December 30, 2024 • 56 mins
Confronting the inevitable is no easy feat, yet it's a conversation that needs to be had. Join us for a replay of “What You Need To Know About End Of Life Planning” from Season 1.
Speaking of Women's Health Podcast Host Holly Thacker, MD interviews Dr. Silvia Perez-Protto from the Cleveland Clinic for a heartfelt dialogue about end-of-life planning. The episode encourages listeners to engage in conversations about end-of-life plans with loved ones.
As we close our second season, we invite you to continue this journey with us, sharing and supporting our mission to bring thoughtful discussions on these crucial topics.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
National Speaking of Women'sHealth, and I'm back in the
Sunflower House for our verylast episode of Season 2.
But don't despair, we'relooking forward to season three.
(00:26):
In the last episode of thefirst season pretty apropos I
interviewed physician Dr SylviaPerez Prato, who's a staff
physician in intensive care andresuscitation department of
(00:47):
anesthesia at the ClevelandClinic and she is the medical
director of the End of LifeCenter in the Office of Safety,
quality and Patient Experienceand she's quite an innovator and
she developed the Advanced CareProgram at Cleveland Clinic.
And I really thought it wassuch an important episode to
(01:10):
replay in Season 2 because itdiscusses a much needed and many
times avoided tough topicend-of-life planning, of life
(01:30):
planning.
In this episode, dr Perez-Pradoshares resources for you and
your family in terms of theplanning process as well as how
to have that conversation withyour loved ones about what is
important to them and what theywant for end of life care.
And in the holiday season,where it's the end of the year
and the beginning of the newyear and there's so much
excitement and a lot of timesthere's family get-togethers and
(01:52):
reunions.
It's kind of a good time totalk about this.
In addition, end-of-lifeplanning is a key part of
financial and estate planning.
An end-of-life plan allows youto officially document your
wishes for your end of life inthe final days Now.
(02:17):
Sometimes death is unexpectedand sudden, so not everyone has
the advanced notice that theywill in fact be reaching the end
of their life here on Earth.
So there's lots of importantdecisions to make, such as the
medical care that you want orthat you do not want, funeral
(02:39):
and burial arrangements you'dprefer, and what you want to
happen to your assets and yourcherished items.
Now I was talking with myhusband and I said I'm going to
write up an obituary and Iwanted him to do the same thing
and he just thought that was somorbid and I said but there
(03:01):
might be something that's reallyimportant to you that, in the
stress of the acute grief thatone of us would forget, that we
might want written about ourlife.
So I think it's a good thing togo through, and a lot of times
at the end of the year peoplelook at their finances, they get
(03:22):
ready for the new year andtaxes, taxes and death, they say
, are two things that everyoneexperiences, and I know from
talking with patients andfriends and family that many
people as they age, even intoadvanced age, avoid planning at
all for their death, because itseems depressing and an
(03:45):
overwhelming idea to think aboutas to what will happen to them
and their family when they die.
But actually, if you do thisplanning, it can help alleviate
extra stress during an alreadyincredibly stressful time.
This is true not only for theindividual who's passing on but
(04:05):
for their loved ones and,importantly, hopefully it can
help alleviate all the extrafighting that sometimes happens
amongst the family, since theperson is ill if they've already
laid out how they wanteverything handled, and planning
(04:27):
for the future can make all thedifference in an emergency.
It's always good to be prepared, not just for the end of life,
but prepared for any kind ofemergency.
We've seen terrible hurricanesand devastations in the year of
2024.
Power outages, weather problems, disruption in supply chains.
(04:50):
So being prepared and havingall your important documents in
a single place can really giveyou peace of mind and help
ensure your wishes are honoredand ease the burden on your
loved ones.
Your wishes are honored andease the burden on your loved
ones.
My husband is legendary forgiving good gifts.
He's really a great gift giver.
(05:10):
I would say, though, that someof his Christmas gifts weren't
always the best received by hissons, in that a lot of it has to
do with survival kits for yourcar, chain links to add to your
tires if you're stuck in asnowstorm, blankets and devices
(05:34):
and kits needed for beingprepared, and one of our sons,
stetson, who's, of course, beena guest on this podcast and will
be a guest in season three onetime he was so busy and he got
stranded that he actually brokeinto the food supply kit that he
(05:54):
had gotten for Christmas andeaten one of these really high
protein, high calorie bars, andhe said it was actually good and
it was the only food he hadeaten that whole day.
So a lot of people say the bestday is the day that you find
out that you didn't have to useany kind of survival foods.
That's for sure, but people doget stranded in cars, and, with
(06:20):
the cold weather coming, youreally want to make sure your
car battery is good, that yourphone is charged, that you have
an alternative way to chargethings that areed and put in
boots and extra blankets andcoats.
My husband got this really nicecompact shovel that he carries
(06:52):
in his car.
So planning for the future isjust a great idea, and when I
was doing research for thisepisode reprising end of life
planning I came across a reallyhelpful checklist on the
National Institute of Agingwebsite about getting your
(07:13):
affairs in order a checklistdocuments to prepare for the
future.
I always like checklists.
I write checklists to myself onthe weekend of all the things I
want to do, like record apodcast, make food and prepare
in advance for the week, thingsthat I need to tick off to start
(07:33):
the week or the new month orthe new year anew.
And, depending on your faith,many of us are looking forward
to the future, afterlife, and sofor some it's not depressing,
for others it may be, butregardless, everyone, regardless
(07:55):
of their health and their age,if you're an adult, you should
plan your estate and finances,which includes a will, your
estate and finances, whichincludes a will, a durable power
of attorney for finances and aliving trust.
It's important to plan for yourfuture health care, which
(08:16):
includes a living will thattells your doctors and health
team how you want to be treatedif you cannot make your own
decisions about emergencytreatment, and this alleviates a
lot of stress for familymembers.
It also includes a durableattorney for a health care that
would name your health careproxy, for instance, your spouse
(08:36):
, a person who could make healthcare decisions for you if
you're not able to communicatethis yourself.
It's important to put all yourimportant papers and copies of
legal documents in one place,preferably something that's
fireproof.
That's another one of myhusband's gifts at Christmas to
my sons are containers that arefireproof to put those documents
(09:02):
in.
You want to let someone thatyou know and trust, like a
lawyer, where to find yourimportant papers or your family
members, and you want to talk toyour loved ones and a doctor
about advanced care planning anddiscussing this advanced care
planning with your physician isactually covered through
Medicare.
During your annual wellnessvisit, you want to give
(09:26):
permission in advance for adoctor or lawyer to talk with
your caregiver as needed, andyou want to review your plans
regularly In terms of thatannual wellness visit with
Medicare.
The one women's healthperspective I would have is
Medicare will cover for a pelvicexam, like an annual so-called
(09:50):
previously annual gynecologicexam, every two years.
So some women will alternatebetween seeing their primary
care physicians like aninternist or a family medicine
doctor and then with theirwomen's health clinician if
they're seeing someone inwomen's health, and they'll
alternate that.
Now, the NIA, nationalInstitutes of Aging, also
(10:13):
suggests making decisions aboutorgan donations and funeral
arrangements, or what you wantto happen after you die.
Some people want to be buriedin a certain location or a
certain cemetery, others preferto be cremated and have thoughts
about where they want theirashes to go.
(10:34):
If you and your long-termpartners are not legally married
, then you might want to get adomestic partnership agreement,
because that could be a verysmart idea and this document
allows you to declare theresponsibilities that you want
your partner to take on andrights that you'd like them to
(10:57):
have, regarding both end-of-lifecare and financing, life care
and financing and some of thesetopics like end of life,
financial planning, divorce.
We've done a podcast with thewonderful attorney, ava Saulnier
(11:21):
, in previous episodes.
In fact, if you're new to ourpodcast and hopefully you'll
pass on this podcast to friendsbecause it's free you may want
to take some time scrolling downall of the podcasts that we've
already done, because when I seesome of my patients and friends
and they'll ask me something,I'll say, oh, did you listen to
(11:42):
that podcast that we had anexpert on or that I discussed,
and they're like no, somehow Imissed that.
So sometimes, when you'retaking stock of everything, that
might be a good thing just todo a little screen and make a
notation of some of these greatpodcasts and wonderful guests
that we've had that you mightwant to listen to, that we've
(12:10):
had, that you might want tolisten to.
So up next is the End of LifeCare podcast from season one,
the last episode what you Needto Know About End of Life
Planning with Dr SylviaPerez-Prato, and even if you've
heard this before, it's really awonderful listen to remind you
about end-of-life planning beingmore comfortable for both you
and your loved ones, and sheshares how planning for your
(12:33):
death is really an importantpart of your life.
It is part of the life cycle.
So I hope you enjoy listeningto this episode either for the
first time or the second time,and I certainly listen to these
podcasts myself when I'm doingthem, but then when I listen to
them after they're published,I'll think, wow, that's really a
(12:54):
good point.
And sometimes when I'minterviewing people, I'm so
focused on the flow of thepodcast that I may actually miss
some important points.
So it's always good toreinforce things, and please be
sure to join us in the SunflowerHouse for season three in 2025.
(13:15):
2025 to 2026 is when we're goingto start to celebrate the 250th
anniversary of our country.
250th anniversary of ourcountry.
So we're just celebrating theupcoming third season and it
will kick off January 1st 2025.
So, happy new year, wishing youand your family a wonderful,
(13:36):
blessed, happy and healthy newyear, and please enjoy this
episode.
And please enjoy this episode.
Welcome to the Speaking ofWomen's Health podcast.
I'm your host, dr Holly Thacker, the Director of National
(13:57):
Speaking of Women's Health, andI am so excited to be back in
the Sunflower House today andjoining us for one of the last
episodes of season one is a veryimportant and somber topic
about end of life, and joiningus in the Sunflower House for
(14:20):
this special episode is DrSylvia Perez-Prato, and Dr
Perez-Prato is a staff physician.
She's one of my colleagues, butshe's in the intensive care and
resuscitation department at theAnesthesia Institute at
Cleveland Clinic.
She's also an associateprofessor of anesthesiology at
(14:43):
the Cleveland Clinic LernerCollege of Medicine and she's
the medical director of the Endof Life Center at the Office of
Safety, quality and PatientExperience and she is so
interesting and fascinating andtalented.
She has specifically developedadvanced care planning program
(15:05):
at the Cleveland Clinic, whichwe're going to talk about in
depth, and she has had the goalof goal concordant care.
She led the implementation ofthe pause not anything about
menopause, but to honor theperson who dies at the hospital
and the care provided by thathospital team and she also
(15:26):
co-created death over dinner forhealthcare.
I know that sounds a little bitstrange and we're past the
Halloween season, but it is soimportant to plan for a healthy
death.
And she also is going to talkto us about the pause app that
she created, developed to fostercaregiving and caregiver
(15:48):
resilience related to theend-of-life care.
Welcome, dr Sylvia Perez-Prato.
Speaker 2 (15:57):
Well, thank you so much.
Thank you for your words.
I'm very honored to be here.
Speaker 1 (16:04):
Well, we are so excited to have you as a guest
on the Sunflower Women's HealthPodcast to talk about advanced
care planning and advanceddirectives, and several years
ago you did a wonderful columnfor us on
speakingofwomenshealthcom.
But as we start off this veryimportant and somewhat somber
(16:27):
discussion, but it's soimportant for the whole entire
circle of life, Tell us moreabout your role in advanced care
planning and why did you decideto go into this field and
develop this so fully.
Speaker 2 (16:43):
Well, I'm a critical care physician, as you said, and
20% of the people in the UnitedStates die during or after an
ICU admission.
So, even though you start as anintensivist, to save patients
actually you develop.
Yes, one every five people inthe United States has been
(17:06):
admitted, during or after an ICUadmission die.
So it's part of our role asintensivists to understand death
and dying, as part of our roleto help patients to navigate
that time, you know, and theirfamilies.
So that's why I am in thisfield and I come from another
(17:27):
country.
As you see with my accent, I'mfrom Uruguay, south America, and
back home, death and dying ismore part of our life cycle.
It's something that usuallypeople talk about and I grew up
talking about that in my familyat the dinner table right and
(17:49):
here I was sometimes surprisedhow people didn't like I was
bringing some discussions aboutprognosis and they were all
surprises.
And I say people need to talkabout this as part of a life
cycle, as a natural act, youknow.
Speaker 1 (18:08):
Yes, it is a natural part of the life cycle.
Certainly, my goal in theCenter for Specialized Women's
Health is to help improvelongevity and quality of life,
but no matter how healthy one isand how much everybody does the
right thing, eventually we areall going to pass on.
You told me a very touchingstory when I first met you about
(18:32):
your dad.
Do you want to share that withour listeners?
Speaker 2 (18:36):
Yeah, so my dad was a physician and I remember we
were in a very small town so hewas an anesthesiologist during
the day and then he has hisoffice and then he used to go to
see patients at their homes.
So sometimes he picks us up.
(18:56):
And then we went with him andsome patients and families
invited us to eat cookies whilemy father was taking care of
them.
And one day he said I want towarn you, so-and-so passed, so
he died, so he's not going to bethere.
We are going to only say hi tothe wife because she is grieving
(19:21):
that her husband died.
And so I grew up seeing thesethings.
At that time there were nobilling or anything you know.
So we went there and saw thefamily, only to say hi.
You know, totally differentapproach, like today.
I think that shaped what I amnow.
(19:46):
And he always say how importantis dignity at the end of life.
So these are the concepts Igrew up with and this is what I
want for my patients.
Speaker 1 (20:00):
Wow, so you really are your father's daughter.
That is just so wonderful.
And one of our earlier podcasts, when I talked with an attorney
about divorce and family law.
One of the things that did comeup is having papers in order
and finances in order, and wetouched just a little bit about
(20:20):
advanced care planning.
But tell our listeners, doctor,what specifically is advanced
care planning?
Speaker 2 (20:28):
Yes.
So that's a great question.
So advanced care planning is aprocess, right, and changes over
time.
It's basically understand yourgoals, how you want to live up
to the end.
So, first of all, thisconversation is about life, how
you want to live.
So if we say, oh, how we wantto die, that's another approach
(20:50):
to the same topic, right?
So a fast care planning includes, first, who is going to make
decisions for you if you are notable to and this is something
important for anyone, becauseanyone can have an accident, you
know, or a stroke, or any time.
Even the healthiest person canbe diving and have an accident,
(21:12):
right?
So it's important to know who'sgoing to make decisions for you
if you are unable to, and thatperson could be in the order in
Ohio, in the state you are, orcould be outside right of that
order.
So the best is to have adocument saying who is the first
person and the second and thethird, and sometimes, even if
(21:35):
you have five kids and you knowthat one is going to take your
wishes up to the end and anotheris not going to be able to do
it, and it's not a manifestationof love to choose one over the
other, it's like who is going tobe able to do it, and it's not
a manifestation of love tochoose one over the other.
It's like who is going to bethe best one for healthcare, and
(21:56):
perhaps another kid is best forthe finances, right?
So the first step is statingwho is going to speak for you.
I recommend to have a documentthat is the healthcare power
attorney Healthcare powerattorney, yes, and be in the
chart.
So you have to bring thedocument to the hospital.
(22:17):
We have many, many ways to doit and I can share a website
where all this is explained.
So it's in the chart.
So when we have a problem, weknow exactly who to talk to
chart.
So when we have a problem, weknow exactly who to talk to.
And then for patients that areseriously ill, with a diagnosis
that decreases your expectancyof life, like, says, six months,
(22:40):
one year, those patients needgoals of care, conversations,
and these are conversations thatwe talk what matters most to
you, and that's why it'simportant to do it often,
because your goals change.
Right, as your disease processprogresses, you may change your
(23:02):
goals, so that's why it's aprocess.
So what matters most to you,what are your fears, your
worries?
And then we can deliver a curethat is aligned to your wishes.
And then, of course, we talkabout what are your wishes in an
emergency, if you are weak andwith a terminal diagnosis, if
(23:25):
the heart stops, do we want anatural death or we want to do
chest compressions, intubation,go to the machine, even when
it's futile and it's not goingto help?
So, and again, there's patientsthat say I want everything done
and we have to respect thosedecisions.
(23:45):
But again, when doctors in thestate of Ohio, we feel that they
are futile and it's against thestandards and we are not going
to help, we are going to damagethe body, we, even two
physicians, we can say we willnot offer CPR or resuscitation
(24:06):
maneuvers, we are going to allowa natural death and we can talk
about it and explain why wethink that this is the best
approach.
So understanding death as anatural part of our life cycle
is crucial.
Speaker 1 (24:21):
Very crucial.
So you are listening to theSpeaking of Women's Health
podcast and I'm your host, drHolly Thacker, the Executive
Director of Speaking and Women'sHealth, and we are joined by a
physician, dr Sylvia Perez-Prato, who specializes in the last
(24:42):
stages of life, which can, ofcourse, unfortunately happen at
any time.
None of us can predict thefuture.
Can you tell us, doctor?
You talked about a healthcarepower of attorney, which is
important to name.
I know, as soon as my threesons turned 18, on the day they
turned 18, they filled out theirpaperwork, because once they're
18, they're an illegal adult,doesn't matter that you're their
mom, and they signed it.
(25:03):
Tell us what the living will is.
Speaker 2 (25:06):
Yes.
So the living will is adocument that says in the case I
am terminally ill by twophysicians or permanently
unconscious and I don't havecapacity to share my wishes, I
don't want to be connected withmachines, die naturally and
(25:27):
please, doctor, place a DNRorder, do not resuscitate order.
So basically, the living willapply in very small population.
You need to have a patient thatis terminally ill, there's
nothing else to do in order toextend the life, and two
physicians should sign thatdocument.
(25:49):
It's very important thatdocument in cases, for example,
with no surrogate, there's nofamily, there's no documents.
The patient is admitted it's aterminal condition.
In these cases, if we don't havea living will, we have to keep
them on the machines until thebody, you know, with time it
(26:13):
stops and working.
But the problem is that we atthe ICU are very good today with
all the machines and support wehave.
So many terminal patients maybe alive for a long time with no
meaningful recovery, nomeaningful life.
So the living will assures usnot to be kept on machines if we
(26:38):
are terminal and we are notable to speak.
And that helps families becauseif we have a document it's
helping the family sometimes tomake the decision to say, yes,
let's allow a natural death, andthis is another thing that I
like to say to my family is,instead of saying, do not
(27:01):
resuscitate, just allow anatural death.
This is what it is.
Speaker 1 (27:04):
That sounds so much better.
I'm thinking of one situationof a good dear friend who had a
terminal diagnosis and had, youknow, the advanced directives,
health care power of attorney,had the living will, including
the natural, you know, wanting anatural death.
It got revoked because thisperson who was dying had air
(27:31):
hunger, which of course we knowhow to treat to make someone
comfortable and peaceful.
And so he then revoked the donot resuscitate and it was like
on off, on off and it justseemed like it was not a good
death and just like we want goodbirths for moms who are
bringing babies into the world,sometimes it can be a little
(27:55):
rocky, it's not always asaccording to the birth plan.
You know it's the same thingwith the end of life.
People are given the comfortcare so they're not so
uncomfortable and air hungrythat they say oh no, do
(28:20):
everything and intubate and putme on the machines.
Speaker 2 (28:23):
Yes, so actually we have many teams working in these
cases, right In the ICU we havethe training to make sure the
patient is comfortable, with noshortness of breath, air, hunger
, anxiety.
So we have medications to helpthem and if they survive enough,
we can even send them tohospice or to the regular nurse
floor with palliative care andor hospice care.
(28:46):
And the goal change we want thepatient to be as much in peace
as possible, connecting with thefamily if possible, and we
invite the families to celebratelife, to tell us stories about
the patient, and then we have alot of people that help us, like
(29:07):
spiritual care, healingservices, services, music
therapy.
We can even bring their petsand you know we we tried
everything that matters most tothis person.
Right, and this is the questionI love to use what matters most
to you and that is a veryopen-ended question that unpacks
(29:28):
a lot and you can find like ourgoal is to make sure that time
is meaningful.
Speaker 1 (29:38):
Very important.
Speaker 2 (29:40):
Yeah, so the goal is not always more treatment, more
surgeries, more time.
Sometimes patients really wantthis time of peace, this time,
and that's why it's so importantfor us to be honest with
prognosis, so they can preparefor that time realistically,
right, and you know, say goodbye, say forgive someone, you know
(30:03):
ask for forgiveness.
I don't know, life iscomplicated, right, and it's the
time of the patient, it's notour time.
Speaker 1 (30:11):
Now, every time I meet a new patient in the Center
for Specialized Women's Health,I always give them a folder
with information about thepractice and people on the team
and who the scheduler to call,and I always include information
about health care, power ofattorney, living will and
advanced directives.
And some people are just takenaback because they're not
(30:34):
expecting that.
But I thought you know we'replanning for the rest of your
life and we need to plan for thewhole entire life cycle.
How does one start oncompleting their advanced
directives?
I mean, I certainly prompt allmy patients, but I know not
everyone is necessarily seeing aphysician or a healthcare
(30:56):
clinician that's having thesediscussions with them.
Speaker 3 (31:01):
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Speaker 2 (31:45):
Yes, and the documents are pretty complex
it's 12 pages long and sometimesit's hard to understand.
So I think you can find us inthe website I will share with
you.
There are resources forpatients that we have guides on.
Page one is this, page two isthis so you can do it yourself
(32:07):
and could be witnessed by twopeople that are not related to
you by blood or by marriage orby adoption, so your neighbor
can be a witness and then it'scalled with two witnesses or a
notary, but you don't need anotary, and also the clinic
social workers, spiritual careare are trained to help patients
(32:32):
to complete the documents.
And more than the document, Iwill say.
The next step is to have theconversation, and that's another
tricky thing, right, becausesometimes I know who's the
person, right?
Uh, chosen by the patient, andthen say we never talk about
(32:52):
this, I don't know what he orshe would have wanted.
So, and again I will tell mystory my dad passed away years
ago.
So death he was super youngwhen he died.
So death is a pretty difficulttopic to bring up sometimes.
But I wanted to know what mymom would have wanted if
(33:16):
something happens to her.
And then one day I went walkingin the beach with her and I
started asking questions, andeven me being a physician, it
was kind of difficult.
I didn't know exactly what toask and got a little tricky.
And then I changed topics and Ifound a guide that I always
(33:37):
offer to my families andfamilies of my patients and I
use it with my mom later, andthe name is the Conversation
Project conversation project andthis is a guide with questions
that are validated by researchand that are questions to share
with people when we are healthy,right and uh, and you know, in
(34:00):
my house my husband and mydaughter was how you're always
talking about this and I one dayI wanted to have a conversation
and they didn't want to hide so.
So I wrote everything in one dayand sent it out.
It was a Tuesday night and Iwas on call and I wrote
everything.
I said Mom, are you crazy?
You're sending me a Tuesdaynight.
(34:21):
But then COVID hit and myhusband we have been married for
30 years he said that it wasthe time that he never saw me so
stressed and so afraid of goingto the ICU.
So one day we were almost to goto bed and he said what exactly
(34:41):
you want if something happensto you.
And I said seriously.
So I said you know, pablo,let's do death over dinners,
let's do it.
So what said you know, pablo,let's do death over dinners,
let's do it.
Speaker 1 (34:51):
So we actually connected.
Speaker 2 (34:53):
What is?
Speaker 1 (34:53):
death over dinner for health care.
Speaker 2 (34:57):
Yes.
Speaker 1 (34:59):
It's not some new restaurant I take.
Speaker 2 (35:01):
Death over dinner.
I know, I know.
So.
Death over dinner started yearsago for friends and families to
have this discussion aboutdeath and dying and how you want
to die and what your legacywould be, and to think about
that and share it with yourloved ones, right.
So we started for families andfriends and this is what I
(35:23):
invited him to do, and so we didthe first online death over
dinner, because usually it's ina table of six or eight people
breaking bread.
That connects to your coreright, sharing a dinner, sharing
a meal, answering thosequestions.
It's a way to connect withothers and open up with others
(35:56):
and open up, and that wasbrought by Michael Hebb.
That is the creator of DeathOver Dinner and he came to the
Empathy Summit years ago thatthe clinic used to offer a host
and then we said, oh my God, weneed to do it for healthcare
teams.
So, basically, I wanted to takeus from the hospital right
(36:17):
without our badges that says I'mthe doctor, I'm the nurse, I'm
the respiratory therapist, rightas people, but in teams, right
in multidisciplinary teams, andshare our feelings regarding end
of life and death and dying,because it's hard for us, you
know, sometimes if you have apatient for a long time and that
(36:39):
patient starts having issuesand then die.
You miss your patients, right.
Or, for us in the ICU, you meetthis family in a very stressful
situation for one week and thenthe patient dies, right.
Like even in differentsituations, means different
things to us, but it's hard.
No, we have these feelings andsometimes patients remind us of
(37:04):
our own families or our previousexperiences, our previous
experiences.
So this is a way where thesurgeon, the anesthesiologist,
you know, the consultant, theinternal medicine, the nurse, we
all come together as people,not from our roles, and share.
(37:25):
And at the beginning of thedinner we bring, we turn on a
light like a candle to honorsomeone that we lost.
And it was amazing to me to seea surgeon talk about a patient.
The first thing he did was totalk about a patient.
So it's like, wow, like most ofus, we talk about our parents
(37:50):
or our grandparents, or thatperson brought a patient.
So it was eye opening for mebecause I never saw that part
from him, you know.
So I think it's a way.
And then we have questions.
So while we have dinner weanswer those questions and then
(38:13):
at the end we all do a pause tohonor everybody.
We honor that night and wehonor the teamwork for all these
patients that we were talkingabout at the end.
So we close with a pause.
And this is what is death overdinner for healthcare.
Speaker 1 (38:35):
Wow.
So do you encourage everyone todo this, individually or for
primarily healthcare workers oranyone who's interested in this
process?
Speaker 2 (38:47):
Yes.
So if you put death overdinners, there are many versions
.
So there are death over dinners, even for Jewish people, for
Brazilian people there's one inBrazilian, for Brazilian culture
it's a huge movement therethere's one for families and
friends and then the healthcareone is for healthcare team.
(39:09):
So the questions are kind ofdifferent and at the beginning
you you go and choose things.
You can choose a podcast, youcan choose a reading, and then
at the end brings you questionsthat you're going to use during
the dinner so you can organizeyour own dinner yeah, that is so
important to do.
Speaker 1 (39:28):
Just the other day I just had a wedding anniversary
and so my husband had my weddingrings because I had lost, you
know, one of my side diamondsdoing some heavy work.
So he had it fixed and, youknow, brought it back to me and
I had my granddaughter, artemis,on my lap and I said, oh, one
day you'll probably have some ofthese rings.
(39:50):
Which one would you like?
So she picked the biggest oneand then she said and my little
sister, beatrice, can have thisone.
And I thought, okay, this was agood discussion to start to
have.
And my son said, oh, that's somorbid, you're being so morbid.
It's like no, I mean, mostlikely I'm, I hope to
pre-decease my children andgrandchildren.
(40:13):
Exactly, yes, and I think thatsome people think that they
either don't want to deal withit at all or they only deal with
certain aspects, like when I'llask patients, they'll be.
Oh, yes, I have a lawyer.
I've dealt with all thefinancial stuff and certainly
the financial things are veryimportant.
Having an executor and, youknow, do you need a consult to
(40:35):
your will and are you havingtrust?
I mean.
So certainly all of that'simportant, but I always say well
, we're interested in the healthaspects and how you want to be
cared for.
So it really is a whole, entire, comprehensive process that we
all need to face once you're 18.
Speaker 2 (40:53):
Yeah, and also organ donation right.
I always think I want to die ina way that I can be a donor.
I always say that because fromdeath you give life right.
So part of the discussions, andthat's why the discussion
should be early.
Like you know, anyone can havean accident right, and if you
(41:18):
have an accident you have highlikelihood to be a donor and to
be healthy, to save many livesright Up to eight life we can
save and many, many moreimproving quality of life.
So why we don't talk about thisright?
And then I always say cremation, and then to the Atlantic Ocean
(41:39):
.
But I told them don't go toUruguay, it's too much.
You can go to any part of theAtlantic.
Speaker 1 (41:48):
But it has to be the Atlantic Ocean for you, right,
right now the pacific.
Yes, yeah, I was born in theatlantic you know, but that
whole thing about organ donationand giving life is so important
and um, on our website, umheather mckessa, who runs life
bank, uh, in charge of organdonation, she's done a wonderful
(42:09):
column and she was highlightingto me that the group of
millennial parents many of them,when they're diagnosed and
carrying a baby with a fatalcondition, they don't choose to
terminate the pregnancy.
They carry the pregnancy eventhough they know that the baby
may not have a brain or may havesomething that will not allow
(42:30):
life, but they give life throughorgan donation, because little
babies need organs too.
Speaker 2 (42:38):
Yes, yes, so this was part of my story as an
intensivist.
When I was 24 years old, I wasin the ICU and this patient came
with a procedure in the brainin the right side and she was
fine and she needed the leftside and she said I don't want
(42:59):
to have it, I want to go homeand have Christmas with my
daughter at eight and then Iwill come back next month.
And then what happened?
In January I received her inbrain death because she bled
after the second procedure andback home at that time we have a
document that was pink, sayingthat you wanted to be a donor,
(43:19):
and she had three documentssigned.
So I said, oh my God, this isthe last thing I can do for her
is to make sure she's a donor.
And in that time, donation gavemeaning to death for me as a
24-year-old intensivist at thattime, and since then I've been
(43:41):
involved in organ donation aswell.
So everything dies right andhow we want to live, how we want
to die and what we want to beafter, how we want to do it
right.
Speaker 1 (43:54):
Absolutely so.
You're listening to theSpeaking of Women's Health
podcast and we are talking aboutend-of-life decisions, which
are all part of our missionbeing strong, being healthy and
being in charge, because it isthe circle of life and we're
talking with expert physicianand intensivist anesthesiologist
, dr Sylvia Perez-Prato, and you, dr Perez-Prato, helped create
(44:19):
the PAWS app.
Can you talk to us about howthis app works and how we might
get it?
Speaker 2 (44:27):
Yes.
So the pause was invented byJonathan Bartels in Virginia, in
the University of Virginia.
He was a nurse in the ED andone day he was involved in the
resuscitation of a patient, veryyoung, after a trauma and they
couldn't save him.
(44:48):
And then one started preparingthe body, another started going
to the you know talk to thefamily cleaning up the room and
then he said stop, let's pause.
Let's honor this person, thatwe help him.
We try to help him.
Let's honor he was loved.
He was somebody who lovedothers.
(45:09):
Let's honor he was loved.
He was somebody who lovedothers.
And let's honor us as a teamand the care we provided to him.
And he did a pause and then hesaid thank you, and it was
transformational.
So since then, when we foundout that, because a fellow came
(45:30):
to the clinic and did that andwas amazing for the nurses, so
they came to me and said Sylvia,we need to do this at the
clinic.
So I connected with him andsaid, hey, every time I talk
about the post I will say thatwe didn't invent it, it came
from you.
And then we, as a ClevelandClinic way, we did a pilot.
And then we, as a ClevelandClinic way, we did a pilot, we
(45:56):
got feedback and this, and thatuntil we had a script that is
very, very plain words, becausewe don't want any religion,
anything there.
It's only honor the person,honor the team and stop, as in
community, but in silence.
So each person lives it as theywant, as they feel, but it's in
communities, all together.
So, uh, and then, of course,when you start doing it, you get
(46:19):
used to the words andeverything, but at the beginning
it's hard.
So we wanted to have somethingthat is available.
So we created the pause app andyou can find it is free and we
have the script in many, manylanguages.
So, if their family doesn'tspeak english, yes, so if the
family doesn't speak english, weexplain to them that we are
(46:41):
going to do that and we askpermission and we show the what
we say in their own language.
So they are sure there's noreligion, anything there.
And I have only one family whoasked me not to do that because
they wanted to have their owncelebration.
(47:02):
So our team went to the nurse'sroom and then we did it there
without the patient.
But usually families stay withus, they are with us and they
they love it.
So, um, and it's a way for usto close.
You know that relationship thatsometimes it was very short and
(47:26):
intense and sometimes waslonger.
Speaker 1 (47:29):
Um, but it's a way to do it together and so people
can go on like their appleitunes store and just download
the pause for free.
So it's kind of like a yes,health care focused, team
focused, non-denominationalclosure and certainly that
doesn't preclude other peoplefrom their own religious or
spiritual uh, end life or lastrites, which you know many
(47:54):
people will get as their last.
You know, sacrament, end oflife, and certainly cultures,
religions, ages, backgrounds, Imean, we respect whatever is how
that person and their familywant to mark and celebrate their
death and their life.
Speaker 2 (48:12):
So one of the things interesting that happened
because we did this for the careteam right In the ICU, in the
floor, in the ED, in theemergency room.
But one time somebody from IThad a colleague that died and
they were very unsettled andthis manager brought everybody
(48:39):
together, said hey, let's do apause to honor so-and-so.
And since then it ended uphappening in M&Ms when we
discuss cases, some people say,okay, let's do a pause about the
patient or in quality eventsthey do the pause and then they
end up doing it in the executiveteam and during the pandemic
(49:03):
was quite important becauseexecutive team were more about,
you know, preparing for thesearch.
But every Monday, when theyname everybody that died Friday,
saturday, sunday and they nameall the persons who died in the
(49:23):
enterprise and they do the pause, it was coming to reality that
these numbers were people withnames.
So since then they do it everyday in Huddle 6 executive team
have all the names of the peoplewho died the day before and
they honor everybody with apause.
And the Joint Commission washere and found that as one of
(49:47):
the 10 most impactful changes atthe clinic.
So yes, it's incredible how alittle act can have so much
reach, you know.
Speaker 1 (50:01):
So tell us a little bit about yourself personally,
because you're still full oflife and living life very full.
You're the mom of two daughters, right?
Speaker 2 (50:11):
Yes, I have a 23-year-old and a 12-year-old.
That's quite a span, yes, Well,I had some miscarriages, so
some doctors in your fieldhelped me a lot and I decided
that I will stop studying andgetting bored and I started
(50:33):
dancing flamenco again last yearso I'm very excited.
Speaker 1 (50:36):
That's great.
Yes, you're a dancer and Istarted dancing flamenco again
last year, so I'm very excited.
That's great, yes.
Speaker 2 (50:39):
You're a dancer?
Yes, so there's a group of AbrePaso is the name, and I'm a
board member of thisorganization, non-for-profit to
create community through the artof dancing.
You know, to create communitythrough the art of dancing.
It's Spanish, dancing is verydifficult, so I'm preventing
(51:02):
Alzheimer's, that's true, itdoes help your brain Because you
have to think about it a lot.
Speaker 1 (51:06):
Yes, You'll have to send us some video clips.
So I think it's my name.
Yes, please send me a videoclip of your dance, oh okay.
I'll put it up on our socialmedia on Speaking of Women's
Health, because people canfollow us, not just the podcast.
So if you're listening to thispodcast on any place you listen
to podcasts, just hit follow orsubscribe because it's free.
(51:29):
Oh, that's wonderful, but we'reon Facebook and LinkedIn and
Pinterest and X, which isformerly known as Twitter, so we
can put that up.
I'm sure our followers wouldlove to see you dancing.
That is like so wonderful, andyou've also had leadership roles
.
Speaker 2 (51:48):
I'm not sure I'm ready.
I'm not sure if I'm ready to bein the Just a little clip.
Speaker 1 (51:55):
Just a little clip.
I'm sure you're ready.
I will see.
I will see.
You've also been involved inleadership roles for the Women's
Professional Staff Affairs aswell, so you have the respect of
all your colleagues.
Oh yes.
Speaker 2 (52:10):
Yeah, so well, this is part of my goal of lifting
others while I lead, so I havethe honor to represent the women
professional staff at theclinic.
So, yes, I'm humbled by thatand, yes, it's something that is
important to me to help otherswhile I'm leading.
Speaker 1 (52:35):
Well, we're so proud of you and this has been so
helpful.
In wrap-up, Doctor, any finaltips that people need to keep in
mind, that we all need to keepin mind in terms of planning our
end of life.
Speaker 2 (52:48):
Yeah, I would say that if you live your life at
fullest, we want to live up tothe end at fullest, so we need
to live it in our own terms.
So it's important to sharethose wishes, to think about it,
reflect and then share thatwith our loved ones and with our
(53:09):
care teams so we can have thebest experience at the end the
best experience at the end.
Speaker 1 (53:20):
I was recently visiting the grave site of one
of my friends who sadly gotdementia during the pandemic and
it rapidly progressed and shedied.
And so I was going there and Iran into her husband because it
was the first time he was goingto visit the headstone.
It was beautiful and he wasthere with his sister whose
husband had died.
And they gave some really goodadvice to me and my husband.
(53:43):
They said plan your own funeral, get your own headstone,
because your children willeither spend way too much money
that you wouldn't want yourmoney to have been spent on or
they'll spend way too little.
And I thought okay.
I've got some penny pinchingsons, so that was really good
advice because it made you knowmy husband and I think we need
(54:06):
to plan all this out and pay forit and you know.
So the whole shebang, of course, the healthcare part, and who's
going to speak for you, andwhat are your own personal goals
and what you want done, whatyou don't want done.
That is, like you said, livingto the fullest, to the very end.
But there are factorsafterwards that can make it very
difficult on the loved ones,like if your paperwork is not in
(54:28):
order and you don't have anexecutor and you haven't decided
where you want things to go.
That is so important.
So we're going to putinformation about the pause and
how people can reach you andlinks to your column in our show
notes.
So thank you so much, doctor,for joining us at the end of our
first season about end of life,which is so important to being
(54:51):
strong and being healthy andbeing in charge up to the very
end, and I'd like to thank allof our listeners for joining us,
and if you've enjoyed thispodcast, you can give us a
five-star rating.
Share it with your friends,share it with your family, use
this as a point in time to startto talk about this, and it's
(55:13):
free to subscribe.
And if you want to donate toour nonprofit
speakingofwomenshealthcom, wewould much appreciate it.
And please follow us whereveryou listen to your podcast Apple
Podcasts, google, spotify,iheartradio and I'll look
forward to joining you in theSunflower House next year in
(55:33):
season two.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
National Speaking of Women'sHealth, and I'm back in the
Sunflower House for our verylast episode of Season 2.
But don't despair, we'relooking forward to season three.
(00:26):
In the last episode of thefirst season pretty apropos I
interviewed physician Dr SylviaPerez Prato, who's a staff
physician in intensive care andresuscitation department of
(00:47):
anesthesia at the ClevelandClinic and she is the medical
director of the End of LifeCenter in the Office of Safety,
quality and Patient Experienceand she's quite an innovator and
she developed the Advanced CareProgram at Cleveland Clinic.
And I really thought it wassuch an important episode to
(01:10):
replay in Season 2 because itdiscusses a much needed and many
times avoided tough topicend-of-life planning, of life
(01:30):
planning.
In this episode, dr Perez-Pradoshares resources for you and
your family in terms of theplanning process as well as how
to have that conversation withyour loved ones about what is
important to them and what theywant for end of life care.
And in the holiday season,where it's the end of the year
and the beginning of the newyear and there's so much
excitement and a lot of timesthere's family get-togethers and
(01:52):
reunions.
It's kind of a good time totalk about this.
In addition, end-of-lifeplanning is a key part of
financial and estate planning.
An end-of-life plan allows youto officially document your
wishes for your end of life inthe final days Now.
(02:17):
Sometimes death is unexpectedand sudden, so not everyone has
the advanced notice that theywill in fact be reaching the end
of their life here on Earth.
So there's lots of importantdecisions to make, such as the
medical care that you want orthat you do not want, funeral
(02:39):
and burial arrangements you'dprefer, and what you want to
happen to your assets and yourcherished items.
Now I was talking with myhusband and I said I'm going to
write up an obituary and Iwanted him to do the same thing
and he just thought that was somorbid and I said but there
(03:01):
might be something that's reallyimportant to you that, in the
stress of the acute grief thatone of us would forget, that we
might want written about ourlife.
So I think it's a good thing togo through, and a lot of times
at the end of the year peoplelook at their finances, they get
(03:22):
ready for the new year andtaxes, taxes and death, they say
, are two things that everyoneexperiences, and I know from
talking with patients andfriends and family that many
people as they age, even intoadvanced age, avoid planning at
all for their death, because itseems depressing and an
(03:45):
overwhelming idea to think aboutas to what will happen to them
and their family when they die.
But actually, if you do thisplanning, it can help alleviate
extra stress during an alreadyincredibly stressful time.
This is true not only for theindividual who's passing on but
(04:05):
for their loved ones and,importantly, hopefully it can
help alleviate all the extrafighting that sometimes happens
amongst the family, since theperson is ill if they've already
laid out how they wanteverything handled, and planning
(04:27):
for the future can make all thedifference in an emergency.
It's always good to be prepared, not just for the end of life,
but prepared for any kind ofemergency.
We've seen terrible hurricanesand devastations in the year of
2024.
Power outages, weather problems, disruption in supply chains.
(04:50):
So being prepared and havingall your important documents in
a single place can really giveyou peace of mind and help
ensure your wishes are honoredand ease the burden on your
loved ones.
Your wishes are honored andease the burden on your loved
ones.
My husband is legendary forgiving good gifts.
He's really a great gift giver.
(05:10):
I would say, though, that someof his Christmas gifts weren't
always the best received by hissons, in that a lot of it has to
do with survival kits for yourcar, chain links to add to your
tires if you're stuck in asnowstorm, blankets and devices
(05:34):
and kits needed for beingprepared, and one of our sons,
stetson, who's, of course, beena guest on this podcast and will
be a guest in season three onetime he was so busy and he got
stranded that he actually brokeinto the food supply kit that he
(05:54):
had gotten for Christmas andeaten one of these really high
protein, high calorie bars, andhe said it was actually good and
it was the only food he hadeaten that whole day.
So a lot of people say the bestday is the day that you find
out that you didn't have to useany kind of survival foods.
That's for sure, but people doget stranded in cars, and, with
(06:20):
the cold weather coming, youreally want to make sure your
car battery is good, that yourphone is charged, that you have
an alternative way to chargethings that areed and put in
boots and extra blankets andcoats.
My husband got this really nicecompact shovel that he carries
(06:52):
in his car.
So planning for the future isjust a great idea, and when I
was doing research for thisepisode reprising end of life
planning I came across a reallyhelpful checklist on the
National Institute of Agingwebsite about getting your
(07:13):
affairs in order a checklistdocuments to prepare for the
future.
I always like checklists.
I write checklists to myself onthe weekend of all the things I
want to do, like record apodcast, make food and prepare
in advance for the week, thingsthat I need to tick off to start
(07:33):
the week or the new month orthe new year anew.
And, depending on your faith,many of us are looking forward
to the future, afterlife, and sofor some it's not depressing,
for others it may be, butregardless, everyone, regardless
(07:55):
of their health and their age,if you're an adult, you should
plan your estate and finances,which includes a will, your
estate and finances, whichincludes a will, a durable power
of attorney for finances and aliving trust.
It's important to plan for yourfuture health care, which
(08:16):
includes a living will thattells your doctors and health
team how you want to be treatedif you cannot make your own
decisions about emergencytreatment, and this alleviates a
lot of stress for familymembers.
It also includes a durableattorney for a health care that
would name your health careproxy, for instance, your spouse
(08:36):
, a person who could make healthcare decisions for you if
you're not able to communicatethis yourself.
It's important to put all yourimportant papers and copies of
legal documents in one place,preferably something that's
fireproof.
That's another one of myhusband's gifts at Christmas to
my sons are containers that arefireproof to put those documents
(09:02):
in.
You want to let someone thatyou know and trust, like a
lawyer, where to find yourimportant papers or your family
members, and you want to talk toyour loved ones and a doctor
about advanced care planning anddiscussing this advanced care
planning with your physician isactually covered through
Medicare.
During your annual wellnessvisit, you want to give
(09:26):
permission in advance for adoctor or lawyer to talk with
your caregiver as needed, andyou want to review your plans
regularly In terms of thatannual wellness visit with
Medicare.
The one women's healthperspective I would have is
Medicare will cover for a pelvicexam, like an annual so-called
(09:50):
previously annual gynecologicexam, every two years.
So some women will alternatebetween seeing their primary
care physicians like aninternist or a family medicine
doctor and then with theirwomen's health clinician if
they're seeing someone inwomen's health, and they'll
alternate that.
Now, the NIA, nationalInstitutes of Aging, also
(10:13):
suggests making decisions aboutorgan donations and funeral
arrangements, or what you wantto happen after you die.
Some people want to be buriedin a certain location or a
certain cemetery, others preferto be cremated and have thoughts
about where they want theirashes to go.
(10:34):
If you and your long-termpartners are not legally married
, then you might want to get adomestic partnership agreement,
because that could be a verysmart idea and this document
allows you to declare theresponsibilities that you want
your partner to take on andrights that you'd like them to
(10:57):
have, regarding both end-of-lifecare and financing, life care
and financing and some of thesetopics like end of life,
financial planning, divorce.
We've done a podcast with thewonderful attorney, ava Saulnier
(11:21):
, in previous episodes.
In fact, if you're new to ourpodcast and hopefully you'll
pass on this podcast to friendsbecause it's free you may want
to take some time scrolling downall of the podcasts that we've
already done, because when I seesome of my patients and friends
and they'll ask me something,I'll say, oh, did you listen to
(11:42):
that podcast that we had anexpert on or that I discussed,
and they're like no, somehow Imissed that.
So sometimes, when you'retaking stock of everything, that
might be a good thing just todo a little screen and make a
notation of some of these greatpodcasts and wonderful guests
that we've had that you mightwant to listen to, that we've
(12:10):
had, that you might want tolisten to.
So up next is the End of LifeCare podcast from season one,
the last episode what you Needto Know About End of Life
Planning with Dr SylviaPerez-Prato, and even if you've
heard this before, it's really awonderful listen to remind you
about end-of-life planning beingmore comfortable for both you
and your loved ones, and sheshares how planning for your
(12:33):
death is really an importantpart of your life.
It is part of the life cycle.
So I hope you enjoy listeningto this episode either for the
first time or the second time,and I certainly listen to these
podcasts myself when I'm doingthem, but then when I listen to
them after they're published,I'll think, wow, that's really a
(12:54):
good point.
And sometimes when I'minterviewing people, I'm so
focused on the flow of thepodcast that I may actually miss
some important points.
So it's always good toreinforce things, and please be
sure to join us in the SunflowerHouse for season three in 2025.
(13:15):
2025 to 2026 is when we're goingto start to celebrate the 250th
anniversary of our country.
250th anniversary of ourcountry.
So we're just celebrating theupcoming third season and it
will kick off January 1st 2025.
So, happy new year, wishing youand your family a wonderful,
(13:36):
blessed, happy and healthy newyear, and please enjoy this
episode.
And please enjoy this episode.
Welcome to the Speaking ofWomen's Health podcast.
I'm your host, dr Holly Thacker, the Director of National
(13:57):
Speaking of Women's Health, andI am so excited to be back in
the Sunflower House today andjoining us for one of the last
episodes of season one is a veryimportant and somber topic
about end of life, and joiningus in the Sunflower House for
(14:20):
this special episode is DrSylvia Perez-Prato, and Dr
Perez-Prato is a staff physician.
She's one of my colleagues, butshe's in the intensive care and
resuscitation department at theAnesthesia Institute at
Cleveland Clinic.
She's also an associateprofessor of anesthesiology at
(14:43):
the Cleveland Clinic LernerCollege of Medicine and she's
the medical director of the Endof Life Center at the Office of
Safety, quality and PatientExperience and she is so
interesting and fascinating andtalented.
She has specifically developedadvanced care planning program
(15:05):
at the Cleveland Clinic, whichwe're going to talk about in
depth, and she has had the goalof goal concordant care.
She led the implementation ofthe pause not anything about
menopause, but to honor theperson who dies at the hospital
and the care provided by thathospital team and she also
(15:26):
co-created death over dinner forhealthcare.
I know that sounds a little bitstrange and we're past the
Halloween season, but it is soimportant to plan for a healthy
death.
And she also is going to talkto us about the pause app that
she created, developed to fostercaregiving and caregiver
(15:48):
resilience related to theend-of-life care.
Welcome, dr Sylvia Perez-Prato.
Speaker 2 (15:57):
Well, thank you so much.
Thank you for your words.
I'm very honored to be here.
Speaker 1 (16:04):
Well, we are so excited to have you as a guest
on the Sunflower Women's HealthPodcast to talk about advanced
care planning and advanceddirectives, and several years
ago you did a wonderful columnfor us on
speakingofwomenshealthcom.
But as we start off this veryimportant and somewhat somber
(16:27):
discussion, but it's soimportant for the whole entire
circle of life, Tell us moreabout your role in advanced care
planning and why did you decideto go into this field and
develop this so fully.
Speaker 2 (16:43):
Well, I'm a critical care physician, as you said, and
20% of the people in the UnitedStates die during or after an
ICU admission.
So, even though you start as anintensivist, to save patients
actually you develop.
Yes, one every five people inthe United States has been
(17:06):
admitted, during or after an ICUadmission die.
So it's part of our role asintensivists to understand death
and dying, as part of our roleto help patients to navigate
that time, you know, and theirfamilies.
So that's why I am in thisfield and I come from another
(17:27):
country.
As you see with my accent, I'mfrom Uruguay, south America, and
back home, death and dying ismore part of our life cycle.
It's something that usuallypeople talk about and I grew up
talking about that in my familyat the dinner table right and
(17:49):
here I was sometimes surprisedhow people didn't like I was
bringing some discussions aboutprognosis and they were all
surprises.
And I say people need to talkabout this as part of a life
cycle, as a natural act, youknow.
Speaker 1 (18:08):
Yes, it is a natural part of the life cycle.
Certainly, my goal in theCenter for Specialized Women's
Health is to help improvelongevity and quality of life,
but no matter how healthy one isand how much everybody does the
right thing, eventually we areall going to pass on.
You told me a very touchingstory when I first met you about
(18:32):
your dad.
Do you want to share that withour listeners?
Speaker 2 (18:36):
Yeah, so my dad was a physician and I remember we
were in a very small town so hewas an anesthesiologist during
the day and then he has hisoffice and then he used to go to
see patients at their homes.
So sometimes he picks us up.
(18:56):
And then we went with him andsome patients and families
invited us to eat cookies whilemy father was taking care of
them.
And one day he said I want towarn you, so-and-so passed, so
he died, so he's not going to bethere.
We are going to only say hi tothe wife because she is grieving
(19:21):
that her husband died.
And so I grew up seeing thesethings.
At that time there were nobilling or anything you know.
So we went there and saw thefamily, only to say hi.
You know, totally differentapproach, like today.
I think that shaped what I amnow.
(19:46):
And he always say how importantis dignity at the end of life.
So these are the concepts Igrew up with and this is what I
want for my patients.
Speaker 1 (20:00):
Wow, so you really are your father's daughter.
That is just so wonderful.
And one of our earlier podcasts, when I talked with an attorney
about divorce and family law.
One of the things that did comeup is having papers in order
and finances in order, and wetouched just a little bit about
(20:20):
advanced care planning.
But tell our listeners, doctor,what specifically is advanced
care planning?
Speaker 2 (20:28):
Yes.
So that's a great question.
So advanced care planning is aprocess, right, and changes over
time.
It's basically understand yourgoals, how you want to live up
to the end.
So, first of all, thisconversation is about life, how
you want to live.
So if we say, oh, how we wantto die, that's another approach
(20:50):
to the same topic, right?
So a fast care planning includes, first, who is going to make
decisions for you if you are notable to and this is something
important for anyone, becauseanyone can have an accident, you
know, or a stroke, or any time.
Even the healthiest person canbe diving and have an accident,
(21:12):
right?
So it's important to know who'sgoing to make decisions for you
if you are unable to, and thatperson could be in the order in
Ohio, in the state you are, orcould be outside right of that
order.
So the best is to have adocument saying who is the first
person and the second and thethird, and sometimes, even if
(21:35):
you have five kids and you knowthat one is going to take your
wishes up to the end and anotheris not going to be able to do
it, and it's not a manifestationof love to choose one over the
other, it's like who is going tobe able to do it, and it's not
a manifestation of love tochoose one over the other.
It's like who is going to bethe best one for healthcare, and
(21:56):
perhaps another kid is best forthe finances, right?
So the first step is statingwho is going to speak for you.
I recommend to have a documentthat is the healthcare power
attorney Healthcare powerattorney, yes, and be in the
chart.
So you have to bring thedocument to the hospital.
(22:17):
We have many, many ways to doit and I can share a website
where all this is explained.
So it's in the chart.
So when we have a problem, weknow exactly who to talk to
chart.
So when we have a problem, weknow exactly who to talk to.
And then for patients that areseriously ill, with a diagnosis
that decreases your expectancyof life, like, says, six months,
(22:40):
one year, those patients needgoals of care, conversations,
and these are conversations thatwe talk what matters most to
you, and that's why it'simportant to do it often,
because your goals change.
Right, as your disease processprogresses, you may change your
(23:02):
goals, so that's why it's aprocess.
So what matters most to you,what are your fears, your
worries?
And then we can deliver a curethat is aligned to your wishes.
And then, of course, we talkabout what are your wishes in an
emergency, if you are weak andwith a terminal diagnosis, if
(23:25):
the heart stops, do we want anatural death or we want to do
chest compressions, intubation,go to the machine, even when
it's futile and it's not goingto help?
So, and again, there's patientsthat say I want everything done
and we have to respect thosedecisions.
(23:45):
But again, when doctors in thestate of Ohio, we feel that they
are futile and it's against thestandards and we are not going
to help, we are going to damagethe body, we, even two
physicians, we can say we willnot offer CPR or resuscitation
(24:06):
maneuvers, we are going to allowa natural death and we can talk
about it and explain why wethink that this is the best
approach.
So understanding death as anatural part of our life cycle
is crucial.
Speaker 1 (24:21):
Very crucial.
So you are listening to theSpeaking of Women's Health
podcast and I'm your host, drHolly Thacker, the Executive
Director of Speaking and Women'sHealth, and we are joined by a
physician, dr Sylvia Perez-Prato, who specializes in the last
(24:42):
stages of life, which can, ofcourse, unfortunately happen at
any time.
None of us can predict thefuture.
Can you tell us, doctor?
You talked about a healthcarepower of attorney, which is
important to name.
I know, as soon as my threesons turned 18, on the day they
turned 18, they filled out theirpaperwork, because once they're
18, they're an illegal adult,doesn't matter that you're their
mom, and they signed it.
(25:03):
Tell us what the living will is.
Speaker 2 (25:06):
Yes.
So the living will is adocument that says in the case I
am terminally ill by twophysicians or permanently
unconscious and I don't havecapacity to share my wishes, I
don't want to be connected withmachines, die naturally and
(25:27):
please, doctor, place a DNRorder, do not resuscitate order.
So basically, the living willapply in very small population.
You need to have a patient thatis terminally ill, there's
nothing else to do in order toextend the life, and two
physicians should sign thatdocument.
(25:49):
It's very important thatdocument in cases, for example,
with no surrogate, there's nofamily, there's no documents.
The patient is admitted it's aterminal condition.
In these cases, if we don't havea living will, we have to keep
them on the machines until thebody, you know, with time it
(26:13):
stops and working.
But the problem is that we atthe ICU are very good today with
all the machines and support wehave.
So many terminal patients maybe alive for a long time with no
meaningful recovery, nomeaningful life.
So the living will assures usnot to be kept on machines if we
(26:38):
are terminal and we are notable to speak.
And that helps families becauseif we have a document it's
helping the family sometimes tomake the decision to say, yes,
let's allow a natural death, andthis is another thing that I
like to say to my family is,instead of saying, do not
(27:01):
resuscitate, just allow anatural death.
This is what it is.
Speaker 1 (27:04):
That sounds so much better.
I'm thinking of one situationof a good dear friend who had a
terminal diagnosis and had, youknow, the advanced directives,
health care power of attorney,had the living will, including
the natural, you know, wanting anatural death.
It got revoked because thisperson who was dying had air
(27:31):
hunger, which of course we knowhow to treat to make someone
comfortable and peaceful.
And so he then revoked the donot resuscitate and it was like
on off, on off and it justseemed like it was not a good
death and just like we want goodbirths for moms who are
bringing babies into the world,sometimes it can be a little
(27:55):
rocky, it's not always asaccording to the birth plan.
You know it's the same thingwith the end of life.
People are given the comfortcare so they're not so
uncomfortable and air hungrythat they say oh no, do
(28:20):
everything and intubate and putme on the machines.
Speaker 2 (28:23):
Yes, so actually we have many teams working in these
cases, right In the ICU we havethe training to make sure the
patient is comfortable, with noshortness of breath, air, hunger
, anxiety.
So we have medications to helpthem and if they survive enough,
we can even send them tohospice or to the regular nurse
floor with palliative care andor hospice care.
(28:46):
And the goal change we want thepatient to be as much in peace
as possible, connecting with thefamily if possible, and we
invite the families to celebratelife, to tell us stories about
the patient, and then we have alot of people that help us, like
(29:07):
spiritual care, healingservices, services, music
therapy.
We can even bring their petsand you know we we tried
everything that matters most tothis person.
Right, and this is the questionI love to use what matters most
to you and that is a veryopen-ended question that unpacks
(29:28):
a lot and you can find like ourgoal is to make sure that time
is meaningful.
Speaker 1 (29:38):
Very important.
Speaker 2 (29:40):
Yeah, so the goal is not always more treatment, more
surgeries, more time.
Sometimes patients really wantthis time of peace, this time,
and that's why it's so importantfor us to be honest with
prognosis, so they can preparefor that time realistically,
right, and you know, say goodbye, say forgive someone, you know
(30:03):
ask for forgiveness.
I don't know, life iscomplicated, right, and it's the
time of the patient, it's notour time.
Speaker 1 (30:11):
Now, every time I meet a new patient in the Center
for Specialized Women's Health,I always give them a folder
with information about thepractice and people on the team
and who the scheduler to call,and I always include information
about health care, power ofattorney, living will and
advanced directives.
And some people are just takenaback because they're not
(30:34):
expecting that.
But I thought you know we'replanning for the rest of your
life and we need to plan for thewhole entire life cycle.
How does one start oncompleting their advanced
directives?
I mean, I certainly prompt allmy patients, but I know not
everyone is necessarily seeing aphysician or a healthcare
(30:56):
clinician that's having thesediscussions with them.
Speaker 3 (31:01):
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Speaker 2 (31:45):
Yes, and the documents are pretty complex
it's 12 pages long and sometimesit's hard to understand.
So I think you can find us inthe website I will share with
you.
There are resources forpatients that we have guides on.
Page one is this, page two isthis so you can do it yourself
(32:07):
and could be witnessed by twopeople that are not related to
you by blood or by marriage orby adoption, so your neighbor
can be a witness and then it'scalled with two witnesses or a
notary, but you don't need anotary, and also the clinic
social workers, spiritual careare are trained to help patients
(32:32):
to complete the documents.
And more than the document, Iwill say.
The next step is to have theconversation, and that's another
tricky thing, right, becausesometimes I know who's the
person, right?
Uh, chosen by the patient, andthen say we never talk about
(32:52):
this, I don't know what he orshe would have wanted.
So, and again I will tell mystory my dad passed away years
ago.
So death he was super youngwhen he died.
So death is a pretty difficulttopic to bring up sometimes.
But I wanted to know what mymom would have wanted if
(33:16):
something happens to her.
And then one day I went walkingin the beach with her and I
started asking questions, andeven me being a physician, it
was kind of difficult.
I didn't know exactly what toask and got a little tricky.
And then I changed topics and Ifound a guide that I always
(33:37):
offer to my families andfamilies of my patients and I
use it with my mom later, andthe name is the Conversation
Project conversation project andthis is a guide with questions
that are validated by researchand that are questions to share
with people when we are healthy,right and uh, and you know, in
(34:00):
my house my husband and mydaughter was how you're always
talking about this and I one dayI wanted to have a conversation
and they didn't want to hide so.
So I wrote everything in one dayand sent it out.
It was a Tuesday night and Iwas on call and I wrote
everything.
I said Mom, are you crazy?
You're sending me a Tuesdaynight.
(34:21):
But then COVID hit and myhusband we have been married for
30 years he said that it wasthe time that he never saw me so
stressed and so afraid of goingto the ICU.
So one day we were almost to goto bed and he said what exactly
(34:41):
you want if something happensto you.
And I said seriously.
So I said you know, pablo,let's do death over dinners,
let's do it.
So what said you know, pablo,let's do death over dinners,
let's do it.
Speaker 1 (34:51):
So we actually connected.
Speaker 2 (34:53):
What is?
Speaker 1 (34:53):
death over dinner for health care.
Speaker 2 (34:57):
Yes.
Speaker 1 (34:59):
It's not some new restaurant I take.
Speaker 2 (35:01):
Death over dinner.
I know, I know.
So.
Death over dinner started yearsago for friends and families to
have this discussion aboutdeath and dying and how you want
to die and what your legacywould be, and to think about
that and share it with yourloved ones, right.
So we started for families andfriends and this is what I
(35:23):
invited him to do, and so we didthe first online death over
dinner, because usually it's ina table of six or eight people
breaking bread.
That connects to your coreright, sharing a dinner, sharing
a meal, answering thosequestions.
It's a way to connect withothers and open up with others
(35:56):
and open up, and that wasbrought by Michael Hebb.
That is the creator of DeathOver Dinner and he came to the
Empathy Summit years ago thatthe clinic used to offer a host
and then we said, oh my God, weneed to do it for healthcare
teams.
So, basically, I wanted to takeus from the hospital right
(36:17):
without our badges that says I'mthe doctor, I'm the nurse, I'm
the respiratory therapist, rightas people, but in teams, right
in multidisciplinary teams, andshare our feelings regarding end
of life and death and dying,because it's hard for us, you
know, sometimes if you have apatient for a long time and that
(36:39):
patient starts having issuesand then die.
You miss your patients, right.
Or, for us in the ICU, you meetthis family in a very stressful
situation for one week and thenthe patient dies, right.
Like even in differentsituations, means different
things to us, but it's hard.
No, we have these feelings andsometimes patients remind us of
(37:04):
our own families or our previousexperiences, our previous
experiences.
So this is a way where thesurgeon, the anesthesiologist,
you know, the consultant, theinternal medicine, the nurse, we
all come together as people,not from our roles, and share.
(37:25):
And at the beginning of thedinner we bring, we turn on a
light like a candle to honorsomeone that we lost.
And it was amazing to me to seea surgeon talk about a patient.
The first thing he did was totalk about a patient.
So it's like, wow, like most ofus, we talk about our parents
(37:50):
or our grandparents, or thatperson brought a patient.
So it was eye opening for mebecause I never saw that part
from him, you know.
So I think it's a way.
And then we have questions.
So while we have dinner weanswer those questions and then
(38:13):
at the end we all do a pause tohonor everybody.
We honor that night and wehonor the teamwork for all these
patients that we were talkingabout at the end.
So we close with a pause.
And this is what is death overdinner for healthcare.
Speaker 1 (38:35):
Wow.
So do you encourage everyone todo this, individually or for
primarily healthcare workers oranyone who's interested in this
process?
Speaker 2 (38:47):
Yes.
So if you put death overdinners, there are many versions
.
So there are death over dinners, even for Jewish people, for
Brazilian people there's one inBrazilian, for Brazilian culture
it's a huge movement therethere's one for families and
friends and then the healthcareone is for healthcare team.
(39:09):
So the questions are kind ofdifferent and at the beginning
you you go and choose things.
You can choose a podcast, youcan choose a reading, and then
at the end brings you questionsthat you're going to use during
the dinner so you can organizeyour own dinner yeah, that is so
important to do.
Speaker 1 (39:28):
Just the other day I just had a wedding anniversary
and so my husband had my weddingrings because I had lost, you
know, one of my side diamondsdoing some heavy work.
So he had it fixed and, youknow, brought it back to me and
I had my granddaughter, artemis,on my lap and I said, oh, one
day you'll probably have some ofthese rings.
(39:50):
Which one would you like?
So she picked the biggest oneand then she said and my little
sister, beatrice, can have thisone.
And I thought, okay, this was agood discussion to start to
have.
And my son said, oh, that's somorbid, you're being so morbid.
It's like no, I mean, mostlikely I'm, I hope to
pre-decease my children andgrandchildren.
(40:13):
Exactly, yes, and I think thatsome people think that they
either don't want to deal withit at all or they only deal with
certain aspects, like when I'llask patients, they'll be.
Oh, yes, I have a lawyer.
I've dealt with all thefinancial stuff and certainly
the financial things are veryimportant.
Having an executor and, youknow, do you need a consult to
(40:35):
your will and are you havingtrust?
I mean.
So certainly all of that'simportant, but I always say well
, we're interested in the healthaspects and how you want to be
cared for.
So it really is a whole, entire, comprehensive process that we
all need to face once you're 18.
Speaker 2 (40:53):
Yeah, and also organ donation right.
I always think I want to die ina way that I can be a donor.
I always say that because fromdeath you give life right.
So part of the discussions, andthat's why the discussion
should be early.
Like you know, anyone can havean accident right, and if you
(41:18):
have an accident you have highlikelihood to be a donor and to
be healthy, to save many livesright Up to eight life we can
save and many, many moreimproving quality of life.
So why we don't talk about thisright?
And then I always say cremation, and then to the Atlantic Ocean
(41:39):
.
But I told them don't go toUruguay, it's too much.
You can go to any part of theAtlantic.
Speaker 1 (41:48):
But it has to be the Atlantic Ocean for you, right,
right now the pacific.
Yes, yeah, I was born in theatlantic you know, but that
whole thing about organ donationand giving life is so important
and um, on our website, umheather mckessa, who runs life
bank, uh, in charge of organdonation, she's done a wonderful
(42:09):
column and she was highlightingto me that the group of
millennial parents many of them,when they're diagnosed and
carrying a baby with a fatalcondition, they don't choose to
terminate the pregnancy.
They carry the pregnancy eventhough they know that the baby
may not have a brain or may havesomething that will not allow
(42:30):
life, but they give life throughorgan donation, because little
babies need organs too.
Speaker 2 (42:38):
Yes, yes, so this was part of my story as an
intensivist.
When I was 24 years old, I wasin the ICU and this patient came
with a procedure in the brainin the right side and she was
fine and she needed the leftside and she said I don't want
(42:59):
to have it, I want to go homeand have Christmas with my
daughter at eight and then Iwill come back next month.
And then what happened?
In January I received her inbrain death because she bled
after the second procedure andback home at that time we have a
document that was pink, sayingthat you wanted to be a donor,
(43:19):
and she had three documentssigned.
So I said, oh my God, this isthe last thing I can do for her
is to make sure she's a donor.
And in that time, donation gavemeaning to death for me as a
24-year-old intensivist at thattime, and since then I've been
(43:41):
involved in organ donation aswell.
So everything dies right andhow we want to live, how we want
to die and what we want to beafter, how we want to do it
right.
Speaker 1 (43:54):
Absolutely so.
You're listening to theSpeaking of Women's Health
podcast and we are talking aboutend-of-life decisions, which
are all part of our missionbeing strong, being healthy and
being in charge, because it isthe circle of life and we're
talking with expert physicianand intensivist anesthesiologist
, dr Sylvia Perez-Prato, and you, dr Perez-Prato, helped create
(44:19):
the PAWS app.
Can you talk to us about howthis app works and how we might
get it?
Speaker 2 (44:27):
Yes.
So the pause was invented byJonathan Bartels in Virginia, in
the University of Virginia.
He was a nurse in the ED andone day he was involved in the
resuscitation of a patient, veryyoung, after a trauma and they
couldn't save him.
(44:48):
And then one started preparingthe body, another started going
to the you know talk to thefamily cleaning up the room and
then he said stop, let's pause.
Let's honor this person, thatwe help him.
We try to help him.
Let's honor he was loved.
He was somebody who lovedothers.
(45:09):
Let's honor he was loved.
He was somebody who lovedothers.
And let's honor us as a teamand the care we provided to him.
And he did a pause and then hesaid thank you, and it was
transformational.
So since then, when we foundout that, because a fellow came
(45:30):
to the clinic and did that andwas amazing for the nurses, so
they came to me and said Sylvia,we need to do this at the
clinic.
So I connected with him andsaid, hey, every time I talk
about the post I will say thatwe didn't invent it, it came
from you.
And then we, as a ClevelandClinic way, we did a pilot.
And then we, as a ClevelandClinic way, we did a pilot, we
(45:56):
got feedback and this, and thatuntil we had a script that is
very, very plain words, becausewe don't want any religion,
anything there.
It's only honor the person,honor the team and stop, as in
community, but in silence.
So each person lives it as theywant, as they feel, but it's in
communities, all together.
So, uh, and then, of course,when you start doing it, you get
(46:19):
used to the words andeverything, but at the beginning
it's hard.
So we wanted to have somethingthat is available.
So we created the pause app andyou can find it is free and we
have the script in many, manylanguages.
So, if their family doesn'tspeak english, yes, so if the
family doesn't speak english, weexplain to them that we are
(46:41):
going to do that and we askpermission and we show the what
we say in their own language.
So they are sure there's noreligion, anything there.
And I have only one family whoasked me not to do that because
they wanted to have their owncelebration.
(47:02):
So our team went to the nurse'sroom and then we did it there
without the patient.
But usually families stay withus, they are with us and they
they love it.
So, um, and it's a way for usto close.
You know that relationship thatsometimes it was very short and
(47:26):
intense and sometimes waslonger.
Speaker 1 (47:29):
Um, but it's a way to do it together and so people
can go on like their appleitunes store and just download
the pause for free.
So it's kind of like a yes,health care focused, team
focused, non-denominationalclosure and certainly that
doesn't preclude other peoplefrom their own religious or
spiritual uh, end life or lastrites, which you know many
(47:54):
people will get as their last.
You know, sacrament, end oflife, and certainly cultures,
religions, ages, backgrounds, Imean, we respect whatever is how
that person and their familywant to mark and celebrate their
death and their life.
Speaker 2 (48:12):
So one of the things interesting that happened
because we did this for the careteam right In the ICU, in the
floor, in the ED, in theemergency room.
But one time somebody from IThad a colleague that died and
they were very unsettled andthis manager brought everybody
(48:39):
together, said hey, let's do apause to honor so-and-so.
And since then it ended uphappening in M&Ms when we
discuss cases, some people say,okay, let's do a pause about the
patient or in quality eventsthey do the pause and then they
end up doing it in the executiveteam and during the pandemic
(49:03):
was quite important becauseexecutive team were more about,
you know, preparing for thesearch.
But every Monday, when theyname everybody that died Friday,
saturday, sunday and they nameall the persons who died in the
(49:23):
enterprise and they do the pause, it was coming to reality that
these numbers were people withnames.
So since then they do it everyday in Huddle 6 executive team
have all the names of the peoplewho died the day before and
they honor everybody with apause.
And the Joint Commission washere and found that as one of
(49:47):
the 10 most impactful changes atthe clinic.
So yes, it's incredible how alittle act can have so much
reach, you know.
Speaker 1 (50:01):
So tell us a little bit about yourself personally,
because you're still full oflife and living life very full.
You're the mom of two daughters, right?
Speaker 2 (50:11):
Yes, I have a 23-year-old and a 12-year-old.
That's quite a span, yes, Well,I had some miscarriages, so
some doctors in your fieldhelped me a lot and I decided
that I will stop studying andgetting bored and I started
(50:33):
dancing flamenco again last yearso I'm very excited.
Speaker 1 (50:36):
That's great.
Yes, you're a dancer and Istarted dancing flamenco again
last year, so I'm very excited.
That's great, yes.
Speaker 2 (50:39):
You're a dancer?
Yes, so there's a group of AbrePaso is the name, and I'm a
board member of thisorganization, non-for-profit to
create community through the artof dancing.
You know, to create communitythrough the art of dancing.
It's Spanish, dancing is verydifficult, so I'm preventing
(51:02):
Alzheimer's, that's true, itdoes help your brain Because you
have to think about it a lot.
Speaker 1 (51:06):
Yes, You'll have to send us some video clips.
So I think it's my name.
Yes, please send me a videoclip of your dance, oh okay.
I'll put it up on our socialmedia on Speaking of Women's
Health, because people canfollow us, not just the podcast.
So if you're listening to thispodcast on any place you listen
to podcasts, just hit follow orsubscribe because it's free.
(51:29):
Oh, that's wonderful, but we'reon Facebook and LinkedIn and
Pinterest and X, which isformerly known as Twitter, so we
can put that up.
I'm sure our followers wouldlove to see you dancing.
That is like so wonderful, andyou've also had leadership roles
.
Speaker 2 (51:48):
I'm not sure I'm ready.
I'm not sure if I'm ready to bein the Just a little clip.
Speaker 1 (51:55):
Just a little clip.
I'm sure you're ready.
I will see.
I will see.
You've also been involved inleadership roles for the Women's
Professional Staff Affairs aswell, so you have the respect of
all your colleagues.
Oh yes.
Speaker 2 (52:10):
Yeah, so well, this is part of my goal of lifting
others while I lead, so I havethe honor to represent the women
professional staff at theclinic.
So, yes, I'm humbled by thatand, yes, it's something that is
important to me to help otherswhile I'm leading.
Speaker 1 (52:35):
Well, we're so proud of you and this has been so
helpful.
In wrap-up, Doctor, any finaltips that people need to keep in
mind, that we all need to keepin mind in terms of planning our
end of life.
Speaker 2 (52:48):
Yeah, I would say that if you live your life at
fullest, we want to live up tothe end at fullest, so we need
to live it in our own terms.
So it's important to sharethose wishes, to think about it,
reflect and then share thatwith our loved ones and with our
(53:09):
care teams so we can have thebest experience at the end the
best experience at the end.
Speaker 1 (53:20):
I was recently visiting the grave site of one
of my friends who sadly gotdementia during the pandemic and
it rapidly progressed and shedied.
And so I was going there and Iran into her husband because it
was the first time he was goingto visit the headstone.
It was beautiful and he wasthere with his sister whose
husband had died.
And they gave some really goodadvice to me and my husband.
(53:43):
They said plan your own funeral, get your own headstone,
because your children willeither spend way too much money
that you wouldn't want yourmoney to have been spent on or
they'll spend way too little.
And I thought okay.
I've got some penny pinchingsons, so that was really good
advice because it made you knowmy husband and I think we need
(54:06):
to plan all this out and pay forit and you know.
So the whole shebang, of course, the healthcare part, and who's
going to speak for you, andwhat are your own personal goals
and what you want done, whatyou don't want done.
That is, like you said, livingto the fullest, to the very end.
But there are factorsafterwards that can make it very
difficult on the loved ones,like if your paperwork is not in
(54:28):
order and you don't have anexecutor and you haven't decided
where you want things to go.
That is so important.
So we're going to putinformation about the pause and
how people can reach you andlinks to your column in our show
notes.
So thank you so much, doctor,for joining us at the end of our
first season about end of life,which is so important to being
(54:51):
strong and being healthy andbeing in charge up to the very
end, and I'd like to thank allof our listeners for joining us,
and if you've enjoyed thispodcast, you can give us a
five-star rating.
Share it with your friends,share it with your family, use
this as a point in time to startto talk about this, and it's
(55:13):
free to subscribe.
And if you want to donate toour nonprofit
speakingofwomenshealthcom, wewould much appreciate it.
And please follow us whereveryou listen to your podcast Apple
Podcasts, google, spotify,iheartradio and I'll look
forward to joining you in theSunflower House next year in
(55:33):
season two.
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