Learn how ICU and Palliative Care Physician Dr. Jessica Zitter is changing the culture of critical care medicine in America.
My guest Dr. Jessica Zitter, MD, MPH, is committed to changing the current paradigm of end-of-life medical decision-making. In today’s medical culture, the dying are often put on what she calls the “End-of-Life Conveyor Belt.” They are intubated, catheterized, and die attached to machines, frequently without even knowing they are dying.
In her work, Zitter builds bridges between patients and the healthcare team, striving to offer care aligned with each patient’s values and preferences. She has come to see that patients empowered with knowledge can die well, even beautifully.
Dr. Zitter practices the unusual combination of Critical and Palliative Care medicine at Highland Hospital, a public hospital in Oakland, California. She attended Stanford University and Case Western Reserve University Medical School and earned her Masters in Public Health from University of California, Berkeley. Her medical training includes an Internal Medicine residency at the Brigham and Women’s Hospital in Boston and a fellowship in Pulmonary/Critical Care at the University of California, San Francisco. She is also co-founder of Vital Decisions, a telephone-based counseling service for patients with life-limiting illness.
Dr. Zitter is the author of the new book, Extreme Measures – Finding a Better Path to the End of Life, published by Penguin Random House in February 2017. She is a regular contributor to The New York Times on these issues, and her writing has appeared in The Atlantic, The Huffington Post, Pacific Standard, and JAMA, The Journal of the American Medical Association. She is featured in the short documentary Extremis, which won top honors at the Tribeca and San Francisco International Film Festivals, has been nominated for an Academy Award, and is now streaming on Netflix.
This 4-module course is like having your own personal consultation with an end-of-life physician (me!) who guides you through completing your paperwork one step at a time!
Check it out!
This podcast is sponsored through the EOLU donation page at Patreon.com/eolu. By contributing just $1 or $2 per month you can help support the podcast and the End-of-Life University Interview Series. If you become a supporter I will happily promote your book, website, cause or organization on a future episode of the podcast! THANK YOU to my latest patron Sylvie and to all current patrons!!
IN THE NEWS:
Facebook announces it will offer employees up to 20 days of paid bereavement leave and 6 weeks of paid leave to care for an ill loved one.
A study done by U of Colorado Anschutz showed that oncologists are reluctant to have conversations with patients about their prognosis and patients seem equally unwilling to discuss the difficult facts about their diagnosis. This demonstrates the need for better preparation for the end of life BEFORE the onset of a life-limiting illness.
Change Happens: How to be Prepared for the Ultimate Transition
What steps should you take now to be fully prepared for later life? I like to break them down into 3 categories: Paperwork, People, and Purpose.
Here are some suggestions for your own preparations:
Make sure you have completed an estate plan and/or will to protect your financial assets
Appoint someone to be your financial power of attorney AND a separate person as your medical power of attorney
Complete your advance directive (or living will)
Plan for your funeral and burial
Gather important documents, account numbers, passwords, etc. into on file where they will be accessible in the future (Check out the BE Ready Checklist for a list of all these documents you should gather)
Tie up “loose ends” in your life by practicing forgiveness
Make amends with the people closest to you
Say “I love you” whenever you have the opportunity
Talk with your loved ones about your healthcare wishes
Talk with your doctors (and also spiritual advisor or attorney if relevant) about your end-of-life wishes
Be prepared to care for an ill or dying loved one at home if that should become necessary
Think about your own sense of meaning and purpose in life–are you living life fully in each moment?
Practice being present in the moment by taking up mindfulness or using deep breathing
Recognize that your purpose is not really something you hope to accomplish in the future; it lies in how you live your life each moment
Face your fear of death so that you can fully prepare and then relax and enjoy all that your life offers to you
Click hereto download the End-of-Life Preparedness Assessment to see if you are ready!
Tune in every Monday for a new episode. Until the next time, remember:
What do you do when a family (your own or a patient’s) is crumbling due to unhealed resentments and irreconcilable differences? Find out now.
In today’s episode I’ll share my best tips for helping families move through conflict toward resolution during stressful times like the death of a loved one. I’ve had lots of experience with this work during my years as a hospice doctor so be prepared for a longer-than-usual episode!
My new course Step-by-Step Roadmap for End-of-Life Planning is almost ready for release (just a few days away as I record this!) The course is simple yet comprehensive and will help you examine your mindset, values, beliefs, and fears about death before you make decisions about your end-of-life healthcare. Go to eoluniversity.com/roadmap to learn more and sign up to be notified as soon as the course is released.
This podcast is sponsored through the EOLU donation page at Patreon.com/eolu. By contributing just $1 or $2 per month you can help support the podcast and the End-of-Life University Interview Series. If you become a supporter I will happily promote your book, website, cause or organization on a future episode of the podcast! THANK YOU to all current patrons!!
Managing Family Conflict at the End of Life:
Families facing the death of a loved one are particularly prone to be divided by the resurgence of old conflicts and resentments. Over my years as a hospice doctor I have seen many families split apart by their differences at a time when they most need to be united.
Most of these families had longstanding grievances that had been buried and ignored over the years, only to rise to the surface under the stress of a loved one’s death. Sibling rivalries, parental favoritism, divorce, and competition for inheritances are the most common reasons for these resentments. In addition many families are also divided over religious and political differences, which is an especially prevalent problem right now.
One of the important functions of hospice staff members and other end-of-life workers is to assist splintered families with healing and resolution of their conflicts, whenever possible. But sometimes we are called to assist our own families when challenges arise. Here are some tips for being a peacemaker for a fractured family:
Remain neutral on the issues of conflict. As much as possible leave your own biases, preferences and beliefs at the door if you hope to help resolve a disagreement. This will be much easier if you are not emotionally entangled in the conflict. But even if you are, you need to learn to become a “Witness” to the situation (a higher state of consciousness that allows you remain detached.)
Listen to all sides of the argument. Spend time with each person involved in the conflict until you can grasp their perspective. If you are part of the disagreement then at least try to understand the point of view of the others involved in the situation. As soon as you begin to understand how and why the others feel the way they do then you have taken a huge step toward reconciliation.
Avoid trigger topics. Political and religious differences may complicate family conflicts at the end of life but are usually not reconcilable. So it is best to “agree to disagree” about these points of view and set them aside so that the focus can be on healing other issues.
Be present. By staying calm and unemotional you can prevent the conflict from escalating into an all-out war. Practice mindfulness to help strengthen your ability to be present so that your own emotions don’t flare up when you are trying to help others.
Find common ground. As you listen carefully to the stories of each opponent in the disagreement you may recognize certain common threads–areas where they actually share the same perspective without realizing it. Gather these threads so that you can remind those in conflict that are some things they have in common. Help them untie around the things that matter most (like doing what’s best for their loved one.)
Learn the wishes of the dying loved one (if possible.) If you can still communicate with the patient you may find out that she has a wish for her family to reconcile. You can use this wish to help draw the combatants together in their desire to please and comfort the one they love. Let the patient’s wishes become a “magnet” around which the rest of the family gradually comes together.
Have patience. Don’t try to force a reconciliation by rushing into a family conference or intervention. Allow for some separation initially and let the gaps between individuals gradually begin to close.
The bottom line is that families who don’t wait until the end of life to resolve their differences have a much easier time negotiating the challenges of death and dying. But that’s not the case for most families. Most are left to rehash old sibling issues, betrayals, disappointments, and wounds during the last days of their loved one’s life when they should be sitting at the bedside offering love and comfort.
What advice do hospice patients have about how we should live?
In this episode I’ll share some of the wisdom I gathered from my hospice patients as they faced the end of life. This simple advice can help us live more fully with less fear and worry.
This podcast is sponsored through the EOLU donation page at Patreon.com/eolu. By contributing just $1 or $2 per month you can help support the podcast and the End-of-Life University Interview Series. If you become a supporter I will happily promote your book, website, cause or organization on a future episode of the podcast!
Today I have a huge thank-you for my new patron on Patreon.com/eolu: Kerrie Noonan. Thank you for your support Kerrie!
In the News:
An article on Time.com listed “7 New Jobs That Are So ‘2017’” and included Death Doula as one of the new occupations! What’s great about this is the fact that a major news outlet is breaking through the taboo and using the word “death” and that there has been a recognition of the importance of people who assist others at the end of life. In Episode 71I listed Death Doula as one of the trends for the year and included links to several training programs for becoming a doula. If you are considering a career change or looking for some post-retirement work you might want to become a midwife for the dying. There will be a huge demand in the very near future for people fulfilling this role.
In a story reported on the Today show we learned that 31-year-old actor Chris Salvatore invited his 89-year-old neighbor to live with him when she was no longer able to live on her own. Salvatore and Norma live in the same apartment building and had been friends for about 5 years when she was hospitalized with leukemia and respiratory problems. When doctors told Norma she would have to go to a long-term care facility because she had no family members to care for her, Chris stepped up and took her into his home. He now provides care for her as she faces the end of her life. Doctors didn’t expect Norma to live through the holidays but she is thriving in her new home. This example of selfless generosity is exactly what we need as we move into the future where 25% of Baby Boomers will have no family members available to provide care to them. Well done Chris Salvatore – a huge salute to you from End-of-Life University!
What My Hospice Patients Wanted You to Know:
Here is some of the wisdom my hospice patients shared with me as they neared the end of their lives. I promised them that I would bring their messages to you since they are no longer here to speak for themselves.
“What seems important now doesn’t matter in the end.”
“Don’t worry so much about diet and exercise.”
“Your doctor doesn’t have all the answers for you.”
“Your life’s purpose isn’t what you think.”
“Religion is less important than learning how to love others.”
“Dying isn’t as scary as you think.”
“You’re going to die anyway so you might as well be ready.”
Listen to this episode so you can learn more about each of these statements. And then maybe you’ll be inspired to change some aspects of your life and prepare for the very end!
Be sure to subscribe to End-of-Life Interview Series (if you haven’t already) so you can listen to our fantastic educational interviews with EOL experts every month. Go to www.eoluniversity.com to register. And if you’d like to support EOLU and this podcast check out the donation page at Patreon.com/eolu.
Tune in next week for another new episode and until then remember:
It’s not enough to get your paperwork done … make sure it’s done right!
In this episode we’ll look at several common mistakes people make when doing their advance directives–mistakes that could make it more difficult for their end-of-life wishes to be carried out. Learn how to get your paperwork right so you can relax!
This podcast is supported through the generous donations of listeners made on Patreon.com/eolu. When you donate just $1 or $2 per month I will thank you by mentioning your name on the podcast and promoting your cause!
Thank you to my latest patron: Jayne Boulton–I appreciate your support Jayne!
In the News:
An online article from Managed Healthcare Executive asks the question: Can Data Analytics Aid in End-of-Life Care Decisions? The author cites a recent study from JAMA that shows 70% of MD’s reporting that they have not been trained to have end-of-life conversations with patients and 73% of patients over the age of 65 have never had an advance care planning discussion with a doctor.
Medical data analysts have suggested that EHR’s might be useful to help health systems identify patients in need of end-of-life conversations. The article points out that current management of advance directives on EHR’s is poor since on average it requires clicks on 12 different screens to locate a patient’s AD, which takes 1.3 minutes–not fast enough in an emergency situation. In addition many patients at the end of life experience more than 3 transfers to different facilities and their paperwork is often lost in the process.
Much work needs to be done to help patients get their wishes met at the end of life! For that reason I have created a NEW online course to guide people through creating their advance directives, making them legal, and having conversations with loved ones and doctors about their wishes.