Ep. 45 Dr. Bob Uslander on Crafting a Peaceful Closure to Life's Journey

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Welcome in.

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This is Ron Greenwald, the Ron Greenwald Podcast, and today, as I say, they're all important podcasts because we bring stories of great value, great insights into aging, aging well, aging successfully, aging, aging well, aging successfully.

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But when I do my presentations on senior living and senior health, one thing I always say there's a 100% death rate.

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You're not going to avoid it, and one of the biggest pitfalls in our society is that we don't talk about I don't want to call it a successful passing, but a less stressful passing, I guess amongst the family, Because all too often I see the incredible angst that goes along when watching a loved one pass away.

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It's tragic, it's terrible, and today I am thrilled to have on the show somebody who can address those issues head-on and has done an amazing job to be at the forefront of changing how we view dealing with one's passing.

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Dr Bob Uslander is here with us today.

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Thank you for joining us.

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I'm going to turn it over to you to give us a little bit of your background and how you got into the field we are in today.

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Sounds good.

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Thanks, ron.

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Thanks for having me Thrilled to have you, doc.

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I've enjoyed our collaboration, our relationship, over the years, so I'm very happy to be here and hopefully it'll be insightful in your audience.

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It's going to be very insightful because this is not a topic everybody.

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Stay tuned, people.

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So I'm Bob Uslander.

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I spent the majority of my early career as an emergency physician.

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I trained in emergency medicine in Chicago and I spent time working in emergency rooms in Chicago in different parts of the world.

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I worked on Guam for a few years.

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I settled in a small community up in Northern California where I spent 15 years as an ER doc up there and I dealt with death a lot.

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As you can imagine, in the ER kind 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 focus on prolonging extending life almost at all costs.

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We've done such a good job of treating so many illnesses and keeping people alive longer, but we're not doing a very good job of addressing the needs that come towards the end of life, when things get really complicated.

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I saw a lot of this in the ER.

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It's sort of like a big fishbowl Everything comes down, trickles down, so you really get a firsthand look at all the issues and problems and stresses in the healthcare system.

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About 10 years into my practice I had a good friend of mine die of melanoma and he was 32.

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He had three little boys that were under the age of six and he had a mole removed on his back when he was 27.

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The doctors told him that they got it.

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Everything's great, go on with your life.

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A few years later he had a lump under his armpit and it ended up being metastatic melanoma.

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So as he got sicker over the months, I was his friend, but I also became his doctor and then I kind of became his guide.

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As his health was deteriorating, we brought in the local hospice team and I really had had no exposure to hospice before that.

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But this was my first real connection with hospice and together with the hospice team and Darren and his family and friends, we created this really beautiful end-of-life experience and had these celebrations and these really meaningful moments and at the end, when he actually died, it was incredibly gentle and peaceful.

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We were able to really create this beautiful ending for him and I saw for the first time that death doesn't have to be traumatic.

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It's still tragic, especially when a young person dies and has small children, but it doesn't have to be something that is harrowing and scary.

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It can actually be a beautiful and actually transformational experience.

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After a period of time, I started a house call practice for homebound seniors.

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I was just really drawn in to that world and I started kind of building towards being able to expand my practice and somehow incorporate working with people at end of life and do that in a way that really filled me up.

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I moved to San Diego in 2011 and kind of looking for my next path.

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I was trying to transition out of emergency medicine, which was very stressful, and I really wanted to do something that was going to fill me up and allow me to have more of an impact.

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I just happened to actually, I kind of had a download.

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I had this epiphany one day that I can remember very, very clearly.

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It was very momentous and I just in that moment realized that I'm here to help people die better.

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And I the next day randomly met a hospice nurse and started conversations.

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And then I started working in a palliative care and hospice company in San Diego and I spent two years working in that traditional model.

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So I was going into people's homes and helping to identify their needs and provide this high level of support.

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But I was working within the healthcare system and I saw so many gaps and challenges that still existed, identify some of those gaps.

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I think it's important.

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Well, you know, some of the biggest ones were, for example, when somebody is admitted to hospice, they lose the relationship with the doctors who they've been engaged with, who have been caring for them, sometimes for decades, and they lose the connection with the who have been caring for them, sometimes for decades, and they lose the connection with the specialists who have been helping them along on their journey and they have a whole new team of people and in many cases most cases they never see a doctor again.

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All the care is delivered by nurses and nurse practitioners through hospice care.

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And that's a huge gap not having doctors involved at this really intimate time of life.

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The other huge gap one of the other huge gaps is that the healthcare system doesn't have a mechanism to take care of the families.

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You have these families who are struggling to try to meet the needs of their loved one who's ill and dying and all the stresses that that brings on, and they become extremely overwhelmed and they they don't know where to turn.

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They don't know how to find the right support and the right resources and navigate all the different specialists.

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So families are kind of left out in the cold and it's extremely overwhelming and traumatic for them as things unfold.

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People don't doctors don't talk with people about end of life.

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They don't talk with people about dying.

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It's almost as if, like death doesn't even exist.

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And then when it, when it becomes clear that the person's terminal and nearing death, then they sort of offload them to hospice and and and there's just this sense of like throwing.

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You know throwing in the towel like there's nothing more you can do, and know throwing in the towel like there's nothing more you can do.

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And that's not the case.

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There's so much more you can do.

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One of the things that that people need is to be given choice.

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They need to be on, they need to understand what the reality of their circumstances are and what the options are that are available to them when they're terminally ill and looking at a potentially horrific final stage of life.

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I'm going to the website empoweredendingscom.

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Empoweredendingscom.

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Dr Bar.

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There's so much good information on that website that's so relative relevant, and you used the word choices, and choices is part of that website.

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Define what that means to the audience.

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That's an interesting choices is kind of at the foundation of everything that we do, because we well, we're writing a book and the title of the book is Permission to Choose because we believe.

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You say we, you and Elizabeth was your wife.

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We're writing the book together Because we really believe in freedom of choice and when people are, especially when they're approaching the end of their life, they need to know that they have choices and they need to understand what their options are, that they have choices and they need to understand what their options are.

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So choice is really powerful, but it also is an acronym for the principles that we've built our company on, and what it stands for is.

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C is commitment we're completely committed to serving people and we expect the people that work for us and with us and partner with us to share that level of commitment.

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O is for.

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H is for honesty we approach everything with transparency and honesty and helping people look at things from a very honest perspective, not shying away from the truth.

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O is for ownership taking ownership of our part and allowing the patients and families to take ownership of their part.

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I is imagination we are very creative, thinking outside the box, looking for whatever resources and tools would be valuable to help these people and improve their quality of life and improve the quality of their death.

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Let's see if I can remember.

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C is collaboration, which is unfortunately lacking in health care in most spaces, but collaboration is really critical for doing this effectively.

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E is for empathy, which you need to have to work in this field, and S is for service.

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We are very much coming from a place of service.

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That's one of the things that actually drew Elizabeth and I together is our deep passion for being of service.

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So that's what Choice is.

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Choice is on the website Empowered.

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It's beautiful, thank you.

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It's well done, and one of the questions that Linda, my partner, wanted me to ask of you is in her family, dementia and Alzheimer's has reared its ugly head with the passing of her mom, and it's always the end of.

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What are the end of life care options today in California, or how do you approach that?

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Specifically for people with dementia?

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Yeah well, we don't.

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We can go on to dementia or just in general.

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You hear so much about taking one's own life.

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That's not really what we're about here.

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No, when I.

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One of the things that we do is we have a program where we meet with people, sometimes before they're even diagnosed with any serious illness.

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They're just getting older and they want to understand how to protect themselves.

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They've seen loved ones go through illnesses and in and out of the hospital and have a lot of challenges and they want to make sure that they don't have to go through the same things that their parents went through or other people that they know.

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So people sometimes meet with us just to explore what's possible, how to create a plan that would protect them and create the appropriate documentation that would allow their health care agent power of attorney to act on their behalf in a way that would be consistent with what they want.

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So putting those plans in place is really critically important.

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One of the things that we do is talk about the options that are available for people who are at a point, who have reached a threshold where the quality of their life is no longer adequate because of advanced age, illness, the challenges that come with either aging or illness.

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So the options that we share with people are number one, full steam ahead.

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You know, full-core press.

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Do everything that the doctors tell you to do do everything possible to extend your life at all costs.

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There are some people who want that option.

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They're going to take their doctor's advice, they're going to let them guide things and they will do everything until the bitter end.

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And that's fine, that's their choice.

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Other options are, to, you know, kind of pick and choose to do the things that would allow you to maintain a certain quality of life, potentially improve your, extend your life, but not do things that are going to compromise it too much.

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Another option is to go on comfort care.

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So people who have a terminal illness have the option of going on to hospice and not pushing towards a cure, not doing a lot of aggressive treatment, not going in and out of the hospital.

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But when they make that choice, they're focusing on comfort and they have to be aware of some of the things that they give up.

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So differentiate empowered endings from hospice.

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Well it's there, isn't so.

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So we are not a hospice.

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We take care of people regardless of.

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There's no qualification to come under our care On hospice.

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To get on hospice, somebody needs to have a terminal condition and a life expectancy of less than six months, and that requires that two doctors usually one of the doctors is a treating physician for the patient and one is like a medical director for the hospice those two doctors have to agree that the patient is likely to die or there's a good chance that they'll die within six months if the condition runs its typical course.

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So hospice is an insurance benefit, medicare and insurance and Medi-Cal pay for people to be on hospice care.

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Our services are sometimes in place of hospice.

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Sometimes people want our support, which is physicians and very multidisciplinary, similar to some of what hospice offers, but more personalized, more customized, and we don't have the limitations and constraints that hospice does.

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We have a lot more flexibility with the resources that we bring into the person's life.

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I like to focus on that.

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I in the choices, imagination and thinking outside the box.

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That's where some of the fun stuff comes in.

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So, with that, take a client that you have now change the name as obviously, and take the audience through the initial consultation and what you are now doing on behalf of that client's wishes choices so that their death will be more pleasant Less traumatic Less traumatic Take us through a day of the Dr Bob.

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Okay, so there's such a wide range, I'll pick one patient and I'll call her Shirley.

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So Shirley is 82 years old.

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Several months ago she was diagnosed with lung cancer and it's stage four.

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It's metastatic and she's had significant compromise in her quality of life.

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She's gotten weaker, she's lost weight, she's having some breathing issues, but she's still undergoing treatment.

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Lost weight, she's having some breathing issues, but she's still undergoing treatment.

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And she won't because there is there is, she has enough, you know residual health that she can withstand some of the treatment and the hope is that it will slow down the progression of the cancer.

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This woman, shirley, lives alone and she actually has no family.

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She has a number of friends in the community who are supportive, but she stopped seeing her friends because she felt like she was kind of a drag.

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She didn't have energy.

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The world becomes very small.

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Right and the friends wanted to be helpful, but she was becoming more reclusive and she would have chemotherapy be helpful and but she didn't.

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But she was becoming more reclusive and she was just she would have chemotherapy and then after that she would feel horrible for two weeks and just really dragging.

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And and she a friend, actually a psychiatrist, who was seeing her recommended that she contact us and I went and met with her and we just explored all the different things that she was dealing with and sort of the gaps that she was experiencing.

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And I brought our team together to support her.

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And I have nurses that work with me, I have grief counselors that work with me, I have volunteers that can come and show up and just be a caring and kind presence, help her go out and get her hair done and go shopping.

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And so the team came together and literally after the first week and she was pretty skeptical.

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She was asking, like, what are you going to do for me?

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How does this work and why would I invest my money in paying you?

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And I said, well, just wait and see.

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Just see how things go, and if it's not making a positive difference for you, then you don't need to continue.

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Within a week she was communicating with me and saying my world feels completely different because the nurse showed up and the nurse is just incredibly compassionate and kind and gentle with her.

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And then we just so we had somebody go with her to her appointment with the oncologist and we got a massage therapist to come in and we have music therapists.

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So in addition to the medical care that we provide Human care, we're providing total human care.

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There's we're bringing back sort of the human element and she has been thriving.

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We've been caring for her for a few months now.

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I continue to receive texts that says I'm gardening for the first time in six months and this is, this is my Zen, and she's just she, she's bubbling over.

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The cute thing is she's texting you yeah, oh, yeah, no, she, no, we, she, she, and she's just she, she's bubbling over the cute thing is she's texting you yeah, oh yeah no, she, no we, she, she, and and she's.

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She's communicating with the whole team.

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Her life has been transformed because she has people who are showing up for her and and providing this really comprehensive holistic care on the other.

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So, and so she's, and she's going to go on for as long as she can go on.

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She'll continue to get treatment and once it's clear that the treatment is no longer effective or the burden of the treatment is becoming too great, then we'll take a different approach, but we'll be with her through that and bringing in the appropriate resources that will continue to honor her, empower her and allow her to be in control and make choices.

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On the other side of that, we support people through medical aid in dying, which is the End-of-Life Option Act.

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So when we were talking about the options that we share with people for people who are terminally ill, competent to make decisions it doesn't apply to people with dementia, but when they're competent to make decisions and they have a life expectancy of less than six months, they can go through a process that we support them through to ultimately get access to a prescription for medication that, if they choose to take it, they will go to sleep within four or five minutes and die peacefully, and it's called medical aid in dying and it's a beautiful process for people who are dying and don't want to have to suffer through the final indignities of a terminal illness.

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So we have people who are at the very end stage of pancreatic cancer, lung cancer, als, parkinson's disease, heart failure, who are struggling and suffering and they come to a point where they feel like life is too much of a struggle and they want to accelerate their death and not have to go through that final, bitter end.

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So they can go through this process and we guide them and we counsel them and we support their families and we're with them at the time that they take the medication.

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And it is an incredibly beautiful thing to see somebody allowed to end their struggling, bring their family together, have them around telling stories, telling jokes, and then go to sleep and then go to sleep and the loved ones are.

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The grieving process for those people is so different than the ones who had to watch somebody struggle to the point where they could barely breathe or they were comatose.

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This allows the family to give this gift that gives them the loved one permission.

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You're empowering them.

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Everybody, everybody, and it's not always universally accepted by the families.

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Sometimes there's a lot of counseling that goes into that and support so they understand why their loved one might be making this choice and because we've been through it so many times with so many different people.

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Are you leading that conversation?

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Are you the leader of that conversation?

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Typically yeah, but now we have end-of-life doulas and social workers and other people who are very comfortable and capable of engaging in those conversations as well.

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End-of-life doula.

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End-of-life doula.

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End-of-life doula.

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What, what?

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Take that and roll run with that.

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Well.

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So I remember back in the 70s and 80s when the then when child the birth move, the birthing center movement started and birth midwives and birth doulas were were showing up to getting training and they were helping to sort of demedicalize childbirth.

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Up until that time the only options people had when they were pregnant and going towards delivering were working with an OBGYN, going into the hospital, having all their care done there, delivering in the hospital.

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Well, doulas and midwives and birth centers gave them other options where they could have a more holistic approach.

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They could be the doctors, might still be involved, but more peripherally and only when there's really significant.

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There were challenges.

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But end-of-life doulas are now.

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They're a group of people who are.

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Some of them are like retired or retiring hospice nurses who love caring for people at end-of-life but they don't want to do it through that constraining system.

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Working in hospice has become challenging in many respects and for many people, but they could be nurses and social workers or chaplains or people who have just had a lot of life experience and they go through a training and they learn how to support patients and families through the end-of-life journey.

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They companion them.

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I'm a doula.

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I see myself as a doula Elizabeth, my wife is a doula, and we have other people who are showing up and they're like Sherpas.

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They're like helping people get to the peak and do it in a way that is gentle and empowering.

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So you've been doing this for how many?

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So I?

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started doing palliative care in hospice in 2013.

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And then I started my own practice in 2016.

00:24:23.813 --> 00:24:28.465
So it's been eight years since I've been doing it in the way that I do it now.

00:24:29.297 --> 00:24:30.962
Do you see a greater?

00:24:30.962 --> 00:24:35.336
Was there more resistance eight, ten years ago than it is today?

00:24:35.336 --> 00:24:37.164
Or do you see this more acceptance of?

00:24:37.164 --> 00:24:45.644
Yes, this is a fantastic concept and, in terms of talking about death and dying, Well, I think there's more and more openness to it.

00:24:45.914 --> 00:24:49.125
I think that I see a lot more being written.

00:24:49.125 --> 00:25:04.163
There's movies and documentaries that are popping up, and part of it is that's just the world I live in, so I may be more aware of it, but my sense is there is a lot more attention being placed on these conversations and having the conversations planning.

00:25:04.163 --> 00:25:09.307
There's much more attention now on doing advanced care planning, which is really critical.

00:25:09.307 --> 00:25:19.728
That's one of the biggest gaps that exist is people are not planning ahead and making sure that they're communicating with their loved ones what they would want or not want.

00:25:19.728 --> 00:25:34.903
So we're really heavily focused on getting people to engage with us to do those planning explorations and get those documents in place and get those conversations started and again I'll go into that because again I've lost my parents.

00:25:35.003 --> 00:25:38.957
Linda has lost her parents and they each all went very differently.

00:25:38.957 --> 00:25:40.201
No two are the same.

00:25:40.201 --> 00:25:55.357
But really the whole care process, the whole hospitalization situation, the calling the 911, my dad probably he knew the EMT guys on a very first name basis because they were calling 911 almost every other day for something.

00:25:55.994 --> 00:26:01.895
And you go into the hospital and they do what they do and it just seemed like a train wreck.

00:26:01.895 --> 00:26:14.904
And so, combating that, because the hospital, the doctor is there, I'm going to keep you alive and does all the documentation in the world counteract that?

00:26:14.904 --> 00:26:17.686
Or is it just the doctors and the hospitals are going to do what they're going to?

00:26:17.727 --> 00:26:18.366
do so.

00:26:18.366 --> 00:26:21.528
The documentation doesn't necessarily counteract that.

00:26:21.528 --> 00:26:36.457
The documentation is helpful in that it identifies what people want or don't want and it gives direction to the health care agents who are going to be making decisions when the person can't.

00:26:36.457 --> 00:26:41.121
Until a person loses that capacity, they are advocating for themselves, but they don't know how to advocate for themselves.

00:26:41.121 --> 00:26:44.124
When someone ends up in the hospital, all bets are off.

00:26:44.124 --> 00:26:48.607
They just become the property of the hospital and the system.

00:26:48.607 --> 00:26:50.449
Everybody gets a piece of them.

00:26:50.449 --> 00:27:04.356
All the consultants come in and this isn't universal but it's pretty common, pretty universal.

00:27:04.356 --> 00:27:05.799
And because the hospital there's a number of reasons for that.

00:27:05.799 --> 00:27:06.601
They don't want to miss anything.

00:27:06.601 --> 00:27:10.788
Their focus is on is on extending life, and every test that's done, every consult that's done, somebody's making money.

00:27:10.788 --> 00:27:31.138
And if, if no one is like is kind of stepping in to ask if this makes sense, if it's necessary, it just happens like you get into the hospital and you're sort of on this conveyor belt and and it, just it, it, and then you go home and things, and then there's more complications and it's just a cycle, a vicious cycle.

00:27:31.961 --> 00:27:43.684
One of the things that that we do is we help keep people out of the hospital because instead of calling 911, they can call us, and not in not every situation it's appropriate to call us versus 911.

00:27:43.684 --> 00:27:54.226
If you fall and break a hip or if you're you know cutting your, you know your gushing blood or you know you're having chest pain, and there's a lot of reasons why it makes sense to call a 911.

00:27:54.226 --> 00:28:01.135
But there's there are many times when people end up in the hospital because they couldn't reach a doctor.

00:28:01.135 --> 00:28:09.885
They couldn't get somebody to communicate with them about what's happening and what the options are for providing appropriate care.

00:28:09.885 --> 00:28:12.438
As an ER doctor, I saw that all the time.

00:28:12.578 --> 00:28:20.183
I saw people coming in by ambulance because they couldn't get information that would allow them to feel good about staying home.

00:28:20.183 --> 00:28:32.337
Or they called their doctor and if their doctor was able to respond usually it's somebody on call for their doctor but the knee-jerk reflex is go to the hospital, go to the hospital.

00:28:32.337 --> 00:28:49.650
That's the safest thing to do and we know that when people end up in the hospital it's often not the safest place to be because there's all kinds of errors that happen in the hospital, infections that happen in the hospital, tests that are done that result in more procedures.

00:28:49.650 --> 00:28:56.753
So there needs to be more attention on things further upstream.

00:28:56.753 --> 00:29:01.640
There needs to be more common sense when it comes to addressing these situations.

00:29:01.640 --> 00:29:26.941
There needs to be more engagement and support, which is why we're not only providing the medical care to people, but we're building this educational institute, the Empowered Endings Institute, to teach people about, and to teach and train about, optimal palliative and end-of-life care, so more people have more knowledge and more resources.

00:29:27.321 --> 00:29:32.864
Talk a little bit about the foundation, yeah so the Empowered Endings is a collective.

00:29:33.025 --> 00:29:36.702
We have the medical group that provides care throughout Southern California.

00:29:36.702 --> 00:29:52.546
We have the Institute, the Empowered Endings Institute, which is developing, bringing a community of people together, both healthcare providers and lay people, to have conversations, and we'll be doing monthly webinars and we're starting a podcast soon.

00:29:52.546 --> 00:29:56.070
So there's a lot of education that's coming in and community building.

00:29:56.070 --> 00:30:02.779
And we also have a foundation it's a 501c3, the Empowered Endings Foundation that is devoted.

00:30:02.779 --> 00:30:10.030
The mission is to improve end-of-life care for everybody, so the patients, the families as well as the health care providers.

00:30:10.640 --> 00:30:28.431
The foundation provides financial support for people who need assistance in the final kind of stretch of life, and it could be for medication, it could be to pay other physicians to provide support, it could be for getting caregiving and nursing support.

00:30:28.431 --> 00:30:36.431
We also have bereavement groups, free bereavement groups for people who have supported loved ones through the medical aid in dying process.

00:30:36.431 --> 00:30:54.311
So people anywhere in the country who have supported somebody through that process if they need additional emotional support, they can join these virtual groups free of charge and be part of this community of supportive people, and it's facilitated by our phenomenal grief counselors.

00:30:54.311 --> 00:31:25.147
The other in the fourth element, the fourth pillar of Empowered Endings is a management services organization because we're preparing to expand the medical practice and to try to replicate it, find doctors and doulas and and people who feel similarly about the need to improve end of life care in those communities and we'll be helping to establish practices throughout the country that's where my mind went is can this be duplicated?

00:31:25.188 --> 00:31:45.906
I mean, having done this for the years you're doing it, I have to believe there's a doctor in Chicago that knows of you, sees you, what you're doing and says I want to move in that direction, given I mean any ER doctor of any duration, like you were, has to go there's got to be a better, something like what's next?

00:31:45.987 --> 00:31:46.147
right?

00:31:46.147 --> 00:31:49.769
Some of your doctors can't imagine doing anything different.

00:31:49.769 --> 00:31:56.667
A lot of them get to a point where working nights and weekends and those long, stressful shifts gets a little bit.

00:31:56.667 --> 00:31:57.932
It wears on them.

00:31:57.932 --> 00:32:03.526
So I agree Chicago would be a great place to start a practice, because that's where I'm from.

00:32:03.526 --> 00:32:06.026
And I have a number of really good friends who are there.

00:32:06.426 --> 00:32:07.249
I was just there.

00:32:07.249 --> 00:32:08.192
That's why I'm here.

00:32:09.740 --> 00:32:11.684
Every community needs better end-of-life care.

00:32:11.684 --> 00:32:27.796
So as we develop this and refine it and systematize it, we will be in a position to identify those doctors and other people who want to partner with them, to create a model.

00:32:27.796 --> 00:32:34.579
And it's not rocket science, it's not rocket science.

00:32:34.981 --> 00:32:36.448
You just have to be committed.

00:32:36.448 --> 00:32:41.071
You have to believe in those principles.

00:32:41.071 --> 00:32:44.895
Anyone who believes in the principles that we outlined in that CHOICES acronym would be able to create a practice in their community principles.

00:32:44.895 --> 00:32:53.685
Anyone who believes in the principles that we outlined in that CHOICES acronym would be able to create a practice in their community that would support people in having a better end of life experience.

00:32:54.722 --> 00:33:01.506
And before we sign off, Doc, I want you to talk about music therapy and how that plays such an incredible role in end of life.

00:33:01.506 --> 00:33:03.750
I think it's one of the most beautiful things ever.

00:33:04.941 --> 00:33:18.093
Yeah, well, one of the gaps that speaks to another, one of the gaps that we've identified, which is lack of access to alternative holistic therapies, quality of life enhancing care, music therapy being one of those.

00:33:18.093 --> 00:33:29.123
We also have massage therapists and acupuncturists, and you know sound healing, acupuncturists and you know sound healing.

00:33:29.123 --> 00:33:40.795
But we music therapy is powerful and we have some music therapists who come in and just really help people experience a deeper sense of connection and joy through exploration of music and how it's impacted their life.

00:33:40.795 --> 00:33:43.080
Sometimes they create music together.

00:33:43.080 --> 00:33:54.460
Sometimes the person listens to music, sometimes it's just kind of talking about the concerts they went to when they were younger and the dances that they went to with their spouse.

00:33:54.460 --> 00:34:10.411
It's been shown that when people with dementia are exposed to music and there's been studies that have been shown in documentaries about this it wakes up a part of their brain that has been dormant and it enlivens them.

00:34:10.411 --> 00:34:21.284
So music I have an incredible relationship with music and I know that that's something that has brought incredible joy and connection to a number of the patients that we work with.

00:34:21.304 --> 00:34:21.726
Are you in a band?

00:34:21.726 --> 00:34:22.648
I am not.

00:34:22.648 --> 00:34:23.751
I wish I was.

00:34:23.751 --> 00:34:24.847
I never got.

00:34:24.847 --> 00:34:32.346
I stopped playing piano when I was 13 because I got interested in girls and I you know my parents let me quit.

00:34:32.346 --> 00:34:33.128
I wish they hadn't.

00:34:33.128 --> 00:34:34.271
You know that same story.

00:34:34.271 --> 00:34:38.490
But I love listening to music.

00:34:38.490 --> 00:34:40.804
I, you know.

00:34:40.804 --> 00:34:51.148
Just like I couldn't sleep last night and I just put my headphones on and I just found myself in this beautiful space of peace and comfort just listening to music.

00:34:51.148 --> 00:34:52.492
That's been meaningful throughout my life.

00:34:52.492 --> 00:34:55.367
So we try to expose people to that.

00:34:55.367 --> 00:34:56.690
Some people don't get it.

00:34:56.690 --> 00:35:00.630
They don't understand why we would recommend music therapy.

00:35:00.630 --> 00:35:04.019
And then, once they experience it, then they understand.

00:35:04.019 --> 00:35:05.585
It's like oh, I get it now.

00:35:05.585 --> 00:35:06.889
That's amazing.

00:35:08.201 --> 00:35:15.735
So is there one story that you want to share that just is so transformational in terms of a patient and the family?

00:35:15.735 --> 00:35:20.789
Because that's where I always see it the family is always skeptical.

00:35:20.789 --> 00:35:23.400
I have to believe they're skeptical they're.

00:35:23.400 --> 00:35:24.923
What is this all about?

00:35:24.923 --> 00:35:29.673
And there's just that one transformational story that you look back on and go.

00:35:29.673 --> 00:35:55.626
I mean, I know there's thousands of stories, there's so many, put you on the spot, yeah, but is there one that just always comes up in your mind that goes, wow, that was the most beautiful, transformational, where you went from this very negative family environment to like they can't thank you enough for the way mom or grandma, uh, so that's happened.

00:35:55.646 --> 00:36:09.094
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 because it was so transformational, was a gentleman named Edward who was in his mid-80s.

00:36:09.094 --> 00:36:15.630
He had been diagnosed with colon cancer and he was pretty far along.

00:36:15.630 --> 00:36:23.972
I met him when he was on hospice and he was bedridden and he had a catheter and he was just miserable.

00:36:23.972 --> 00:36:29.403
He was in pain and he had a catheter and he was just miserable.

00:36:29.403 --> 00:36:32.273
He was in pain, just losing weight and basically just laying there waiting to die.

00:36:32.273 --> 00:36:43.570
And the oncologist had stopped treating him because he couldn't tolerate the chemotherapy and they gave him a month or two to live and he didn't accept that and he hadn't seen a doctor.

00:36:43.570 --> 00:36:45.266
He'd been on hospice for a month, hadn't seen a doctor.

00:36:45.266 --> 00:36:52.681
Because He'd been on hospice for a month, hadn't seen a doctor, because doctors don't typically see people on hospice and I was asked to come in and evaluate him.

00:36:52.681 --> 00:36:59.440
He wanted to see if he wanted a relationship with a doctor who could give him more support and guidance.

00:36:59.440 --> 00:37:00.800
But he was on hospice.

00:37:00.800 --> 00:37:05.623
He had a nurse care manager who invited me in to meet with him.

00:37:06.405 --> 00:37:23.016
He had a nurse care manager who invited me in to meet with him and this gentleman he was never married, he was an engineer, he was a very science kind of organized kind of a mind, but he was also very, very isolated and kind of reclusive.

00:37:23.016 --> 00:37:28.164
He was Japanese, he was a Japanese-American, he was in an internment camp during World War II.

00:37:28.164 --> 00:37:42.507
So he was open and I met with him and I started talking about the things that we could provide for him, including my medical oversight, where I pulled some medications away that he'd been taking.

00:37:42.507 --> 00:37:44.351
We brought in a music therapist.

00:37:44.351 --> 00:37:47.648
We brought in a massage therapist, we brought in an acupuncturist.

00:37:47.648 --> 00:37:50.760
At that point we had an art therapist, physical therapy.

00:37:50.760 --> 00:38:00.324
We started bringing people in to just be part of his world and connect with him and touch him and help him move.

00:38:01.085 --> 00:38:12.632
And within a few weeks the catheter was out, he was up, walking, getting dressed, and he lived for a year and a half and he had the most beautiful final year and a half.

00:38:12.632 --> 00:38:27.393
His sister, who lived in the Bay Area, would come down and after a while he was a completely different person and she was incredibly gratified because she didn't know that this was possible.

00:38:27.393 --> 00:38:32.192
She just thought she was going to be losing her brother and was helpless and hopeless.

00:38:32.192 --> 00:38:58.248
And not only did he have this amazing experience, but the connection that he made with every one of my team members was so profound that every time they would go and see him, they would come out glowing and re-energized and inspired, because they saw how powerful their showing up was and he was.

00:38:58.248 --> 00:38:59.871
It was just as beautiful.

00:38:59.871 --> 00:39:01.456
Everybody wins.

00:39:01.456 --> 00:39:03.320
Everybody's a better human.

00:39:03.320 --> 00:39:05.528
For having been part of this experience.

00:39:06.061 --> 00:39:12.342
I think it's so important and you and I have talked about it off air, so to speak, in terms of the coming.

00:39:12.342 --> 00:39:14.289
There is a tsunami already.

00:39:14.289 --> 00:39:54.411
It's not going, it's not coming, it's here and so many people live isolated and if I can encourage anything from family members is to be proactive, because your parents, your grandparents are not going to live forever and if you want to try to have a peaceful ending and then maybe have a peaceful family harmony after your loved one passes, harmony- after your loved one passes, having that, having you there for that final six, whatever it is, whatever, what a couple days.

00:39:54.952 --> 00:40:04.181
I think can bring people to react to a sense of peace amongst themselves so they don't go to war after right.

00:40:04.181 --> 00:40:10.766
That's kind of my big thing is the wars that we see after the patriarch, matriarch had passed away.

00:40:10.766 --> 00:40:19.230
But if there was some peaceful resolution at those final moments, maybe that would dissolve the angst amongst the family.

00:40:19.469 --> 00:40:20.413
And it starts upstream.

00:40:20.413 --> 00:40:26.789
Being able to achieve that peace starts by having those conversations, by getting prepared.

00:40:26.789 --> 00:40:32.771
I like to think about it as like the landing a plane Everybody wants a soft landing.

00:40:32.771 --> 00:40:45.793
We're trying to give people that soft landing, but in order to have that, you need to have an appropriate flight plan, you need to have a landing strip right, you have to have a runway.

00:40:45.793 --> 00:40:51.663
So we help people create the runway and the flight plan.

00:40:51.822 --> 00:40:57.373
I think the individual, the person whose life is coming to an end, is both the plane and the pilot.

00:40:57.373 --> 00:41:06.500
We're the co-pilot and we're the maintenance crew and we're the flight simulator.

00:41:06.500 --> 00:41:14.786
Yeah, but we're helping to put everything in place so that they can have a soft landing, and that's a beautiful thing If we can help people achieve that.

00:41:14.786 --> 00:41:36.184
What it does is it helps prevent the trauma and the angst and the guilt and the regret in the loved ones so that they can go on and have a meaningful life that's not marred by this experience of trauma and wishing they had done things differently, wishing they had done a better job of caring for mom or dad.

00:41:36.284 --> 00:41:39.992
Don't be afraid to have the conversations.

00:41:39.992 --> 00:41:43.302
It's so enlightening, it's so amazing, it's so uplifting.

00:41:43.342 --> 00:41:48.472
In so many ways it's just fantastic, and we're happy to guide that conversation and I think that's….

00:41:48.771 --> 00:41:50.835
EmpoweredEndingscom.

00:41:50.835 --> 00:41:53.320
Exactly Endings with an S EmpoweredEndingscom.

00:41:53.320 --> 00:41:58.331
I can't encourage you enough to go to the website.

00:41:58.331 --> 00:42:00.846
There's a ton of great information.

00:42:01.347 --> 00:42:03.161
More coming all the time, more coming all the time.

00:42:03.201 --> 00:42:11.498
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.

00:42:11.498 --> 00:42:12.199
Yeah, we love to educate.

00:42:12.199 --> 00:42:22.900
Retirement associations abound throughout the nation now, so I encourage everybody to just get you out to listen and understand the options that are available.

00:42:22.900 --> 00:42:29.608
So, dr Bob, I will give you last word as to how you want to sign off today, and I thank you so much for joining us today.

00:42:29.608 --> 00:42:30.824
It's hugely important.

00:42:30.824 --> 00:42:39.010
Hugely important because, again, nobody gets out of here alive, and if we can do it in a peaceful way, so much better.

00:42:39.010 --> 00:42:39.931
So last word.

00:42:41.885 --> 00:42:45.039
Well, we love to help people and provide resources.

00:42:45.039 --> 00:42:55.713
When people call to get information and to learn about the resources, or even just schedule a 10, 15-minute call with me to explore, that thrills us.

00:42:55.713 --> 00:42:58.141
We want people to reach out, we want to be.

00:42:58.141 --> 00:43:09.382
Whether you're going to engage with our services or not, we'd love to be of service and to provide access to the resources that we have and we've accumulated over the years.

00:43:12.389 --> 00:43:19.322
And I want to second that when my partner, Linda's dad was diagnosed back in 2018.

00:43:19.322 --> 00:43:21.967
It's an amazing story.

00:43:21.967 --> 00:43:38.916
He was his caregiver for his wife who battled Alzheimer's for 12 years and then, unfortunately, a year after she passed, he got cancer and went pretty quickly and you were so gracious to reach out to Linda and her family and him and talk about it.

00:43:38.916 --> 00:43:39.338
It was just.

00:43:39.338 --> 00:43:43.226
It really did help quite a bit, so I appreciate that it's a long time.

00:43:43.226 --> 00:43:46.693
Again, a very important podcast.

00:43:46.693 --> 00:43:50.382
Please share this with your family Again.

00:43:50.382 --> 00:43:57.929
Idea get the family together and listen to this podcast and share your thoughts openly, honestly.

00:43:57.929 --> 00:44:00.427
Call Dr Bob for some insights.

00:44:00.427 --> 00:44:04.530
Very, very important topic Please share.

00:44:04.530 --> 00:44:07.467
This is Ron Greenwald, the Ron Greenwald Podcast.

00:44:07.467 --> 00:44:08.510
Have a great day.