(00:00): You're listening to the live happier longer podcast, episode 68

(00:15): Welcome to the live happier longer podcast. This podcast is equal parts, information, inspiration, education and motivation, all dedicated to increase longevity and improving overall quality of life. I'm your host, Molly Watson and I'm here to help you build the habits of a happier laundry life. Let's get started.

(00:37): Hello and welcome back to the live happier longer podcast coming to you live from Oregon on the very first day of March. And though I typically give a weather update, I'm going to dazzle you with a quote from Charles Dickens about March and I think it describes the weather here perfectly. It was one of those March days when the sun shines hot and the wind blows cold when it is summer in the light and winter in the shade. I think that is like a perfect description of March. At least it is March here in Oregon. And yeah. So today on the podcast, I feel like I'm going to start with a little disclaimer here because the podcast is called live happier longer and we are dedicated to building the habits of increased longevity and improved overall happiness. So this episode may seem a bit contradictory because it's going to be about death and dying.

(01:42): But what I want to propose to you now is that having this conversation is actually part of the process. And this will be how you plan. I mean, and how you play on your death is how you honor your happiness really, or how you help other people plan their dad. This now, I will be the first to admit that I owe, I haven't always handled conversations about death very well. In fact, I used to not be able to, I used to not be able to talk about it without crying fairly immediately when my dad would want to discuss his celebration of life ceremony or the fundamental mechanics of his advanced directive. But despite all my emotionality around it, my dad still believed that I was the best person to be his power of attorney. And to hold the directions for the end of his life, which I truly appreciate as fates would have it.

(02:41): I actually breakfast with him this morning and and he actually handed me again an updated version of a lot of these details. Why the update you ask? Well, I asked it too. He added this line and I quote upon his death, he wishes his body to be cremated as it's his last hope for a smoking hot body and the ashes are to be put in a corrugated cardboard box to be provided by crown Memorial services for which he is also provided the address. Yes, he really did give me an update just to include that line about his smoking hot body. Got to love a guy who's 92 with a good sense of humor anyway. I am no longer myered in sadness when I imagined my dad passing away. Now, of course it's going to be hard, but at 92, I know that he has had an amazing life and quite humbly now I just really hope beyond hope that his passing is peaceful and whatever I can do to make that happen, I will definitely be doing.

(03:50): And this is kind of where a book that I read this last week comes into the equation. Many of you know that I work in a senior living community now and I guess last a week ago, Friday, a prospective resident there recommended this book to me called being mortal by a tool go on day and the full title of it is being mortal medicine and what matters in the end. This book came out in 2014 and was immediately in New York times bestseller and sort of like when we reviewed Brenae Brown's the gift of imperfection quite awhile ago on the podcast. It came out on the heels of Bernay Brown's Netflix special. And prior to that time I, I had maybe heard her name but, but I was not familiar with her work at all, which seems kind of unbelievable. And in this instance I had never heard of a tool go on day and was and was not familiar with anything of it and I feel like I was kind of living under a rock again.

(05:05): So after the book was published in 2014 it was made the subject of a PBS documentary and it's just been a, this is not his only book, but a little more on dr a tool go on day and this is not a full list I will add, he is a practicing physician and surgeon, a host, his masters in public health. He is just been recently named CEO of Haven, which is a healthcare venture between Amazon, Berkshire Hathaway and JP Morgan chase. He has been a surgeon at a Brigham, Brigham and women's hospital and professor at the Harvard school of public health and Harvard medical school. Anyways, he is, he's got a nonprofit and he's been just on the side, a staff writer for New York magazine since 1998 and he's written four bestselling books. He's the winner of two national magazine awards, MacArthur fellowship and the Louis Thomas award for writing about science.

(06:16): So to say that he's got an impressive background is, is really understated. And he is recognized as a thought leader in, in this, you know, for, for many things, especially for medicine. So I listened to a talk he did for Google and whoever introduced him there said he wouldn't have been surprised if the bio had also included a couple of gold medals and an Emmy. So just to kind of give you the caliber of person we're talking about, and I totally agree. So I'll link that. I will link the, the sh the show notes for that talk at Google and his Ted talk on this book and the trailer to the documentary. And of course all links to the book. But I'm, I want you to understand, I listened to this book on audible and I really have to tell you that not only was it a great narration, but the book is just amazing and I really want you to go read it.

(07:16): So this summary and this review of it, I hope is not going to, is really not going to dive into it as deeply, you know, can't. But I hope that you just understand how, how beautifully written and how much this, this means, how important these conversations and how important this topic is. So in the trailer of the documentary, dr Gawande explained that he wrote this book because it deals with two things that medicine can't solve for aging and dying medicine can't solve for either. And as a practicing physician, he felt like he was comfortable with situations where he could provide a solution. But in the scenarios where someone has been given like a terminal diagnosis or has an incurable disease, he felt as though he was ill prepared to handle these situations. And what he saw in his training and his practice was people ending up with very poor experiences as they became frail and or as they died.

(08:21): And he says that he uses writing as a way to understand things that confuse him, which I can totally appreciate. And this book was an example of that. So this book is really about two things. It's about aging with autonomy and dying with dignity. And it's packed with cases that demonstrate these two different pieces. Two fundamental ideas. Dr Towanda interviewed more than 200 patients, families clinicians. He followed people, health care workers and palliative care specialists, nursing specialists, geriatricians and other experts in the fields, all in an effort to pull this book together. And it's again beyond the fact that he's an incredibly intelligent physician. The fact that he's an exceptional writer is what's so great about this book. So the first part of the book focuses on aging and the challenges and the ways that we can do better in providing options for our elders as they are reaching the stages of life when they are the most frail.

(09:38): And this was actually where this conversation that I had with these prospective residents at, at the senior living community I work for. How it came about was I was explaining to them our philosophy of care and they were commenting how it reflected some of the ideals that are in being mortal. So that was amazing. One of the things that I learned about from reading being mortal was that the origins of what we now call assisted living actually started right here in Oregon and were started really in, pioneered by a woman named Karen Wilson Brown in the 1990s. She started trying to figure out a better solution for what she wanted for her own mother and really what existed prior to her, her work and what exists now is just amazing. And the, in terms of the differences and really, even though the story for Brown ultimately got changed in a negative direction by corporate stakeholders she is undoubtedly responsible for laying the foundations and the most basic changes that seniors have now from what was once available only in, you know, in nursing homes.

(10:54): Now she's trying to help low income seniors with care in West Virginia. I believe the beginning part of the book also explores the work of dr bill Thomas, who I have learned about before. And but I did not know this story about him. And it's again, just a crazy, amazing story. And really he talks about it from the beginning of his, of bill Thomas's youth and lead you up to and kind of his personality and sets you up for the work he did for chase Memorial nursing home. That also was provided the framework for what he and his wife would go on to call the Eden alternative and he works still in the Eden alternative. And again, looking, he has another, now he has a sustainable, a sustainable living project for seniors too. Anyway, the story, both the science and the sheer humor of the logistics that go into it for the chase Memorial nursing home are pretty, pretty hilarious.

(12:02): Bill Thomas calls the three plugs of nursing home existence, boredom, loneliness, and help helplessness at chase. He wanted to change the atmosphere from that of an institution to a home by bringing in dogs, cats and birds for the residents to care for. And this is the part that's hilarious because he talks about them delivering all 100 parakeets and they didn't even have the cages ready for them. So it was pretty hilarious. Anyway and this is what we're, this is some of the outcome of what of the of that project. Researchers studied the effects of this program over two years comparing a variety of measures for Chase's residence with those residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psychotropic drugs for agitation, like Haldol decreased in particular, the total drug costs fell to just 38% of the comparison facility and deaths fell 15%.

(13:11): His whole notion was to bring life into this nursing home and those were the results that they got. And so it just an amazing way of framing how we can do better with the aging process and how aging people want their independence still, even when they are in a frail state and what we can do to foster their purpose for living, even if it's much as taking care of a plant, taking care of an animal these things matter. And it's an important conversation to be having about how we are preparing moving forward. And what the best practices are for helping people as they age and to have the best experiences that they can. From there, the book turns from the conversation of aging to the discussion of dying and I have to tell you that the story share throughout these chapters are told both very scientifically and completely poignantly.

(14:19): It's some of the most amazing write writing that I've, I've ever read. Now mind you, I am an admitted science nerd, so hearing the actual anatomical descriptions and technical details of treatment is fascinating to me, but the way that it has done in this book never feels overwhelming or difficult to understand. As we move through these stories and he shares information he learned through these experiences as well as researching for the book. It's pulled together in a way that is as logical as it is compelling. Dr Towanda shares his own missed understanding of what hospice was, any defines in a very personal way what he learned from a palliative care doctor and and how that really has shaped the conversations he continues to have with patients today. And, and I think really gives an example for all of us of the kind of conversations that we want to be having ahead of time with our loved ones and with ourselves.

(15:22): So what he says about hospice, and I think it's very, it's very important to understand. I'm not sure most of us really have a good clear understanding of what hospice is here. He explains the difference between standard medical care and hospice is not the, the difference between treating and doing nothing. The differences in the priorities in ordinary medicine, the goal is to extend life. We'll sacrifice the quality of your existence now by performing surgery, providing chemotherapy, putting you in intensive care for the chance of gaining time later. Hospice deploys nurses, doctors, chaplains and social workers to help people with a fatal illness had the fullest possible lives now. And I think that's important because sometimes people think you can be on, you could be living in with hospice for for a long time. And the difference is that it's all about having the fullest possible lives right now.

(16:36): And it is a challenging concept to know when to stop trying another treatment and stop fighting and to really be able to enjoy and live your life to the fullest right then. But these conversations that he has and the stories and the cases that he presents in this book, I think really help bring this conversation, this discussion to life and it's moving but also very illuminating. Dr Guan to also explains the value of palliative palliative care. I learned about palliative care from my own experience with my mother passing away and, but I didn't understand it again nearly as well as what dr Gawande explains. And again, it's focusing on managing pain and managing symptoms and managing the, the, the problems and, and diseases from trying to help patients from relieving suffering. And he presented a research piece done from Massachusetts general hospital in 2010 where researchers studied patients with stage four lung cancer and the control group received the usual oncology care. So stage four lung cancer, right? Pretty, pretty grim prognosis. So the control group received the usual oncology care and the other half received a usual oncologic care plus parallel visits with a palliative care specialist. These are specialists in preventing and relieving the suffering of patients. The ones in the study discussed with the patients their goals and priorities for if and when their condition worsened. The result, those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives and they lived 25% longer.

(19:01): Just make sure you heard that correctly. The result was that those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier and experienced less suffering at the end of their lives and they lived 25% longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. That's some pretty strong stuff right there. And I just thought that again, it's, it's, it's an amazing, it's amazing stuff. It's amazing information. He visits the lessons from palliative care specialist Susan block many times during this book. And I think the questions that are so imperative for each of us to consider for ourselves as well as to ask the elders in our lives, especially if your parents haven't provided you with a very clear advanced directive like mine or even in spite of, you really need to ask people their priorities.

(20:14): And I want to read from you from the book specifically on those questions. Being mortal is about the struggle to cope with the constraints of our biology with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we, we in medicine do when we fail to acknowledge that such power is finite and always will be. We've been wrong about what our job is in medicine. We think our job is to ensure health and survival, but really it is larger than that. It is to enable wellbeing and wellbeing is about the reasons one wishes to be alive. Those reasons matter, not just at the end of life or when debility comes, but all along the way, whenever serious sickness or injury strikes and your mind or body breaks down, the vital questions are the same.

(21:25): What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the tradeoffs you are willing to make and not willing to make? And what is the course of action that best serves this understanding? The final chapter of the book includes probably the hardest story of all for dr Towanda to share, but another journey that makes this book so beautiful. And it was the experience that he had with his own father in the course of the research for being mortal. Doctor go on to his father. Also a physician developed a spinal tumor and his father basically told him that he was afraid and dr Guana had to find out his father's fears, the physical trade-offs his father was prepared to accept in order to live longer, and what it was that he defined the quality of, of how he defined the quality of his life beforehand.

(22:29): As he writes, he'd feared, I don't know what anger from my father or mother depression or the sense that just by raising such questions I was letting them down, but we've got what we felt afterward after asking the questions was relief. We felt clarity, communication he'd learned from palliative care experts was crucial, and in the end, his father died at home with his family. I really can't do this book justice, any justice here. You know, I've reviewed a few books in the past and while I believe everything I've reviewed, I would recommend this book feels different to me. This feels urgent, like I have to insist that everyone read it. I believe that it's good and important. And I also believe that part of living a happier, longer life is knowing that you've laid out a plan with intention and had these difficult conversations with the people you love, both the people that you might have to make decisions for and those people that might need to make decisions for you. So I will leave you with that tonight and I will link everything

(23:46): In the show notes for being mortal medicine and what matters in the end by doctor a tool go on day. Thanks and I'll see you next week. Thanks for listening to the live happier longer podcast. If this podcast is helping you and you'd like to go a little deeper, maybe track your progress on your habit building, you should check out our five for life planner. The planner is 13 weeks undated and you can start literally at any time to create the habits of a happier, longer life. It'll keep you motivated and it'll keep you accountable and Hey, it's affordable. So go to shop dot five for life.co that's shop.buy for life.co and enter promo code podcast for a special discount.