09:25,688.75544332 Yeah. 202 00:09:25,838.75544332 --> 00:09:26,198.75544332 Yeah. 203 00:09:26,198.75544332 --> 00:09:30,98.75544332 I think, uh, you know, kids forget quickly. 204 00:09:30,278.75544332 --> 00:09:30,758.75544332 Hopefully. 205 00:09:30,961.25544332 --> 00:09:31,711.25544332 I won't though. 206 00:09:33,164.82567182 --> 00:09:35,283.32567182 Brody that's my awkward segue for the day. 207 00:09:36,474.55527678 --> 00:09:37,374.55527678 Back to you, James. 208 00:09:40,682.05527678 --> 00:09:41,102.05527678 you know. 209 00:09:41,732.05527678 --> 00:09:44,252.05527678 Sorry, beloved niece. 210 00:09:44,916.05527678 --> 00:09:45,396.05527678 Yeah. 211 00:09:45,396.05527678 --> 00:09:45,906.05527678 Really. 212 00:09:46,840.06524915 --> 00:09:51,100.06524915 well, I, I don't think, I don't think we're topping that, so we might as well just get into it. 213 00:09:51,366.06524914 --> 00:09:54,580.06524915 Well, speaking of awkward conversations that you could have with Hey. 214 00:09:55,213.56524914 --> 00:09:56,473.56524914 Nice. 215 00:09:56,646.06524915 --> 00:09:58,63.56524914 Here we Nailed it. 216 00:09:58,68.56524914 --> 00:09:58,448.56524914 Mm-hmm. 217 00:09:58,450.06524915 --> 00:10:01,810.06524915 Just, just for the record, 'cause I think we've talked about segues like a hundred times. 218 00:10:01,930.06524915 --> 00:10:06,700.06524915 You're not supposed to call out the segue every time, but we're gonna call out the segue every time. 219 00:10:06,703.56524914 --> 00:10:09,103.56524915 Yeah, and I think that we should be calling a se segue at every time. 220 00:10:09,220.06524915 --> 00:10:10,573.56524914 A hundred That's how you know it's coming. 221 00:10:10,896.06524915 --> 00:10:11,586.06524915 absolutely. 222 00:10:11,826.06524915 --> 00:10:12,366.06524915 Absolutely. 223 00:10:12,726.06524914 --> 00:10:13,540.06524915 It's That's that. 224 00:10:13,866.06524915 --> 00:10:14,586.06524915 people will know. 225 00:10:15,430.06524915 --> 00:10:20,143.56524915 Yeah, We have to really highlight how funny we are because otherwise it's, we're just not funny. 226 00:10:20,500.06524914 --> 00:10:20,740.06524915 yeah. 227 00:10:21,426.06524915 --> 00:10:25,273.56524915 right? what's that? Listeners, you actually wanna hear a medical podcast and Damnit. 228 00:10:25,330.06524915 --> 00:10:25,750.06524914 guys. 229 00:10:25,810.06524915 --> 00:10:27,220.06524915 Okay, let's go. 230 00:10:27,682.92808873 --> 00:10:28,12.92808873 Yeah. 231 00:10:28,12.92808873 --> 00:10:34,142.92808873 So guys, we're, um, yeah, we're, we're gonna talk the code discussion. 232 00:10:34,276.26142206 --> 00:10:34,996.26142206 Dun dun. 233 00:10:35,523.09475539 --> 00:10:41,793.09475539 And this is not cracking the code like a cool wartime code machine. 234 00:10:41,889.59475539 --> 00:10:44,79.59475539 No, but there's, there's cracking. 235 00:10:44,79.59475539 --> 00:10:46,839.59475539 The code conversation might actually be a good title for this. 236 00:10:47,342.92808873 --> 00:10:49,179.76142206 Yeah, we You're welcome. 237 00:10:49,536.26142206 --> 00:10:52,478.65053713 Yeah, Are you done yet? we're both finished. 238 00:10:52,478.65053713 --> 00:10:53,78.65053713 Thank you, James. 239 00:10:53,613.3803341 --> 00:10:54,183.3803341 So, yeah. 240 00:10:54,183.3803341 --> 00:10:58,743.3803341 So, uh, let's talk about, you know, this code discussion. 241 00:10:58,803.3803341 --> 00:11:11,313.3803341 You know, mean, you know, even from title of this, like, you know, I don't know if the listeners really understand know, maybe if they're, they have it involved in this discussion, they'll, they'll understand it. 242 00:11:11,313.3803341 --> 00:11:13,743.3803341 Because once you have something like this, you'll never forget it. 243 00:11:15,303.3803341 --> 00:11:29,373.3803341 for those who have not had opportunities to participate in this, Josh, tell us like what status means here and, uh, what the discussion around that code status, you know, entails. 244 00:11:30,307.3803341 --> 00:11:37,537.3803341 And I think you said it, there's a bunch of listeners, well, however many listeners there are, there's a bunch of those ones that are like, oh yeah, I know what's going on here. 245 00:11:37,687.3803341 --> 00:11:41,77.3803341 There's a couple that, a couple that'll just no clue. 246 00:11:41,77.3803341 --> 00:11:45,157.3803341 And this is something everyone, most people will probably be exposed to. 247 00:11:45,157.3803341 --> 00:11:51,517.3803341 So a code discussion is really something that a healthcare professional will have with you. 248 00:11:51,547.3803341 --> 00:11:54,397.3803341 Not necessarily just healthcare professional, but we'll focus on that. 249 00:11:54,727.3803341 --> 00:12:02,377.3803341 Um, and it's a decision around critical illness and what happens during times of critical illness. 250 00:12:03,337.3803341 --> 00:12:16,27.3803341 It's an absolutely vital conversation to have, and especially more so in different settings, and we'll get into all that, but it's not something that people actually do like to talk about because at the end of the day, you're talking about life and death with these conversations. 251 00:12:16,747.3803341 --> 00:12:31,237.3803341 And just to be very specific, what we are going to talk about during this podcast and what the code conversation is, is kinds of things do you or your loved one want when you're critically ill? And we're gonna talk about things like CPR, where we press on the chest. 252 00:12:31,237.3803341 --> 00:12:36,427.3803341 Everyone's seen that, or most people have seen that in TV or movies, or hopefully not in real life. 253 00:12:36,757.3803341 --> 00:12:44,187.3803341 Um, intubation where we put tubes in the lungs to get, um, to help people breathe on machines and some other lifesaving treatments. 254 00:12:44,187.3803341 --> 00:12:54,197.3803341 So it all sounds very complicated because it is, and I think we'll just kind of flush out what the code conversation is, why we have it, why it's difficult. 255 00:12:54,257.3803341 --> 00:12:56,867.3803341 Lots of, uh, lots of things to, to go over with this. 256 00:12:57,613.24847767 --> 00:13:11,943.24847767 So maybe let's break it down, you know, there, you know, uh, at least, least in my mind, are kind of three, uh, options is probably not the best word, but they're kind of. 257 00:13:12,498.24847767 --> 00:13:17,868.24847767 Three or four different status within this code discussion. 258 00:13:18,318.24847767 --> 00:13:52,883.82263165 Can you tell us like what they are? Let's, let's, you know, start by saying that doctors, a lot of doctors, not everyone, like, not all of doctors, but doctors are not good at talking about this either, right? sometimes you'll hear, especially from more junior, trainees, if they are having this conversation, like they'll just kind of blur out all these different, oh, like DNR, like CPR, like DNI, like, you know, what do they mean? And tell us like, know, what the, the, the listeners should understand. 259 00:13:53,907.82263165 --> 00:13:54,267.82263165 For sure. 260 00:13:54,717.82263165 --> 00:14:02,847.82263165 So you're getting Josh's view here, and I'll just be very specific about that because everyone has a different view of what is a good code conversation, what these things are. 261 00:14:03,297.82263165 --> 00:14:06,657.82263165 Um, the whole option thing is a very interesting conversation. 262 00:14:06,777.82263165 --> 00:14:15,867.82263165 I, I try to stay away from options because this is a continuum of what people think is best for them at the, their critical illness. 263 00:14:16,296.32263165 --> 00:14:16,516.32263165 Mm. 264 00:14:16,617.82263165 --> 00:14:20,457.82263165 So things we will talk about and just specifically I said a couple of them. 265 00:14:20,697.82263165 --> 00:14:23,127.82263165 So CPR is a big part of this conversation. 266 00:14:23,127.82263165 --> 00:14:27,147.82263165 If your heart stops here's what CPR is, here's what it'll do. 267 00:14:27,807.82263165 --> 00:14:31,407.82263165 Is that something we wanna include? Number two, life support machines. 268 00:14:31,407.82263165 --> 00:14:34,677.82263165 And again, we talk about the breathing machines, so putting tubes in your throat. 269 00:14:35,67.82263165 --> 00:14:39,77.82263165 Um, so intubation, if you hear DNI, that's do not intubate. 270 00:14:39,877.82263165 --> 00:14:59,277.82263165 And then there are simple things, not simple, but easier things like intensive unit care where you're on special medications to keep you alive If this, and this happens, and as much as like this all sounds like, of course I'd want intensive care unit, these things carry a lot, a lot of side effects and complications with them. 271 00:14:59,277.82263165 --> 00:15:00,657.82263165 And it's not as simple yes or no. 272 00:15:00,957.82263165 --> 00:15:02,127.82263165 And we'll get into that in a bit. 273 00:15:03,357.82263165 --> 00:15:08,127.82263165 the big one, people here, and this may kind of clue people in is DNR. 274 00:15:08,557.82263165 --> 00:15:11,487.82263165 It is my least favorite three letters. 275 00:15:11,817.82263165 --> 00:15:14,397.82263165 DNR means do not resuscitate. 276 00:15:15,267.82263165 --> 00:15:20,217.82263165 if I poll a thousand people about what resuscitate means, I'm gonna get a thousand different answers. 277 00:15:20,487.82263165 --> 00:15:37,161.71143793 And if I just ask you guys, like if someone tells you DNR, does it mean to you? Or, or what do you kind of talk to patients about when you say DNR? Yeah, I, I think that the DNR is often attributed with unfortunately not doing anything, which is not really what it is. 278 00:15:37,161.71143793 --> 00:15:37,431.71143793 Right. 279 00:15:37,431.71143793 --> 00:15:37,761.71143793 Like when. 280 00:15:38,231.71143793 --> 00:15:41,771.71143793 When I think of resuscitation, really these are the invasive things that you're talking about. 281 00:15:41,771.71143793 --> 00:15:47,231.71143793 For the most part, it's supporting someone's breathing through a breathing tube and or chest compressions if if the heart stops. 282 00:15:47,231.71143793 --> 00:15:52,1.71143793 So for me, DNR means that someone's not going to have chest compressions if they lose a pulse. 283 00:15:52,991.71143793 --> 00:16:00,11.71143793 And if they get into worsening problems with their breathing, we're not going to go to the point of inserting a breathing tube. 284 00:16:00,221.71143793 --> 00:16:02,291.71143793 But between those, there's a lot of other. 285 00:16:02,916.71143793 --> 00:16:09,856.71143793 You know, escalations in care that can still happen, right? You can get support through things like BiPAP or CPAP. 286 00:16:09,856.71143793 --> 00:16:14,406.71143793 So again, people at home that might have sleep apnea might have like a CPAP machine that helps you their breathing. 287 00:16:14,406.71143793 --> 00:16:18,726.71143793 In the hospital, we have things like that as well that can help with people that have some breathing difficulties. 288 00:16:19,176.71143793 --> 00:16:25,676.71143793 So again, Josh, it's, it kind of like you said, it's not really an all or nothing. 289 00:16:25,986.71143793 --> 00:16:35,601.71143793 And then I don't think the checklist, kind of menu type approach is helpful either, because I don't think that it's actually really fair to people to understand what these things are .But 290 00:16:35,601.71143793 --> 00:16:46,298.1194563 when I think you're talking about code status, what's your underlying goal of that? What's the the purpose for having those conversations? Yeah. 291 00:16:46,958.1194563 --> 00:16:51,833.1194563 So I see it the same as any medical intervention that we do. 292 00:16:52,268.1194563 --> 00:16:55,898.1194563 You start a medication, your doctor's gonna talk to you about risks and benefits. 293 00:16:55,898.1194563 --> 00:16:57,518.1194563 You're going for surgery with James. 294 00:16:57,518.1194563 --> 00:16:59,648.1194563 He'll talk to you about risks and benefits. 295 00:16:59,918.1194563 --> 00:17:01,928.1194563 You're seeing Brodie in the emergency room. 296 00:17:02,258.1194563 --> 00:17:09,68.1194563 If you're awake and alert, he'll talk to you about risks and benefits of seeing his beautiful face you. 297 00:17:09,656.6194563 --> 00:17:11,711.6194563 And if you're not, I'll whisper them into your ear. 298 00:17:12,578.1194563 --> 00:17:13,628.1194563 Yes. 299 00:17:14,738.1194563 --> 00:17:15,428.1194563 There you go. 300 00:17:16,268.1194563 --> 00:17:17,108.1194563 And I've seen him do it. 301 00:17:17,108.1194563 --> 00:17:19,898.1194563 Guys, the same thing here. 302 00:17:20,228.1194563 --> 00:17:29,318.1194563 These are interventions and you need to know what can happen and what it will do and the side effects and the benefits so you can make a personal decision. 303 00:17:29,318.1194563 --> 00:17:38,558.1194563 So it's, it's patient autonomy at the end of the day and shared decision making, where you have the right to decide how things go for you now. 304 00:17:38,904.786123 --> 00:17:40,854.786123 I think it, it's there. 305 00:17:40,854.786123 --> 00:17:45,204.786123 There are situations where these kinds of things are not gonna be offered and maybe we'll get into that later. 306 00:17:45,204.786123 --> 00:17:52,164.786123 So it's not always your decision, but at least just inform you on what available, just like any other medical intervention. 307 00:17:53,124.786123 --> 00:17:56,664.786123 Does that sound Yeah, I kind of like you guys? Thank you. 308 00:17:57,560.786123 --> 00:18:07,640.786123 The interventions that Josh are talking about, you know, these CPR or aggressive or invasive resuscitation, these are taking place in case of. 309 00:18:08,300.786123 --> 00:18:16,715.2244492 Somebody having, know, crisis, right? We're not doing these interventions on patients who are doing fine. 310 00:18:17,45.2244492 --> 00:18:27,355.2244492 These are patients who are having cardiac arrest or respiratory arrest, or, this is when their heart stops, moving, or they're not breathing, they're unconscious. 311 00:18:27,455.2244492 --> 00:18:37,205.2244492 And that's when we, have to act very quickly in order to be able to revive, these patients, bring them back to life, literally. 312 00:18:37,585.2244492 --> 00:18:52,315.2244492 And if we don't have these discussions about what interventions the patient would want in advance, we're just not gonna have the luxury of the opportunity to talk about that at the time of crisis. 313 00:18:52,365.2244492 --> 00:19:14,95.2244492 So when patients are admitted to the hospital, especially, where we think that there is possibility that this patient may unexpected crisis, is important to have these discussions earlier on so that, the patient's wishes are reflected in how the care is provided at the time of crisis. 314 00:19:14,875.2244492 --> 00:19:19,705.2244492 are patients who would say, you know, I've lived pretty good 92 years of my life. 315 00:19:19,825.2244492 --> 00:19:25,405.2244492 I know that I'm here because I have pneumonia, and there is a chance that I, my heart may stop. 316 00:19:25,855.2244492 --> 00:19:39,305.2244492 If that's the case, then I don't want some provider, compressing on my chest, breaking on my ribs, and the expected, percentage of me surviving that is very low. 317 00:19:39,495.2244492 --> 00:19:44,295.2244492 I want to pass away with dignity and without having all these things happen to me. 318 00:19:44,295.2244492 --> 00:19:48,435.2244492 So I think this is the discussions that, that we're talking about. 319 00:19:48,825.2244492 --> 00:19:51,274.2441286 This is why that advanced planning is important. 320 00:19:51,676.1684363 --> 00:19:52,153.6684363 Yeah, I. 321 00:19:52,411.1684363 --> 00:19:59,951.1684363 I think you, you nailed it there, right? It's really trying to respect the patient's values for, what they do and don't want being done to them as well. 322 00:19:59,951.1684363 --> 00:20:00,71.1684363 Right. 323 00:20:00,191.1684363 --> 00:20:06,261.1684363 End of the day, these are all interventions, these are all treatments to which we would try to, to ideally have those conversations ahead of time. 324 00:20:06,531.1684363 --> 00:20:12,31.1684363 Um, I will add on that there's also some times, you know, uh, anticipated, deaths as well. 325 00:20:12,31.1684363 --> 00:20:20,538.6684363 So thinking about, patients that maybe have advanced stages of cancer and, you know, part of, palliation and, and I think kinda your, your goals of care, Yeah. 326 00:20:20,711.1684363 --> 00:20:22,661.1684363 comes up in, into play for some of those as well. 327 00:20:22,661.1684363 --> 00:20:24,11.1684363 So, but I totally agree. 328 00:20:24,11.1684363 --> 00:20:24,851.1684363 I think ideally. 329 00:20:25,166.1684363 --> 00:20:32,126.1684363 You know, these, these talks could be removed from an emergency or, you know, really timely environment. 330 00:20:32,156.1684363 --> 00:20:38,466.1684363 'cause those are really challenging times to, to try to have those conversations, when they're really pressured and you're not able to have that. 331 00:20:38,826.1684363 --> 00:20:40,776.1684363 Um, and you're not sure, you know, 'cause I guess. 332 00:20:41,256.1684363 --> 00:20:54,6.1684363 Otherwise, if we don't have any, you know, goals of care, then really it's the healthcare providers or the, the family that kind of takes on that burden of trying to guess, you know, what would, what would the patient want and, and what would their values be. 333 00:20:54,6.1684363 --> 00:20:56,446.1684363 So it's, it's great if you can have those, ahead of time. 334 00:20:56,915.9462111 --> 00:21:01,385.9462111 Just to summarize, you wanna have these conversations when you don't need to have these conversations. 335 00:21:01,775.9462111 --> 00:21:12,215.9462111 So, I mean, in a perfect world, if family doctors had more time and, and less patients waiting in the waiting room, a lot of them would probably have this discussion and this discussion changes. 336 00:21:12,215.9462111 --> 00:21:17,795.9462111 If you're a 30-year-old and someone says, Hey, if this, and this happens, we can do CPR and intubation and you're otherwise healthy. 337 00:21:18,875.9462111 --> 00:21:24,555.9462111 The survival rates are decent in those cases, like 20, 25% So you're gonna say, yeah, do that. 338 00:21:24,975.9462111 --> 00:21:28,605.9462111 If, like you said, James, you're 90 and you have other medical issues. 339 00:21:30,255.9462111 --> 00:21:34,215.9462111 often going to say, no, don't, don't gimme these traumatic interventions. 340 00:21:34,475.9462111 --> 00:21:40,385.9462111 But some people they may say, you know what? I want to live as long as possible no matter what. 341 00:21:40,385.9462111 --> 00:21:41,375.9462111 So do that. 342 00:21:42,35.9462111 --> 00:21:45,755.9462111 But the earlier you have the conversations, the better. 343 00:21:45,815.9462111 --> 00:21:46,865.9462111 And it is just fluid. 344 00:21:46,925.9462111 --> 00:21:52,177.061205 So always thinking about it, always changing it and as importantly, just Brody, you said it already. 345 00:21:52,927.061205 --> 00:21:54,787.061205 You need to know what your loved ones want. 346 00:21:54,877.061205 --> 00:22:07,717.061205 So you are not struggling to make the decision when they're sick, because the emotional toll that takes and the inability to take emotions out of those kinds of decisions makes it so, so difficult if you're deciding for someone else. 347 00:22:08,182.1842833 --> 00:22:14,427.1842833 There's some, um, staggering statistics around, you know, this, uh, unfortunately, you know, these discussions. 348 00:22:15,502.1842833 --> 00:22:19,942.1842833 Do not take place in advance and are not documented anywhere. 349 00:22:19,942.1842833 --> 00:22:27,742.1842833 Some studies demonstrated that like 40% of patients who are in critical conditions, uh, do not have any co discussion documented. 350 00:22:27,742.1842833 --> 00:22:36,562.1842833 So this really, you know, makes it challenging for providers to understand what the patient's wishes are at the time of the crisis. 351 00:22:36,712.1842833 --> 00:22:46,612.1842833 Uh, and at, you know, at those points you're kind of giving up your kind of right to choose how you want interventions to be provided to you. 352 00:22:47,108.4923185 --> 00:22:57,601.8256518 the other thing is that oftentimes, even if these are documented and you as a patient have had discussions with the providers, and these are documented, may not. 353 00:22:57,976.8256518 --> 00:23:14,626.8256518 Remember, or understand what the discussions were and some of the statistics around that, uh, is that, you know, the, about 30% of the, the families, you know, don't remember having had these discussions, uh, with the patients. 354 00:23:14,926.8256518 --> 00:23:40,486.8256518 And because of that, they're in very high emotional distress when, let's say the, the, the, the loved one had said that, you know, I do not want any resuscitation, and the patients is in crisis, and the doctors tell the family, while we're not gonna perform any CPR or heroic measures, uh, and the family feel very much distressed, uh, in, in these kind of situations. 355 00:23:40,486.8256518 --> 00:23:41,585.8256518 So James. 356 00:23:41,996.5349227 --> 00:23:44,306.5349227 James, I am gonna you the word heroic. 357 00:23:44,306.5349227 --> 00:23:45,206.5349227 I can't stay. 358 00:23:45,206.5349227 --> 00:23:45,885.0349227 I can't know. 359 00:23:46,286.5349227 --> 00:23:46,856.5349227 Oh no. 360 00:23:47,96.5349227 --> 00:23:47,396.5349227 Oh no. 361 00:23:47,396.5349227 --> 00:23:48,116.5349227 I jumped in. 362 00:23:48,866.5349227 --> 00:23:50,906.5349227 Well, I mean, you know, uh. 363 00:23:52,211.5349227 --> 00:23:53,141.5349227 I stand by those. 364 00:23:53,201.5349227 --> 00:23:54,60.5349227 Uh, I Yeah. 365 00:23:54,191.5349227 --> 00:23:54,780.5349227 you heroic. 366 00:23:55,1.5349227 --> 00:23:56,501.5349227 it's really heroic. 367 00:23:56,981.5349227 --> 00:24:03,821.5349227 Uh, I mean, you know, not that what we're doing is heroic, but it is really, know, you are throwing everything. 368 00:24:03,821.5349227 --> 00:24:04,811.5349227 It's a Hail Mary. 369 00:24:04,991.5349227 --> 00:24:12,0.5349227 Uh, it's, you know, if Hail Mary, I'll give you this is a really good thing. 370 00:24:12,0.5349227 --> 00:24:16,530.5349227 This highlights the difficulty with these conversations that maybe we'll get into is everyone has different wording. 371 00:24:16,530.5349227 --> 00:24:18,90.5349227 Everyone has different ways of doing it. 372 00:24:18,570.5349227 --> 00:24:24,30.5349227 Um, and to do it right, you need time, you need space, you need quiet. 373 00:24:24,390.5349227 --> 00:24:30,60.5349227 And really to do it right, you need multiple conversations for people who just have never gone through it all before. 374 00:24:30,470.5349227 --> 00:24:34,70.5349227 But we do have all these words, like heroic. 375 00:24:34,410.5349227 --> 00:24:44,976.5349227 We have phrases like, do you want us to do everything possible? And depending how those are put out there, it can really sway someone's decision, Yeah. 376 00:24:45,290.5349227 --> 00:24:47,150.5349227 if it's not necessarily what they want. 377 00:24:47,150.5349227 --> 00:25:07,347.9778206 It's very interesting 'cause when you hear heroic, you're like, yes, be a hero But, but Josh, to your point, I think it's, it's, you know, and, and I've seen this and been involved in some of these conversations that yeah, the, the terms used can very much so change the tone of the conversation or things like that as well. 378 00:25:07,447.9778206 --> 00:25:09,7.9778206 And it's interesting. 379 00:25:09,7.9778206 --> 00:25:16,697.9778206 So, I'd say as of the three of us, you probably have the most goals of care discussions, um, certainly in the merge when I have to have them. 380 00:25:16,697.9778206 --> 00:25:21,677.9778206 It's awful because it's loud and chaotic and in the middle of the hallway and it's not an ideal place to have them. 381 00:25:22,37.9778206 --> 00:25:26,57.9778206 Um, you have to make the decision and then you're also forced at a time where. 382 00:25:26,147.9778206 --> 00:25:26,969.4778206 Yeah, Yeah. 383 00:25:27,107.9778206 --> 00:25:27,647.9778206 Absolutely. 384 00:25:27,647.9778206 --> 00:25:27,917.9778206 Yeah. 385 00:25:28,187.9778206 --> 00:25:35,867.9778206 So, you know, Josh, maybe share, you're prepping to meet with a family to talk about code status. 386 00:25:35,867.9778206 --> 00:25:44,161.1444873 Like what do you do? What's your, you know, what, what's the approach? What sort of things, like, how do you phrase it for, for families? Yeah. 387 00:25:44,251.1444873 --> 00:25:53,221.1444873 So first I figure out if they've ever had the conversation before, and if like a med student was in the room before me and I know they just have the conversation, I know I may have to walk some things back. 388 00:25:53,534.6444873 --> 00:25:55,474.6444873 James walked out saying, I'm a hero. 389 00:25:56,254.6444873 --> 00:25:57,94.6444873 I'm a do it all. 390 00:25:57,511.1444873 --> 00:25:57,841.1444873 Yeah. 391 00:25:58,232.1444873 --> 00:26:03,291.1444873 Yeah, Generally I'll walk in, I will talk to the family about other things first. 392 00:26:03,291.1444873 --> 00:26:11,541.1444873 I don't usually walk in, say, Hey, I'm Josh, do you want CPR? Figure out where things are at and I will tell you I have these conversations to someone coming in with a cough. 393 00:26:11,691.1444873 --> 00:26:17,541.1444873 They're completely well, and I have these conversations with people who are like borderline going to the intensive care unit. 394 00:26:18,441.1444873 --> 00:26:20,401.1444873 I'll talk, I'll build a little rapport. 395 00:26:21,371.1444873 --> 00:26:22,801.1444873 And then I'll set them up. 396 00:26:22,801.1444873 --> 00:26:27,421.1444873 I'll say, Hey guys, like I gotta talk to you about a pretty hard subject that you may or may not have heard before. 397 00:26:27,801.1444873 --> 00:26:37,551.1444873 And I say, have you guys ever talked about things like CPR, life support, intensive care, or has the word DNR come up in your life? And I will ask them and let them kind of tell me. 398 00:26:39,81.1444873 --> 00:26:44,661.1444873 most people I will say these days who come into the hospital have heard it in some way. 399 00:26:45,831.1444873 --> 00:26:55,11.1444873 And I mean, I'll kind of say, Hey, has there been decisions made before? If it's a yes or no, then conversation's done if they have it written down somewhere even better. 400 00:26:55,131.1444873 --> 00:26:56,301.1444873 We know what everyone wants. 401 00:26:57,411.1444873 --> 00:27:02,631.1444873 but then I'll go into the specifics and I'll talk about CPR and I'll talk about how it can save a life. 402 00:27:02,631.1444873 --> 00:27:06,621.1444873 It can keep a heart going, but it doesn't often fix the underlying issue. 403 00:27:07,11.1444873 --> 00:27:08,271.1444873 It can break ribs. 404 00:27:08,301.1444873 --> 00:27:09,561.1444873 It's very traumatic. 405 00:27:09,921.1444873 --> 00:27:18,979.4778206 And depending where you are in your age and medical journey, the chances of survival are 0 percent, all the way up to, I don't know, 25, 30%. 406 00:27:18,979.4778206 --> 00:27:21,259.4778206 I won't, I won't throw percentages in there too much. 407 00:27:21,529.4778206 --> 00:27:23,89.4778206 Then I'll talk about life support machines. 408 00:27:23,299.4778206 --> 00:27:25,189.4778206 If you go on that, there's a lot of medications. 409 00:27:25,189.4778206 --> 00:27:39,439.4778206 There's trauma to the airways potentially, and depending how sick you are and what you have coming off those machines might be really, really hard and you might not ever be able to come off Someone who's younger and healthier, I'm not gonna phrase it that way necessarily. 410 00:27:39,709.4778206 --> 00:27:49,459.4778206 So I will be gauging my audience I will be using my experience to say, this probably is a good idea for you because it may work if that's what you wanted. 411 00:27:49,789.4778206 --> 00:27:53,359.4778206 Or in some people these days, I'm so comfortable saying, don't do this. 412 00:27:53,689.4778206 --> 00:27:54,949.4778206 It is not going to work. 413 00:27:54,949.4778206 --> 00:27:58,279.4778206 Just like if you don't have diabetes, I'm not giving you insulin. 414 00:27:58,729.4778206 --> 00:28:06,979.4778206 If you are 90 with cancer all over your body, do not do CPR or life support because it's not fixing the cancer, which is ultimately leading to all that. 415 00:28:07,65.4778206 --> 00:28:07,485.4778206 Mm-hmm. 416 00:28:08,164.4778206 --> 00:28:11,854.4778206 So more in those conversations, but like I kind of gauge it to the person. 417 00:28:12,304.4778206 --> 00:28:13,474.4778206 Um, that's my style. 418 00:28:13,504.4778206 --> 00:28:15,595.4778206 I am one out of a Yeah. 419 00:28:16,414.4778206 --> 00:28:26,794.4778206 so Uh, I didn't know that there are billion doctors out of, uh, you know, this world that only has 11 billion or something like James set stats guy here. 420 00:28:26,824.4778206 --> 00:28:27,214.4778206 Okay. 421 00:28:27,214.4778206 --> 00:28:28,57.9778206 I could do stats. 422 00:28:28,57.9778206 --> 00:28:28,957.9778206 Check that for sure. 423 00:28:28,957.9778206 --> 00:28:30,644.4778206 James, Yeah, yeah, yeah. 424 00:28:31,80.4778206 --> 00:28:32,677.9778206 I pulling it up now. 425 00:28:32,790.4778206 --> 00:28:34,627.9778206 population, lied. 426 00:28:35,130.4778206 --> 00:28:39,570.4778206 Yeah, But, um, yeah, it's, it's really hard discussion. 427 00:28:40,20.4778206 --> 00:28:48,510.4778206 And as Josh alluded to, I think, you know, Josh, you definitely have, you know, a broader and deeper experience with this. 428 00:28:49,140.4778206 --> 00:29:07,590.4778206 know, in surgery the discussions are a little different because it's more episodic in that, you know, I'm treating the patients, taking this patient to the operating room, and they're, know, usually they receive general anesthesia, meaning they're intubated already. 429 00:29:07,870.4778206 --> 00:29:31,450.4778206 I don't know whether I agree with this ethos or not, but because we're so much into the invasive therapy, we feel that we would do everything in case of, you know, cardiac arrest or heart stopping or breathing, stopping, to get them back at this episodic, this episode of perioperative, period. 430 00:29:32,590.4778206 --> 00:29:48,880.4778206 Although, you know, I, I feel, you know, their chances of survival are probably unchanged, uh, you know, whether it's surgical or not, right? Uh, but we feel that, you know, if it had something to do with surgery, then the onus is upon. 431 00:29:49,495.4778206 --> 00:30:05,587.8133049 Not just the patient's disease, but the surgical, outcomes that,, we need to to reverse if it's due to the complications of surgery that we feel, uh, that we should do everything possible to get them better. 432 00:30:05,856.8668097 --> 00:30:18,29.3668097 so, there, there's some variations of, you know, uh, this, but general kind of consensus among surgeons is that we're more aggressive, uh, because we're taking the patients to, you know, very invasive therapies, Mm-hmm. 433 00:30:18,246.8668097 --> 00:30:25,296.8668097 uh, that we would do everything to bring them back even at, the extremes of, uh, critical conditions. 434 00:30:25,464.9133274 --> 00:30:35,214.9133274 I'd argue, if you're in there in surgery, you're trying to fix something, and if something big and bad happens, like the heart stops, lung stops, you're in there trying to fix what's causing it. 435 00:30:35,274.9133274 --> 00:30:43,194.9133274 So, so maybe with that conversation it is a bit more realistic that you do those things and people who may have said in other situations, I don't want it. 436 00:30:44,307.5809924 --> 00:30:44,787.5809924 maybe. 437 00:30:44,933.5809924 --> 00:30:49,853.5809924 over to, you know, after surgery for the period of time that they're recovering from surgery too. 438 00:30:50,187.5809924 --> 00:30:50,397.5809924 Yeah. 439 00:30:50,633.5809924 --> 00:31:00,143.5809924 um, but yeah, 'cause you know, we feel that, you know, what happens in the surgery is the determinant of their outcomes. 440 00:31:00,143.5809924 --> 00:31:06,822.1085435 So we feel that we should go back to the operating room and try to fix it if it's caused by surgical issues. 441 00:31:06,909.3357544 --> 00:31:08,559.3357544 Yeah, and, and it makes sense to you. 442 00:31:08,559.3357544 --> 00:31:28,239.3357544 I mean, you know, to a degree I can see code status being sometimes fluid when it comes to you going for surgery, right? Because there are inherent risks just to the anesthesia, the medications that might drop your blood pressure be really low and you just need a brief period of some additional medications or some support or something like that to get through it. 443 00:31:28,479.3357544 --> 00:31:32,739.3357544 Whereas it's a very different than if you were to, you know, your heart were to stop for other reasons. 444 00:31:32,739.3357544 --> 00:31:34,389.3357544 So that, that totally makes sense. 445 00:31:34,778.6350986 --> 00:31:42,788.6350986 Josh, um, and, and James actually for both of you, I'm quite jealous for the time you sometimes potentially are able to leverage for being able to have those conversations. 446 00:31:42,788.6350986 --> 00:31:43,735.1350986 You know, I think, Yep. 447 00:31:44,408.6350986 --> 00:31:47,988.6350986 Again, in the emerg it can be very short. 448 00:31:48,68.6350986 --> 00:31:52,18.6350986 The most drastic example that I, that I have of this is. 449 00:31:52,568.6350986 --> 00:31:55,448.6350986 I remember one time with a very sick patient in front of me. 450 00:31:56,588.6350986 --> 00:31:57,788.6350986 Family was at bedside. 451 00:31:58,238.6350986 --> 00:32:09,938.6350986 And you know, maybe for listeners, it's really hard to know when someone's going to die, right? Sometimes you, you know, I get an idea that someone's probably going to die, but I don't know when. 452 00:32:10,118.6350986 --> 00:32:11,318.6350986 Minutes, hours, days. 453 00:32:11,318.6350986 --> 00:32:12,758.6350986 That could be really, really hard to tell. 454 00:32:12,758.6350986 --> 00:32:13,988.6350986 I knew the patient was really sick. 455 00:32:13,988.6350986 --> 00:32:17,798.6350986 I knew they needed to come into the hospital and they didn't have anything for goals of care discussion. 456 00:32:18,428.6350986 --> 00:32:19,208.6350986 And I remember. 457 00:32:19,488.6350986 --> 00:32:40,98.6350986 Literally as I'm doing the introduction to try to not be as Josh joked about, like, hi, I'm Brodie, have you ever thought about CPR? As I'm starting that introduction, I see like the heart rate on the monitor going down, and the blood pressure going down, I and like the, the speed of my voice had to go faster and faster to be like, I have one minute to get an answer. 458 00:32:40,98.6350986 --> 00:32:40,908.6350986 Because like. 459 00:32:41,345.1350986 --> 00:32:45,335.1350986 when Brodie gets excited, his voice goes high and it goes fast. 460 00:32:45,335.1350986 --> 00:32:46,685.1350986 It is impressive. 461 00:32:46,735.1350986 --> 00:32:49,205.1350986 We will get it out one of these podcast episodes. 462 00:32:49,205.1350986 --> 00:32:49,265.1350986 Yeah. 463 00:32:49,868.6350986 --> 00:32:50,78.6350986 yeah. 464 00:32:50,78.6350986 --> 00:32:53,198.6350986 This is me, like three times speed slowed down when I'm on here. 465 00:32:53,198.6350986 --> 00:32:54,608.6350986 Like, it's, oh man. 466 00:32:54,608.6350986 --> 00:32:57,638.6350986 But I remember that happening being like, this can't be real. 467 00:32:57,998.6350986 --> 00:33:02,378.6350986 Like, um, but it, it can be really pressured. 468 00:33:02,708.6350986 --> 00:33:10,238.6350986 So I think to add my, like, my take on that then is I tend to err on the side of, um. 469 00:33:10,883.6350986 --> 00:33:16,253.6350986 Maybe being more on the aggressive edge because it's easier to scale that back afterwards. 470 00:33:16,253.6350986 --> 00:33:28,133.6350986 Right? So if I'm not sure what someone's code status, you know, code status is, we are, we're not, we don't have the luxury of having that time, then it might go towards the end of doing, you know, quote unquote everything or starting CPR intubating them. 471 00:33:28,283.6350986 --> 00:33:30,713.6350986 And sometimes that unfortunately comes out that actually they did have. 472 00:33:30,958.6350986 --> 00:33:34,678.6350986 A code status that, that, that wasn't part of the patient's wishes. 473 00:33:34,678.6350986 --> 00:33:38,518.6350986 And like that's a, the really hard thing for, for the, the team that happens. 474 00:33:38,578.6350986 --> 00:33:48,583.6350986 Um, but it's usually the context of we're dealing with the best information we have at the time and trying to make those decisions literally sometimes with like seconds or minutes to, to try to make them. 475 00:33:49,211.1350986 --> 00:34:07,631.1350986 And you know, for patients, uh, and their families who are listening to this conversation, they may feel very puzzled too, right? Like, you know, let's say their father or their loved one, uh, is getting admitted to the hospital for pneumonia. 476 00:34:07,991.1350986 --> 00:34:13,181.1350986 You know, had pneumonia before and he survived that fine without any issues. 477 00:34:13,871.1350986 --> 00:34:16,750.1350986 You know, why are we all of a sudden having these conversations Mm-hmm. 478 00:34:17,531.1350986 --> 00:34:21,658.1744304 he should have CPR or not? So they may feel very puzzled. 479 00:34:22,78.1744304 --> 00:34:27,418.1744304 And I think it reflects that the, the inconsistency in, you know. 480 00:34:27,838.1744304 --> 00:34:43,918.1744304 In us, right? Like we not at all doctors do a good job of, know, just having, documenting the code discussion or having discussions about code feel uncomfortable sometimes about having discussions about code status. 481 00:34:44,308.1744304 --> 00:34:47,847.1744304 Uh, so I, I could certainly understand why patients Yep. 482 00:34:48,118.1744304 --> 00:34:51,148.1744304 puzzled when they're approached and talk about it. 483 00:34:52,155.5241677 --> 00:34:59,445.5241677 are, what are your strategies to, in talking to patients who are too overwhelmed to make a decision, right away. 484 00:35:00,18.0241677 --> 00:35:04,38.0241677 I mean, it's a nice distraction for not talking about politics over Thanksgiving dinner. 485 00:35:04,428.7723769 --> 00:35:06,258.7723769 Let's just, let's just hammer this out, fam. 486 00:35:06,258.7723769 --> 00:35:08,168.7723769 We're gonna, we're gonna sit down. 487 00:35:09,298.7723769 --> 00:35:13,415.2723769 Who wants CPR? Who wants a breathing tube? Yeah. 488 00:35:13,625.2723769 --> 00:35:16,445.2723769 I'll take a drumstick and some CPR please. 489 00:35:16,445.2723769 --> 00:35:16,685.2723769 Yeah. 490 00:35:16,776.6403153 --> 00:35:17,346.6403153 it's amazing. 491 00:35:17,346.6403153 --> 00:35:31,145.6716881 Like I have, I consider myself decent or good at these conversations over the years I've developed it, um, more than an amateur and these, I would say, but once a shift, I will scare the hell outta someone with this conversation. 492 00:35:31,145.6716881 --> 00:35:31,745.6716881 Unintentionally. 493 00:35:31,745.6716881 --> 00:35:34,85.6716881 Like I will walk in, we'll be having a great conversation. 494 00:35:34,85.6716881 --> 00:35:35,765.6716881 I'll say, Hey, we gotta talk about this, this, and this. 495 00:35:35,945.6716881 --> 00:35:45,135.6716881 And they'll look at me and say, why didn't you tell me he's dying? Or, why are you doing this? Or, and it is just, I'm like this is medical care. 496 00:35:45,155.6716881 --> 00:35:45,875.6716881 I gotta do it. 497 00:35:45,875.6716881 --> 00:35:49,445.6716881 And I've had patients yell at me like, it's just inevitable because the emotions are high. 498 00:35:50,225.6716881 --> 00:35:51,605.6716881 strategy is. 499 00:35:51,646.9881138 --> 00:35:53,536.9881138 You don't have to get an answer. 500 00:35:53,596.9881138 --> 00:36:00,166.9881138 Most of the time in that moment, You are there to start a conversation outside of the urgent ones like Brodie's talking about. 501 00:36:00,526.9881138 --> 00:36:03,466.9881138 And you give them time and you say, listen, I don't need decisions now. 502 00:36:03,831.4142225 --> 00:36:15,231.4142225 I mean, the person whose body it is should be able to make the decision, but if they can't because they're unconscious or otherwise, and you give 'em time and you say, I'm gonna circle back with you, talk to your family, let's just take it easy. 503 00:36:15,631.4142225 --> 00:36:17,251.4142224 Inevitably it's a tough conversation. 504 00:36:17,251.4142224 --> 00:36:22,951.4142224 People don't like talking about death, and let's be honest, that's what we're talking about, how we die or how we live. 505 00:36:23,131.4142225 --> 00:36:26,491.4142225 Um, it's, it's uncomfortable, but it's so vastly important. 506 00:36:26,944.9142224 --> 00:36:27,184.9142224 Yeah. 507 00:36:27,334.9142224 --> 00:36:34,579.9142224 The other way to to frame it is though it's also helping you choose a bit for what that death looks like. 508 00:36:34,579.9142224 --> 00:36:46,844.9142225 And I know we're not talking about like medically assisted suicide and MAID and those types of things, but there is a degree of, you know, when you're approaching something so critical like that, like what do you want that to look like. 509 00:36:46,844.9142225 --> 00:36:55,134.9142225 So it really is trying to empower patients to make sure that everything is done for their wishes. 510 00:36:55,184.9142225 --> 00:37:01,203.2475558 It's almost like the way that we do screening for colon cancer, your tetanus shot is up to date. 511 00:37:01,203.2475558 --> 00:37:10,403.2475558 It's almost like there should be a recurring part within the primary care system, ideally, where it's just a routine part of your check-in. 512 00:37:10,403.2475558 --> 00:37:24,383.2475558 You know, like, I mean, I think about you have like a financial risk tolerance, right? Like you meet with your financial advisor if anyone has one and they're like, Hey, what's your, what is your, when do you wanna retire? What's your risk tolerance for investments? And they do that every time. 513 00:37:24,413.2475558 --> 00:37:26,993.2475558 'cause they have to by law to be able to. 514 00:37:27,8.2475558 --> 00:37:28,28.2475558 To do things like that. 515 00:37:28,28.2475558 --> 00:37:29,18.2475558 It's almost like the same. 516 00:37:29,18.2475558 --> 00:37:30,278.2475558 It's kind of what we should be doing. 517 00:37:30,278.2475558 --> 00:37:36,548.2475558 Like what's your, you know what's your tolerance? What's your code status? What would you want done if these were the things it's gonna change over time. 518 00:37:37,324.7475558 --> 00:37:40,54.7475558 my financial advisor says I can never retire. 519 00:37:40,204.7475558 --> 00:37:42,548.2475558 Is that good or bad? He said to start a podcast. 520 00:37:45,479.7475558 --> 00:37:45,559.7475558 Yeah. 521 00:37:45,789.7475558 --> 00:37:51,578.2475558 He said "don't, focus on something that will make you money" James and I have been your financial advisor for the last three years. 522 00:37:51,625.7475558 --> 00:37:51,745.7475558 Right. 523 00:37:51,845.7475558 --> 00:37:54,64.7475558 It, it's so true. 524 00:37:54,69.7475558 --> 00:37:55,985.7475558 Everything I've learned, took over. 525 00:37:56,885.7475558 --> 00:37:57,859.7475558 Um, oh boy. 526 00:37:58,265.7475558 --> 00:38:07,356.1537731 another scenario that I've come across, especially, when the patient is elderly person. 527 00:38:08,331.1537731 --> 00:38:18,921.1537731 And then there's usually a dominant family member, whether that be their child or, or children or, you know, a spouse and whoever. 528 00:38:18,921.1537731 --> 00:38:19,221.1537731 Right. 529 00:38:20,181.1537731 --> 00:38:23,301.1537731 they like to be at the center of the discussion. 530 00:38:23,691.1537731 --> 00:38:36,820.1537731 And they, they're doing that not because they want to, but they, well, maybe they want to, but they, they're doing it in the name of, I wanna protect my mom, or I wanna Hmm dad from mm-hmm. 531 00:38:37,131.1537731 --> 00:38:38,781.1537731 emotional discussions. 532 00:38:38,841.1537731 --> 00:38:40,821.1537731 They can't take this kind of discussions. 533 00:38:41,271.1537731 --> 00:38:49,705.1537731 How do you approach, you know, you guys, I'm, I'm sure you guys have come across this, you know, how do you approach this kind of scenario? Yeah. 534 00:38:49,795.1537731 --> 00:38:53,125.1537731 Like I, I see, I see more often with the breaking bad news kind of thing. 535 00:38:53,125.1537731 --> 00:38:56,125.1537731 Like I'm telling someone they have cancer, but the family's like, don't tell them. 536 00:38:56,305.1537731 --> 00:38:58,255.1537731 And that's maybe a discussion for a different time. 537 00:38:58,555.1537731 --> 00:39:05,125.1537731 Um, these ones, if the person is awake and alert and capable, I say to the family member, I appreciate your input. 538 00:39:05,395.1537731 --> 00:39:07,495.1537731 I got to hear from Mrs. 539 00:39:07,495.1537731 --> 00:39:08,35.1537731 X. 540 00:39:08,395.1537731 --> 00:39:09,955.1537731 Um, this is her decision. 541 00:39:09,955.1537731 --> 00:39:11,305.1537731 She needs to be part of this. 542 00:39:12,85.1537731 --> 00:39:13,195.1537731 unless she defers to you. 543 00:39:13,525.1537731 --> 00:39:15,355.1537731 And I'm just, I'm pretty honest about these things. 544 00:39:15,385.1537731 --> 00:39:21,655.1537731 'cause these decisions should not be made by someone else if you are able to make it or unless you want someone else to make it. 545 00:39:22,75.1537731 --> 00:39:22,825.1537731 That's, that's me. 546 00:39:23,65.1537731 --> 00:39:23,245.1537731 Yeah. 547 00:39:23,421.1537731 --> 00:39:39,591.1537731 and I also see, you know, the same patients, you know, these patients who are elderly, you know, usually they feel a little, um, to some degree guilty about being unwell sick to their family. 548 00:39:40,461.1537731 --> 00:39:43,791.1537731 You know, sometimes their family members are supporting them. 549 00:39:44,271.1537731 --> 00:39:52,431.1537731 And, you know, I hear from patients like, oh, I feel bad that my son is taking me to the hospital all the time and I'm taking too much of his time. 550 00:39:53,1.1537731 --> 00:39:57,621.1537731 And when conversations about this life and death situations comes along. 551 00:39:58,761.1537731 --> 00:40:07,71.1537731 They inevitably kind of looks to the, to the family members and kind of shrug and say, oh, like, I, I don't know. 552 00:40:07,71.1537731 --> 00:40:12,711.1537731 It's up to, you know, my family members or it's up to my son, or, know, uh, whatever. 553 00:40:12,771.1537731 --> 00:40:15,141.1537731 You know, it is heartbreaking to see. 554 00:40:15,464.9837021 --> 00:40:22,554.4871065 Maybe to kind of summarize, I think what you're getting to James, it can be contentious within, sometimes it can bring up family dynamics. 555 00:40:22,824.4871065 --> 00:40:27,924.4871065 Sometimes it can bring out dynamics between the providers and the family as well. 556 00:40:28,284.4871065 --> 00:40:30,954.4871065 Um, and so I think it is good sometimes if you. 557 00:40:31,449.4871065 --> 00:40:50,649.4871065 You know, uh, if you are a family member whose questions to ask questions, and sometimes if, if I'm the provider and I feel like it's kind of steering into a way that it's, you know, getting people's back up against the wall, um, the, you know, they, maybe they're getting a little bit distraught if you have the time and taking Josh's approach of. 558 00:40:51,169.4871065 --> 00:40:53,59.4871065 You know, let, I wanna plant this seed. 559 00:40:53,59.4871065 --> 00:40:54,679.4871065 I want to come back and talk about this. 560 00:40:54,709.4871065 --> 00:41:00,889.4871065 Let's set a time to come back where we can, can discuss something, I think is a really good approach and trying to bring other people there. 561 00:41:01,9.4871065 --> 00:41:03,979.4871065 And even sometimes it's clarifying that the right people. 562 00:41:04,794.4871065 --> 00:41:06,204.4871065 Are there for those meetings too. 563 00:41:06,825.9345848 --> 00:41:10,35.9345848 So it kind of, it kind of sucks that it leaves sometimes like a bitter taste. 564 00:41:10,940.9345848 --> 00:41:14,900.9345848 You know what I mean? Or, or, or memory for the family, um, for that. 565 00:41:14,900.9345848 --> 00:41:28,190.9345848 So I do think, you know, calling if you know, uh, calling upon additional people within the healthcare team from there, making sure that the family is, is supported as best they can to try to have, um, have someone there that they feel supported with and represented with. 566 00:41:28,818.4345848 --> 00:41:29,732.4345848 Yeah, yeah, Yeah. 567 00:41:30,32.4345848 --> 00:41:32,212.4345848 And it, I think two good things on that. 568 00:41:32,212.4345848 --> 00:41:36,442.4345848 Number one, if a family hears it, they've heard it, so they, they can't argue it later. 569 00:41:36,442.4345848 --> 00:41:39,412.4345848 If, if something happens to the person making the decision, that's always important. 570 00:41:39,412.4345848 --> 00:41:44,752.4345848 'cause inevitably, if there's more than one child than a family, always agree. 571 00:41:45,112.4345848 --> 00:41:47,452.4345848 So if you hear it from the source, it's best. 572 00:41:47,643.4345848 --> 00:41:47,913.4345848 Yeah. 573 00:41:48,112.4345848 --> 00:41:54,892.4345848 And then I think number two with what you said, Brody, going back to this DNR do not resuscitate, um, it's a tough conversation. 574 00:41:54,892.4345848 --> 00:42:01,792.4345848 You're talking about end of life, but you, if you don't use this resuscitate thing, you say like, here's the things we can do. 575 00:42:02,62.4345848 --> 00:42:04,342.4345848 It doesn't take away all the other stuff we're gonna do though. 576 00:42:04,612.4345848 --> 00:42:09,262.4345848 Like, we're still going to give the antibiotics and the fluids and the other medications if that's what you want. 577 00:42:09,262.4345848 --> 00:42:15,172.4345848 So, um, it's really important that even though it can be a tough conversation about end of life, you have to be clear that. 578 00:42:15,952.4345848 --> 00:42:23,673.4345848 Some people would say, are you just giving up on me? And you make it clear that unless you wanted that kind of end of life care, which is a whole different thing, Yeah. 579 00:42:23,782.4345848 --> 00:42:24,622.4345848 still treating you. 580 00:42:24,652.4345848 --> 00:42:26,932.4345848 We're just not treating you with stuff that may or may not help you. 581 00:42:27,353.4345848 --> 00:42:33,113.4345848 It is not just the life sustaining measures like that, that we're not providing. 582 00:42:33,173.4345848 --> 00:42:33,503.4345848 Right. 583 00:42:33,597.4345848 --> 00:42:33,887.4345848 Yeah. 584 00:42:34,23.4345848 --> 00:42:38,257.4345848 So, uh, yeah, it is a great distinction Yeah, Brody. 585 00:42:38,257.4345848 --> 00:42:41,222.4345848 Brody will still whisper in your ear if that's what you want. 586 00:42:55,238.4345848 --> 00:42:55,358.4345848 Mm-hmm. 587 00:43:10,708.4345848 --> 00:43:11,128.4345848 Mm-hmm. 588 00:43:48,348.4345848 --> 00:43:48,768.4345848 Mm-hmm. 589 00:43:55,293.4345848 --> 00:43:55,713.4345848 Mm-hmm. 590 00:43:56,472.4345848 --> 00:43:59,17.4345848 Yeah, they listen. 591 00:43:59,22.4345848 --> 00:43:59,347.4345848 Can. 592 00:44:05,808.4345848 --> 00:44:06,258.4345848 Yeah. 593 00:44:09,648.4345848 --> 00:44:12,547.4345848 Yeah, Um, Canadian healthcare system. 594 00:44:12,547.4345848 --> 00:44:15,802.4345848 You'll probably still be left in the hallway, but you'll get treatment while you're there. 595 00:44:16,112.4345848 --> 00:44:17,522.4345848 Just gotta clarify that one. 596 00:44:17,988.4345848 --> 00:44:18,558.4345848 yeah. 597 00:44:18,648.4345848 --> 00:44:20,28.4345848 Thank you for that clarification. 598 00:44:20,222.4345848 --> 00:44:20,442.4345848 Yep. 599 00:44:20,542.4345848 --> 00:44:20,762.4345848 Yep. 600 00:44:20,762.4345848 --> 00:44:21,362.4345848 Very important. 601 00:44:22,375.6731295 --> 00:44:47,6.7230128 You know, there's something that I've been kind of thinking about that I, I wish the listeners will, will hear this as well,, talking about how your end of life will look like increasingly more and more When you are in a hospital setting, when your heart stops, and we'll see that your breathing stop, we'll see that because we have monitoring going on. 602 00:44:48,206.7230128 --> 00:45:07,190.0563461 If your status is full code, meaning you want chest compression intubation in the United States, especially because, uh, the healthcare providers don't have the ability to reverse the course of, you know, uh, the status code. 603 00:45:07,610.0563461 --> 00:45:16,370.0563461 Unlike Canada, there's some flexi, not flexibility, but there's some degree of, you know, making medical decisions. 604 00:45:16,434.0563461 --> 00:45:19,434.0563461 We have the ability to say, we are not doing CPR. 605 00:45:19,464.0563461 --> 00:45:22,164.0563461 We will not intubate if we don't think it's medically indicated. 606 00:45:22,164.0563461 --> 00:45:23,285.0563461 Yeah, right. 607 00:45:24,485.0563461 --> 00:45:26,329.0563461 but in the US I. 608 00:45:27,335.0563461 --> 00:45:35,525.0563461 It's unlikely that the doctors will go against what's being documented clearly as full code. 609 00:45:36,335.0563461 --> 00:46:12,605.0563461 So if you foresee that your last minutes of your life will be that you are a cold situation with, you know, 10, 20 people, not, you know, loved ones, but healthcare workers, know, working on you giving chest compressions, intubations, because again, you know, depending on what age you are, what medical condition you are, and what kind of disease that brought you here, chance of survival is exceedingly rare, right? In these situations. 610 00:46:13,25.0563461 --> 00:46:13,685.0563461 So. 611 00:46:14,90.0563461 --> 00:46:39,330.0563461 If you have to think about how your last moments, uh, will be like, and how your family members will see the last moments for you as well, so these are kind of things that, uh, very, you know, obviously emotional to think about, but I think it's really important for you to the listeners to think about for all of us as well, you know, as we get older, especially Josh. 612 00:46:39,690.0563461 --> 00:46:41,119.0563461 Um, Hmm. 613 00:46:41,854.0563461 --> 00:46:42,244.0563461 Hmm. 614 00:46:42,720.0563461 --> 00:46:45,47.8186813 gotta Um, I'm, I'm okay with that. 615 00:46:45,777.3896794 --> 00:46:52,394.0563461 I will bring it back because a lot of what we focused on is these conversations in people who are, um, sicker. 616 00:46:52,605.5007876 --> 00:46:56,702.3896794 Or who are maybe advanced age. 617 00:46:57,152.3896794 --> 00:47:01,52.3896794 Um, and the reason we're kind of focused on that is that's where the conversations are the hardest. 618 00:47:01,82.3896794 --> 00:47:05,162.3896794 That's, those are the ones that we, we don't know if there's gonna be benefit to these kinds of things. 619 00:47:05,522.3896794 --> 00:47:15,272.3896794 If you are my, um, super young, um, age, my super young age, Josh's super young age, you guys got this. 620 00:47:15,482.3896794 --> 00:47:22,443.3896794 Um, and you asked me if I wanted intubation and CPR, I'm gonna say yes, like, and I have a good chance of surviving Yeah. 621 00:47:22,592.3896794 --> 00:47:24,2.3896794 depending what obviously causes it. 622 00:47:24,212.3896794 --> 00:47:38,252.3896794 So we're not focusing as much on these, but I have had that conversation with my wife right now, and she knows if I ever get something that is terminal or if I ever get dementia, that goes out the window. 623 00:47:38,252.3896794 --> 00:47:39,332.3896794 I don't want the intubation. 624 00:47:39,332.3896794 --> 00:47:40,352.3896794 I don't want the CPR. 625 00:47:40,352.3896794 --> 00:47:43,262.3896794 So again, it just kind of goes back to have the conversation. 626 00:47:43,982.3896794 --> 00:47:46,652.3896794 Like Brody said, all walks of life, all stages of life. 627 00:47:46,862.3896794 --> 00:47:47,882.3896794 You keep these things going. 628 00:47:47,882.3896794 --> 00:47:47,972.3896794 One. 629 00:47:48,223.3896794 --> 00:47:48,513.3896794 yeah. 630 00:47:48,613.3896794 --> 00:47:50,193.3896794 And it's longitudinal discussion. 631 00:47:50,263.3896794 --> 00:47:50,553.3896794 Yeah. 632 00:47:53,487.3896794 --> 00:47:53,777.3896794 Okay. 633 00:48:13,772.3896794 --> 00:48:20,372.3896794 Every, every time I try to do takeaway, James interrupts me and tells me it's not time yet, so I'm not making this decision today. 634 00:48:21,662.3896794 --> 00:48:23,582.3896794 Just wait. 635 00:48:23,702.3896794 --> 00:48:36,733.3896794 Can I mute him? the, the, the way I'm envisioning, I go into my rabbit hole and take away like 10 minutes, my takeaways and I take away 10 minutes of your time. 636 00:48:41,893.3896794 --> 00:48:49,502.3896794 So final thoughts? Well, should I go? No, no. 637 00:48:49,502.3896794 --> 00:48:51,212.3896794 Brody has this, he started it. 638 00:48:51,212.3896794 --> 00:48:51,877.3896794 Go Brody. 639 00:49:11,383.3896794 --> 00:49:21,147.3896794 So the way, no, so I, I think, you know, really, in all seriousness, I think my key takeaway is what I said like for the last 10 minutes, is that I. 640 00:49:21,283.3896794 --> 00:49:28,963.3896794 how you're, this is the discussion about how your last minutes, you know, of your life to look like. 641 00:49:29,293.3896794 --> 00:49:36,973.3896794 So be empowered and make, think about this longitudinally and make the decisions for yourself. 642 00:49:39,557.3896794 --> 00:49:40,397.3896794 Yeah, I like that. 643 00:49:41,147.3896794 --> 00:49:41,657.3896794 That was good. 644 00:49:42,47.3896794 --> 00:49:42,677.3896794 I'm proud of you. 645 00:49:43,165.764628 --> 00:49:47,935.764628 And I think I'll, I'll finish off with saying, um, again, this isn't a one size fits all. 646 00:49:48,25.764628 --> 00:50:04,45.764628 There's lots of discussions to have around these medical interventions and one thing that didn't come up, and maybe we'll end with is when a doctor has these conversations, um, most of us should not be trying to get a decision that we think is right or wrong. 647 00:50:04,225.764628 --> 00:50:07,255.764628 We should be exploring values of the person making the decision. 648 00:50:07,645.764628 --> 00:50:13,135.764628 We should be medically recommended what we think based on the person and the medical conditions and all that. 649 00:50:13,585.764628 --> 00:50:17,935.764628 Um, but this is your decision for the most part. 650 00:50:18,445.764628 --> 00:50:21,925.764628 And, um, you should make it so have those conversations. 651 00:50:21,985.764628 --> 00:50:27,625.764628 And, um, thanks for, uh, listening to a pretty heavy, heavy conversation, guys. 652 00:50:28,825.764628 --> 00:50:29,455.764628 Important. 653 00:50:29,991.764628 --> 00:50:32,974.9806567 What'd you say, Brody? Nope. 654 00:50:35,674.9806567 --> 00:50:36,964.9806567 That one's getting edited out. 655 00:50:38,545.8196725 --> 00:50:39,415.8196725 Brody, you killed it. 656 00:50:40,424.8196725 --> 00:50:47,365.8196725 No, Brody. 657 00:50:47,414.8196725 --> 00:50:50,639.8196725 this guy, I don't know. 658 00:50:55,609.8196725 --> 00:50:55,899.8196725 Yeah. 659 00:50:57,715.8196725 --> 00:50:58,829.8196725 But Yeah, for sure. 660 00:50:59,65.8196725 --> 00:51:02,35.8196725 discussion, you know, Yeah, by me. 661 00:51:05,529.8196725 --> 00:51:07,64.8196725 and let's end on that note. 662 00:51:07,124.8196725 --> 00:51:09,164.8196725 Let's end on that note guys. 663 00:51:09,254.8196725 --> 00:51:10,514.8196725 Take care everybody. 664 00:51:10,555.8196725 --> 00:51:11,395.8196725 All right, take care. 665 00:51:12,205.8196725 --> 00:51:12,775.8196725 you next week.