Podcast Summary: Before We Go

Episode: Daughter, Doctor, Patient – November 19, 2024

Host: Dr. Shoshana Ungerleider
Producer: Podcast Nation

Brief Overview

In this deeply personal and insightful episode, Dr. Shoshana Ungerleider shares her dual journey as a physician and a daughter when her father, Steven, is diagnosed with terminal cancer. Forced to confront both her family's intertwined medical risks (BRCA mutation) and her own vulnerability, Shoshana explains how navigating her father's care while making major preventative health decisions of her own leads to unexpected struggles, lessons, and moments of self-discovery. The conversation features anecdotes from her husband Ed, her sister Ariel, and menopause expert Dr. Mary Claire Haver, giving voice to the complexities of caregiving, boundaries, surgical menopause, and the gaps in health education for women.

Key Discussion Points & Insights

San Francisco, Roots, and Community Care ([00:10]–[03:11])

• Ed’s Love for San Francisco:

  • Ed humorously professes his love for San Francisco's weather and the Golden Gate Bridge, even joking about pitching a 100-part podcast on the bridge ([00:15]).
  • During the pandemic, he hosted “sunset sets” – online DJ parties – to lift spirits, showing creativity and deep community ties ([00:36]).
  • "I love the Golden Gate Bridge. I love looking at it." – Ed ([00:27])
  • These sets included costumes, multiple cameras, and the now-famous “zucchini cam” ([01:27]).
  • "I went hard. I did it. I did not. Halfway. I went all the way." – Ed ([02:09])

• Sacrifice for Family:

  • Shoshana asks Ed to move from beloved San Francisco to Healdsburg to care for her father, setting up the episode's central challenge ([02:54]).
  • Ed’s reluctance is real: “We live in my favorite house on my favorite street … It was hard for me to reconcile your clarity of view … with how I felt about it.” ([04:01])

Caregiver Story: Love, Loss, and Shifting Roles ([03:12]–[07:25])

• The Move to Healdsburg:

  • Ed and Shoshana move repeatedly, staying in Airbnbs before settling in to support her father’s care ([03:22]).
  • Their friend Tracy offers a heartfelt perspective: “The number one thing Ed loves is you.” – Tracy ([04:43])

• Juggling Roles:

  • Shoshana describes the stress of being both a daughter and a doctor, foreshadowing her eventual need to set boundaries to protect her own health and emotional wellness.

Facing Genetic Risk & Medical Complexity ([07:25]–[12:03])

• BRCA Mutation and Hope:

  • The BRCA mutation in her father's cancer creates hope for new therapies, but also brings fear for Shoshana and her sister’s own health ([07:25]).

• Father–Daughter Dynamics:

  • Her father’s neediness as a patient is draining:
    • “He would call you to try to get a second opinion or maybe you were the third opinion.” – Ed ([07:31])
    • “He wanted to call me every day and tell me about his bowel movements.” – Shoshana ([08:22])
  • This leads to a boundary crisis, with Shoshana realizing that over-involvement confuses care and increases her stress.

• Drawing Boundaries:

  • Aunt Jeannie’s advice—to be a daughter, not a doctor—hits home:
    • “Jeannie was very clear that, like, it's inappropriate and it is okay for you to draw a boundary around him and his medical care … make the space or take the space to do what you need to do for you.” – Ed relaying Jeannie’s words ([10:11])

The Emotional Journey of Preventative Surgery ([12:03]–[19:32])

• Facing Surgery:

  • Despite feeling overwhelmed and guilty prioritizing herself, Shoshana decides on a laparoscopic hysterectomy and bilateral oophorectomy ([12:06]).
  • She shares voice memos of gratitude, anxiety and fear leading up to surgery – authentic moments about medical decision-making, patient vulnerability, and uncertainty.
    • “I feel so grateful that I can do something to lower my risk… but I just feel like it's a lot.” – Shoshana ([13:41])
    • “Waiting rooms just feel really heavy… I've talked to people in them as a doctor, but I haven't waited in one as a patient…” – Shoshana ([16:46])

• Surgical Menopause:

  • After surgery, Shoshana describes sudden surgical menopause, including debilitating hot flashes and night sweats.
    • “It meant that over just a week or two, my body had undergone a change that usually takes a decade or more.” – Shoshana ([17:12])
    • Humorous coping: "I would put ice packs, like, in the back of my pants." – Shoshana ([18:10])

• Normalizing Menopause:

  • Shoshana makes menopause visible, including anecdotes like asking a waiter for ice at a fancy dinner ([18:50]).

Sisterhood and Shared Experiences ([19:32]–[21:25])

• Ariel’s Story:
  • Ariel, Shoshana’s sister, shares her own experience with surgical menopause post-BRCA surgery.
    • “No one told me… I was gonna immediately turn into a psychopath of, like, crazy hot flashes and mood swings…” – Ariel ([19:33])
  • Ariel connects her menopausal grief with her sadness about their father's decline.

The Confusion Around Menopause Care ([21:25]–[32:14])

• Expert Insights: Dr. Mary Claire Haver

  • Dr. Haver, OB-GYN and menopause specialist, explains the drastic lack of education in medicine about menopause, validating Shoshana’s confusion ([22:09]–[24:58]).
    • “In medical school, I maybe got one hour, one lecture on menopause… in residency, maybe five or six hours out of a four-year curriculum…” – Dr. Haver ([24:24])
  • She addresses how surgical menopause brings higher risks and how HRT advice is inconsistent and often fear-based.
    • “You should be allowed a modern approach … a true buffet of your options…” – Dr. Haver ([23:27])
    • “Surgical menopause is so much more devastating than natural menopause…” – Dr. Haver ([21:35])

• Misconceptions from the Women’s Health Initiative (WHI):

  • Shoshana describes how the WHI led to HRT fear, media misrepresentation, and decades of confusion ([29:04]–[30:36]).
    • “The study’s results, based on older women, were incorrectly generalized to younger women starting HRT in their 50s…” – Shoshana ([29:45])

• Personal Resolution:

  • After much deliberation, Shoshana begins HRT and finds dramatic symptom relief ([30:36]).
  • “Within about 10 days, the hot flashes completely stopped. I felt totally normal.” – Shoshana ([30:36])
  • She reminds listeners to consult personal medical professionals for individualized advice.

Second Surgery & Unbreakable Caregiving Bonds ([32:14]–[36:44])

• Double Mastectomy Decision:

  • The breast surgery is significantly harder, emotionally and physically, especially with her father deteriorating ([31:16]–[32:14]).
    • “It felt really selfish… but while I was in the hospital, my dad had a problem I couldn’t delegate to someone else.” – Shoshana ([31:55])

• Family Crisis:

  • Shoshana, still in pain post-surgery, is thrust back into action when her father’s insurance denies his crucial cancer medication ([32:14]).
    • “You were on the phone screaming… you never cry… something very bad was going on.” – Ed ([32:14])
    • The urgency and helplessness are palpable as she mobilizes all connections, even contacting the CEO of the insurance company.
    • “I couldn’t escape the responsibility that I felt for my dad's well being.” – Shoshana ([33:14])

• Recovery Realities:

  • The practical and emotional challenges of healing (pain, movement limitations, surgical scars) are discussed openly ([34:00]–[36:32]).

Return to Strength and Forward Momentum ([36:32]–[37:08])

• Resilience Through Routine:

  • Shoshana’s relentless drive to regain her physical capability (jogging, exercise) and the power it gave her during an uncertain period.
    • “Maybe I should be glad that she waited four weeks.” – Ed ([36:32])

• Foreshadowing the Next Chapter:

  • The episode closes with her father’s worsening condition and the challenges ahead ([36:44]).
    • “I was about to need all that strength because my dad was about to get really, really sick.” – Shoshana ([36:44])

Notable Quotes & Memorable Moments

| Timestamp | Quote | Speaker | |-----------|-----------------------------------------------------------------------------------------------------------------------------------|----------------------| | 00:27 | "I love the Golden Gate Bridge. I love looking at it." | Ed | | 02:09 | "I went hard. I did it. I did not. Halfway. I went all the way." | Ed | | 04:43 | "The number one thing Ed loves is you." | Tracy | | 08:22 | "He wanted to call me every day and tell me about his bowel movements." | Shoshana | | 10:11 | "It's inappropriate and it is okay for you to draw a boundary…you are his daughter and not his doctor." | Ed, relaying Jeannie | | 13:41 | "I feel so grateful that I can do something to lower my risk … but I just feel like it's a lot." | Shoshana | | 16:46 | "Waiting rooms just feel really heavy … I've talked to people in them as a doctor, but I haven't waited in one as a patient…" | Shoshana | | 17:12 | "…Over just a week or two, my body had undergone a change that usually takes a decade or more." | Shoshana | | 19:33 | "No one told me… I was gonna immediately turn into a psychopath of, like, crazy hot flashes and mood swings…" | Ariel | | 21:35 | "Surgical menopause is so much more devastating than natural menopause for so many women." | Dr. Haver | | 24:24 | "In medical school, I maybe got one hour, one lecture on menopause… in residency, maybe five or six hours out of a four-year curriculum." | Dr. Haver | | 29:45 | "The study’s results, based on older women, were incorrectly generalized to younger women starting HRT in their 50s…" | Shoshana | | 30:36 | "Within about 10 days, the hot flashes completely stopped. I felt totally normal." | Shoshana | | 32:14 | "You were on the phone screaming… you never cry… something very bad was going on." | Ed | | 33:14 | "I couldn’t escape the responsibility that I felt for my dad's well being." | Shoshana |

Important Segment Timestamps

• San Francisco and Sunset Sets: [00:10]–[03:12]
• Moving to Healdsburg for Family Care: [03:12]–[04:35]
• Ed’s Perspective on Family Sacrifice: [04:36]–[07:25]
• Boundary-Setting in Caregiving: [07:31]–[12:03]
• Preparing for and Undergoing Preventative Surgery: [12:03]–[19:32]
• Ariel’s Experience and Comparing Notes on Menopause: [19:32]–[21:25]
• Medical Confusion: HRT, Expert Advice: [21:25]–[32:14]
• Double Mastectomy, Crisis During Recovery: [32:14]–[36:44]
• Physical and Emotional Recovery: [34:00]–[36:32]
• Looking Ahead, Father’s Decline: [36:44]–[37:08]

Tone and Style

The conversation is warm, candid, and at times humorously self-deprecating, but remains direct and unflinching in facing medical and emotional hardships. The inclusion of real-time voice memos and family banter with Ed, as well as expert opinion, adds a feeling of intimacy but also authority.

Final Thoughts

Daughter, Doctor, Patient offers an honest portrayal of how expert knowledge can’t always shield one from the pain and ambiguity of illness, caregiving, and personal vulnerability. It explores the deep intersections of family, identity, and medicine, brings forward the too-often overlooked perils of surgical menopause and the failures of women’s health education, and underlines the relentless, messy hope at the core of family caregiving.

Listeners walk away both better informed and genuinely moved, empowered to ask better questions, set boundaries, and seek the support they deserve at any stage of life.