May 13, 2024 • 44 mins
Death often remains a taboo subject, but imagine if we could confront it with dignity, peace, and even a sense of empowerment. That's the revelation Dr. Bob Uslander brings to our heartfelt conversation on end-of-life choices. As an emergency physician turned end-of-life care advocate, Dr. Uslander shares his profound insights on transforming the final chapter of life from one of fear and uncertainty to a period filled with grace and meaningful connections. We discuss the pivotal role of clear, compassionate conversations in easing the emotional burden for individuals and their families, and the striking difference these discussions can make in the quality of our final days.
Navigating through the complexities of end-of-life care, we present an array of options that go beyond traditional models. Dr. Uslander and I shed light on the value of proactive planning and the nuances of treatment choices that prioritize the individual's quality of life. We also address the intricacies of medical aid in dying, offering an earnest look at how this choice not only supports those seeking control over their suffering but also lends a profound sense of closure to their loved ones. The episode is seasoned with stories of empowerment and the beauty of fulfilling one's final wishes—testaments to the possibility of a serene transition that resonates with peace and comfort for families during a time of grief.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:26):
Welcome in.
This is Ron Greenwald, the RonGreenwald Podcast, and today, as
I say, they're all importantpodcasts because we bring
stories of great value, greatinsights into aging, aging well,
aging successfully, aging,aging well, aging successfully.
But when I do my presentationson senior living and senior
(00:49):
health, one thing I always saythere's a 100% death rate.
You're not going to avoid it,and one of the biggest pitfalls
in our society is that we don'ttalk about I don't want to call
it a successful passing, but aless stressful passing, I guess
amongst the family, Because alltoo often I see the incredible
(01:12):
angst that goes along whenwatching a loved one pass away.
It's tragic, it's terrible, andtoday I am thrilled to have on
the show somebody who canaddress those issues head-on and
has done an amazing job to beat the forefront of changing how
we view dealing with one'spassing.
(01:34):
Dr Bob Uslander is here with ustoday.
Thank you for joining us.
I'm going to turn it over toyou to give us a little bit of
your background and how you gotinto the field we are in today.
Speaker 2 (01:47):
Sounds good.
Thanks, ron.
Thanks for having me Thrilledto have you, doc.
I've enjoyed our collaboration,our relationship, over the
years, so I'm very happy to behere and hopefully it'll be
insightful in your audience.
Speaker 1 (02:00):
It's going to be very insightful because this is not
a topic everybody.
Stay tuned, people.
Speaker 2 (02:06):
So I'm Bob Uslander.
I spent the majority of myearly career as an emergency
physician.
I trained in emergency medicinein Chicago and I spent time
working in emergency rooms inChicago in different parts of
the world.
I worked on Guam for a fewyears.
I settled in a small communityup in Northern California where
(02:29):
I spent 15 years as an ER doc upthere and I dealt with death a
lot.
As you can imagine, in the ERkind of the MO is you try to
save everybody and in general,as you're aware, in the health
care system there's a real focuson prolonging extending life
(02:51):
almost at all costs.
We've done such a good job oftreating so many illnesses and
keeping people alive longer, butwe're not doing a very good job
of addressing the needs thatcome towards the end of life,
when things get reallycomplicated.
I saw a lot of this in the ER.
It's sort of like a bigfishbowl Everything comes down,
(03:14):
trickles down, so you really geta firsthand look at all the
issues and problems and stressesin the healthcare system.
About 10 years into my practiceI had a good friend of mine die
of melanoma and he was 32.
He had three little boys thatwere under the age of six and he
(03:34):
had a mole removed on his backwhen he was 27.
The doctors told him that theygot it.
Everything's great, go on withyour life.
A few years later he had a lumpunder his armpit and it ended
up being metastatic melanoma.
So as he got sicker over themonths, I was his friend, but I
(03:55):
also became his doctor and thenI kind of became his guide.
As his health was deteriorating, we brought in the local
hospice team and I really hadhad no exposure to hospice
before that.
But this was my first realconnection with hospice and
together with the hospice teamand Darren and his family and
(04:16):
friends, we created this reallybeautiful end-of-life experience
and had these celebrations andthese really meaningful moments
and at the end, when he actuallydied, it was incredibly gentle
and peaceful.
We were able to really createthis beautiful ending for him
and I saw for the first timethat death doesn't have to be
(04:39):
traumatic.
It's still tragic, especiallywhen a young person dies and has
small children, but it doesn'thave to be something that is
harrowing and scary.
It can actually be a beautifuland actually transformational
experience.
After a period of time, Istarted a house call practice
(05:00):
for homebound seniors.
I was just really drawn in tothat world and I started kind of
building towards being able toexpand my practice and somehow
incorporate working with peopleat end of life and do that in a
way that really filled me up.
I moved to San Diego in 2011 andkind of looking for my next
(05:26):
path.
I was trying to transition outof emergency medicine, which was
very stressful, and I reallywanted to do something that was
going to fill me up and allow meto have more of an impact.
I just happened to actually, Ikind of had a download.
I had this epiphany one daythat I can remember very, very
(05:49):
clearly.
It was very momentous and Ijust in that moment realized
that I'm here to help people diebetter.
And I the next day randomly meta hospice nurse and started
conversations.
And then I started working in apalliative care and hospice
company in San Diego and I spenttwo years working in that
(06:10):
traditional model.
So I was going into people'shomes and helping to identify
their needs and provide thishigh level of support.
But I was working within thehealthcare system and I saw so
many gaps and challenges thatstill existed, identify some of
those gaps.
Speaker 1 (06:27):
I think it's important.
Speaker 2 (06:27):
Well, you know, some of the biggest ones were, for
example, when somebody isadmitted to hospice, they lose
the relationship with thedoctors who they've been engaged
with, who have been caring forthem, sometimes for decades, and
they lose the connection withthe who have been caring for
them, sometimes for decades, andthey lose the connection with
the specialists who have beenhelping them along on their
(06:48):
journey and they have a wholenew team of people and in many
cases most cases they never seea doctor again.
All the care is delivered bynurses and nurse practitioners
through hospice care.
And that's a huge gap nothaving doctors involved at this
really intimate time of life.
The other huge gap one of theother huge gaps is that the
(07:11):
healthcare system doesn't have amechanism to take care of the
families.
You have these families who arestruggling to try to meet the
needs of their loved one who'sill and dying and all the
stresses that that brings on,and they become extremely
overwhelmed and they they don'tknow where to turn.
They don't know how to find theright support and the right
resources and navigate all thedifferent specialists.
(07:33):
So families are kind of leftout in the cold and it's
extremely overwhelming andtraumatic for them as things
unfold.
People don't doctors don't talkwith people about end of life.
They don't talk with peopleabout dying.
It's almost as if, like deathdoesn't even exist.
And then when it, when itbecomes clear that the person's
(07:54):
terminal and nearing death, thenthey sort of offload them to
hospice and and and there's justthis sense of like throwing.
You know throwing in the towellike there's nothing more you
can do, and know throwing in thetowel like there's nothing more
you can do.
And that's not the case.
There's so much more you can do.
One of the things that thatpeople need is to be given
choice.
(08:14):
They need to be on, they needto understand what the reality
of their circumstances are andwhat the options are that are
available to them when they'reterminally ill and looking at a
potentially horrific final stageof life.
Speaker 1 (08:30):
I'm going to the website empoweredendingscom.
Empoweredendingscom.
Dr Bar.
There's so much goodinformation on that website
that's so relative relevant, andyou used the word choices, and
choices is part of that website.
Speaker 2 (08:49):
Define what that means to the audience.
That's an interesting choicesis kind of at the foundation of
everything that we do, becausewe well, we're writing a book
and the title of the book isPermission to Choose because we
believe.
You say we, you and Elizabethwas your wife.
We're writing the book togetherBecause we really believe in
(09:13):
freedom of choice and whenpeople are, especially when
they're approaching the end oftheir life, they need to know
that they have choices and theyneed to understand what their
options are, that they havechoices and they need to
understand what their optionsare.
So choice is really powerful,but it also is an acronym for
the principles that we've builtour company on, and what it
stands for is.
C is commitment we'recompletely committed to serving
(09:38):
people and we expect the peoplethat work for us and with us and
partner with us to share thatlevel of commitment.
O is for.
H is for honesty we approacheverything with transparency and
honesty and helping people lookat things from a very honest
(09:58):
perspective, not shying awayfrom the truth.
O is for ownership takingownership of our part and
allowing the patients andfamilies to take ownership of
their part.
I is imagination we are verycreative, thinking outside the
box, looking for whateverresources and tools would be
(10:19):
valuable to help these peopleand improve their quality of
life and improve the quality oftheir death.
Let's see if I can remember.
C is collaboration, which isunfortunately lacking in health
care in most spaces, butcollaboration is really critical
for doing this effectively.
E is for empathy, which youneed to have to work in this
(10:43):
field, and S is for service.
We are very much coming from aplace of service.
That's one of the things thatactually drew Elizabeth and I
together is our deep passion forbeing of service.
So that's what Choice is.
Choice is on the websiteEmpowered.
Speaker 1 (10:57):
It's beautiful, thank you.
It's well done, and one of thequestions that Linda, my partner
, wanted me to ask of you is inher family, dementia and
Alzheimer's has reared its uglyhead with the passing of her mom
, and it's always the end of.
(11:18):
What are the end of life careoptions today in California, or
how do you approach that?
Speaker 2 (11:25):
Specifically for people with dementia?
Yeah well, we don't.
We can go on to dementia orjust in general.
Speaker 1 (11:31):
You hear so much about taking one's own life.
That's not really what we'reabout here.
Speaker 2 (11:36):
No, when I.
One of the things that we do iswe have a program where we meet
with people, sometimes beforethey're even diagnosed with any
serious illness.
They're just getting older andthey want to understand how to
protect themselves.
They've seen loved ones gothrough illnesses and in and out
of the hospital and have a lotof challenges and they want to
(11:59):
make sure that they don't haveto go through the same things
that their parents went throughor other people that they know.
So people sometimes meet withus just to explore what's
possible, how to create a planthat would protect them and
create the appropriatedocumentation that would allow
(12:19):
their health care agent power ofattorney to act on their behalf
in a way that would beconsistent with what they want.
So putting those plans in placeis really critically important.
One of the things that we do istalk about the options that are
available for people who are ata point, who have reached a
threshold where the quality oftheir life is no longer adequate
(12:42):
because of advanced age,illness, the challenges that
come with either aging orillness.
So the options that we sharewith people are number one, full
steam ahead.
You know, full-core press.
Do everything that the doctorstell you to do do everything
(13:03):
possible to extend your life atall costs.
There are some people who wantthat option.
They're going to take theirdoctor's advice, they're going
to let them guide things andthey will do everything until
the bitter end.
And that's fine, that's theirchoice.
Other options are, to, you know, kind of pick and choose to do
(13:24):
the things that would allow youto maintain a certain quality of
life, potentially improve your,extend your life, but not do
things that are going tocompromise it too much.
Another option is to go oncomfort care.
So people who have a terminalillness have the option of going
on to hospice and not pushingtowards a cure, not doing a lot
(13:49):
of aggressive treatment, notgoing in and out of the hospital
.
But when they make that choice,they're focusing on comfort and
they have to be aware of someof the things that they give up.
Speaker 1 (13:59):
So differentiate empowered endings from hospice.
Speaker 2 (14:03):
Well it's there, isn't so.
So we are not a hospice.
We take care of peopleregardless of.
There's no qualification tocome under our care On hospice.
To get on hospice, somebodyneeds to have a terminal
condition and a life expectancyof less than six months, and
that requires that two doctorsusually one of the doctors is a
(14:27):
treating physician for thepatient and one is like a
medical director for the hospicethose two doctors have to agree
that the patient is likely todie or there's a good chance
that they'll die within sixmonths if the condition runs its
typical course.
So hospice is an insurancebenefit, medicare and insurance
and Medi-Cal pay for people tobe on hospice care.
(14:48):
Our services are sometimes inplace of hospice.
Sometimes people want oursupport, which is physicians and
very multidisciplinary, similarto some of what hospice offers,
but more personalized, morecustomized, and we don't have
(15:10):
the limitations and constraintsthat hospice does.
We have a lot more flexibilitywith the resources that we bring
into the person's life.
Speaker 1 (15:20):
I like to focus on that.
I in the choices, imaginationand thinking outside the box.
Speaker 2 (15:25):
That's where some of the fun stuff comes in.
Speaker 1 (15:27):
So, with that, take a client that you have now change
the name as obviously, and takethe audience through the
initial consultation and whatyou are now doing on behalf of
that client's wishes choices sothat their death will be more
(15:49):
pleasant Less traumatic Lesstraumatic Take us through a day
of the Dr Bob.
Speaker 2 (15:55):
Okay, so there's such a wide range, I'll pick one
patient and I'll call herShirley.
So Shirley is 82 years old.
Several months ago she wasdiagnosed with lung cancer and
it's stage four.
It's metastatic and she's hadsignificant compromise in her
quality of life.
She's gotten weaker, she's lostweight, she's having some
(16:19):
breathing issues, but she'sstill undergoing treatment.
Lost weight, she's having somebreathing issues, but she's
still undergoing treatment.
And she won't because there isthere is, she has enough, you
know residual health that shecan withstand some of the
treatment and the hope is thatit will slow down the
progression of the cancer.
This woman, shirley, livesalone and she actually has no
(16:39):
family.
She has a number of friends inthe community who are supportive
, but she stopped seeing herfriends because she felt like
she was kind of a drag.
Speaker 1 (16:54):
She didn't have energy.
The world becomes very small.
Speaker 2 (16:56):
Right and the friends wanted to be helpful, but she
was becoming more reclusive andshe would have chemotherapy be
helpful and but she didn't.
But she was becoming morereclusive and she was just she
would have chemotherapy and thenafter that she would feel
horrible for two weeks and justreally dragging.
And and she a friend, actuallya psychiatrist, who was seeing
her recommended that she contactus and I went and met with her
(17:20):
and we just explored all thedifferent things that she was
dealing with and sort of thegaps that she was experiencing.
And I brought our team togetherto support her.
And I have nurses that workwith me, I have grief counselors
that work with me, I havevolunteers that can come and
show up and just be a caring andkind presence, help her go out
(17:45):
and get her hair done and goshopping.
And so the team came togetherand literally after the first
week and she was prettyskeptical.
She was asking, like, what areyou going to do for me?
How does this work and whywould I invest my money in
paying you?
And I said, well, just wait andsee.
(18:06):
Just see how things go, and ifit's not making a positive
difference for you, then youdon't need to continue.
Within a week she wascommunicating with me and saying
my world feels completelydifferent because the nurse
showed up and the nurse is justincredibly compassionate and
kind and gentle with her.
(18:27):
And then we just so we hadsomebody go with her to her
appointment with the oncologistand we got a massage therapist
to come in and we have musictherapists.
So in addition to the medicalcare that we provide Human care,
we're providing total humancare.
There's we're bringing backsort of the human element and
(18:47):
she has been thriving.
We've been caring for her for afew months now.
I continue to receive textsthat says I'm gardening for the
first time in six months andthis is, this is my Zen, and
she's just she, she's bubblingover.
The cute thing is she's textingyou yeah, oh, yeah, no, she, no
, we, she, she, and she's justshe, she's bubbling over the
cute thing is she's texting youyeah, oh yeah no, she, no we,
she, she, and and she's.
She's communicating with thewhole team.
(19:07):
Her life has been transformedbecause she has people who are
showing up for her and andproviding this really
comprehensive holistic care onthe other.
So, and so she's, and she'sgoing to go on for as long as
she can go on.
She'll continue to gettreatment and once it's clear
that the treatment is no longereffective or the burden of the
(19:28):
treatment is becoming too great,then we'll take a different
approach, but we'll be with herthrough that and bringing in the
appropriate resources that willcontinue to honor her, empower
her and allow her to be incontrol and make choices.
On the other side of that, wesupport people through medical
(19:48):
aid in dying, which is theEnd-of-Life Option Act.
So when we were talking aboutthe options that we share with
people for people who areterminally ill, competent to
make decisions it doesn't applyto people with dementia, but
when they're competent to makedecisions and they have a life
expectancy of less than sixmonths, they can go through a
process that we support themthrough to ultimately get access
(20:10):
to a prescription formedication that, if they choose
to take it, they will go tosleep within four or five
minutes and die peacefully, andit's called medical aid in dying
and it's a beautiful processfor people who are dying and
don't want to have to sufferthrough the final indignities of
a terminal illness.
(20:31):
So we have people who are at thevery end stage of pancreatic
cancer, lung cancer, als,parkinson's disease, heart
failure, who are struggling andsuffering and they come to a
point where they feel like lifeis too much of a struggle and
(20:52):
they want to accelerate theirdeath and not have to go through
that final, bitter end.
So they can go through thisprocess and we guide them and we
counsel them and we supporttheir families and we're with
them at the time that they takethe medication.
And it is an incrediblybeautiful thing to see somebody
allowed to end their struggling,bring their family together,
(21:14):
have them around telling stories, telling jokes, and then go to
sleep and then go to sleep andthe loved ones are.
The grieving process for thosepeople is so different than the
ones who had to watch somebodystruggle to the point where they
could barely breathe or theywere comatose.
(21:36):
This allows the family to givethis gift that gives them the
loved one permission.
Speaker 1 (21:43):
You're empowering them.
Speaker 2 (21:45):
Everybody, everybody, and it's not always universally
accepted by the families.
Sometimes there's a lot ofcounseling that goes into that
and support so they understandwhy their loved one might be
making this choice and becausewe've been through it so many
(22:05):
times with so many differentpeople.
Speaker 1 (22:07):
Are you leading that conversation?
Are you the leader of thatconversation?
Speaker 2 (22:10):
Typically yeah, but now we have end-of-life doulas
and social workers and otherpeople who are very comfortable
and capable of engaging in thoseconversations as well.
Speaker 1 (22:22):
End-of-life doula.
End-of-life doula.
End-of-life doula.
What, what?
Take that and roll run withthat.
Speaker 2 (22:27):
Well.
So I remember back in the 70sand 80s when the then when child
the birth move, the birthingcenter movement started and
birth midwives and birth doulaswere were showing up to getting
training and they were helpingto sort of demedicalize
childbirth.
(22:47):
Up until that time the onlyoptions people had when they
were pregnant and going towardsdelivering were working with an
OBGYN, going into the hospital,having all their care done there
, delivering in the hospital.
Well, doulas and midwives andbirth centers gave them other
options where they could have amore holistic approach.
(23:09):
They could be the doctors,might still be involved, but
more peripherally and only whenthere's really significant.
There were challenges.
But end-of-life doulas are now.
They're a group of people whoare.
Some of them are like retiredor retiring hospice nurses who
(23:29):
love caring for people atend-of-life but they don't want
to do it through thatconstraining system.
Working in hospice has becomechallenging in many respects and
for many people, but they couldbe nurses and social workers or
chaplains or people who havejust had a lot of life
experience and they go through atraining and they learn how to
support patients and familiesthrough the end-of-life journey.
(23:52):
They companion them.
I'm a doula.
I see myself as a doulaElizabeth, my wife is a doula,
and we have other people who areshowing up and they're like
Sherpas.
They're like helping people getto the peak and do it in a way
that is gentle and empowering.
Speaker 1 (24:13):
So you've been doing this for how many?
So I?
Speaker 2 (24:15):
started doing palliative care in hospice in
2013.
And then I started my ownpractice in 2016.
So it's been eight years sinceI've been doing it in the way
that I do it now.
Speaker 1 (24:29):
Do you see a greater?
Was there more resistance eight, ten years ago than it is today
?
Or do you see this moreacceptance of?
Yes, this is a fantasticconcept and, in terms of talking
about death and dying, Well, Ithink there's more and more
openness to it.
Speaker 2 (24:45):
I think that I see a lot more being written.
There's movies anddocumentaries that are popping
up, and part of it is that'sjust the world I live in, so I
may be more aware of it, but mysense is there is a lot more
attention being placed on theseconversations and having the
conversations planning.
There's much more attention nowon doing advanced care planning
(25:07):
, which is really critical.
That's one of the biggest gapsthat exist is people are not
planning ahead and making surethat they're communicating with
their loved ones what they wouldwant or not want.
So we're really heavily focusedon getting people to engage
with us to do those planningexplorations and get those
documents in place and get thoseconversations started and again
(25:30):
I'll go into that because againI've lost my parents.
Speaker 1 (25:35):
Linda has lost her parents and they each all went
very differently.
No two are the same.
But really the whole careprocess, the whole
hospitalization situation, thecalling the 911, my dad probably
he knew the EMT guys on a veryfirst name basis because they
were calling 911 almost everyother day for something.
(25:55):
And you go into the hospital andthey do what they do and it
just seemed like a train wreck.
And so, combating that, becausethe hospital, the doctor is
there, I'm going to keep youalive and does all the
documentation in the worldcounteract that?
Or is it just the doctors andthe hospitals are going to do
(26:17):
what they're going to?
Speaker 2 (26:17):
do so.
The documentation doesn'tnecessarily counteract that.
The documentation is helpful inthat it identifies what people
want or don't want and it givesdirection to the health care
agents who are going to bemaking decisions when the person
can't.
Until a person loses thatcapacity, they are advocating
(26:38):
for themselves, but they don'tknow how to advocate for
themselves.
When someone ends up in thehospital, all bets are off.
They just become the propertyof the hospital and the system.
Everybody gets a piece of them.
All the consultants come in andthis isn't universal but it's
(27:03):
pretty common, pretty universal.
And because the hospitalthere's a number of reasons for
that.
They don't want to missanything.
Their focus is on is onextending life, and every test
that's done, every consultthat's done, somebody's making
money.
And if, if no one is like iskind of stepping in to ask if
this makes sense, if it'snecessary, it just happens like
you get into the hospital andyou're sort of on this conveyor
belt and and it, just it, it,and then you go home and things,
(27:26):
and then there's morecomplications and it's just a
cycle, a vicious cycle.
One of the things that that wedo is we help keep people out of
the hospital because instead ofcalling 911, they can call us,
and not in not every situationit's appropriate to call us
versus 911.
If you fall and break a hip orif you're you know cutting your,
(27:47):
you know your gushing blood oryou know you're having chest
pain, and there's a lot ofreasons why it makes sense to
call a 911.
But there's there are manytimes when people end up in the
hospital because they couldn'treach a doctor.
They couldn't get somebody tocommunicate with them about
what's happening and what theoptions are for providing
(28:09):
appropriate care.
As an ER doctor, I saw that allthe time.
I saw people coming in byambulance because they couldn't
get information that would allowthem to feel good about staying
home.
Or they called their doctor andif their doctor was able to
respond usually it's somebody oncall for their doctor but the
knee-jerk reflex is go to thehospital, go to the hospital.
(28:32):
That's the safest thing to doand we know that when people end
up in the hospital it's oftennot the safest place to be
because there's all kinds oferrors that happen in the
hospital, infections that happenin the hospital, tests that are
done that result in moreprocedures.
So there needs to be moreattention on things further
(28:56):
upstream.
There needs to be more commonsense when it comes to
addressing these situations.
There needs to be moreengagement and support, which is
why we're not only providingthe medical care to people, but
we're building this educationalinstitute, the Empowered Endings
Institute, to teach peopleabout, and to teach and train
(29:18):
about, optimal palliative andend-of-life care, so more people
have more knowledge and moreresources.
Speaker 1 (29:27):
Talk a little bit about the foundation, yeah so
the Empowered Endings is acollective.
Speaker 2 (29:33):
We have the medical group that provides care
throughout Southern California.
We have the Institute, theEmpowered Endings Institute,
which is developing, bringing acommunity of people together,
both healthcare providers andlay people, to have
conversations, and we'll bedoing monthly webinars and we're
starting a podcast soon.
So there's a lot of educationthat's coming in and community
(29:55):
building.
And we also have a foundationit's a 501c3, the Empowered
Endings Foundation that isdevoted.
The mission is to improveend-of-life care for everybody,
so the patients, the families aswell as the health care
providers.
The foundation providesfinancial support for people who
need assistance in the finalkind of stretch of life, and it
(30:18):
could be for medication, itcould be to pay other physicians
to provide support, it could befor getting caregiving and
nursing support.
We also have bereavement groups, free bereavement groups for
people who have supported lovedones through the medical aid in
dying process.
So people anywhere in thecountry who have supported
(30:39):
somebody through that process ifthey need additional emotional
support, they can join thesevirtual groups free of charge
and be part of this community ofsupportive people, and it's
facilitated by our phenomenalgrief counselors.
The other in the fourth element, the fourth pillar of Empowered
Endings is a managementservices organization because
(31:03):
we're preparing to expand themedical practice and to try to
replicate it, find doctors anddoulas and and people who feel
similarly about the need toimprove end of life care in
those communities and we'll behelping to establish practices
throughout the country that'swhere my mind went is can this
(31:24):
be duplicated?
Speaker 1 (31:25):
I mean, having done this for the years you're doing
it, I have to believe there's adoctor in Chicago that knows of
you, sees you, what you're doingand says I want to move in that
direction, given I mean any ERdoctor of any duration, like you
were, has to go there's got tobe a better, something like
(31:45):
what's next?
Speaker 2 (31:45):
right?
Some of your doctors can'timagine doing anything different
.
A lot of them get to a pointwhere working nights and
weekends and those long,stressful shifts gets a little
bit.
It wears on them.
So I agree Chicago would be agreat place to start a practice,
because that's where I'm from.
And I have a number of reallygood friends who are there.
Speaker 1 (32:06):
I was just there.
That's why I'm here.
Speaker 2 (32:09):
Every community needs better end-of-life care.
So as we develop this andrefine it and systematize it, we
will be in a position toidentify those doctors and other
people who want to partner withthem, to create a model.
And it's not rocket science,it's not rocket science.
(32:34):
You just have to be committed.
You have to believe in thoseprinciples.
Anyone who believes in theprinciples that we outlined in
that CHOICES acronym would beable to create a practice in
their community principles.
Anyone who believes in theprinciples that we outlined in
that CHOICES acronym would beable to create a practice in
their community that wouldsupport people in having a
better end of life experience.
Speaker 1 (32:54):
And before we sign off, Doc, I want you to talk
about music therapy and how thatplays such an incredible role
in end of life.
I think it's one of the mostbeautiful things ever.
Speaker 2 (33:04):
Yeah, well, one of the gaps that speaks to another,
one of the gaps that we'veidentified, which is lack of
access to alternative holistictherapies, quality of life
enhancing care, music therapybeing one of those.
We also have massage therapistsand acupuncturists, and you
know sound healing,acupuncturists and you know
(33:28):
sound healing.
But we music therapy ispowerful and we have some music
therapists who come in and justreally help people experience a
deeper sense of connection andjoy through exploration of music
and how it's impacted theirlife.
Sometimes they create musictogether.
Sometimes the person listens tomusic, sometimes it's just kind
(33:50):
of talking about the concertsthey went to when they were
younger and the dances that theywent to with their spouse.
It's been shown that whenpeople with dementia are exposed
to music and there's beenstudies that have been shown in
documentaries about this itwakes up a part of their brain
that has been dormant and itenlivens them.
So music I have an incrediblerelationship with music and I
(34:17):
know that that's something thathas brought incredible joy and
connection to a number of thepatients that we work with.
Are you in a band?
I am not.
I wish I was.
I never got.
I stopped playing piano when Iwas 13 because I got interested
in girls and I you know myparents let me quit.
I wish they hadn't.
You know that same story.
But I love listening to music.
(34:38):
I, you know.
Just like I couldn't sleep lastnight and I just put my
headphones on and I just foundmyself in this beautiful space
of peace and comfort justlistening to music.
That's been meaningfulthroughout my life.
So we try to expose people tothat.
Some people don't get it.
They don't understand why wewould recommend music therapy.
(35:00):
And then, once they experienceit, then they understand.
It's like oh, I get it now.
That's amazing.
Speaker 1 (35:08):
So is there one story that you want to share that
just is so transformational interms of a patient and the
family?
Because that's where I alwayssee it the family is always
skeptical.
I have to believe they'reskeptical they're.
What is this all about?
And there's just that onetransformational story that you
(35:28):
look back on and go.
I mean, I know there'sthousands of stories, there's so
many, put you on the spot, yeah, but is there one that just
always comes up in your mindthat goes, wow, that was the
most beautiful, transformational, where you went from this very
negative family environment tolike they can't thank you enough
(35:54):
for the way mom or grandma, uh,so that's happened.
Speaker 2 (35:55):
I I'm not coming up with one specific story with
around that specific dynamic,but one of the stories that I
that I love to to share becauseit was so transformational, was
a gentleman named Edward who wasin his mid-80s.
He had been diagnosed withcolon cancer and he was pretty
far along.
I met him when he was onhospice and he was bedridden and
(36:21):
he had a catheter and he wasjust miserable.
He was in pain and he had acatheter and he was just
miserable.
He was in pain, just losingweight and basically just laying
there waiting to die.
And the oncologist had stoppedtreating him because he couldn't
tolerate the chemotherapy andthey gave him a month or two to
live and he didn't accept thatand he hadn't seen a doctor.
(36:43):
He'd been on hospice for amonth, hadn't seen a doctor.
Because He'd been on hospicefor a month, hadn't seen a
doctor, because doctors don'ttypically see people on hospice
and I was asked to come in andevaluate him.
He wanted to see if he wanted arelationship with a doctor who
could give him more support andguidance.
But he was on hospice.
He had a nurse care manager whoinvited me in to meet with him.
(37:06):
He had a nurse care manager whoinvited me in to meet with him
and this gentleman he was nevermarried, he was an engineer, he
was a very science kind oforganized kind of a mind, but he
was also very, very isolatedand kind of reclusive.
He was Japanese, he was aJapanese-American, he was in an
(37:26):
internment camp during World WarII.
So he was open and I met withhim and I started talking about
the things that we could providefor him, including my medical
oversight, where I pulled somemedications away that he'd been
taking.
We brought in a music therapist.
We brought in a massagetherapist, we brought in an
(37:46):
acupuncturist.
At that point we had an arttherapist, physical therapy.
We started bringing people into just be part of his world and
connect with him and touch himand help him move.
And within a few weeks thecatheter was out, he was up,
walking, getting dressed, and helived for a year and a half and
(38:08):
he had the most beautiful finalyear and a half.
His sister, who lived in theBay Area, would come down and
after a while he was acompletely different person and
she was incredibly gratifiedbecause she didn't know that
this was possible.
She just thought she was goingto be losing her brother and was
(38:30):
helpless and hopeless.
And not only did he have thisamazing experience, but the
connection that he made withevery one of my team members was
so profound that every timethey would go and see him, they
would come out glowing andre-energized and inspired,
(38:52):
because they saw how powerfultheir showing up was and he was.
It was just as beautiful.
Everybody wins.
Everybody's a better human.
For having been part of thisexperience.
Speaker 1 (39:06):
I think it's so important and you and I have
talked about it off air, so tospeak, in terms of the coming.
There is a tsunami already.
It's not going, it's not coming, it's here and so many people
live isolated and if I canencourage anything from family
members is to be proactive,because your parents, your
(39:31):
grandparents are not going tolive forever and if you want to
try to have a peaceful endingand then maybe have a peaceful
family harmony after your lovedone passes, harmony- after your
loved one passes, having that,having you there for that final
(39:52):
six, whatever it is, whatever,what a couple days.
I think can bring people toreact to a sense of peace
amongst themselves so they don'tgo to war after right.
That's kind of my big thing isthe wars that we see after the
patriarch, matriarch had passedaway.
But if there was some peacefulresolution at those final
(40:14):
moments, maybe that woulddissolve the angst amongst the
family.
Speaker 2 (40:19):
And it starts upstream.
Being able to achieve thatpeace starts by having those
conversations, by gettingprepared.
I like to think about it aslike the landing a plane
Everybody wants a soft landing.
We're trying to give peoplethat soft landing, but in order
to have that, you need to havean appropriate flight plan, you
(40:42):
need to have a landing stripright, you have to have a runway
.
So we help people create therunway and the flight plan.
I think the individual, theperson whose life is coming to
an end, is both the plane andthe pilot.
We're the co-pilot and we'rethe maintenance crew and we're
(41:04):
the flight simulator.
Yeah, but we're helping to puteverything in place so that they
can have a soft landing, andthat's a beautiful thing If we
can help people achieve that.
What it does is it helpsprevent the trauma and the angst
and the guilt and the regret inthe loved ones so that they can
go on and have a meaningfullife that's not marred by this
(41:27):
experience of trauma and wishingthey had done things
differently, wishing they haddone a better job of caring for
mom or dad.
Speaker 1 (41:36):
Don't be afraid to have the conversations.
It's so enlightening, it's soamazing, it's so uplifting.
Speaker 2 (41:43):
In so many ways it's just fantastic, and we're happy
to guide that conversation and Ithink that's….
Speaker 1 (41:48):
EmpoweredEndingscom.
Exactly Endings with an SEmpoweredEndingscom.
I can't encourage you enough togo to the website.
There's a ton of greatinformation.
Speaker 2 (42:01):
More coming all the time, more coming all the time.
Speaker 1 (42:03):
You have a lot of topics that you will talk about,
whether it's to your church,your synagogue, your Rotary Club
, whatever the case may be.
Yeah, we love to educate.
Retirement associations aboundthroughout the nation now, so I
encourage everybody to just getyou out to listen and understand
the options that are available.
So, dr Bob, I will give youlast word as to how you want to
(42:26):
sign off today, and I thank youso much for joining us today.
It's hugely important.
Hugely important because, again, nobody gets out of here alive,
and if we can do it in apeaceful way, so much better.
So last word.
Speaker 2 (42:41):
Well, we love to help people and provide resources.
When people call to getinformation and to learn about
the resources, or even justschedule a 10, 15-minute call
with me to explore, that thrillsus.
We want people to reach out, wewant to be.
Whether you're going to engagewith our services or not, we'd
(43:02):
love to be of service and toprovide access to the resources
that we have and we'veaccumulated over the years.
Speaker 1 (43:12):
And I want to second that when my partner, Linda's
dad was diagnosed back in 2018.
It's an amazing story.
He was his caregiver for hiswife who battled Alzheimer's for
12 years and then,unfortunately, a year after she
passed, he got cancer and wentpretty quickly and you were so
(43:34):
gracious to reach out to Lindaand her family and him and talk
about it.
It was just.
It really did help quite a bit,so I appreciate that it's a
long time.
Again, a very important podcast.
Please share this with yourfamily Again.
Idea get the family togetherand listen to this podcast and
(43:55):
share your thoughts openly,honestly.
Call Dr Bob for some insights.
Very, very important topicPlease share.
This is Ron Greenwald, the RonGreenwald Podcast.
Have a great day.
Welcome in.
This is Ron Greenwald, the RonGreenwald Podcast, and today, as
I say, they're all importantpodcasts because we bring
stories of great value, greatinsights into aging, aging well,
aging successfully, aging,aging well, aging successfully.
But when I do my presentationson senior living and senior
(00:49):
health, one thing I always saythere's a 100% death rate.
You're not going to avoid it,and one of the biggest pitfalls
in our society is that we don'ttalk about I don't want to call
it a successful passing, but aless stressful passing, I guess
amongst the family, Because alltoo often I see the incredible
(01:12):
angst that goes along whenwatching a loved one pass away.
It's tragic, it's terrible, andtoday I am thrilled to have on
the show somebody who canaddress those issues head-on and
has done an amazing job to beat the forefront of changing how
we view dealing with one'spassing.
(01:34):
Dr Bob Uslander is here with ustoday.
Thank you for joining us.
I'm going to turn it over toyou to give us a little bit of
your background and how you gotinto the field we are in today.
Speaker 2 (01:47):
Sounds good.
Thanks, ron.
Thanks for having me Thrilledto have you, doc.
I've enjoyed our collaboration,our relationship, over the
years, so I'm very happy to behere and hopefully it'll be
insightful in your audience.
Speaker 1 (02:00):
It's going to be very insightful because this is not
a topic everybody.
Stay tuned, people.
Speaker 2 (02:06):
So I'm Bob Uslander.
I spent the majority of myearly career as an emergency
physician.
I trained in emergency medicinein Chicago and I spent time
working in emergency rooms inChicago in different parts of
the world.
I worked on Guam for a fewyears.
I settled in a small communityup in Northern California where
(02:29):
I spent 15 years as an ER doc upthere and I dealt with death a
lot.
As you can imagine, in the ERkind of the MO is you try to
save everybody and in general,as you're aware, in the health
care system there's a real focuson prolonging extending life
(02:51):
almost at all costs.
We've done such a good job oftreating so many illnesses and
keeping people alive longer, butwe're not doing a very good job
of addressing the needs thatcome towards the end of life,
when things get reallycomplicated.
I saw a lot of this in the ER.
It's sort of like a bigfishbowl Everything comes down,
(03:14):
trickles down, so you really geta firsthand look at all the
issues and problems and stressesin the healthcare system.
About 10 years into my practiceI had a good friend of mine die
of melanoma and he was 32.
He had three little boys thatwere under the age of six and he
(03:34):
had a mole removed on his backwhen he was 27.
The doctors told him that theygot it.
Everything's great, go on withyour life.
A few years later he had a lumpunder his armpit and it ended
up being metastatic melanoma.
So as he got sicker over themonths, I was his friend, but I
(03:55):
also became his doctor and thenI kind of became his guide.
As his health was deteriorating, we brought in the local
hospice team and I really hadhad no exposure to hospice
before that.
But this was my first realconnection with hospice and
together with the hospice teamand Darren and his family and
(04:16):
friends, we created this reallybeautiful end-of-life experience
and had these celebrations andthese really meaningful moments
and at the end, when he actuallydied, it was incredibly gentle
and peaceful.
We were able to really createthis beautiful ending for him
and I saw for the first timethat death doesn't have to be
(04:39):
traumatic.
It's still tragic, especiallywhen a young person dies and has
small children, but it doesn'thave to be something that is
harrowing and scary.
It can actually be a beautifuland actually transformational
experience.
After a period of time, Istarted a house call practice
(05:00):
for homebound seniors.
I was just really drawn in tothat world and I started kind of
building towards being able toexpand my practice and somehow
incorporate working with peopleat end of life and do that in a
way that really filled me up.
I moved to San Diego in 2011 andkind of looking for my next
(05:26):
path.
I was trying to transition outof emergency medicine, which was
very stressful, and I reallywanted to do something that was
going to fill me up and allow meto have more of an impact.
I just happened to actually, Ikind of had a download.
I had this epiphany one daythat I can remember very, very
(05:49):
clearly.
It was very momentous and Ijust in that moment realized
that I'm here to help people diebetter.
And I the next day randomly meta hospice nurse and started
conversations.
And then I started working in apalliative care and hospice
company in San Diego and I spenttwo years working in that
(06:10):
traditional model.
So I was going into people'shomes and helping to identify
their needs and provide thishigh level of support.
But I was working within thehealthcare system and I saw so
many gaps and challenges thatstill existed, identify some of
those gaps.
Speaker 1 (06:27):
I think it's important.
Speaker 2 (06:27):
Well, you know, some of the biggest ones were, for
example, when somebody isadmitted to hospice, they lose
the relationship with thedoctors who they've been engaged
with, who have been caring forthem, sometimes for decades, and
they lose the connection withthe who have been caring for
them, sometimes for decades, andthey lose the connection with
the specialists who have beenhelping them along on their
(06:48):
journey and they have a wholenew team of people and in many
cases most cases they never seea doctor again.
All the care is delivered bynurses and nurse practitioners
through hospice care.
And that's a huge gap nothaving doctors involved at this
really intimate time of life.
The other huge gap one of theother huge gaps is that the
(07:11):
healthcare system doesn't have amechanism to take care of the
families.
You have these families who arestruggling to try to meet the
needs of their loved one who'sill and dying and all the
stresses that that brings on,and they become extremely
overwhelmed and they they don'tknow where to turn.
They don't know how to find theright support and the right
resources and navigate all thedifferent specialists.
(07:33):
So families are kind of leftout in the cold and it's
extremely overwhelming andtraumatic for them as things
unfold.
People don't doctors don't talkwith people about end of life.
They don't talk with peopleabout dying.
It's almost as if, like deathdoesn't even exist.
And then when it, when itbecomes clear that the person's
(07:54):
terminal and nearing death, thenthey sort of offload them to
hospice and and and there's justthis sense of like throwing.
You know throwing in the towellike there's nothing more you
can do, and know throwing in thetowel like there's nothing more
you can do.
And that's not the case.
There's so much more you can do.
One of the things that thatpeople need is to be given
choice.
(08:14):
They need to be on, they needto understand what the reality
of their circumstances are andwhat the options are that are
available to them when they'reterminally ill and looking at a
potentially horrific final stageof life.
Speaker 1 (08:30):
I'm going to the website empoweredendingscom.
Empoweredendingscom.
Dr Bar.
There's so much goodinformation on that website
that's so relative relevant, andyou used the word choices, and
choices is part of that website.
Speaker 2 (08:49):
Define what that means to the audience.
That's an interesting choicesis kind of at the foundation of
everything that we do, becausewe well, we're writing a book
and the title of the book isPermission to Choose because we
believe.
You say we, you and Elizabethwas your wife.
We're writing the book togetherBecause we really believe in
(09:13):
freedom of choice and whenpeople are, especially when
they're approaching the end oftheir life, they need to know
that they have choices and theyneed to understand what their
options are, that they havechoices and they need to
understand what their optionsare.
So choice is really powerful,but it also is an acronym for
the principles that we've builtour company on, and what it
stands for is.
C is commitment we'recompletely committed to serving
(09:38):
people and we expect the peoplethat work for us and with us and
partner with us to share thatlevel of commitment.
O is for.
H is for honesty we approacheverything with transparency and
honesty and helping people lookat things from a very honest
(09:58):
perspective, not shying awayfrom the truth.
O is for ownership takingownership of our part and
allowing the patients andfamilies to take ownership of
their part.
I is imagination we are verycreative, thinking outside the
box, looking for whateverresources and tools would be
(10:19):
valuable to help these peopleand improve their quality of
life and improve the quality oftheir death.
Let's see if I can remember.
C is collaboration, which isunfortunately lacking in health
care in most spaces, butcollaboration is really critical
for doing this effectively.
E is for empathy, which youneed to have to work in this
(10:43):
field, and S is for service.
We are very much coming from aplace of service.
That's one of the things thatactually drew Elizabeth and I
together is our deep passion forbeing of service.
So that's what Choice is.
Choice is on the websiteEmpowered.
Speaker 1 (10:57):
It's beautiful, thank you.
It's well done, and one of thequestions that Linda, my partner
, wanted me to ask of you is inher family, dementia and
Alzheimer's has reared its uglyhead with the passing of her mom
, and it's always the end of.
(11:18):
What are the end of life careoptions today in California, or
how do you approach that?
Speaker 2 (11:25):
Specifically for people with dementia?
Yeah well, we don't.
We can go on to dementia orjust in general.
Speaker 1 (11:31):
You hear so much about taking one's own life.
That's not really what we'reabout here.
Speaker 2 (11:36):
No, when I.
One of the things that we do iswe have a program where we meet
with people, sometimes beforethey're even diagnosed with any
serious illness.
They're just getting older andthey want to understand how to
protect themselves.
They've seen loved ones gothrough illnesses and in and out
of the hospital and have a lotof challenges and they want to
(11:59):
make sure that they don't haveto go through the same things
that their parents went throughor other people that they know.
So people sometimes meet withus just to explore what's
possible, how to create a planthat would protect them and
create the appropriatedocumentation that would allow
(12:19):
their health care agent power ofattorney to act on their behalf
in a way that would beconsistent with what they want.
So putting those plans in placeis really critically important.
One of the things that we do istalk about the options that are
available for people who are ata point, who have reached a
threshold where the quality oftheir life is no longer adequate
(12:42):
because of advanced age,illness, the challenges that
come with either aging orillness.
So the options that we sharewith people are number one, full
steam ahead.
You know, full-core press.
Do everything that the doctorstell you to do do everything
(13:03):
possible to extend your life atall costs.
There are some people who wantthat option.
They're going to take theirdoctor's advice, they're going
to let them guide things andthey will do everything until
the bitter end.
And that's fine, that's theirchoice.
Other options are, to, you know, kind of pick and choose to do
(13:24):
the things that would allow youto maintain a certain quality of
life, potentially improve your,extend your life, but not do
things that are going tocompromise it too much.
Another option is to go oncomfort care.
So people who have a terminalillness have the option of going
on to hospice and not pushingtowards a cure, not doing a lot
(13:49):
of aggressive treatment, notgoing in and out of the hospital
.
But when they make that choice,they're focusing on comfort and
they have to be aware of someof the things that they give up.
Speaker 1 (13:59):
So differentiate empowered endings from hospice.
Speaker 2 (14:03):
Well it's there, isn't so.
So we are not a hospice.
We take care of peopleregardless of.
There's no qualification tocome under our care On hospice.
To get on hospice, somebodyneeds to have a terminal
condition and a life expectancyof less than six months, and
that requires that two doctorsusually one of the doctors is a
(14:27):
treating physician for thepatient and one is like a
medical director for the hospicethose two doctors have to agree
that the patient is likely todie or there's a good chance
that they'll die within sixmonths if the condition runs its
typical course.
So hospice is an insurancebenefit, medicare and insurance
and Medi-Cal pay for people tobe on hospice care.
(14:48):
Our services are sometimes inplace of hospice.
Sometimes people want oursupport, which is physicians and
very multidisciplinary, similarto some of what hospice offers,
but more personalized, morecustomized, and we don't have
(15:10):
the limitations and constraintsthat hospice does.
We have a lot more flexibilitywith the resources that we bring
into the person's life.
Speaker 1 (15:20):
I like to focus on that.
I in the choices, imaginationand thinking outside the box.
Speaker 2 (15:25):
That's where some of the fun stuff comes in.
Speaker 1 (15:27):
So, with that, take a client that you have now change
the name as obviously, and takethe audience through the
initial consultation and whatyou are now doing on behalf of
that client's wishes choices sothat their death will be more
(15:49):
pleasant Less traumatic Lesstraumatic Take us through a day
of the Dr Bob.
Speaker 2 (15:55):
Okay, so there's such a wide range, I'll pick one
patient and I'll call herShirley.
So Shirley is 82 years old.
Several months ago she wasdiagnosed with lung cancer and
it's stage four.
It's metastatic and she's hadsignificant compromise in her
quality of life.
She's gotten weaker, she's lostweight, she's having some
(16:19):
breathing issues, but she'sstill undergoing treatment.
Lost weight, she's having somebreathing issues, but she's
still undergoing treatment.
And she won't because there isthere is, she has enough, you
know residual health that shecan withstand some of the
treatment and the hope is thatit will slow down the
progression of the cancer.
This woman, shirley, livesalone and she actually has no
(16:39):
family.
She has a number of friends inthe community who are supportive
, but she stopped seeing herfriends because she felt like
she was kind of a drag.
Speaker 1 (16:54):
She didn't have energy.
The world becomes very small.
Speaker 2 (16:56):
Right and the friends wanted to be helpful, but she
was becoming more reclusive andshe would have chemotherapy be
helpful and but she didn't.
But she was becoming morereclusive and she was just she
would have chemotherapy and thenafter that she would feel
horrible for two weeks and justreally dragging.
And and she a friend, actuallya psychiatrist, who was seeing
her recommended that she contactus and I went and met with her
(17:20):
and we just explored all thedifferent things that she was
dealing with and sort of thegaps that she was experiencing.
And I brought our team togetherto support her.
And I have nurses that workwith me, I have grief counselors
that work with me, I havevolunteers that can come and
show up and just be a caring andkind presence, help her go out
(17:45):
and get her hair done and goshopping.
And so the team came togetherand literally after the first
week and she was prettyskeptical.
She was asking, like, what areyou going to do for me?
How does this work and whywould I invest my money in
paying you?
And I said, well, just wait andsee.
(18:06):
Just see how things go, and ifit's not making a positive
difference for you, then youdon't need to continue.
Within a week she wascommunicating with me and saying
my world feels completelydifferent because the nurse
showed up and the nurse is justincredibly compassionate and
kind and gentle with her.
(18:27):
And then we just so we hadsomebody go with her to her
appointment with the oncologistand we got a massage therapist
to come in and we have musictherapists.
So in addition to the medicalcare that we provide Human care,
we're providing total humancare.
There's we're bringing backsort of the human element and
(18:47):
she has been thriving.
We've been caring for her for afew months now.
I continue to receive textsthat says I'm gardening for the
first time in six months andthis is, this is my Zen, and
she's just she, she's bubblingover.
The cute thing is she's textingyou yeah, oh, yeah, no, she, no
, we, she, she, and she's justshe, she's bubbling over the
cute thing is she's texting youyeah, oh yeah no, she, no we,
she, she, and and she's.
She's communicating with thewhole team.
(19:07):
Her life has been transformedbecause she has people who are
showing up for her and andproviding this really
comprehensive holistic care onthe other.
So, and so she's, and she'sgoing to go on for as long as
she can go on.
She'll continue to gettreatment and once it's clear
that the treatment is no longereffective or the burden of the
(19:28):
treatment is becoming too great,then we'll take a different
approach, but we'll be with herthrough that and bringing in the
appropriate resources that willcontinue to honor her, empower
her and allow her to be incontrol and make choices.
On the other side of that, wesupport people through medical
(19:48):
aid in dying, which is theEnd-of-Life Option Act.
So when we were talking aboutthe options that we share with
people for people who areterminally ill, competent to
make decisions it doesn't applyto people with dementia, but
when they're competent to makedecisions and they have a life
expectancy of less than sixmonths, they can go through a
process that we support themthrough to ultimately get access
(20:10):
to a prescription formedication that, if they choose
to take it, they will go tosleep within four or five
minutes and die peacefully, andit's called medical aid in dying
and it's a beautiful processfor people who are dying and
don't want to have to sufferthrough the final indignities of
a terminal illness.
(20:31):
So we have people who are at thevery end stage of pancreatic
cancer, lung cancer, als,parkinson's disease, heart
failure, who are struggling andsuffering and they come to a
point where they feel like lifeis too much of a struggle and
(20:52):
they want to accelerate theirdeath and not have to go through
that final, bitter end.
So they can go through thisprocess and we guide them and we
counsel them and we supporttheir families and we're with
them at the time that they takethe medication.
And it is an incrediblybeautiful thing to see somebody
allowed to end their struggling,bring their family together,
(21:14):
have them around telling stories, telling jokes, and then go to
sleep and then go to sleep andthe loved ones are.
The grieving process for thosepeople is so different than the
ones who had to watch somebodystruggle to the point where they
could barely breathe or theywere comatose.
(21:36):
This allows the family to givethis gift that gives them the
loved one permission.
Speaker 1 (21:43):
You're empowering them.
Speaker 2 (21:45):
Everybody, everybody, and it's not always universally
accepted by the families.
Sometimes there's a lot ofcounseling that goes into that
and support so they understandwhy their loved one might be
making this choice and becausewe've been through it so many
(22:05):
times with so many differentpeople.
Speaker 1 (22:07):
Are you leading that conversation?
Are you the leader of thatconversation?
Speaker 2 (22:10):
Typically yeah, but now we have end-of-life doulas
and social workers and otherpeople who are very comfortable
and capable of engaging in thoseconversations as well.
Speaker 1 (22:22):
End-of-life doula.
End-of-life doula.
End-of-life doula.
What, what?
Take that and roll run withthat.
Speaker 2 (22:27):
Well.
So I remember back in the 70sand 80s when the then when child
the birth move, the birthingcenter movement started and
birth midwives and birth doulaswere were showing up to getting
training and they were helpingto sort of demedicalize
childbirth.
(22:47):
Up until that time the onlyoptions people had when they
were pregnant and going towardsdelivering were working with an
OBGYN, going into the hospital,having all their care done there
, delivering in the hospital.
Well, doulas and midwives andbirth centers gave them other
options where they could have amore holistic approach.
(23:09):
They could be the doctors,might still be involved, but
more peripherally and only whenthere's really significant.
There were challenges.
But end-of-life doulas are now.
They're a group of people whoare.
Some of them are like retiredor retiring hospice nurses who
(23:29):
love caring for people atend-of-life but they don't want
to do it through thatconstraining system.
Working in hospice has becomechallenging in many respects and
for many people, but they couldbe nurses and social workers or
chaplains or people who havejust had a lot of life
experience and they go through atraining and they learn how to
support patients and familiesthrough the end-of-life journey.
(23:52):
They companion them.
I'm a doula.
I see myself as a doulaElizabeth, my wife is a doula,
and we have other people who areshowing up and they're like
Sherpas.
They're like helping people getto the peak and do it in a way
that is gentle and empowering.
Speaker 1 (24:13):
So you've been doing this for how many?
So I?
Speaker 2 (24:15):
started doing palliative care in hospice in
2013.
And then I started my ownpractice in 2016.
So it's been eight years sinceI've been doing it in the way
that I do it now.
Speaker 1 (24:29):
Do you see a greater?
Was there more resistance eight, ten years ago than it is today
?
Or do you see this moreacceptance of?
Yes, this is a fantasticconcept and, in terms of talking
about death and dying, Well, Ithink there's more and more
openness to it.
Speaker 2 (24:45):
I think that I see a lot more being written.
There's movies anddocumentaries that are popping
up, and part of it is that'sjust the world I live in, so I
may be more aware of it, but mysense is there is a lot more
attention being placed on theseconversations and having the
conversations planning.
There's much more attention nowon doing advanced care planning
(25:07):
, which is really critical.
That's one of the biggest gapsthat exist is people are not
planning ahead and making surethat they're communicating with
their loved ones what they wouldwant or not want.
So we're really heavily focusedon getting people to engage
with us to do those planningexplorations and get those
documents in place and get thoseconversations started and again
(25:30):
I'll go into that because againI've lost my parents.
Speaker 1 (25:35):
Linda has lost her parents and they each all went
very differently.
No two are the same.
But really the whole careprocess, the whole
hospitalization situation, thecalling the 911, my dad probably
he knew the EMT guys on a veryfirst name basis because they
were calling 911 almost everyother day for something.
(25:55):
And you go into the hospital andthey do what they do and it
just seemed like a train wreck.
And so, combating that, becausethe hospital, the doctor is
there, I'm going to keep youalive and does all the
documentation in the worldcounteract that?
Or is it just the doctors andthe hospitals are going to do
(26:17):
what they're going to?
Speaker 2 (26:17):
do so.
The documentation doesn'tnecessarily counteract that.
The documentation is helpful inthat it identifies what people
want or don't want and it givesdirection to the health care
agents who are going to bemaking decisions when the person
can't.
Until a person loses thatcapacity, they are advocating
(26:38):
for themselves, but they don'tknow how to advocate for
themselves.
When someone ends up in thehospital, all bets are off.
They just become the propertyof the hospital and the system.
Everybody gets a piece of them.
All the consultants come in andthis isn't universal but it's
(27:03):
pretty common, pretty universal.
And because the hospitalthere's a number of reasons for
that.
They don't want to missanything.
Their focus is on is onextending life, and every test
that's done, every consultthat's done, somebody's making
money.
And if, if no one is like iskind of stepping in to ask if
this makes sense, if it'snecessary, it just happens like
you get into the hospital andyou're sort of on this conveyor
belt and and it, just it, it,and then you go home and things,
(27:26):
and then there's morecomplications and it's just a
cycle, a vicious cycle.
One of the things that that wedo is we help keep people out of
the hospital because instead ofcalling 911, they can call us,
and not in not every situationit's appropriate to call us
versus 911.
If you fall and break a hip orif you're you know cutting your,
(27:47):
you know your gushing blood oryou know you're having chest
pain, and there's a lot ofreasons why it makes sense to
call a 911.
But there's there are manytimes when people end up in the
hospital because they couldn'treach a doctor.
They couldn't get somebody tocommunicate with them about
what's happening and what theoptions are for providing
(28:09):
appropriate care.
As an ER doctor, I saw that allthe time.
I saw people coming in byambulance because they couldn't
get information that would allowthem to feel good about staying
home.
Or they called their doctor andif their doctor was able to
respond usually it's somebody oncall for their doctor but the
knee-jerk reflex is go to thehospital, go to the hospital.
(28:32):
That's the safest thing to doand we know that when people end
up in the hospital it's oftennot the safest place to be
because there's all kinds oferrors that happen in the
hospital, infections that happenin the hospital, tests that are
done that result in moreprocedures.
So there needs to be moreattention on things further
(28:56):
upstream.
There needs to be more commonsense when it comes to
addressing these situations.
There needs to be moreengagement and support, which is
why we're not only providingthe medical care to people, but
we're building this educationalinstitute, the Empowered Endings
Institute, to teach peopleabout, and to teach and train
(29:18):
about, optimal palliative andend-of-life care, so more people
have more knowledge and moreresources.
Speaker 1 (29:27):
Talk a little bit about the foundation, yeah so
the Empowered Endings is acollective.
Speaker 2 (29:33):
We have the medical group that provides care
throughout Southern California.
We have the Institute, theEmpowered Endings Institute,
which is developing, bringing acommunity of people together,
both healthcare providers andlay people, to have
conversations, and we'll bedoing monthly webinars and we're
starting a podcast soon.
So there's a lot of educationthat's coming in and community
(29:55):
building.
And we also have a foundationit's a 501c3, the Empowered
Endings Foundation that isdevoted.
The mission is to improveend-of-life care for everybody,
so the patients, the families aswell as the health care
providers.
The foundation providesfinancial support for people who
need assistance in the finalkind of stretch of life, and it
(30:18):
could be for medication, itcould be to pay other physicians
to provide support, it could befor getting caregiving and
nursing support.
We also have bereavement groups, free bereavement groups for
people who have supported lovedones through the medical aid in
dying process.
So people anywhere in thecountry who have supported
(30:39):
somebody through that process ifthey need additional emotional
support, they can join thesevirtual groups free of charge
and be part of this community ofsupportive people, and it's
facilitated by our phenomenalgrief counselors.
The other in the fourth element, the fourth pillar of Empowered
Endings is a managementservices organization because
(31:03):
we're preparing to expand themedical practice and to try to
replicate it, find doctors anddoulas and and people who feel
similarly about the need toimprove end of life care in
those communities and we'll behelping to establish practices
throughout the country that'swhere my mind went is can this
(31:24):
be duplicated?
Speaker 1 (31:25):
I mean, having done this for the years you're doing
it, I have to believe there's adoctor in Chicago that knows of
you, sees you, what you're doingand says I want to move in that
direction, given I mean any ERdoctor of any duration, like you
were, has to go there's got tobe a better, something like
(31:45):
what's next?
Speaker 2 (31:45):
right?
Some of your doctors can'timagine doing anything different
.
A lot of them get to a pointwhere working nights and
weekends and those long,stressful shifts gets a little
bit.
It wears on them.
So I agree Chicago would be agreat place to start a practice,
because that's where I'm from.
And I have a number of reallygood friends who are there.
Speaker 1 (32:06):
I was just there.
That's why I'm here.
Speaker 2 (32:09):
Every community needs better end-of-life care.
So as we develop this andrefine it and systematize it, we
will be in a position toidentify those doctors and other
people who want to partner withthem, to create a model.
And it's not rocket science,it's not rocket science.
(32:34):
You just have to be committed.
You have to believe in thoseprinciples.
Anyone who believes in theprinciples that we outlined in
that CHOICES acronym would beable to create a practice in
their community principles.
Anyone who believes in theprinciples that we outlined in
that CHOICES acronym would beable to create a practice in
their community that wouldsupport people in having a
better end of life experience.
Speaker 1 (32:54):
And before we sign off, Doc, I want you to talk
about music therapy and how thatplays such an incredible role
in end of life.
I think it's one of the mostbeautiful things ever.
Speaker 2 (33:04):
Yeah, well, one of the gaps that speaks to another,
one of the gaps that we'veidentified, which is lack of
access to alternative holistictherapies, quality of life
enhancing care, music therapybeing one of those.
We also have massage therapistsand acupuncturists, and you
know sound healing,acupuncturists and you know
(33:28):
sound healing.
But we music therapy ispowerful and we have some music
therapists who come in and justreally help people experience a
deeper sense of connection andjoy through exploration of music
and how it's impacted theirlife.
Sometimes they create musictogether.
Sometimes the person listens tomusic, sometimes it's just kind
(33:50):
of talking about the concertsthey went to when they were
younger and the dances that theywent to with their spouse.
It's been shown that whenpeople with dementia are exposed
to music and there's beenstudies that have been shown in
documentaries about this itwakes up a part of their brain
that has been dormant and itenlivens them.
So music I have an incrediblerelationship with music and I
(34:17):
know that that's something thathas brought incredible joy and
connection to a number of thepatients that we work with.
Are you in a band?
I am not.
I wish I was.
I never got.
I stopped playing piano when Iwas 13 because I got interested
in girls and I you know myparents let me quit.
I wish they hadn't.
You know that same story.
But I love listening to music.
(34:38):
I, you know.
Just like I couldn't sleep lastnight and I just put my
headphones on and I just foundmyself in this beautiful space
of peace and comfort justlistening to music.
That's been meaningfulthroughout my life.
So we try to expose people tothat.
Some people don't get it.
They don't understand why wewould recommend music therapy.
(35:00):
And then, once they experienceit, then they understand.
It's like oh, I get it now.
That's amazing.
Speaker 1 (35:08):
So is there one story that you want to share that
just is so transformational interms of a patient and the
family?
Because that's where I alwayssee it the family is always
skeptical.
I have to believe they'reskeptical they're.
What is this all about?
And there's just that onetransformational story that you
(35:28):
look back on and go.
I mean, I know there'sthousands of stories, there's so
many, put you on the spot, yeah, but is there one that just
always comes up in your mindthat goes, wow, that was the
most beautiful, transformational, where you went from this very
negative family environment tolike they can't thank you enough
(35:54):
for the way mom or grandma, uh,so that's happened.
Speaker 2 (35:55):
I I'm not coming up with one specific story with
around that specific dynamic,but one of the stories that I
that I love to to share becauseit was so transformational, was
a gentleman named Edward who wasin his mid-80s.
He had been diagnosed withcolon cancer and he was pretty
far along.
I met him when he was onhospice and he was bedridden and
(36:21):
he had a catheter and he wasjust miserable.
He was in pain and he had acatheter and he was just
miserable.
He was in pain, just losingweight and basically just laying
there waiting to die.
And the oncologist had stoppedtreating him because he couldn't
tolerate the chemotherapy andthey gave him a month or two to
live and he didn't accept thatand he hadn't seen a doctor.
(36:43):
He'd been on hospice for amonth, hadn't seen a doctor.
Because He'd been on hospicefor a month, hadn't seen a
doctor, because doctors don'ttypically see people on hospice
and I was asked to come in andevaluate him.
He wanted to see if he wanted arelationship with a doctor who
could give him more support andguidance.
But he was on hospice.
He had a nurse care manager whoinvited me in to meet with him.
(37:06):
He had a nurse care manager whoinvited me in to meet with him
and this gentleman he was nevermarried, he was an engineer, he
was a very science kind oforganized kind of a mind, but he
was also very, very isolatedand kind of reclusive.
He was Japanese, he was aJapanese-American, he was in an
(37:26):
internment camp during World WarII.
So he was open and I met withhim and I started talking about
the things that we could providefor him, including my medical
oversight, where I pulled somemedications away that he'd been
taking.
We brought in a music therapist.
We brought in a massagetherapist, we brought in an
(37:46):
acupuncturist.
At that point we had an arttherapist, physical therapy.
We started bringing people into just be part of his world and
connect with him and touch himand help him move.
And within a few weeks thecatheter was out, he was up,
walking, getting dressed, and helived for a year and a half and
(38:08):
he had the most beautiful finalyear and a half.
His sister, who lived in theBay Area, would come down and
after a while he was acompletely different person and
she was incredibly gratifiedbecause she didn't know that
this was possible.
She just thought she was goingto be losing her brother and was
(38:30):
helpless and hopeless.
And not only did he have thisamazing experience, but the
connection that he made withevery one of my team members was
so profound that every timethey would go and see him, they
would come out glowing andre-energized and inspired,
(38:52):
because they saw how powerfultheir showing up was and he was.
It was just as beautiful.
Everybody wins.
Everybody's a better human.
For having been part of thisexperience.
Speaker 1 (39:06):
I think it's so important and you and I have
talked about it off air, so tospeak, in terms of the coming.
There is a tsunami already.
It's not going, it's not coming, it's here and so many people
live isolated and if I canencourage anything from family
members is to be proactive,because your parents, your
(39:31):
grandparents are not going tolive forever and if you want to
try to have a peaceful endingand then maybe have a peaceful
family harmony after your lovedone passes, harmony- after your
loved one passes, having that,having you there for that final
(39:52):
six, whatever it is, whatever,what a couple days.
I think can bring people toreact to a sense of peace
amongst themselves so they don'tgo to war after right.
That's kind of my big thing isthe wars that we see after the
patriarch, matriarch had passedaway.
But if there was some peacefulresolution at those final
(40:14):
moments, maybe that woulddissolve the angst amongst the
family.
Speaker 2 (40:19):
And it starts upstream.
Being able to achieve thatpeace starts by having those
conversations, by gettingprepared.
I like to think about it aslike the landing a plane
Everybody wants a soft landing.
We're trying to give peoplethat soft landing, but in order
to have that, you need to havean appropriate flight plan, you
(40:42):
need to have a landing stripright, you have to have a runway
.
So we help people create therunway and the flight plan.
I think the individual, theperson whose life is coming to
an end, is both the plane andthe pilot.
We're the co-pilot and we'rethe maintenance crew and we're
(41:04):
the flight simulator.
Yeah, but we're helping to puteverything in place so that they
can have a soft landing, andthat's a beautiful thing If we
can help people achieve that.
What it does is it helpsprevent the trauma and the angst
and the guilt and the regret inthe loved ones so that they can
go on and have a meaningfullife that's not marred by this
(41:27):
experience of trauma and wishingthey had done things
differently, wishing they haddone a better job of caring for
mom or dad.
Speaker 1 (41:36):
Don't be afraid to have the conversations.
It's so enlightening, it's soamazing, it's so uplifting.
Speaker 2 (41:43):
In so many ways it's just fantastic, and we're happy
to guide that conversation and Ithink that's….
Speaker 1 (41:48):
EmpoweredEndingscom.
Exactly Endings with an SEmpoweredEndingscom.
I can't encourage you enough togo to the website.
There's a ton of greatinformation.
Speaker 2 (42:01):
More coming all the time, more coming all the time.
Speaker 1 (42:03):
You have a lot of topics that you will talk about,
whether it's to your church,your synagogue, your Rotary Club
, whatever the case may be.
Yeah, we love to educate.
Retirement associations aboundthroughout the nation now, so I
encourage everybody to just getyou out to listen and understand
the options that are available.
So, dr Bob, I will give youlast word as to how you want to
(42:26):
sign off today, and I thank youso much for joining us today.
It's hugely important.
Hugely important because, again, nobody gets out of here alive,
and if we can do it in apeaceful way, so much better.
So last word.
Speaker 2 (42:41):
Well, we love to help people and provide resources.
When people call to getinformation and to learn about
the resources, or even justschedule a 10, 15-minute call
with me to explore, that thrillsus.
We want people to reach out, wewant to be.
Whether you're going to engagewith our services or not, we'd
(43:02):
love to be of service and toprovide access to the resources
that we have and we'veaccumulated over the years.
Speaker 1 (43:12):
And I want to second that when my partner, Linda's
dad was diagnosed back in 2018.
It's an amazing story.
He was his caregiver for hiswife who battled Alzheimer's for
12 years and then,unfortunately, a year after she
passed, he got cancer and wentpretty quickly and you were so
(43:34):
gracious to reach out to Lindaand her family and him and talk
about it.
It was just.
It really did help quite a bit,so I appreciate that it's a
long time.
Again, a very important podcast.
Please share this with yourfamily Again.
Idea get the family togetherand listen to this podcast and
(43:55):
share your thoughts openly,honestly.
Call Dr Bob for some insights.
Very, very important topicPlease share.
This is Ron Greenwald, the RonGreenwald Podcast.
Have a great day.
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