Podcast Summary: "Before We Go" Episode – "Hidden Faults"

Introduction

In the episode titled "Hidden Faults," released on October 22, 2024, Before We Go delves deep into the intricate and emotionally charged journey of Dr. Shoshana Ungerleiter. As a physician, science journalist, and founder of End Well, Dr. Ungerleiter shares her personal experiences and professional insights into end-of-life care, shedding light on the complexities of mortality both in her family and professional life.

Medical School Beginnings

Dr. Ungerleiter reminisces about her unexpected path into medicine, attributing it to her father's early encouragement despite her struggles with science and math.

Dr. Shoshana Ungerleiter [00:02]: "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."

She recounts forming close friendships during her medical training, particularly with Cara Lutzi, highlighting the camaraderie and challenges faced during those intense years.

Dr. Ungerleiter [02:08]: "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."

Residency and ICU Experiences

Post-medical school, Dr. Ungerleiter and Cara matched into the same internal medicine residency program in San Francisco, a decision filled with mixed emotions and uncertainties.

Cara Lutzi [07:07]: "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."

Their initial days in the ICU were overwhelming, grappling with the harsh realities of patient care and the emotional toll it takes.

Dr. Ungerleiter [08:10]: "I really couldn't make sense of it all and just tried to keep my head above water."

The Hidden Costs of Aggressive Treatment

A pivotal moment in the episode focuses on the systemic issues within the U.S. healthcare system, particularly the tendency to pursue aggressive treatments regardless of their efficacy or the patient's quality of life. Dr. Ungerleiter illustrates this with the heartbreaking story of an elderly Russian man receiving invasive treatments despite declining health.

Dr. Ungerleiter [20:50]: "There was so much love in that room. It was just as nice as a hospital based death can be."

Insights from Healthcare Economics

Dr. Ungerleiter engages in a thought-provoking discussion with Dr. Bapu Jena, a medical doctor and healthcare policy expert, about the financial incentives in healthcare and their impact on end-of-life care decisions.

Dr. Bapu Jena [21:22]: "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."

Dr. Jena challenges the conventional belief that fee-for-service models drive unnecessary treatments, suggesting instead that the absence of financial restraints leads to a lack of necessary limitations.

Dr. Bapu Jena [23:07]: "Because doctors aren't responsible for the costs of the care that they provide, they don't have to consider it so much."

Personal Reflections and Turning Points

A significant turning point for Dr. Ungerleiter was her interaction with a patient named Mr. Jones, which solidified her resolve to advocate for better end-of-life conversations and care.

Dr. Ungerleiter [30:01]: "But something happened during my intern year that gave me the confidence and conviction to try. I was in the emergency room... and 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."

Her reflections emphasize the importance of understanding patients as individuals and prioritizing quality of life over mere extension of it.

Conclusion

"Hidden Faults" offers a profound exploration of the often-overlooked aspects of end-of-life care within the medical system. Through Dr. Ungerleiter's personal narratives and expert conversations, listeners gain a deeper understanding of the emotional and systemic challenges in providing compassionate and meaningful care at life's end.

Notable Quotes

• Dr. Ungerleiter [00:02]: "By the time my dad got sick, I had already spent years thinking deeply about end of life care."

• Cara Lutzi [07:07]: "They set out your envelope. Enclosed in the envelope is your future."

• Dr. Bapu Jena [21:22]: "I think what it is is that even though there's not a financial incentive, it's functionally the same as saying there's no restraint."

• Dr. Ungerleiter [30:01]: "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."

Engage with the Community

Join the conversation and connect with other listeners on Instagram @beforewegopodcast. Share your thoughts and experiences related to the episode's themes of love, loss, and finding meaning in the face of mortality.