Before We Go: Episode 7 – Quality of Life
Release Date: November 26, 2024
Introduction
In this poignant episode of Before We Go, hosted by Dr. Shoshana Ungerleider, listeners are taken on a deeply personal journey through her father's battle with terminal pancreatic cancer. The episode, titled “Quality of Life,” delves into the complexities of facing mortality, the impact of genetic mutations, the challenges of maintaining quality of life during severe illness, and the invaluable role of palliative care. Through heartfelt discussions, expert insights, and memorable anecdotes, Shoshana and her family share their experiences of love, resilience, and the search for meaning in the face of life’s greatest challenges.
Diagnosis and Initial Treatment
The journey begins in the summer of 2022, when Shoshana’s father, Steven Ungerleider, is diagnosed with a BRCA genetic mutation-linked pancreatic cancer. This mutation offered a glimmer of hope through targeted therapies but also posed a genetic risk to Shoshana and her sister.
Notable Quote:
Dr. Shoshana Ungerleiter (00:31): “When my dad tested positive for a BRCA mutation, it meant that he was eligible for new targeted treatment that had the potential to extend his life for months, maybe even years.”
Steven bravely underwent traditional IV chemotherapy, a grueling process that took a significant toll on his health and spirit. Despite his initial larger-than-life personality and love for adventure, Steven’s diagnosis led him to retreat from his usual vibrant activities, highlighting the profound psychological impact of a terminal illness.
Emotional Journey and Coping Mechanisms
As Steven’s treatment progressed, the family grappled with the emotional weight of his condition. Shoshana describes how her father, previously an avid traveler and thrill-seeker who even learned to fly helicopters in his 70s, became withdrawn and hesitant to engage with others.
Notable Quote:
Esteban (01:04): “Your dad retreated and hid like a dog hearing fireworks. He didn't want people to visit. He didn't want to tell anyone. I don't know if he was ashamed or if he was scared, but he was so overwhelmed by it that I think he didn't want to see people, to confront it or talk about it.”
Shoshana and her brother Esteban struggled to balance their father’s bravery in facing treatment with their own fears and frustrations over his withdrawal and declining morale. They encouraged him to continue treatment, holding onto hope for his extended life and the possibility of seeing his grandchildren grow.
Role of Palliative Care
A turning point in their journey was the introduction of Dr. Mindy Shapiro, a retired physician and palliative care specialist. Dr. Shapiro played a crucial role in managing Steven’s care, emphasizing comfort and quality of life over aggressive treatment.
Notable Quote:
Dr. Mindy Shapiro (09:20): “He was so vibrant and he so liked living. Yet the other half of him knew that his time was limited. And he really wanted to discuss how he could be as vibrant as he was for as long as possible. That was what was really important to him.”
Dr. Shapiro’s approach provided Steven with a sense of autonomy and peace, allowing him to make informed decisions about his care. She highlighted the distinction between palliative care and hospice, explaining that palliative care is available at any stage of illness and focuses on improving quality of life for both patients and their families.
Notable Quote:
Dr. Mindy Shapiro (13:01): “Hospice is strictly defined as care for patients who are thought to have a lifespan of six months or less. Palliative care is for anybody at any phase in their illness.”
Challenges with Depression and Mental Health
Despite the support from palliative care, Steven struggled with depression and a diminished appetite—a common plight among pancreatic cancer patients. The family faced significant challenges in addressing his mental health needs, often feeling that the medical system dismissed his depression as a simple byproduct of his illness.
Notable Quote:
Esteban (24:35): “He was depressed and common with pancreatic cancer. So that was really, really complicated. But I also feel like maybe his doctors weren't taking that as seriously as they should have.”
This struggle was compounded by societal stigmas, particularly around older white men with financial resources, who may not have developed the resilience required to face such adversity. The family's efforts to implement strategies from Steven’s own work in sports psychology, such as positive imagery and mental training, proved insufficient as Steven increasingly withdrew from their support.
Transition to Hospice and Final Moments
After months of chemotherapy and the introduction of targeted therapies like PARP inhibitors and immunotherapy, Steven’s condition ultimately worsened. With declining health and diminishing treatment efficacy, the family made the difficult decision to transition him to hospice care.
Notable Quote:
Ed (32:49): “He was not happy. And it didn't seem like there was a path for him to get better.”
This transition brought a sense of relief and acceptance, allowing Steven to focus on comfort rather than endless treatment. The final weeks were marked by meaningful moments of joy and connection, underscored by humorous and tender interactions that highlighted the enduring bonds of family.
Notable Quote:
Dr. Shoshana Ungerleiter (35:12): “Looking back, I reminded that even in the hardest times, there can be joy.”
Insights and Conclusions
“Quality of Life” offers a raw and authentic exploration of the multifaceted challenges faced by families dealing with terminal illness. Dr. Ungerleider’s narrative underscores the importance of palliative care in providing holistic support, addressing not just physical symptoms but also emotional and psychological needs. The episode highlights the delicate balance between hope and acceptance, illustrating how families can find moments of peace and happiness even amidst profound sorrow.
Notable Quote:
Dr. Mindy Shapiro (17:45): “It's an intimate, trusting relationship that really shouldn't span just a place. People are in your life for a reason, a season or a lifetime.”
Through candid conversations and expert insights, listeners gain a deeper understanding of what it means to navigate the end of life with dignity, compassion, and resilience. Before We Go not only honors Shoshana’s father’s legacy but also serves as a guide for others facing similar journeys, emphasizing that quality of life remains paramount even in the face of inevitable loss.
Conclusion
In this deeply moving episode, Before We Go captures the essence of what it means to live fully while preparing for the end of life. By sharing their personal story, Dr. Shoshana Ungerleider and her family offer invaluable lessons on love, loss, and the importance of quality over quantity in the time we have. This episode is a testament to the human spirit’s capacity to find meaning and joy amidst life’s most challenging moments.
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