Before We Go: Episode Summary – "Grandma Joy"

Released on October 15, 2024

Introduction

In the poignant episode titled "Grandma Joy," Dr. Shoshana Ungerleiter delves deep into her family's emotional journey through illness, loss, and the intricate dynamics that unfold when confronting mortality. This episode offers listeners an intimate look into Shoshana's personal experiences, enriched by conversations with her sister Arielle and insights from medical professionals.

Family Background and Early Memories

Dr. Ungerleiter opens the episode by reminiscing about her childhood, highlighting her father's penchant for documenting every moment on video. She shares tender memories of her sister Arielle, showcasing the closeness and unique bond they share.

Shoshana Ungerleiter [00:10]: "I'm less than a year old in this video and the man holding the camera is my dad."

The siblings reflect on their upbringing as Jewish hippies in Oregon, often feeling isolated in their predominantly non-Jewish schools. This sense of being the "only Jewish kids" laid the foundation for a tightly-knit extended family community.

Arielle [03:24]: "It was very isolating and I don't think I really knew until I was an adult or now, raising my kids with other Jewish kids within their school what it means to have that sense of community."

Grandma Joy's Illness and Passing

The narrative takes a somber turn as Shoshana recounts the diagnosis of her beloved grandmother, Joy. At 13, she grapples with the reality of Grandma Joy's pancreatic cancer, a diagnosis that starkly contrasts with the vibrant, healthy image she held of her grandmother.

Shoshana Ungerleiter [09:56]: "At 13, I remember feeling shocked that such a vibrant, healthy and independent person could be so ill."

Despite the distance, Shoshana and Arielle had cherished summers in Martha's Vineyard and frequent visits during Passover. Grandma Joy's spirited personality left an indelible mark on them, characterized by her sophisticated yet approachable style and zest for life.

Arielle [10:46]: "She would drink a really stiff cocktail and classical music would be playing in the background, which I always thought was so weird."

Grandma Joy's passing had a profound impact on the family, casting a "big cloud" over their lives and setting the stage for subsequent challenges.

Arielle [14:42]: "It really just felt like there was a big cloud over our family. And so it felt like it kind of kicked off a pretty, not so great time in our family's lives."

Father's Cancer Diagnosis and Genetic Testing

A few years after Grandma Joy's death, Shoshana's father, Steven Ungerleiter, was diagnosed with pancreatic cancer—the same ailment that took Grandma Joy's life. This development was especially daunting given the family's genetic predisposition to BRCA mutations, which heightened the risk for both Shoshana and Arielle.

Shoshana Ungerleiter [21:24]: "And I thought there was at least one other first degree relative of his who had a malignancy that could be associated with a genetic predisposition."

Initially hesitant to inform Arielle, Shoshana felt the weight of their father's fear and the looming threat of cancer within the family lineage.

Arielle [17:09]: "I talked to dad, he said, well, we're not exactly sure. Sure what's going on. He kind of wanted to sugarcoat it, I think, for me and probably for himself."

Insights from Medical Oncologist Ari Baron

A pivotal moment in the episode is Shoshana's consultation with Dr. Ari Baron, a medical oncologist and hematologist. Dr. Baron emphasizes the critical importance of BRCA mutation testing, not only for tailored treatment options but also for the broader implications it holds for the entire family.

Shoshana Ungerleiter [22:10]: "I can't give you an exact number, but I'll just say that it's been very difficult to make any advances in the treatment of pancreatic cancer."

Dr. Baron explains how BRCA-positive pancreatic cancers can respond to new targeted therapies, such as PARP inhibitors and immunotherapy, offering extended survival rates and improved quality of life for patients.

Ari Baron [23:21]: "What we're seeing now is that treatment is not based just on the primary site of the cancer, but rather on the genetic mutation profile, including BRCA."

Impact on the Family and Future Implications

The revelation of her father's BRCA mutations necessitated that Shoshana and Arielle undergo genetic testing, unveiling a 50% probability of each sister carrying the mutation. This knowledge empowers them to take proactive measures in managing their health risks and underscores the ripple effect genetic information has on future generations.

Shoshana Ungerleiter [25:20]: "If my father tested positive for a BRCA2 mutation, Ariel and I would each have a 50% chance of testing positive."

Arielle candidly shares her surprise at not having undergone genetic testing earlier, highlighting a common oversight even among those with medical backgrounds.

Arielle [27:04]: "I know."

Conclusion

"Grandma Joy" serves as a heartfelt exploration of family, resilience, and the evolving landscape of medical science in the face of genetic predispositions. Dr. Shoshana Ungerleiter masterfully intertwines personal narratives with professional insights, offering listeners both emotional depth and informative content. The episode underscores the importance of genetic testing, not just for individual health, but for the collective well-being of families navigating similar challenges.

Listeners are left reflecting on their own perceptions of mortality, the bonds that sustain us, and the advancements in medicine that offer new hope in the relentless fight against cancer.

Notable Quotes

• Shoshana Ungerleiter [00:10]: "I'm less than a year old in this video and the man holding the camera is my dad."

• Arielle [03:24]: "It was very isolating and I don't think I really knew until I was an adult or now, raising my kids with other Jewish kids within their school what it means to have that sense of community."

• Shoshana Ungerleiter [09:56]: "At 13, I remember feeling shocked that such a vibrant, healthy and independent person could be so ill."

• Arielle [14:42]: "It really just felt like there was a big cloud over our family. And so it felt like it kind of kicked off a pretty, not so great time in our family's lives."

• Ari Baron [23:21]: "What we're seeing now is that treatment is not based just on the primary site of the cancer, but rather on the genetic mutation profile, including BRCA."

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