Podcast appearances and mentions of bob one

On this episode, Aries and Andy talk about Jason Collins and BJ Armstrong, Monkey Man and One Love. Social Media Instagram: @SpearsBergPod Twitter: @SpearsBergPod Facebook: SpearsBergPod Patreon: SpearsBergPod Youtube: SpearsBergPod  Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Robert Lefkowitz shares anecdotes and wisdom from his extraordinary career. This episode delves into the power of storytelling and narratives, building a legacy based on mentorship, overcoming harsh criticism, and using personal values at work. Lefkowitz won the Nobel Prize in Chemistry in 2012 for “for studies of G-protein-coupled receptors.” His memoir is titled “A Funny Thing Happened on the Way to Stockholm”. Today, more than half of all prescription drug sales are of drugs that target either directly or indirectly the receptors discovered by Dr. Lefkowitz and his trainees. If you enjoy the show, please rate it on Spotify. Your rating helps more people like you discover the podcast! Episode Highlights The importance of crafting and telling stories How revising an old story we tell ourselves can pay off professionally Coping with challenges and setbacks Constructively decoding rejection Why learning to say no to career opportunities matters Bob's criteria for making career decisions Advice for making life's most important decisions Bob's first rule of mentoring: tailor it for each and every person How Bob wants to be remembered Bob's view on the greatest unmet wellbeing need at work today "You're coming to turf that's very near and dear to my heart...Both my parents had premature heart attacks. My father died of his fourth heart attack at 63. He had his first one when he was 50. So there were clearly strong genetic factors favoring heart disease in my family...I developed angina and had quadruple bypass surgery. That was 30 years ago, and I'm still here and still kicking. So how did that come to be? Because I, as a cardiologist, paid meticulous attention to risk factors that I can alter. The one I can't alter, of course, is my genetics. But there are lots of others that you can. So in the workplace, if I could focus on two things, one would be the food that people are eating. [Addressing] the vending machines, and the crap that they serve in the cafeteria. So healthier eating. The other is exercise. Okay, I'm a nut about both subjects. So, for most of my career, I would go out, and about noon time with a very close friend of mine who's a faculty member. And we would go for a run at lunchtime. And I wish there were more emphasis on that facilities that were conveniently available, and ways to structure the work day so that people are given breaks to go out and exercise. I think wellness is very, very important. And then of course, you know that there's the whole stress business, which there are various ways to handle. But I think an emphasis on wellness is extremely important. It has been for me, the fact that I'm still here 30 years later, I work full time at 80 [years old]. I'm still full time, and I just renewed my grants for another five years. I'm still at it!" What “working with humans” means to Bob “One of my most closely held core values is human dignity. And to me, one of the most important things about working with people is to show everybody the same level of respect. I don't care if a Nobel laureates coming into my office, or -- I have a great relationship with the guy who picks up the trash every day, he comes in. And I'll say, "Hey, I got some great stuff for you here!" You know, I'll hand in my trash can. I say, "be careful with it!" as I banter with him. I don't care if you're picking up the trash or you're a Nobel Laureate. I want to show you the respect that, to me, every human being deserves. Now there's a balance. One of the things I learned when I was in Hebrew school as a kid that I remember to this day is there was a there's an ancient Jewish texts, called Pirkei Avot, which means Stories of the Fathers. These are sage pieces of advice passed down for centuries and centuries. One of them is attributed to him ancient rabbi whose name was Hillel. Hillel had this saying, it goes something like this. "If I am not for me, who will be for me? If I am only for me, who am I? If not now, when?" And there's huge wisdom in that. But to me the balancing between self-interest because, in the end, you're responsible for yourself. Because, if I'm not for me, who will be for me? But on the other hand, if I'm only for me, then who am I? You got to take care of others. And to me, that's what it's all about.” Resources Read: Bob's profile on Wikipedia and at Duke University's website Read: A Funny Thing Happened on the Way to Stockholm: The Adrenaline-Fueled Adventures of an Accidental Scientist Watch: Bob's Nobel Lecture (slides and transcript also available) Read: about Pirkei Avot For more episodes that give you fresh perspectives and actionable ideas for making working with other humans better for everyone, visit our website at https://en.peoplefocusconsulting.com/resources/podcast/ ©Michael Glazer

Kara and Scott discuss Tesla's Cybertruck, Tucker Carlson's new media company, and a drop in Threads engagement. Also, Bob One's contract has been extended after a rough first year, and SAG-AFTRA President Fran Drescher has him in her crosshairs. Plus, Earth is experiencing its hottest days on record. What does that mean for politics and infrastructure? Then we're joined by Friend of Pivot Ashlee Vance to talk all things space and Elon Musk. You can find Ashlee on Twitter at @ashleevance and can buy his book here. We've got some more listener mail episodes coming your way soon, so send us your questions! Call 855-51-PIVOT or go to nymag.com/pivot. Learn more about your ad choices. Visit podcastchoices.com/adchoices

BRONCO FOCUS EVERY MONDAY-FRIDAY AT 3:45 P.M.: Bob Behler, the voice of Boise State athletics, has a scouting report conversation with Northwestern play-by-play broadcaster Dave Eanet. BSU plays the Big Ten program in a first-round game of the NCAA Tournament on Thursday night in Sacramento.See omnystudio.com/listener for privacy information.

Kara and Scott discuss Elon Musk's latest moves, including letting Former President Trump back onto the Twitter. And Bob 1 has returned to replace Bob 2 at Disney. Also, Elizabeth Holmes was sentenced to over 11 years, and Swifties are coming for Ticketmaster. Then, they're joined by former Waze CEO Noam Bardin to discuss his newest endeavor, Post News, a social network with the goal of paying publishers.Y ou can join Post News here: post.news Send us your questions! Call 855-51-PIVOT or go to nymag.com/pivot. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Episode Summary:  Today, we speak with Poolside Tech's Founder and CEO Bob Doan, Chief Revenue Officer Jennifer Doan, and Chief Technology Officer Stan Reznik.  Poolside Tech provides smart pool automation technology. Their flagship product, The Attendant, actively monitors and maintains all equipment on the pad. It makes operational decisions, improving water quality and sending real time notifications when equipment malfunctions.  Running on the belief that smart pool tech needs to be easy for the homeowner to use first and foremost, The Attendant was developed to hide all “the complexity behind something that is easy to use.”  They also explain how Poolside Tech as a whole provides user-friendly solutions to pool pros and distributors in addition to pool owners and how their product is different from all others on the market today.  Topics Discussed:  01:20 - An introduction to Poolside Tech  09:20 - Transition from Food and Bev industry  13:06 - Developing The Attendant  20:46 - Our guests' frustrations with their personal pools  31:43 - Bob's first interaction with a “real pool guy”  34:05 - Ensuring the application has all the features  41:59 - Amount of iterations to achieve the finished product  46:33 - Hiding complexity behind something easy to use  53:49 - All about The Attendant  59:56 - Solutions Poolside Tech brings  1:09:15 - Kids inspired some of The Attendant's features  1:11:47 - Differences between them and others on the market  1:21:48 - Warranty and being open to feedback  Sponsors:  Skimmer  Leslie's  Primate Pool Tools  Connect with Guest:  Website  Instagram  Facebook  LinkedIn  YouTube  Connect with Pool Chasers:  Website  Instagram  Facebook  Facebook Group  Twitter  YouTube  Patreon  Key Quotes from Episode:  Simplicity: You don't need a tutorial when you use Uber. You just figure it out. ~Jennifer  One of the things that makes us different is trying to learn as much as possible from pool professionals. We've gotten so many great ideas just from talking to pool professionals every day and listening to their pain points. ~Stan  That's the hard part: hiding the complexity behind something that is easy to use. ~Bob  One of our original design goals is to be able to treat every single piece of pool equipment out there as a true first-class citizen without forcing you to pick and choose bundles or families of things that only work together. ~Bob 

Dr. Mac returns for a chat about a couple of discoveries in his Gift Guide adventures: One to look for, and one to look OUT for.

FamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. Approaching Adolescence  Guest:                        Dennis RaineyFrom the series:       Stepping Up (day 3 of 5)  Bob:  One of the key steps a young man will take as he progresses toward courageous, authentic, biblical masculinity is the step where he begins to assume more responsibility.  Here's Dennis Rainey. Dennis:  You know what?  As a young man, get used to stepping up.  Get used to taking on more responsibility because it is the stuff of manhood.  It's why God created you.  Back in Genesis, chapter one, you were designed to reign over the creation and make a living by the sweat of your brow and be a part of God's redemptive work on the planet. Bob:  This is FamilyLife Today for Wednesday, March 9th.  Our host is the President of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  We're going to explore today what has to happen for a young man to move through adolescence and to embrace authentic masculinity.   Welcome to FamilyLife Today.  Thanks for joining us on the Wednesday edition.   We're going to have to start with some definition, maybe, or some discussion here at the beginning.  You've just finished a book that you call Stepping Up, a Call to Courageous Manhood.  You're challenging men to step up.   One of the things you address in this book is the idea that men go through a middle phase, from boyhood to manhood, the phase of adolescence.  You know there are people in the culture today who push back on that whole idea of adolescence and say that's an artificial construct.  Back a hundred years ago there was no such thing as an adolescent.  You just went from boyhood to manhood.  So what do you say to that, huh? Dennis:  Well, they're right.  It wasn't even in the dictionary at the turn of the twentieth century.  In the early nineteen hundreds there were two steps, boyhood and manhood.  There wasn't anything in between.  You stepped up from boyhood to manhood and probably did so at a much earlier age back then than we do today. Bob:  So you'd have teenagers, young men, fifteen, sixteen, seventeen years old getting married, taking jobs…Dennis:  Oh, yeah!  Right. Bob:  …taking responsibilities for families.  The idea that there would be an extended period where you would learn and study and grow and just kind of enjoy life before you got down to the duties and responsibilities of adulthood?  That just didn't exist. Dennis:  It didn't.  In fact there's a guy who wrote a book, Dr. Michael Kimmel, called Guyland.  In it he describes a world where young men live.  He said it's a stage of life, an undefined timespan between adolescence and adulthood that can stretch out for a decade or more.  It's a bunch of places where guys gather to be guys with each other, unhassled by the demands of parents, girlfriends, jobs, kids and other nuisances of adult life.   What he's saying is he actually wants to add another step between adolescence and manhood, one that can go on into the late twenties.  In fact, it's happening! Bob:  Guyhood? Dennis:  Guyland, I guess.  I don't know. Bob:  You get your video game controller and you work a job where you can go home and sit down with the dudes and crack some beers and get out the videogames and have a blast. Dennis:  Yeah.  In fact, listen to this statement that Dr. Kimmel concludes with.  He says, “In this topsy turvy Peter Pan mindset, young men shirk the responsibilities of adulthood and remain fixated on the trappings of boyhood while the boys they still are struggle heroically to prove that they are real men, despite all the evidence to the contrary.” Bob:  Well, he's really just saying that adolescence has been extended in our culture and there's kind of this state of perpetual adolescence.  In fact, again as you've addressed in this book and you've spoken to men, you're calling all of us to step out of what is that inertia that pulls us back into the irresponsibility of adolescence and say “Step up to the responsibility of manhood.” Dennis:  I don't think it's wrong that adolescence ultimately emerged.  I think what has become a trap, however, is when young men are allowed to stay in some in-between world, in between boyhood and manhood for an extended period of time where no one in the culture, no one in their family, no one in their lives, is stepping into their lives and saying, “It's time to grow up.  It's time to assume responsibilities.”   I have to say it's interesting in this culture to watch a bunch of single people, for that matter single men, moving into their thirties delaying marriage with one foot in boyhood, one foot in adolescence.  I think they need some older men in their lives who are on the steps above, looking down at them, and not in an arrogant fashion, but reaching down to them, saying, “Come on up.”   It may be frightening.  It may feel like it is more responsibility, because it is but you need to get out of childhood.  As Paul said in 1 Corinthians, chapter 13, verse 11, “When I was a boy I acted like a boy.  I behaved like a boy.  I spoke like a boy.  But when I grew up I put away childish things.”  We need a generation of young men putting away childish things. Bob:  But you know the messages they're getting in the culture, the messages on TV, from their peer group, the messages in the movies, and even the message of their own flesh, it's not calling them to put away childish things.  It's saying, “This is a time for fun.  Enjoy it!” Dennis: Well, you were a teenage young man one time. Bob:  I was!  I remember! Dennis:  Do you remember it?  I mean, it was totally confusing and life was a lot simpler back then.  But what's happening today I fear, is the older men in the lives of these young men, instead of reaching out with their hand and calling them to step up, they're not challenging them to much of anything.  They've forgotten what it was like. Let me just read to you what I wrote in the book in terms of what teenage boys are facing today.  “A teenage boy's body is changing in strange and foreign ways.”  Think about it!  I mean, hair growing in some unusual places!  What's he supposed to do?  He's starting to think about things he's never thought about before.  All of a sudden, sexual allurement and the mystery of sex becomes powerful.  If you've never been spoken to about this, what's a boy, a young man, going to do with all that? Secondly, he's bombarded with bewildering thoughts and choices about sex and morality.  In other words, when can he have sex?  Now he's thinking about it.  What is appropriate?  If you watch what's on TV, there are no boundaries.   Barbara and I sat at the movies back around Christmas watching previews and there was, and I forget the name of the movie and I'm glad I'm forgetting it here, because I don't want to give it any advertising, but it was all about having sex.  That was the theme of the entire movie.   It was like all these single people were just born for this purpose, to just figure out how to ultimately make out and get in bed with one another.  There was no restraint on passion.  So here are teenage boys coming to a movie like that.  What are they supposed to do with those images? Third, he faces relentless, unbelievable peer pressure, friends encouraging, enticing him to go along with, frankly, barbaric ways.  I mean teenage boys left to go their own route are going to be little barbarians. Next, he battles an emotional upheaval of anger, sometimes rage that he has no idea where it's coming from.  I watched out sons going through this.  Without a strong daddy in their lives, they can be punitive upon a mom. Bob:  They're getting some hormones squirted into their systems that haven't been squirted there before and aggression is a part of what comes with that.  It's got to be directed and it's got to be channeled. Dennis:  Yes.  And in this culture, in addition to all that, he's also has to deal with other people's expectations.  I mean, with all the expectations around the tests they're taking, the college they go to, how well their grades are, it's pressure on pressure on pressure.   The last one is he feels this strong gravitational pull toward independence.  He wants to spin out and away from the family orbit and establish his own authority away from his parent's authority all on his own. Bob:  And that's a good thing, isn't it?   Dennis:  It is. Bob:  …that he wants to do that? Dennis:  It is.  But it is if he's trustworthy, if he's been trained, if he understands how to begin to exercise his own authority. Bob:  If he wants to kind of be in charge of his own universe simply so he can indulge his own fleshy desires then that's a recipe for trouble. Dennis:  It is. Bob:  But if he wants to be out on his own so that he can subdue the earth and fulfill it as the biblical mandate calls him to do, then that's a good thing. Dennis:  Yes.  But just pull back for a second and think as a parent. Here's a young man that you're observing that has this wash of chemicals and hormones surging through his system, all these outside forces impacting him.  He's spinning off to his own orbit and two things can happen with parents.  One, I call the push back and the other is what I call the pull out.   The push back is when a young man begins to push back against his parents, specifically his father, and the father lets him.  He lets him push him back and push him out of his life so that the father is not in there helping him navigate uncharted waters.   The second area is the pull out.  Some parents just get busy and it's a hassle to engage your teenagers.  The easiest thing to do, again, is nothing.  So a dad can pull out of his son's life, in my opinion, at one of the most dangerous, most important times, when a young man needs an older man, in his entire life. Bob:  So ideally, as I hear you describing all of this, I'm thinking to myself ideally you want to get a son from boyhood to manhood kind of as quickly as possible, get him  through the adolescent rapids as quickly as you can? Dennis: Well, you know, you really understand why back at the turn of the twentieth century, why they got married and started their own families.  These young men had to step up and had to assume the responsibilities of a man.  They were given no other choices.  The problem is we've built an entertainment culture appealing to these teenagers, enticing them to stay in this phase well into their twenties. Bob:  A lot of the young men at the turn of the century weren't in school after the seventh or the eighth grade.  Now they're in school to college and beyond and their only responsibility is to study. There's no job.  There's no work.  All of a sudden you've got all this free time.  I mean, I remember when I was a student thinking, “Boy, I've got no free time.”  Well, I'd go back and trade, you know? Dennis:  No doubt. Bob:  …because you've got all kinds of time.  If there's no direct responsibility attached to that, that's a recipe for mischief. Dennis:  You know, Bob, my boys at this point would cringe because they know exactly what I'm about to say.  When they entered that phase I would look at them and I said, “You have the least amount of responsibility you will have for the rest of your life.”  But the idea there is that, you know what, as a young man, get used to stepping up.  Get used to taking on more responsibility because it is the stuff of manhood.   It is why God created you.  Back in Genesis, chapter 1, you were designed by God to rule.  You were designed to reign over the creation and make a living by the sweat of your brow and be a part of God's redemptive work on the planet.   Probably the best illustration I have of what the teenage years look like and the assignment of a father during those years, used to occur as I completed my sixth grade Sunday school class.  Now this was a class I used to teach.  I had seventy, seventy-five young people in that class so it wasn't just to the boys.  But I would always use a boy to illustrate the last principle. Bob:   Now this was seventy twelve year olds? Dennis:  Yes, eleven and twelve year olds. Bob:  Oh my goodness.  Alright… Dennis:  What I did in that class was I used to call it the traps of adolescence.  So I had a bear trap that represented sexual immorality.  I had smaller traps that represented drugs and alcohol and pornography, other traps that represented peer pressure.  I had a dozen traps that were illustrated.   For the last session I had all the traps set on the floor.  It's a miracle, Bob, that in all the years I taught this I never once caught a kid.  They never once stepped in any of those traps!  I was relieved! Bob:  It was a miracle that the Fish and Game people didn't come in and shut down your Sunday school class! Dennis:  No doubt about it. But I had all these traps and kids knew what those traps stood for.  So I took a young man on the other side of the traps, on the other side of the rooms, and he could see the traps in front of him, and I blindfolded him.  Then I said, “I want you to take off your shoes.”   And on the other side of the room, with the traps in between us and the young lad, was his father.  I instructed the father in what they were supposed to do.  I would say to the young man, “On the count of three I want you to come to your father and to me.  It's representing going through adolescence all the way to adulthood.” Bob:  So come barefoot through the traps with blindfolds on? Dennis:  Right!  Exactly!  And I would say, “One.  Two.”  And the father would interrupt me every time and say, “Hold it son.  Don't' take a step!”   He would walk over, around the traps, would go over and whisper to his son, “I want you to stick your hands on the back of my shoulders and I want you to scoot along and follow me very closely because we are going in between these traps.   So the father would begin scooting through those traps, all of this taking place in front of seventy-five young people about to encounter these traps and the parents who were about to raise them.  They were in the room too because this was graduation.   The father and the young man, closely behind him, would make it through to the other side and the class always began to applaud and clap and cheer as they finished it and the young man took his blindfold off and gave his father a hug.   That's a picture of what adolescence was meant to look like--a father in the midst of doing life with his son, in the midst of the traps.  First and foremost, staying out of the traps himself. Bob:  Right. Dennis:  And then calling his son to step up and away from the traps and to step with him toward manhood.   What is missing today are the fathers walking around the traps and then sticking with it all the way through the next five, six, seven years.  It's not a matter of having one birds and bees conversation with a thirteen year old boy.  It's a matter of talking with him as you're watching a football game and a commercial comes on and you tell him to look away.   It's a matter of talking about the movies he goes to and having boundaries in his life.  It's a matter of training him to know how to deal with the opposite sex and honor a young ladies' femininity by keeping his hands off of her body.   Young men today, more than ever, need a daddy, a daddy who is on the manhood step facing upwards, who knows who he is as a man, who's not dabbling in pornography himself, so he can reach down to his son and say, “Let's go.  Come on.  Follow me as I follow Jesus Christ.” Bob:  The dads who are there and who can't reach back because they're got one foot still stuck in adolescence themselves?  How do they get unstuck? Dennis:  As we've talked here Bob, we've created a picture of five steps, a step going upwards from boyhood to adolescence, from adolescence to manhood, manhood to mentor, and, the ultimate step and most noble call for a man, that of being a patriarch.   We also created an image that a man can find himself with one foot on the manhood step and one foot on the lower step of adolescence, standing sideways.  When a man finds himself standing sideways, he has to realize a couple of things.   Number one, his own life is in peril.  Number two, the kind of model he is leaving for his son, and for that matter the rest of his family, is not a good one.  And third, he needs to realize that from time to time all of us make foolish decisions.   All of us step down and we have to turn our back, that's call repentance in the Bible, we have to turn our back on selfishness and on sin and turn away from it and turn upward toward Jesus Christ and the scriptures and being obedient to what God has called him to do.  So I wish it was a simple matter of just turning away from evil one time and stepping up.  But it's never just that.   I mean, it occurs as we walk in the middle of an airport and you look over in the magazine stand.  I don't ask to see those pictures.  I don't ask to have those magazines faced outward to me, thirty feet away, not even going into the book store that's in the airport.  But they're there and they can be a temptation and they can call a man away from what he knows is right to becoming a doorway through which sin can gain entrance, not only to his own life, but also to his son's. There's a warning in scripture that the sin of one generation will be passed down to four generations.  To me that's a frightening thought, that my life would be used to pass on sin rather than righteousness to my descendants. Bob:  If a dad is going to lead his son through the phase of adolescence to manhood, the dad's got to have a pretty secure standing on the manhood step himself. Dennis:  He'd better keep short accounts with God.  All of us make mistakes.  I've shared many of them here on FamilyLife Today.  I run into listeners all around the country who says, “You know what?  We appreciate the no baloney approach to the Christian faith and to real life as we all live it.”   I've shared about cutting down trees in front of my own son.  And I've shared to repenting of cutting down a tree that wasn't on my property and calling the owner of that tree and confessing my sin and offering to pay restitution in front of my son.  Now that's no fun.  But you know what?  It's a part of showing our sons where to find life. Proverbs 4:23 says, “Guard your heart for from it flow the wellsprings of life.”  My heart is a precious thing for life in terms of it beating right now.  It's also a precious thing, if I understand the scriptures, spiritually,  for me to continue to guard my heart so that I might be a source of life, that my life might be a spring that would come from my life to my wife, to my sons, to my daughters, and to those that I impact and influence.  That's a great picture for any man standing on the manhood step.  There needs to be a stream of water influencing all those around him. Bob:  I think it's helpful, and this is one of the things you do so well in the book, men need to see that the essence of authentic manhood involves sacrifice, involves laying down your life, giving your life away for others.  It's not about being a man for yourself.  It's about being a man for others and dying to self. That's what's at the heart of authentic manhood.   I want to encourage listeners to get a copy of this new book.  Again, it's called Stepping Up—A Call to Courageous Manhood.  This week we want to send it to you.  All we're asking you is that you make a donation to help support the ministry.  When you do, we're happy to send you a copy of Dennis's brand new book.   If you're donating on line at FamilyLifeToday.com, when you open up the donation form there's a key code box there.  Just type “STEPUP” in the key code box and we'll know to send you a copy of Dennis's book.   Or call 1-800-FLToday and make a donation over the phone.  Again, just ask for a copy of Dennis' book when you do. Right now the only place the book is available is here at FamilyLife so, if you want to get a copy, go online or call us and make a donation.  If you're interested in multiple copies of the book, those are available for purchase as well.  I know there are a lot of men's groups that are going to look at doing a book like this for a men's study.  So if you want to get multiple copies, contact us, again, online at FamilyLifeToday.com or when you call 1-800-“F” as in family, “L” as in life, and then the word “Today.” Now tomorrow we're going to talk about what authentic, mature masculinity looks like.  What are some of the characteristics of someone who has stepped up to manhood?  We'll talk about that tomorrow. I hope you can be with us for that. I want to thank our engineer today, Keith Lynch, and our entire broadcast production team.  On behalf of our host, Dennis Rainey, I'm Bob Lepine.  We will see you back tomorrow for another edition of FamilyLife Today.   FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas.  Help for today.  Hope for tomorrow. We are so happy to provide these transcripts. However, there is a cost to produce them for our website. If you've benefited from the broadcast transcripts, would you consider f to help defray the costs?2011 Copyright © FamilyLife. All rights reserved. www.FamilyLife.com 

Dr. Bob's patient, Bill Andrews had ALS and was terminally ill. Before Bill decided to exercise his right to die in California, he agreed to do this interview to help others understand the importance of the law and his decision.     Transcript Dr. Bob:  Hi everybody. I'm here today on the phone with a gentleman who I'm really interested in having everybody hear from and meet. It's kind of a unique opportunity on all counts to hear from a gentleman who has lived life very fully, really did a lot of things that many people only dream about doing in his life and before he was able to really see that life through, was afflicted by a disease that has no cure and is universally debilitating and in many cases fatal. He's become a patient and a friend and I've had an opportunity to really be amazed by his story and by his outlook and approach, both himself and his family. We only have a brief opportunity to hear from and learn from Bill because, well, you'll find out why in just a bit. I'd love to introduce William Bill Andrews. Bill, say hello to our listeners. Bill Andrews: Hello listeners. Dr. Bob: Thanks. Bill Andrews: This is Bill Andrews reporting in. Dr. Bob: Thank you, Bill. Thank you so much for being here. Bill, who's with you? You have a couple of your sons with you as well. Can we introduce them? Bill Andrews: Yes. I'm with my oldest son, Brian, and my youngest son, Chris. Dr. Bob: All right, and thank you guys for Bill Andrews: They can say hello, I guess. Brian: Hello. Dr. Bob: All righty. Sounds good. As I mentioned, Bill is a 73-year-old gentleman with ALS. Bill, how long have you had ALS? Bill Andrews: I'm going to say probably about—I'm going to guess about two years. Dr. Bob: Okay. Bill Andrews: I was diagnosed about what, a year and a half ago, Brian? Brian: One year ago. Bill Andrews: One year ago. Then it was very obvious that there was something seriously wrong. The precursor to this is I had broken my back. I used to motocross and do a lot of surfing and stuff and I had many, many ... I brought injuries into the ALS experience. Broken back. Oh, just all kinds of stuff, so when I finally couldn't deal with the kind of the day-to-day life of my current injuries and stuff, that's when I really got [inaudible 00:02:51 ALS because I couldn't stand up. I could barely walk. I was still trying to surf, like an idiot, but it became very difficult. Just a year and a half ago I was in Peru surfing. Dr. Bob: Wow, but you knew something was going on? You had already Bill Andrews: I knew something was going on. Dr. Bob: Okay. Bill Andrews: I knew something serious was going on. Dr. Bob: Then a year ago it was officially diagnosed and then what's Bill Andrews: Correct. Dr. Bob: What are things like today? Bill Andrews: Horrible. I'm in bed. I get fed. I wear diapers. I'm kind of confined to my bed. We have a Hurley lift, I'm going to guess that thing is called. Dr. Bob: A Hoyer lift. Bill Andrews: Hoyer lift, and I just get into that and I have an electric wheelchair. Last weekend I was able to get out and see my kids play some sports and stuff, but that's about it. This is where I live now. At Silvergate, room 1-1-3 in my hospital bed. Dr. Bob: Wow, and a year and a half ago you were surfing in Peru? Bill Andrews: When was it? Brian: Yeah. It was a year and a half ago. Yeah. Yeah. Bill was surfing in Peru. Bill Andrews: But I knew there was something wrong, you know? I was struggling. Dr. Bob: Mm-hmm (affirmative). Bill Andrews: Really mightily. Dr. Bob: Yeah. As far as you are aware, and you've been dealing with this and obviously researching being treated. You've been in the system. Bill Andrews: Correct. Dr. Bob: Everybody, the best that medical care has to offer has been offered to you, I'm assuming. Bill Andrews: Correct. Dr. Bob: Here you are in this situation. What is your understanding of what will happen if things just are allowed to go on as they would normally? Bill Andrews: Well, as I understand it, I will not be able to swallow my food chew my food, swallow my food. Nor be able to breathe on my own, as I understand it. Dr. Bob: Right. Which is correct. I mean, the timeframe for those things is unclear. Bill Andrews: Right. Dr. Bob: Have the doctors given you any estimates? Bill Andrews: No. That's a moving target. No, they haven't. No. Uh-uh (negative). Dr. Bob: Okay, but that's inevitable for every person who has amyotrophic lateral sclerosis. Bill Andrews: I haven't heard of anything yet. I tell people, you know, I'd guess ... Because I have some friends that say, “Well, look, Bill, a cure may be right around the corner. You know, just stay in bed and they'll invent a cure and you're going to be fine." Well, that ain't going to happen. In my lifetime anyway. I don't want to go out with the tube in me and all that stuff. I feel at least now I'm reasonably good mentally and this is kind of where  I'm at a good point right now. Spiritually, emotionally, physically. Dr. Bob: Great. Bill Andrews: That's where I am. Dr. Bob: That's where you are. Bill Andrews: Yep. Dr. Bob: What's your game plan? You want to talk about the strategy and what's been happening? Bill Andrews: Well, my game plan is—well, for the last couple of weeks I've been trying to wrap up a lot of little-unfinished tasks and chores that I wanted to complete, little projects, but I think they're doing just fine. I think my family ... I guess the big thing for me is that my family, that we're all on the same page. That to me was crucial. That we all understood what I was doing and why I was doing it and that this was all my choice. Looking at what the options are and for me, an option is not being confined to my bed the rest of my life and being kept alive. I don't want to be a Stephen Hawking, and another thing that I wanted to really pass on to my kids is that I'm not fighting the battle, I'm just kind of lying here. I'm getting taken care of. This ain't a bad ... You know, if you like getting taken care of, this ain't bad. I get my diapers changed, get fed, get dessert. People run errands for me, but the warriors are like my kids and the caregivers and the doctors like you are. You guys are the warriors. I'm just a ... You know, you're the warriors and right now I'm just kind of a settler. I just got to lie here but you guys are out there doing the battle. Dr. Bob: What an incredibly refreshing perspective to have. You know? You're not feeling like a victim like so many people justifiably do. You know, you're seeing it from so many different angles, not just your own. Not only through your own eyes, which is remarkable, I think. Bill Andrews: Oh, thank you. Well, yeah. About 30-something years ago I was diagnosed with a real, pretty bad case of malignant melanoma and I was only given a few months to live at that time. That was about 30-something years ago. My kids were there when I was diagnosed and everything, so I've already fought that battle. I had the tumor taken out of my arm. Had my lymph nodes excised. I fought that battle because I could see there's was a way to win that one, so there I kind of feel like I was a warrior, but here, ah, you guys are. Dr. Bob: Mm-hmm (affirmative). That battle, the melanoma battle, I've seen how that turns out in most cases, which is not the way it turned out for you. It was, at least back then - Bill Andrews: No, I was bad with the - Dr. Bob: You were well aware of that. I know. Bill Andrews: I was very, very lucky. Yeah, I was very lucky. In fact, kind of going a little off track, at the time I had it they were experimenting with BCG injections. Dr. Bob: Mm-hmm (affirmative). Bill Andrews: Up at UCLA. They were going to inject BCG in the initial site of the tumor for melanoma. Dr. Bob: Mm-hmm (affirmative). Bill Andrews: I sent my path report up to them and they rejected me because the path report looked so bad, that I probably was going to die. They didn't want that on the report. Dr. Bob: Wow. Bill Andrews: I kind of fought that one out anyway. Dr. Bob: Yeah. Bill Andrews: Flipped a little bit. Dr. Bob: You faced your mortality, right? You had no choice but to face your mortality at that point. Bill Andrews: Correct. Dr. Bob: You were what? Bill Andrews: Oh, there is no choice. Dr. Bob: Yeah. You were in your 40's? Bill Andrews: Yeah. Absolutely. Dr. Bob: With children that were young. Right? Bill Andrews: Right. Correct. Dr. Bob: Certainly not grown adults. Bill Andrews: They were there in the doctor's office with me, yeah. Dr. Bob: Yeah. Bill Andrews: Right. Dr. Bob: I think you were sort of alluding to this and assuming that, maybe assuming that some of the people out there who are listening know what we're talking about.  But I don't think we actually discussed what the option is that you are taking to handle things the way that you feel best. Can you share a bit, share that? Bill Andrews: Sure. I, you know, kind of put a box on the board. I'll kind of equate this back to my melanoma. With the melanoma, I was given ... The doctors said, "Well, you kind of have three choices. 1: You do nothing because it appears to be fairly advanced melanoma and just see what happens. 2: You look for some miracle cure somewhere. Go to Haiti or somewhere and find a miracle cure. Or 3: Let conventional medicine dig in, and I took the third choice and I'm still here. With the ALS the choices seem to be kind of the same. I can just sit back here and wait until I can no longer breathe or eat. Or I can be kept alive by breathing tubes and feeding tubes and stuff. Or I can do with this choice that I'm making now, which is to go through the end of life in a peaceful happy way with ... I mean, I feel good about this, doctor, I really do. As long as my family's on board with me it's spectacular. I really don't think there's ... The choice for me, and this is easy, you know. This is the time and I'm not going to be kept alive. I watched a Stephen Hawking film on TV years ago and there was a lot of recrimination and stuff about, anger and stuff, by keeping him alive and I don't want that to happen with my family. Nor do I want it to cost eight trillion dollars to keep me alive. There're  factors that went into my decision. Dr. Bob: Many factors and the decision is still being made every day. Bill Andrews: Every day. Every single day, Doctor. Dr. Bob: Yeah. Bill Andrews: Yeah. Dr. Bob: For clarification, Bill is exercising his legal right in California to go through the end of life option act. To receive Aid in Dying, which means that he's made requests of his physician, who's me in this case, to prescribe a medication that will allow him to end his life if he chooses to take it on his terms at the time and place of his choosing. A second doctor who knows him well has concurred that Bill is of sound mind and has a condition that's terminal. Bill has submitted a written request saying basically the same thing. Four days from the date of this recording, Bill's plan is to get this prescription filled and take this medication with his family around him, his loved ones, and he will peacefully, quickly, and in a very dignified way, stop breathing and die. As I said, Bill's making this choice each day because there's no requirement. He doesn't need to take the medication. He can choose at any time not to, and it's just fascinating to be having a conversation with a man who has the presence of mind, the courage, the support from his family, and knows that there's a very good chance and in his mind an absolute chance, that his life will be ending in four days. I am completely honored and awed to be able to have this really frank conversation with you about what you're thinking and feeling and I remember our last conversation you just kind of blew me away when you told me that you're excited. This whole thing is in some way exciting to you. Are you still feeling that way? Bill Andrews: Oh, absolutely. No, this is a ... No. We're, you know we're ... You, I mean… It's great talking. Let me just kind of preface. You have this really kind way of speaking that most of my other doctors haven't had quite the effect on me that you have. Yeah, I'm enjoying this. I've kind of been a pioneer in a lot of things and this is just ... I'm really enjoying this and let me tell you, Doctor, the thing that's the most incredible thing to me, and this is more of a, really a spiritual and emotional thing, is being able to choose when you're going to die. I've always thought if I were to die the most noble way, for me, would be to be protecting my family, my loved ones, or even a dog in the street or something. If I were going to die, would be doing, I guess maybe doing good, but you never know when it's going to hit, but with this, I get to say the goodbyes. I get to do whatever unfinished business. I get to finish any unfinished business and it's unreal, kind of. Very interesting. I think this can do a lot of good. I was telling somebody this morning that if one were suicidal, the worst way to end one's life would be by suicide by cop or something. Where you actually in one's selfishness at ending your life, you end others. Dr. Bob: Mm-hmm (affirmative). Bill Andrews: Where I think that's horrible and I have friends who have done that, but for this, you know, I'm choosing the time. I'm choosing the place. I'm choosing the environment. I'm choosing the company and for me, this is by far, I can't think of anything better. I've almost drowned a couple of times. I've been in car accidents and all that but this is almost soothing. I hope it really works in the way that it's been intended to work and doesn't get prostituted or something in some way that it goes off track. Dr. Bob: You mean the whole idea of the ability to support people in this way with terminal illnesses and the physician aid in dying? You're worried that it could somehow get off track? Bill Andrews: I hope it doesn't is what I'm saying. Dr. Bob: Yeah. Well, there's a lot of protections in there and if I have anything to say about it, it won't. There's enough. You know? Bill Andrews: Yep. Yeah. Well, I know. That's why you know, you guys at the beginning are the ones that are going to chart the course and that's I think, really, really important. Dr. Bob: Yeah, and I think it's important for people to consider, to understand that this is so far away from suicide. When I hear the word physician-assisted suicide I understand Bill Andrews: Yeah. Dr. Bob: It irks me because I think that there's nothing remotely like the suicide that most people think about, which is to end, you know, your life because of some emotional suffering or situation that you're in. People who are using this option, like you, are dying. I mean, you would choose. I'm sure that you would give anything, anything, to be able to not be in that position. Right? In which case you would be— the furthest thing from your mind would be taking a medication and ending your life. Bill Andrews: Absolutely. That's absolutely true and I know sometimes I throw the word suicide out and that's only because maybe because it's simple to say that word but I certainly like your definition a heck of a lot better than mine. Dr. Bob: I guess I took that opportunity just to insert my bias on that. Bill Andrews: Well, I agree. I think you're absolutely not. Dr. Bob: This is your experience and you can think about it or talk about it Bill Andrews: Right. Dr. Bob: Any way you want. Bill Andrews: Yeah. Dr. Bob: Bill, I have the advantage of having a little bit more knowledge of your background and who you are and I think this whole conversation becomes more poignant when people have a sense of what you've done. Could you share a little bit about your background? Bill Andrews: Oh boy. How much time do we have? Dr. Bob: Let's do the Reader's Digest version. Bill Andrews: Well, we'll do a real quick one, yeah. My grandfather's a general in the army. The Air Force. My father was in the military. I was born in Chicago. We moved to California in the '50s and eventually, my family ended up in La Jolla. I grew up right across the street surfing and enjoying the ocean at La Jolla Shores. Graduated from La Jolla High School. Got a scholarship to the University of New Mexico as the United States was preparing for Vietnam. I didn't do real well with that experience with the military side of my education. Anyway, I kind of did an odd thing. I just worked. I have a very broad, broad work history. Not very deep. I know a little bit about a lot of stuff. I've done engineering. I've done clothing manufacturing. I've made garments overseas. I did some advertising programs for Pepsi-Cola. I was on the cover of Surfer magazine if that makes any big deal. I used to motocross motorcycles. I used to race motorcycles. An avid sportsman, fishing. Loved education so this is why this program that you're doing is so fascinating to me. I'm absolutely enjoying every second of watching this go through the process. Raised three beautiful children. Actually, their mother did a much better job at raising them than I did. I just love learning about this and I am so thankful that we've progressed to a state where we can talk about these things. Dr. Bob: Yeah. Bill Andrews: You know, maybe my kids have a one- sentence thing they can say. Not something too bad. Dr. Bob: I would love to get a little bit of the insight from them if they're willing. No pressure though. Brian: Hello, this is Brian and just—my dad's always been a real go-getter in life and wants us to be the very best we can be and always wanting us to be improving and really to be exceptional. Of course, it's been very difficult to watch him go from a very active person and suffering through the loss of being able to use his body. Back on that comment about the suicide, I'm finding a lot of comfort from knowing that you know the cause of death is ALS and that we're able to make this choice. The aid in dying is just fabulous for us that this was passed in California and we're getting the help to do this and your guidance. It's either, you know, going to be that path or watching him really suffer and go through a long and much more difficult process, having a result in a very short time from now that we get to avoid with this. Dr. Bob: Yeah. Brian: Feeling very fortunate and very proud of my dad and very thankful we have this choice. Dr. Bob: Wonderful and I have to tell you, you know, that giving him the gift of supporting him is incredibly powerful. I've had the opportunity to be with many of the family members. The children, the spouses, parents of people who have done the end- of- life option and they are all so at peace knowing that they gave that gift and it didn't always start out— they didn't start out feeling supportive or comfortable with it by any stretch of the imagination but having come through that together, recognizing how desperately important it is to the person who's dying to have that support and to have people with them at the time, you get to go on the rest of your life knowing that you gave that ultimate and last gift. Brian: Yeah. Yeah. Dr. Bob: Good for you and thank you. This might be helpful for people. When your dad first—and Chris, if you want to chime in too—When your dad first approached this with you, what was your initial reaction? Do you remember? Brian: Well we actually brought this forward ourselves in working with him. We were looking at researching ALS and talking about what we wanted to do in the time ahead from diagnosis and we decided we were going to really come together as a family and we took a great trip together, a road trip, and we spent a lot of time together and had a lot of great conversations. Dad's friends from surfing—he's got hundreds of friends— threw him an amazing party. It was a celebration of life while he was here and that's the way Dad wanted to do that versus waiting until he was gone and having a big service and paddle out after he was gone, so that was an amazing day. We had a band, amazing food. It was a beautiful day at the beach. Dr. Bob: Wow. Brian: His friends made this happen down in La Jolla. We've really just taken this time to come closer together and have these great experiences. We were thinking about how this was all going to come to an end and we were going to ALS meetings and just really learning about it and part of that was just researching. I remember reading about it online and then we talked about it as a family and then, you know, it kind of went from there. Dr. Bob: Okay. Brian: Yeah, just exploring the options. We all have felt really good about it from day one. Dr. Bob: Great, so it kind of happened organically and a lot of times it's the individual who finds out about it or comes to that kind of decision, sometimes having been thinking about it for quite a while and it does take some finesse sometimes and time to get families onboard, so I'm glad that you didn't have to go through that. You were able to just, from day one, be united and working together, which is great. Bill Andrews: Yeah, I think in general we were 90 to 95% onboard in total from day one. My decision was I did not want to be kept alive and if it came down to not eating, not drinking or whatever, that was my chosen course. I wasn't going to put my family—I didn't want to put my family through a whole bunch of torture but a torture for me would be breathing help and eating help. Dr. Bob: Mm-hmm (affirmative). Bill Andrews: And selfishly watching my bank account go from a very small amount to negative numbers. Dr. Bob: Mm-hmm (affirmative). Bill Andrews: A lot's played into my decision, selfishly, on what I was going to do. Dr. Bob: I hear you. Bill Andrews: I appreciate them that they're going along with this. Dr. Bob: Yeah. Chris: This is Chris. I have one more thing to add to that. Dr. Bob: Great. Chris: I think in the beginning we were very curious about the disease and that curiosity led us to read a lot and also like Brian said, they started going to meetings. I was living in New York and I was pretty far away, so for me, it was more of like an academic research. Like what can I read and what can I understand more of? Once you start to dive into that space and you get like ... If you don't have a disease you need proximity to it to understand it and once you do, it sort of is like "this is awful" and you want to do everything you can to help. I think that for other families that might be going through this, I imagine there's a lot of avoidance of kind of really want to think about the end or "I don't really want to know too much about it”.  But for us I think having, throwing ourselves into it, it gave us a lot more strength, I guess, to just keep moving through this process with him. Dr. Bob: Mm-hmm (affirmative). Chris: Because we know what's on the other side of it. We don't know how he's feeling but we're able to paint a picture of it by seeing how other people, what it's done to other people. Dr. Bob: Yeah. Now other people will be able to look and have, hopefully, hear this conversation, and the conversation can continue in various forms, but to see how powerful it can be to plan. Right? Not to avoid but to see what's coming, what are the alternatives, how do you make sure that at the end you feel like you have the control you need, that you always would want. The disease takes pretty much all control, at least physical control, away. I imagine knowing that you're going to be able to make this last decision for yourself, Bill, gives you a real sense of control back that's been missing. Bill Andrews: Oh, it absolutely does. I just want to add one more thing too. When I first was diagnosed I wanted to learn more and more about the disease. I'm reading, reading, voraciously and you know, it's all over the place of what it is, what causes it, what doesn't cause it and on and on and on.   So I kind of, I started writing originally about my experiences on my blog and then I thought, eh, if people want to learn about the disease they can go to Wikipedia or something. People had asked and they go, “Well, how are you feeling today? You're moving your toes.", or something. I go, “Well, you know, maybe you ought to learn more about the disease yourselves and then maybe you'd understand where I'm coming from a little easier." Because it's all kind of basically the same, so rather than explaining to the same people every other day how I'm feeling, just, you know, make your own calendar and chart it yourself and they can make their own timeline or something. Dr. Bob: Mm-hmm (affirmative). Mm-hmm (affirmative). Brian: Yeah, my dad's real quick as well. Dad would always say, "Hey, if this is where it would stop, I could be okay. Where I still can stand up and take a few steps with my walker or be able to feed myself and go to the bathroom. Yeah, okay, I'm okay." Then every day we'd get progressively worse and you hit a new level and it'd be like "Wow, I didn't think I'd keep going with this but now that I'm here I could keep going a little more.", and it was just like, and I'm going where is the line? You know? Where is the final level where it's not going to be okay anymore and then it becomes a— there is a point where ... Because as Chris said, "Dad, we're researching." In the end Dad, he was consistent from day one. "I will not be in a feeding tube. I will not be in on a respirator. I don't want to be kept alive. If I have to be fully cared for and bedridden, that's not the quality of life I want to have and that's when I'm ready to go." So always trying to think about, well, at some point we're going to hit a point where you can't move your arms at all. Today he can't move his legs and he doesn't have the strength to do anything with his arms other than lift something that weighs just a few ounces. Pretty soon he won't have the ability to use his arms at all and that's very close so we're trying to stay ahead. We know that there're only a few decisions left. You know, at the very end he's going to starve to death and go through a [inaudible 00:33:26. A difficult process or take this option, so it's been just always trying to stay ahead, but as the years evolved, choices and the days and the weeks and the equipment we need and choices to make has been—it's all in Dad's own journey. Dr. Bob: Mm-hmm (affirmative). Brian: But here we are and now we're all feeling really good about this choice. You know, given where we are. Dr. Bob: Yeah. Thank you. That was really awesome to hear and it's Dad's journey but you're a team and the obvious connection and bond that you guys share in his knowing that this isn't—it's not going to tear you apart, it's not going to destroy you. That you are so together on it and seeing this is the compassionate option. I mean that's going to allow him to slip away so peacefully with that feeling of I don't know, completion or this ultimate sense of connection so that's really powerful that you've been able to create that for him together, all of you. Bill Andrews: Yeah, it's the compassion I think that is so important. You know, everybody can have sympathy or they can have empathy, but all I ask from people is you don't even have to understand it, just accept it as it is and when I tell you how it is, that's what it is. If you need any more information, go to Wikipedia. Go to WebMD or something, I don't know. That's the way I feel. Dr. Bob: All right. Hey, I have two more questions if that's okay and then I'm going to let you go. Bill Andrews: Okay. Dr. Bob: One of them is do you have any fear at this point? Is there anything about this that is causing fear or anxiety for you? Bill Andrews: Absolutely not. Not a drop of fear. Dr. Bob: Awesome. Great. Bill Andrews: No. This is like, you know— Dr. Bob: Oh, go ahead. Bill Andrews: Just a new adventure. A new adventure. Dr. Bob: Okay. That's beautiful. Bill Andrews: Anticipation, not fear. Dr. Bob: Great. I guess the last one is what would you like to share? I know it's not like you're out shouting from the mountaintops to the masses here but Bill Andrews: Right. Dr. Bob: Can you distill down your message? Bill Andrews, Big Pink. Bill Andrews: Surfing. Surfing nickname, no less. Dr. Bob: It's a surfing nickname. Bill Andrews: I guess now that I'm looking back, obviously you can't make every move the right move and just a couple of things. I think if you kind of put your life on autopilot— this may be a little weird but, kind of set a course if you can. You know, get a point A to point B and of course, then obviously by judgment is the right course. You know, a good course. Like a righteous course, and try to stay to that and every once in a while get, but because of your autopilot and that comes internally or God or your friends or whatever, kind of knocks you back into ... Excuse me. Back on course so you're not out there one month, two months, three months. You know, kind of lost out there and then you're looking at time bandits and everything. I think it's very important to make as much effective use of your time as you possibly can, and there again, you know I'm preaching to the choir and all that stuff, but I look back at my life. You know, you only have so many minutes in your life and, gosh, if you could just make 60% of those minutes effective and doing good again, all by definition, that would be my—that's my message to my kids. Kind of pick that course, stay on that course, and you'll look back and go, "Gosh, I've lived a good life and I'm proud of what I've done." Dr. Bob: That's beautiful. Thank you. That's really phenomenal. You guys, Brian, Chris, do you have anything you'd like to say about your dad or anything regarding this before we close out? Brian: Just that we love Dad very much and we're proud of him and proud to be your son, Dad. Bill Andrews: Thank you. Dr. Bob: All right, guys. Bill Andrews: Okay. Dr. Bob: Hey, thank you so much for your time and thank you so much for all you know, Bill, all you've brought to the world. I will be seeing you soon and looking forward to every moment that we have together.

The Teal Chair, a film that was nominated for the Future Filmmakers Award this year at Sun Valley Film Festival was the brainchild of Kimberly Ouwehand. Find out why the hospice community outreach coordinator wanted to create this film and how its impacted her life and others. Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text. We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Contact Treasure Valley Hospice website Transcript Dr. Bob: Kimberly Ouwehand is a passionate Community Outreach Coordinator for Treasure Valley Hospice in Nampa, Idaho. When Kimberly got the inspiration to videotape people answering the question, "If you knew you had a limited time to live, what would you do," amazing things started to happen. She collaborated with a local group of high school students, and what came out of it is an extraordinary documentary called The Teal Chair. The film was nominated for the Future Filmmakers Award at the 2018 Sun Valley Film Festival. In this podcast, Kimberly shares how the film came about and how its creation has impacted her life and the lives of many others in her community. I hope you enjoy it. Share with me, the listeners, a little bit about your journey, your working in hospice, and how long have you been part of hospice? How did you get into hospice, and kind of where are you in that, in the course of your career? Kimberly Ouwehand: Well, I started out in clinical. I worked in internal medicine for about 10 years, 10 to 12 years, and kind of fell into hospice, because, and it's kind of a different animal, because you're in people's homes, and you're dealing more with people than you are the clinical side of things, and so I've been doing hospice for about seven years now- Dr. Bob: Okay, and in what capacity? Kimberly Ouwehand: I love it. I do outreach, and communication, and education, so kind of I'm a marketer for it, but I do a lot of hands-on and outreach. Dr. Bob: Got it. Kimberly Ouwehand: A lot of education. Dr. Bob: I think probably a lot of people don't realize ... Well, a lot of people don't realize a lot of things about hospice, right, but- Kimberly Ouwehand: Yeah, that's for sure. Dr. Bob: When they hear "marketer," they probably don't understand how much that involves being with families, and patients, and kind of in the thick of things, because I know I've been associated with hospice for a while now, and sometimes the marketers develop such incredible relationships, because they're the first point of contact for a lot of these folks and people who are in pretty somewhat desperate situations or very vulnerable. It's a really important role to be playing, don't you think? Kimberly Ouwehand: I do. I wish sometimes we didn't ... I mean, I hate to use the word "marketer," because traditionally it's pushing sales and things like that. I find myself making connections and building, like you said, building relationships so that people know, like, and trust you, and they'll call you whenever there's question, and they don't understand something. I feel like my reputation should be built on trust, and I feel like I've done a pretty good job of that so far. Dr. Bob: Good. Well, you've expanded beyond just doing the hospice marketing to take on a whole 'nother realm and project, so The Teal Chair. Tell us how that came about. Kimberly Ouwehand: Well, actually, it started out with just a very simple question. I was getting frustrated that people were waiting way too long to use hospice services. I mean, hospices, it is medical, and palliative and comfort care all at home, but hospice traditionally, especially for the older generation, feels like you're signing off on a death wish. They were missing out on a lot of other services, and I loved that hospice was all about surrounding the family with the patient and making it ... Well, it is one of the most important things you do in your life is die well, but I was getting frustrated, because it's a hard subject to bring up, and people were afraid to talk about it, and doctors were putting it off way too long. I wondered if we'd made it more of just a simple question, "If you knew you had limited time, how does that change the way you live today?" That question seemed a little bit softer, so I thought to myself, I thought, "Well, I have this teal chair," and I was just going to plop it in the middle of some public area and pull people off the street and just ask them a question, record it. It was going to be kind of a short YouTube video, but what happened was, I realized I had no video skills whatsoever, and my son had taken a video class at the high school, and I just liked the rawness of it. I didn't want it to be a production. I wanted it to be real. I didn't want it to be ... I just wanted it to be honest, and so I went and asked the teacher over at Eagle High School if he had a couple students who would do a YouTube video. He said, yeah, he had a couple students, and so he kind of ... I found out later he kind of coerced them a little bit to do this death video. Dr. Bob: They were resistant. You think- Kimberly Ouwehand: That's kind of- Dr. Bob: ... that there was resistance- Kimberly Ouwehand: Yeah. Dr. Bob: ... initially? Kimberly Ouwehand: There was a little ... Yeah, but he got five incredible students to ... Sorry. Incredible students to take part in it. The outcome was phenomenal. It took legs very quickly. Dr. Bob: Yeah. I can imagine if you get the support and you get sort of the passion of youth, and it's a creative process that the school could support. It's one of those things that if someone takes that initiative and puts the pieces in place, people want to talk. Right? They want to talk about these issues, and they just need to, it just needs to be presented to them in a, I guess in a safe way, maybe an inspired way that you're going to do good for other people. That's what I've found. When was the, like how long did it take to produce, and what's the status of the film, and I have a lot of questions, but- Kimberly Ouwehand: I know. It is an amazing story. We started out at a venue called JUMP downtown. It was a great collaboration. They were doing a Day of the Dead event, and I thought it was colorful and fun, and festive. The more I learned about the Day of the Dead, the more I appreciate it, and so I thought it would be visually stimulating for the students, so we went down there, and it just grew into one team did events, did the filming of the event on the outside, people looking at the altars. There was, a Before I Die Wall was set up there. I don't know if you know about that, but it's an amazing exhibit. Then the other half went up into the studio, and they were so excited because it was a professional studio. They had the green, and all the lighting and everything, and we were able to take 22 people off out of the event and bring them into the studio and ask them this question. "If you knew you had limited time, how does that change the way you live?" We interviewed people from eight years old up to I think the oldest we've interviewed that day was about 89. It was just, it was interesting. It wasn't scary. It was thought-provoking, and one thing led to another, and I said, "Well, why don't you submit it into the Sun Valley Film Festival for Future Filmmakers?" We made it instead of just a YouTube, to a 10-minute one that would fit the criteria, and submitted it, and out of about 120 across the nation, we were nominated. There were, I think, 12 nominations. We went to the Sun Valley Film Festival, and then since then, we're, it's going, we've sent it to Washington, D.C., to the National Hospice and Palliative Association, and I'll be submitting it into the American Public Health Association- Dr. Bob: Awesome. Kimberly Ouwehand: ... for educational pieces, because what happened is, it just started this huge conversation, and it's not only about dying, but it's about the different seasons you are in your life and what that looks like and having those conversations, because you never know if you're going to die suddenly or if you're going to have a chronic illness that will take a long time. Dr. Bob: One of the things that came to you when you were just posing the question to people, "What would you do differently, or how would you live, if you knew you had a limited time," did people ask you like, "What do you mean by a limited time? Like are you talking about days or months?" Did that seem to be an issue, or did they all sort of feel like they could take that and speak to it without getting more clarity? Kimberly Ouwehand: That's a really ... I mean, nobody's asked me that question, but some people did, like about how much time, but most people didn't ask. They just thought, "Okay. Where am I right now, and what's important to me?" Like the eight-year-old said he wanted to have a pizza party, and you just realize that the shorter, the younger you are in your life, your life doesn't expand very much, and then the teenagers, the college, they wanted to experience life as much as they could. They wanted to get out and just learn as much about the world and everything around them, and then it seems like, and I'm kind of stereotyping it a little bit, but the career, your middle-aged people would be more focused on balance of life, realizing really what is important, not working so much. The family becomes important... Working so much, the family becomes important. And then older people got it was usually something to do with a memory, revisiting a place or a person, or for sure it was all about family. Dr. Bob: I imagine some of them would want to have a pizza party. Kimberly Ouwehand: Yeah, I mean, and the conversations that's come out of it. When I set it up, I set up interviews, and we interviewed doctors, and we interviewed a couple of professional people. And we interviewed a hospice patient and a family who had hospice. When we were doing the interviews, I would think to myself; these kids are going to think it's stupid, it was a waste of time, they're not going to pull anything off of this interview. But what they did, and pulled, and put together, I was amazed. I thought he knows it's boring; they're not going to think it's exciting, they're kids, you know. But they pulled stuff off that I would never have thought of. Some of the pieces that I thought were really long, I had people come up and say that really spoke to them. So you really can't make it into one topic, it's a super broad topic that hits people in all different areas. Dr. Bob: Yeah, it's so personal. That's part of the idea of how do we spend our time, what's important to us, what do we value most? That's what we're getting at, and everyone has such a unique experience. So, I don't want to put you on the spot Kimberly, but what would you want to do if you knew that you only had a limited time? Kimberly Ouwehand: You know what, that's- Dr. Bob: Did you answer it? Were you interviewed? Kimberly Ouwehand: No, I was not interviewed. And I don't know if I really know what I would do because I feel like my life is centered around that already, that everything I do today, it matters. So I hope that when I do die, if I die suddenly, that people will look at my life as I've lived it, and the things that I've done, that I was nice, and that I was kind, and that I was just a good person, I think. But I don't have any bucket list things. I wouldn't do anything differently, really. Dr. Bob: I agree with you. I'm in that same place, and it really feels good to feel like I don't really need anything else. I probably would want to just be with my family, and have friends. I think about it, you being in the hospice world and me being, caring for people at the late stage of life and many of them in their final days and weeks of life, I think about it often. Like, where am I? Am I complete? Am I good? It's a really gratifying feeling to feel like I'm good to go. I would hate not seeing my son grow up and all these things. But I don't feel like there's anything undone or unsaid at this moment. It feels powerful to me. It sounds like you're sort of in that same place. Kimberly Ouwehand: Yeah, and I agree with you too, in the film, I asked one of the interviewers, what would he do? It was interesting because really, and I can see this with a lot of parents that they would hope that they had left enough of them with their children, that their children wouldn't forget him, and his values and what he was like. I think for parents, and I'm a parent too, but my kids are getting older now and more independent, I feel I've done a pretty good job. But I just would want everybody to know that I did love them. The parent thing is a little hard because you're leaving something that you can't follow up with, I guess. Dr. Bob: Kind of unfinished. You feel like you're not, you feel like there are a little bit more unfinished business and a gap that be left more ... I agree with you more so than if the kids were already adults and launched. Was there anything you can think of that was really surprising, that people said, that you, "Wow, that was really interesting," or crazy... Kimberly Ouwehand: Yeah, there was a lot of things that people that I took away from there, just with a little bit of different perspective. One person said, and I thought this was really interesting, and I think I live my life a little bit differently because of it, was, "If you give up one thing if you focus on one thing, sometimes you have to unfocus on another thing." In other words, you can't have it all. You can't focus on everything because then it doesn't, you don't hit the bullseye, basically. I thought that was interesting because I think sometimes we try to do too much, and we forget that you can't. And it's okay not to do everything. And we can't do everything well. And that's why we have people in our lives. That's why we have people like you doing podcasts that are reaching out to a whole different demographic that I can't reach, and I'm doing my thing that you can't reach. I think that put a new perspective on a stressful job, to be honest with you. Dr. Bob: I'm sure that the gift of being involved in that, I'm sure there were many gifts, but one of them was this new perspective and the wisdom that came out of people speaking from their heart, from this place of a different awareness than they would otherwise have. I wonder if, how many of the people that were interviewed, who were able to share what they would do if they had limited time, started doing more of those things. If the impact is not just on the people who watch the film, but the impact on the individuals who got to reflect on that. Kimberly Ouwehand: I feel like the interviewers that I knew, all said that they had conversations later, because their families ask, "What are you doing?" I don't know about the other interviews, that we did at the jump event, the Day of the Dead event because I kept that anonymous, so I didn't want to put names or tag any links on that. So most of them, I never really heard back from. Dr. Bob: It'd be interesting if there was a way to come back and interview those people again. Kimberly Ouwehand: That would be, I know. Dr. Bob: I think we talked a little bit earlier. I think it's so important to get the conversation about life and death, and preparing, and living intentionally, to the younger demographic, into college age kids, and high school age kids, and even elementary school kids. I just feel like we have become such a death-phobic culture and we don't allow ourselves to promote these conversations. I think it just continues to, this fear continues to escalate as we get older, and no one's having the conversations. Do you feel like the film, I haven't seen it, I'm looking forward to seeing it, do you feel like it's something that could be used in schools to help open up the topic and stimulate conversation and sort of a structured format? Kimberly Ouwehand: I really do. At this point, because it really only got finished, there's a 30-minute documentary, and that really didn't get finished until May. So we'll be doing more screenings, but we're talking with BSU, Boise State University to implement that as part of their curriculum in their nursing program. And then also, with the Boise State Center of Aging and their social workers, we will probably be doing a couple of presentations with that. The biggest resistance that I found interestingly enough is with the medical professionals, the ones that are already doctors and physicians. And that one, I've been very surprised at how resistant they have been in having it be presented as a topic. Dr. Bob: And why do you think that is? Kimberly O.: I think number one, they are busy, and they don't necessarily have the time, or maybe even the energy. I think a lot of times, after you get through medical school, you feel like you're an expert in whatever you're doing so you don't think anything outside of that, except for your bubble, I think. I don't know; I'm not a doctor. Dr. Bob: Yeah, no, well I am, and I think those are accurate. But you said there's resistance to actually them coming out and viewing the film, or somehow allowing it to be shown in different venues? I'm curious, it would seem to me that this is the kind of thing that anybody would benefit from seeing, and watching, and taking the teachings. I apologize on behalf of the medical specialty. Kimberly Ouwehand: Oh no, and I don't mean... Dr. Bob: I do. I find myself doing that. I find myself doing that all the time. I hear people talking about all the challenges they have with the medical- Dr. Bob: On all the challenges they have with the medical system and with physicians in particular, and I mean, I'm diverging a little bit, but I do see all the challenges, and I see physicians being stretched and very narrowly focused, and people suffer because of it. Both from when the medical care, as well as the physicians aren't open in many cases to thinking outside the box and supporting something like this project. Anyway, I do find myself apologizing on behalf of physicians [inaudible 00:22:39] to patients. Kimberly O.: I sound like I'm bashing doctors and physicians, but I really am not. I mean, again, it goes back to the focus physicians who are specialties. They need to focus on that. They can't be looking at every other angle, because they'll lose their focus. They'll lose their specialty. I think too; they are asked to do a lot. They're busier now than ever; the paperwork is crazy. Covering your bases all the time. Healthcare, in general, is just getting more complicated. I don't necessarily feel that they're being resistant, but I do feel that they can only handle what they can handle, and one more thing, even if it is outside of the box a little bit, might be just a little bit ... Until they understand it, I just think it might be harder for them to grasp. Dr. Bob: Right. I think you're being gracious, and that's nice, because these are the kinds of things that, yes, it's important to focus on your area of expertise and your practice and to try to maintain balance in your life, but this is the kind of thing that helps to further our humanity, right? Kimberly Ouwehand: It does. Dr. Bob: I mean, this is the stuff, every physician needs to work on their humanity, on their compassion, and on their empathy. It doesn't matter what you do, what specialty you're in, this kind of project is something that everybody should be at least open to bringing in and supporting. That's my thought. Kimberly Ouwehand: Yeah, I appreciate that. I think too; I think sometimes physicians need to stop and think about their own mortality. I think they forget that they are ... They're going to die someday too, and it might help them center what's important to them a little bit too. I would hope, I hope it's one of those films that people take and just apply it to where they need to apply it, you know? Dr. Bob: Yeah. Kimberly Ouwehand: I think too, you mentioned earlier about the younger generation, the high school students, and the college students, and when we had started filming, we started filming the first week of November, and later that month, one of their classmates died in a tragic car accident. At the end of the school year this year, one of the students at the high school committed suicide. Death is around them. It's interesting how they handle it, though. I don't know how they handle it, quite frankly. I don't know if adults put what we know onto kids or if kids just know how to ... It was interesting, 'cause there was hardly any talk about it at school. Dr. Bob: It's hard to imagine that that's healthy. You would think at least you want to have an opening for the kids who feel like they do need to talk or to ask questions or to come together. You'd like to think that they would put that in place to give an opening for those who may be struggling with it more. Kimberly Ouwehand: Yeah, I agree. I think they made it ... I mean, I think the students know they have a counselor that they can go to. I think some of the friends, the girl that died in the car accident, they had a vigil, but it was done just through her girlfriends. It wasn't really ... They didn't talk about it at a school level, and I just thought that was interesting. Especially when it comes to the suicide. There have been several suicides in high schools here, and they don't talk about it. I don't know if that's for the family's sake, or how they handle that in the schools. They don't really tell us, so it's interesting. Dr. Bob: Yeah. It's scary. It's also I think more than people realize, there's also a lot of suicides in medical school, and physicians. It's increasing in numbers. Kimberly Ouwehand: I think that's true, and there is a lot of emphasis on physicians and mental health care, taking care of their mental health. I think you're absolutely correct. Dr. Bob: I want to take it back to the film, and how do I get my hands on not a copy probably, but the ability to get it and show it and potentially have an event around it, or do a showing? Kimberly Ouwehand: At this point, the 30-minute documentary, we're editing it just a tiny bit, and it will be available by link. The 10-minute one that went to the Sun Valley Film Festival will be on our website, at TreasureValleyHospice.com. It's not up yet, but we're working on that. I'm happy to send you a link so you can see it- Dr. Bob: Awesome that'd be wonderful. Kimberly Ouwehand: ... before then. Dr. Bob: Well good. I'm excited, and this is the kind of thing we need to do more of this, and it's cool, 'cause this is taking a softer approach, right? It's not a death café; it's not in your face. It's taking the backdoor approach to are you really living your life intentionally? And doing the things that truly matter, and not ... Go ahead. Kimberly Ouwehand: I'm sorry. I keep interrupting. Dr. Bob: No, that's okay. This is your interview; we're here to hear you. Kimberly Ouwehand: I think the film really almost mirrors a little bit what hospice is because hospice is taking what's really important to you in your life, and everything that surrounds your life at that moment in time. I feel like it's a very softer approach to really what hospice does and is. I hope that's what the message is, in the end. Dr. Bob: Yeah, that's nice. You're right. Many people don't get that. Society, until you've had a personal experience with a really good hospice team, the perception out there still for many people is hospice is basically just where you go to die, and we know that that is ... There are times when that's true when somebody's dying, and they're in their last stages, and hospice comes in and helps facilitate it and make it more comfortable. But there are so many people who spend months on hospice, and they live so much more richly, and so much more peacefully, because of that support. It really is about living well until you die, as opposed to just dying, and I- Kimberly Ouwehand: And the family, too. Dr. Bob: Yeah, that family support. I can see the film helping to further that concept and that philosophy. I'm looking forward to it, to seeing it and sharing it, and who knows what other projects you'll be getting to next. I did an interview not long ago with Michael Rossato-Bennett, who directed the film "Alive Inside." Have you seen that? Kimberly Ouwehand: No, but I'd love to- Dr. Bob: Wonderful film. It's about music and bringing music to people with dementia, and people who are isolated. It started out as just a little project that someone asked him to come and do some filming, and out of that, he has now created a foundation, and there are iPods and headphones being given out to people all throughout the country, and it's launched into something beyond what anyone could ever have imagined. Who knows? Something like that could be happening with you as well. You never know. Kimberly Ouwehand: I hope so. You never know. Thank you so much, Dr. Bob.

Please Note:  This was recorded as a Facebook Live earlier this year prior to the recent ruling to overturn the California End of Life Options Act 2015 by Riverside County Superior Court Judge. In response, California Attorney General Xavier Becerra filed an emergency appeal seeking a stay of Superior Court Judge Daniel Ottolia's ruling that invalidated the less than two-year-old medical aid-in-dying law.  "It is important to note the ruling did not invalidate the law or the court would have said so explicitly in its order, so the law remains in effect until further notice," said John C. Kappos, a partner in the O'Melveny law firm representing Compassion & Choices. If this law and the right to die with dignity is important to you, we urge you to learn more from Compassion and Choices the organization that helped get the law passed.  Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text.  We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Need more information? Contact Dr. Bob for a free consultation. Transcript Dr. Bob: On this episode, Elizabeth Semenova and I speak very frankly about what it's like to support people through Medical Aid and Dying. We explain the process; we discuss who asks for this kind of support and why there are still so many barriers. This was originally captured as a Facebook Live and repurposed as a podcast because this information is so vitally important. Please share the podcast with everyone and anyone you feel would benefit from listening. Thank you. Dr. Bob: I'm going to do a little bit of introduction for myself, if you're watching this and you have been on the integrated MD Care site, you probably know a bit about me. I've been a physician for 25/ 30 years, somewhere in that range. Over the past several years I've been focusing on providing care for people who are dealing with complex illnesses, the challenges of aging, the challenges of dying. During these few years, I've discovered a lot of gaps in the health care system that cause a lot of challenges for people. Dr. Bob: We developed a medical practice to try to address those big challenges in those big gaps that we've encountered. It's been really remarkable to be able to do medical care in a way that is truly sensitive to what people are really looking for and what their families are looking for that is not constrained and limited to what the medical system will allow. It's not constrained by what Medicare will pay, what insurance will pay. We allow people to access us completely and fully and we are there to support them in a very holistic way with medical physician care, nursing care, social working care and then a whole team of therapists. Massage therapists, music therapists, acupuncturists, nutritionists. Dr. Bob: So that has been really fascinating and phenomenal. Elizabeth came along in the last several months. Really, she was drawn primarily to the true end of life care that we deliver and has been truly surprised how beautifully we are able to care for people who aren't necessarily dying as well. Elizabeth: Absolutely, yeah. Dr. Bob: So we can talk about all the different aspects of that, but we are here today to really talk about Medical Aid and Dying. Because, shortly after we started this practice, back in January 2016 California became one of the few states in the United States that does allow physician-assisted death. Dr. Bob: It allows what is also known as Death with Dignity, Medical Aid in Dying. The California End of Life Option Act passed in June 2016. At that point, a person with a terminal illness, an adult who is competent, had the ability to request a prescription of medicine from their physician, from a physician. That if taken, would allow them to have a very peaceful, dignified death at a place and time of their choosing. Since June 2016 we have become essentially experts and kind of the go-to team in San Diego for sure and actually throughout a good portion of Southern California because other physicians are reluctant to participate or because the systems that the patients are in make it very difficult or impossible for them to take advantage of this law. There is a lot of confusion about it. It's a very complex, emotionally charged issue. We as a team, Elizabeth and I, along with other members of our team have taken it upon ourselves to become true experts and guides so that people can get taken care of in a way that is most meaningful and sensitive. In a way that allows them to be in control and determine the course of their life leading up to their death and how they are going to die. That's why we are here. We want to educate; we want to inform, we want people to not be afraid of the unknowns. We want to dispel the myths. I'm passionate about that. We work together, and I think we do a very good job as a team, of supporting patients and families. I'd like to have Elizabeth share a little about why this is so important to her and then we are going to get into some more of the specifics about what's actually taking place, the requirements, how the process works and if there are questions people have we are going to answer those as well. We are going to go for about 20/ 25 minutes, and if it turns out that we don't get through enough of our material then we will have another session, but we don't want to make this too long. We want to make it concise, meaningful and impactful. Elizabeth: Okay. Dr. Bob: All right. Elizabeth: Okay. I started as a hospice social worker, and I became an advocate for Aid and Dying because I learned about the law. Learned that there were not a lot of options, policies, procedures in place, in Southern California when I started working in hospice for people to take advantage of and participate in the End of Life Option Act. Elizabeth: There were very, very, very few resources. There were no phone numbers to call of people who would answer questions. There were no experts who, well not no experts, who thoroughly understood the law but it was very hard to access that information. Elizabeth: I did my best to find it and became connected with some groups and some individuals who were experienced with and understood the law and became really passionate about pursuing advocacy and allowing as many people to have access to that information as possible. I started working on sharing that information and being a resource and learning everything that I could so that other people could have that. How I became connected with Integrated MD care and with you, I found you as a resource for another client, and we started having conversations, and I learned that it was possible to be supportive of people through this process through the work you were doing and I took the opportunity to become a part of it. We have done a lot to support a lot of people, and it's become a really special part of our work and my life. Dr. Bob: Why is it so important to you? Why is it so important to you for people to have access and the information? Elizabeth: I really believe that every life can only be best lived if you know all of the options that you have available to you. So how can you make choices without information? Right? So when it comes to something like this which is a life and death situation, quite literally, there are limited resources for people to make informed choices. What could possibly be more important than having access to information about what your legal rights are to how you live and die? With California only having begun this process of Aid and Dying. Exploring different perspectives and legal options and philosophical positions on the subject, I think it's really important to open that conversation and to allow people who support it as well as people who are against it to have those conversations and to explore how they feel about it and why. Then of course for the people who want to participate, who want information, resources, support in the process they have every legal right to it, in my opinion, they have every moral right to it and if there are no other people who are willing to support them I feel it is my duty to do that. Dr. Bob: Awesome. And you do it well. Elizabeth: Thank you. Dr. Bob: Yeah it's kind of crazy to think we have this legal process in place. People have spoken up and said, we want to have access to this, and we believe it's the right thing. Despite the fact that we have a law in place that allows it, it was so difficult, and it's still is to some degree, but especially in the beginning, it was like a vast wasteland. If somebody wanted to find out how to access this process, no one could really give them adequate information. There were organizations that would tell them what the process is and how it happens but there was no one stepping up to say 'I'll support you.' There were no physicians, and there was no one who was willing to give the name of a physician who was willing. It was very frustrating in the beginning of this process, in the first, I would say, the first year and a half. Still, to some degree, getting the right information, getting put in touch with those who will support it is difficult or impossible. Even some of the hospital systems that do support Medical Aid and Dying their process is very laborious, and there are so many steps that people have to go through that in many cases they can't get through it all. Our practice we are filling a need. Our whole purpose in being is to fill the gaps in health care that cause people to struggle. One of my mantras is 'Death is inevitable, suffering is not.' Right. We are all going to die, but death does not have to be terribly painful or a struggle. It can be a beautiful, peaceful, transformative process. We've been involved in enough End of Life scenarios that I can say that with great confidence that given the right approach, the right information, the right guidance, the right support it can always be a comfortable and essentially beautiful process. Elizabeth: Something that is important too also is to have people who have experience with these processes these struggles that people have. Not just anyone can make it an easy process. Not just anyone can make it a smooth process. You have to have it those obstacles you have experienced what the difficulties are and where the glitches are and in order to be able to fill those gaps you have to know where they are. Dr. Bob: Right. Elizabeth: Sometimes that comes from just falling into the hole and climbing out which is something we have experienced a few times. Dr. Bob: Having been through it enough times to... and of course we will come across- Elizabeth: More... Dr. Bob: Additional obstacles but we'll help...and that doesn't just apply to the Medical Aid and Dying it applies to every aspect of health care, which of course, becomes more complex and treacherous as people's health becomes more complicated and their conditions become more dire, and their needs increase. Hospice, yes it's a wonderful concept, and it's a wonderful benefit, but in many cases, it's not enough. Palliative Care, in theory, great concept, we need more Palliative Care physicians and teams and that kind of an approach, but in many cases, it's not enough. What we are trying to do is figure out how to be enough. How people can get enough in every scenario. We are specifically here talking about Medical Aid and Dying. In California, the actual law is called The End of Life Option Act. It was actually signed into law by Governor Brown in October 2015, and it became effective June 9th, 2016. I'll note that just yesterday the Governor of Hawaii signed the bill to make Medical Aid and Dying legal in Hawaii. The actual process will begin January 1st, 2019. There is a period of time, like there was in California, a waiting period, while they're getting all the processes in place and the legal issues dealt with. Elizabeth: Which you would think, that would be the time frame that health care intuitions would establish policies, would determine what they were going to do and how they were going to help. Dr. Bob: One would think. Elizabeth: You would think. Dr. Bob: Didn't happen here. Elizabeth: That didn't happen here. Dr. Bob: So maybe Hawaii will learn from what happened in California recently when all of a sudden June 9th comes, and still nobody knows what to do. What we are becoming actually, is a resource for people throughout California. Because we have been through this so many times now and we have such experience, we know where the obstacles are, we know where this landscape can be a bit treacherous. But, if you understand how to navigate it doesn't have to be. Elizabeth: We have become a resource not just for individuals who are interested in participating or who want to find out if they qualify but for other healthcare institutions who are trying to figure out how best to support their patients and their loved ones. TO give them without the experience that they need without having the experience of knowing what this looks like. Dr. Bob: Yup. Training hospice agencies. Training medical groups. At the heart of it, we just want to make sure that people get what they deserve, what they need and what they deserve and what is their legal right. If we know that there is somebody who can have an easier more supported, more peaceful death, we understand how incredibly valuable that is, not just for the patient but for the family. For the loved ones that are going to go on. So let's get into some of the meat of this. I'm going to ask you; we can kind of trade-off. Elizabeth: Okay. Dr. Bob: I'll ask you a question. Elizabeth: Okay. Dr. Bob: You ask me a question. Elizabeth: Okay. Dr. Bob: All right. If you don't know the answer, I'd be very surprised. In general who requests General Aid and Dying? Elizabeth: A lot of the calls we get are from people who qualify. So I don't know if you wanna go over the qualifications... Dr. Bob: We will. Elizabeth: Okay. Dr. Bob: That's the next question. Who is eligible. Elizabeth: Sorry. A lot of the people who call are individuals who are looking to see if they qualify and want to know what the process is. There are people who are family members of ill and struggling individuals, who wanna support them in getting the resources they might need. There are some people who just want the information. There are some people who desperately need immediate support and attention. Dr. Bob: Do you find, cause you get a lot of these calls initially, do you find that it's more often the patient looking for the information or is it usually a family member? Elizabeth: It's 50/50. Dr. Bob: Oh 50/50. Elizabeth: I think it depends a lot on where the patient is in the process and how supportive the family members are. Some people have extremely supportive family members who are willing to make all the phone calls and find all the resources and put in all the legwork. Some people don't, and they end up on their own trying to figure out what to do and how to do it. There are some people who are too sick to put in the energy to make 15 phone calls and talk to 15 different doctor's offices to find out what the process is. A lot of people start looking for information and hit wall, after wall, after wall. They don't even get to have a conversation about what this could look like, much less find someone who is willing to support them in it. Dr. Bob: Great, thank you. So who is eligible? Who does this law apply to? That's pretty straightforward, at least in appearance. An adult 18 or older. A resident of California. Who is competent to make decisions. Has a terminal illness. Is able to request, from an attending physician, the medication that if taken, will end their life. Pretty much 100% of the time. The individual has to make two requests, face to face with the attending physician and those requests need to be at least 15 days apart. If somebody makes an initial request to meet and I determine that they are a resident of California, they are an adult, they are competent, and they have a medical condition that is deemed terminal (I'll talk more about what that means) if I see them on the 1st, the 2nd request can happen on the 16th. It can't happen any sooner. The law requires a 15 day waiting period. That can be a challenge for some people, and we will talk a bit about that as well. In addition to the two requests of the attending physician, the person needs to have a consulting physician who concurs that they have a terminal illness and that they are competent to make decisions and the consulting physician meets with them, makes a determination and signs a form. The patient also signs a written request form that is essentially a written version of the verbal request and they sign that and have two people witness it. That's the process. Once that's completed, the attending physician can submit a prescription if the patient requests it at that time to the pharmacy. Certain pharmacies are willing to provide these medications, and many aren't. But, the physician submits the prescription to the pharmacy, and when the patient wants to have the prescription filled, they request that the pharmacy fill it and the pharmacy will make arrangements to have it delivered to the patient. The prescription can stay at the pharmacy for a period of time without getting filled, or it can be filled and be brought to the patient, and at that point, the patient can choose to take it or not. The patient needs to be able to ingest it on their own. They have to be able to drink the medication, it's mixed into a liquid form. They need to be able to drink five to six ounces of liquid, and it can be through a glass or through a straw. If the patient can't swallow, but they have a tube-like either a gastric tube or a feeding tube as long as they can push the medication through the tube, then they are eligible. The law states that no one can forcibly make the patient take it. They have to be doing it on their own volition, willingly. Okay. So, that's pretty much the process. Is there anything that I left out? What is a terminal illness? That is a question that is often asked. For this purpose, a terminal illness is a condition that is likely or will likely end that person's life in six months if the condition runs its natural course. Most of the patients that we see requesting Medical Aid and Dying have cancer. They have cancer that is considered terminal. Meaning there is no cure any longer. It's either metastasized, or it involves structures that are so critical that will cure them. In most cases, there is no treatment that will allow them to live with a meaningful quality of life, past six months. Of course, it's difficult to say to the day, when somebody is going to die, but there has to be a reasonable expectation that condition can end their life within six months. We also see a number of people with ALS, Lou Gehrig's disease, amyotrophic lateral sclerosis. That's a particularly sensitive scenario because those people lose their ability to function, they lose their motor function, and as it gets progressively, further along, they lose their ability to swallow. They can lose their ability to speak and breathe. The time frame of that condition can be highly variable. We see people with advanced heart disease, congestive heart failure, advanced lung disease other neurologic diseases. Elizabeth: The gamut. Dr. Bob: We see the gamut, but those are the majority. We've talked about who's requesting this for the most part, who's eligible? A patient who is competent has a terminal diagnosis and is an adult resident of California. We talked about the requirements, what's the process. Let's talk a little bit about the challenges that we've identified or that other people have identified. At the very beginning of this process, I became aware that the law was going to begin taking effect just a few months after I started my medical practice at Integrated MD Care and I figured great this is progressive. We are kind of like Oregon, we are going to have this option available, and I felt like it was the right thing. I've always felt like people should have more control and be able to be more self-determining. Especially at end of life. Who's life is it? Right? Who are we to tell somebody that they have to stay alive longer than they want to. That never made sense to me. I think if you're not in this world of caring for people at end of life or you haven't had an experience with your family. Most people figure when people are dying they get taken care of adequately. Hospice comes in, and they take care of things. IN some cases that's true. In many cases, it is the furthest thing from the truth. People struggle and suffer. Patients struggle and suffer, families suffer and if we have another option, if we have other options available wouldn't we be giving them credence? My answer is yes, we should. So when the law was coming into effect, I figured physicians would be willing to support patients because it's the right thing. I just assumed people would go to their doctors and say 'we now have this law, can you help me' and the doctors would say 'of course.' It didn't quite work out that way. Now I understand why I see it more clearly. People started calling me to ask for my support, and I started meeting with them and learning about what they were going through and learning about all of the struggles they've had through their illness and trying to get support with what is now their legal right and they were getting turned away by doctor, after doctor, after doctor. I learned what I needed to learn about the process and I started supporting a few patients here and there. As time went on, I saw A)what an incredibly beautiful, beautiful process it is. What an extraordinary peaceful end of life we could help people achieve and the impact that it has on the families was so incredibly profound that I know that this was something that I needed to continue supporting. With the hope that other physicians would come on board and there wouldn't be such a wasteland and so much struggle because I can only take care of some many people. Well, it's a year and a half later, and I do think things have- Elizabeth: Improved. Improved some. Some of the hospital systems in San Diego certainly, have developed policies and process to support patients through the Aid and Dying, sometimes it can still be laborious and cumbersome, and hiccups occur that create great challenges and struggles. But what we've developed is a process that is so streamlined. Like Elizabeth mentions, we've come across so many of these obstacles and these issues that couldn't have really been anticipated. That have to do with hospice agencies not wanting to be supportive. Of not being able o find a consulting physician for various reasons. Coroners and medical examiners not understanding anything about this process. So we've had to be educating them to make sure that the police don't show up at somebodies house in the middle of the night. It's become a real passion for both of us and our whole team. To be able to do this and to be able to do this really well, as well as it could possibly be done. More doctors are coming on board and being open to this. I'll tell yeah, I'm not so sure that's the right thing, and we have thoughts about that. I've been talking a lot, so I wanna sit back and let you talk, take a sip of my coffee and I wanna hear your thoughts on- Elizabeth: Other doctors. Dr. Bob: Other doctors and how they perceive this. Why we may not just want every doctor- Elizabeth: Doing it. Dr. Bob: Doing it. Elizabeth: I think it's really important that other doctors be open to it. Especially open to the conversations. I think one of the things that has been the most important for me is to help people start those conversations with their doctors, with their families, with other healthcare providers. A lot of the doctors are restricted by policies where they work or by moral objections or just by not really being familiar and being concerned that they might misstep. I think that having doctors come on board first in terms of conversations is fantastic. Then also learning the process is important. As simple as it is in the way that you described it it's more complex than that. There are a lot of small details, paperwork, and requirements. Things have to be done a certain way in order to be compliant with the law. There are aspects of supporting the family. This is a very unique experience. If you as a physician don't have time to have longer conversations with patients and families, if you don't have time to provide anticipatory support and relief for the grieving process or for the dying process, it can be a struggle for the patients and families to go through this even if they have the legal support that they need. I think that that's one of the things you were referring to in terms of why it's not necessarily good for everybody to come on board. Dr. Bob: Yeah. Because if they say that they will support a patient and be their attending physician through this process, they could start the process and then come across some of these hurdles that they don't know what to do with and it could completely derail the process. It's too critical when patients finally feel that they now have this option available to them, that they see the light at the end of the tunnel, every little misstep and every little delay, is- Elizabeth: Excruciating. Dr. Bob: Excruciating. We see that happening over and over again. So when people find us and we assure them, we will help you get through this without any more hiccups, without anything getting derailed, they are very cynical. We tell them- Elizabeth: They've been so many doctors, they've been to doctors who've said... Dr. Bob: They've been screwed, they've... Elizabeth: We will help you, and they haven't gotten the help that they need. Dr. Bob: There is nothing that's more painful for somebody, an individual or a family member who's finally come around to wanting to support mom or dad or husband or a wife or a child and then to have it be taken away from them or threatened. We make ourselves available. There are times when we say we are available for you anytime, day or night; you can contact us. They start calling us; I've gotten calls at 2 in the morning from somebody just to say I just wanted to make sure you were really there. That you really would respond. They can't wait to get to the endpoint. Not even because they are ready to take the medication but because they are ready to have the peace of mind and the security of knowing that they have an easy out, rather than have to struggle to the bitter end. Elizabeth: This is really about empowering the patient and the family. This is all about providing them with the opportunity to do what they want to do with their life. To live it the way they want to live it and to end it the way they want to end it. Not in a way that is incongruent with their moral, ethical, spiritual life choices. In a way that supports the way that they've lived, the principals they've lived by and the things that matter to them. I would also say that the difficulties that doctors have had and the struggles that we've had in working with other physicians it's not because they don't care about their patients. It's not because they don't want the best thing for them. Maybe they disagree with what the best thing is, or maybe they feel that they are not able to provide sufficient support. There are a lot of really good doctors who aren't able, for whatever reason, to do this. Dr. Bob: That's a great point. I think a part of it is that sometimes they work for organizations that won't allow them to, and that happens often. Then they don't understand the process; they are intimidated by it. They don't want to mess it up. And, they are so busy that they feel like it's going to require too much time out of their day. Elizabeth: Which it does. Dr. Bob: Which it can, and they don't have any way to bill for that. They feel like they are going to be doing everybody a disservice. But unfortunately, that often leads to the patients being in this state of limbo and not knowing where to turn. Elizabeth: Thinking that they maybe they have started in the process and Dr. Bob: Not, we have certainly seen that. Elizabeth: Discovering later that they haven't. Dr. Bob: So we are going to close it down here shortly. One of the things, and you spoke about empowerment, and how really important that is, both for the patients and for the families. One thing that I've recognized, so now I've assessed and supported well over a hundred patients through this process. I've been with many of these people when they've taken the medication and died. So, I've seen how beautiful and peaceful it is. It literally in most cases, a lot of times there's laughter and just a feeling of incredible love and connection that occurs with the patient and the family in the moments leading up to that. Even after they have ingest the medication we have people who are expressing such deep gratitude and love and even laughing during the time because they are getting freed. They are not afraid, they are almost rushing towards this because it's going to free them. Most of the time they fall asleep within a matter of minutes and die peacefully within 20 to 30 minutes. Sometimes sooner. Occasionally a bit longer. But, if anyone is wondering if there is struggle or pain or flopping around in the death throws. None of that. This is truly...this is how I want to go when it's my time. The one thing that seems very consistent with the patients that I've care for through this process is, they have a physical condition that is ravaging their bodies. Their bodies are decaying, they are declining, they are not functioning. Their bodies are no longer serving them. But their spirit, is still strong. They have to be competent to be able to make this decision. Most of the time they are so determined to be in control of what happens to them, their spirit has always been strong. They have lost control because their bodies no longer function and that is irreconcilable for them. They cannot reconcile this strong spirit in a body that is no longer serving them and that is only going to continue getting worse. That's the other important part of this. These are people who are dying, they are not taking this medication because they are tired of living. They are taking this medication because they are dying and they don't see any reason to allow their death to be more prolonged and more painful, than it needs to be. They are empowered, and we are empowering people to live fully until their last moments and to die peacefully. My last little note here is, why do we do this? Well, that's why we do this. Elizabeth: Yeah. Dr. Bob: Because people deserve the absolute best most peaceful, most loving, death. This is in many cases, the only way to achieve that. I think we are going kinda wrap it up. We obviously are passionate about this topic. We are passionate about wanting to share the realities of it. We don't want there to be confusion, misconceptions, misunderstandings. Aid and Dying is here; it's not going away. It's going to continue to expand throughout our country. We are going to get to a place where everybody has the right to determine when their life should end peacefully when they're dying. I'm very happy and proud to be on the forefront of this. I know it's controversial, I imagine there are people who think that I'm evil and I'm okay with that because I know. I see the gratitude that we get from so many patients and families. When we go out and speak to groups about this the vast majority of people are so supportive and Elizabeth: Sort of relieved, even the professionals are so relieved. We have a patient, we have been helping another doctor support that patient, and he's so relieved and so friendly and so grateful just to be able to provide the support that he wouldn't otherwise be able to provide. It's not just the patients; it's everybody we engage on this, it's really amazing. Dr. Bob: Thank you. It really is an honor to watch you engage with the patients and families and to be as supportive of what we're doing. It's remarkable. Elizabeth: Thank you. Dr. Bob: We will talk about some of the options that people have when they don't qualify for Aid and Dying because there are other options. We wanted to address some of those options as well but not on this live; we'll do that maybe next time. Thanks for tuning in, have an awesome day, and we will see you soon, take care. Photo Credit:  CENTERS FOR DISEASE CONTROL AND PREVENTION/WIKIMEDIA COMMONS PUBLIC DOMAIN