Podcast Summary: Before We Go

Episode 8: "You Think You Have Time"

Host: Dr. Shoshana Ungerleider
Date: December 3, 2024

Overview

In this deeply personal and emotionally charged episode, Dr. Shoshana Ungerleider narrates the final days of her father's life, illuminating not just the medical, but also the emotional, spiritual, and logistical complexities of dying at home. Through candid conversations with her partner Ed, her sister Ariel, Rabbi Steve Finley, and hospice nurse Steve Einstein, Shoshana explores the realities of hospice care, family togetherness, rituals of farewell, and the messiness, beauty, and regrets that surface when time becomes short.

Key Discussion Points & Insights

1. The Transformation of Hospice Care

(00:03 - 01:33)

• Hospice Decision: After Shoshana’s father transitioned to hospice, "a lot of things changed for the better." Joy, humor, and meaningful connections returned, highlighting how hospice can bring comfort and togetherness amid decline.
• Family Time: Ed and Ariel recount music sessions, laughter, and old friends visiting.
  • Quote: “He'd lay down to take a nap and ask me to play him music while he was going to sleep.” – Ed (00:29)
• Connection: Friends and family sent video messages; these made her father “laugh and sometimes cry” (02:08), reflecting deep bittersweetness.

2. Signs and Mysteries in the Last Days

(02:37 - 04:12)

• Visions Before Death: Ariel recalls her father’s vivid descriptions of “the train station” and seeing faces not present—a phenomenon Shoshana notes as “pretty interesting but well documented.”
  • Quote: “He would say things like, they're all here. I see the pictures. Are you getting on the train?” – Ariel (02:37)
• Peacefulness: Despite the mysticism, Ariel found these visions comforting, a sign that her father was “getting more comfortable with the idea of dying.” (03:45)

3. The Unpredictable Pace of Decline

(04:12 - 04:50)

• The end comes suddenly. The family, though experienced and well-prepared, is still caught off-guard by the rapid decline.
  • Quote: “We were obviously prepared for the end, but not prepared that day.” – Shoshana (04:50)

4. Preparing Practically and Spiritually

(05:44 - 11:19)

• Advance Directives: Shoshana’s father had detailed his end-of-life preferences years before, smoothing some logistical aspects.
• Green Burial & Legacy: Family discussions were held about burial location, environmental considerations, and what mattered most for ongoing connection.
  • Quote: “I want people to come see me.” – Shoshana’s father, relayed by Ariel (06:53)
• Missed Opportunities: Shoshana wishes they’d involved a death doula to supplement what hospice couldn’t provide (07:53).
• Hospice Limitations: Ariel felt unprepared for hands-on caregiving; the reality at home is more daunting than expected—even for an experienced physician (09:52-10:20).
  • Quote: “Even I did [call the nurse advice line]. And I am an expert. The experience is really, really hard.” – Shoshana (10:20)

5. Spiritual Support and Ritual

(10:52 - 14:46)

• Even without a religious background, Shoshana’s father requested to see Rabbi Steve, exploring deep questions about life and death.
  • Quote: “We have human instincts that we really can't explain, and sometimes we just have a need.” – Rabbi Steve (12:27)
• Their conversations ranged from normal topics to meaningful discussions about spirituality, God, and the afterlife.

6. Witnessing and Supporting the Dying

(15:34 - 20:03)

• The Death Rattle: The family is unsettled by the physical signs of dying, including the "death rattle." Despite medical knowledge, emotional reassurance was needed.
  • Quote: “It can feel like the scariest thing you've ever heard. It doesn't mean the person is in distress.” – Shoshana (16:43)
• Musical Farewells: Ed played piano at the bedside in the final hours, recording the last song—a gesture both loving and difficult to revisit.
  • Quote: "I just kind of like, improvised peaceful music that I would hope if he heard it, would help him feel calm." – Ed (19:03)

7. The Moment of Passing

(20:03 - 23:36)

• In the rain and darkness, surrounded by love, Shoshana’s father died quietly, family by his side. There is an awareness of the ambiguity and slowness of the moment—a stark contrast to TV depictions.
  • Quote: “On TV, they really make it seem like there's this, like, really clear line between alive and dead… I don't know when he left.” – Ed (22:53)

8. Ritual, Closure, and Hospice Wisdom

(24:33 - 34:26)

• Hospice Rituals: Hospice nurse Steve Einstein led the family through Jewish rituals, washing, and prayers—offering guidance that felt essential and personal.
  • Quote: “I kind of think of myself as a secular Hevra Kadisha.” – Steve Einstein (25:56)
  • Quote: “It was almost like he was a hospice nurse rabbi.” – Shoshana (25:46)
• Personal Touches: Steve gathered a flower for each loved one named, placing them on the body as a symbolic farewell.
  • Quote: "Then I like going outside and picking that number of flowers for somebody and lying those flowers on the patient's body... I want some kind of symbolic representation of all these other key people in somebody's life." – Steve Einstein (31:37)
• These rituals mattered:
  • Quote: "This flower's tribute, this ritual, this was really meaningful for me... I'm just so grateful to you for bringing that to us." – Ed (32:56)
• Steve also reflects on the differences between families and the universal dignity owed to the dying, no matter their circumstance.
  • Quote: “People die in all kinds of different ways, and we need to be equally respectful.” – Steve Einstein (34:26)

9. Aftermath, Guilt, and Regret

(36:08 - 40:35)

• Many, including Joanna and even Shoshana, questioned whether administering morphine hastened death—an extremely common form of guilt.
  • Quote: "I was the one that gave my dad what would be the final dose... Of course not. But that's how natural and human it is to ask those questions." – Shoshana (38:23)
• Reflections on Choice: Ed has “no regrets.” Shoshana is grateful for Ed’s support but wishes they had explored hospice and medical aid in dying sooner. Ariel regrets not pushing harder for specialized care.
  • Quote: “I wish I would have been more forceful with him about going somewhere where he could get the best care possible." – Ariel (40:09)
  • Quote: “I think he was a perfect candidate [for medical aid in dying]. Going out on his own terms would have been so much better for everybody.” – Shoshana (40:28)

10. Embracing Imperfection and Presence

(42:34 - End)

• In the end, the family cherishes the imperfect, loving, messy moments of goodbye. This experience deepened Shoshana’s belief in the importance of a dignified, presence-filled end of life.
  • Quote: “This journey has deepened my commitment to helping everyone experience a dignified end... filled with warmth and love and the quiet beauty of presence.” – Shoshana (41:38)
• Ariel notes how the awareness of limited time makes every moment stand out.
  • Quote: “You really start to slowly capture every single one of those moments.” – Ariel (43:06)
• The episode closes with the reminder that “we’re all terminal,” and the work of End Well is ultimately about learning how to live with that knowledge every day.

Notable Quotes & Memorable Moments

• "He was still eating and drinking and joking around and asking for ice cream and making song requests."
  – Dr. Shoshana Ungerleiter (00:21)
• “He would say things like, they're all here. I see the pictures. Are you getting on the train?... I'm at the train station.”
  – Ariel (02:37)
• "We were obviously prepared for the end, but not prepared that day."
  – Dr. Shoshana Ungerleiter (04:50)
• “Even I did [call the nurse advice line]. And I am an expert. The experience is really, really hard.”
  – Dr. Shoshana Ungerleiter (10:20)
• “We have human instincts that we really can't explain, and sometimes we just have a need.”
  – Rabbi Steve Finley (12:27)
• "I just kind of like, improvised peaceful music that I would hope if he heard it, would help him feel calm."
  – Ed (19:03)
• “On TV, they really make it seem like there's this, like, really clear line between alive and dead... I don't know when he left.”
  – Ed (22:53)
• "I kind of think of myself as a secular Hevra Kadisha."
  – Steve Einstein (25:56)
• "This flower's tribute, this ritual, this was really meaningful for me... I'm just so grateful to you for bringing that to us."
  – Ed (32:56)
• “We're all terminal, right? Like, regardless of whether we have a diagnosis or not. ... How can we live in the present moment? How can we operate day to day knowing that time is limited?”
  – Dr. Shoshana Ungerleiter (44:00)

Timestamps for Key Segments

• Hospice and Last Days at Home: 00:03 – 01:33
• Visions & Emotional Shifts Near Death: 02:37 – 04:12
• Family Preparation and Burial Choices: 05:44 – 07:08
• Reflecting on Support Systems (Hospice, Death Doulas): 07:08 – 09:52
• Hands-On Care and Spiritual Needs: 09:52 – 14:46
• Final Hours and Physical Signs of Death: 15:34 – 20:03
• Death and Moments After: 20:03 – 23:36
• Hospice Rituals, Jewish Customs, and Closure: 24:33 – 34:26
• Family Regrets, Guilt, and Reflections: 36:08 – 40:35
• Embracing Imperfection and Finite Time: 42:34 – End

Tone & Final Reflections

This episode is unflinching and compassionate, deeply personal yet universally resonant. The language is candid, sometimes humorous, always warm—full of frank discussion of regrets, comfort in ritual, the unpredictable logistics of death, and the courage to make meaning amid uncertainty. Dr. Shoshana Ungerleider, her family, and their support system offer a powerful message: facing death together can be imperfect, beautiful, filled with laughter and sorrow—and sometimes, that is enough.