Life and Death in the ER with Dr. Jeffrey Sankoff

Dr. Jeffrey Sankoff, originally from Montreal, Quebec, Canada moved to Denver over two decades ago, where he has been practicing as an emergency physician while raising their children. Outside of medicine, Dr. Sankoff is an avid triathlete and triathlon coach, hosting a podcast on the sport.

He shares how early-career doctors often grapple with feelings of failure when a patient dies, a process complicated by the litigious nature of the medical environment. Laws allowing physicians to apologize without admitting liability have improved communication with families, making difficult conversations slightly more manageable.

In discussing these conversations, Dr. Sankoff emphasizes the importance of being direct and compassionate. He strives to provide clarity and support to families during their most challenging moments, ensuring they leave without unanswered questions. The emotional toll of his work, especially when it involves children or unexpected violent deaths, is significant. He finds solace in physical activities like swimming, biking, and running, which help him recharge mentally.

Dr. Sankoff contrasts the healthcare systems of Canada and the United States, highlighting the benefits of Canada's single-payer system despite its flaws. He criticizes the profit-driven nature of American healthcare, arguing that it leads to worse outcomes and greater financial burdens for patients. He advocates for a system focused on patient care rather than profit, pointing out the ethical conflicts inherent in the current U.S. model.

Dr. Sankoff's philosophy on life and death extends to his approach to aging and health. He believes in staying active to maintain a high quality of life, seeing a direct correlation between how one lives and dies. He observes that those who live well tend to have better end-of-life experiences, advocating for a balanced, active lifestyle to maximize longevity and well-being.

Ultimately, Dr. Sankoff contemplates the medicalization of death and the societal fear of dying, advocating for a more accepting and prepared approach. He envisions a future where more people can die at home, surrounded by loved ones, rather than in the sterile environment of a hospital. This holistic view of life and death underscores his commitment to his profession and personal life, aiming to live fully and prepare for the inevitable with grace and acceptance.

www.tridoccoaching.com

Transcript

[00:00:00] Jeff: As soon as you put healthcare and profit in the same sentence, You have a major conflict because health care should be about the patients should not be about profits. 

[00:00:13] Jill: Welcome back to Seeing Death Clearly. I'm your host, Jill McClennen, a death doula and end of life coach here on my show. I have conversations with guests that explore the topics of death.

[00:00:24] Death, dying, grief, and life itself. My goal is to create a space where you can challenge the ideas you might already have about these subjects. I want to encourage you to open your mind and consider perspectives beyond what you may currently believe to be true. Today on the podcast, I talk with Dr.

[00:00:41] Jeffrey Sankoff. An emergency physician originally from Montreal, Canada, now practicing in Denver, Colorado. With over two decades of experience, Dr. Sankoff shares about the emotional complexities faced by physicians, particularly the struggle young doctors face with patient deaths. He contrasts the healthcare systems of Canada and the United States.

[00:01:05] Advocating for patient-focused care over profit-driven models. Dr. Sandoff also shares his philosophy on aging health and the medicalization of death, envisioning a future where more people can die at home surrounded by loved ones. Thank you for joining us for this conversation. Welcome to the podcast, Jeffrey.

[00:01:24] Thank you so much for coming on. I'm looking forward to hearing about you and the work that you do, and if you would like to just kind of start us off, tell us a little bit. about yourself, even outside of your work, maybe where you grew up, anything like that. 

[00:01:37] Jeff: Sure. I'm originally from Montreal in Quebec, Canada.

[00:01:41] I grew up there, spent most of my education there, and then did some training, well, did all of my training as a physician there. I did a residency in emergency medicine, followed that up with a fellowship in critical care medicine. And then my wife and I made a move to down to Denver, where we've been for the last 20 plus years, raising our kids, been in practice as an emergency physician here.

[00:02:05] My wife is a pediatric surgeon. And, uh, when I'm not practicing medicine, I'm very active as a triathlete. I coach triathlon. I do all kinds of things with triathlon. I do a podcast on triathlon, all kinds of stuff. So yeah, I like to keep myself busy. 

[00:02:22] Jill: I understand that I like to keep myself busy as well. And so you are a physician and your wife's also a physician, which is kind of cool.

[00:02:30] One of the things that I learned coming from outside of the medical system at all, right? I was a cook. for all of my life, all of my career before this. Um, and now I've been volunteering in hospitals and I'm just learning a lot about the way that doctors deal with death and dying and talking to families and all of that stuff.

[00:02:53] In your experience, I'm sure you've had to deal with death and dying and talking with families. How does that work for you? What have you found that maybe helps when it's time to talk to people about those things? Is there anything you can share with us about that? 

[00:03:08] Jeff: Yeah, it's a very layered sort of nuanced question.

[00:03:11] I have to think back to where we begin as physicians. And as physicians, we come into medicine wanting to help people. And so everything we do is focused on trying to help people get better, better from whatever it is that ails them. Sometimes, in my opinion, That can be from anything from a cut to some back pain to a life threatening presentation.

[00:03:38] And when somebody succumbs to whatever it is that brought them in, then it can immediately, at least when you're very junior in your practice, can feel like a failure. And so I think a lot of physicians early in their practice, when they encounter a patient who dies, feel as though they have failed. That could be a sort of feelings of conflict for them.

[00:03:59] It can cause moral distress for them. It could be a lot. And I think it takes Junior physicians, a little while to kind of process that and get past the it's not about them kind of thing. And instead, it's just a fact of life that we're not always going to succeed. I think it's compounded by the environment that we work in, which is so litigious and In the past five, six years or so, I know here in the state of Colorado, we have had passage of some laws, apology type laws, where when there is a medical error, physicians can now apologize for those things without necessarily incurring any liability.

[00:04:42] And I think that kind of opened up communications a bit more, physicians now, I would say the vast majority of deaths that we encounter are not related to medical error, but it just, I think, has engendered better communication between physicians and patient families to feel a little bit better about the fact that, oh, I can have conversations without necessarily opening myself up.

[00:05:05] But there's this, these two, I think, issues that compete against the compassion. The first is this sort of internal ego thing that all physicians have to deal with, which is like, oh, I failed, the patient died. And then the second thing is this, environment of medical legal liability. I came from Canada where I did all of my training and I practiced for a few years before I moved here.

[00:05:31] And I wasn't familiar with the medical legal part of things, but I definitely had the first part of that, the ego thing that we all do, I think, as physicians. And it took me a little while to really recognize things from the patient family perspective, which is that I view every patient who presents the emergency department as no matter how trivial I may feel their problem is when they're coming in for them.

[00:05:55] It's an emergency. And when I see a patient who's got a true life threatening problem that I'm seeing them on the worst day of their life. And if the patient dies, then I have to speak to the family. And I know That they're waiting to speak to me and the words that I'm going to say to them are going to be forever life changing.

[00:06:14] So I have kind of formed a thing that I go through that I, that moment that I have with them, I want it to be direct. I want it to be compassionate, but I also I want it to be memorable in a way that they don't remember me, but they just remember the moment and that they don't come away with any ambiguity.

[00:06:34] They don't come away with any unanswered questions. And that took me a little while to kind of. formulate exactly how to have those conversations. But I'm really happy that I finally figured out how to do it because I've recognized in the responses I get from families that I think I'm doing it pretty well.

[00:06:51] Jill: I'm sure it takes time to learn how to do that. I don't think it will ever be easy for anybody to have that conversation. But something that None of us want to tell somebody the worst news potentially of their life. But I would think part of the job that physicians take on is having to do that. Like that is part of it.

[00:07:14] Does it affect you a lot when one of your patient dies? Like, is that something that you have a hard time kind of processing it yourself? And is there any techniques that you use personally? It sounds like you're really active and I'm a big person for moving our body is a great way to work through emotional things.

[00:07:34] But how does that affect you when something like that happens? 

[00:07:37] Jeff: There are certain circumstances where it's more impactful on me personally than others. The vast majority of the deaths that we, I mean, all of the deaths that we encounter are essentially unexpected. People come to the emergency department because they were going about their day to day and then all of a sudden, bang, something happens and they have an event and that event either ends up well or it doesn't.

[00:08:02] And if it doesn't, then it was unexpected. Now, there are. the occasional patients who we get who were in the midst of some terminal cancer or terminal disease and they just end up dying and it's expected in those cases. But those are the minority. So almost all of the deaths that we see are to some degree unexpected.

[00:08:23] Still, I would say probably Two thirds of the people who die in my emergency department are going to be elderly. And so, while it's an unexpected death, it's not completely, it's not out of the realm of possibility. So, if I have a patient in their 70s or 80s who comes in cardiac arrest and they die, and I go, I have to tell the family, it's, while it's a sudden and unexpected event, at the same time, there is a degree of, you know, it was their time almost.

[00:08:52] But if you have a child or if you have a death from violence, which I work in a trauma center and so we unfortunately see a lot of young people dying from car collisions, bicycle versus cars, pedestrians, those kinds of things. That's a very different situation. Those are truly unexpected, truly out of the blue kind of things.

[00:09:14] Not to say that they're not preventable because almost all of those things are preventable. But in that situation, they happen completely unexpectedly to the families. And when you have to tell a family who was expecting to see that person minutes, hours, the next day, whatever, and they're never going to see them again, that is definitely impactful.

[00:09:36] And especially when it's a child, you see the reaction of the family you're talking to. It's very hard not to get emotionally brought into all of that. And you're a human being. I mean, you're going to be impacted. It was especially difficult for me when my kids were smaller and I would have a child who was around their age who I would have to tell family.

[00:09:56] It was very difficult. Still, if I have a patient who is similar to my own children's ages or my wife's, it's personally very difficult. You mentioned my being physically active and that is a respite for me. I'm training every single day Be it swimming, biking or running. And when I'm doing that, that is a way for me to kind of turn off my brain and just kind of mentally recharge from all of the things that I see, honestly, I don't see death and dying every single day.

[00:10:24] Thank goodness. I think that would overwhelm me, but I see a lot of things at work that would, I think. Cause mental duress for a lot of people and it does for me, I'm a little bit inured to it simply because I trained for it and it doesn't bother me the way it might bother others, but it does get to you a little bit here and there.

[00:10:42] That's that's how I keep my mental sanity. 

[00:10:45] Jill: What's your favorite part about being deaf? Because when I was a child, actually, I wanted to be a doctor, like that was kind of my, I wanted to actually be a brain surgeon. That was like the very specific thing that I wanted to do. And I think it's because I first thought it was really interesting.

[00:11:00] I thought it was fascinating that you could cut open people's heads and get into their brain and then they would live afterwards. But also I wanted to help people. I thought that that was a way that I can give back and help people. And So I know most physicians, when you get into this work, a lot of it is because you see a need and a way that you can help people.

[00:11:19] But I'm sure there's some parts of your job that you really enjoy more than others. And like, what kind of work is it that you love the most? 

[00:11:27] Jeff: I like being a doctor. I don't love medicine. Things have changed dramatically over the last five years or so. And so in point of fact, I'm actually very much looking forward to not being in medicine anymore simply because the practice of medicine has gotten so onerous.

[00:11:42] That being said, I still love being a doctor, and there are several things I love about being a doctor. I love the intellectual challenge, especially in my line of work in emergency medicine. I never know what's coming in. I don't have set appointments. I don't have the same types of presentations, and so it's really, really has to keep you on your toes.

[00:12:00] You have to know a bit about everything and a lot about a lot of things in order to be able to look at people who come in with undifferentiated disease and Understand and be able to tease out what's actually going on. So I love the intellectual stimulation of the specific area of practice that I am in.

[00:12:19] I also love the fact that I get to work with young physicians. So we work in a educational program. I have medical students and residents and being able to. Work with them and have an impact on the future of medical practice is really, really important to me. I still love the fact that I work in a team, the nurses, the techs, all of the people that contribute to the care of the patients, we all work together very, very closely.

[00:12:45] And it's really important to me to have that kind of camaraderie and support and be able to rely on each other the way that we do. And the interaction with the patients is still. First and foremost, very important to me as well, having an impact on people's lives and being able to help them. Because at the end of the day, we all get into this altruistically.

[00:13:06] And that remains the driving force of why I go into work every day to try and help people. 

[00:13:12] Jill: I do volunteer at a hospital as an doula or death doula, however you want to say it. And I've been in the emergency room a Like handful of times, but for the most part, they have me working with the palliative care team, and I'm typically working with people a lot of cancer, right?

[00:13:32] There seems to be. And of course, I think because cancer is such a broad umbrella, right? That people have all these variety of cancers. But that tends to be where I spend most of my time. But I would actually like to spend more time, especially the hospital, the one hospital that I volunteer at locally.

[00:13:50] It's a teaching hospital as well. It's a trauma hospital. And so a lot of people from around South Jersey, if there's bad accidents, we do actually see shootings, unfortunately, we see a lot of that. And I think I would like to work in that. Department a little bit more helping people when they're getting this really unexpected news of unfortunately, your loved one didn't survive, whatever they came in for.

[00:14:19] And is that something that you I guess you might not even know, but is that something that you could see there being a need or that there would be a role that a death doula. Could still outside of what you already has on your team. 

[00:14:33] Jeff: Well, we have chaplaincy and we have social workers that are present for any time we're going to speak with a family for these kinds of situations because I can't stay.

[00:14:43] And so when I go in to talk to a family, I'm pretty direct about it. Try not to beat around the bush. I know what they want to know. And so I'm not going to spend five minutes not telling them what they actually want to hear. I mean, they want to know is so and so alive or dead. That's what they really want to know.

[00:15:00] So I come in and I say, look, so and so was brought in for whatever. And I'll say we worked on them for whatever amount of time. And unfortunately, they did not survive. And I'm very direct because I, I think that that's what they want to know. And also, I'm not ambiguous about it. I know a lot of people will say they passed away.

[00:15:17] So I'm just very direct about it. I let them process that news. And then I'm like, listen, do you have any questions? Is there anything you would want to know? And they usually have some immediate questions. But I can't stay and answer the questions that come up 30 minutes later. There's all these other patients that demand my time.

[00:15:33] So I will Tell them, if you think of anything, please let the social worker or the chaplain or whoever's going to be there, let them know and I will come back and I will talk to you more. So, there are people that are in the emergency department to help with the families, but they're not there for very long.

[00:15:50] What I mean is they being the families. The families tend not to be in the emergency department for very long because what ends up happening is the body will get moved to the morgue or to another viewing area and those people will go with them and In general, because the process is so unexpected and happens so quickly, there's not a lot of time for preparation.

[00:16:09] I don't know how much the family wants to be around there. I get the sense that most of the time they just want to leave and go and be together with their family. I don't know if we have death doulas where I work. I don't work with the palliative care service. So I don't know if there is such a role that is being filled here.

[00:16:28] I also don't even know what you do. So I wouldn't be able to say if it would be something that could be helpful in the emergency department. My sense, just I'm totally spit balling here, but I'm guessing that your work is mostly with the palliative care. patient and with the family and preparing and helping them go through that journey together.

[00:16:48] There's no time or there's no ability to prepare in this scenario. This happens often violently and a lot of the emotional and sort of cognitive processing happens after the fact, in the days that follow. I think if anything, maybe there would be a role for someone like yourself to be available to the families after the fact, for like maybe home visits or something like that, but in the department, I don't know.

[00:17:17] I don't know because the families are often so taken by surprise by these kinds of things that I don't know that they have time to really process everything and to really, if they would take advantage of the kinds of services that you provide. I think after the fact, That would be a different story.

[00:17:32] Jill: It's hard because all death doulas, we kind of do things a little bit differently. And so even if you have death doulas in your hospital, which I mean, at this point, most hospitals in our country do not have death doulas, even as volunteers. It's just kind of a new ish thing that, I don't know, it took me a lot of work to even be able to volunteer in a hospital.

[00:17:55] It is partially the preparation and getting people prepared. It is partially just the emotional support where there is a lot of similarities between what chaplains do and social workers do and what death duelists do, right? There's definitely some overlap in all of that. I was just curious, so it's not very often that I get to have death duelists.

[00:18:14] an emergency room doctor on the call with me to ask about it. And I'm curious too, coming from Canada, because I know in our country, there was a lot of talk about trying to do socialized medicine. And there's the people that are like, they do it in Canada, and it sucks. It doesn't work. You have to wait around forever.

[00:18:33] It's just a hot mess. And I was curious if there was anything that you can share with us. between the differences in what you see between the way that things are done in Canada versus the United States that you're willing to share with us, at least. 

[00:18:49] Jeff: First and foremost, it's not socialized medicine, socialized health insurance.

[00:18:53] All that means is that you have a single payer. The government of each province provides health insurance for all of its citizens. That's what it means. All of the Fear mongering, all of the silliness that American insurers and American hospital corporations will let people in the United States think is so terrible.

[00:19:17] It's just not the way it is. Just to dispel all of the silliness, Canadian medicine is exactly the same as American medicine. The only difference is where you get your insurance. Your insurance is paid for through your taxes. Do you pay higher taxes in Canada? Absolutely. What do you get for your taxes?

[00:19:38] You get free health care. So in the United States, I pay a lot less taxes. You know what I pay a lot more for? Health insurance. And then after I pay for my health insurance, I pay deductibles, I pay copays, I pay for all my medications, I pay all these other things. And at the end of the day, I'm not sure I'm coming out ahead because also not really getting great health care here.

[00:19:59] So the idea that the United States has a health care. System I'm using air quotes here is kind of a joke because the problem ends and begins with the notion that health care in the United States is driven by profit as soon as you put health care and profit in the same sentence. You have a major conflict because healthcare should be about the patient, should not be about profits.

[00:20:27] The second you put profits into that equation then you immediately have both a ethical and a conceptual conflict because the concept of healthcare shouldn't be about making money. Healthcare should be about taking care of people. Now. I'm a physician. I get paid a salary. I get it. All the people who work in healthcare get paid salaries.

[00:20:50] So yes, there needs to be revenue. I understand that. And I'm not saying that I'm a pinko commie or anything like that. I understand that there are market forces and all those things, but you know what? The United States needs Last I checked is the only country that has healthcare for profit and does almost the worst amongst all of the quote unquote developed nations in any healthcare metric you look at.

[00:21:13] And that includes death and dying. So talk to me about having to wait for things. Talk to me about how terrible Canada is and I will turn it around and say, actually, you've got it backwards. Do you have to wait in Canada to get certain elective procedures? True, you do. You will have to wait your turn to get certain elective procedures.

[00:21:32] Elective, meaning procedures that are not emergent. Will you get them though? 100%. I see patients in my emergency department, in Denver, every single shift, who need elective procedures. And we'll never get them. So their wait is infinite. So don't talk to me about people who have to wait a little while to get their elective procedures in Canada because they're going to get them.

[00:21:55] And they're going to get them for free. Here, people will never get them. That part just seems to get swept under the rug. Because. They can't afford health insurance. They don't have health insurance because they don't fit into the ever widening gap. Because remember Obamacare, which was demonized by one side of the aisle, that same side of the aisle who has all the patients who now can't get Obamacare?

[00:22:19] Well, Because of that, we have an ever growing population who can't get health insurance and therefore will never get those elective procedures that they so desperately need. Not to mention the fact they also can't get a lot of the emergent things that they so desperately need, such as care for the cancers they have, because I can't get them into life saving treatments.

[00:22:40] Because they don't have insurance, I get a little tired of hearing over and over again about how terrible other country systems are, and it is not your fault, but this is a message that has been propagated by the people who stand to lose the most money, and that is the insurance companies who Continue to take in all of the premiums, and then we'll cut you off the second you get sick.

[00:23:03] And the hospital corporations who treat the physicians and the nurses like chattel. And that's why I said being a doctor is great, but being in medicine sucks. It's because of the corporations we work for. So, that's my diatribe. Glad you asked. It's not a good situation in this country. And until people stop listening to the profit motivated people who tell you that anywhere else has it wrong, you're going to get the Medicare, you're going to get the medical care that these people want you to have, which is not very much.

[00:23:35] Jill: My husband and I used to own a bakery down in South Jersey, right? Small business, the two of us working together, and we could not afford health care. I mean, we couldn't, there was. No way we looked into it. There was no way we could do it. I ended up having our first child and I was using Medicaid because that was all I could get.

[00:23:56] And I know when they were getting ready to vote on Obama, we actually set up a meeting with our local representative and I literally sat in front of him and cried and I was like, We can't do we're young and we can't afford health insurance and we're never going to be able to. And he just kind of was like, okay, thank you.

[00:24:13] And he still voted against it. And I was like, all right. And it's so frustrating because we ended up partially having to close our business because one of us had to go get quote unquote, a real job that had health insurance. And at that point, I'd already had one child. And I was like, we can't do mom and pop businesses anymore in our country because you can't afford.

[00:24:34] To support yourself and support a family if you don't have health insurance. And the only way you're going to get health insurance is if you work for a large company. And even then the health insurance sucks. Like it's not like it's great. So yes, it's really frustrating to me. And I think the bigger thing too, is that a lot of people times because the health insurance is not great, then people wait a long time before we go to the doctor because I'm like, I'm not going to go to the doctor and pay my copay and potentially pay to have all these tests for them to be like, there's nothing wrong with you.

[00:25:04] So then I wait on things. And then God forbid, that means that then I wait until something's really serious. And they say, you should have come six months ago. And I'm thinking, well, I didn't want to come six months ago. months ago because I couldn't afford the money, so it is a mess. And so that's like, yeah, when you said where you came from, I was like, all right, I have to ask this question because I feel like I've talked to friends that live in Canada and they're like, no, that's all bullshit.

[00:25:29] Don't listen to it. But I've never had the opportunity to talk to somebody that works in it because then I've also heard like, oh, talk to doctors, they'll tell you how bad it is. And I'm like, All right. Well, next time I get the chance to, I will. And I had my chance. So thank you. I appreciate it. 

[00:25:44] Jeff: Well, listen, I don't want to make it seem like it's a utopia.

[00:25:46] It's not. Are there problems with the Canadian healthcare system? A hundred percent there are. It's underfunded. There is access to healthcare system, access to primary care issues the same way as there are in this country. So there are problems, but you will never encounter patients who are bankrupt because.

[00:26:06] of a medical problem. You will never encounter patients who cannot get a procedure they need, be it elective or emergent. They may have to wait, but they're going to be able to get it. You're not going to encounter a lot of the things that you see in this country. And you're not going to see billion dollar insurance companies.

[00:26:26] You're not going to see billion dollar hospital corporations. You're not going to see all of those things. And you're not going to see, quite frankly, you're not going to see multi million dollar cardiologists. X surgeons or ophthalmologists or dermatologists, either because the physicians aren't making, uh, nearly as much, you're comfortable, you're making a living, but y you're not exploiting patients, you're not exploiting the system, uh, as w as much as they can here, because there's not as much money in the system for that.

[00:26:55] So yeah, there are problems, but on the whole. comparing one to the other for patients and for physicians, I would argue that the system north of the border is significantly better than south. I 

[00:27:07] Jill: guess that's some of it too is in some cases, I can imagine it must be really difficult as a physician. Like you said, you just want to help your patients, right?

[00:27:16] You just want to do the work of working with your patients. And some of the other stuff that must come with it is probably Causing a lot of the burnout and the stress and the anxiety and these things, because one of the things I've been hearing more about is that even right now, nurses and hospitals, right, that like a lot of hospitals are understaffed.

[00:27:37] And they're like, it's not that there's not nurses, there's just not nurses that want to work in hospitals right now, because of everything that's been going on. And that's really sad. That's really frustrating that people can't do work that they love. Right. Because of all this other stuff that comes along with doing the work that they love.

[00:27:55] Jeff: Yeah. Yeah. Well, like I said, my wife and I are counting down to our own departure. So, and it won't be long. It used to be, I think people work till they were 65 or so. We're not, we're going to stick around till we're maybe 60 and then we're gone. 

[00:28:07] Jill: What are your plans after you retire? What do you want to do with your retirement years?

[00:28:12] Jeff: We live abroad. We're both avid travelers and we scuba dive and we will go somewhere where we can avail ourselves of other opportunities. We've been fortunate to prepare and we've had our eyes on the prize for a long time. So our kids are going to go back to Canada to go to school. So college is going to be a lot easier to take care of and we'll see.

[00:28:35] Still a couple years to go. 

[00:28:36] Jill: Yeah, that's wonderful, though. That's something that I know when I talk with people that are nearing the end of life, sometimes it's like, I worked and I worked and I worked and I didn't take that time to travel and to do the things with my spouse or my children or my loved ones that I really wanted to do because of the pandemic.

[00:28:55] Drive that we sometimes have of working and making as much money as possible and whatever it is, right, because some of it's ego for sure, right, that like we need to keep working our way up this ladder, this imaginary ladder, you know, hang more things on our wall to say how special we are. And then we get to the end of life.

[00:29:13] And then we're like, Oh, that was dumb. I really wasted a lot of my time. 

[00:29:17] Jeff: Some people live to work. We work to live. And we have lived very well. We've always lived by don't put things off, no regrets, live today to the max because you don't know what tomorrow is going to bring. And we've, I think, done that well.

[00:29:34] We've instilled in our kids the love of travel that we have. We've taken them all over the world. We've done all kinds of things together. And we've managed to be able to be, by starting very young, we've managed to save. As much as we possibly could, and we are in a good position to be able to retire early and go live the life that we want, and we're looking forward to it, so we'll see.

[00:29:58] Listen, anything can happen, right? So we're planning ahead, but ready for anything that comes our way. 

[00:30:03] Jill: Yeah, and that's the truth, too. And I'm sure you know this very well, that Accidents could happen at any point, illnesses could happen at any point, no matter how well we take care of ourselves. Because I'm sure that some of it with you being so active, I know for me, that's part of it too, is I try to stay so active and take care of myself.

[00:30:22] But it's really more so that I can set myself up for living a long, healthy life. Not hitting 65 or 70 and then having all these health problems so I can't enjoy life when I actually have the time to enjoy life. But things can happen at any point, no matter what we do, how well we quote unquote take care of ourselves.

[00:30:42] Jeff: Absolutely. Yeah, no, you're right. I think you're as old as you think you are. And as long as you continue to live young, feel young, believe you're young, but you have to kind of hold up your end of the bargain. I'm active for that reason. I continue to do what I do because I know that I have the best chance of being able to continue being as active as I am, the longer I keep it going.

[00:31:05] Is it easy? No. It's not. I ran a half marathon on the weekend and I'm definitely feeling it today, but it's okay. It's totally worth it because I know that it pays off in the long run. And how you live, I firmly believe that how you live will impact how you die. I see all the time, like going back to the topic at hand, I see all the time people who don't live well and have horrible, long drawn out chronic illness leading to an eventual not so pleasant death.

[00:31:37] And then, every once in a while, I see these people who come in in their late 90s. They look amazing. And it's because they lived well. And their deaths generally tend to be not so bad. I look at my wife's grandmother. She died at 100. And she lived incredibly well right to the end and had a very, very easy, the death that she wanted.

[00:31:59] We all want that. How many of us get that? Probably a very tiny percentage, but we can at least strive for it and do whatever we can to try and help us get there. 

[00:32:08] Jill: When I talk to people about their biggest fears around death, It's probably the biggest one is not the death itself, it's the, what is leading up to the death, because I think we've all seen that in people that we know and that we love.

[00:32:20] The long extended illnesses and the treatments and the pain and the suffering and all the things that led them up to their eventual death. It's difficult. It's difficult to watch, and ideally, that's not how I want to go. Again, I might not have control. I could, in six months, find out I have some crazy rare cancer and have to go through this whole process that drags on.

[00:32:42] Like, I don't know for sure, but that's why I just try to do the best I can. 

[00:32:48] Jeff: Well, there's this competing thing, right? We've medicalized death, and a lot of it has to do with the fact that we all want to stay alive at all costs. And I get that. There's this like, we want to stay alive at all costs. We fear death.

[00:33:01] And I'm not a religious person at all. If anything, I'm an atheist. But at the same time, not knowing what happens when you die doesn't make me necessarily afraid of it. But I'm not in that position yet. Nor do I want to be there anytime soon. But the thing is, I get it. We have all this technology, we have all these drugs, we have all these things.

[00:33:21] And so the second we have any kind of terminal illness or any kind of thing that puts us at risk of death, we want to fight it. And we fight it tooth and nail. And that leads to this whole process where we end up in this long battle. The younger we are, the harder we fight, and the longer it goes on until finally you get to this acceptance.

[00:33:39] And it's only once I, I see people get to this acceptance that they seem to be much more at peace. But it's that long process to get there. And clearly we, as a species, we weren't like that. I think for the longest time, death was accepted much more as a fact of life. We obviously didn't have advanced medicine.

[00:33:56] We didn't have all these things. We did it, we just accepted that we were going to die in our thirties and that's just the way it was. Or if we were lucky enough to get out of childhood anyways. And so. We just lived until it was our time and that was the end of it. It was just a fact of life and it's become something now that we fight tooth and nail and because we're afraid of it.

[00:34:16] I'm saying this like I have an answer. I don't have an answer. More of an explanation than anything else. But I think in the back of our minds, we all hope that we don't die in a hospital bed. I think we all want to die at home. And yet at the same time, very few people do. Most people end up in a hospital.

[00:34:32] And I think that's really sad because the hospital, that's the worst place to die. Everybody should have a chance to die at home if they can. Surrounded by family. That's really what would be ideal. Not sure how we get there as a society, how we become less afraid and how we become more accepting of alternative realities around death.

[00:34:51] Maybe that's, maybe that's where you come in. 

[00:34:53] Jill: Yeah, for sure. That's part of what. I'm doing with my podcast. That's part of what I'm doing with classes that I do out in my community is just helping people get more comfortable with the fact that death is part of existence. It's part of living a life is we have to die at the end.

[00:35:10] And I think some of it too, as the more that I talk to people, doctors and nurses and social workers and people that work in health care is what's really difficult. difficult. It's difficult to figure out how to find that balance of let's treat people because we have all these amazing treatments. Versus let's drag out something that is going to kill them anyway, and the dragging it out actually is going to cause a lot of the pain and the suffering.

[00:35:36] But how do you have that conversation easily and compassionately with a family and say, hey, we can do these things, but maybe that's not the option you want to choose. There's another way that we could do it when none of us are great at having that conversation yet. Right? None of us have figured that out yet.

[00:35:55] Jeff: It's so complicated, though, because there's so many competing intros, right? You've got the family members who want the person to stick around. You've got the patient who might want to stick around for certain events. Often we see, frequently, it's amazing how death rates spike after holidays. It's amazing to me, like patients have so much control over their own deaths.

[00:36:14] We see it every year after Christmas, after New Year's, after Thanksgiving, after the families come together for a holiday. All of a sudden, death rates spike right after those holidays. It's amazing to me how much control we have over our own deaths. And after weddings, we see deaths, but it's really fascinating.

[00:36:31] So, the patients clearly have a role in when they die, but the family members are often very resistant to let go. And so, they obviously, there's these dynamics, there's all these dynamics that play into the whole thing. It's just never a straightforward, easy thing. I tell patients this all the time, the time to have the conversations is not when you're sick.

[00:36:49] It's to have it well in advance. So my wife and I have living wills. We know exactly what each other would want in these kinds of situations. We've involved our children in those conversations, as difficult as that is, but we do it in a very sort of superficial way. And as they get older, we make the conversations more mature.

[00:37:06] But it's important to have those kinds of conversations when you're well, when you don't have these kinds of things Hanging over your head because once they come to fruition, it's hard to, to be level headed about it and to take the emotion and the fear out of it. So I know you, you, this is something I'm sure you, you preach all the time.

[00:37:24] Jill: Oh, for sure. That is probably my main soapbox is like, let's have the conversation now. Because you don't want to have it when you're under stress, when you're anxious and you're upset and things are, because again, I know coming outside of health care, a lot of the things that doctors say when you don't understand necessarily the technical terms, even when they're trying to be as clear as possible.

[00:37:50] I don't know what they're saying to me. I'm not able to clearly make decisions when it's almost like y'all are speaking a whole different language than the rest of us. And so if we can have the conversations with our loved ones earlier on, and that's part of the work that I think a lot is due, is I'm not a doctor, but I've been learning more about.

[00:38:11] Some of the different questions and some of the different procedures and some of the different things that you might be asked if your loved ones in the ER, or if your loved ones going through a terminal diagnosis, just so that I can help people understand a little bit better what is even being talked about, because you can't make a decision about some of these things when you don't even understand what the thing is, or what it's going to do.

[00:38:34] It's a process, right? None of us have any quick, easy answer to it. But that is really part of why I think my mission is to help educate, help people get more comfortable, and I also talk with my children, and I can only imagine they're probably the ones that go to school and say to their friends things about death and dying, and it's like, I try to make it normal.

[00:38:56] And comfortable, but age appropriate, right? Like you said, you don't want to talk to them about things that are too much for them. But I also don't think there's ever going to be that perfect time to have the conversation if we don't start having it in a normal, natural way. And that's part of, too, what I tell people is this doesn't have to be.

[00:39:15] a deep, heavy, depressing conversation. You don't just sit down once and say, okay, we're going to talk about this whole thing for eight hours and get out of the way. If it doesn't work like that, you can have little bits of conversations. You should have it that way too, because depending on what age you are, what you want at 40 is going to be different at 70.

[00:39:35] So continue to have the conversation with your loved ones. It's not one and done. 

[00:39:39] Jeff: Yeah, it's like you said, it's a process. It's an ongoing conversation and just like life, right? Things change and you have to update that conversation and let it flow just the way everything else does. 

[00:39:49] Jill: For sure. Is there any last things you want to leave us with?

[00:39:53] You're welcome to talk a little bit about your podcast, whatever you want to leave us off with. 

[00:39:57] Jeff: Well, my podcast is dramatically different than yours, so I'm not sure how much crossover there'll be, but I'll throw it out there. It's called the TriDoc Podcast. It's a podcast I do that's related to triathlon, multisport, and the intersection between health and wellness and endurance sports.

[00:40:14] So, anybody who might be listening who is a runner, a cyclist, or a multisport athlete, come on, check it out. You can find it anywhere you download podcasts, or I have a website that's dedicated to it, which is podcast. com. And the other thing I just wanted to mention quickly, and I know this would be a topic unto itself, is Colorado does have a medical aid in dying law, and that's something else that I don't know.

[00:40:37] I don't think New Jersey has one. 

[00:40:38] Jill: No, we do, actually. Yeah, medical aid in dying is legal in Jersey. 

[00:40:42] Jeff: It's a whole other conversation, but I have worked as a physician in that service, and people who are suffering from some kind of terminal illness should definitely be Look into that. You don't have to pursue that route, but having control over that final process is something to think about.

[00:41:00] And if it's something you and your family are comfortable with, it really is a very powerful way to have control of that final decision. It's controversial for a lot of different reasons, but it's become more. It's normalized here, certainly on the West Coast and Oregon for sure. And then here in Colorado, it's becoming more accepted here as well.

[00:41:24] And having worked on the service and seen patients with ALS, patients with really advanced heart failure, really advanced cancers, it's been very rewarding to be involved with. 

[00:41:35] Jill: I'm with you in that. To me, that seems like it's something that should be available to us, right? We should have the option to choose that as a human being.

[00:41:44] If I am going to die anyway, I should be able to control when that is and how I die and when I can end my own suffering. And I know not everybody agrees with that. 

[00:41:54] Jeff: And that's fine. Like you said, the key word there was choose. And nobody's forcing anybody to choose anything, but at least the option is there.

[00:42:02] And it's like so many things in our society, you put the word choice in it, and suddenly it becomes controversial. 

[00:42:08] Jill: I'm excited to hear that that is something that you're willing to work with people on. And like everything, There's a lot of fear mongering that is going on when people talk about it and really just educate yourself.

[00:42:22] If you or your loved one thinks that that might be a good option for you, there is many resources out there. There's doctors, if you, if your state, if it's legal, there's doctors you can reach out to that can help educate you. Just look into it, find out more about it. Don't just all the beer based stuff, make up your mind about it.

[00:42:42] Exactly. Awesome. Well, thank you so much for coming on. I really appreciate you taking your time out of your early morning for me. 

[00:42:49] Jeff: Absolutely. It was a pleasure to be here. I enjoyed the conversation. Great. 

[00:42:53] Jill: Thank you. In my next episode, I talk with Shelby Forsythia. A grief coach, author, and host of the podcast, Dear Grief Guide.

[00:43:03] Facing many losses during her formative college years, she tells us about how that profoundly impacted her identity and future, and she shares how she found healing and a new purpose in life. Today, she helps others through their grief with compassion and creativity, building a community through her podcast.

[00:43:23] Join us as Shelby discusses her journey, the complexities of grief, and how she's turned her pain into a source of strength and support for others. If you enjoyed this episode, please share it with a friend or family member who might find it helpful. Your support in spreading the podcast is greatly appreciated.

[00:43:40] Please consider subscribing on your favorite podcast platform and leaving a five star review. Your positive feedback helps recommend the podcast to others. The podcast also offers a paid subscription feature that allows you to financially support the show. Your contribution will help keep the podcast advertisement free.

[00:43:57] Whether your donation is large or small, every amount counts. is valuable. I sincerely appreciate all of you for listening to the show and supporting me in any way you can. You can find a link in the show notes to subscribe to the paid monthly subscription, as well as a link to my Venmo if you prefer to make a one time contribution.

[00:44:13] Thank you, and I look forward to seeing you in next week's episode of Seeing Death Clearly.