Loading summary
Transcript92 lines
- [00:03]
Dr. Shoshana Ungerleiter
By the time my dad got sick, I had already spent years thinking deeply about end of life care. There's a beginning to that story, and it also starts with my father. My dad always joked when we were kids that I would go to medical school, which was very odd because I was terrible at science and math. Like, terrible. But much to my surprise, it turned out that my dad was right. And in 2006, I found myself starting classes as a first year medical student. So tell me who you are and how you know me.
- [00:41]
Cara Lutzi
My name is Cara Lutzi, previously Kara Soy. Which is who I was when I first met you in medical school on our way to becoming physicians. I still remember exactly when I first laid eyes on you.
- [00:54]
Dr. Shoshana Ungerleiter
I think it was the second day of medical school. It was in the basement of one of the science buildings on the campus of Oregon Health and Science University.
- [01:05]
Cara Lutzi
We were on the same cadaver during our anatomy class.
- [01:09]
Dr. Shoshana Ungerleiter
We named her Sally. Eight hours a day, I felt like in this room full of cadavers and learning about muscles and joints and nerves and blood vessels, and it smelled really bad, like formaldehyde.
- [01:25]
Cara Lutzi
We sat together in like the third or fourth row in medical school lectures.
- [01:30]
Dr. Shoshana Ungerleiter
And we became fast friends. Kara and I and our other dear, dear friend Kathy were just this crew. And we figured out a way to kind of make it fun.
- [01:43]
Cara Lutzi
Getting takeout, studying together, hanging out on the weekends.
- [01:47]
Dr. Shoshana Ungerleiter
And then we'd have exams about every two or three weeks that were like, massively important. So we'd be cramming for these tests, taking the tests, and then partying. I remember dance clubs, oh, my God, prominently for some reason.
- [02:02]
Cara Lutzi
And bars, lots of bars, lots of drinking, lots of dancing, late nights, for sure.
- [02:09]
Dr. Shoshana Ungerleiter
For sure. And then Monday would come around and we'd start all over with a new set of things to learn about, kind of wipe the slate clean and move right on. I hated medical school. I really did. The first two years were so intense. They say this, it's like drinking from a fire hose. You just have so much information thrown at you. Things just that you have to memorize that are so complicated. I spent pretty much every day in the library for six hours, in addition to being in class for four hours in the morning. And because I was like, all of us that go into medical school really, really type A and a total perfectionist. Anything below an A was, you know, failure. How would you describe the experience of medical school?
- [03:06]
Cara Lutzi
Totally humbling. I still remember. I remember the dean gave us that talk in the beginning where he said, you guys have all been on this part of the bell curve and that some of you are going to have to realize what it's like to not be in that top tail. I always felt a little bit inferior to everyone else as we were going through med school. I just felt like there were people who were like, they knew what was going on. They knew they were kind of crushing it. They had an understanding even. I mean, I definitely remember you saying something once about the cath lab and I was like, what's a cath lab? I just did not know.
- [03:36]
Dr. Shoshana Ungerleiter
Do you remember learning anything about death and dying or even palliative care in med school?
- [03:44]
Cara Lutzi
I don't. Do you remember, did we have a lot of curriculum in med school?
- [03:47]
Dr. Shoshana Ungerleiter
I mean, I don't remember much. I think we maybe had one lecture, but honestly, it didn't stick with me. It didn't hit home until I was actually a medical resident. After I'd finished medical school and I was taking care of my own patients as a brand new doctor in the ICU when I realized, oh, wow, we do some wild things to keep people alive and they don't understand always what we're doing because we're not explaining it and we're not having these conversations and we really should be. I saw just so much suffering in and around the end of life for my patients, for their families, for the doctors, for the nurses. We weren't really on board with what was going on either, but it wasn't something that was talked about enough. I'm Dr. Shoshana Ungerleiter and this is Before We Go episode 3 Hidden Faults hey there, it's Shoshana. I'd love for you to join me for this year's EndWell forum on November 22nd. It's streaming live and it's free to register. EndWell is a one of a kind gathering that's all about inspiration, connection and finding new ways to live fully, even in the face of life's biggest challenges. This isn't just an event about end of life. It's about affirming what matters most and how we all live. You'll hear from actors, artists, authors, healthcare innovators and spiritual leaders all sharing heartfelt stories and perspectives that lift us up and invite us to rethink how we connect, love and leave a lasting impact. For those who join, this experience is often life changing. Past participants have left inspired with new ideas, deep connections and a sense of purpose that they've carried back into their lives and communities. So if you're looking for something meaningful that reminds you what's possible. Register now for the free livestream@endwellproject.org I'd love for you to be a part of it.
- [06:05]
Ed
This episode is brought to you by Allstate. Some people just know they could save.
- [06:09]
Dr. Shoshana Ungerleiter
Hundreds on car insurance by checking Allstate First.
- [06:12]
Ed
Like, you know to check the date.
- [06:14]
Dr. Shoshana Ungerleiter
Of the big game first before you accidentally buy tickets on your 20th wedding anniversary and have to spend the next 20 years of your marriage making up for it. Yeah, checking first is smart. So check Allstate first for a quote.
- [06:27]
Ed
That could save you hundreds. You're in good hands with Allstate Savings. Vary terms apply.
- [06:31]
Dr. Shoshana Ungerleiter
Allstate Fire and Casualty Insurance Company and affiliates, Northbrook, Illinois. Kara and I happen to choose the same specialty, internal medicine. At the end of medical school, all students send in a list of where we'd like to go for training. Hospitals rank the candidates and the results are announced. On what's called match day.
- [06:56]
Cara Lutzi
They set out your envelope. Enclosed in the envelope is your future. And they're just laying out perfectly neatly on this table. But you can't open it yet. You have to all open it at the same time. And there it is. Your fate.
- [07:07]
Dr. Shoshana Ungerleiter
Cara and I matched at the same place, a small program in San Francisco that took just 14 internal medicine residents from the whole country. So how did you feel when you found out that we'd matched at the same residency?
- [07:21]
Cara Lutzi
I was filled with emotions. I got my number one choice, which is wonderful, but it was bittersweet because I would have also just loved the safety to stay at ohsu. Also really excited to get to move to San Francisco and, you know, be with you.
- [07:35]
Dr. Shoshana Ungerleiter
Before we knew it, Kara and I were settled in in San Francisco, working at a busy urban hospital.
- [07:42]
Cara Lutzi
I definitely always felt like you knew what you were doing, and I did not. Maybe you didn't feel like that.
- [07:48]
Dr. Shoshana Ungerleiter
No, I mean, I definitely did not. Oh, I can tell you this. I did not know what I was doing. In my first few months of taking care of patients in the icu, I was so overwhelmed by how sick people were. All the new medications and machines and procedures I had to learn, I didn't know up from down. I really couldn't make sense of it all and just tried to keep my head above water.
- [08:11]
Cara Lutzi
I was the first one to cry, I think, in our class. It was so scary. I mean, starting on the coronary icu, I remember one of the older residents signing out her team of patients to me, which was huge, terrifying. So sick. One individual had a ventricular assist device, which I didn't even know what that was, but I knew it was probably pretty scary. Like, just. It was just a total fire hose.
- [08:39]
Dr. Shoshana Ungerleiter
That first year of training was so intense, but there was still a little bit of time to live our lives. And about eight months in, Kara was set up on a date by a college friend. That's how she and I both met our future husbands. I met Ed almost the same week, I think, that you and Erin met. Did you know anything about Erin's new roommate? And did you think it'd be a good idea for us to meet?
- [09:05]
Cara Lutzi
Okay, let me tell you when I first met Ed, I met Ed the first night I met Erin. The very first night. It just happened that it was going to be my birthday. And so I ended up inviting Aaron to come out and meet after karaoke, I think, just out at a bar, I want to say. And then Ed came with.
- [09:21]
Dr. Shoshana Ungerleiter
Ed was this guy who was just full of energy and had a million things he wanted to talk to me about. And I found him very annoying. It was a lot.
- [09:35]
Ed
For me. It was great. I was, like, super. I was super into you.
- [09:41]
Dr. Shoshana Ungerleiter
Really?
- [09:42]
Ed
Yeah.
- [09:43]
Dr. Shoshana Ungerleiter
I was tired and wanted to just go home. And so I kind of listened for a while and then said, you know, I gotta go. Here's my phone number. Call me sometime. Bye.
- [09:57]
Ed
I didn't realize that women would give out their phone numbers as charity, but apparently that happens. It happened to me.
- [10:04]
Dr. Shoshana Ungerleiter
He ended up calling me a week later and inviting me over to listen to music with him, a new Radiohead.
- [10:11]
Ed
Album that had come out, which I thought was a really good idea.
- [10:14]
Dr. Shoshana Ungerleiter
He's a musician, among many other things. And I was like, I don't even know what you're talking about. Why would I come over and listen to music with you? No, thank you.
- [10:23]
Cara Lutzi
I remember once after that, I was going somewhere with Aaron, and you said to me something along the lines of, like, is Ed gonna be there? Like, you were, like, joking around, like, oh, Ed. But then everything changed.
- [10:40]
Ed
I was admitted to your hospital with appendicitis.
- [10:45]
Dr. Shoshana Ungerleiter
So Kara texts me one morning, and I'm taking care of patients in the ICU that month. And she says, well, if you're around, if you can pop over to the fifth floor and visit Ed. Do you remember him? He's, you know, Aaron's roommate. So I was like, sure. Sort of knocked on the door, and I was like, hey, do you remember me? Sorry I never called you back, and whatever. And he was charming and funny and sweet, and he was in the hospital for about three Days. Had a successful appendectomy, but I kept going back to visit him and I would, like, bring him food and I don't know, just wanted to keep going back.
- [11:24]
Ed
My first after surgery walk, we took a walk on. Was it five south?
- [11:28]
Dr. Shoshana Ungerleiter
Yep.
- [11:29]
Ed
And I looked out the window, and the hospital is at the top of this hill, and it looks over the Golden Gate Bridge. And there were lenticular clouds forming over the Marin headlands. I'm like, you have to take a picture because you're never going to believe that this happened.
- [11:45]
Dr. Shoshana Ungerleiter
And I was like, how do you know the name of that type of rare cloud? And you said, I'm a member of.
- [11:53]
Ed
The Cloud Appreciation Society.
- [11:57]
Dr. Shoshana Ungerleiter
Yes, you did. And I was like, wow, this guy's a next level nerd. So I thought to myself, what in the world? I don't like this guy. What am I doing? And then I was like, maybe I do like him. And so I texted Kara. I was like, I kind of like Ed. Is that weird?
- [12:18]
Cara Lutzi
And I was like, what? Where did this come from?
- [12:21]
Dr. Shoshana Ungerleiter
And she said, no, I think he's into you. And this is perfect because he's Jewish and you've been wanting to date more Jewish guys.
- [12:30]
Cara Lutzi
And then I think I actually did go to dinner with you guys.
- [12:33]
Dr. Shoshana Ungerleiter
You were on our first date.
- [12:34]
Cara Lutzi
But again, it wasn't like. It wasn't. I mean, I wouldn't say that it was, like, super magical.
- [12:38]
Dr. Shoshana Ungerleiter
I'm not sure it was not super magical. We go to this Vietnamese restaurant in San Francisco, which was delicious, and Ed's like, ordering the appetizers.
- [12:49]
Ed
I thought that I was being chivalrous, and I ordered, like, the pork buns or something. And you're like, oh, I can't eat that. I keep kosher. And I said, okay, I guess we'll have the spring rolls with shrimp. And you're like, what is wrong with you?
- [13:03]
Dr. Shoshana Ungerleiter
And he looked at me kind of blankly and is like, okay, just order whatever you want.
- [13:06]
Ed
I thought you were just being mean to me because I didn't know I wasn't versed in these details.
- [13:12]
Dr. Shoshana Ungerleiter
And Kara says to Ed, so, Ed, do you usually only date Jewish girls? And he says, well, I've dated one before. Why? And she said, because you're Jewish. And he's like, no, I'm not. What are you talking about?
- [13:27]
Cara Lutzi
Is he not Jewish?
- [13:31]
Dr. Shoshana Ungerleiter
Are you serious?
- [13:32]
Cara Lutzi
Yeah, I must have just thought he was Jewish because maybe he looked Jewish to me. I don't know.
- [13:38]
Dr. Shoshana Ungerleiter
Exactly. Ed still looks Jewish. We always say that he's Jewish. Ish.
- [13:47]
Cara Lutzi
I love that.
- [13:50]
Dr. Shoshana Ungerleiter
It took a few more months, but eventually Ed and I figured it all out.
- [13:55]
Ed
Since then, we've just been together. It was the best.
- [14:07]
Dr. Shoshana Ungerleiter
Early in my intern year, which is the first year of medical training, I had an experience that started me thinking about the end of life and what it can look like in a hospital setting. So all the baby intern doctors, the internship, have this required several weeks of night shifts carrying what feels like 20 pagers on your scrub belt loop, but it's probably only three or maybe four. And you basically just have to cover the whole hospital because everyone else has gone home. And this particular night, a nurse called from actually one of the very quiet, more mellow wings of the hospital, and she asked me to come pronounce a patient dead. And I think my face probably turned white because I was totally clueless about how to do that. I was all alone and I literally googled how to pronounce someone dead. So I marched over there, my heart was pounding, and knocked on the door and came into this really quiet room with the lights down low and several family members were sitting in the plastic chairs. It was really calm. This was the hospital room of an older woman who'd been sick for some time. I learned from the nurses that her daughters and her grandchildren had been there every day, brought her her favorite foods, and sat vigil at her bedside. It's always weird to walk into a room where you've never met any of them, you know very little about them besides what's in their medical chart. And then to do something so intimate and personal, to physically touch their loved one who's died, it almost like doesn't make any sense. I looked around to her family and just said, I'm so sorry for your loss. And they kind of look blankly at me like, of course she's gone. There was so much love in that room. And people had brought in plastic bags of food, and I think there was, you know, at some points, music playing in the background. It was just as nice as a hospital based death can be. I have pronounced many, many, many, at least hundreds of other patients. And this one just stands out, maybe because it was the first one, but also because it was just one that I feel like her wishes were really honored, even though I didn't know her. And her family got time that they wanted to say goodbye and be with each other around the end of her life. But soon I started to realize that that calm, peaceful death that I'd witnessed that night wasn't what generally happened in hospitals. And that's what really Started me on the path to reconsidering end of life care. You're listening to before we go. I'm Dr. Shoshana Ungerleiter. We'll be right back. I started seeing this pattern of older patients who were being admitted to the ICU where the sickest of the sick, you know, land. And they were often dealing with a lot of chronic medical problems and then on top of that had cancer or end stage organ disease. By default in the U.S. patients receive aggressive, invasive treatment, no matter how old they are or how sick they are. And even if it may not help them unless they opt out or have someone advocating on their behalf. And I realized that we weren't having conversations with patients and families about what it meant to be this sick, what was going to happen in the icu or what were the possibilities, the range of possibilities and what their prognosis looked like. Even if we weren't sure, of course, we often were just so focused on the minute to minute, hour to hour, day to day, of what's their sodium level today, what is their blood pressure. And instead of taking a big step back and looking at kind of the bigger picture, really important conversations about is this person going to survive this hospitalization and is more treatment better for them. I was seeing it over and over and over where we just weren't having these conversations. Kara saw it too.
- [19:33]
Cara Lutzi
You start to feel like a manager. You're like system by system and you got your problems and you just, you know exactly what you're doing and they've got, you know, they're on this and that for their renal failure and everything down. You got the code status and you're just so organized. I feel like it's easy to get caught up in did I get all the stuff, did I hit all the systems? In a way it's easier to step back and not question the whole thing because everyone's got their little piece of the piece and we're all busy and.
- [19:58]
Dr. Shoshana Ungerleiter
Sometimes what's best for the patient gets lost in all of this. I remember one patient, a man from Russia, he was in his mid-80s and Russian speaking and had been in the hospital so many times over the last probably year. And I'd taken care of him on the general medicine wards. I'd taken care of him in the step down unit from the ICU and in the ICU over and over. He kept getting very aggressive treatment even though he was experiencing multi organ failure. He was just so, so, so sick and so unhappy. That was the thing. You could just see him refusing to eat, saying, I don't want to be here, through the translator. Where is my family? Get me out of here. And that broke my heart.
- [20:51]
Dr. Bapu Jena
We often say that the way in which we are paid in this country is a driver of the kind of care that we provide. You know, the term that people use is fee for service.
- [21:01]
Dr. Shoshana Ungerleiter
That's Dr. Bapu Jena. He's a medical doctor with a PhD in economics who teaches healthcare policy and medicine at Harvard.
- [21:09]
Dr. Bapu Jena
Doctors or hospitals are paid fees for every service that they provide. And their sort of standard rationale is that if you pay someone a fee for everything that they do, they're going to have an incentive to do more. That's sort of a standard thing that people say.
- [21:23]
Dr. Shoshana Ungerleiter
And in the case of end of life care, this is often cited as a driving factor. But Dr. Jenna has a different perspective.
- [21:31]
Dr. Bapu Jena
Just like unpack it a little bit. When a person goes to the emergency department and the emergency room doctor says, I think you should be admitted to the hospital, is that emergency room doctor getting paid any more for that decision? No, they're not getting paid anymore. When the ICU doctor is caring for the patient, is that ICU doctor getting paid each time that person gets intubated, each time that person gets dialysis? No, they're not.
- [21:58]
Dr. Shoshana Ungerleiter
There are exceptions, of course. Surgeons generally do get paid for performing surgeries, and hospitals usually benefit when expensive end of life care is provided to a patient. But Dr. Jenna believes that that has a very limited effect on the type of care that's offered.
- [22:15]
Dr. Bapu Jena
I just think that, like when I was a resident or when I'm in the hospital now thinking about people at the end of life, no one from the hospital is calling me and telling me, papu, you know, maybe, maybe push this person towards the icu. Because, you know, this year has not been a good year for us. It's never happened to me. I've never heard anybody describe that. I think what it is is that even though there's not a financial incentive, a meaningful financial incentive for a decision maker to make the decision that they do, it's functionally the same as saying there's no restraint.
- [22:44]
Dr. Shoshana Ungerleiter
And this is what Dr. Jenna sees as the problem. Without needing to consider costs, doctors might suggest all possible options, even expensive ones with low success rates. This, combined with a cultural reluctance to accept death, leads to a tendency to pursue every possible treatment, no matter the cost, financially and emotionally.
- [23:07]
Dr. Bapu Jena
Because doctors aren't responsible for the costs of the care that they provide, they. They don't have to consider it so much. Right. So if I say to a patient, yeah, look, I think there's a 5% chance, 10% chance that going to the ICU might help your loved one live, you know, a few more weeks, a few more months, potentially. At what quality of life? It's impossible to know. There's a small chance it would be meaningful, but it's a small chance if there's no one there putting the brakes on that decision from sort of a resource allocation perspective, some families will say, well, let's actually. Let's go ahead with it. Let's try it. So I think it's. It's the absence of the restraint, as opposed to a set of positive financial incentives that are driving what we see.
- [23:53]
Dr. Shoshana Ungerleiter
And in Dr. Jenna's view, it's that lack of restraint that results in that pattern. I was seeing in the hospital, where patients with very little quality of life were being subjected to invasive and potentially painful procedures that had very little chance of success. Patients like that elderly Russian man I was telling you about. And just a little note here, if you're squeamish, you may want to skip ahead a minute or so. It was another late evening on the night shift in the ICU when the code blue alarm went off. And we quickly ran to the bedside of this patient. And because he was a full code, which means that he wanted every aggressive measure done to keep him alive, that's what we did. So we took turns giving him chest compressions, which, on his very, very frail body, almost immediately broke his ribs. So with every push on the chest, we could feel his bones grating against each other. We probably spent 30 minutes placing sharp needles into his veins and doing everything we could by giving him medication through IVs and putting a tube down his windpipe to help him breathe. And nothing worked. And I just remember hearing that long beep or the flat line of no heartbeat and looking up at the team and just saying, is it. Is it time? Kara and I weren't together that day, but she experienced this kind of thing, too. Whenever a patient's heart goes into a rhythm that doesn't support the circulation of blood to their body, a full team rushes to that room to perform CPR and other measures designed to get the heart pumping again. It's called a code. What was it like to perform CPR on a very frail or an elderly patient?
- [26:12]
Cara Lutzi
I mean, you feel like, I am hurting this person. That is always crossing your mind, even though, you know, okay, compress the chest to a certain depth so I can help the heart circulate Blood. You're thinking about all the structures in between yourself and that person's heart, including the sternum and the. Where the ribs connect. So while you're doing that, you're thinking, I'm probably inflicting some harm at the same time as trying to save their life.
- [26:39]
Dr. Shoshana Ungerleiter
Yeah. I will never forget what it felt like to crack the ribs and then keep doing cpr. It was just, oof.
- [26:49]
Cara Lutzi
Yeah, well, and then the patient's right there, you know, like their head is just right there by the chest. And so it's like. It's almost like they're not a person, but they are. It's just this horrible dichotomy.
- [26:59]
Dr. Shoshana Ungerleiter
Did you ever question whether all the interventions that were being asked to do were always necessary?
- [27:06]
Cara Lutzi
I think there's. There's so many moments where, I guess, really in a granular level during so many codes, time, you know, time is ticking. You've been, you've been doing this for a while. We're at like 15 minutes now. What. What are we thinking is going to actually happen here? You know, like, at what point are we going to stop? And so there's that kind of immediate situation, and then there's like the more, I guess the longer term situation where you've got a patient who has clearly been frail, maybe they're in and out of the hospital several times, and you're thinking, what is the purpose of this? Why do we need to expend all of this energy and effort and medical expense and emotion for this patient and.
- [27:46]
Dr. Shoshana Ungerleiter
The family that probably has no quality of life. Right.
- [27:49]
Cara Lutzi
Guaranteed? The hospital is not a great place to be.
- [27:55]
Dr. Shoshana Ungerleiter
Before speaking with Dr. Jenna, I hadn't considered an economist's point of view on all of this. And that conversation did add to my understanding of the forces at play. But I don't think a purely economic view can explain everything that's happening. I'm definitely not an economist. So, you know, thinking about it in this context, I think is really, really helpful. And certainly, like you said, every individual is not thinking in terms of dollars and cents when we are making medical decisions and recommendations. But I do think that those incentives, even at the highest level, kind of pervade how medical education is taught and how we think about care. And it plays into this bigger cultural conversation about seeing death as something that, you know, we want to avoid at all cost. And in a lot of ways, I think that's true and important. But I also, maybe, because this is the work that I do, I think that having an acceptance or a relationship with Our own mortality can actually allow us to live better every day. And that while certainly we want to live as long as possible, it's important to think about living as well as possible.
- [29:07]
Dr. Bapu Jena
A lot of people don't give as much thought as they probably should to what to do when, you know, the body starts crumbling, but I think it's important, right? And as providers, we should be trying to make the time with our patients, think about what we're incentivized to do in clinical care. We're not incentivized to have those kinds of discussions with patients. So that is a place where I think that incentives do really matter.
- [29:31]
Dr. Shoshana Ungerleiter
And when you're a brand new doctor, it can be difficult to have these kinds of conversations with patients, even if you want to. The hard thing about being a resident, being a trainee, is that you don't always have the authority to jump into those kinds of conversations. Did you ever push back with, like, attendings as an intern or resident on any of this stuff?
- [29:56]
Cara Lutzi
I did not. I am not a pushback gal, Shosh.
- [30:02]
Dr. Shoshana Ungerleiter
I pushed back, or at least I tried to, but it didn't get me very far. You know, no, we're going to try this treatment next or we're not giving up on him. So it took a while for me to really trust myself and feel like these kinds of conversations were okay to be having. But something happened during my intern year that gave me the confidence and conviction to try. I was in the emergency room, and this patient, who I will call Mr. Jones, came in with his family, and he had lung cancer. His lungs had become full of fluid, which made it really, really hard to breathe. He could barely get out of bed and definitely couldn't walk across the room without collapsing. And I could tell that he was really, really scared. He hadn't been sick very long, and he'd actually had a really healthy life up until that point. This was a different kind of patient experience for me. I don't know what it was, but I think I just had time to sit down and chat with him and to learn a little bit about his life and how connected he was to his family, who all lived nearby. And after reviewing the information and talking to his oncologist on the phone, I told him that I thought his cancer had progressed. We could put him in the icu, put a needle, you know, into his chest to help drain some of that fluid, but it would only temporarily provide relief. He was getting quite sick. He looked at me and tears were welling up in his eyes, and he said, listen, I don't want to be here. I just want to go home. I just want to spend however long I have left with my family. And as nice as this place is, it's not where I want to be. I had a realization then that stuck with me, that focusing on all the details of patient care is absolutely essential and very, very important. But also getting to know patients as people as often as we can is so helpful in providing the best care for them. I was able to get him home the very next day on hospice. Our wonderful social worker and Keith's manager worked miracles to get him out of the hospital that next morning. And I found out that he died a couple of days later in the place that he loved the most, surrounded by his family and peacefully with hospice care. That, I think was a turning point for me, that it was going to be so important for me personally to really embrace these kinds of conversations with patients, even if I got busy, even if it was chaotic. Wherever I was practicing, I knew that for me to feel good about being a doctor and a healer, that this had to happen and that we need to change medicine. I think when you can wrap your head around the fact that doctors still have a place and a role in healing, when cure isn't possible, it's really helpful and it's really empowering. There's always more that we can do. We're just changing our perspective on what care and what treatment is. And so I finished my residency with a determination to change the way that we as doctors talk about illness and the end of life, not just with our patients, but also with their loved ones and with each other. But I wasn't quite sure how to go about it.
- [33:59]
Ed
I remember you having the vision, having the idea, but feeling like you didn't have the qualifications or that there was some secret that like some. Some list of things you needed to know and you didn't know what they were, so you couldn't do it. And I really just remember being like, you can absolutely do this.
- [34:19]
Dr. Shoshana Ungerleiter
That's next time on Before We Go. Before We Go is a production of Podcast Nation and Me. Our production team includes Karen Given, Abby Williams, and Madison Britt. Our story editor is Laci Roberts. Original music by Edward Ayton. I'm Dr. Shoshana Ungerleiter. If you like what you've heard, please tell a friend. You can also leave us a review on your favorite podcast app. It helps people who need us find the show. And if you'd like to see photos and videos and connect with other before we go, listeners. Visit us on Instagram before we go podcast.