59: Being Mortal by Atul Gawande

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1. 00:00:00 It's a question of the day, Mike. How's Scrum doing?
2. 00:00:03 Scrum is not happening. No.
3. 00:00:06 Well, as we were talking about before we hit the red button,
4. 00:00:10 basically since we recorded the last episode, which has been a while,
5. 00:00:14 we've had a couple of issues. Your internet got knocked out. I had to travel.
6. 00:00:18 I really haven't done anything with my OmniFocus.
7. 00:00:25 So confession time. I confess this on the latest episode of Free Agents that we recorded as well.
8. 00:00:30 I feel a little bit like a productivity hypocrite because I find myself in this place where I don't
9. 00:00:36 even think about the things that I have to do and then select the most important thing.
10. 00:00:41 I don't even know everything that I need to do. All I know is that I need to get this course
11. 00:00:47 off the ground and I know what the next thing is. And so I do the next thing and then I see two
12. 00:00:52 more things that I need to do. And I'm just in the thick of it right now.
13. 00:00:57 I told David when we recorded, I'm telling all of you right now that this is not a normal state for
14. 00:01:02 me. I'm not going to stay here. But over the holidays, I'm going to take some time off and
15. 00:01:08 we're going to hit the reset button and everything's going to be back the way it's supposed to be.
16. 00:01:12 My email is going to be back under control. I'm not going to have 700 unread messages anymore.
17. 00:01:18 Yeah, the wheels have basically fallen off, but it's been good because I have been able to make
18. 00:01:24 some significant progress. And as we're recording this, I actually launched my personal retreat course
19. 00:01:29 yesterday. So things are moving in the right direction. Hopefully we can get these things
20. 00:01:36 kind of moving on their own and I don't have to babysit them so much. And then we can kind of take
21. 00:01:41 a step back breathe and reevaluate the systems. But for now, it's a little bit crazy in Mike's world.
22. 00:01:47 So right scrum and omni focus was not going to happen this time.
23. 00:01:50 Happens sometimes. Yeah, how about you? Well, it's worth a shot though, right? You know,
24. 00:01:57 these things happen. You had the same thing. You're going to do a personal scrum setup. Did you
25. 00:02:01 succeed? Yeah, I've been running it. It's been going pretty well for me. I feel like it's been a
26. 00:02:08 pretty good balance of getting the planning for the week ahead nailed down and then basically
27. 00:02:15 having a way of knowing, am I doing like, am I planning to do more than I can handle? Like,
28. 00:02:20 that's a lot of what the big pieces are there. So I found it extremely helpful. I'm going to keep
29. 00:02:27 doing it, but I will say that you having the break from it for a little while, like that sometimes
30. 00:02:34 has to happen when you've got a lot going on one project, because it seems like you can
31. 00:02:42 just go heads down on the project and it's more work than it's worth to constantly be add things
32. 00:02:47 and then check them off Adam and check them off. Yep. It seems to get to where it's too much sometimes.
33. 00:02:51 So yes, I feel like it's sometimes you have to step away from it at times. So I'm not in that spot
34. 00:02:58 right now, but I'm in the middle of a transition work wise. Like, we did the episode on free agents.
35. 00:03:06 We're talking about free agents a lot today already, but free agents. We did that episode
36. 00:03:10 about how I'm leaving free agency to go work for a corporation. Well, that's going to be happening
37. 00:03:15 next week pending paperwork at the moment. So yeah, there's a lot going on there, which means that
38. 00:03:23 the whole scrum thing has been very well flexed lately trying to help me keep that under control.
39. 00:03:31 So yes, I'm still definitely in the thick of it and it's been going pretty well. So I'm happy with it.
40. 00:03:38 Nice. You said something at the beginning of that along the lines of scrum has helped you
41. 00:03:45 identify how much you could actually do. Yes. And I'm not kidding when I say like, it's been crazy
42. 00:03:53 busy. I feel like if I would have done that, I would have recognized that I've got twice as much
43. 00:03:58 to do as I can possibly do. And then it's like, well, oh, well, figure out a way to do it.
44. 00:04:03 On Monday, just as an example, I edited, exported, uploaded and published all 10 videos for the
45. 00:04:13 personal retreat course. I created half of the workbook pages. So there were like five or six
46. 00:04:19 designs that I had to get done that day. I talked to you and you helped me spin up a discourse
47. 00:04:25 forum associated with the site. I decided to host a goal setting workshop. So I signed up for
48. 00:04:32 webinar platform, integrated it with my email marketing, and then created the landing page
49. 00:04:36 in the event for all of that. Like, it's been ridiculous. I get done and I journal at the end
50. 00:04:41 of the day and I like, what did you accomplish? It's like a week's worth of work. But I know it's
51. 00:04:49 not sustainable. So I know I got to stop revving the engine so hard pretty soon. But right now,
52. 00:04:55 it's just you do what you got to do. Yeah. Which interestingly, you know, we've talked about
53. 00:05:01 for agents a lot this episode, David and I made an announcement on the episode that went live
54. 00:05:05 as we were recording this yesterday that we're pivoting the show and we're going to talk a lot
55. 00:05:09 more about productivity, but from a different perspective and a more authentic perspective,
56. 00:05:15 I think it's going to be rebranded as focused. And it's going to be a productivity podcast about
57. 00:05:20 more than cranking widgets. It's going to be talking about intentionality and sharing a lot of
58. 00:05:26 the struggles and the mistakes that we make, which is something that is missing in the productivity
59. 00:05:30 space a lot of times. You see that the experts quote unquote, you know, Sharon, this, these are
60. 00:05:35 the three things you got to do to reclaim 10 hours a week, whatever. And so my hope is that it's going
61. 00:05:41 to be refreshing in the productivity podcast space because it's going to be a little bit different
62. 00:05:47 approach to we're still going to dive deep on some of the topics and share the things that we learn.
63. 00:05:51 You can apply them to your life and hopefully improve your life that way. Really, the only thing
64. 00:05:55 that would be required to benefit from the podcast, I think would be the growth mindset.
65. 00:05:59 And just a little bit, you know, talking about the reason behind that, we recognized after you
66. 00:06:04 put together the Mac Power users discourse that there are a ton of people who listen to free agents
67. 00:06:10 who aren't free agents. Yeah. Yeah. And who have no intention of being a free agent. They just like
68. 00:06:16 the content. They understand the mindsets and the principles and they apply them to their own life,
69. 00:06:20 which I think is awesome. But also, I think that there's a lot of people who don't even listen to
70. 00:06:26 the show because of the name who could fall into that category and who could benefit from the
71. 00:06:32 discussion. Sure. And so we want to make it more open, peel maybe to a broader audience, but really
72. 00:06:39 not change the show all that much other than it's not going to be called free agents. And we're not
73. 00:06:46 going to be talking about freelancing quite as much. We're going to be talking about a lot of the
74. 00:06:49 same principles and ideas and systems and things like that. But it's going to be a little bit more
75. 00:06:55 general. And also, it's going to open us up to have a few more interesting guests on there.
76. 00:06:59 Like Chris Bailey is going to be on there actually in January, I believe.
77. 00:07:03 Nice. So it should be fun. Yeah, it sounds very interesting. It seems definitely you and David.
78. 00:07:08 Like, I feel like that'll be a really good fit. Definitely for sure. So I'm excited about this one.
79. 00:07:14 I've known it's coming for a while. So I'm excited about it. Sweet. Yeah. And I also want to say,
80. 00:07:21 because I know we were chatting before this and theirs, there's people out there who are a little
81. 00:07:26 bit concerned maybe about the, how should I say this? You know, the one more thing in the productivity
82. 00:07:33 space, I think that if you have an idea that is worth sharing, you don't need to worry about
83. 00:07:40 whether somebody else is doing it already. And I just want to throw that out there because I know
84. 00:07:44 that there are people myself, I've been there, you know, where it's like, I don't want to do
85. 00:07:48 something that somebody else is already doing. And a lot of times you may be talking about the
86. 00:07:54 exact same things even, but you've got a different perspective. You've got different dots that you're
87. 00:07:58 connecting. And so just go make your thing. That's kind of what I'm learning is I'm going through
88. 00:08:03 this faith based productivity thing is like, well, I'm super niche on some of this stuff. And it's
89. 00:08:08 not going to appeal to a lot of different people. But for the people who does it, who it does appeal
90. 00:08:12 to, like they're raving fans, they absolutely love this thing. There's always going to be an
91. 00:08:17 audience. The internet is big enough for both of us or all of us, I should say.
92. 00:08:22 Yeah, I know that there's a quite a few productivity-ish and related podcasts and things that are out
93. 00:08:30 there. But, you know, there's a lot of those that I don't listen to because I don't really resonate
94. 00:08:36 with the hosts that much. Whereas I know that I do resonate with you and David. So I'm one that
95. 00:08:42 will listen to free agents and then focused. And then I'll skip on almost all the other shows.
96. 00:08:49 Just because I have a relationship with you guys. And I feel like you guys have a lot of the same
97. 00:08:54 views I do. And I resonate with you, whereas I don't with others. So I say that because I know
98. 00:09:00 there's a lot of folks who have talked about or want to get into the space, it's like, go for it.
99. 00:09:04 Because yes, there may be quite a few people out there. But there's always going to be, you know,
100. 00:09:11 a group who don't really resonate with the people who are already there. And your voice
101. 00:09:16 is likely the one that they will resonate with. So just go make your thing.
102. 00:09:21 Just as to proof of that. In the productivity guild, there is a thread on goal planning for 2019.
103. 00:09:29 And I was tagged in the discussion saying, "What do you do?" And before I could respond,
104. 00:09:34 somebody else had posted in there, "I do a personal retreat." And here's a link to my PDF guide. And
105. 00:09:40 my response when I saw that was, "That's awesome. Like, way to go with that. It's actually really
106. 00:09:44 well put together. It's totally not the way I would do it. But that's fine. Whatever works
107. 00:09:51 for you." And so I shared my stuff in there and my process. But it just shows the point that I
108. 00:09:57 ended my comment with, "The world needs more personal retreats." It doesn't bother me that
109. 00:10:03 you put together this thing and it's free. And I put together this course and I'm selling it.
110. 00:10:07 Because you could have that response. It's like, "Oh, this is a competitor." We're not competitors.
111. 00:10:11 We're buddies. And since I talked about it, I don't like to sell promotion, but I do want to
112. 00:10:17 just throw this out there because I mentioned it a couple of times. The personal retreat course
113. 00:10:20 is available. And I'm doing the same thing for listeners, a bookworm that I did for listeners
114. 00:10:24 of free agents, which is a 50% discount until the beginning of the year. So it's only $47.
115. 00:10:32 I think it's $23.50 then if you get the discount. And so that will, you just use the coupon code
116. 00:10:37 bookworm when you check out. You can say 50% on that. And then I also mentioned the goal setting
117. 00:10:42 workshop that I was doing. That's going to happen January 5th, which is a Saturday,
118. 00:10:46 a 12 p.m. Central time. And really what inspired this was I've done a lot of these for Asian
119. 00:10:53 efficiency in the past. So I was kind of in the back of my mind. I wanted to do one of these one
120. 00:10:57 sometime. And then I read a statistic that 92% of New Year's resolutions next year are going to fail.
121. 00:11:03 And I got more upset than I probably should have. My newsletter that went out today,
122. 00:11:10 I mentioned like, I have to do something about this. Yes. So I'm hosting this goal setting workshop.
123. 00:11:16 And I'm going to walk through actually a lot of the exercises that are in the courses and just
124. 00:11:21 kind of help people connect to the why behind the goals that they want to set or the resolutions
125. 00:11:25 if you wanted to frame it a different way. And help this be the year that you actually achieve
126. 00:11:29 your goals. So the workshop is free. I think there is limited space, but I don't know what it is,
127. 00:11:35 whatever the webinar software software is limited is. But there'll be a link to that in the show
128. 00:11:39 notes if you want to want to reserve your spot. Nice. All right. Stop talking about my stuff.
129. 00:11:44 Let's get into this book. All right. So takeaways here. Oh, I'm sorry. I got to do one more.
130. 00:11:51 Because there's listener of the show, Michael Diamond, he's actually kind of like a mentor of mine.
131. 00:11:58 He bought a bookworm t-shirt when we did the campaign a while back. He's got a website and
132. 00:12:03 he's putting together this huge list of his favorite books. And this is somebody that I really
133. 00:12:09 respect somebody who reads a lot. And he's actually been in the national news lately. He's a really
134. 00:12:15 smart guy. And he's got a list of his favorite books. And I remember one of the comments that
135. 00:12:19 people made was you got to quit talking about the productivity and self help stuff all the time.
136. 00:12:23 And my response in the bookworm club was, well, that's what I like. But Michael Diamond has a list
137. 00:12:29 which has all the great categories. So he's got history, he's got biographies, he's got a whole
138. 00:12:36 bunch of things. He showed me basically the work in progress, the draft version of this.
139. 00:12:41 And I asked him if I could share it with bookworm. And so I've got the link. We're going to put this
140. 00:12:46 in the show notes. He's assured me that this is going to be live by the time the episode publishes.
141. 00:12:51 But when he showed it to me, it was really close. And I think that for people who wish we would cover
142. 00:12:56 a broader selection of books on bookworm, there's going to be some great resources on this list.
143. 00:13:01 Got it. Because I was clicking the link from the show notes thinking this 404 is Mike. Like this
144. 00:13:06 doesn't exist. Okay, that makes more sense. It was basically done. And then I told him, hey,
145. 00:13:12 that looks great, except it would look even better if you had like pictures of the books and like
146. 00:13:16 the actual physical books. You created more work for me. He's working on it.
147. 00:13:21 Still seem an harder for him. Okay, good job. Yeah. All right, that said, we're going to step into
148. 00:13:28 a book today that is not in the self help, you know, productivity space at all. Like this is
149. 00:13:33 very, very different than what we normally do. Today's book is being mortal by a tool go on day
150. 00:13:40 who we've done one of his previous books, the checklist manifesto, one of my favorites that
151. 00:13:45 we've done so far. And this, I'll put it this way. Mike and I had our, we normally catch up a little
152. 00:13:53 bit before or after the show. We definitely did it before the show this time because I think we were
153. 00:13:58 both just a little nervous about hitting the record button today. Yeah. Because so the tagline
154. 00:14:03 on this book is medicine and what matters in the end. This is about end of life care, aging and death.
155. 00:14:13 Very different than what we normally cover, Mike. Yep. So I think this will be an interesting
156. 00:14:18 conversation. I feel like this was a very eye opening book and has led to a lot of questions,
157. 00:14:24 conversations and such. But this is one I'm glad to have read, but I will say I think this book
158. 00:14:31 probably made me cry more than any book we've read by a long shot. So this is a tough one. Very
159. 00:14:39 large number of tears shed over this one. Yeah, this was difficult to read for sure. And I want
160. 00:14:45 to preface this at the beginning because I feel like on this topic, we are not qualified to really
161. 00:14:54 talk about sure. The productivity stuff, the self help stuff. I mean, maybe I should feel the
162. 00:15:01 same way about that stuff. But I've been in that world for long enough that I feel like,
163. 00:15:06 I feel more confident saying and sharing my opinions about different ideas in that arena.
164. 00:15:12 This one, I really, I really don't know what to do because I haven't had to go through
165. 00:15:19 some of the stuff that they talk about in here. Both of my parents are still living and they're
166. 00:15:24 both pretty healthy. I remember going through it with my grandparents, but I was in high school at
167. 00:15:29 the time and didn't really get it. So it feels like it's been a long time since I've had to go
168. 00:15:36 through that. And there's some really heavy stuff in here. There really are no right answers. I feel
169. 00:15:42 like for any of these specific situations, there's so much nuance that goes along with everything
170. 00:15:48 in here. And I just want to preface this by saying like, we're going to do our best to treat the
171. 00:15:53 subject with care and with sensitivity. But if I say something stupid, please forgive me because
172. 00:15:59 I don't have the perspective that Dr. Gawande has. Agreed. Yeah, for sure. Because I know that
173. 00:16:05 like I run sound at church. And one of the things you don't think about when you say that is that
174. 00:16:11 our church hosts quite a few weddings, but even more so, a lot of funerals. And with that,
175. 00:16:19 somebody's got to run the sound system. So I find myself at the church, at a lot of funerals,
176. 00:16:26 and sometimes it's babies. It's grandparents, great grandparents. It's young dads, young moms.
177. 00:16:34 Like it's hard. Like those are hard conversations. And it's hard being there in the room at one of
178. 00:16:43 these funerals, hearing the stories and understanding what exactly happened. These are people I don't
179. 00:16:50 know most of the time. These are complete strangers. And yet, it's very emotional even to just be
180. 00:16:58 there with them and try to serve them in some way. I would say that is very different than this,
181. 00:17:05 you know, if this was my parents that we were talking about who developed a cancer of some kind
182. 00:17:12 and we needed to make decisions about end of life care, that's very different than experiencing it
183. 00:17:18 with strangers, of course. But at the same time, I think that a tool Goanda takes us through this
184. 00:17:26 process in a very emotional and a very detailed way, tells a lot of stories that are very hard
185. 00:17:34 to read sometimes. And I think when you come out of it, you have a sense of not necessarily
186. 00:17:42 closure on what you should do when confronted with an end of life situation, but more along the lines
187. 00:17:51 of how should you think about it? And how do you make decisions once you get to the point of realizing
188. 00:17:57 that you are at an end of life stage? So I think there's a lot of hard questions to ask here.
189. 00:18:03 And again, I think you're right, Mike, that this is going to be kind of tricky to work through.
190. 00:18:08 So it's very possible we may misquote something or say something off base. So feel free to call
191. 00:18:15 us out on it. But at the same time, you know, this is not a simple topic either.
192. 00:18:20 No, I can basically guarantee I'm going to say something stupid.
193. 00:18:23 Sure. I apologize in advance. And it kicks off in the introduction, even.
194. 00:18:29 Yes. So the introduction introduces us to a character named Mr. Lazaroff.
195. 00:18:36 And the reason that I put this one in here is that he shares a statement which,
196. 00:18:41 as I read the rest of the book, I found myself coming back to this over and over again,
197. 00:18:48 because it kind of challenges everything else that Dr. Gawande talks about. But he says,
198. 00:18:54 don't you give up on me? You give me every chance I've got. So using that as a
199. 00:19:00 to set the tone for this book, basically, this is an older guy who they're trying to decide,
200. 00:19:08 do you want to go through this surgery or not? What's the best thing that could happen if you
201. 00:19:11 go through it? What's going to happen if you don't go through it? Whatever. And he responds
202. 00:19:14 by saying, basically, give me every chance that I've got. So they do the operation. It's technically
203. 00:19:19 a success, but he ends up dying anyways. And the point that they make at the introduction
204. 00:19:24 of this book is that before they did the operation, they avoided talking honestly about the choice
205. 00:19:29 that was really before him. And you need to have those difficult conversations and you need to let
206. 00:19:34 the patient understand what all of the possibilities are and then let them make their own decision.
207. 00:19:39 It kind of challenges the traditional view of medicine, at least the way Dr. Gawande
208. 00:19:46 proposed it in this book, which was basically just do everything you can to keep the patient alive.
209. 00:19:54 Do no harm sort of a thing. And he's basically saying that maybe that's not the best thing
210. 00:19:58 for the patient in a lot of cases. And again, like, I'm not qualified to say yes or no.
211. 00:20:05 But as I'm thinking about Mr. Lazarov and somebody who, this seems like a fairly common
212. 00:20:11 response to me. And I'm trying to put myself in these shoes. And if my dad is trying to decide
213. 00:20:16 whether he wants to have the surgery or not, and he says to me, don't you give up on me,
214. 00:20:21 you give me every chance that I've got. I mean, I'm going through with it,
215. 00:20:24 regardless of the risks. But Dr. Gawande is saying, well, maybe you shouldn't, basically.
216. 00:20:30 I feel like it's a classic, you know, quantity of life versus quality of life.
217. 00:20:36 Yep.
218. 00:20:36 And we have a tendency to say that quantity of life is always the trump card. If you can extend
219. 00:20:46 my life by two days, it's worth it. But what if those two days are you spent in a hospital bed
220. 00:20:55 and you sacrificed a week with grandkids to get those two days? Like that's, that's the question
221. 00:21:01 he's asking. Yep.
222. 00:21:03 And that if you look at it in a retrospect, yeah, sure, you could probably make that decision,
223. 00:21:09 especially, you know, you and I can make that decision right now, because we're not in the,
224. 00:21:13 we're not there. We're not in a hospital sitting in with three nurses and a doctor trying to make
225. 00:21:18 that decision. We're not there. We can do that right now. That's easy. But put me in the hospital,
226. 00:21:24 and if that's my wife on the, that's, you know, that we're having this conversation about,
227. 00:21:29 it's going to be very hard for me to make that clean decision like that.
228. 00:21:33 Yep. Yeah, exactly. And he shares a vision in this introduction, section two, which,
229. 00:21:40 I mean, this is pretty heavy, but he said that he had this recurring nightmare where the corpses
230. 00:21:45 of the people who had died showed up at his house, holy cow. But really, like the thing that got him
231. 00:21:50 moving in this direction was this, this vision and then encountering these patients he talks about
232. 00:21:55 on four, on page three and being forced to confront the realities of where they are. Like they're
233. 00:22:00 in the middle of decline of mortality. And he said it didn't take long to realize how
234. 00:22:05 unready I was to help them. It just, it's, it really is emotional. Again, I'm not, I know nothing
235. 00:22:13 about this, this world, but he kind of frames it as like the system doesn't teach you what you
236. 00:22:18 need to know to look somebody who's older and dying in the eyes and actually help them not just
237. 00:22:25 prolong their life, but help them live their best life until the point where they die. And,
238. 00:22:32 yeah, like I said, I feel completely unqualified to talk about this.
239. 00:22:36 Sure. Yeah, because we are, you know, and I would almost venture to say there's very few people who
240. 00:22:41 feel qualified to talk about it. Thankfully, Dr. Gawande is one of those. I feel that is very well
241. 00:22:49 respected in the and has the ability to talk about this stuff. But I also know that when you
242. 00:22:57 think about, because I'm reflecting on a number of the doctors that I worked with going through
243. 00:23:04 all of my Lyme disease process, it was very much an informational. Like here's what we know,
244. 00:23:11 but never was it asked, how are you feeling with all this? Like that's not, you know,
245. 00:23:19 the emotional side doesn't seem to be at the forefront of a lot of doctors and nurses'
246. 00:23:25 thoughts. Maybe I'm wrong on that. At least that's been my perception, but it doesn't seem to be
247. 00:23:32 the norm at least. And I kind of wish it was, but I don't know what you do to get to that point.
248. 00:23:38 Yeah. But that's what he's getting at here is you get to a point where you're talking with
249. 00:23:43 somebody who has cancer and they're dealing with or coming to grips with the fact that
250. 00:23:48 this is it. Like the chemo is not working. Now what? And being able to have those conversations
251. 00:23:55 about the reality of the situation versus, well, here's the third type of chemo that you could try
252. 00:24:02 and it does have like a 10% success. Well, that's just information sharing. Like that's not actually
253. 00:24:09 working through what the patient wants in that case. Yeah. That's not a simple thing to approach.
254. 00:24:15 And I understand it from the doctor's stance. Like, I wouldn't want to bring that up.
255. 00:24:18 I wouldn't want to be the one that says, Hey, by the way, you're dying. Like, what? That's
256. 00:24:24 insensitive. Like that's not not a thing I would want to bring up. But he's the one saying that,
257. 00:24:31 you know, maybe we do need to bring it up. Yeah, I agreed. Also,
258. 00:24:35 playing into this conversation to my perspective and my inner turmoil with this topic is my religious
259. 00:24:44 belief system. Because I have seen people close to me who have been healed of cancer and the doctors
260. 00:24:53 don't know how they were healed. And I believe that faith has a big part to do with that.
261. 00:24:59 It really doesn't have any place in the discussion of this book, I feel. But if you have somebody who
262. 00:25:08 has faith that they can and will be healed and like Mr. Lazar off, they say, don't you give up on me,
263. 00:25:15 you give me every chance I've got to feel like there's not a whole lot you do do in that situation.
264. 00:25:20 You pray and you believe God or whatever, you know, and that's that's the other side of this coin.
265. 00:25:29 And I don't have a simple answer for that. I try to disconnect from that as I read through
266. 00:25:35 the rest of this this book because he's approaching it from a medical perspective. And you look at
267. 00:25:43 the facts and you make an informed decision. But that's also, like I said, based on my experience,
268. 00:25:50 I've seen people close to me Rachel's mom was was healed of cancer. And so how do you weigh that
269. 00:25:58 into this conversation? I don't know. Yeah, because he's he's definitely in the science
270. 00:26:04 side of this. Yeah, you know, I feel like you and I could have a whole conversation about,
271. 00:26:09 you know, how does how does God play into this? Into this conversation, but he's left completely
272. 00:26:15 out of this book entirely, which is fine. Again, this is a medical doctor talking about this
273. 00:26:20 from a medical perspective. And I know we get accused of bringing our faith into this podcast
274. 00:26:25 too much. Whoops, literally, like Rachel's mom, we we had communion, we prayed for her and she
275. 00:26:32 went into the doctor and the cancer was gone. Like you can't explain that. And I don't know what
276. 00:26:39 doctor go on. They would say about something like that. But I've seen it happen myself. So like,
277. 00:26:44 it's real. And you can define real based on your own experiences, your own belief systems,
278. 00:26:49 however you want to. But that's what's going through my mind as I read this. I also think there
279. 00:26:55 is very much a valid perspective to everything that he shares here. It really challenged me and
280. 00:27:00 we're going to get into some of this stuff in a little bit, like the specifically the assisted
281. 00:27:03 living and like the poor houses, that sort of thing. Like that's that's crazy. But I just I'm
282. 00:27:09 having a really hard time. And this is a big reason why I was hesitant to record this one, like
283. 00:27:14 reconciling all of this in my head and trying to speak to it in a way that is bringing information
284. 00:27:24 and value to the person who's going to invest their time to listen to this and not just hearing me
285. 00:27:29 from a religious perspective say, Oh, you got to believe God. Like, you got to have wisdom too.
286. 00:27:34 And you got to listen to to wisdom and you got to look at the facts. But also like,
287. 00:27:40 the facts can can tell part of the picture and you can believe that picture. And then
288. 00:27:46 that picture may not be the true reality. Like there's there's so much nuance to this. It's so
289. 00:27:52 difficult for me to talk about this. I feel a lot of weight and a lot of responsibility in trying
290. 00:28:00 to articulate this the right way. I'm trying to be very careful with my words. And I feel even
291. 00:28:05 then like I'm failing miserably. You get over it. We'll be all right. All right, let's do this.
292. 00:28:11 Let's just jump in. So chapter one, the independent self. You got a couple points here,
293. 00:28:16 one of which is activities of daily living. Where are you going with that?
294. 00:28:20 Yeah, well, there were a couple lists in this section, which were interesting to me because I,
295. 00:28:25 for the last several years, I've worked with a family business that creates software,
296. 00:28:29 even before I was working with Asian efficiency, like I've been doing this out of college,
297. 00:28:34 create software for special education. And there's a subset of people in special education with
298. 00:28:39 moderate to severe disabilities, who the classification for the type of instruction that they need
299. 00:28:46 would be something like independent living skills. And so when he's talking about these
300. 00:28:51 activities of daily living, this is a lot of the stuff that our software is designed to help people
301. 00:28:56 with moderate to severe special needs do. He's got the eight activities of daily living, which are
302. 00:29:01 use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair and walk. And then
303. 00:29:06 there's eight independent activities of daily living, which are shop for yourself, prepare your
304. 00:29:10 own food, maintain your housekeeping, do your laundry, manage your medications, make phone calls,
305. 00:29:14 travel on your own, handle your finances. So those are kind of all independent living skills.
306. 00:29:19 And those are the things that we've worked with a lot of people over the years to get them to the
307. 00:29:23 point where they can live as independently as possible. And when he's talking about in this
308. 00:29:27 first chapter, the independent self, the way I read this is kind of like, if you have somebody
309. 00:29:33 who is independent, and then at some point they become dependent, at what point are they,
310. 00:29:40 at what point do they cross that line? Like how many of these things do they have to be able to
311. 00:29:44 check the box in order to make their own decisions still sort of a thing? Because I've mentioned that
312. 00:29:49 the nursing homes and the assisted living and stuff like that, that's one of the things that
313. 00:29:53 really impacted me in this book. And we'll talk about that in a few chapters where it really comes
314. 00:29:57 up again. But as someone with parents who are doing great, but my parents are both about 70 years
315. 00:30:03 old. And so it's going to come to the point not too far in the future, where they're not going to be
316. 00:30:09 able to live completely independently. And what happens at that point? Do we stick them in a nursing
317. 00:30:15 home? And I should say like the nursing home may be the right answer for some people. But it shouldn't
318. 00:30:21 be, I would argue the default answer, which is kind of what it's become. And he even talks about
319. 00:30:26 later on, like this daughter who goes into a nursing home with her father to look at it,
320. 00:30:30 the person who's there is selling it to the daughter. He's not even talking to her dad who's
321. 00:30:35 going to be living there. And he's just kind of resigned to the fact that like my daughter doesn't
322. 00:30:39 want to take care of me sort of a thing. Like he doesn't say that, but that's kind of the picture
323. 00:30:42 that you get. Right. You know, and so I don't know, like again, there's no right answer to this, but
324. 00:30:49 I like the the list here of the activities daily limit. It really got me thinking like,
325. 00:30:54 okay, so these are the things that we kind of accept as like, this is what you need to be able
326. 00:30:58 to do. But then maybe one of these things you can't do anymore. That's a warning sign. A couple of
327. 00:31:05 them, you know, now you really got to start thinking about this. And it shouldn't just be,
328. 00:31:08 okay, now I need to take care of my elderly parents. I've got all this stuff going on. I have to take
329. 00:31:14 my kids all these different places. I have no idea where this came from. I never saw this coming.
330. 00:31:18 Well, if you look at these lists, like you can basically see this coming. And then don't make a
331. 00:31:23 decision, a reactionary decision based off of the needs of the of your current situation.
332. 00:31:28 Because you can't, you can't figure out a way to do that. Like I feel like if you see it coming,
333. 00:31:34 you can make modifications and you can take steps which are going to allow you to take care of
334. 00:31:39 elderly parents and not just put them under somebody else's care. And that's really the second point
335. 00:31:46 where he compares like aging in India versus aging in the US because they're two totally different
336. 00:31:50 things. Yes. And that's, you know, this is a thing that really struck me. Because as I was reading this,
337. 00:31:58 this first chapter, I finished the first chapter and thought, hmm, I feel like I would rather live
338. 00:32:05 in India right now like that. That's my thought because he tells the story of his grandfather
339. 00:32:10 who ran a farm in India. And then he was what late 80s and he had some health issues that struck
340. 00:32:20 at that point. And instead of, you know, if you go back to this list of activities of daily living,
341. 00:32:27 I think it was close to half of those he was incapable of doing.
342. 00:32:30 After, I want to see it was like a stroke or something. I'm blanking on what it was, the health
343. 00:32:36 issue was. But he was incapable of doing close to half of those activities. In the US, that would
344. 00:32:43 immediately put him in a situation where they would, they would highly recommend a nursing home
345. 00:32:50 and look at something along those lines. Whereas in India, it just meant that the sons and daughters
346. 00:32:58 and grandkids got involved with helping grandpa with his day to day life, which kind of dumbfounded
347. 00:33:06 me. It's like, well, yeah, I know of people who do that and take care of their parents and such, but
348. 00:33:10 that's a lot of work, to be honest. And it kind of struck me on a little bit of a different chord
349. 00:33:19 because, you know, in that realm, he ended up living to where he was in his over 100 years old.
350. 00:33:27 So he lived for quite a while after that in that scenario, having never gone into formal, long-term
351. 00:33:33 care of any kind. And it kind of struck me in a couple ways. One, we don't have that expectation
352. 00:33:41 in the US at all. Well, I shouldn't say at all. The majority of people don't expect that. Nursing homes
353. 00:33:48 are kind of the de facto answer there. And two, it was kind of sad to think about how, you know,
354. 00:33:56 families are quite distributed across the US anymore. You know, even my immediate family were
355. 00:34:01 spread out quite a bit. And I'm the one who is the furthest away. So, you know, I think about that,
356. 00:34:08 and it's kind of concerning. But it's interesting how that has led us to a point where it's not really
357. 00:34:16 an option to just move in with your kids when you hit that point. Like, say you're not able to do
358. 00:34:22 half of these activities of daily living. It's not normal to move in with your kids long-term,
359. 00:34:29 anyway. Like, sure, it happens as kind of a halfway point until you can find a nursing home.
360. 00:34:34 But it doesn't seem to be the norm. But is that because families aren't as close as they used to
361. 00:34:40 be? Are they not as reliant on each other as they used to be? You know, I feel like there's a lot of
362. 00:34:45 potential reasons for that. But it was a little bit disheartening to think about that we just
363. 00:34:51 don't help our own families out as much as what we used to. So, it was kind of sad to think that
364. 00:34:56 through. Bottom line is we're all a bunch of selfish jerks. Well, there's that.
365. 00:35:00 Seriously. I mean, he talks about some of the different contributing factors to the situation.
366. 00:35:07 And I think that a couple of things are worth calling out here. Number one is that people are
367. 00:35:14 living longer. And number two, that wisdom and status are no longer being attributed to the elderly.
368. 00:35:22 So, in India, where wisdom and status are attributed to the elderly, the age of the live,
369. 00:35:28 how they want supported by their family. Because that's what you do. Grandpas are in the right to
370. 00:35:33 live how he wants. But in the US, we view it as having to take care of my elderly parents. It's
371. 00:35:38 like a convenience. It's cramping my style. So, I got to figure out how to get my freedom back.
372. 00:35:46 And it really is selfish if you think about it. The question that he poses here, based on those
373. 00:35:53 lists of independent daily living, is if independence is what we live for, what happens when it can
374. 00:36:00 no longer be attained. And I think the respect and the wisdom that you attribute to the elder
375. 00:36:07 generation, that's definitely going to influence the decision that you make. But that's also
376. 00:36:14 not what happens in the US for a lot of people. I mentioned the story about the lady bringing her
377. 00:36:20 dad to look at the nursing home and the salesperson selling the nursing home to her. That just seems
378. 00:36:26 so wrong to me. But I don't know. I mean, that's where we are. So, the big question then is,
379. 00:36:34 where do we go from here? And it's going to be different for every situation. Like I said,
380. 00:36:37 there's so much nuance associated with this. I really can't make a call and be like, this is
381. 00:36:41 what should happen. But I will say that it challenged me. And by the end of this book,
382. 00:36:47 I was like, there's no way my parents are going to a nursing home. I'm doing everything I can.
383. 00:36:51 Yeah, I can't say I made it to that point, Mike, but I'm not far.
384. 00:37:01 I feel like there's a lot here. And it's very, it's an empowering book, I think, in that way,
385. 00:37:07 to your point. My parents are not going to a nursing home. But at the same time,
386. 00:37:11 we are still in a point where we do like our freedom to a pretty large degree. So,
387. 00:37:20 yes, I feel like it's not that simple. Right. It's definitely not that simple.
388. 00:37:26 No, no, not at all. All right. Chapter two, things fall apart, Mike.
389. 00:37:31 Yes, they do. And they fall apart quickly. We don't really need to spend a ton of time in here,
390. 00:37:35 but there is a story about a lady Jean Gavrilles. I think is how you say that.
391. 00:37:39 And she was living on her own and was doing fine. And then things fall apart, hence the chapter
392. 00:37:50 title. So basically in this section, they talk about the three primary risk factors of falling,
393. 00:37:57 because falling is a big thing that causes people to quickly go from being able to live
394. 00:38:07 independently to not being able to live independently, and then very quickly coming to the end of their
395. 00:38:12 life. They actually said that the greatest threat to elderly people was falling because 40% of people
396. 00:38:18 who fall end up in a nursing home and 20% can never walk again. So from there, it's a quick downward
397. 00:38:25 spiral. But the three primary factors, or risk factors for falling are poor balance, taking
398. 00:38:31 more than four medications and muscle weakness. So when she goes in to the doctor because she's got
399. 00:38:38 back pain and this thing with her lung, they get fixated on her on her lack of balance in the
400. 00:38:46 five medications that she's on. And they're like, we really need to make sure that you do not fall,
401. 00:38:53 because if you don't have any of those risk factors, then you have basically a 12% chance of falling.
402. 00:39:00 But if you have all three of them, you're at virtually 100% and Jean had two of them.
403. 00:39:05 So I thought this was an interesting perspective. Like you go in for one thing, and then the wisdom
404. 00:39:11 of the doctor, they recognize that something else is wrong, and then they're able to identify.
405. 00:39:14 This is the thing that we really need to be careful of. This is the thing that could
406. 00:39:18 end your independence quickly. And so this is what we're going to do to fix this and the other
407. 00:39:22 stuff that's minor. I think there's a lot there that you could unpack. I think it's...
408. 00:39:29 I'm just going to say this. This is where my action item came from. I have one.
409. 00:39:36 But this is where it started, I guess, because Jean's story here concerned me quite a bit.
410. 00:39:45 Okay. Between my parents, my in-laws, probably more so my in-laws than my parents, as hard as
411. 00:39:53 that is to say. If something happened and happened quickly, I feel like we would want to be very
412. 00:40:02 involved. But at the same time, it means that we need to have some of these difficult conversations
413. 00:40:09 now versus waiting. Because how many times in the book does he tell a story, and then they have
414. 00:40:18 to ask some hard questions that no one wants to answer, but they should have really asked those
415. 00:40:23 questions six years prior, or a decade prior, or longer. Like, I don't want to be in that position.
416. 00:40:31 I don't want to be in a spot where I need to ask, you know, how do you want us to handle things if
417. 00:40:38 you're incapable to make decisions for yourself? That's not a fun conversation.
418. 00:40:43 Yeah. Don't walk up to your in-laws and say, "How do you want to die?"
419. 00:40:47 Yeah. But at the same time, they may not be able to answer those questions, but it should at least
420. 00:40:54 spark the thought process to work through that. And again, that's not a fun thing to bring up.
421. 00:41:02 You have to be very delicate in how you even approach the topic, but it's still one that I feel
422. 00:41:09 like needs brought up because things can happen quickly. That was my takeaway from this chapter.
423. 00:41:16 I think we got to be delicate in how we approach this topic, and we're still going to lose a
424. 00:41:19 bunch of listings. Well, in Teach Their Own. Yeah. Now, I agree. That action item could probably
425. 00:41:28 come from a lot of these different chapters. That really is the only action item that you could
426. 00:41:33 possibly have from this book. I didn't have an action item, by the way, because I'm not ready to
427. 00:41:38 have those talks yet, but it does make me think about it. Like I mentioned, as I'm reading this
428. 00:41:45 book, and especially in the next couple chapters where they talk about the nursing home,
429. 00:41:48 I'm like, my parents are not going there. But I do recognize that at some point you are going to
430. 00:41:52 have to have those difficult conversations, and you are going to have to figure out how to come
431. 00:41:57 to an agreement with these things. And again, no easy answers to that. Should we talk about
432. 00:42:02 nursing homes? I don't want to, but I feel like we should. All right. So chapter three is called
433. 00:42:09 dependence. And the all my notes, basically, from this section have to do with the Irving
434. 00:42:19 Goffman who compared prisons and nursing homes in his book Asylum. There were four characteristics.
435. 00:42:26 All aspects of life are conducted in the same place and under the same central authority.
436. 00:42:31 Number two, each phase of the member's daily activity is carried on in the immediate
437. 00:42:35 immediate company of a large batch of others. Number three, all phases of the day's activities
438. 00:42:40 are tightly scheduled. Number four, the various and forced activities are brought together into
439. 00:42:44 a single plan, purportedly designed to fulfill the official aims of the institution. And as you
440. 00:42:50 read those four things, I'm not sure what kind of reaction you had, but I'm like, that sounds miserable.
441. 00:42:55 So, not a, not a painting nursing homes in a very positive light, but also in this chapter,
442. 00:43:04 they talk about the history of them. Because in the early 1900s, the elderly that weren't wealthy or
443. 00:43:12 had children to take care of them went to poorhouses, which were sad, disgusting places for elderly
444. 00:43:19 poppers out of like immigrants, young drunks, and the mentally ill. And they typically spring up,
445. 00:43:25 he mentions in the book, in countries that were transitioning from poverty to wealth,
446. 00:43:29 because at that point, you are breaking up the extended families without producing enough
447. 00:43:35 affluence to really take care of these people. So they're kind of falling through the cracks.
448. 00:43:40 And on page 71, he says that nursing homes weren't created to help people facing dependency in old
449. 00:43:47 age. They were created to clear out hospital beds. And when you think about it that way,
450. 00:43:55 I don't know, it just left a very poor taste in my mouth. But I can think back to all the nursing
451. 00:44:01 homes that I have been in. We even have a ministry at our church where once a month we go to the
452. 00:44:07 nursing home that's down the street from our church. And it's got a reputation in town is not a very
453. 00:44:12 nice one. And we just go visit with people who don't have anybody else who is going to come visit them.
454. 00:44:18 And every time you step in there, it just, it doesn't feel great. It feels great talking to the
455. 00:44:26 people and seeing the reactions that they have and how appreciative they are, but just walking into
456. 00:44:30 the place, as he's describing this, I'm like, "Oh, yep, that's that place. We go there once a month."
457. 00:44:36 Like he's hitting the nail on the head. And I know that they're not all that way. And in a couple
458. 00:44:42 chapters, we'll talk about Bill Thomas, who had a different way of doing things. So there are
459. 00:44:48 people who are challenging this, but understanding the history behind it, I don't know. It just helps
460. 00:44:54 me see where we got where we are. And then also it just makes me feel real sad for the current
461. 00:45:00 situation and challenges me like, "What can I do to help this?" Like I said, we've got to
462. 00:45:06 ministry our church where we're going once a month. That's great. That's one small step in the right
463. 00:45:10 direction. But there's a lot of hurting people there. And there's probably a lot more that I could do.
464. 00:45:16 Yeah. I think we're generalizing when we say nursing homes, when we talk about the state of
465. 00:45:22 nursing homes, as he does as well. And he acknowledges that in the book. He's like,
466. 00:45:27 "This is not necessarily... It's not every nursing home because he knows of nursing homes
467. 00:45:34 that do things absolutely right." And again, we'll talk about one of those here in a little bit.
468. 00:45:39 But generally speaking, there are a lot of similarities between nursing homes and prisons,
469. 00:45:47 to your point earlier. And this just struck me so hard. You think about what happens in prison
470. 00:45:56 versus what happens in a nursing home. Well, it's all set schedule. Everyone gets up at the same time.
471. 00:46:00 Meals happen at the same time. All of that happens. Everything's dictated.
472. 00:46:06 You have no control over it. Everything is... When do you take your medications,
473. 00:46:09 when are you going to take a bath? All of that. All has to happen on a schedule that's set by
474. 00:46:15 someone other than yourself. Well, that's the same thing in a prison.
475. 00:46:19 Okay. Exactly. So just taking a step back, you and I are creatures of habit. We do things based
476. 00:46:29 on routines. We have our way of doing things. If someone told me that I now needed to get up at
477. 00:46:37 six o'clock and I was going to have breakfast once, not twice, lunch is going to happen at 11.30.
478. 00:46:45 You know, we'll have game time at 1 p.m. Like, if someone started dictating that to me all the time,
479. 00:46:51 I am pretty sure I would revolt. Yeah, exactly. Which makes it easy to see then why there are so
480. 00:46:58 many people there that are bitter. One of my gap books, I forget which episode it was for,
481. 00:47:03 was 30 Lessons for Living. And it was written by a guy who went to all of these different
482. 00:47:10 nursing homes and he found the bright spots. The people who have the great personality,
483. 00:47:15 they're always smiling, they've got joy, which is not normal for that situation because a lot of
484. 00:47:21 those people are there. It is a prison to them. They're there against their will. They don't want
485. 00:47:25 to be there, but they're not independent enough to do anything about it. You know, the kids stuck
486. 00:47:29 them there and they never come to visit. That sounds very general and negative, but that's the story
487. 00:47:33 of a lot of the people, the one that we go visit. It's really, really sad. So, the 30 Lessons for
488. 00:47:40 Living though, he goes and he interviews thousands of these people who have a different perspective
489. 00:47:44 about what are the things that allowed you to live a good life? Why do you have the attitude that
490. 00:47:52 that you have? And so, there is obviously things that you can do to overcome your circumstances.
491. 00:47:58 It's not just a situation that you happen to be in, but it's easy to see how you can default to
492. 00:48:05 that and you really can't blame anybody who's stuck in that nursing home because their kids don't
493. 00:48:09 want to take care of them. That's convicting to me. I don't want that to happen.
494. 00:48:13 Yeah, and I suppose we need to be careful there too because their kids don't want to take care
495. 00:48:17 of them. That may not necessarily be the case. True. Yeah, again, we're generalizing. I'm going
496. 00:48:21 to say stupid stuff. I apologize. I just caught that one. That's all because I know of,
497. 00:48:28 even personally, I know of situations where it's not a matter of whether or not
498. 00:48:33 son or daughter wants to put mom or dad in a nursing home. It's simply not an option.
499. 00:48:41 Correct, but there are people that we go visit. I'm like, "Hey, how are you doing?"
500. 00:48:47 Okay, and we get to talking to them and like, "Do you have any family?" "Yeah,
501. 00:48:51 do they live nearby?" "Yeah, they live in town." "Oh, did you get to see them?" "No,
502. 00:48:55 they haven't been here in years." "That shouldn't be." Yeah, yeah. It's way too common for the people
503. 00:49:02 that we minister to anyway. Yeah, no, I totally agree with you. I mean, it's overcome, but
504. 00:49:11 just wanted to say it's not necessarily everybody, for sure. Okay. Thank you for clarifying.
505. 00:49:17 So many disclaimers this time around. Yeah, it's sensitive topics. So many. Got a lot of it.
506. 00:49:23 Chapter four, "Assistance." I feel like you have a lot to say on this one, but a lot of it has to do
507. 00:49:28 with kind of a new way that came out after nursing homes because nursing homes and poor houses got
508. 00:49:35 quite a bit of press. I forget the timeframe, the 40s, 20s. I've drawn a blank member to tell you
509. 00:49:43 that she's... We read this book a while ago. It's been a while since we have tried to record it.
510. 00:49:47 Yeah, we had our time getting recording done on this one, but there was kind of this next level
511. 00:49:53 of assisted living as opposed to a nursing home. And with that, I feel like there's a chance for
512. 00:50:03 assisted living could be a good step forward, at least by its original design, but I think it's
513. 00:50:09 become more than that, more than they intended it to be. Maybe not more, less than the intended to
514. 00:50:15 be. I don't know. One of those two. Right. So the thing that I wrote down here, I've got a couple
515. 00:50:20 personal stories to talk about here. One story that stood out to me was "Loo and Ruth," which is an
516. 00:50:29 older couple. And if I remember the story right, Ruth passes away. And typically, at that point,
517. 00:50:35 when you're significant, other passes away and you're elderly, one of two things happens either.
518. 00:50:41 You're so heartbroken that you follow not long after. Or if you've been the one that's taking care
519. 00:50:47 of them, you now find some independence and you find another reason for living. My grandma was
520. 00:50:52 kind of that way. She's taken care of my grandpa. And then when he passed away, it wasn't like she
521. 00:50:57 was biting time until he passed away. She definitely loved him, but she found another purpose.
522. 00:51:02 And she was really involved with her church and did a bunch of stuff. And it was cool to see how
523. 00:51:09 she connected to something else when she needed to. And that's kind of what Lou did. I mentioned
524. 00:51:14 in here that Lou made friends easily. He didn't mind being alone. He played cribbage with friends.
525. 00:51:18 He went to the library, etc. And that totally reminded me of my great grandma Clara, who lived
526. 00:51:23 to be, I believe, 98. And she lived in a town in Minnesota that my mom is from, called Welch.
527. 00:51:30 She's only 60 people, but if you ski, you're probably familiar with Welch Village, which is
528. 00:51:33 like a big ski hill. It's like the only thing in the town. And I remember going to visit my grandma,
529. 00:51:39 who took care of my great grandma, and they retrofitted her house so that she could use the
530. 00:51:44 bathroom and take a shower and all that stuff. My grandma took care of her. And every day,
531. 00:51:51 she would go down to down the hill. In this town, there was like two stores, and one of them was a
532. 00:51:59 tavern. And she would go to the tavern at like 1130 every day, and she would play Uker with a
533. 00:52:04 bunch of other old people. And so as I'm reading this story about Lou, I'm like, that is so my grandma
534. 00:52:10 Clara, because I never met my great grandpa. He passed away long before I was born. But that
535. 00:52:16 was like she had so much fun doing that. And I thought that was kind of cool. But then also
536. 00:52:22 later in this story, as he evolves it, and he talks about the assisted living part. He talks
537. 00:52:27 about Shelley, who was Lou's daughter, I believe. And they're looking at assisted living,
538. 00:52:33 lose in assisted living, because he loses some of his independence. And she goes to visit him
539. 00:52:39 and the assisted living at page 104. It says what bothered Shelley most was a little curiosity
540. 00:52:44 the staff members seem to have about what Lou cared about in his life, and what he had been forced to
541. 00:52:48 forfeit. So basically, they didn't even care that he really got a lot of life out of playing
542. 00:52:53 crib vision going to the library. And they didn't try to replace those things. You know, just you're
543. 00:52:58 here, you're on our terms. They didn't recognize their ignorance in this regard. They might have
544. 00:53:03 called the service they provided assisted living, but no one seemed to think it was their job to
545. 00:53:06 actually assist him with living to figure out how to sustain the connections and the joys that most
546. 00:53:12 mattered to him. Their attitude seemed to result from incomprehension rather than cruelty. But as
547. 00:53:18 Tolstoy would have said, what's the difference in the end? Like, that's a really convicting
548. 00:53:22 paragraph. And I think that accurately describes a lot of assisted living situations again, not all.
549. 00:53:29 Yes. Okay. But I don't know, just one of these instances is enough for me to say like, that's wrong.
550. 00:53:37 And then we need to fix it. And it reminds me also of a story with Rachel's mom,
551. 00:53:43 because really, what is the point of assisted living? Is it health and safety? Or is it like he
552. 00:53:49 talks about in page 104? Is it to assist in actual living? Rachel's mom was working, she was doing
553. 00:53:56 childcare, I think at a church, and she heard her back on the job. They were being kind of dumb
554. 00:54:01 about the workman's comp stuff. She needed to have back surgery, and she was living in a
555. 00:54:06 downstairs apartment at the time. So we were like, this isn't going to work. You just come stay with
556. 00:54:12 us and stay as long as you need. So she had the surgery, we have a ranch house. So she moved into
557. 00:54:18 one of the bedrooms on the main floor. And she not only healed up, but she went back to school,
558. 00:54:24 you know, once the workman's comp stuff got figured out. And she's actually graduating this
559. 00:54:28 Saturday with a communications degree. She's got a job all lined up. Yeah, the Boys and Girls Brigade,
560. 00:54:34 like it's awesome. She kind of reinvented herself. But it's encouraging to me to see that because
561. 00:54:41 not to pat ourselves on the back, but I feel like that's the goal with assisted living. And
562. 00:54:49 depending on how old you are, maybe the end goal is a little bit different. But to help people get
563. 00:54:54 back on their feet, or to help people maintain the connections that are going to produce the
564. 00:54:59 quality of life that they want to have, it's not just to keep them safe.
565. 00:55:03 So he gives the history of assisted living here too. Like where that concept comes from. And
566. 00:55:09 again, I'm going to blank on names here, but the gal who basically dreamed this up,
567. 00:55:17 were started to build it, to build it out had a lot to do with her mom. And her mom going into a
568. 00:55:25 nursing home and deciding, no, we're not going to do this. We're going to do something different.
569. 00:55:31 We're going to find a different way to help people in the end of life stages. And it was designed
570. 00:55:38 to help people maintain their own schedule, set their own, you know, if they want to skip their
571. 00:55:45 meds, that's their call. Yeah, that's, you know, that's the thing. Like, as much as we like to say,
572. 00:55:50 well, that's not that's being unwise, that's not being safe. Like you need to help them make sure they,
573. 00:55:55 well, what if they cause side effects that they don't like? And by taking their ability to make
574. 00:56:04 those decisions away from them, you're taking away their will to live at the same time. Yes.
575. 00:56:09 So there's something to be said for allowing people the like, and I'm saying people there just to
576. 00:56:17 kind of separate myself from it to some degree, but allowing people to make their own decisions
577. 00:56:23 and make the calls in their own day to day life, because that gives them the dignity of having
578. 00:56:28 control over themselves and not having it dictated to them like it would in prison.
579. 00:56:34 Yep. So anyway, yeah. So page 89 to speak to the situation you're just discussing, he says,
580. 00:56:42 home is the one place where your own priorities hold way at home. You decide how you spend your
581. 00:56:47 time, how you share your space, how you manage your possessions away from home. You don't. And so
582. 00:56:51 Wilson, I think was the lady's name, she talks to her mom, but well, what does your ideal place
583. 00:56:56 look like? And actually wrote down the list that's small with a little kitchen in the bathroom.
584. 00:57:00 It's going to have her favorite things in it. There's going to be people to help her with things
585. 00:57:04 that she can't do without assistance, but she'd have control. She could adjust the heat, she could
586. 00:57:07 lock the door, et cetera. Like you were saying, if she doesn't want to take her medication, she doesn't
587. 00:57:11 have to. No one would make her get up, turn off her favorite soaps or ruin her clothes. She'd have
588. 00:57:15 privacy when she wanted. She'd be a person living in an apartment rather than a patient in a bed.
589. 00:57:20 So the history of this is that in 1983, Wilson and her husband created this thing called
590. 00:57:24 Part Place, which was assisted living. And over the years, Dr. G
591. 00:57:43 explains the reason that it got this way is because the focus was no longer on
592. 00:57:50 helping Wilson's mother achieve the quality of life that she wanted, but it was focusing on
593. 00:57:54 that health and safety because it's hard to measure Wilson's vision for assisted living.
594. 00:57:58 It's a lot easier to measure health and safety. So that's where the regulations are, and that's
595. 00:58:03 what gets measured. And the thing that I wrote down in response to that was a quote that he has.
596. 00:58:09 He says, "We want autonomy for ourselves and safety for those we love." And I think that applies to
597. 00:58:14 the middle-aged son or daughter who is looking at nursing homes for their parents. And I put as a
598. 00:58:20 comment, "Don't fall into this trap." So like you said, assisted living, it's not all bad. It
599. 00:58:26 actually started out really good. It was a response to something that they saw in nursing homes that
600. 00:58:30 they wanted to fix. But over the years, because health and safety is the thing that is easy to
601. 00:58:35 measure, it's kind of evolved to that point, generally speaking.
602. 00:58:39 I want to talk about Bill Thomas. Can we talk about Bill Thomas?
603. 00:58:42 Yeah. Chapter 5, Bill Thomas, he's an interesting guy. Let me tell you, this was the bright spot in
604. 00:58:48 the entire book for me. I read this whole story twice. Yeah. Because it made me want to throw a party.
605. 00:58:56 So chapter 5 is actually called a better life. And Bill Thomas was actually, he describes,
606. 00:59:03 a doctor, wanted to describe them in the book as more farmer than doctor. He was a homesteader who
607. 00:59:09 started working at a nursing home because of the regular day hours. And while he was there,
608. 00:59:14 he recognized that this isn't a great place. And so he wanted to inject life into the nursing home.
609. 00:59:20 And the director at the time told him, "You're confusing care and treatment," which
610. 00:59:25 maybe we want to unpack that, maybe we don't. I don't know. But anyways, Bill Thomas believed,
611. 00:59:31 yeah. Bill Thomas believed that a good life was one of maximum independence. And so he sought to
612. 00:59:37 fix what he considered the three plagues of nursing homes, boredom, loneliness, and helplessness.
613. 00:59:44 And in this story, they talk about a couple specific things that he did. He proposed right
614. 00:59:51 away two dogs, four cats, and a hundred birds. And he had trouble selling it initially, but once
615. 00:59:58 they got them, they found that the drug costs for the people who were living there fell 38%, and
616. 01:00:03 the death rate fell 15%. And so this brings up this whole idea of individualism versus loyalty to a
617. 01:00:10 cause bigger than yourself because a lot of these people, the highlight of their day was taking care
618. 01:00:14 of their bird or taking the dog for a walk or whatever, like even just something simple, like
619. 01:00:19 caring for an animal, that was enough to infuse purpose behind their existence in that place,
620. 01:00:25 which when you think about it, if it's really that simple, like, what a crime to let people
621. 01:00:32 stay in that place. And that's, again, there's so much nuance to all these different situations.
622. 01:00:37 Everybody's going to be a little bit different, but reading this story, it kind of makes you think,
623. 01:00:41 like, yeah, there is a way out. There are things that you can do.
624. 01:00:44 I just love this story. Like, let's bring animals into a nursing home, and let's bring in a whole
625. 01:00:56 bunch and let them take care of the birds. That just, it just made me smile and made me happy.
626. 01:01:03 And I was kind of dumbfounded by the number of, like, he shared, Bill Thomas shared quite a few
627. 01:01:09 of the results that they had with that. Even so much as there were people who they had never heard
628. 01:01:16 speak before start to ask questions about whether or not they can walk the dogs, or, you know,
629. 01:01:23 and that sort of thing starts to come out. Like, okay, well, there's more of this that's mental
630. 01:01:29 than what we think. It's in our brains more than it is in the physical, in our biology, if you will.
631. 01:01:37 I was thrilled to see this, and it kind of helped me realize that, you know, because I thought about
632. 01:01:45 a number of the elderly folks that I have close relationships with, all of them have animals,
633. 01:01:52 and some degree. It's like, huh, kind of interesting. I don't know if that's related at all, but
634. 01:01:58 it was at least a point that was kind of interesting to me. But I like Bill Thomas. I think he has a
635. 01:02:04 great idea with how to improve the situation. I would be curious to see how it's still going
636. 01:02:10 today after a long-term process. But I've not done my research there. Call me a failure.
637. 01:02:17 That's okay. No. I think really the big takeaway from here, because you spend so, so much up until
638. 01:02:25 this point, talking about the negative atmosphere of these places, it's just injecting some positivity
639. 01:02:30 and some life into them and making you think that it's not as hopeless as maybe it appears up until
640. 01:02:35 this point. So chapter six, it's time to let go, Mike. This is a tough one. Can we skip this one?
641. 01:02:43 Well, I'd like to. Okay. Let's not. Chapter six, just real briefly, there is something that I
642. 01:02:51 want to call it for me. I actually have a ton of notes on this chapter because maybe I'm just
643. 01:02:57 a naive millennial, but I had no idea what hospice really was. I just knew it was something
644. 01:03:03 that when people said it, you kind of, everybody else got real quiet. Like, it was almost like a
645. 01:03:09 bad word. So this is the first time I really understood it. He explained it here. Hospice,
646. 01:03:16 he said, is only available for patients with a life expectancy that's less than six months,
647. 01:03:20 and the goal of hospice is to help people with fatal illnesses have the fullest lives possible
648. 01:03:25 right now. That seems like a really noble goal to me. And I understand why people don't want to talk
649. 01:03:35 about it because it's almost like we're giving up at this point. And actually later on in this
650. 01:03:41 chapter, he talks about a concurrent care program where policyholders with life expectancy of less
651. 01:03:47 than a year were allowed to get hospice, but also still get the treatment. So when they did that,
652. 01:03:54 hospice use jumped from 26% to 70%, but they found that those people visited the emergency room
653. 01:04:00 half as often. And the use of hospitals and ICUs overall drop by more than two thirds.
654. 01:04:05 And overall costs drop by 25%. That's the not attractive part of this chapter that he talks a
655. 01:04:10 lot about is like a lot of the spending that comes with health care, like 25% of Medicare
656. 01:04:17 spending, he said, is on the 5% of patients who are in their final year of their life.
657. 01:04:21 So the point he's making without really making it is maybe we shouldn't spend so much money on
658. 01:04:28 these people who are at the end, which isn't a fun conversation to have. But also the question
659. 01:04:36 in the back of my mind. And again, not trying to make this a religious discussion. But the big
660. 01:04:41 question here and the reason why a lot of people don't want to talk about hospice is like, why are
661. 01:04:45 we so afraid of death? This is a natural transition. Everybody is going to go through this. And maybe
662. 01:04:52 if we could, especially if we have something like a concurrent care program, maybe we can,
663. 01:04:57 we can take advantage of this and we can work our way out of this, just the fact that we have
664. 01:05:01 this support system, that means that we end up living a lot longer than we would have otherwise.
665. 01:05:06 Another point he makes here is that doctors typically overestimate how long people live.
666. 01:05:13 Out of 50 patients, they said 63% were overestimated, only 17% were underestimated. But the ones that
667. 01:05:20 were overestimated, their average estimate was 530% too high. So I don't know, there's just so
668. 01:05:27 much information and so much facts here that say like the best thing to do here is to provide
669. 01:05:33 the hospice care to have your best life now. But also don't say we're pulling the plug and
670. 01:05:40 continue to offer the care. Like going back to Mr. Lazarov at the beginning, you give me every
671. 01:05:45 chance that I've got. Reading this chapter really struck me that you shouldn't have to,
672. 01:05:52 by saying yes to hospice care, that shouldn't be the concession that we're not going to give
673. 01:05:57 you every chance that you've got. Well, I work on church staff. Well, I'm on my way out of working
674. 01:06:04 on church staff. So that's one of the side effects of me joining our company. But part of those
675. 01:06:11 conversations on our weekly staff meetings have been, there's a time when we pray for
676. 01:06:16 our church body and those who have requested prayer. So we have a whole prayer request process that
677. 01:06:22 that they go through, which can sound kind of cold, but it's really quite endearing and it's
678. 01:06:29 been a big part of our church. So it's common for the church staff to be talking about folks who
679. 01:06:37 just learned the head cancer or they fell and now they're under hospice care or you know,
680. 01:06:44 this person had to move into a nursing home. But I feel like whenever the term hospice is thrown
681. 01:06:52 out, at least my experience firsthand with it is that we're not necessarily afraid to talk about it
682. 01:06:59 as much as we are realizing that that means we need to go see them or go help in some way.
683. 01:07:07 So it hasn't necessarily been a kind of a scary thing. It's more of a call to action of sorts,
684. 01:07:14 which is probably the way it should be. But so I can't say that I can't say that I share that
685. 01:07:22 reaction, Mike, where you hear the term hospice and you're a little bit afraid of it or don't
686. 01:07:26 want to talk about it. I can't say that we'd operate that way. It might just maybe that's just
687. 01:07:31 subcultures of areas and such regional thing. I don't know, but at least that's been my reaction
688. 01:07:38 to it. Yeah, and that's that's completely fair. That probably is the right reaction. And really,
689. 01:07:42 it's the result of normalization of the conversation. Like I said, my grandparents passed away when I
690. 01:07:49 was quite a bit younger. And so I remember hearing the word thrown around, but also I remember
691. 01:07:54 more seeing the reaction on my mom and dad's faces and my aunt and uncle's faces whenever it was,
692. 01:08:01 you know, it's just like something you didn't want to talk about. And so again, I'm probably a naive
693. 01:08:07 millennial when it comes to this stuff. But like when he explained it in this book, it was kind of
694. 01:08:11 like, well, yeah, this is the right approach. This concurrent care program where it's not just
695. 01:08:16 where you have to make the decision between hospice or having the surgery, giving you the person
696. 01:08:22 every chance that they've got be willing to do both. And it sounds on the surface like doing
697. 01:08:29 both. Maybe that's more expensive. But although the research shows that it's actually quite a
698. 01:08:32 bit less expensive from if that really is the concern. And again, like that's making it
699. 01:08:37 cold and based on a money decision instead of a person decision. But right, that's how insurance
700. 01:08:43 companies probably would look at the situation. Again, I'm not qualified to speak to this, but
701. 01:08:47 that's just the reaction that I had. The other thing here is the breakpoint discussions.
702. 01:08:52 So this comes from a story about Susan Block and her dad. And her dad needed to have surgery.
703. 01:09:01 Basically, there was surgery and there was some complications with his spine, I think.
704. 01:09:06 And she had to make a decision about whether to send him back in for surgery. And they had had
705. 01:09:10 this breakpoint discussion, they call it, to sort out when to stop fighting for time and when to
706. 01:09:15 start fighting for something else. That's how Dr. Gawande describes it before they went in for
707. 01:09:20 the surgery. And her dad said, "If I'm able to watch football and eat chocolate ice cream,
708. 01:09:24 keep me alive." Which I love, by the way. I love that that was so clear cut to him.
709. 01:09:30 Yeah. And it sounds maybe too simple or maybe it sounds, I don't know, like,
710. 01:09:36 that's not real. But the story goes that complications in the surgery, Dr. comes out,
711. 01:09:43 she's got to decide, she's got three minutes to decide about going back in for surgery on his spine.
712. 01:09:48 And because they had that conversation, she's able to ask the doctor if it's successful,
713. 01:09:52 "Is he going to be able to watch football and eat chocolate ice cream?" And so, yep, easy
714. 01:09:56 decision. They go back in, they do the surgery, and he ends up living another 10 years and he
715. 01:10:00 writes two more books. So not only was he able to watch football and eat chocolate ice cream,
716. 01:10:05 he was able to write and do basically what he had been doing, what his life was all about,
717. 01:10:10 up until that point. Which is awesome. But just taking the time to think that through,
718. 01:10:15 I think that's a really powerful point. Yes. And at the same time, that particular
719. 01:10:20 conversation is one that Dr. Gawande brings up with his dad. Because it's about this point in the
720. 01:10:30 book where he starts to talk about his own personal experience with his father. And his father's decline
721. 01:10:37 because of some health issues as well. So he posed that question to his dad and he's like,
722. 01:10:45 "Well, that wouldn't be enough for me. Ice cream and football, I have no interest in football.
723. 01:10:50 It's not a thing I'm going to do." But at least sparked the conversation that they needed to have,
724. 01:10:56 which is exactly what the next chapter is about my hard conversations.
725. 01:10:59 True. So there's a couple things from this chapter, but really I want to spend a big part
726. 01:11:07 of this chapter talking about patch atoms. So there's three different types of relationships
727. 01:11:15 between doctor and patient that he talks about in this section. There's paternalistic where the
728. 01:11:20 doctors are the medical authorities aiming to ensure patients receive what they consider best.
729. 01:11:25 The doctor makes all the critical choices. Take the red pill. Then there's informative,
730. 01:11:30 which is the opposite. Doctors share the facts and figures the rest is up to you. So the doctor
731. 01:11:34 is the technical expert, the patient's the consumer. And this is the more common way he says,
732. 01:11:38 "Here's what the red pill does. Here's what the blue pill does. You decide." But he argues that
733. 01:11:42 the ideal one is called interpretive. It's in between where the doctor helps the patient determine
734. 01:11:46 what they want. And only when the doctor knows these answers can they say whether you should have
735. 01:11:50 the red bill or blue pill. It's kind of a shared decision-making process. And as he was going through
736. 01:11:57 this, I texted you because I was thinking about the movie patch atoms, which I hadn't watched in
737. 01:12:05 a really long time. But I remembered the doctor at the beginning of that movie when he checks himself
738. 01:12:11 into the medical or the mental hospital. And he's talking to
739. 01:12:20 him and the doctor's not even listening. He's totally the paternalistic guy. He's like,
740. 01:12:24 "I'm the one who can make the decisions about whether you're cured and you can live independently
741. 01:12:30 or not." And I went back and watched the movie. I asked you if you would do it too, and maybe we
742. 01:12:37 could share some insights from this because I was pretty amazed after I watched it how much of an
743. 01:12:44 emotional impact that movie had on me after reading this book. And again, this is totally Hollywood,
744. 01:12:51 so I'm sure that you could nitpick a bunch of stuff in here. But there's some really profound
745. 01:12:58 things I think that happened here. When he's checking himself into the psych ward and he's
746. 01:13:02 talking, he's narrating through all of the things that are going through in his head,
747. 01:13:07 that felt a lot to me like the description of what people go through before they enter a nursing home.
748. 01:13:14 And then even once he gets in there, they say, "Wake up as at 7am," and they lock the door behind
749. 01:13:18 him. The doctor doesn't listen. He doesn't really care about the patients. It attaches an image
750. 01:13:27 to it. And again, it's Hollywood. It's a movie, but you see it in a way, I don't know. I saw it
751. 01:13:34 different when I read this, after I read this book, it hit me in a more profound way. And obviously,
752. 01:13:40 the character in that movie, Patch Adams, he's able to just walk out of there and completely
753. 01:13:43 change his life because he gets this revelation that I really want to help people. In fact,
754. 01:13:47 he tells the doctor at one point, "I want to help people." He's like, "That's what I do." He's like,
755. 01:13:50 "Yeah, but you suck at them. You don't even look at people when they're talking to you."
756. 01:13:53 So I don't know. What was your response? When you went back and watched the movie?
757. 01:14:01 Well, I didn't get a chance to actually watch it, but it's only been, I think, two years ago,
758. 01:14:06 since I watched it most recently. So I went and watched a bunch of the trailers and stuff just
759. 01:14:12 to refresh my memory on it because I remember watching it and seeing that as something that
760. 01:14:23 I wished happened more. Now, granted, so it's a Robin Williams movie.
761. 01:14:27 Which, that alone, by the way, knowing what we know now about him committing suicide, like,
762. 01:14:32 "Wow, you go through that movie and you see him going, his character is portraying this internal
763. 01:14:39 struggle later on in the movie. He's contemplating suicide." And you're like, "Wow."
764. 01:14:43 Yep. I had no idea when I watched it the first time.
765. 01:14:47 Yeah. It's bone-chilling when you start thinking through all the nuances that come with it. So,
766. 01:14:57 yeah, it's a fascinating movie. I think if you were to read being mortal and then turn around
767. 01:15:04 and watch it in the way that you just did, Mike, I could definitely see how that could really
768. 01:15:10 almost mess with your head. It does. What? Like, this is, yes, that's exactly what I could
769. 01:15:16 definitely see those reactions. Totally personifies what Dr. Gawande is talking about. In fact,
770. 01:15:22 we just got them talking about the three different types of relationship between doctor and patient.
771. 01:15:26 And the dean, when he first gets into medical school, Robin Williams' character,
772. 01:15:32 he says, "First, do no harm." And that made me ask the question after reading this book, like,
773. 01:15:37 "What is harm?" Yeah. Keeping them alive even though they're miserable, is that harm? Or is it not
774. 01:15:44 doing everything that you can to extend the life of the patient? There's so many questions that
775. 01:15:48 he's struggling with that I did not even realize in the nuance of how that movie was filmed.
776. 01:15:54 He says, "In that same speech, the dean, he says, "We're going to train the humanity out of you."
777. 01:16:00 And I was like, "Wow." Like, Dr. Gawande was just talking about this, how we don't address these
778. 01:16:05 things in the medical system, and we need to change this. And I'm like, "Here's this guy in this
779. 01:16:09 movie who's totally living up to the stereotype that Dr. Gawande just painted in this picture."
780. 01:16:14 Yeah, perfectly too. Like, that's to a T. That is the type of doctor you do not want. But,
781. 01:16:20 you know, that's the way the movie goes. But that's also the exact relationship that Dr. Gawande is
782. 01:16:26 almost warning against. And how, I mean, go back to one of the questions I asked at the very beginning,
783. 01:16:32 is taking a week of treatments to prolong your life by two days better than just taking the
784. 01:16:37 week that you had to spend it with grandkids. You know, that's, is it doing harm to do the treatment
785. 01:16:45 to extend your life by those two days? In that particular case, I would say yes. Right now,
786. 01:16:52 not being in the situation and having zero emotional ties to it right now. Like, that's,
787. 01:16:56 that's the decision I feel like I should make. But trying to think that through from a doctor,
788. 01:17:04 from a training aspect, like when doctors are in school, like, how do you teach that? Like,
789. 01:17:11 that's, that's not simple. I don't think like, you're basically teaching people to be subjective.
790. 01:17:17 Yep. Which brings all kinds of potential messiness with it and how our insurance
791. 01:17:23 company is supposed to deal with that. Exactly. And then when something goes wrong,
792. 01:17:27 whose fault is it? Right. If it's subjective and you did something,
793. 01:17:32 I can totally see how that can haunt you. I can totally see how Dr. Gawande deals with that
794. 01:17:37 nightmare that he described at the beginning of where the corpses of the people who died showed
795. 01:17:41 up at his house. And I remember, when I watched the movie, there's a point in there. So spoiler alert
796. 01:17:46 right now, if you've not watched Patch Adams and you don't want to know how this ends,
797. 01:17:49 turn off the podcast right now. Because there is a point in there where Patch Adams convinces
798. 01:17:55 everybody that is around him that the thing to do is to increase the quality of the patient's life.
799. 01:18:00 So they kind of go and they start their own clinic. It's not really a clinic, but it's just a place
800. 01:18:04 where they can go show care to people who, who need something. Maybe they need a band aid or they
801. 01:18:10 need a, you know, this brain and ankle or whatever. They're not professing to be like a medical
802. 01:18:15 alternative, but they're for all of the people who aren't getting the, the human element of the
803. 01:18:21 care that they want when they go to the hospital. Okay, so there's this guy Larry who walks in and
804. 01:18:26 he makes a call later and he says he needs some help. Okay, so Patch Adams, his character,
805. 01:18:32 falls in love with his other medical student, Corinne, she gets the call and she goes to Larry's
806. 01:18:38 house. Larry ends up, they don't show anything. So it's not brutal or anything, but he ends up
807. 01:18:43 killing her and himself. And Patch Adams that rocks him and he's, he's, he basically walks away from
808. 01:18:50 medical school. He's about to graduate. He's just like, everything I know is wrong. And he's talking
809. 01:18:54 to Truman, who's another medical student. He's like, you can't just walk away from this place.
810. 01:18:58 You're the one who did this. You know, Corinne's death doesn't change anything. Like we still need
811. 01:19:02 to help these people and Patch the struggle when she dies. He's like, I taught her the medicine that
812. 01:19:07 killed her. Oh, the ouch. Twist the knife a little deeper. You know, like I can see where as a,
813. 01:19:14 especially as a doctor, like Dr. Goan day, you're gonna constantly be going back to the lives of the
814. 01:19:19 patients that you have, that you have delivered care to and saying like, have I done everything?
815. 01:19:24 Have I done the right thing? Especially if you don't have any formal training in geriatric care
816. 01:19:29 or whatever the case may be. Geriatric care is one small subset of this, but it's also a point
817. 01:19:34 that stood out to me. He said that they really don't teach this. And this is where the need is.
818. 01:19:39 This is where we're completely unqualified as doctor, Dr. Goanda's words to minister to these
819. 01:19:46 people and to care for their real needs. It's so powerful. Now the movie isn't all negative.
820. 01:19:52 And Zana positive. The dean tries to keep him from getting his medical license. He ends up getting
821. 01:19:59 it. And he delivers this really passionate speech at the end in front of the medical board.
822. 01:20:04 And he says a couple things, which really I thought encapsulated the whole idea behind this book is
823. 01:20:09 that a doctor's mission should be not just to prevent death, but also to improve the quality
824. 01:20:13 of life. If you treat the disease, you win or you lose. If you treat the person, you win every time.
825. 01:20:18 And I thought that was a really powerful idea. I may feel like that encompasses a lot of this book.
826. 01:20:23 Yes. Single handedly. Yep. Exactly. I could not believe after I watched it, how many parallels
827. 01:20:30 I found. Because I did go back and I watched the whole thing. And I was trying to take notes as
828. 01:20:36 I was going through. But a lot of times I just got myself, found myself just sucked into the
829. 01:20:40 emotion of the movie in a way that I never had been before. So I don't know if this is an
830. 01:20:45 interesting topic to you. I definitely recommend that movie, especially after listening to this
831. 01:20:48 podcast. Yeah. Yeah. Give it a new light for sure. Yeah. One more chapter. Okay. You ready?
832. 01:20:58 Courage. I have to admit that whenever I saw the title for this, the only thing that came into my
833. 01:21:04 mind was Phil Schiller on the stage at Apple when they pulled the headphone jack out of the iPhone.
834. 01:21:13 Oh my gosh. I didn't even think about that. I'm glad I did. That was the first thing I came
835. 01:21:17 to mind. I didn't. Wow. I'm sorry. There you go. Easter egg of the day. I'm not sure I can even
836. 01:21:21 talk about this now. Yes. Two kinds of courage. I'll cue you up. How about that?
837. 01:21:29 So the two different kinds of courage that are required in aging and sickness that he outlines
838. 01:21:34 in this chapter are the courage to confront the reality of mortality and the courage to act on
839. 01:21:39 the truth that we find. And I think that's a great way to articulate this. He defines courage as
840. 01:21:45 strength in the face of knowledge of what is to be feared or hoped. Like I said at the beginning,
841. 01:21:50 there is a faith element to this for me which maybe overrides some of this stuff, but not all
842. 01:21:58 of it. And again, I'm not in the situation where I can really say like, "Oh, this is what I would do."
843. 01:22:02 It's way more difficult than that. But this is… I hate this chapter. This is the chapter where he
844. 01:22:11 shares the story of how his dad died. And he obviously has a very close relationship with his
845. 01:22:17 dad and he basically is very detailed. And all of the steps along the way to his father leaving.
846. 01:22:25 And I think it's really sad. It's very emotional. It does raise a very powerful and
847. 01:22:34 interesting question. He does call out in this chapter the fact that like… He's been talking
848. 01:22:40 about, "We don't want to just keep people alive, but there's also the other side of this," which
849. 01:22:44 is not necessarily great either. In fact, in the Netherlands, I believe, like one in 35 people
850. 01:22:50 have an assisted suicide. Like, that's not the right answer either. So he kind of ends it as like,
851. 01:22:56 there's these different ends of the spectrum. What we're shooting for is something in the middle,
852. 01:23:01 but we shouldn't just say we want to keep the person alive. We shouldn't just say we want to
853. 01:23:04 make them happy. But we have to consider all of the information when deciding what is best for the
854. 01:23:11 patient. And by the way, this is really emotional for me too. So I don't know, by the end of this
855. 01:23:16 chapter, you're just in tears. Is that fair to say? Yes. He takes you through the whole process of
856. 01:23:24 his father's death. And he's a very good writer. He's very descriptive. And this is a very emotional
857. 01:23:35 story for him. So he spells it out in a lot of detail. Yes, he talks about courage. He talks about
858. 01:23:42 the courage to confront that you are dying and then the courage to act on it. He talks about how
859. 01:23:50 we have this illusion of control. We feel like we have control over everything all the way up to the
860. 01:23:56 end, but you really don't. You just kind of have to navigate your way through what happens.
861. 01:24:05 Through all of that story, the bulk of the chapters about his father's story,
862. 01:24:09 which means that when you're talking about courage here, he's telling you how they went through
863. 01:24:16 theirs. Yep. Well, through their personal scenario and how his mom fought it.
864. 01:24:22 How his siblings fought it to some degree. And what happened afterwards, what did they do
865. 01:24:33 after his father died? And how did that help them bring closure? It's hard to read this. It really is
866. 01:24:42 because you can't help but think, you know, what would I do in that situation? And you can't help but
867. 01:24:49 wonder, like, if that were me, if I was Dr. Gawande's father in this situation, which was a little
868. 01:24:57 confusing to some degree because his father was a doctor as well. So they would refer to him as
869. 01:25:01 Dr. Gawande to. So it got a little confusing here and there. Right. Over that. But they did a lot
870. 01:25:09 of things right. They did a few things wrong. They will tell you that. But that's what he's
871. 01:25:14 getting at. You feel like you have control over the whole situation. But even though they had
872. 01:25:21 everything done right, they were in the middle of hospice care. They felt like they had a good
873. 01:25:25 handle on everything. Some things happened. You know, his dad made a decision. He was a doctor. So he
874. 01:25:33 was always messing with his own medications. He decided to do something different with his
875. 01:25:37 medications and it caused him to go into some form of shock and it scared his mom. So
876. 01:25:45 she called the hot she called 911. Now, you know, that's what she did. Well, that ended up
877. 01:25:52 causing more pain than it should have. Yeah. What she should have done in that case is called hospice
878. 01:25:56 care and they could have worked through it and everything would have been fine, it seems. If it
879. 01:26:00 didn't want to consider hospice because of the stigma attached to it. Yeah, they didn't want to
880. 01:26:05 do all of that. So it was hard to make those decisions. They had had a lot of these difficult
881. 01:26:13 conversations that we've been talking about. You know, if you're able to have X, Y, and Z, is it
882. 01:26:17 worth continuing life or should we pull the plug? Not a fun conversation. Definitely a hard one to
883. 01:26:22 have, but you have to have in this case the courage to have those conversations and act on it.
884. 01:26:28 That's what he's talking about. And again, they didn't do everything right. They will tell you that
885. 01:26:34 through his father's process. But what he's trying to do and I think he does a very good job
886. 01:26:43 in his story is show just how messy it can be and how hard it can be and how much you feel like
887. 01:26:51 you can control the situation and yet you can't. Yep. And that's what he's getting at is you have
888. 01:26:57 to navigate your way through this in the moment and just make sure that you're constantly talking
889. 01:27:04 about it instead of just making assumptions because how many times did they talk about the
890. 01:27:09 conversations that you had to have and the person who was ill shares with the caretaker what they
891. 01:27:17 would want in an end-of-life situation and it's completely different than what the caretaker was
892. 01:27:24 expecting. Yeah. That just blew ice cream and football really. That's it. You don't ever watch
893. 01:27:30 sports. Why does that? You know, that's what happens. And I think that's really important. It's
894. 01:27:36 hard to get your head around it. It's an emotional process, but it's a vital process. Definitely.
895. 01:27:44 And the last point here, the illusion of control. So there's really like two different
896. 01:27:49 selves that he describes in this last chapter, the experiencing self who endures every moment
897. 01:27:54 equally. And the remembering self who gives almost all the weight of judgment afterwards to two
898. 01:28:00 points in time, the worst moment and the last one. So this kind of gets into maybe predictably
899. 01:28:06 irrational territory or the art of thinking clearly where like you can't trust the way that
900. 01:28:11 you're thinking about things. But the main takeaway here and really the thing that kind of struck me
901. 01:28:17 is that no one ever has control, but we're not helpless either. So maybe rephrase that no one
902. 01:28:23 ever has complete control. So there are things that you can do. There's things that you can do
903. 01:28:27 to influence the quality of your life as you come to the end of your life. But it is something that
904. 01:28:32 everybody deals with and there are no easy answers. And you need to ask the tough questions in order
905. 01:28:37 to figure out what the right situation is for each individual. The last chapter we talked about
906. 01:28:43 the old model where the patient comes to the physician and the physician just tries to fix him
907. 01:28:47 or her. And Dr. Gawande proposes a new model where we figure out how to navigate the end of this
908. 01:28:52 life together. Again, not a fun conversation to have, not a very uplifting read, but I'm very
909. 01:28:57 glad that I read it. I really appreciate Dr. Gawande's perspective. And I feel like he's the
910. 01:29:02 perfect person to have written this. Yeah, I don't know how well it would have come across from anyone
911. 01:29:07 else. So I think it was perfectly done by him. So take his word for it, not ours.
912. 01:29:12 There's that. So we've made our way through the book. You feel better now, Mike? I do.
913. 01:29:19 Until this releases. And then people point out all the dumb things that I said.
914. 01:29:24 Okay, action items. I have one here. Do you have anyone you want to add to this? No, no, I'm not
915. 01:29:33 putting that action item on there. It's not happening for a while. I'm going to attempt to
916. 01:29:38 start this conversation. You let me know how it goes. I don't know that I want to.
917. 01:29:46 It's not one that I'm looking forward to at all. And it may not happen soon either.
918. 01:29:52 This may be something that doesn't happen for a year because I'm not sure.
919. 01:29:57 It's not a thing I think needs to happen over the phone. It means it has to happen in person.
920. 01:30:03 And especially with my parents. Yeah, with my parents, I don't think we don't,
921. 01:30:11 we're not able to connect face to face very often because of the distance between us.
922. 01:30:15 My in-laws, we could probably have that conversation very quickly. But it's one that I at least want
923. 01:30:22 to embark on starting. How do you want us to handle things? I know for example, my mother-in-law
924. 01:30:32 has been telling us for years now, don't put me in a nursing home. I'm coming to live with you.
925. 01:30:36 Like she's been telling us that for a while. So, okay, we've been joking about this for years now.
926. 01:30:43 Let's talk about it. Let's be honest and figure it out. So, I want to at least start that.
927. 01:30:49 Sure. Again, I don't know how it's going to go. I don't know how to report back on it
928. 01:30:52 until it happens. And I may not remember to bring it up once it does happen. But I think it's
929. 01:30:58 worthwhile. Yeah. So, I'm going to attempt it. You're a brave man, Joe Buleg. Yeah, we'll see.
930. 01:31:03 All right. Yeah. No action items for me. I'm styling rating. I almost want to skip this part.
931. 01:31:08 How do you rate a book about end of life care?
932. 01:31:13 So, I'll rate it from a bookworm perspective. And that is based off of the entire history of
933. 01:31:20 bookworm and why we started bookworm. Okay. And I will give this four stars because I feel like
934. 01:31:27 the information that's provided here is great information. I find that there really isn't anything
935. 01:31:32 actionable from this other than having that conversation. And even that's not something that's
936. 01:31:37 going to happen in the next couple years for me. And so, when you think about like, why do we
937. 01:31:43 read books and why do we have bookworm in the format that we have it? Why do we do the follow-up
938. 01:31:48 every week stuff like that? Like, this book really doesn't fit. But it's a good book. I would
939. 01:31:53 recommend that people read it. I was really challenged reading it. It was an emotional read.
940. 01:31:57 It inspired me to go back and watch Patch Adams again. I found myself like really emotional in the
941. 01:32:02 description of like the nursing homes and the assisted living and just deciding been in there.
942. 01:32:08 Like, this is not happening for my parents. But I don't know. I mean, like, I don't know what you
943. 01:32:14 can expect from this book other than having your perspective changed a little bit. I even think,
944. 01:32:19 man's search for meaning was more actionable than someone. Which, obviously, that one is one of
945. 01:32:26 my favorite books of all time. Yeah. This was a really difficult read. It was hard for me to get
946. 01:32:31 through it. But I'm really glad that I read it. I'll just leave it at that. Sure. Well, you can
947. 01:32:37 find excuses around it all you want. But I'm going to give it a 5.0. Which I don't think I've done for
948. 01:32:41 a while. I have a lot of reasons for that. I had a hard time finding really any fault with it
949. 01:32:48 from a book stance. Like, I feel like he covered at least every point around this topic that I
950. 01:32:54 feel like I would want covered. And he did it in a very well thought out in a well-designed way.
951. 01:33:00 You know, per conversations we've had in the past, I feel like the length of this was spot-on.
952. 01:33:07 It's kind of long. But I feel like it needed to be long in this case. Which is kind of weird.
953. 01:33:12 We usually say the other thing. Like, this is way too long. This should have been a blog post. Like,
954. 01:33:16 no, this was almost 270 pages and it needed every one of them. I felt like as much as,
955. 01:33:23 you know, I only have the one action item. It's about the only action item I feel like you could
956. 01:33:28 get out of this. Right. From a broad perspective. I'm sure there's a lot of little stuff that you
957. 01:33:34 could pull from it. But I do think that this is one, and I've recommended this already to a lot of
958. 01:33:40 people. Especially in our church. And I continue to tell people to pick it up. I don't know that I
959. 01:33:47 run across many people that I would say shouldn't read it. Just because I feel like it's been so
960. 01:33:53 important as far as understanding. Because everyone's going to approach this topic at some point.
961. 01:33:58 Sure. Whether it's with relatives, friends, yourself, everyone's going to approach this
962. 01:34:04 at some point. So that means I feel you should have at least thought this through
963. 01:34:12 and to some level or at least be aware of it. That's why I put it at the five. Oh, I think it's
964. 01:34:17 well worth that. It's done very well. And I just, I loved reading it as much as it was hard to read.
965. 01:34:24 I've been a long time since I've cried that much reading a book. The number of times I was reading
966. 01:34:29 this and Becky, my wife would look at me and be like, "You're right over there? Yes, I'm fine.
967. 01:34:34 Leave me alone." Just let me do this. So, yes. So there you go.
968. 01:34:42 Well, I think Five-O is definitely, it's definitely you deserved. A tool or Dr. Gawande is a very,
969. 01:34:52 very good writer. There is tons of personal story in here. There's tons of research. It
970. 01:34:56 checks all the boxes for me, other than, "What am I going to do with this?" And if you were to say,
971. 01:35:02 "Give me the five most influential books that you've ever read that I'm just getting into
972. 01:35:06 productivity. Just getting into self-help because that's typically, I'm just going to go and say,
973. 01:35:11 "That's typically where Bookworm resides." The average person who comes to Bookworm,
974. 01:35:16 they're coming here as a productivity podcast for the most part.
975. 01:35:20 So, looking at if that lends, what are the top five books that I should read?
976. 01:35:24 This isn't going to be on the list, but that doesn't mean that it's not a phenomenal book.
977. 01:35:27 It's totally going to be on that list. Well, think about it this way. A lot of the people
978. 01:35:32 that listen to Bookworm do so because they want the cliff notes versions of the books.
979. 01:35:37 If you listen to this podcast and you don't go read this book, you are a fool. You cannot,
980. 01:35:43 like you said, this book is a perfect length. It's kind of long, but it needs every word that he
981. 01:35:47 uses. I totally agree with that. This is not something that you can skip through.
982. 01:35:52 You can't abbreviate this in any way, shape or form. It's just such a heavy topic. But because of
983. 01:35:58 that, I kind of feel like it doesn't really fit, which is my only knock on this. I'm trying this
984. 01:36:03 just to say, I'm putting it at 4.0 for those reasons, but I completely agree with your 5.0 rating.
985. 01:36:10 And if this is the right thing for you at this season of your life, like absolutely, definitely,
986. 01:36:15 this is the thing that you should pick up and read next. You won't be disappointed. Dr. Gawande,
987. 01:36:19 like I said, he's a phenomenal writer. He's so good. Not just like it's interesting to read him,
988. 01:36:25 which is how some of the books that we read, like Chris Bailey is a great writer because he
989. 01:36:30 keeps you interested. Then there's people like Mahali who you can tell, they're just really,
990. 01:36:34 really smart. Dr. Gawande is both. He's phenomenal. I would not hesitate to read another book by him,
991. 01:36:44 even though this is maybe the first repeat. No, second repeat author we've had in Bookworm history.
992. 01:36:48 Yeah. There's a couple we've done. Yeah. Cool, cool. All right. We can put this one on the shelf.
993. 01:36:53 What's next, Mike? Put the tier-stained pages on my shelf. Yep. Go for it.
994. 01:37:00 So the next one is my number one book of all time, I think, when we did the Bookworm draft.
995. 01:37:05 Yes. And that is The One Thing by Gary Keller and Jay Popison. This one does not have any votes
996. 01:37:10 in the Bookworm Club, but my wife read it recently. Sorry, everybody in the club, my wife's
997. 01:37:15 saying I should go back and revisit this one. I totally agree with it.
998. 01:37:19 For the most part, we are going to go off of those readings every once in a while. I'm going to pull
999. 01:37:25 a Trump card though, and I feel like this is one. It's my favorite book of all time. We've got
1000. 01:37:29 to cover it for Bookworm. It's unbelievable that we haven't done it yet. All right, listeners.
1001. 01:37:33 So you heard it here. Mike's wife trumps you all. I'm sorry. I guess we're going to do the one thing
1002. 01:37:40 next then because of Rachel. Yep, you can blame her totally. I've not read it, so this will be good.
1003. 01:37:47 I should also say that I picked this one now because of my current situation.
1004. 01:37:52 Yeah, I wonder. I feel like this is the right thing at the right time. So selfishly, that's why.
1005. 01:37:59 Yeah, but also going back to the Bookworm library and catalog, I'm kind of ashamed that we don't
1006. 01:38:05 have one on the one thing. So this is an episode that I want to have in the catalog.
1007. 01:38:09 Got it. Well, following the one thing, I have selected Blink by Malcolm Gladwell.
1008. 01:38:16 Yes. I feel like Gladwell is one of these authors that people love or hate, it seems.
1009. 01:38:26 And I feel like we should at least enter that world to some degree. He's got a few books out.
1010. 01:38:33 I selected Blink partially because I already owned it. And partially because I like some of
1011. 01:38:40 the taglines and stuff that come with it, the power of thinking without thinking. So, I don't
1012. 01:38:45 know. I'm just kind of interested in that one specifically. So we'll dive into Gladwell a little
1013. 01:38:49 bit. Cool. Gap books. I've got one and there's a story behind this one, by the way. Oh, stories.
1014. 01:38:57 So I had a Skype call with a Bookworm listener who wanted to talk about the faithless productivity
1015. 01:39:07 stuff that I've got spinning up. And they recommended to me a book called Do More Better by Tim Chally's,
1016. 01:39:15 I believe it's how you say his name. It is a Christian perspective to productivity systems.
1017. 01:39:21 It is a short book. I started it. It's pretty interesting. And I am excited to get through the
1018. 01:39:27 rest of this. I just am like a chapter in, but it gets into a lot of the systems that Matt Perman
1019. 01:39:34 tried to address in what's best next, but it's a really short book. Forget how many pages it is.
1020. 01:39:40 Does it say on Amazon? It's little though. You could probably get through this in a couple of
1021. 01:39:45 hours if you just crank through it. But there's so much stuff in here that there's going to be a
1022. 01:39:50 pretty decent Mind Node file for this. Sure. Sure. Mind Node is now a part of set app, by the way.
1023. 01:39:57 I saw that. So go sign up for set app right now and then go sign up for my newsletter so you
1024. 01:40:01 can get the Mind Node file. No, those are PDFs. Yeah. A huge fan of set app. I've got a gap book
1025. 01:40:09 this time, Mike. I see that. Exciting. A place of my own by Michael Pollan. I'm
1026. 01:40:16 show a hand. Who knows Michael Pollan? I don't know if you raised your hand or not. I'm not raising
1027. 01:40:21 my hand. He has written, says his fourth, third. He's written three or four books. His other ones
1028. 01:40:30 that are more well known as the omnivores dilemma and in defense of food. So he's he's a journalist
1029. 01:40:36 of in the diet world, if you will. He's got another one too. I forget what it is. Cooked,
1030. 01:40:44 I think is what it is. Yeah. I've read all three of those. Yeah. So call me a Michael Pollan fan.
1031. 01:40:49 Anyway, this one came before all of those and it was the tagline on it is the architecture of
1032. 01:40:55 daydreams. He built like his own little room out in the woods so that he could do his writing and
1033. 01:41:02 reading. That's amazing. That's where he wrote one and a half of his books. So he goes through the
1034. 01:41:07 process. He's not a handyman at all. So he goes through the process of how did he learn architecture
1035. 01:41:12 and design and go about building this place, which sounded fascinating to me because I feel like I
1036. 01:41:16 want to build a place like this at some point. Thankfully, my wife doesn't listen to this podcast.
1037. 01:41:21 So she doesn't know that I'm plotting this. So there you go. All right. Cool. So if you want
1038. 01:41:29 to recommend a book, I promise I will look at your recommendations and pick one from the club next
1039. 01:41:33 time until Rachel Trump. Nope, not true. I'm going on the record right now. I'm going to pick a
1040. 01:41:42 listener recommendation for next time. So get your recommendations in. I was recording this,
1041. 01:41:46 by the way, I just recorded through the Bookworm Club. I got connected with Patrick from Knowledge
1042. 01:41:52 Without College podcast. We recorded that yesterday. So I don't know when that's going to go live,
1043. 01:41:56 but that was a fun conversation. And he said he's going to go recommend some books too. So you can
1044. 01:42:02 join Patrick, recommend your books at the at the Bookworm Club, which is club.bookworm.fm.
1045. 01:42:08 You can also get there via the website bookworm.fm/list. Just click the button to recommend a book.
1046. 01:42:14 And you will also see a list of all of the books that we have covered, including Amazon links to
1047. 01:42:21 buy them, which are affiliate links. So if you want to support the podcast, that is one of the ways
1048. 01:42:24 that you can do that. Another way you can support us is with iTunes reviews. We love reading these
1049. 01:42:29 things. They're fun. Yes, we do. I don't care if it's good or bad. I just like reading them. I feel
1050. 01:42:35 like I have to call out one by the way. WebGuy9402 gave it four stars is please add chapter bookmarks.
1051. 01:42:40 Great podcast, but I'd like to be able to skip all the follow ups and jump straight into the book
1052. 01:42:44 discussions, even moving through the book discussions with with chapters will be very helpful. And
1053. 01:42:50 since I started editing the podcast a couple of episodes ago, there are actually chapter bookmarks
1054. 01:42:56 in the episodes. I'm not sure if people have noticed that. So you can skip the follow up
1055. 01:43:01 by clicking the chapter button in your podcast player that supports it. I know not all of them do,
1056. 01:43:06 but I wanted to want to address that. So other people know that there are actually chapter bookmarks
1057. 01:43:11 in the most recent episodes. Why would you skip our follow up? Anyway, I just just gonna throw that
1058. 01:43:19 out there. Maybe there's sick of hearing about you and your meditation practices.
1059. 01:43:24 So here's a good thing to call out. We do read these reviews and sometimes we do act on what you
1060. 01:43:30 say. Yes, we do. I don't think I said quote unquote at all this episode. I was trying to think of a way
1061. 01:43:36 to use it right now. But there's some feedback we'll take and then we'll just do exactly what you
1062. 01:43:43 tell us not to do. But if you have good feedback, we would love to hear it or if it's just something
1063. 01:43:48 you want us to know. That's a really good way to let us know. Another way to jump into the
1064. 01:43:53 conversation around Bookworm is to just join the club club.bookworm.fm. Some fun conversations
1065. 01:43:58 around the episodes and stuff that happen out there. And if you want to share maybe your action
1066. 01:44:03 items and we can follow up with you, no one would skip that. They just wouldn't click it. So,
1067. 01:44:09 you know, you can share your action items on the club as well. If you're looking for some of the
1068. 01:44:13 accountability that Mike and I have through the show and if you don't have someone to do that with,
1069. 01:44:18 the club is a great place to do that. So club.bookworm.fm. Join the podcast book club.
1070. 01:44:24 Submit a review. Help us take down KCRW. And we will talk to you next time when we cover the one
1071. 01:44:29 thing by Gary Keller and Jay Popison.