Ep. 109 Twenty Years of “Dying Well” – A Conversation with Ira Byock, MD

Learn from palliative care thought leader Dr. Ira Byock how end-of-life care has changed over the past 2 decades since his book “Dying Well” was published.

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IralaughingIn this episode I share a recent interview with Dr. Ira Byock that celebrates the 20th anniversary of his book Dying Well and features his wise perspective on end-of-life care “then and now.”

Learn more about Dr. Byock at www.irabyock.org.

Get Dying Well at Amazon or Barnes & Noble

ANNOUNCEMENTS:

OLYMPUS DIGITAL CAMERAAs you listen to this broadcast I am currently in Italy–traveling and doing research for my new book on grief (also eating … a lot!) This episode has been pre-recorded (along with several others) so that there will be no interruptions in the podcast. If you want to see photos of my journey follow me on Instagram or Facebook.

Patreonbecome2xThis podcast is generously sponsored by donations on my page at Patreon.com/eolu. Thank you to all of my patrons–your support means everything to me!! Submit your questions for the next “Hospice Happy Hour” Q&A Session here and I’ll answer them next month. You can become a patron for just $1 or $2 per month and you’ll receive access to the Q&A recordings, the Top 10 Interviews from EOLU, and the opportunity to have your work promoted on this podcast. Go to Patreon.com/eolu to learn more!

FEATURED PRESENTATION:

Read the transcript of this interview here:

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In this interview I will talk with Dr. Ira Byock about his groundbreaking book Dying Well: The Prospect for Growth at the End of Life which was published in 1997. We discuss:

  • How he first got interested in hospice care during his residency training
  • What inspired him to write Dying Well
  • How writing the book helped him heal his own grief over his father’s death
  • Changes he has seen in hospice and palliative care over the past 20 years (“the good, the bad, and the ugly”)
  • Where we should be focusing our efforts now to continue to improve the end of life for everyone
  • The upcoming Symposium on Palliative Care, Pain Management and Whole Person Care where Dr. Byock will be a presenter
  • Where to purchase Dying Well

Download the Readers Discussion Guide for Dying Well here.

Dr. Ira Byock is a leading palliative care physician, author, and public advocate for improving care through the end of life. He is the Founder and Chief Medical Officer for the Institute for Human Caring of Providence St. Joseph Health.

Tune in every Monday for a new episode of the podcast! If you enjoy this content please take a moment to leave a review on iTunes – it will help other listeners find the podcast.

Meanwhile remember ….

Face Your Fears.                       BE Ready.                      Love Your Life.

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Ep. 105 Choosing the Right Healthcare Proxy

Learn how to make the best choice for an advocate for your end-of-life wishes.

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In this episode I discuss the importance of choosing the right person to be your healthcare advocate. This might be the most important decision you will make regarding your end-of-life wishes, so choose wisely!

Read the companion blog to this podcast here.

ANNOUNCEMENTS:

In this episode I reference two previous interviews where the importance of the healthcare proxy and the problems with paper advance directives were discussed:

Listen to the interview with Dr. Ira Byock here.

Listen to the interview with Dr. Fred Mirarchi here.

Patreonbecome2xAs always, donations to the EOLU Podcast fund at Patreon.com/eolu are greatly appreciated! A huge THANK YOU to all current patrons–you make this podcast and the EOL University Interview Series possible. Become a patron and receive gifts and bonuses by going to Patreon.com/eolu.

Follow my trip to Italy this fall on Pinterest or Instagram! I’ll be taking a pilgrimage and writing about grief along with doing a bike trip to Puglia!

FEATURED PRESENTATION:

Tune in to this episode to learn:

  • What is a healthcare proxy
  • Why it’s important to choose the right person as your healthcare proxy
  • The responsibilities of a proxy
  • How to choose the best person for this job
  • Next steps to make it legal

Download Guidelines for a Healthcare Proxy here.

Tune in to a new episode every Monday (even when I’m in Italy!) And be sure to leave reviews for this podcast on iTunes to make sure others can find it. Click here to find the iTunes page.

Until next week remember…

Face Your Fears.                    BE Ready.                   Love Your Life.

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Ep. 81 Let’s Talk About It: The Conversation Project with Dr. Jessica McCannon

Find out how The Conversation Project is helping families talk about planning ahead for the end of life.

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Jess McCannon HeadshotIn this episode we’ll hear about the work of  The Conversation Project from an advisor to the organization, ICU physician Dr. Jessica McCannon. Learn how to utilize this excellent tool to get your own conversations started.

Get more info at TheConversationProject.org

ANNOUNCEMENTS: 

COLORADO LISTENERS!! You can download a special version of The Conversation Starter Kit that has been customized just for Coloradans. This version is a little shorter and includes a place where you can name your Medical Durable Power of Attorney. Visit this website to download your copy now:

http://TheConversationProjectinBoulder.org

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You can still sign up for the Death & Afterlife Summit, which takes place March 16-18, 2017. You’ll be able to learn from 10 experts about dying, death and beyond in this series of online interviews–and it’s totally FREE! Go to eoluniversity.com/afterlife to learn more and register.

slide01If you’d like some guidance in completing your own advance directives, check out the Step-by-Step Roadmap to End-of-Life Planning–my NEW online self-directed course that will help you prepare and plan for your later years.

Learn more and sign up here.

 

IN THE NEWS:

The Huntsville Hospital in Huntsville AL has started a unique pilot program that places a hospice nurse in the Emergency Department 3 days a week. The RN meets with patients and families and educates them about end-of-life options to help in their decision-making processes. She also helps them complete advance directives and other documents needed for their hospitalization.

THE CONVERSATION PROJECT:

Join Dr. Karen Wyatt and her special guest Dr. Jessica McCannon, ICU physician and advisor to The Conversation Project, a non-profit organization dedicated to helping people talk about their wishes for end-of-life care. They will discuss The Conversation Project, the history and goals of this organization, and how their resources can benefit you, your loved ones or your patients when making plans for the end-of-life.

You will learn:

  • How and why The Conversation Project was started
  • The value of telling stories about the end-of-life
  • Benefits of The Conversation Starter Kit and The Pediatric Starter Kit
  • How doctors might utilize The Conversation Starter Kit

Dr. Jessica McCannon is board-certified in internal medicine, and completed Harvard’s Clinical and Research Fellowship in Pulmonary and Critical Care Medicine. After completing her internal medicine residency training at Massachusetts General Hospital, she began providing care to adults at the Mass General Hospital Down Syndrome Program. Prior to starting medical training she received her BA from Cornell University. Dr. McCannon currently practices clinical medicine as an ICU physician and serves as an advisor to The Conversation Project.

supportonpatreon-e1412764908776Tune in each Monday for a new episode. If you are interested in supporting the podcast and the End-of-Life University Interview Series you can make a small contribution of just $1 or $2 a month and help keep us on the air! Go to Patreon.com/eolu to learn more!

Until next week remember ….

Face Your Fears.                 BE Ready.                    Love Your Life.

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Ep. 79 The Death-Positive Mindset: How to Create and Share It

The term “death-positive” is everywhere these days. But what does it mean and how do we spread this mindset through our society?

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In this episode I’ll share thoughts from a recent blog post about how to make sure your own death mindset  is clear and free of hidden wounds. These simple practices will help you stay on track as you do your work in the world.

ANNOUNCEMENTS:

slide01The Step-by-Step Roadmap for End-of-Life Planning Course is now available if you need any help with your own advance care planning paperwork. You can learn more at this link:

http://www.eoluniversity.com/roadmap

 

death-afterlifesummitRegister now for the Death & Afterlife Summit, which will talk place on March 16-18, 2017. You’ll be able to hear presentations from 10 speakers on dying, death and beyond for FREE. Replays will be available if you can’t attend live. Learn more and register at this link: http://www.eoluniversity.com/afterlife

IN THE NEWS:

A Dutch nursing home is offering college students free rent in exchange for spending 30 hours per month with residents of the home. The students teach the elders how to use technology and get valuable experience connecting with the older generation. The expected benefits for the residents are decreased dementia symptoms, decreased loneliness and isolation, and increased life expectancy. A similar study is being conducted in the UK where students read poetry to nursing home residents, which has led to improved memory skills. We need programs like this in the US!

THE DEATH-POSITIVE MINDSET:

Read the original article here.

In order to help our society achieve a death-positive mindset we must tend to our thoughts and personal awareness of death. Even though we may work with the deaths of others on a daily basis, we can still be in denial of our own mortality. Here are some steps to take to ensure that your own death mindset is as free as possible of denial and fear:

  • Address your fears of death. Learn to live with your fear but not be controlled by it.
  • Explore your past experiences of grief. Process your old, unhealed losses and gradually work to release the pain you carry.
  • Challenge your misperceptions about death. Stop seeing death as sorrowful and learn to see that death can be both beautiful and tragic.
  • Change your language. Free yourself of “tragic-speak” and use non-negative language when describing death. Beware of overly positive platitudes as well, such as “It’s for the best” or “He’s in a better place.” Allow others to experience their own emotions about death without judging or amplifying their pain.
  • Think about death every day. Cultivate a daily death-awareness practice to stay mindful of how precious life is and to remember to make the most of every moment.

Do your work with an open mind and heart and help spread a death-positive mindset wherever you go.

supportonpatreon-e1412764908776If you’d like to support this podcast, go to Patreon.com/eolu to donate $1 or $2 per month.

Thank you to current patrons! Your support is greatly appreciated.

 

Tune in every Monday for a new episode and until next week remember:

Face Your Fears.               BE Ready.                 Love Your Life.

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SPECIAL EPISODE: Extreme Measures in the ICU with Dr. Jessica Zitter

Learn how ICU and Palliative Care Physician Dr. Jessica Zitter is changing the culture of critical care medicine in America.

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jessicazitterMy 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.

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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.

Purchase Extreme Measures here.

This interview will cover:

  • How Dr. Zitter became aware of the need for a culture shift in critical care medicine
  • How our life-saving technology has become a nightmare for some patients
  • The changes needed in medical education to help physicians provide better end-of-life care to patients
  • How patients and their loved ones can prepare for end-of-life decision-making
  • Advice for choosing the best healthcare proxy

Learn more about Dr. Zitter’s work:

Website: www.jessicazitter.com

Facebook:  www.facebook.com/jessicazitter

Twitter: www.twitter.com/JessicaZitter

Be sure to tune in every Monday for the regular weekly episodes of the EOLU Podcast and until then remember:

Face Your Fears.                       BE Ready.                    Love Your Life.

Ep. 78 Change Happens: How to be Prepared for the Ultimate Transition

What does it take to be ready and at peace when you reach the end of life? Here are some thoughts on how to prepare.

 

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In this episode we’ll take a look at what you need to do to prepare for the future, particularly the end of life. You’ll find out how to BE Ready for whatever life brings your way!

ANNOUNCEMENT:

slide01The Roadmap for End-of-Life Planning Course is finally available! Click here to learn more.

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!

supportonpatreon-e1412764908776This 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:

  1. 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.
  2. 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

17153795 - are you ready illustration design over a white backgroundWhat 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:

  1. Paperwork:
  • 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)

2. People:

  • 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

3. Purpose:

  • 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 here to 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:

Face Your Fears.                     BE Ready.                Love Your Life.

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Ep. 77 Managing Family Conflict at the End of Life

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.

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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!

Announcements:

slide01My 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.

Sponsorship:

supportonpatreon-e1412764908776This 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.

Start working through your own resentments now–practice love and forgiveness earlier in life and your final days will be blessed. If you need extra help consider checking out the Step-by-Step Roadmap for End-of-Life Planning or the book What Really Matters. You’ll find guidance and support from me for your journey!

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Tune in every Monday for a new episode! Until next week remember:

Face Your Fears.                 BE Ready.                   Love Your Life.

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