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As a property management business owner, how do you find the best people to build an effective sales team? In this episode of the #DoorGrowShow Podcast, property management growth expert Jason Hull sits down with Bob Lachance, founder of REVA Global, to talk about how you can utilize virtual assistants for lead generation and growth. You'll Learn [01:22] Identifying a Need in the Real Estate Industry [08:53] How to Utilize VAs in Your Business [14:35] Creating a Hiring System in Your Business [19:30] Using VAs for Lead Generation  Tweetables “When marketing consistently goes out, what we find is all those leads end up piling up.” “Over 70% of all sales never happen on the first touch.” “People want to do business with people they see, feel, touch, and like.” “Property management can definitely be death by a thousand cuts.” Resources DoorGrow and Scale Mastermind DoorGrow Academy DoorGrow on YouTube DoorGrowClub DoorGrowLive TalkRoute Referral Link Transcript [00:00:00] Bob: Virtual assistants are a big part of anyone's business. In my opinion today, I think you got to start looking at that because small businesses, a lot of times, especially when we start, we are on a tight budget.  [00:00:12] Jason: Welcome DoorGrow property managers to the DoorGrow Show. If you are a property management entrepreneur that wants to add doors, make a difference, increase revenue, help others impact lives, and you are interested in growing in business and life, and you're open to doing things a bit differently, then you are a DoorGrow property manager DoorGrow property managers love the opportunities daily variety unique challenges and freedom that property management brings. Many in real estate think you're crazy for doing it. You think they're crazy for not because you realize that property management is the ultimate high trust gateway to real estate deals, relationships and residual income. At DoorGrow, we are on a mission to transform property management business owners and their businesses. We want to transform the industry, eliminate the BS, build awareness, change perception, expand the market, and help the best property management entrepreneurs win. I'm your host, property management growth expert, Jason Hull, the founder and CEO of DoorGrow. [00:01:10] Jason: Now let's get into the show. And today's guest is Bob. Do you say Lachance?  [00:01:18] Jason: Lachance. Yep. Lachance.  [00:01:20] Jason: I nailed it. All right. So Bob, great to have you on the show. And, Bob, you are helping people discover the top marketing channels that can maximize lead generation when working with VAs. And so we're going to chat a bit about that today before we get into that, tell everybody a little bit about you, how you got into entrepreneurism and what led you to what you're doing now.  [00:01:43] Bob: Yeah. So right now I'll just start right now. I have a real estate investment company as well. And I have a virtual assistant staffing company, so I use my VAs in my own business. So I have a rental portfolio as well as a buy sell fix flip company here in Connecticut, doing a couple of different states, but I started back about 20, 21 years ago now back in 2004. [00:02:06] Bob: I played professional hockey prior to that for eight years and then got into real estate. And you know, from real estate, helped start an education program while I was, you know, working on properties. I did a lot of, you know, fixed flip wholesaling, all that kind of good stuff. This is, again, I'm dating myself, but this is back in 2004. [00:02:25] Bob: And through the process, when I helped start this education company there was a huge need in the industry, just like you, right? You see a need out there. And I'm a lot like you on that side of it, helping people and figuring out, you know, where they could. Create passive income or income in general. [00:02:42] Bob: So, during the coaching program, while I was in it, I realized there was a huge need. Majority of the students that I coached didn't have the time to actually put into their real estate business because they were either working part time or full time. They just needed to, you know, they needed help. And for years, upon years, I was looking for a solution for that. [00:03:01] Bob: Whether it was a product I didn't know back then, again, this is going back from 2007 to 2013. I didn't know there was any services out there, like what virtual assistants were. And then I got introduced back in 2013 what a virtual assistant was. You know what this could help my business So I hired my first one and then light bulb went on like, you know what we could turn this into a business I could take the back end of what it helps create which is the real estate education company And our students could use it to help them grow their business help scale help, you know, get your time and freedom back. So launched it in 2014 and then fast forward today you know 10 years later i've been in business for a while and I also have like I said my real estate investment company  [00:03:45] Jason: Nice. [00:03:46] Jason: Nice. All right. And so let's get into the topic at hand. So, we're going to talk a little bit about leveraging virtual assistants. And so how did you kind of start doing this yourself?  [00:03:58] Bob: Yeah well, when I first got into this, like I said I door knocked first, we didn't have the opportunity to have, you know, virtual assistants do some outbound stuff. [00:04:07] Bob: And I didn't understand, you know, I didn't understand what outsourcing was when I first started. It was just me. I had an individual who was my business partner back in the day, but first year I door knocked. I went from door to door, individuals that were behind on payments. So it wasn't the easiest job in the world, but it allowed you to understand how to build a business from ground up. [00:04:29] Bob: I think that was very important back then. So nowadays you can have virtual assistants do that, whether it's you know, cold calling, whether it's responding to direct mail, whether it's text messaging, whether it's social media, whether it's going out to, you know, Facebook marketplace and going right direct to seller, you also have rarely used now Craigslist, of course, but there's different ways to acquire and use your virtual assistant to do that. So that's just, again, a long and short.  [00:04:54] Jason: So go ahead and tell people a little bit about your company and what you help people do. And I'm really curious because this is usually a difficult thing for business owners to outsource. [00:05:05] Jason: Usually they'll outsource some of the lowest level stuff, and it's usually not towards growth, lead generation, outreach, stuff like that. Those pieces can be really difficult to get dialed in or to do effectively. And so, tell us a little bit about REVA global? Okay. Yeah.  [00:05:22] Bob: So, you know, like I said, we started back in 2014. [00:05:26] Bob: Like I said, I've been doing this for a long time and just to fast forward to what that looks like today and working with property managers, because obviously the individuals that are on your podcast here, I'll speak to them. And I know, you know, many people that also buy and hold also probably do fix and flip or also may wholesale, but it's kind of the same concept, but there's a lot of different tasks within it that virtual assistants can do. [00:05:50] Bob: So what I did is I broke up all the stuff that our VA is doing in my own business because you know, many individuals that are listening to this will relate to a company like ours because like I said, we have a real estate investment company, but we also use our VA's which I think is pretty cool. I think Nowadays, it's very important as a service provider like myself to use it to make sure it works so I think that's a pretty unique thing that we actually have. But what we do, we have virtual assistants that acquire, we call them like a department of acquisition. So if you're looking for leads, you could do cold calling, you do text blasting, you could do lead management. You know, lead management, a lot of us, I'm just like, you will have all these leads in your database, but if you don't get ahold of them the first time, your marketing is going to consistently go out. So when marketing consistently goes out, what we find is all those leads end up piling up. And if you try to reach out to them the first time, you know you have a very small percentage that are actually going to pick up the phone. Right? So you need somebody then that will continue to follow up on those leads. [00:06:57] Bob: And a national statistic is over 70% of all sales never happen on the first touch, right? So you have to continue. And I think that's probably 90 or 95 percent nowadays. So that's what we find in our office. And I know a lot of our clients say the same thing. So that number could change a little bit depending on what you read, but our experience in our office is over 90%. [00:07:21] Bob: So what I mean by that is the first touch, whether it's direct mail call or a cold call, whatever you do for direct mail or whatever you do for marketing, that first touch will not equate to a contract, so you're going to have somebody that's continuing to follow up with those individuals. Very important. [00:07:39] Bob: I wish I would have understood that stat when I first started real estate. But again, you know, you learn over time. Another stuff. If you look at other tasks as well, that works very well is marketing. Right social media management because you look at any type of business if you don't have marketing It's very difficult brand awareness, right people want to do business with people they see, feel, touch, and like so you need to make sure that you're out there You're out in the public's eye. [00:08:05] Bob: I think that's very important. I know you guys do a great job of that Jason on the marketing side of always being out there because I see in a lot of different places everywhere I'm looking online. So whoever's doing your stuff man, great job. So you're doing a fantastic job on that side of it. And then you go into leasing so if we look at property management you know driving leads is one thing, but you also have to, you know, close them. [00:08:27] Bob: So if it's you, me, or whoever's the one on the phone locking up those deals, it then goes to once you own them, you got leasing, you got move in, move out, you have collection, you have evictions, you have maintenance, you have accounts receivable, you have accounts payable, bookkeeping, accounting etc that fall underneath that property management umbrella, that virtual assistants are phenomenal to actually take on those tasks for you.  [00:08:52] Jason: Got it. Yeah. Yeah. So what's the typical process for somebody that could use some help from a company like yours? How do you engage them? [00:09:01] Jason: What's onboarding like? How does that work?  [00:09:03] Bob: I think for anybody who's looking to scale or looking to just get help in their business. You know, here in Connecticut, it's pretty interesting because if you're looking to hire someone in house, you start looking at what's going on with the world and what's going on with the economy in state of Connecticut, minimum wage is up to $15.69. [00:09:24] Bob: So when you start looking at that I know in my area, if I try to hire someone at minimum wage, they don't have a four year college degree. That's just not the highest level individual that you'd want working in your office. And so now you start looking at those things and what's happening around the country. [00:09:42] Bob: Virtual assistants are very are a big part of anyone's business. In my opinion today, I think you got to start looking at that because small businesses, a lot of times, especially when we start, we are on a tight budget. Right. And so for us to start to scale or start to grow or start to hire, we really need to look at what's going out, meaning out of our pocket. [00:10:04] Bob: So it's very important. So they first look at number one, what can we afford as small business owners? If we look at that number, now we start looking at what tasks in our business do not put money in our pocket. Right? And if you look in your world, meaning the property management world, it is a lot of the tasks like leasing, like taking calls from tenants, move in, move outs, eviction process when you're calling attorneys back and forth. What does that look like? There's just a lot of back and forth, right? Maintenance concerns. You get those all the time and those are the things that burn up your time. Your phone doesn't stop ringing. [00:10:44] Bob: So if your husband or wife wants to go on vacation with you and your phone doesn't stop ringing. That's going to put a lot of stress and a lot of challenges in your personal life to where, especially when you continue to grow. You have to put more systems and processes in your business. You know, if you had one house, that's one headache. [00:11:02] Bob: You had two, that's two headaches. You have a hundred, you have a hundred potential headaches that if you don't want to take those headaches on yourself, it's always good to have somebody else take those headaches before it gets to you.  [00:11:15] Jason: Yeah. Property management can definitely be death by a thousand cuts. [00:11:18] Bob: Yep.  [00:11:18] Jason: Yep. And if you get it really well dialed in though, yeah, it can be a really great residual income business model.  [00:11:25] Bob: So Very good. Very good. Well, two sides of it, right? You buy, right? You have an equity play there, right? And if you don't have to deal with the headache, you get the positive income, you get tax advantages, things like that. [00:11:36] Bob: So, I mean, I'm a huge advocate of buying and holding and property management because over time, the more, like you said, the more properties you actually hold, the bigger your income grows.  [00:11:48] Jason: Nice. Yeah. Cool. So, so I love this. There's lots of low level tasks. It does get really expensive trying to afford staff and team members and you don't want the cheapest or lowest level or worst people. [00:12:02] Jason: You know, in the United States representing your business. And so, sometimes you can get people at a fraction of the price point that have a lot more education that are a lot better. And so when you, any of the roles that are able to be done virtually, you open yourself up to a global marketplace rather than just your local city. [00:12:22] Jason: And so, yeah, so there's definitely advantages. So my entire team are virtual and I've got team members in various areas, Canada, Philippines. Egypt gosh, I don't know where else like all over the place and I've hired people over the past and just about everywhere. So yeah. And so, and so I'm not limited, so I'm able to just go find the best and I'm able to figure out, okay what can kind of fit into our budget and what can we afford in order to do that. [00:12:49] Bob: Right. And to your point, to get back to what that looks like, I mean, anyone in this world could go out and go source for their own candidates. You know, we set up a very unique system process. We have a whole sourcing and recruiting team. All my virtual assistants are in the Philippines. We set up a sourcing and recruiting team out of the Philippines, so they're Looking through, you know, thousands of resumes every single month sifting through and we're getting the best of those Resumes that come in as soon as they pass then they go through an interview process. [00:13:22] Bob: They pass the interview process They go to our training team and they train for about a month on various tasks property management tasks lead generation tasks, etc And then once they actually get to the end of that stage, they do another test and a lot of individuals do not pass our testing phase. And that's a positive thing because, you know, that's a way to kind of weed out the individuals that wouldn't make it, yeah, very good. [00:13:48] Bob: So, after that goes to our placements team and our placements team, it's kind of like match. com. They look at exactly what you're, you know, what the tasks are. And we do DISC profiling, things like that, and predictive index. And we look at the tasks that they're good at, and we match them exactly up with the client and the tasks that they're looking for. [00:14:05] Bob: So for instance, if someone's looking for a bookkeeper, you're not going to give them a profile that's a sales profile, right? You're going to, you're going to give them the correct profile. You put them together, they go through an interview process, and they pick the best candidate that fits within them so after that, it goes to our operations team. We have what we call a client service manager that helps manage the relationship between you and your va, so it's very streamlined. [00:14:27] Bob: You know, we tried every different business model there is out there and the model that we have right now seems to be the best model.  [00:14:34] Jason: Nice. Yeah, I always recommend if you're a property manager like watching this or listening if you don't have a really solid hiring process you have not like tested embedded and experimented with, then the best initial way to do hiring is to leverage other companies' hiring processes. Go and work with a company and there's lots of different companies I've worked with over the years to get people on my team, and then eventually we've built a really good process internally, but In the beginning, I do think every business eventually needs their own hiring system, but if you don't have a great robust hiring system that you can get candidates consistently, that you know are a good culture fit, a good skill fit for the role, a good personality fit for the role then you need to go leverage somebody else's hiring system. [00:15:20] Jason: So I would highly recommend, especially if you're going to dabble with VAs, especially in the Philippines or any other area, that you want to not be dealing with all the riff raff and the challenges and everything else. You want to have some help with this. So I highly recommend you leverage somebody else's hiring system. And they're going to help you not waste as much time and money for sure.  [00:15:46] Bob: And that's one of the things that's a great very great point because when you're first starting out or you're smaller. The best thing to do is learn off of others, right? [00:15:55] Bob: It's you'll walk through a company like mine. You say, "wow, what a great system." You know what? Document what we do and then implement it in your own business if you start growing. I think that is a fantastic idea, Jason, for that. Because, you know, you look at the biggest companies in the world. [00:16:09] Bob: They didn't just, you know, start being the biggest companies in the world or that, you know, it doesn't, you don't have to be the biggest, but they learned from somebody and they started implementing and they tested, you don't always get it right the first time. But after a while you will hone in and get that right. [00:16:24] Bob: So I 100 percent agree whether it's with our company or anybody else. Like I said, anyone could do anything themselves. It all depends on what you need help with at the beginning.  [00:16:34] Jason: Yeah. And it also depends on how long do you want to suck until you figure it out.  [00:16:40] Bob: That's true.  [00:16:41] Jason: Like so if you want to collapse time, I highly recommend. Because I know when I started experimenting with hiring in the Philippines. Like there's just things you don't even think to ask like we had to ask like where are you accessing the internet? [00:16:53] Jason: Is this like at a cafe at your home? Is it reliable? What kind of computer do you have? You know, we needed to be able to you know there's just so many little quality controls we had to implement in order to figure out if they would be a good candidate, I mean, I've had team members in the Philippines with chickens going off constantly in the background and roosters crowing and like all sorts of stuff and their internet going up and down and so you know, there's there's a lot of quality controls that I think need to be put in place because it's not America. We have a little bit more stability in our infrastructure and in our internet connections and everything else. [00:17:29] Jason: And so, and then, you know, it helps to have somebody that manages the relationship like your company, because a lot of times, in that culture, they can be a little bit shy, I think at times, or a little bit nervous about displeasing their employer or giving honest feedback. And so they tend to ghost or disappear. [00:17:49] Jason: People have talked about people in the Philippines doing this. And so having somebody manage that relationship as a liaison can help improve the results that you're getting from team members. And but the cost savings are awesome. I mean, it's like a third to a half of what you would get and you can get college educated people, you get people that have like lots and lots of experience and skill, and they are able to be paid very well for their area. [00:18:14] Jason: And for you, it's seems like a steal. So.  [00:18:17] Bob: And that's one of the things that we pride ourselves on. I mean, you nailed it. You touched upon all of that. You know, we make sure there's backup. We make sure there's the right internet connection, the right computer system, etc. So to your point that is definitely something for everyone listening to this to look at because the vetting process, that's what I found the most tiring. When I first hired my first VA, I got it wrong a lot, to be honest with you. And I didn't ask any of those questions. And then it's kind of funny to talk about the rooster. That happened to me. And that was before I actually owned the company. And then I started my company. That's one of the things I'm like, all right, we have to listen for, right? [00:18:52] Bob: What's your background, what's your surrounding, right to your point. And then you start learning over time. And then the more interviews you go on, the more stuff you learn, right? Like you said, you don't learn or you don't know all this stuff until you actually go through the process. And I think it's important for you to understand if you're going to do this, know that you're going to have a lot of pain up front when you hire at the beginning, right? And then you work with a company like mine and you'll realize you didn't go through that pain, but then you want to go hire someone. And then you decide to then throw your hat in the ring and do this yourself. [00:19:25] Bob: 100%. The questions to ask, just like Jason said up front, those are some of the things to look at.  [00:19:30] Jason: You know, based on the stuff that you said, I there's a lot of. Property management targeted, you know, VA companies leveraging talent in the Philippines, but it seems like one of the things you brought up that seems to be unique to what you guys do that's different than most of the others, or maybe all of them is the focus on client acquisition, lead gen, and on the sales side of things. [00:19:53] Jason: Most are usually focused on trying to find VAs that are more like executive assistants or that are going to do tasks and be told what to do rather than people that you can trust to be the initial connection and face of your business.  [00:20:08] Bob: You know what it's interesting, again, it's interesting you say that because I've been in this business for about 21 years, real estate investing. [00:20:14] Bob: And we realized over time that If you don't have, you talk about acquisition and lead generation, if you don't have leads for any of our businesses, we are going to struggle to make ends meet, right? So you have to figure out a way that's going to drive in leads to your business. I mean, I know for me, I'll just give you a perfect example. [00:20:32] Bob: When I door knocked, I went door to door to door every day from 10 a. m. to 3 p. m. But when I go home, I'd get that list and I would skip trace it back in the day You'd use 401. com white pages, and I would look for the best possible phone number for that individual then I would call. So when I got home, I would skip trace then I'll call until seven at night until I had to eat dinner with the family. But over time, I was beat up. [00:20:55] Bob: I don't recommend doing that anymore. You don't have to do that anymore because you can hand over those tasks over to a virtual assistant. And they're the ones that are going to be doing the outreach for you. And again, I do recommend you should try it because you'll realize you know, open your mind and understand that outsourcing that task will really give your energy back and bring your success up. [00:21:16] Bob: You may feel, well, I don't think anyone could do that task better than me. We all said, I know you said it before, Jason, I've said it. We all feel that way. And if you think about it, if they do 80 percent as good as you, that's a huge win. Now you get to do other tasks. That's going to drive business and revenue to your business. [00:21:36] Jason: Even if they do it half as well as you, but they're getting. You know, half the result and you're able to hire two or three of them and not do that work. Like it's easily time and money well spent. So it's consistency, right?  [00:21:48] Bob: It's all the consistency. If you have something, a task that gets on a consistent manner, consistent basis every single day, you will get results by the end of the week. [00:21:58] Jason: Yeah. So what are kind of SLA you know, you know, what do you sort of think are the metrics or KPIs for as an appointment setter or somebody trying to help, you know, maybe reaching out directly to owners or maybe reaching out to schedule, I don't know, appointments with real estate agents to build referral relationships. [00:22:17] Jason: How many calls should they make a day? If this is their full time gig and how many appointments do you think they should be booking?  [00:22:22] Bob: Well, it depends. So if you have, so for instance, if you have a, you know, triple line dialer, as an example, it depends if you're, you know, calling just on a, you know, on your phone and just dial like this, but there's a lot of very good technology out there. [00:22:36] Bob: You got mojo dialer, you have things like that actually are very good. You may have a company that you refer, Jason, that you could tell everyone but you're probably calling if you're full time, anywhere between 400 and 600 dials using that dialer, not manual dialing. You're probably going to hit about a hundred, 150 if you're manually dialing. [00:22:57] Bob: And that's a day. Yeah. But if you have a triple line dialer, you're going to hit on average 400 to 600 and this is just what I've seen through the years that I've been doing this. You may have a technology that burns through a thousand calls and then you're going to be listening to me saying, well, Bob, you're a hundred percent wrong. [00:23:13] Bob: I'm just telling you what I see on a daily basis and what comes out of, you know, mine and my client's offices.  [00:23:19] Jason: I think yeah, even if they're doing it manually, if they can get a hundred to two hundred calls a day and get two appointments booked a day, like, so they're getting roughly about 10 a week. [00:23:27] Jason: Like that's a solid result for an appointment setter.  [00:23:31] Bob: That's a win. That's a win. You're looking at, if you're looking for, so we call them ITS's in our office, interested to sell. I know other people call it different, but that's what we look for. Same exact thing. One to two per day per VA. [00:23:44] Jason: Nice. Yeah, very cool. And those listening, I'm sure all of you would love to have one or two appointments booked for you per day, and that would fill up a nice little chunk of your time and help you close some deals. So, yeah.  [00:23:57] Bob: Especially on the buy and hold side Jason. It's a lot easier to look at your numbers. [00:24:03] Bob: And I know you have a formula that you guys look at to make sure the rent and you know, what the interest rates are today, et cetera, et cetera, whatever financing you have, but it is easier on the buy and hold side to fit within your buy box, right? Rather than having to go at, you know, 30 or 40 or 50 or 60 percent of the value. [00:24:20] Bob: When you fund it out and then try to resell it. So it's a different kind of mindset. So you're very fortunate if you're going to buy and hold your buy box is usually different than somebody who's either trying to wholesale or fix and flip.  [00:24:32] Jason: Got it. So we've probably got some property management business owners listening to this. [00:24:37] Jason: And for some reason, maybe they're just crazy and they have not yet worked with DoorGrow yet, but they're like, Hey, I would like to grow, add some doors and maybe have somebody do some calls and reach out to Bob. How could they get in touch with you and how can they initiate a conversation?  [00:24:54] Bob: Well, you can check us out on our all of our social, of course, but REVA Global. R-E-V-A Global. com. If you have any specific questions, obviously for you, you could just reach me direct at bob@revaglobal.com.  [00:25:07] Jason: Awesome. Hey Bob, thanks for coming on the show. Any parting words for entrepreneurs that are struggling, they've never hired an assistant yet they, even if they've built out part of their team or an entire team already, which is ludicrous to me, but what would you say to them? [00:25:22] Bob: Well, I would say number one, get started, of course, but number two, I would say you got to set up your processes and systems and get them done consistently because if you just get success here. And then you stop doing it. Real estate's a long game. You know, like I said, I started this 21 years ago and I wish I knew what I knew now back then. [00:25:43] Bob: I would start buying properties back then because right now I'd be retired with thousands of doors and rental income of a thousand doors. But I started a little bit later.  [00:25:54] Jason: Hey, Bob, we appreciate you coming and hanging out with me on the DoorGrow show today. And I'm excited to see if you helped maybe some of our clients listening or some of the people let me know what results they get and maybe we'll have you come back on. [00:26:07] Bob: Thanks for having me. Appreciate it.  [00:26:08] Jason: All right. So if you are a property management entrepreneur, you're struggling to add doors, you're struggling to figure out how to grow your business. We want to help you. We want to support you. Reach out to us at DoorGrow. com. You can also join our free community at DoorGrow club. com. Go there. Answer the questions. We reject 60 to 70 percent of applicants. It's just for property management business owners And if you get inside, we'll give you some free stuff that'll help you out and help out your business. So that's it for today until next time to our mutual growth I'm, Jason Hull, and I hope you crush it. [00:26:40] Jason: Bye, everybody. 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Get ready to dive deep into the future of Vocational Rehabilitation (VR) with Dr. Joe Ashley and Dr. Bob Schmidt in our latest episode! Joe, the dynamic Project Director of the VR-ROI initiative at George Washington University, teams up with Bob, one of the leading economists and the Project Research Coordinator, to bring you insider knowledge on revamping return on investment models for VR programs. They're on a mission to streamline and elevate how VR agencies operate, helping them become more efficient, effective, and impactful. Their discussion is packed with actionable insights that will empower your agency to sharpen its data collection strategies, ensuring the true value of your services shines through. Plus, learn how to better communicate the VR success story to policymakers and stakeholders! Tune in to discover how you can maximize your VR impact with the latest advancements from the VR-ROI project. Don't miss out!   Listen Here   Full Transcript:   {Music} Joe: We're trying to make sure we have information that the director can use with policymakers, and something for clients and counselors to use to say, yes, this is the kind of services we're looking for.   Bob: The model we develop is based on readily available administrative data.   Joe: It's built on the individual customers and how well they do and what their outcomes are.   Bob: The human capital development, that's what it's all about a lot. Some things just aren't measurable. So when you mentioned financial return on investment, that's what we're talking about.   Joe: If you can't capture it, you're not able to tell the story.   Carol: Yep, if it isn't documented, it didn't happen.   Bob: That's right.   Joe: Yeah.   Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.   Carol: Well, welcome to the manager minute. Joining me in the studio today are Dr. Joe Ashley, the project director for the VR Return on Investment project based at the George Washington University, and Dr. Bob Schmidt, one of the five economists working on the project and the project research coordinator. So, Joe, how are things going for you today?   Joe:  Today they are doing really well. Thanks for asking, Carol.   Carol: Nice to hear it, Joe. and Bob, how are you doing?   Bob: I'm doing well as well, at least, as well as Joe is doing.   Carol: That's awesome. Alright, glad to have it guys. Okay, so for our listeners, Joe is my colleague and we got him out of retirement to serve as the project director for this important initiative. And this project is funded by the National Institute on Disability, Independent Living and Rehabilitation Research, also known as NIDILRR. Now, this is the federal government's primary disability research organization and is part of the Administration for Community Living. Now, NIDILRR's mission is to generate new knowledge and to promote its effective use to improve the abilities of individuals with disabilities to perform activities of their choice in the community and to expand society's capacity to provide full opportunities and accommodations for its citizens with disabilities. NIDILRR achieves this mission by funding research, demonstration, training, technical assistance, and related activities to maximize the full inclusion and integration into society, employment, independent living, family support, and economic and social self-sufficiency of individuals with disabilities of all ages. They also promote the transfer of, and use and adoption of rehab technology for individuals with disabilities in a timely manner, and also ensure the widespread distribution and usable formats of practical, scientific and technological information. And they do address a wide range of disabilities and impairments across populations of all ages. Now, Joe, I know you have a little disclaimer you wanted to make.   Joe: Yeah, I just want to be sure that people understand that what Bob and I are going to talk about today is our opinion of what return on investment should be, and is not necessarily reflect what NIDILRR is looking at.   Carol: Excellent. Well thanks Joe. Let's dig in. So, Joe, why don't you kick us off and tell us a little bit about yourself and your journey in vocational rehabilitation?   Joe: Carol, I've been in rehabilitation for quite a while. I worked with the Virginia Department for Aging and Rehabilitative Services, the general agency in Virginia, for over 25-27 years, most of the time as an assistant commissioner in a variety of roles. I have a master's in rehabilitation counseling from the University of South Carolina. That sort of got me focused on vocational rehabilitation. And then later I had a Doctorate in rehabilitation from SIU at Carbondale that took me on a path of looking at program evaluation and program development. When I got to Virginia, I was working out of the Woodrow Wilson Rehab Center, now called Wilson Rehabilitation Center, and was working in a program that was collaborative across, it was one of the early transition grants, 1985,and it looked at vocational evaluation as a part of a process to help kids learn what they needed to do. And we were working with students from special education and vocational education in the schools, and vocational rehabilitation, and getting these systems to collaborate to help kids find out what they want to do and to be successful in employment and in life. And I got to where I really enjoyed that kind of collaborative work, and I ended up as an assistant commissioner in the agency, looking at developing innovative new programs as a part of my responsibilities and looking at a lot of the ancillary support services like rehabilitation, engineering and other kinds of things. Through a series of circumstances, I ended up as the director of the field services for four years, where I began to get a good sense of what disabilities needed to be in terms of supports to be successful in employment and being able to live successfully in their communities. In addition to that, what counselors and other staff needed to be able to provide those services to them. And then I got into the job that was my favorite, which was something called grants and special programs, where I did a lot of the Social Security stuff, cost reimbursement, work, incentives specialist advocates. We created a new system there to do fee for service for the work incentive services. We did a lot of work with the workforce agencies. I did all the agreements with that, and then I got to do grants and any of the grants that helped people with disabilities be able to live and work and thrive in their communities were things that we were willing to support. And I got to work with a lot of different funding systems and across a lot of different systems, you know, Special Ed workforce systems, behavioral health, a lot of different groups to help people with disabilities have opportunities. So that's what I really enjoyed. And that's where I came across the late doctor David Dean and then Bob Schmidt as a part of that package with Dean. And it was about telling the VR story. And I got real passionate about how do you tell this story in a way that is going to get people like GAO to pay attention, as well as help directors with policymakers and individuals and counselors help make decisions about what's a good choice for them. So that's really how I got to where we are today with this new grant.   Carol: Very cool Joe. I know we all look to your program in Virginia for kind of the cutting edge stuff that was happening, because you all seem to always have just something cooking.   Joe: Yes.   Carol: It didn't matter what. And especially like the disability work incentive stuff that you were talking about and all of that. Oh gosh. I just think you've done a lot of stellar things there.   Joe: Well thank you. It was fun.   Carol: It's awesome. So, Bob, tell us a little bit about yourself.   Bob: Sure. Happy to. Joe mentioned Doctor David Dean. He was a colleague of mine in the Department of Economics at the University of Richmond. He worked on what he called economics of disability, and he started working on that in graduate school at Rutgers with a faculty member there. And he worked on that. So that was in the 1980s. He came to the University of Richmond, and he got me interested in it because he was an outgoing, gregarious, very bright guy and made friends easily. So he got me involved in this probably early 1990s, and we started working with DARS and several other things at the time with Joe, but also Kirsten Roe. I don't know how many people remember her, but she was instrumental in all the work we did. So this is actually our third grant with NIDILRR. The first one was a demonstration grant. So it's a kind of a proof of concept. Second was implementing it. Now this one is refining it and taking it to the next step. That's what we're trying to do with that. So David got me excited about it. Joe keeps me excited and he keeps me honest.   Carol: That is awesome. Well, I know just being around the director ranks for years and folks talking about return on initiative, it's been a, you know, a hot topic. People chat about it, but I don't know that everybody always really understands it. And I think sometimes people think maybe it's something that it isn't and they aren't very good at explaining it, but everybody wants to do it. So you guys are going to unpack all this for us. Joe, why don't you tell us a little bit about the project and what you're trying to accomplish?   Joe: Well, with this current iteration. It's what NIDILRR calls a field initiated project on their development side, and it's got a ridiculously long title. So I'm just going to say it is about updating and simplifying our return on investment model. That's its main purpose, and it's about helping our agencies understand what they can do to be more efficient and more effective, and take a look at the mix of services that they provide, to be sure that they are getting the most out of the resources they have to help people with disabilities obtain, you know, that probability of employment and upon employment, their earnings. And we're trying to make sure we have information that the director can use with policy makers, that agencies can take a look inside their own services to say, maybe I need more of a particular type of service because I'm getting good outcomes, or maybe I need to tweak a service because it's not getting what I want it to do, and then something for clients and counselors to use to say, yes, this is the kind of services we're looking for. We got four goals, and the first one is just really to update the model. Our previous model was prior to WIOA implementation, so what we hope to be able to do is take a look at the data systems and take a look at the performance indicators that WIOA requires. And we can do a correlation, perhaps with the long term employment to see how well they're correlated. Also take a look at Covid impact. The second goal is about intensity. Our other model is you either got a service or you didn't. And if you got the service then how did it affect employment and earnings? Well, the next logical step according to The Economist and we have five on the project as you mentioned earlier, was what is the intensity of the service. Does that make a difference. So that intensity measure could be hours of work. It could be what it costs to do something. It could be units of service. And taking a look at if that is related to the propensity for employment. The other piece that goes with that is how about internals provided services, what we had before in the system, nobody had good measures of the services their own staff provided. So we're hoping with what we're seeing now and we're working with the two agencies in North Carolina, and they've been extremely helpful and collaborative with us on this process is take a look at the internally provided services and see what impact they have on the employment and earnings side of things. And then we've been told many times our third goal is simplify the model. Right now it takes economists to run it. Well that's not always a good idea for some people. So what we're trying to do is see what econometric models could we put in place to simplify this process so that it's more available to rehab agencies. But you want to make sure it's still rigorous enough to give you a reliable estimate of return on investment. So one of the things we're having with that is many of the folks on the who are listening to the podcast may be aware that we did a data analysis and management capacity survey that CSVRA sent out. Our advisory committee supported, and with that, we got 54 agencies to provide us information on what their data capacity is and what this capacity of their staff is. And then what kind of training they might be interested in. We're still looking at the data from that and we'll have some information on that later. But what we find in this may make a big difference on how simplified the model can be, or whether we need to take a different track to help people be able to implement a new model. And then finally, it's about knowledge translation. And part of that is coming to us like we did a consumer and stakeholder forum with the North Carolina State Rehab councils and some other stakeholders to get input on what they'd like to see, what kinds of information and would this information be helpful to them. And then we're going to have another consumer and stakeholder forum probably next spring to say, here's the model as we have it so far. Does this make sense to you and would this be valuable to you? So those are the big overriding goals that we have for the project.   Carol: I really like that you guys are digging into the capacity that agencies have, you know, with that data analysis, because I'm just thinking definitely, as I've been out across the country that you've got to have and the have nots. I mean, there for sure. are folks, I think of our friends in Texas and they have a lovely team there. Just they have like an amazing...   Joe: Oh yeah, they do.   Carol: ...resource team. And then you've got other folks trying to scrape together kind of a half of a position that can maybe do a little smidge of a little something around the 911.   Joe: they may have a resource like a data system, but they don't have anybody that can run it, or they may have staff with the capacity to do the data system, but they don't have the system. I mean, it's a lot of different variables there.   Bob: I'd like to jump in here just on one thing, which was on the simplified VR model. So the model we've developed, thank God it was by economists, is we're trying to address the question here. The goal of the program is to get people into competitive employment or keep them in competitive employment. If they already came into the program with it, maybe build on that. So there are a lot of things that are correlated with how well you do in the labor market, gender, race, Age, education level. All things are correlated, right? And maybe service provision in the VR program. But we'd like to take it from well, it's correlated, but we don't know exactly how or why. In the same way you can say, well, provision of this specific type of service leads to improvement in the labor market, leads to a greater likelihood of obtaining competitive employment. Now that's a different issue. Now the way you normally do that, the gold standard is a randomized clinical trial, right? Where you take people and you randomly select them and it's double blind. So neither the researcher nor the individual involved in the experiment know who's receiving the treatment, or  who isn't. Well, that's clearly impossible in VR. First of all, it's illegal to deny service to someone who is eligible and for whom you have the money. But secondly, it's impossible. So what you have to do is you have to impose statistical controls somehow. You have to do it through some sort of statistical model. And we've developed one which is state of the science. What state of the science inherently means that not everybody can implement it. So even at some universities, they aren't able to implement this particular model. And so we wanted to ask the question, could we come up with a simplified version of this model, a simpler model that can be used possibly in a VR agency or possibly at a local community college or university, something like that. And they could get similar results. So we wanted to see how could we do it? Is that a possible goal? What do you lose when you do it? Does it do a good enough job, or what kind of qualifiers do you have on it?   Joe: Where are the tradeoffs?   Bob: Yeah, what are the tradeoffs? That's a simpler model we're trying to do.   Carol: Should we talk about the model you developed now? Do you want to talk about it?   Bob: That'd be fine. Sure.   Carol: Let's do it.   Bob: Okay. One of the things is that the model we developed is based on readily available administrative data. What that means is you don't have to run a survey. You don't have to go out and do a very expensive sort of research project to find out what's going on. Instead, we use data from agency's own data system, which they collect to report to the Rehabilitation Services Administration, (RSA). they have really, really very good data. The RSA forces them to collect very good data. In fact, for some of our economists, their eyes just lit up when David told them the kind of data that he was able to access it. Whoa. That's great. So there are two levels. One is you get data from the agency itself, and then they will provide data to us that they provide through the quarterly RSA and nine over 11 report to the RSA. And more than that. So we get much greater detail than that if we know how to use it. If we can identify and know how to learn how to use it. And then secondly, all the agencies have given us access, been able to give us access to unemployment insurance sort of data. So quarterly data on that and what the RSA collects upon closure. They're mandated to follow employment and earnings for four quarters after closure, but we don't think that's long enough, especially since WIOA was passed Workforce Innovation Opportunities Act and changed the mandate to work on transition age, transitioning students with disabilities or providing those sorts of services. Well, if you're going to start working with young people who are just entering the workforce, or you're providing college level education or skilled training services to any age. You can't just follow them for four quarters. I mean, if you're just entering the workforce, you're not going to enter it at the highest levels of the workforce, right? So if you want to know what the real impact is, you have to follow them longer. So with the unemployment insurance agencies, we've been able to get quarterly employment and earnings data from 2 to 3 years before they even applied to the program. That's kind of a baseline. But what are the services do to you? How do things change? Well, that's your baseline three years before application. Then we try to follow them for at least five years after application at least. Now the current one starts in 2018. So the earliest applicants we have from 2018, and then we collect all applicants between 2018 and 2021. So already it's a stretch to get five years of data. But we had to start that recent because we all wasn't fully implemented effectively until 2017, 1819. In fact, the fellow North County says preferably 19 or 2021. But then you don't have, you know, this thing ends in 2025 and you don't have enough data, enough tracking. So that's the first thing, is readily administrative tracking earnings over a long period of time, as long as possible. Another thing is generally the way these things are done or have been looked at is you look at the VR program as a whole. You don't look at by discipline, you look at the agency. These are people who apply for services, and these are people who got to the point where they got a plan or plan for employment services. And then how do they do? We look a little differently. We look at by disability type. First of all, we look at for broad based disabilities folks with a cognitive impairment. And that could be an intellectual disability or a learning disability. Folks with a mental illness. And then also we try to find out how severe that mental illness is. Folks who have a physical impairment and folks who are blind or visually impaired or otherwise visually impaired. So we look at and we estimate those all separately because we think services are assigned differently by disability type on average. And also the disability type affects how you will do in the marketplace, for example. What we found out was for folks with physical impairment, unlike folks who have a cognitive impairment, cognitive impairment might be with you since birth, perhaps. And so therefore you kind of have a steady level of earnings at a certain level. But if you have a physical impairment that often comes on very quickly, very acutely, very quickly. So all of a sudden you see their preapplication Application for earnings pretty good. And then boom there's a big plummet, right? And so then you have to do something different with the track that the pre-application earnings. So that's the second thing. The third thing is that this idea that these folks, we look at the folks who received,, who had a plan and therefore received services, we compare those people who didn't have a plan and didn't receive services. So he received service, he didn't. Or, in economics or the social sciences, you call it a treatment group and a comparison or a control group. Well, we thought you could do a little bit better than that. What we look at is we look at anywhere from 7 to 9 to 10 to 11 different types of services things like diagnosis, medical treatments, college education, training, all those sorts of things. We say, first of all, how is the decision made that you're going to receive this type of service? And then secondly, what impact does it have? So what factors influence the decision to We see what type of services and what impact does that service have in the labor market on gaining and keeping competitive employment. So we look at that. So we look at different types of service. So you can see already it's a much richer type of analysis therefore much more complicated types of analysis. And then the last part is that we built sort of a state of the science model. And that's what makes it complicated for many people to try to implement. And by that we mean that this correlation versus causation. So instead of doing a randomized clinical trial you have to take the data as you receive it. So therefore you kind of build control by saying how do you control for different things that might affect this that you don't observe. Now one of these might be motivation, right? So if you have someone who's particularly highly motivated that will might lead them to both apply to a VR program and a plan, follow through and move on, successfully complete the program, and might also quite separately, whether or not they receive services. It helps them in the labor market, right? Because they're motivated to succeed. So how do you distinguish those things? That's tough. You do randomized clinical trial. You can't because both types people end up in both parts motivated and unmotivated. So we have to impose this controls. And that gets a little complicated. So that's basically the model is then once you're done. So then we get impacts by type of service. We also collect cost of providing those services. Cost of the program. We have those impacts. We let them spit out and say what would happen if they kept getting this benefit level for the next five to 10 to 15 years? And then you have to do some what's called discounting in technical and finance and econ. So you do that and then you say, okay, this is the total gain from that service or actually from all the services combined. And this was the cost. And the difference to that is kind of cost versus benefits, right? Hopefully the benefits exceed the costs, right? And that's how much they've gained because of the service per versus both the. That's essentially what you do. And the other thing about that is we can calculate that for each individual in the sample. So we have individual level returns on investment individual level benefits or effectiveness. And you can then aggregate that up and say okay agency wide. This is what it looks like. The agency's return on investment for a particular disability. That's what their return on investment look for males their females. Any group you want to do you can just do it because we have the individual impacts of it. So that's the model. And we want to see whether a simplified model can get us similar sort of information.   Joe: One of the things, Carol, that I find compelling about the model in particular is something Bob just pointed out, and that is it's built on the individual customers and how well they do in this process and what their outcomes are, and it builds up. So it starts at that individual client level. The other thing, when the economists were developing the model and they were looking at the data of people who went through the system, they observed that there's a lot of variability in the types of services that are provided. So they built the model around that variability of services. So that individual service model, that is VR is what makes the variability work for this model. So it's very much tied to the core tenets of the VR program, that individual services model. And that's where the variability comes from. And that's why it can give us some causation. So I think it's really important to note that it is consistent with how we do services and how we provide what we do. The other thing I will say about The Economist is they have been dedicated to understanding how VR works. They often in the early days when we were going out, they would sit down with the agencies and say, does this make sense to you? And then they would look at the model to see what would make it make more sense in terms of telling how VR works or the outcomes of VR. So they've spent a lot of time trying to understand the system and get knowledgeable about how VR works and what the opportunities are, what the process is, so that what they're modeling is consistent with how we do business. So I think that's a key component.   Carol: I think that's really cool that you said that, Joe, about taking it back to the individualized nature of the program because VR, you know, you think about it in an aggregate, we get this big $4 billion in a lump. And, boy, each person's experience within that is so individualized. It is, you know, whether you're getting this or that, you know, are you getting educational sorts of services and access to training and post-secondary and all kinds of different things? Or are you a person on a different trajectory, and maybe you needed some medical rehabilitation type of stuff going on? You needed something completely different. Like, people have so many ways to mix and match and use the things they specifically need to get where they need to go. You probably can't do it unless you get down to that level. So that is very interesting. Now, Joe, I know we've talked about this in our team a little bit even. And I know you said you wrestled with your group, but this whole notion of return on investment or taxpayer return on investment has been a really interesting topic and is fraught with some issues itself. And I remember coming into Minnesota and the general agency director like taxpayer return on investment, and I was brand new in the program. I'm like, I don't even know what you're talking about right now, but a lot of times you tend to hear it discussed that way. But I know, Joe, you've said there's a lot of issues around this. So what are some of those issues?   Joe: It's an interesting little issue. The very first meeting we had, it was at Carver, and we had a number of people from different agencies and state rehab councils come into a meeting, and we were laying out the first model. And one of the directors at that point said, well, are you doing a taxpayer return on investment? And by that he meant returning Taxes, increase in taxes, receipts going back to the Treasury. And that was his definition of it. That was the first one. And then when we were in North Carolina at the consumer forum that we did the stakeholder and consumer forum, we got the question from some advocates and said it doesn't seem to go away. We always get that question, but the issue is what is the appropriate way to determine the return on investment for a particular type of program. And it was interesting. We got this question so often, even from some of our workforce friends that are the economists said about writing a paper to describe why taxpayer return on investment is not appropriate for a VR type of program. And they submitted it to, I think it was three, maybe four different econ journals, and some of them didn't even send it out for review. They said, this is already settled. It's not appropriate for this kind of program. So the issue is another workforce programs or human capital development. And the purpose of a human capital development type of program is to in our case, find people employment and look at that probability of employment. And then conditional on that earnings, if you've got people in your system and they're entry level, a lot of them are not going to be at the level where they pay any kind of taxes at all for several years. So you really don't have a lot to show when you do taxpayer return on investment in terms of that. Also, one of the things that we noticed when one of the studies that was done is that in some cases, and this is with a particular type of one of the particular disabilities, is the only one they looked at this with when we had some Social Security earnings available data available to us for a short while. Not only do we get people off of Social Security benefits, but we also find people that go on to Social Security benefits from being involved with VR, and that often makes them more stable. So then they can then participate in a VR type of program and be successful. But it's a long, long term process to do that. So in the short term, you're not going to show anything but about as many come on as go off. So you're really not showing that. But if you're doing what the authorizing legislation says you're supposed to do, which is get people employed, let's just take it down to a simple level and then the question becomes, are you efficient and effective in that process? And that's what this particular return on investment model is about. And that is what the economists would say is the appropriate way to look at this. Now they would call this a social welfare type of program is the category they put it in. And then human capital development. But there's other kinds of benefits that accrue to the individual. Because this model, this type of approach looks at it benefits to the individual and to the society in general, which is the individual being employed. And in this case, there are other benefits that we can't observe. Self-confidence would be a good example. Quality of life would be a good example. So in our case, what we're able to observe is how they're interacting in the workplace. And that's really the piece that we can measure. And that's where we're going with this. And the others might be important, but very few places have really figured out how to measure that.   Carol: Well, Joe, I actually I was telling Bob before we hopped on, I said, you know, I threw something in ChatGPT because I was like, all right, VR return on investment. Explain it to me. And ChatGPT it spit out. It talked about financial return on investment, you know, with employment earnings, cost savings. But it was talking about social return on investment, improve quality of life, community contributions. You know people experiencing that enhanced self-esteem, independence, all those things. And then personal return on investment with skill development, career advancement, those kind of things. It was just kind of fun to run it through and go, hey, yeah, because I know you guys have wrestled with like, what are you going to call the thing? Did you come up with like the name, The Thing??   Joe: Yes, it's interesting. I think what we came down with is that we think the vocational rehabilitation return on investment is the name we're going to stick with. And then say, you know, what we have is a human capital development project, and that's how we're measuring it or return on investment. But what we're going to have to do this is so ingrained in the culture of VR that you've got to return taxpayer dollars. Well, that's really not what VR says it's supposed to do. And so how do you get people to understand that that's not the appropriate way to look at the VR program. So we're going to have to do some education. I think about what return on investment is. And I may use your ChatGPT story...   Carol: Yeah.   Joe: To ...tell it.   Carol: Bob, I see you have something you want to jump in with.   Bob: Yes, and I think well, I have several things. One is I think the reason it's so ingrained, I think I might be wrong. Joe can correct me is because agency directors have to testify before the state legislature to get the money they want from the state legislature, right? And say the legislature, at least for a while. I don't know if they're still doing it. They're saying, yeah, but what's the return to the taxpayer on this? Why are we funding this if it's a money losing proposition Well, that's the thought process. But the problem with that is the state legislatures are kind of going against the odds. The federal authorizing legislation, you know, VR dates back to again, Joe can correct me. After World War One, when veterans came back from war and they had some severe physical injuries, and the federal government said, well, let's try to get them services to help them vocationally help them get back to work, get a job, and keep it so that they're effective in the workplace. Well, that thing was incredibly successful. So over time they said, well, this works so well. Can we expand it to other disabilities? Maybe states want to get involved in this as well. So what's happened over time is every one of the 50 states has this kind of co-funded arrangement with the federal government. And the Rehabilitation Services Administration oversees it, where they jointly sponsor these things, and it now covers many disabilities. Some states have more than one agency, one for the blind and visually impaired and one for the general. Other disabilities. So it goes back that far. And the authorizing legislation says is specifically provide services to help the individual gain and maintain competitive employment. And we're back down to the individual with that. It doesn't say to pay for itself to the fed, to repay the state or federal government for those services. So that's one thing. It's not what the metric to do it by. A second thing is, I mean, I never did like the social welfare. I'm an economist who would never call this a social welfare program. First of all, welfare has a negative connotation, even if its denotation is not negative. It's social improvement or anything. But it's really less a social more. As I said, the human capital development, that's what it's all about. And he also mentioned the issue that a lot of some things just aren't measurable. So when you mentioned financial return on investment, that's what we're talking about. Is the agency doing its job of getting people back to competitive employment and leading a better life, and maybe freeing up some of their family work to do other things. There might also be a multiplier effect in the sense that they earn more money, they spend the money. Other people, as a result, earn more money. And economists call that a multiplier effect. So that dollar has more on it. But it wouldn't get measured in this taxpayer return on investment at all.   Carol: Okay, cool. So I know you guys have made some interesting observations in reviewing the data and looking at some of the longitudinal data. What kind of things are you guys seeing?   Joe: My observation is that it concerns me that some people we've  learned recently that some of the states aren't capturing data after the fourth quarter after exit in terms of UI data. I know one state that is capturing going for that after the fourth quarter for their Social Security cases, because it helps them obtain more resources through cost reimbursement. But I think that we're underselling the value of VR when you only do the fourth quarter up to four quarters after exit. And I realize that's a lot more than we used to do. But on the other hand, it's probably not the best way to tell the VR story, because you just don't capture everything. And younger population exacerbates this. You just don't capture it with all the impact of VR can be for an individual over time. So I think that's one of the things I have seen. We had a study we did from a long time ago, from the first since I did with David, Dean and Bob, where we had a program, that transition program, and the students that participated in it were focused on post-secondary opportunities, and they were measured against the counterpart group that went in the VR system of youth. And the other kids typically went to work faster than the participants in this program. But at year six, after application, the perk students took off in terms of their employment, and the other kids just they were still employed and they were doing well. But the perk kids took off with this post-secondary approach, which is what we're being asked to do now. And you really wouldn't have told the story if you only went for five years after application. So those are the kinds of things that I'm concerned about with the longitudinal data.   Carol: Joe, so what about this to with it. You know, like especially blind agencies tend to provide a lot of the services themselves. What kind of problems are there with that and not sort of capturing the data?   Joe: We have seen that as an issue with the 2007 data set. We have in the 2012 data set, we had and our colleagues in the blind agencies were very clear that there were services that they were providing that were critical to successful employment and adjustment, but we didn't have any way to capture it. And so you're, again, you're undervaluing the impact of those agency provided services by not capturing them. And I think that's going to be critical. I think there's some requirements now that they have to be reporting some of this information, but it's a question of whether it's getting into that case management system and it becomes readily available administrative data that can be used to help tell the story of the impact of the great work that these counselors and other kinds of specialists are providing to help people become employed and adjust into their settings. Bob, you want to talk a little bit about what you're seeing in the data?   Bob: Well, yes. And now with the new data set, RSA 911, that quarterly report that all agencies have to provide and again for four quarters after closure that thing now they've made some changes and it's now required whereby types by 32 different service types they report. Did you provide purchase services during the quarter. If so how much did you provide it in-house or was it provided through a comparable benefit, some other external agency and that might have a dollar value attached to it? So we're going to use that data and see what we have. Now of course with any data set. Now I'll tell you purchase service data that's pretty reliable because they need to get their money back, right? They need to get reimbursed. They need to pay the bills. And so they track that through their accounting system very well. But the other things are and had entered often by counselors who are harried and busy and have a lot of other things to do, rather than this bureaucratic kind of form filling out, so it's only as good as the data that are put into it, and we won't know how good that is, but we'll see how much we learn. this way, hopefully we'll learn some things we didn't know.   Joe: What we have been told is that the data is not there for us to capture, and that it undervalues the kind of work that's being done. So we're hoping we can find a way to tell that story, because it sounds pretty important. And then from my personal experience in managing some of these services, I know how hard these folks work and how valuable these services are. But if you can't capture it, you're not able to tell the story.   Carol: Yep. If it isn't documented, it didn't happen.   Joe: Yeah.   Bob: That's right.   Carol: So what are the next steps on the grant and how can we get folks involved? Are you needing people to help with anything, any states or anything we've got?   Joe: North Carolina is, we're working very closely with them and they've been really good to work with. We will be once we get the prototype, I don't know what to call it. The economists are putting together the data system information so that they can begin to apply the new model and that'll be happening hopefully within a couple of months. And then once we've run the model a couple of times, we'll be asking some other people to come in sort of a national audience to take a look and hear what the model is, what it offers to get their feedback on. Yes, that would be useful or that doesn't seem to work for me much. Could you do this other thing? And then we'll also be asking them about. We'll be showing them what we've come up with for the simplified model to see if that version is going to work or if we need to be developing maybe a template RFP for them to use with a local institution that they work with, then they would be able to get the data set. So we're going to be looking at that. We may be asking folks to work with us a little bit on the capacity survey, where it talks about the training that states might be wanting to say, who can provide this kind of service, and would this be valuable to do to increase people's ability capacity? Because there's a lot of data needs out there. And I think if it would help our project, it would probably help a lot of other projects as well.   Carol: So, Joe, are you thinking about that for fall, possibly at CSAVR or something?   Joe: That's November. That should be a time when we would have an opportunity to gather some information. Yeah, because we might be ready for it by then. Of course, that might put a little pressure on the economists, but I don't mind doing that.   Carol: Yeah. Bob's looking like, oh well okay.   Bob: You love doing that, Joe. I mean, one of the things my major professor in graduate school always said, I love working on a research project where I learn something and what Joe said is exactly right. So we would take and vet our results to various agents. We may make a trip to the agency before Covid. We go and we sit down. We go through everything, explain what we're trying to do when we sell. And then they would say, that looks a little wonky or something, or did you do this? And you say, no, we didn't do that. Yeah, we could do that. Let's do it. And then we would revise the model or no, unfortunately we don't have enough information to do it. Could you collect it? You know, that kind of thing. So yeah, we keep learning things and that's what these groups are intended. That's what they're for. For our selfish purposes. That's what we like about them.   Carol: That's excellent, you guys.   Joe: So November would be good, Bob.   Bob: So you say.   Carol: Well, I'm definitely looking forward to seeing what comes out of all of this. And you were saying that the end of the grant then is in 2025.   Joe: August 31st of 25.   Bob: Right.   Carol: All right. That's coming up quick you guys, really quick.   Joe: Oh it is.   Carol: Well, awesome I appreciate you both being on today. I cannot wait to hear more as this unfolds. So thanks for joining me.   Joe: We really appreciate the opportunity.   Bob: Yes we do.   {Music}   Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Instrumental vs Terminal Desiderata, published by Max Harms on June 26, 2024 on The AI Alignment Forum. Bob: "I want my AGI to make everyone extremely wealthy! I'm going to train that to be its goal." Cassie: "Stop! You'll doom us all! While wealth is good, it's not everything that's good, and so even if you somehow build a wealth-maximizer (instead of summoning some random shattering of your goal), it will sacrifice all the rest of the good in the name of wealth!" Bob: "Maybe if it suddenly became a god-like superintelligence, but I'm a hard take-off skeptic. In the real world we have continuous processes and I'm going to be in control. If it starts to go off the rails, I'll just stop it and re-train it to not do that." Cassie: "Be careful what you summon! While it may seem like you're in control in the beginning, these systems are generalized obstacle-bypassers, and you're making yourself into an obstacle that needs to be bypassed. Whether that takes two days or twenty years, you're setting us up to die." Bob: "Ok, fine. So I'll build my AGI to make people rich and simultaneously to respect human values and property rights and stuff. At the point where it can bypass me, it'll avoid turning everyone into bitcoin mining rigs or whatever because that would go against its goal of respecting human values." Cassie: "What does 'human values' even mean? I agree that if you can build an AGI that is truly aligned, we're good, but that's a tall order and it doesn't even seem like what you're aiming for. Instead, it seems like you think we should train the AGI to maximize a pile of desiderata." Bob: "Yeah! My AGI will be helpful, obedient, corrigible, honest, kind, and will never produce copyrighted songs, memorize the NYT, or impersonate Scarlett Johansson! I'll add more desiderata to the list as I think of them." Cassie: "And what happens when those desiderata come into conflict? How does it decide what to do?" Bob: "Hrm. I suppose I'll define a hierarchy like Asimov's laws. Some of my desiderata, like corrigibility, will be constraints, while others, like making people rich, will be values. When a constraint comes in conflict with a value, the constraint wins. That way my agent will always shut down when asked, even though doing so would be a bad way to make us rich." Cassie: "Shutting down when asked isn't the hard part of corrigibility, but that's a tangent. Suppose that the AGI is faced with a choice of a 0.0001% chance of being dishonest, but earning a billion dollars, or a 0.00001% chance of being dishonest, but earning nothing. What will it do?" Bob: "Hrm. I see what you're saying. If my desiderata are truly arranged in a hierarchy with certain constraints on top, then my agent will only ever pursue its values if everything upstream is exactly equal, which won't be true in most contexts. Instead, it'll essentially optimize solely for the topmost constraint." Cassie: "I predict that it'll actually learn to want a blend of things, and find some weighting such that your so called 'constraints' are actually just numerical values along with the other things in the blend. In practice you'll probably get a weird shattering, but if you're magically lucky on getting what you aim for, you'll still probably just get a weighted mixture. Getting a truly hierarchical goal seems nearly impossible outside of toy problems." Bob: "Doesn't this mean we're also doomed if we train an AGI to be truly aligned? Like, won't it still sometimes sacrifice one aspect of alignment, like being honest, in order to get a sufficiently large quantity of another aspect of alignment, like saving lives?" Cassie: "That seems confused. My point is that a coherent agent will act as though it's maximizing a utility function, and that if your strategy involves lumping together a bunch of desiderata as good-in-...

Bob, it has been a while since we have talked to the contact center show audience, and there are some rumors that I want to put to bed. Bob, the word on the street is we got rich and famous and we stopped putting out new show. I've gotten some responses from our fans. Can you put these rumors to bed? What actually happened here? Bob Well, as you can see, I'm calling you from my yacht. So the rumors are not true. I don't think anyone who uses the word customer service anywhere in their title has gotten rich from being in customer service. I remember the times I used to work with my budgets and nobody got rich there. Maybe some famous authors got rich writing books about customer service. I don't know why both of us are not in that category, but I do say we had a lot of fun doing that podcast we did. And we want you to follow us to the next podcast we're doing. Amas Yes. Bob So let's talk a little bit about that. Amas Let's talk about that. And we're going to talk about the new show, the customer happiness show. But before we do that, I went back and I looked, and over the course of those years, we put out over 70 episodes. I don't know many people, and they average about 45 minutes each. I don't know many people who can talk for 3 hours about most topics. Why do you love contact centers and customer service? Why have you stayed in it most of your career? What's in it for you? Bob Well, first of all, if we put out 70 episodes, then I probably have run out of things to say at this point. So maybe that's the reason why we stopped talking about contact. Amas Good point. Bob What do I love about customer service? I love that customer service is almost always a human experience. And yes, I know that digital is going to take over the world and call centers are going to go away. And all the pontificating about how much we're not going to have a call center, I don't think those are right. And I love that human interactions are almost always part of the equation. And it's in those times that we walk away from a company more loyal, saying, that was a good experience. That is why I like customer service. What about you? What's your draw to customer service? Amas I think, Bob, it's a profession that has allowed me to utilize many parts of my brain and my know, there's a little behavioral economics there, right? How do you get people to do things, whether employees, customers, how do you get them to behave? There's a lot of technologies, technology, and a lot of things. And then there is what we used to call soft skills. And one of our few guests we had on the show taught us there was tough skills. That's a great episode. You guys go check that out. And by tough skills, people used to think about them as just pleases and thank you. There's a little art about how you deliver information, how you listen, how you do that. So you have to learn about those things as well. Then there's data involved, right? You got to measure everything because you're trying to do things efficiently and effectively. And as you know, I tried to go do something else for a little while last year, and I came right back and I'll probably spend the rest of my career doing this, and I can't imagine doing anything else. And so we've stopped putting out. I mean, we'll come occasionally and put out some shows here. The show is still going to be up, guys. You can get it. But we have made this pivot. And I got to tell you the story about how this came of. The name of the show, by the way, is the customer happiness show, but the name of the show, the format of the show, all of this came. I took a trip to Bob lives in Memphis and I live in Oklahoma City, and we go and see each other as often as time, and all of that permits. So I go there. We had a few beers in Memphis. We took that really long walk. I don't know how many miles that thing was. I wanted to see the little river thing. I don't know what you call that body of water, but we took that walk around it and we agonized about what this format will be. All we were sure about is we know that we've put out tons of contents to help contact center people around the world till this date. I still get emails that I don't forward to, Bob. They don't come in as often anymore because there are no new episodes. And every time someone mentions the show, it gives me lots of joy that we put that out. But we wanted to pivot to go talk to consumers, the Joe blow consumers out, Bob, and you can share more about. It's been months since we were having that conversation. Why are you excited about this format and specifically talking about consumers? What really excites you about it? Well, I think the very first time. Bob You and I were on a podcast together, if I'm not mistaken, was sometime in late 2019, where I joined yours, and we started talking in the same vein along. What do we get? Could we do a podcast together and our main number one goal was to have fun doing it. And I think we've met that number one goal. I hope we meet that number one goal with this one. But I'm excited because like you said, we talked a lot about sales and contact centers and walk up service and just about every kind of service. And it's always been the knowledge from the inside out. It's always been helping people on the inside do it better. So I'm excited to take all of those years of knowledge of what happens on the inside and turn it around. We did a show recently over on the new podcast about customer service at SiriusXM. And so what we're able to do is we understand service in general. So we're able to take the inside view and share it with the consumer and say, here are ways that you can be a better consumer to get better service. That's what excites me. It's from the outside. Amas I think. I think for me, Bob, similar to what you're saying, I feel like because we were so focused on the inside, the professionals, we were always helping the consumer. We were trying to teach people who delivered your service, contact center leaders, et cetera, to deliver your good service. Now we get to kind of be in the middle. We're going to focus on the consumer, bring all of our inside information in and teach consumers how to do that. I remember I'm a foodie, as you know, and Bob is as well. We both love food. And the book that changed the way I order out is Anthony Bourdain's kitchen confidential. And that's what I hope this is in know. He taught me that don't order the special, don't order the like because he was a chef and he knew all of that inside deal. And he didn't write the book for chefs, he wrote it for people who go out to eat. Until this date, when I walk into a restaurant, the things I learned from him still kind of echoes in my brain. And I hope this show becomes that. But the second reason I'm really excited is the format that we haven't told you guys about is we debated a little bit on the contact center show, but this show is all it is, all of us, not every single show, but for the most part, we are going back and forth. And I don't think it will surprise anyone who's listened to Bob and I over these four years that I win almost every time. So that part also excites me. I don't know if it excites Bob so much. Losing to me every week. But that part really gives me a lot of joy. Bob You definitely win every time you're talking because you say the most absurd things that I've ever heard, much like the. Amas One you just said. Bob But that is part of the reason for me also. I enjoy the back and forth. Amas So we are on the show and I suspect, and guys, you got to check out the show. I don't think the show is us. While it's called customer happiness, we are not on the show talking about how great customer service is. We are often on the show talking about some of the things and helping consumers navigate it better. So let me ask you, let me put you on the spot. What is your biggest pet peeve? You are a consumer. All of us are consumers. What's your biggest pet peeve? Put your customer hat on. Bob Well, mine is always when I'm told this is the policy and that's the only thing we can do. I hate hearing the word policy. I think that we probably make those agents that way because we do have a policy and we do tell them they can't negotiate. But that's my pet peeve because there should always be negotiation. In fact, I'll tell you an experience. I recently was at a well known shoe store and the employee came back and said, I'm sorry, but that's the policy. So I said, well, the policy doesn't make any sense. And he said something to the degree of, if I had a dollar for every time a corporate policy didn't make sense in my job, I'd be a millionaire. And so here's a guy that would really like to help me. Agrees with me that the policy is crazy. But he's quoting me the policy. So the policy for me is the one. I don't know what yours is. What's yours? Amas Mine is maybe dishonesty is too strong of a word. I don't like the fact that I go somewhere, they ask me for my email address to send me a receipt, and then here comes all these emails. I don't like the we will be with you shortly. Your call is important to us. They will call me and they won't call me back. It's these broken promises for me that makes customer service a pain at times. And so I actually prefer just tell me what I'm getting so that way I know what this is going to look like. So, guys, again, I would be remiss if I didn't say thank you to every single person over the years who downloaded the show, who subscribed who liked, who told people about it, who shared it, I cannot know. Two guys, one in Oklahoma City, one in Memphis. Two friends got on the phone and talked. And at the peak of our show, 4000 of you would download the show. I am incredibly just humbled and thankful and just hope we get a little bit of that success onto the next show. So we're asking you to stick with us. Come with us to the next show. You're going to learn something. You're going to hear us even hopefully funnier and more entertaining. And Bob, by the way, is semi retired now, which means God knows what's going to come out of his mouth. So please come join us. Bob Yeah, I'm on my own now. I can say what I really want to say instead of what I need to be careful how I say it. But you can join us on the same channels you're used to. So we're on Spotify, we're on Alexa, we're on Apple, we're on all the places that you get your podcast. We're still distributing to the same places. You can do a search on the customer happiness show. We're the only one out there with that name. So you can search on that. We'll put the link in, put the name at the end of this video. But as Amas said, thank you so much for your listening to us. I had somebody tell me that was a new research analyst that just began to work in the contact center space in a financial capacity as a research analyst. Tell me that she felt like she got more information from our podcast. And I said, well, how many did you listen to? She goes, I'm too embarrassed to tell you how many of them I listened to. But she said that she got a lot out of it and it felt like she understood both sides of the contact center world by listening. So it's just those kind of comments and the emails that you send that have made us keep doing it. We just hope you'll join us in the new one. Amas Awesome. Well, please subscribe. Like comment. The show is still going to be available, we're going to keep it going, and every now and then we'll pop in and maybe produce some new content. But please subscribe the customer happiness show wherever you get your podcast. Thank you all. Bye.  

This is a free preview of a paid episode. To hear more, visit nonzero.substack.comSeems like only last week I was saying there wouldn't be a Nonzero Newsletter sent out today, owing to the end-of-summer quasi-vacation granted to hard-working NZN staffers. And it's true that the Earthling, the weekend edition of NZN, is skipping this week and next. However, yesterday I had a conversation that was so timely and interesting that I figured I'd share some transcript excerpts—below—with NZN subscribers.The conversation is with Nikita Petrov, who left Russia shortly after the invasion of Ukraine but is monitoring the Russian zeitgeist (and publishing his newsletter Psychopolitica) from Armenia. The subject of the conversation is Yevgeny Prigozhin, long-time leader of the mercenary Wagner Group.This June, you might remember, Prigozhin staged a short-lived mutiny against Russia's military leadership. So when his plane blew up a couple of days ago, pretty much everyone suspected Putin's handiwork. (Although, as Nikita explains, according to a conspiracy theory circulating in Russia, there's less to Prigozhin's apparent death than meets the eye.)Paid subscribers can listen to the full conversation via the audio player above or via their NZN member podcast feed. (To set up that feed, if you're a paid subscriber and haven't done that already, click “Listen on” in the audio player and follow the directions.) Hope you enjoy the excerpts below. More of the conversation will be available in the public podcast we post next week, though the Overtime segment—the final 40 minutes or so—will remain exclusive to paid subscribers.—BobBob: We're taping this on the day after a plane went down that apparently included Yevgeny Prigozhin, the head of the Wagner Group, along with his top commander, the guy from whom the Wagner Group got its name—“Wagner” was his call sign. Nikita: Yep.Bob: And I actually haven't even looked at the news this morning, but it didn't seem to me there was that much doubt, even though they hadn't identified bodies or anything. I assume no one's doubting that he's— Nikita: Well, there are two main theories that I've been hearing. One is the straightforward one: Prigozhin and the top command are dead, and Putin is behind it. The other version is: This is Prigozhin's disappearance. He's somewhere on an island right now drinking a martini, and this is his way out of the business. Normally I would say there's no reason whatsoever to contemplate that approach. But since this is Prigozhin, and we've seen like six fake passports of his with toupees and beards and whatnot. And generally, he's, you know, a peculiar character, he's fighting in Africa, and then he's in Ukraine, and he also has a catering business, and a troll farm. I think that's not a zero-chance probability, but I don't think it's a high-chance probability either.Bob: On the other hand, Russia has always been a hotbed for this kind of theorizing, right? Nikita: Yes. Yes. It's a normal thing for Russians. Whatever happens, there's always a conspiracy theory right away.Bob: So there's a pretty high false positive rate on conspiracy theories in Russia—and increasingly in America. Maybe this can bring the two nations together, that we have this in common.Nikita: I think there is some overlap. I mean, before the war, there were tribes within Russia and the US who were growing closer together, like the QAnon people. And even with the war—Bob: That kind of makes sense actually. Go ahead.Nikita: I was surprised. About a month and a half ago, RFK [Robert F. Kennedy, Jr.] got into that scandal because he said something about Covid, and the way his words were interpreted was that there is a chance that it was designed by the Chinese in a lab and it targets certain groups more than others.Bob: Right. Nikita: And he started talking about bioweapons and whatnot. I think he talked about biolabs in Ukraine. Bob: Yeah. That's a thing. That's a talking point.Nikita: Until then, I was not aware that anybody in the West thinks that. But it was a big part of the Russian propaganda, some versions of which are very strange. On the one hand, according to Russian state propaganda, the Russians and Ukrainians are really the same people, but also, there are biolabs in Ukraine that were designing viruses that would target specifically Russians.Bob: It's a very discerning virus! It picks up on the most subtle differences in DNA. . . .Bob: But, on Prigozhin, tell me… presumably the [staged disappearance] theory is that he actually feared something like this happening for real, right? I mean, he didn't feel safe in this world. Nikita: Either that, or another version of the same theory would be that he made a deal with Putin, that this is how I'm gonna go out. Bob: Oh, and then you [Putin] will look like you were the tough guy and did crack down. Nikita: That's right. And I'll [Prigozhin] get my pension and I'm fine. Bob: I've got a feeling he doesn't need a pension. I forget how much cash was found in his apartment, but I suspect that he's got stashes in various places. Nikita: [laughter] That's right.  Bob: So anyway, your sense is, not that you're in Russia, but your sense is that this will be a minority interpretation anyway, that he's not actually dead?Nikita: From what I've heard so far, most people say there's also this possibility, but it's probably a low possibility. So, I haven't met a true believer in this theory so far. I mean, it's been a day—it's been less than a day. But it's brought up and discussed as a low probability option. And we will never know, I suppose, because the bodies are burned. We're not going to see a picture of Prigozhin that we can recognize. And the people who will tell us (and they might have already; I saw some reports that sounded more official than what I saw last evening, saying yes, this is Prigozhin and Utkin and the other passengers who were supposed to be on the plane) the people who are going to tell us this are the authorities, which if they are the ones who decided to do this staged disappearance, you know, you're not supposed to trust them.Bob: Right. Nikita: But I don't think it matters, frankly. I think that's the low probability version, and I don't think it matters, because both options lead to Prigozhin not being here anymore. If he lives a private life on an island somewhere—Bob: He seems out of the picture. And everyone else will act on the assumption that Putin did it.Nikita: That's right. Bob: Is your sense that among those Russians who do believe Prigozhin's dead, overwhelmingly the assumption is Putin decided to take him out? Nikita: Yes. Yes. Bob: I can't even come up with another theory. Has it been confirmed that there was an anti-aircraft missile fired at the plane, or is that still—Nikita: No, I think they are saying now that there was an explosive in the chassis, the wheel of the plane. And they say they have a suspect, Prigozhin's private pilot, who was supposed to be on the flight maybe, or at least was able to access the plane. And he's MIA somewhere. Some friend of his said that he's trekking in Siberia, or something along those lines. So, they have a suspect and a theory. It doesn't go further than that guy so far, like, why would his pilot do this? But I think that might become the official narrative. This is what I'm seeing this morning.Bob: So is it confirmed that the pilot was not on the plane, the regular pilot? Nikita: I think. He was called Prigozhin's private pilot.  I'm not sure he was supposed to be on this plane. He just flew with Prigozhin before, so they are singling him out as a suspect. Bob: I see. Do you think Putin would go to the trouble to frame somebody, and do the whole court proceeding, and put them in prison? I mean, it's weird, because presumably Putin wants a certain crowd to know he did it, including possibly much of the world, right? He wants some people to think, yeah, Putin cracked down, let's don't plot any mutinies anytime soon. I mean, that's the thing about this. It's so blatant, right? With most of the past assassinations attributed to Putin, there wasn't rock solid evidence. And in fact, I would run into smart people who paid attention, and I'd say, what do you think the chances are that this guy was taken out by Putin? They'd say, well, probably, or 90 per cent or 95 per cent. I don't think you're going to hear many people as low as 95 per cent on this one. It seems like this time, it's a more unabashed assassination.Nikita: I think that's true. But also, nobody tried to, you know, take his private army and march on Moscow before. Bob: Right, right. Absolutely. You know, right after this happened, right after the mutiny, and after the deal was negotiated, American Russia hawks like Michael McFaul said, see, all this stuff about how Putin if you corner him is dangerous, is wrong. We don't need to worry about pushing them out of Crimea and back into Russia and even, what is happening now, attacks on Russian territory. McFaul said, this just shows he'll fold; it's a bluff.  What McFaul said is that he capitulated. And first of all, I pointed out, he did not capitulate. He didn't meet Prigozhin's demands. That's capitulation, if you do fire Shoigu and Gerasimov, the two military chiefs he wanted fired. And I'd be interested in your take on this. Leave aside the fact that apparently, ultimately, Prigozhin paid the ultimate price. I thought, given the situation Putin was in, he didn't handle it that badly. I mean, you've got 5,000 troops marching to Moscow. Things could get seriously out of hand, even if you're confident you can put it down. These people are considered war heroes by a lot of Russians, right? They're the guys who did Bakhmut. They have a base. And after Wagner had shot down the planes, to get out of it with no further bloodshed… Leaving aside the fact that ultimately Putin had it both ways, he finessed it without a big confrontation and got Prigozhin killed, what did you think after the event?Nikita: Well, first of all, during the event itself, and the few days after, the prevalent feeling among all the Russians I know, whether inside or outside Russia, was just how bizarre this whole thing is. Especially as the events were unfolding, like, he started to march, you start to get these audio messages, you get updates in Telegram from Prigozhin himself.For a while, it wasn't clear whether this is actually happening or not. He's saying that they're marching on Rostov and it's like, is he? I haven't seen any pictures. It's just Prigozhin saying that, and he's known for playing games. And then suddenly there are tanks in Rostov.And then he's saying he's marching on Moscow. My brother was in Moscow at the time, and he went into the streets, and he said it was a weird, weird feeling, having been there for a long time, that the cops and the people are on the same side, because the cops in Moscow and people in Moscow were expecting this army to show up. And the cops seemed nervous and unsure what to do.. . .Nikita: So the prevalent feeling from this whole experience was just: This is bizarre and weird. When the analysis started to come in three days, four days after the thing, I had the feeling that maybe this is us trying to pretend that we understand what is going on. Because these past couple of days, nobody knew what was happening. Every theory was thrown out there, whether it's staged, whether it's real. You've heard these, you know, Prigozhin agreed with Putin that he's going to do this thing to find the people who are actually not loyal enough. There was all of this, and nobody had a good theory because the straightforward one seemed also too weird.Bob: Yeah.Nikita: But now in the aftermath, I agree with you that Putin did not lose control. And now, the Russian word they use is signal. This is a strong signal that he's sending that if you try to do this, you're going to blow up.But I think a lot of people did feel as this was happening, surely, that this is not the behavior of a strong leader, because he was nowhere to be found. The day of, Peskov, his spokesperson, said that Putin knows about the situation. But that was all. And then in the morning, he [Putin] made this speech. And during the day, as this was happening, there weren't a lot of people who really jumped in front of the situation and said, I support the president of my country and this is mutiny. They started saying that as the situation progressed and it became more clear that this is what you're supposed to be doing.. . .(Overtime segment available to paid subscribers below the paywall.)0:42 Nikita's life as an expatriate 5:18 Theories among Russians about Prigozhin's death 17:29 Putin's handling of the Wagner mutiny, reassessed 25:46 Did Prigozhin lose his mind? 35:36 How worried should Putin be about Prigozhin's supporters? 43:15 Russians' evolving views of the invasion 50:50 Is Putin feeling heat from the nationalist right? Robert Wright (Bloggingheads.tv, The Evolution of God, Nonzero, Why Buddhism Is True) and Nikita Petrov (https://psychopolitica.substack.com/). Recorded August 24, 2023.Comments on BhTV: http://bloggingheads.tv/videos/66636 Twitter: https://twitter.com/NonzeroPods

Morgan Smith: You're listening to the Raise Your Hand Texas Intersect Ed Podcast where the stories of public education policy and practice meet. I'm your host Morgan Smith, and today, we're taking on a topic that has become a marquee fight of the 88th Legislature, private school vouchers. On one side, we have our state's two most powerful elected officials, Governor Greg Abbott and Lieutenant Governor Dan Patrick, who say every parent should get the freedom to decide how to use taxpayer money in educating their children. On the other, we have every public education advocacy group in the state, including Raise Your Hand Texas, who say that vouchers will do nothing but harm students, teachers, and communities.To help us dive in today we have superintendent Randy Burks of the Hamlin Independent School District, and Bob Popinski, the senior director of policy at Raise Your Hand Texas. Dr. Burks and Bob Popinski, thank you both so much for being here. So first, let's define what we're talking about. There are a lot of different terms we might have heard to describe vouchers, school choice, education savings accounts, and tax credit scholarships. It gets even more confusing because school choice is also used to describe the array of options already available to Texas public school students, like charter schools and magnet programs.Right now, a plan known as an education savings account is what's gaining the most traction at the legislature. The basic gist is that the state gives parents a certain amount of money, $8,000 in Senate Bill 8, the main bill that we're watching, to use for our private school tuition or other educational expenses. On its face, maybe this doesn't seem like a bad idea. Bob, is this proposal, the education savings account, is this a voucher?Bob Popinski: Don't be fooled. No matter what they call them, whether it's an education savings account or a tax credit scholarship, or a virtual voucher, they're all the same thing. Vouchers are a scheme that's used to divert public funds to private schools and vendors, and the keywords there are private schools and vendors, with no accountability, such as public schools have. And then they will continue to undermine traditional schools, including charter schools, in the future because those funds are taken from public schools to invest in our teachers, to invest in our students, and they're investing them into a program that has no accountability whatsoever. So it doesn't matter what you call them – education savings accounts, special education vouchers. They are bad public policy for the state of Texas.Morgan: Dr. Burks, your district is about 40 miles northwest of Abilene in Jones County, Texas. You've been a superintendent there for six years, though, you've worked in public education for more than four decades. Your district is rural and small, with just over 400 students and those students are primarily from economically disadvantaged backgrounds. Give us a little sense for your community. What are you most proud of there? What are you struggling with?Dr. Randy Burks: Well, Hamlin was what might commonly be referred to in some circles of school finances as a CTD district –“circling the drain district,” declining enrollment and loss of some industry that was here previously, and so the district has seen better days definitely. And the city itself is probably typical of a lot of rural Texas, crumbling infrastructure and substandard housing is pretty common here. And, you know, I grew up in a background that's not too different from a lot of our kiddos. And so I really felt like I had something to offer the school and the community because I had a background in school finance.So we moved to a collegiate model early on in my time here, because we just felt like that, so many of our kiddos were struggling with finding a pathway that would be better than the pathway that they could see. They couldn't really envision a better life than what their parents had. So, we're a P-TECH school, early college high school, we have Montessori Elementary School, and we have college and career pathways available for our kiddos. And so we try lots of innovative things, and we fail fast and dust ourselves off when we do and get up and try again, because we think that's what's best for our kids and to help improve our school and, in essence, lift the community up as well as we move forward.Morgan: Now, it's no accident that we're featuring a superintendent from rural Texas today, because that is where Governor Abbott has decided to wage his fight for vouchers, too. Since the start of the legislative session, he's taken the pro-voucher message to the road, stopping at private schools in three to four towns a month around the state. Let's take a quick listen here to the Governor speaking at a private school in Tyler in March. Governor Abbott (audio from an “Education Freedom” March 2023 event in Tyler, TX): I cannot stand alone in getting this across the finish line. I need you standing with me, every step of the way, to make sure we empower parents to educate our kids, better than any state in America.Morgan: Dr. Burks, we just heard the emphasis on parental freedom as an argument for vouchers, and I want to get your thoughts on what that means for rural schools in a second. But Bob, first, can you give us an idea why we're seeing this strategy of targeting rural communities from the Governor? And as we're seeing the conversation evolve at the legislature, we're hearing more discussion about vouchers and special education students. What's the strategy here?Bob: I've always run up to a problem in rural school districts, and rural communities are the center of their communities. And, so what happens is, in the past, you've had Republicans and Democrats alike in the House stopping vouchers. There's an amendment offered, usually during the state budget debate that says, "Our public dollars cannot go towards private schools or vouchers." And that's typically what's known as the Representative Herrero Amendment. And that was a few weeks ago here in the Texas House and passed 87 to 51.And it's an important moment for the House because it sends a signal that we believe in our public schools. They keep saying that overwhelmingly, Texans believe in a voucher program. But I think what's actually happening out there is that Texans really don't know what a voucher program is. When you actually say, "Hey, if a private school or a private vendor actually takes public dollars, are they held accountable?". And in a recent Charles Butt Foundation poll put out at the beginning of the year, it says, “If private schools and private vendors actually take public dollars, what kind of accountability would you like to see?"And overwhelmingly, 88% said, "Yes, we'd love to see how they're actually spending our public dollars." "Yes," 84% said, "We want to see that they provide special education services to all students and not just a select group of students, and that you have to accept students with all special education needs, you have to follow the state curriculum guidelines, you have to administer state standardized tests, and you have to kind of accept all students, even if they have a discipline problem."And so overwhelmingly, when you look at Texans, whether they're from rural Texas or urban and suburban Texas, they want a voucher program that's held accountable underneath all of those standards. I think at that point, what you have is a public school system. And so I think we should take some time to invest in our public schools. Right now, public schools are funded $4,000 below the national average when it comes to per-student funding. We're $7,500 below the national average when it comes to teacher salary.And I think we need to kind of focus on that before we start spending a billion dollars on a voucher program that doesn't accept all students, and it even says within the bill, that parents have to be notified that private schools and vendors don't have to provide the same special education services, under state and federal law as public schools do. There's a lot to unwrap in here. And I think as more Texans actually understand the linkage of what's going on in this voucher program, the more they're pushing back against it.Morgan: And so we've seen that rural communities have been out of this firewall against vouchers in the past and this session, it seems even this main bill, SB8 that we're looking at, it includes a carve-out for rural schools as possibly a way of getting around this opposition that we've seen. And rural school districts like yours, Dr. Burks, they make up about 40% of Texas districts, they educate about 180,000 students in the state.Under SB 8, they would actually get paid if they lose any students to a voucher program. So currently, that amount is $10,000. So all in all, school districts under 20,000 students, the state would be paying $18,000 a year for five years for students to take part in this program. That's $8,000 that goes to the family and $10,000 to the school district. What would a program like this mean in your district, Dr. Burks?Randy: I would say first of all, things are really on a high note financially in Texas right now. And because I've done this for a long time, we know that there are lean years and there are prosperous years. And this is a time that the legislature has a lot of money at its disposal. So this sounds really good. And if you don't understand like Bob was saying, you may not understand all the moving parts here. But for them to commit $18,000, and the price tag that goes with that, at some point that's going to go away, it pulls money from what's available to us.And so I really am opposed to it. Now, we're rural, and it's going to be difficult for our folks to find a private school to attend. They would have to drive to Abilene. We, in fact, bus children from Abilene to our school, because of some of the things we're doing. We have such a high number of disadvantaged folks, and that micro-schools, and homeschooling and different things that pop up would probably pull some of our students for that. Those students are going to come back to us.If you've ever tried to teach a child to read or teach algebra, I believe that there are going to be some hardships created for parents, especially in rural communities where there's already chronic economic hardship and long work hours for parents, and many of them work two jobs or they're single parents. It would be very difficult for our folks to provide a good education for our kids, and they'll come back to us and then the consequences will be back on our shoulders to make sure that we catch them up and provide the high level of education that we already do. I think that the $10,000, it's a carrot for votes. And we'll just call that what it is. Bob: Morgan, if I can jump in there, too.Morgan: Sure.Bob: The bill is actually saying what those who are in favor of vouchers are kind of denying. They're saying "No, we're not going to defund our public schools. The money's going to be there for our kids." But what they're actually saying in the bill, is that, "For those right now, with 20,000 students or less, we're going to provide $10,000 and hold harmless money for you." And it started off as a two-year period, and on the Senate floor, they actually extended that to a five-year period. And so they're actually saying, "Yes, we understand that it's going to actually hurt our public schools, so we're going to hold you harmless for that five years, but we're only going to do it if you're under 20,000 students."For a majority of districts that have students above 20,000, they're not getting that hold harmless. So they're going to see an impact right away. Every time a student leaves a school district, and goes either to a private school or even a charter school that school district loses about on average $10,000. It could be a little bit higher in some districts, a little bit lower in others. But that $10,000, leaving the district means that they're going to have a hard time funding all of their staff, all of the teachers they need, to make sure that they can staff their classrooms properly. All of the folks driving the school buses and the cafeteria workers and all of the aides that help out. There's 375,000 teachers, there's another 200,000 or so staff around the state, and all of that will be impacted once you start diverting funds from public education.Morgan: You bring up a good point, Governor Abbott himself said in his State of the State address this year that even with a voucher program, public schools would remain fully funded. And then you have this provision in the bill that seems to conflict with that, because you're holding harmless the $10,000. I think that's a really good point to bring up. I want to shift back again to the special education services. Dr. Burks, we have a number of bills out there that are focused on vouchers for special education students. Can you talk a little bit about what services for special education are provided in your district?Randy: Well, we're required by law to provide services for all students that reside in our attendance zone. So we have a variety of needs – with learning disabilities, emotional issue – and we have to provide services for those kiddos. And we're happy to do so, but it is expensive to do so. I don't see that private schools are going to take on this responsibility. Now I have been in places where we have actually contracted with a private school for a particular student whose parent had a situation where they moved to our district but did not want to change for their student because of the emotional strain of that.There are isolated cases where that could happen. But, for the most part, we provide services for all of our students, whether that's residential placement, which costs us dearly, or to provide speech services, or the whole gamut of things that we provide for our kiddos. It's our responsibility, that's what public schools do. We take all the children who show up at our door, do our very best to provide a great education for them, whether they have special needs, or whether they're gifted and talented, or anywhere in between.Morgan: And you talk about you're required by law to provide these services. Bob, how would a special education voucher program be conducted to federal guidelines for special education students?Bob: Yeah, and every voucher bill moving through the process, there's provisions in there that clearly state, "You have to notify the parents that private schools and private vendors are not subject to the same federal or state laws regarding special education services in the same manner as public schools." That means they don't have to provide the same services, they don't have to actually accept or admit a special education student under any circumstances. And so they're spelling this out in the bill saying that private schools and vendors don't have to offer the same type of special education services. And so when we move forward, we just have to keep that in mind, and make sure we're doing what's best for all children in the state of Texas.Morgan: I want to talk about oversight for a second, we alluded to this earlier. But when taxpayer dollars start going to education expenses outside of the public school system, it's really hard to design a system that keeps track of how that money is spent. Bob, what accountability measures are attached to the voucher proposals at the legislature right now?Bob: Very little. Right now how these voucher proposals are set up, and we'll look at Senate Bill 8, as one of them. It is a $10,000 hold harmless for school districts that have students using the voucher, but it's an $8,000 voucher. But by the time the education organization that oversees it takes a 5% cut, and the Comptroller takes a 3% cut to oversee it, that amount is diminished. And the oversight that the Comptroller has is just an audit for compliance. They're not looking at student achievement or student progress. They don't have to compare them to the STAAR assessment or the A through F accountability rating system for our campuses and school districts.They don't have to have the same type of certification standards that our teachers do in our school districts. They don't have to follow the same financial integrity rating system that our school districts do. And they're not overseen by an elected body like all of our local school boards do. And so there really is no oversight for this, except for some compliance audits, and a provision that says you have to offer some sort of nationally norm-referenced test and be accredited by one of our state's private school accreditation services. But besides that, they don't have to fall under the same guidelines as our public schools by a long stretch.Morgan: And this brings us to the equity part of this issue, the beauty and the challenge of public schools is that they're required to take students from all backgrounds, regardless of religion, the color of their skin, whether they can or can't speak English, and students whose parents can't afford to feed them breakfast or lunch. All of those students are welcomed at a public school. Dr. Burks, talk a little bit about public school versus private school when it comes to equity.Randy: Well, if they're school age, we serve them regardless of their academic ability, disability, or socioeconomic status. In fact, we take early head start down to three-year-olds, we even have two-year-olds. We feel like we have to intervene as soon as we can, because they're going to come to our school at some point. Private schools just aren't held to that standard. They don't take all of them, and they're not required to make accommodations. They have an acceptance process –  and it is a stringent process.And we hear stories all the time about students who maybe go to a private school, and then they get excluded or sent back to their public school because they had too many tardies, or because they didn't follow the rules. It becomes a screening process for the best and the brightest, who will leave [our public schools]. And, it will not do any favors to public education, whether it's in rural or in urban areas.Bob, when you describe the standards that the private schools would be held to, a national norm-referenced test and some, good financial bookkeeping, it sounds like the way public schools were when I went to school, where there was a lot of local control, and school districts still provided a very good education for kiddos without all of those strings attached to the dollars.And I also have a concern that we're still talking about a static amount of money and some window of time here. And when the dollar amount that goes to private schools, we know that over a very short period of time, the tuition at those private schools is going to increase at least to the amount of the voucher. And so I would say to you that over time, that amount is going to increase because it's still not going to cover the amount and this is just going to be the camel's nose under the tent, and it's going to continue to balloon, if you will.Morgan: So right now we're in the crunch time of the legislative session. The Senate has passed out a voucher bill, SB 8. Meanwhile, the House has passed its budget with a provision that would prevent public money from being spent on private schools, which seemingly would mean that SB 8 or any other voucher proposal wouldn't have the votes to make it out of the House. Bob, what does that mean for vouchers this session? Is it stead?Bob: Even after multiple bills have been heard this session, both in the Senate Education Committee and the House Public Education Committee, there continues to be more bills heard on Education Savings Accounts, specifically for special education students. And so as more bills move through the process than ever before with the six weeks left, there's a lot of vehicles out there for Education savings accounts, for vouchers, for virtual vouchers to be heard and advanced through the legislative process. So it's incredibly important when the House debated the Herrero Amendment during the state budget process, that says they are not willing to accept a voucher program this legislative session. With that being said, as I mentioned, there's a lot of time left, and a lot of legislative vehicles that can move this type of legislation forward. So you have to remain vigilant. Morgan: Well, we're going to have to end here today. Dr. Randy Burks and Bob Popinski, thank you again for being with us. And thanks to you, our audience, for listening. Today's episode was written by me, Mogan Smith. Our sound engineer is Brian Diggs. And our executive producer is Anne Lasseigne Tiedt. To stay informed on vouchers and other critical education issues as the session progresses, you can sign up online for Raise Your Hand Texas Across the Lawn weekly newsletter, at www.raiseyourhandtexas.orgget-involved. To receive text alerts that will allow you to join Raise Your Hand in taking action at key moments this legislative session, text RAISEMYHAND, all one word, to 40649. Thank you for standing up for our Texas public school students.

Sometimes "reality" TV takes it one step too far.  Sometimes two steps.  Sometimes a flying leap. WARNING:  IMPLIED VIOLENCE AND TORTURE Written and Produced by Julie Hoverson Cast List Announcer  - Frankenvox Alison - Beverly Poole Bart - Michael Faigenblum Carl - Mike Campbell Debbie - E. Vickery Ms. Sheldon - Sharon Delong Tanya - Tanja Milojevic Mom - Shayla Conrad-Simms Dad - Reynaud LeBoeuf Son - Eli Nilsson Fred - Joel Harvey Bob - Glen Hallstrom Helen - Helen Edwards June - Shelbi McIntyre Kathy - Kim Poole Additional Voices - Russell Gold; Julie Hoverson Music by Brian Bochicchio (Seraphic Panoply) Show theme:  Kevin MacLeod (Incompetech.com) Editing and Sound:   Julie Hoverson Cover Design:  Brett Coulstock   "What kind of a place is it? Why it's right here, right now, can't you tell?" ************************************************************************ IDIOT BOX Cast: [Opening credits - Olivia] TV Announcer Alison, chipper Bart, sullen Carl, upbeat, hearty Debbie, nervous, angry underneath Ms. Sheldon, executive producer Tanya, in the sound booth Family - mom, dad, teenage son Bar - Fred, Bob, Helen Dorm - June, Kathy OLIVIA     Did you have any trouble finding it?  What do you mean, what kind of a place is it?  Why, it's right here, right now, can't you tell?  MUSIC SOUND     THEME MUSIC ANNOUNCER    last week, in the record-breaking debut of The Box, we were introduced to our four contestants: ALISON    [chipper] I'm Alison, from Santa Monica.  Hi, mom! CARL    [hearty] Carl, from Atlanta - home of the Cartoon Channel!!  DEBBIE    [nervous] Debbie, from Salem.  Uh, Oregon.  [quickly] Salem Oregon. BART    [sullen] Bart, Minneapolis [disgusted sigh]. ANNOUNCER    The rules are on the screen now for all you viewers out there, to cover the formalities.  They are also available on our website at [spelled out superfast] w-w-w-dot-s-k-i-n-n-e-r-i-d-i-o-t-b-o-x-dot-com.  AMB    FAMILY LIVING ROOM SOUND    CHIPS EATEN FROM BAG ANNOUNCER    [TV] And after this brief message, we'll show you the results of last week's voting. SOUND    CLICK OF REMOTE SOUND    POPCORN POPPING IN MICROWAVE MOM    [off] You better not have turned that off, hun! SOUND    MICROWAVE DINGS DAD    Just muted.  Sick of all these ads for freaking erectile dysfunction.  If anything's going to give a guy man-trouble, it's having to watch all those damn ads. SOUND    POURING POPCORN INTO BOWL SON    Ew, dad.  T-M-I. MOM    [coming in, munching popcorn] The one I hate is that smiling guy.  His wife just looks so scared all the time.  Almost as creepy as the King. SON    Am I adopted?  Please say yes. DAD    Ooops, back on! ANNOUNCER    [TV]  Did everyone vote? MOM    I certainly did! SON    Mom?  [disgusted noise] Why? ANNOUNCER    [TV] The voting is closed, the tabulations have been made, and the scores are coming up on the screen now. MOM    [over the announcer] Why not?  I want that nice young girl - the blonde - to win.  She's very wholesome. ANNOUNCER    [TV] And it looks like today Alison has been selected!  MOM    [satisfied] There! ANNOUNCER    We have Alison in the studio now - let's see how she takes it. SOUND     LIGHT MUSIC, ON THE TV SEGUES INTO REALITY ANNOUNCER    Hello Alison!  Say hi to everyone!  ALISON    Hi!  Hi mom!  Dad! ANNOUNCER    How's the first week been treating you? ALISON    This place is great! ANNOUNCER    Throughout the show, we'll be showing some of the fun you four have been having.  Now, why don't you tell me what you think of your new friends? ALISON    Oh, wow - everyone's really great.  ANNOUNCER    Don't you find Bart a bit... isolated? ALISON    He's just self-contained.  I'm sure he's a good guy, he just doesn't open up real easily. ANNOUNCER    And Debbie? ALISON    She's shy - a lot like my sister.  Hi Vickie!! ANNOUNCER    [chuckles] That's great. ALISON    And Carl - well, he's a blast.  He's always thinking up great stuff to do. ANNOUNCER    Yesterday you had sole access to the Dairy Dan Amusement park. ALISON    Oh, man - that was awesome!  They closed the gates and we got to ride all the rides all day long - no lines, no crowds!  Woo! ANNOUNCER    You've been chosen. ALISON    Woo!  [stumbles] I - What?  What? SOUND    CONTROL BOOTH ANNOUNCER    [TV]  Please step into the box. ALISON    [TV - gasp, then steels herself]  Right.  [somewhat bitter] Thanks America. SHELDON That's the shot - tight in on 2, now 3 - yes! Keep her face centered until she shuts the door. TANYA    Got it. SHELDON Okay, keep the volume low on that. It's early yet - don't want to wear out the viewers... SOUND    [TV] ELECTRIC SHOCK NOISE, SOMEWHAT BRIEF ALISON    [TV - short scream] ANNOUNCER    [TV] We'll be right back after the break to find out what today's challenge will be. AMB    DORM ROOM JUNE    Omigod!  Omigod!  Did you see that? KATHY    [distracted] Hmm?  No but I sure heard it - did they just do what I think they did? JUNE    They just shocked the crap out of the blonde chick! KATHY    Was there actually crap? JUNE    [duh] She was in the box.  Shh.  It's coming back on. SOUND    TV TURNS UP ANNOUNCER    [TV] We'll be right back with more of The Box after these messages. SOUND    SOUND DOWN AGAIN JUNE    I hate when they do that. KATHY    Shock someone? JUNE    No, have the logo come up and make you think the show is back on. KATHY    Yeah, that's much worse. JUNE    You know what I mean!  It was totally mean that they shocked her - she's the one who got the most votes! KATHY    Isn't that what everyone was voting for? JUNE    No!  At least, I don't think so - I mean, I thought it was voting for who would win something cool.  I ...voted for her. KATHY    You actually voted? JUNE    On the website, yeah. KATHY    Of course there's a website.  Maybe you should read the fine print. JUNE    Oh, oh!  It's back on!  Jeez, look at her poor hair! SOUND    TV UP ANNOUNCER    [TV] Back to the interview room, to hear from Alison. ANNOUNCER    [real] Before we go on, I need to point out, this is the only time you can choose to leave the show.  Are you prepared to stay? ALISON    [gulps, then quiet]  Yes.  [clears her throat, louder]  Yes.  [very shaky] That wasn't so bad. ANNOUNCER    Excellent.  Now I believe you recently graduated from college, Alison.  What did you get your degree in? AMB    BAR ALISON    [TV]  I'm a liberal arts major, with a minor in art history. FRED    So she's unemployed, eh? ANNOUNCER    [TV]  And you are engaged to be married? BOB    Too bad.  All the cute ones are taken.  Even with that weird hairdo. SOUND    TV SWITCHED TO SPORTS FRED    Hey, we were watching that! HELEN    Why?  It's awful, letting them mess with people on TV like that! FRED    [scornful] It's not real.  BOB    Course it is - it even has a website! HELEN    Puh-leez.  Lots of things have websites that aren't real. BOB    Name one. HELEN    Pamela Anderson's boobs. FRED    She got you there, pal. BOB    C'mon - just switch it back long enough to see what today's challenge is?  Please? HELEN    Ya big softie, you. SOUND    TV CHANGES BACK ANNOUNCER    [TV] Carl, you got the second most votes this week - Do you have anything to say to the viewers at home?  Obviously you're doing something right, to get so many votes. CARL    [TV]  I think it's just my sunny personality, Bob.  People like winners, and I am a winner. AMB    LIVING ROOM SON    Weiner. MOM    Language! SON    [dismissive noise] Doesn't that dipstick know that most votes gets zapped? DAD    Maybe he doesn't - they might not tell THEM everything, either.  Makes sense.  Why else would they be so excited? SON    But that sucks!  That sucks big time!  Here they are, trying to be all cool and get people to vote for them, and they're like masterminding their own torture or something. DAD    It's just a game,  No one really gets hurt. MOM    Well, I was kind of upset that Alicia-- SON    Alison. MOM    Yes, that she got shocked.  I didn't know that voting for her would do that.  I kind of feel bad now. SON    Well, don't vote for her next time. MOM    I certainly won't! ANNOUNCER    [on TV] Well, we've spoken to two of our four contestants, and the voting is open for the halftime winner.  Go on line now or text to-- SOUND    TV MUTES, AMB/DORM SOUND    COMPUTER KEYS KATHY    What are you doing? JUNE    Voting. KATHY    Vicious much? JUNE    No! I - I just don't want her to have to get shocked again.  Damn!  It only lets me choose one of those two - not the other guy. KATHY    So you want to see him get shocked? JUNE    Well, no, but I like him the least. KATHY    Just cause you don't think he's cute. SOUND    ONE LAST KEY JUNE    Um, there. KATHY    So who'd you vote for? JUNE    The guy - the nice one - of course.  I like him, too, but I don't want her to get shocked again. SOUND    TV UP AGAIN ANNOUNCER    [TV] Regular text messaging fees apply.  And now‑‑ SOUND    OMINOUS MUSIC ROLLS IN ANNOUNCER    [TV, ominous] The moment in the spotlight.  Will it be Alison or Carl?  The voting closes in three minutes, so hurry up and make your vote count - if the lines are overloaded, make sure and try back - but be quick.   [normal] While we wait, let's watch some clips from the preliminary interviews with the other two contestants. MUSIC ANNOUNCER    [TV] And what are you studying? DEBBIE    [TV] I'm - um - a poli sci major. FRED    So she's gonna end up unemployed too. BOB    Whatever happened to good old trade schools? FRED    They're still around - just the trades aren't.  You seen any cobblers in the U.S. of A recently?  Nope.  It's all farmed out to Pakistan and Koala Lumper. HELEN    Lumpur. FRED    Sez you. HELEN    I can turn it off, you know. BOB    Yeah - see now Helen here's got a job that can't be farmed out - long as there's guys like us, there's always gonna be bars, eh? FRED    Until they invent a mixology robot. BOB    Hey, the lights are flashing on the screen, must be something important. SOUND    TV TURNED UP. SOUND    OMINOUS MUSIC INTENSIFIES ANNOUNCER    [TV; evil "suspense" pacing]  And the one who got the most halftime votes.  Will it be Alison, our stoic liberal arts major? JUNE    Yes, yes - come on come on!!! ANNOUNCER    [TV] Or Carl, who tutors children with learning disabilities. MOM    Oh, that's awful! SON    Awful? That he works with retarded kids? MOM    [almost a whisper] That I voted for him. ANNOUNCER    [TV] And the one who got the most votes in the 8-minute half-time poll was-- SOUND    HEAVY DRUMBEAT ANNOUNCER    [TV] Was-- SOUND    HEAVY DRUMBEAT KATHY    Look at how much she's sweating! JUNE    You'd sweat too if you just got shocked! ANNOUNCER    [TV] is -Carl! JUNE    Whew! KATHY    Shh.  Let's see what happens. ANNOUNCER    [TV] This means that at the end of tonight's show, Carl will be up against the second half winner in a showdown to see who gets a million dollars sent to the charity of their choice. HELEN    Waitaminute - she gets shocked and he gets a chance to win big bucks?  That's so not fair! FRED    That's the way it is.  Women always getting the short stick. HELEN    Especially when they're dating you, eh? BOB    [laughs, tried to stop] FRED    Yeah, yeah - you can joke now, but I'll give you 70-30 odds that the other winner is that other guy. BOB    The grouch? FRED    Yup.  Is it a bet? BOB    Fifty bucks? FRED    Whoah, whoah!  Let's not get carried away here, now. MUSIC - OPENING THEME, PLAYS FOR A MOMENT ANNOUNCER    Entering week five of The Box, you can see the ratings posted for our four contenders.  [hushed] Last week, it looked as though Debbie had finally broken-- DEBBIE    [TV] I hate it!  I hate you all! You can all just go and-- SOUND    LONG SERIES OF BLEEPED WORDS SOUND    ZAPPING AND SCREAMING UNDER NEXT LINE ANNOUNCER    But after her trip to the box, she refused to cry off. DEBBIE    [TV] [breathing heavily and gulping] No [gasp] way! [gasp]  You don't [gasp] get rid of me [long shaky breath] that easily. [sob] ANNOUNCER    And now, a new week - and what was this week's challenge? STUDIO AUDIENCE Fasting! ANNOUNCER    Yes, fasting.  Whoever could go the longest without eating even a single bite of food got a free pass this week‑‑ ANNOUNCER    [TV] --and we'll find out who managed that in just a moment - after a few words from our sponsors. SOUND    CLICK, SOUND OFF JUNE    [urging] C'mon Debbie! KATHY    Debbie?  Hah.  She's got no body fat to start with.  Bart has a much better chance of surviving-- JUNE    Don't say that!  You just like him cause you know I don't! KATHY    I root for the underdog.  It's a principal. And no one likes that poor bastard. JUNE    If no one likes him, how come Debbie's the one always getting shocked, huh?  [almost a sob] Huh? ANNOUNCER    [TV]  Let's bring our four contestants out on stage to hear who's going to be free and clear for another week.  Alison-- SOUND    MUSIC UP, DOOR OPENS, SHAKY FOOTSTEPS ANNOUNCER    [real] Alison, how are you feeling? ALISON    [trying to be perky] Not too bad.  I made it almost three whole days on nothing but water.  ANNOUNCER    But then you lost it? ALISON    [heavy sigh] Yeah, I had to give in and get something.  [resigned] I figured fine - just put me in the box.  At least that eventually ends.  ANNOUNCER    Thank you, Alison.  Now go over to the isolation booth while we talk with each of your friends. ALISON    [venomous] Friends?  Hah! ANNOUNCER    [TV, confidential] She needs to learn to be careful about trading today's pain for tomorrow's - what she doesn't know is we've [ramping up] turned the voltage up another notch! AUDIENCE    [TV, CHEERS] HELEN    This just keeps getting worse.  It has to be against the law. BOB    Oh, come on.  They signed waivers, didn't they?  Plus, it's all fake - like wrestling.  Seriously.  Even if they did do this stuff, they have to have doctors and all on staff - make sure no one really gets hurt. SOUND    UNWRAPPING AND OPENING A FORTUNE COOKIE FRED    Hey, listen to this - "Those who cannot remember the past are condemned to repeat it." BOB    Figures the Chinese would think of that first. FRED    Nah.  The Chinese didn't make that up. HELEN    Then who did say it? FRED    [immediate] Thomas Jefferson. BOB    I don't think so. FRED    Yeah?  And who do you think it was? BOB    Some Greek philosopher or other.  [idea] Julius Caesar! HELEN    You guys make your bet, I'll call Jonesy on the next commercial and he can google it. SOUND    TV TURNS UP ANNOUNCER    [TV]  So Bart, you made it the longest without eating - you have any special tips for the viewers out there on how you did it? BART    [real] Huh? ANNOUNCER    Any tips?  We'll give you a minute - these moments of uncertainty are just further proof that our show is live and unedited.  While Bart ponders this, I'll recap - Alison gave into her craven need for food first, followed by Carl and Debbie - in a virtual photo finish, where Debbie held out for one millisecond longer than Carl.  Good going Debbie! BART    I hate you. ANNOUNCER    Hmm?  What's that? BART    I hate you and all you stand for.  ANNOUNCER    Do I hear an opt-out coming?  For those of you just tuning in, during this episode and this episode alone, any of our four contestants can opt out at any time - not just immediately following a trip into the Box.  So Bart, are you-- SOUND    A BEEP TRIES TO CUT HIM OFF ON THE FIRST WORD BART    Fuck you!  You can't get rid of me that easily.  BART    [TV] I don't care how many times you drug me and try to get me to bow down to the corporate machine!  You and all you people at home - you are sadistic bastards, but I'm here for the long haul - And when I finish, whether I win or not, I will be traveling around the country demanding the pound of flesh each and every one of you bastards owe me!!! KATHY    For god's sake, turn it off. JUNE    No, he's making a valid point.  We shouldn't be party to this. KATHY    The very act of watching it validates it. JUNE    No.  I'm only doing this to bear witness. KATHY    The advertisers don't care.  They just want to you to watch. JUNE    Well, I won't vote any more. KATHY    Then you can't complain when your favorite gets zapped. JUNE    [upset] Oh hell! ANNOUNCER    [TV]  Well, that was very enlightening.  Before you out there start emailing and phoning - please refer to clause 42 slash 8 slash F, subsection I-I-I, paragraph y, where it sets out the game's rules covering mental illness or defect.  Thank you, and good night! SOUND    TV TURNED OFF HELEN    Anyone checked out the big pools? FRED    What do you mean? HELEN    There's huge bets all over the place - everyone guessing who's gonna last the longest. BOB    Well, no one's washed out yet. FRED    They're a tough bunch of kids, but I bet I could make it on that show.  Age does bring wisdom. BOB    To who? FRED    You're too young to remember this, but I was a P-O-W in nam [rhymes with "ham"].  I been through it all.  Torture, deprivation, brain washing. HELEN    They sure got yours squeaky clean. SOUND    DRINKS WHOLE BEER DOWN. BOB    Ahhh. MUSIC    ANNOUNCER    This week, week 9 of The Box, we might just lose a second contestant.  ANNOUNCER     [TV] Alison, you've spent three days in this jacuzzi - brought to us courtesy of Big Joe's cut-rate pools and spas.  Now, people might think this was fun, but of course, you can't fall asleep or you might drown!  ALISON    [TV, parched, delirious]  You suck, Bob. FRED    Friend of yours? BOB    You wish. ALISON     [TV]  Get me out. ANNOUNCER    [TV] You do know that whomever leaves their jacuzzi first goes directly into the box? ALISON     [TV] No!  I want out!  OUT!  I can't - you can't make me stay here! JUNE    They can't, can they? KATHY     How much you wanna bet she signed something that says they can? JUNE    That's illegal! KATHY    Being stupid and greedy?  Nah.  They'd run out of prisons.  Unless you subscribe to the idea that our whole world is a prison. JUNE    [very upset] Don't talk like that - look at that poor girl!  They're just dragging her across the stage! KATHY    Wow.  I wouldn't'a thought it would take three guys to handle her, after all the crap she's been through. ALISON    [TV - screaming weakly and struggling] ANNOUNCER    [TV] It is understood, under the rules, that the clemency episode has run out and, once again, the only time you can opt out is right after a session in the box-- SON    If she's all wet, wouldn't that make the shock worse? DAD    At least her hair doesn't end up all weird since they shaved her head after that challenge last week-- SON    Three weeks ago. DAD    Really?  Anyway, they probably compensate somehow. MOM    Are you sure? DAD    [unsure] Well... They can't really hurt her - that would be... ANNOUNCER    [TV]     Oh, and - I've just got a word from the producer!  We've got a three minute vote - so grab your phones!  ANNOUNCER    [real] Now this will cost one dollar per vote, so make yours count!  Dial the studio number and hit 1 if you want us to let Allison forfeit and leave now, push 2 if you think we should hold her to the rules.  And voting opens [beat, then TV] Now! SHELDON Start the positive counter. TANYA    On it.  Running. NARRATOR     [TV] The positive votes will tally right here on the corner of the screen, and if, after the vote closes, there are more positive than negative votes, Alison will  immediately leave the studio - damper but wiser... BOB    Man, I wish I was in Vegas. FRED    Nah - you know what's going to happen.  The odd's'll be crap. HELEN    Course.  They'll let her go. FRED    You gotta lotta faith in people, babe.  Nah.  I'll give you 10 to 1 she's gonna ride the lightning. BOB     [incredulous] "Ride the lightning?" FRED    You know - old sparky. The electric chair?  Man where have you been? BOB    Considering no one's been executed in an electric chair in this state for - um - help me out Helen-- HELEN    50 years. BOB    50 years. FRED    Really? HELEN    How the hell'm I supposed to know? BOB    Well, whatever - a long time.  HELEN    Actually, I think this state always hanged people. FRED    Hung. BOB    The countdown! 5 - 4 - JUNE    3-2- MOM    [almost breathless] One. ANNOUNCER    [TV]  All votes are in, and as you can see, we had a regular landslide of support for our dear friend Allison here.  we have 4 million six hundred seventy two thousand, three hundred and forty-two votes for clemency.  Good for you everyone!  We'll show the other side, right after this-- SOUND    TV OFF DAD    No way! MOM    You can't    ! SON    I won't watch any more of this.  This is brutal. MOM    [angry] Don't you dare!  How can we not ... find out? SON    No. MOM    Just until they announce it - we don't have to watch ...if she... SON    Gets it? SOUND    REMOTE THROWN ONTO TABLE SON    You do what you want.  I'll be in the garage. SOUND    [after a moment] TV CLICKS ON COMMERCIAL    [something] KATHY    I bet the commercials for this cost top dollar.  Like superbowl ads. JUNE    How can you just be so snarky - that girl could die! KATHY    Nah.  They can't do that.  It would be illegal. JUNE    Not normally, but remember when that guy had a stroke on "Danger Island" last year?  The family sued, but the waiver made it perfectly legit.  KATHY    And that wasn't even that exciting. ANNOUNCER    [on TV]  For those just tuning in, we have perky little Allison in the Box, awaiting your verdict.  [continues under] Does she take the next shock, or have you tipped toward clemency for this poor girl? SHELDON Give them the split picture. TANYA    Before and after? SHELDON Uh-huh. [grim] Show them what they did. ANNOUNCER    [on TV] The negative votes have been tallied.  SOUND    DRUM ROLL, OMINOUS MUSIC ANNOUNCER    [ON TV] And we had 4 million six hundred seventy two thousand, three hundred and forty-two votes to let her go.  BOB    I'm still saying they'll let her off.  FRED    Nope.  You already lost that twenty, pal. HELEN    Shh! ANNOUNCER    [TV] The negative count is seven million three hundred-- SOUND    TV OFF KATHY    Did you vote? JUNE    Yes.  [beat]  Twenty times. KATHY    [shrug] You can't beat the bastards. JUNE    But if everyone just voted a few more times... KATHY    Three million more times. JUNE    How can people be so horrible? SOUND    [NEXT DOOR TV] SCREAMING PEOPLE    [laughing] SOUND    POUNDING ON WALL JUNE    [yelling at them] How can you be so horrible?? KATHY    They're drunk.  Didn't you see the sign? JUNE    [half a sob] Sign? KATHY    The one that said "come to gary's room, get drunk and watch The Box"? JUNE    [down] No. KATHY    Look, turn it on.  You'll see she's not dead or anything, then you'll feel better. JUNE    But what if she's not?  I mean, what if she is?  I mean-- KATHY    [sigh] Then you'll know. SOUND    [beat, then] TV TURNS ON SOUND    [on TV] AMBULANCE SIRENS JUNE    [sob] MOM    [sob] Her poor parents! DAD    Don't worry so much - she's not dead. MOM    She was for 43 seconds. DAD    That doesn't even count these days - happens all the time on House. MOM    [very upset] But this is real! SOUND    [on tv] MUSIC UP ANNOUNCER    [tv]  And we'll be checking in with Allison as soon as she regains consciousness to confirm her wish to opt out.  For now, the game comes down to Bart and Carl.  ANNOUNCER    Don't forget - no matter what happens, the game's big final episode is in two weeks.  SOUND    CAMERA OFF SHELDON Nicely done. ANNOUNCER    It's really wearing me thin. SHELDON Almost over. And after today's vote, there's no way the station can afford to cancel us. ANNOUNCER    [sigh, then grudging] Two more shows.  SHELDON [with meaning] And then we announce the results. MUSIC - OPENING THEME, PLAYS FOR A MOMENT AMB     NOISY BAR BOB    [ordering] Another one. FRED    Packed tonight. SOUND    DRINK SET DOWN HELEN    It's the finale. FRED    [tired] Oh, yeah.  That. BOB    Bottom's up! HELEN    Slow down, or I'm gonna have to pour you into a cab. SOUND    CAR KEYS SLAPPED ONTO THE BAR, SCOOPED UP SOUND    GLASS SET DOWN HARD BOB    Ahhh. CROWD    ROAR OF EXCITEMENT HELEN    Hold on!  I'll get it. SOUND    TV SOUND UP MUSIC    FANFARE ANNOUNCER    It's the night we've all been waiting for.  The night the final results are announced.  And we will have an ultimate winner.  Let's recap what the winner will walk away with.  SOUND    VOLUME DOWN SOUND    DOOR OPENS KATHY    Oh, you're not watching that, are you?  [sneer] I thought you decided it wasn't worth it! JUNE    [shell shocked] I can't not watch!  I have to know! KATHY    Look, let's go to the library or something. JUNE    No!  I would die of suspense! KATHY    It's not-- SOUND    TV VOLUME COMES UP KATHY    [sigh] I'm not staying. SOUND    DOOR CLOSES ANNOUNCER    And the contest comes down to our two finalists, Bart and Carl.  They have endured amazing hardship to make it this far.  Do you have anything you want to say to the people at home, Bart? BART    You still suck and you always will.  Every single one of you!  Every person who just sits by and supports this shit! ANNOUNCER    [still jovial]  And yet, you have continued to play our sick little games - as you call them - despite being offered chance after chance to leave. BART    Hah!  I don't plan to fucking let you win, you scumbags! ANNOUNCER    Well said.  And you, Carl, do you have anything for the audience? CARL    [mumbles] ANNOUNCER    Speak up? CARL    [vague, reciting] We are the music makers, and we are the dreamers of dreams.  Sitting by lone sea-- lone sea....  the sea.  The sea.  See see oh playmate, come out and play with me.... [fades out] ANNOUNCER    There you have it, folks.  And now we go to our man in the street interviewer, Tanya.  Take it away! TANYA    Thank you.  I'm in a major metropolitan center here, asking people on the street what they think of the Box. ANNOUNCER    If they're outside right now, instead of glued to their sets, they must not think much of it. BOTH    [fake laugh] SOUND    TV OFF SOUND    EATING MOM    What?  Don't you dare! DAD    Hey, we were watching that! SON    Are you enjoying this? MOM    Enjoying? DAD    What do you mean? SON    All this shit they've put those people through!  You can barely tell them apart now, after they've been starved and had their heads shaved.  They look like concentration camp victims! MOM    But - but this is the last show! DAD    What does it matter if we watch or don't watch? SOUND    THROWING DOWN A REMOTE SON    Do what you want.  I'll just hope for a six-car pileup.  Maybe you'll trade up. SOUND    DOOR OPENS AND SHUT SOUND    REMOTE TAKEN, TV ON ANNOUNCER    And for tonight, the big surprise is-- SOUND    DRUM ROLL, OMINOUS MUSIC ANNOUNCER    Two boxes! SOUND    CANNED CHEERING ANNOUNCER    One for each of you.  While we get them all set, here's a word from our sponsor! AMB    BAR CROWD    Buzzing "two boxes?" BOB    [slurry] Whaddaya think they've got up their shleeves? FRED    They're gonna kill one of those boys. HELEN    [confidential] I heard that girl Allison is in a private clinic, barely alive. FRED    Where'd you--? HELEN    Internet.  BOB    [sarcastic]  Yeah.  Then it's probably true. SOMEONE    Turn it up! HELEN    Got it! SOUND    TV UP ANNOUNCER    And now.  The moment of truth!  All the votes have been tallied.  As you can see, we have Bart over here in the red box-- SOUND    CANNED APPLAUSE ANNOUNCER    [tv] --and Carl over there in the blue. SHELDON close up on Bart, camera 2. Yeah, baby, clench that jaw.  Now cut to that trickle of sweat on Carl's face.  Nice. TANYA    Back to the announcer? SHELDON One more second, and - yes! ANNOUNCER    [tv] And now, with the votes tallied, we will find out who you out there have selected as the big winner, and who has to take the big penalty.  ANNOUNCER    [real] But first, we caught each of our contestants here on secret camera last night.  Let's see what they were doing on the penultimate night. SOUND    QUICK JAB OF STATIC VOICE    [tv] ...need to get out now.  You don't understand what they have planned for tomorrow.  It's so much worse! AMB    BAR BOB    Who the hell izzat? BART    [TV] [scoff] Worse?  Worse how? HELEN    Don't know.  FRED    Look at that announcer fellow - he's surprised too.  HELEN    [half a chuckle]  Serves him right. ANNOUNCER    [tv] Sorry - we should have screened that clip before playing it.  Let's go over to Carl's shot. CARL    [tv] Yea though I walk through the valley of the shadow of death, I shall--[cuts out suddenly] ANNOUNCER    [tv] And that's all the time we have for that.  And now the moment of truth.  Carl or Bart?  You held their fate in your hands. SOUND    COMMERCIAL COMES ON UNDER MOM    [coming in]  Where's Kyle?  Have you seen Kyle? DAD    [mesmerized]  He'll be back.  Just ... went out to a friend's house.  Probably. MOM    You should turn that off and find him! DAD    We can look in ten minutes just as easily as we can look now! MOM    This is our son! DAD    It's almost over! SOUND    OMINOUS MUSIC ON TV ANNOUNCER    [tv] And now.  The final countdown. MOM    Five minutes. SOUND    SHE SITS ANNOUNCER     [tv]  This has been quite a journey for everyone - and we would like to thank you all for your support and participation. BOB    Support?  I'd shoot that stupid bastard if I had a chance.  And a gun. HELEN    You're not the only one, but a lot of people paid a lot of money into that damn show. ANNOUNCER    [tv] --making us the highest rated network series ever-- FRED    yeah, and even WE count for ratings, since we happen to be watching it. BOB    [steaming into an alcoholic rage] Then let's not watch it! SOUND    SLAMS GLASS ON BAR, LIQUID SLOSHES FRED    Calm down, pal. BOB    No! Is this what our world has come to?  This crap?? SOUND    THROWS BEER GLASS AT TV, TV DIES, BUT OTHER SET PLAYS ON IN THE BACKGROUND CROWD    [Shocked silence] FRED    Great, one down, only seven hundred million TV sets to go. HELEN    I'll put it on your tab. CROWD     [chatter begins again] ANNOUNCER    [tv] --will definitely be returning for a second season, starting next fall-- SOUND    DOOR OPENS ANNOUNCER    [tv] --and we're looking at celebrity contestants.  TANYA    [tv]  That will be a whole new ballgame. KATHY    Sorry, didn't know it was still on. JUNE    [distraught] Stay.  Please. KATHY    Ugh.  Why? JUNE    Because I don't think I'll make it otherwise. KATHY    Make what? ANNOUNCER    [tv] And now for the final outcome.  MOM    Yes? DAD    About time. ANNOUNCER    [tv]  the final results. FRED    Don't call the police.  I'll get him home. HELEN    Yeah.  This time. ANNOUNCER    [tv] What we've all been working toward. JUNE    [crying] Can't they just say it? TV, MUSIC SWELLS, THEN CUTS OUT SUDDENLY JUNE    What? HELEN    Shit, must have blown the circuit. DAD    The electricity's still on! KATHY    Is there something wrong with your TV? MOM    No!  It's practically new! FRED    Come on.  Quitting time, pal. SOUND    TEST PATTERN NOISE, THEN MUSIC SUDDENLY CUTS BACK IN ANNOUNCER    Thank you all for participating in our experiment.  MOM    [gasp] ANNOUNCER    As you can see, all of our actors are in perfect health. JUNE    [sob]  How could they--? KATHY    Bastards. ANNOUNCER    We would love to hear your reactions to this show.  Please feel free to leave us a message at www-dot- SOUND    TV SWITCHES OFF HELEN     [last call voice] Allright.  That's it. CLOSER   [NOTE:  George Santayana, author of the quote.]

Max: Hello and welcome back to the Recruitment Hackers Podcast. I'm your host, Max Armbruster, and today on the show I've got a world traveler, a man who I first interacted with in Malaysia a few years ago and who has since moved industries and has worked in entertainment, in games today, and a few other, and oiling gas before, and is today the Director of People and Legal for Big Viking Games. Welcome to the show, Bob. Mr. Bob St-Jacques, I hope I'm pronouncing it right. Welcome to the show, Bob.Bob: All right, well thank you, Max, happy to be here.Max: Pleasure to have you. And of course, we interacted with Bob when he was leading the people function at a company called 7Geese which got acquired by Paycor which is a leader in OKR methodologies. So, for the HR performance enthusiasts that are listening, they'll be familiar with OKR methodology and it's a great foundation for start-ups. So, anyway, that's a little bit about your background but perhaps, Bob, I'd like to ask you to walk us back to the early days of how you ended up working in talent acquisition and dealing with people. Was it by design or by accident?Bob: It was by design because I had a very good mentor and it was, going back a few years, 1992 and I was going to get a master's in industrial relations with Cornell and my mentor suggested, he said, what do you want to do? I said, I wanna do HR. He said, no no no that's not gonna work.  He said what you need to do is pick a problem. Pick something that you wanna pour your heart and soul into and I said, well HR is basically broken, right? 91, 92, there was a recession going on in North America. I was working in Parliament at the time, so we were holding hearings, and nobody was happy. Employees, employers, communities would lay off. Nobody was happy. So, I said, hey look this is one of those problems that, like climate change, it's big and I can't fix all of it, but maybe I can fix something. So, he said, look if you wanna do that, go to law school and practice employment law then go into HR because you will spend the first five years learning from other people's mistakes. So that's exactly what I did. I went to law school, practiced employment law for five years and then got hired by my client. And basically, what I've done since 2000 is work on transformation efforts. So, in the beginning, they were turned around. So, I worked for a client who's called the Lens Crafters and they were in pretty rough shape, but if anybody wonders why I'm an optimist two and a half years later they're number 58 on the Fortune 100 best companies to work for list. Then I worked at Delta Airlines after 9/11, so I turned them around, right. So, this is why my optimism comes in. Moved to Dubai, things got a little bit more difficult because I had to help transform companies that were in scale-up and that were already growing about a hundred percent every year and how do you tell those folks, you're leaving money on the table you need to do more. So that was a further challenge and so I helped a lot of high growth organizations in Dubai, all over the Middle East, South Asia and Africa as well, worked in oil and gas in Nigeria for example. And then I went to the Far East and started focusing on tech, tech high-growth companies, tech scale-ups in that area and I've done the same thing here in Vancouver. So, the central theme is I've kept to my mission which is I want to help HR. And that's what I've done throughout my whole career. Sometimes, as you mentioned, being an OKR expert, spreading the love and the gospel of it, of OKRs, and sometimes there's goals more specific toward the company.Max: I think it's good advice for the young people to walk towards the problem, not away from the problem. You see an industry that's broken and a company that has issues and, you know, don't run away from it. That's an opportunity to make an impact and to work on a whole career duration on fixing something. I can empathize with that on my end. I saw a lot of broken things that I'm still trying to fix on high volume recruitment. So, maybe a word about Big Viking Games, your current company, which I understand has gone through some transformation over the last few months since you've been there for six months now. And we're gonna talk about how the talent acquisition strategy has been transformed to expand the talent pool. But can you set the scene for us, what does this company do?Bob: Yeah, so, Big Viking Games was started at, well I could tell you, it was 10 years ago in about a month. We just celebrated our 10th anniversary which is a pretty big deal. Only 4% of companies make it to 10 years so we had a fun event for everybody, and we managed to bring a bunch of people together. Now the challenge was six months ago is that the company had been making games but had been kinda flat-lined and just kinda been bumbling along for the past three four years. And so, they were looking to revive and expand. And the interesting piece is that in the gaming industry it's usually boom and bust all the time, right. Hire a bunch of people to make a new game, I'll make some money, oh you sold it off and then you drop the right number of employees and the revenue goes like this, it's big yoyo. So, what they decided was that's not sustainable and that's not great for employees. Employees in the gaming industry will tell you, yeah, I've been laid off and hired, right. You look at gaming LinkedIn profiles and they've all had 14 jobs in 10 years and it's not because they're job-hoppers, it's been most of the time because they've been laid off. So, the company decided to move towards a live operations model. What does that mean? It means they don't create their own games, they either expand things that they have, and they typically buy intellectual property and then expand it and run it. So that's a big switch from making games boom-and-bust to just kind of like very linear growth. And so, it's a challenge because you need different types of people, different types of mindset in that area.Max: Basically, in the oil and gas, it's like moving from being a builder to an operator.Bob: Correct. And so, there was the challenge. We need different types of individuals, different types of talents. and we needed to grow, and we were looking at acquisitions and so on. So fast forward, six months, what we have found ourselves is before we were in one vertical where we had a Facebook/Web games there which you know was alot so we had really high MPS scores. 70% of our players play our game 27 out of 28 days which is pretty impressive for games right. So, we got this loyal fan base. But now, we've attached, we've done an acquisition, we've expanded on a couple areas and so as folks will see throughout December, we will be putting out press releases in these areas. So, where we were in one verticals, we will not be in four verticals starting in January as we close these deals. So that's created some challenges and opportunity areas as well because we got new places we're expanding into and we're also expanding our current offerings. So, another piece of good news and we just got it less than 24 hours ago, again talk about the power transformation. When I joined, the Glassdoor score for the company was 2.2, when I said things are bumbling along, it was a bit in rough shape. Yesterday we were just notified by the Great Place To Work Institute that we are certified by them as a great place to work. So, when people talk about transformation is too hard, and I love the phrase that you used, running towards the problem. So, if you look at things as an opportunity in terms of aligning people behind the business strategy, OKRs and things like that, once you get alignment and you clarified the strategy for everybody, employees tend to follow along, right, to support you in that area, and that's what we found.Max: Congrats on the Great Place To Work and the transformation, I mean it's not a turn-around, but it's kind of a pivot for Big Viking Games and of course it does sound like a nicer environment for people who want a bit of stability after they changed 14 different jobs in 10 years. That could work your nerves out a little bit. Let's turn to the topic of talent acquisition and you changed the process there as well which you were telling me before we started recording. The testing has started to effect, the use of automated assessments, has changed the composition of your talent people and allowed you to expand to new talent pools. Bob: Correct. So, what we did was, again, because of the challenges that we face in terms of going into new areas we needed new and different talent, is that we decided to turn the whole selection testing paradigm on its head. Usually, people use these tools as deselection tools. So how do we get folks to get them out of the process. We test them and then that's it, they're out and so on. We turned that around. What we wanted to do was opt people in. Let me give you an example. Here's like, we were down to the basics. If we look at a situation where we're looking for a developer, an artist, and so on. Nowhere in the job description does it require these individuals to be excellent at creating resumes. And not to pick on developers, they're not, they're really really bad at writing resumes, right, and showing their skills set and so on and so forth. So, what we said was, you know, we get hundreds of applications, some case thousands of applications per position, you try to read through them the best you can, right. Most people they do a good job of communicating their skills, they tend to get interviews and so on. But what we did was like we're missing people; we're missing some diamonds in the rough. So, what we did was when we saw, we went beyond, right, when somebody was working at a grocery store, but like went down the resume and saw that they had worked as a developer before, right, and for whatever reason they're working at a grocery store now. But like fine. So, what we do is we tested these people in the beginning. And the quid pro quo is we said, look we'll test your own skills, resilience, and general ability, and you know what, we will give you the test, we will give you the feedback, we will give you your scores, the test, the report, everything, just work with us on this. Now here's what happened, if we would have taken one of those CVs which is in pretty rough shape and give it to the VP of Engineering, you would have said, are you kidding me, I can't. Now what happens is if this person's score is very high, intelligence, problem solving, resilience, and skills set, we can say, look this is a CV it's not so great, but look here we have documented proof that this person should be interviewed and move on to the next level.Max: So, the first time the candidate is speaking to somebody, a recruiter or somebody from your team, they've already done the assessments, how long does that assessment typically take. Half an hour, an hour?Bob: Yeah, no more than an hour, right, cause there's four components to it and then they're about 10-15 minutes each. Max: So, then the big question for a lot of employers is, you know this is a very high demand market. I'm sure for hiring artists and developers is very hard as well. How is that not shrinking your talent pool to a very miniscule amount. Sounds great, you know, of course, you get an assessment done before an interview, but that's not how recruitment used to be done. You used to, like, hit the phone and hunt these people. So how you filling the top of the funnel.Bob: In terms of the top of the funnel, those are coming through via ads and so on. So top of the funnel is fine for us. The important piece here is that when we were talking to the folks at various testing regimes, a lot of them said, when we said, hey we wanna offer the test back to the candidate, and they're like why? And I said, well that's the quid pro quo, that's the magic there. Because people will do things if there's something in it for them. Now there are, we use, for example, I don't know if I can say it maybe you could cut it out later if I'm not allowed to, but we use Test Gorilla. Test Gorilla has a certain amount of cache and individuals who take their test are allowed to use their results and give it to other employers. Max: I tried them out. I think they're great. Test Gorilla very easy to use and they have a very wide selection. They're a Netherlands-based company, all self-service, easy to use with APIs to integrate. So, love it.Bob: So that's what we do, right. So, we give people something and that's how we keep the testing level quite high. Now here's the interesting piece because we look at data, so I'm also a fellow in the Center for Evidence-based Management so I am really big on data, right. I wear a watch, I keep track, I can tell you what my macros were last Tuesday at 3pm. I am a fanatic about measuring everything. So, what we did was we said, okay what happened to people who went through the process. So applied or head-hunted, interview, tech test, our very difficult tech test versus applied, Test Gorilla, interview, tech test. What we found was that the uptake on our tech test during our traditional process was 50% five zero. When they took the quick test, got something for it, did the interview and had to do a very in-depth tech test, we're looking at about 85-90%. So, we nearly doubled the people. So even though we've added an extra level, again it's the counter-intuitive piece and this is why you need to look at data. Because if you were to ask me, I would have said, yeah, I don't think this will work. But it's important to measure what you do and put your scientist hat on and say, this is an experiment, it can blow up in my face or it can produce the most wonderful thing every. What we found is because we start by giving something, yes, they're investing their time but they're getting something back for it. People feel like, okay, you know, they continue with the processMax: How do you communicate to them that they're getting something? How do you let them know that they're gonna get something back?Bob: So, when we let them know that they've been selected for the initial test, we tell them, hey look, here's the advantages, you get to keep your test, here's the feedback, here's sample reports, and with some of the skills in tech testing, they're transferable and other employers accept. Max: Yeah, they can get like an act of accreditation that they can put on their profile or something. Bob: Correct, yeah, and it'll be verified by Test Gorilla.Max: Cool. Well, I certainly think you're not alone in making this happen right now. There's a change in candidate behaviors worldwide where they're getting used to it basically. There was an intuition from the TA community that this is too much, but that intuition is being tested and minds are changing on this topic, including mine. I can't believe the completion rates that I hear about for test that take 45 minutes to an hour and I'm shocked myself. Because I always assume that with the shrinking attention span of the young generations that we know about that this is something that they would not do. But well, that's why you gotta test your assumption.Bob: Yeah, and part, this came from one of my recruiters who tends to skew towards the younger generation, and he said, look people are taking these Buzzfeed and other quizzes all the time. There are millions of people, right. And they get a report back. You're a part of this house in Harry Potter and you're this type of potato, and you're this type of vegetable. You know, these people take those quizzes all the time. He said, look it's a higher level and it's something that's verified from a real company, like Test Gorilla. They got something that can help the in their job search and/or career and/or professional life. One other thing that I wish I could say, oh yeah yeah you know we totally planned this, again, because I look at the numbers and what we found by focusing on skills rather than ability to write a resume or CV is that for the past six months, 43% of our new hires are women and 52% are what we call here in Canada BIPOCs, so black, indigenous or people of color. So, again compared that to the rest of the gaming and tech industry, especially here in North America, we're doing quite well, we're on the right track. And I wish I could have said, oh we planned this, you know we did reach to certain group, you know, in those areas, but what we found again by focusing more on skills and abilities and less on the resume, we ended up with a much more diverse workforce. Max: Congratulations. That's the right way to go about it. Focus on competency, give everybody a chance. Glad to see it's paying off and helping you increase your DI metrics. There's maybe another element which is the fact that you're breaking down some of the borders and some of the geographical boundaries of your search and you were telling me how you're leveraging Canada as part of your employer brand. Can you share that story?Bob: Yeah, when the pandemic hit, the decision was made early on, and we basically cancelled our leases with our offices. We had two studios, one in London, Ontario which is about two hours west of Toronto and one is downtown Toronto, and so gone, studios gone.  So, they went all in on transitioning to 100% remote. Again, sounds very good in theory but everybody was learning on the go, so to speak, and you know you've seen all the stories from everywhere from LinkedIn to all kinds of magazines.Max: I've seen my own rental bills go down and I'm very happy about it.Bob: Yeah. So, the thing is then it's taking a lot of that and investing in different pieces. So, in terms of talent acquisition, what is 100% in what we call Remote Awesome. It's a campaign that we started where you're free to move about the world. So, it's telling our Canadian employees, look you're not stuck in Canada. If you wanna go work in Barbados or Mexico for the winter, you could do that too. In terms of recruitment, though, what's happened is we've done two fronts. We said, look, you can come work for us, we work on a concept of core hours, and we do asynchronous work, and you can stay where you are. You could then stay where you are for six months and come to Canada if you want. Or if you want to come to Canada, we will help facilitate your move to Canada. So we tend to take a wide open approach and say, it's up to you. People are at different points of their lives, so some folks come to work for us and boom, either we start the process fairly quickly and other folks will say, yeah next summer, you know, basically July 2022 is when I'd like to apply, it'll take x amount of time, that'll be perfect. So, we, by focusing on, hey either we're able to work based on your interest. Staying where you are, including asynchronous work so you're not working from 11PM to 7AM, some sort of horrible shift. You know maybe like for example, I start work at 5AM because east coast time and we have exec meetings in the morning. Why do we have that? Because some of our executive team is in India and they've been working the large part of the day, right. So, it's that kind of flexibility that we can offer people and say, no everybody in the world has to work eastern standard time hours. That's not the case. And so, we offer flexibility, stay where you are, move later or move now. And so, with that approach, we've managed to get some amazing talents. So, we've grown from employees in two countries when I've joined, we're now up to 14 countries.Max: And their contracts are, some of them are local contracts and some of them are Canadian contracts and some of them are consultant contracts?Bob: Exactly. So, it depends on how long they're gonna spend. So, if you're on your way here, it's a consultant contract, right. So, it helps with integration so we could show immigration, we know who they are, they've worked with us for a little while, bring them in. If they wanna stay there permanently, then we use a local vendor that we pay people through and so that makes sure that all the right deductions are made, and they get access to all the social benefits. For example, France, Netherlands, and the UK. I think in France I think there was like 27 deductions from an individual's salary. So that was interesting to see. But again ---Max: Now you know why I left the country. Bob: Yeah. But that's managed for us. So, we just pay one entity an amount for an employee, and they handle all the deductions and payments. Max: There are a lot of vendors helping with this domain now and I suppose people can reach out to you if they need some recommendations on how to source the right vendor here. Have you had a discussion internally about having local payrates? I mean, you said people can work from anywhere. So, I guess everybody is paid, there's no differences based on where you live and their cost of living. Usually, people have different pay scales for different, let's say, geographies.Bob: No, we run on CTC, which is concept called cost-to-company. So, we look at it, right, so some have higher social legislation requirements, we'll call it that, some have lesser, right. But at the end of the day, what we look at is what the company pays out overall. So that people are paid about the same no matter where they are in the world. Again, we focus on skills, competencies, and so where you are doesn't matter because we do have a fairly tough and rigorous hiring system. So, if you do get through it, we know you're qualified, we know you're able to produce a certain amount of work which has a certain amount of value and we will pay you, just like we pay everybody else that's in a similar position to you no matter where you are. Max: Great, that's great. We in my company also universal pay scales and I'm trying to ring them up to San Francisco standards, but some people on LinkedIn were saying we're not as generous as we should be, but we're working up to it. If the whole world could be paid like San Francisco that'd be awesome. We're working towards that. We're reaching the end of our conversation and there's one question I'd like to ask everybody that comes on the show which is to go back to a hiring mistake that you've made in the past that has stayed with you a little bit and that you had time to reflect on so that you can share with the listeners the lesson that they can take from bad hiring mistake. Of course, I'm not asking for individual name but rather how you took a misstep that one time.Bob: Yes, and so I'm gonna go a little bit against the grain, because I know I've highlighted that I tend to focus on data and information. So, one time I went through a process I was hiring a fairly senior member of my team, Global Recruitment Director, and you know we're getting close, and it was very exciting. When I was doing that, I was asking for references, and when I talked to these references, it was very, something was off. And I'm a lawyer and I could just ask people all kinds of questions, usually you could get them to admit the most horrific thing they did when they were thirteen years old. And I thought I was very good, but something was eating at me, like, I'm missing something, like something's wrong here in this area. And it turned out that I was not as prepared as I could be for those reference checks. Three months later, that individual turned into a nightmare on many fronts, internal, external. It did a lot of reputational damage to the company from that individual. And it's one of those pieces where I've learned where I was a little bit cocky, and I didn't listen to my gut. So rather than be the experimenter, you know what I mean, something came up, I should've asked more questions and I didn't because I was in a hurry and i wanted to find this person, and this individual seemed great, right. And I cut corners, didn't listen to my gut and ended up coming back to be quite embarrassing for me. Max: That's a tough one right because you said you're the data guy and the guts got nothing to do with it, we're trying to silence that thing. But in this case, something was wrong with the reference check. Can you expand on that a bit? What were maybe some signals?Bob: It was the guarded nature, right. I talked at high levels, we tend to be quite positive, right. So, when you talk to people and say, okay you know hey I'm going to be managing this individual what kind of development do you think that they need? And it was two references where there was a pause and I thought that was fascinating. On that pause, I should've jumped on that more. But it was ---Max: This person needs therapy. Okay. All right. So, listen to the pause when you're doing your reference checks because obviously nobody likes to say bad things about their former employees. It can be a treacherous territory so you gotta be very attentive. Good lesson for everyone to remember. Thanks, Bob, for coming on the show and sharing your experience in expanding your talent pool and transforming the recruitment process of Viking Games. It's been a pleasure. Bob: All right. Well, thank you for having me on.Max: Pleasure.

Our seven-part interview with Bob Regnerus of Feedstories begins. Topics covered in this episode What led Bob to become a digital marketing and paid advertising expertThe THREE POWERFUL THINGS Bob's done in his career to help him thrive in business, and attract clientsHow Victor Cheng encouraged Bob to write his first book, Big Ticket EcommerceWhat are the main advantages of writing a book?Finding Your SUPERPOWER Full Convo ➡️ https://brianjpombo.com/bjpchats/ https://www.youtube.com/watch?v=d1RLL3CSeis Transcription Brian: Bob Regnerus of Feedstories, part one. This is a series of conversation that we had with Bob Regnerus. You're really going to enjoy it, you can watch all the other parts of it over at BJPchats.com. And you can see everything else that I'm offering my book, you can have me as a guest on your podcast if you're interested on being a pet guest on this podcast or the other ones we provide. Or if you'd like to have me as a speaker at your event, go check all of that out over at BrianJPombo.com. Now, here's the show. Brian (Intro to show): Coach Bob Regnerus is the co-founder of Feedstories, a digital marketing expert and the author of five books, including, The Fourth Edition of The Ultimate Guide to Facebook Advertising. Bob, welcome to Brian J. Pombo Live. Bob: It is so good to be with you, Brian. Looking forward to a lively conversation today. Brian: Yeah, good deal. So I like to jump into these things without a whole lot of research in general. But the issue is, is that I already knew who you were, because I'd seen you around. I knew that you had co-authored this book. And I'd seen your name around probably for years, because I think we have ran in similar circles. Bob: Yeah, that's probably likely. Brian: Yeah, just tell me…we'll get into the details as far as where you're at right now, eventually. But tell me how did you end up where you are? Bob: Yeah, well, I guess I took a little bit of an indirect approach to being an entrepreneur. I was a programmer by trade, I went to college, you know, studied computer science, studied business, I had a dual degree. And I ended up working for a large corporation out of college doing programming on mainframe computers, that's the computers that take up a whole room. Did that worked at a couple different corporate jobs, and I met a guy at one of my gigs who was there on contract. And like, I was an employee, he was on a contract, I thought that was interesting. He kind of made his own hours. And he was making, you know, I mean, he wasn't getting benefits from the company but it felt like he was making more money than me doing kind of what he was doing. So I became friends with him and eventually, I went on my own with him and was doing some contract work. I worked for TransUnion, the big credit bureau. That was about 1998, I really got the bug for the internet. Obviously 1998 we're going back a few years, internet wasn't what it is today. Right? But I was a coder. I actually developed my first e-commerce website, I built a shopping cart for a business from scratch. By the way, there's still a client today, there's still a client. So it's pretty awesome. But we launched that thing in 98 and it was pretty funny. The business owner who I'm friends with is like, this is great, you know, we're getting orders, like the middle of the night, you know, when we're closed, it was a big deal. He's like, how do we get more people to the site? I said, oh, that's not a big deal, I know exactly how to do that. And of course I had no idea how to do that. So that's where I dove into the World of internet marketing and direct marketing. Discovered Dan Kennedy and Perry Marshall and all those things. I really became a student of marketing. And I shifted from being a technology person to a marketing person, just kind of felt really comfortable for me, it felt like the next step.

Max: Hello. Welcome back to the recruitment hackers podcast. I'm your host Max Armbruster. And today on the show, I'm delighted to welcome Bob Mather, who is a private investigator, as well as the founder and CEO of one of the leading. Background checking company, Pre-Employ, Bob, welcome to the show. Bob: Hey Max, how's it going?Max: Going strong going strong. We in the introduction introduced you as a private investigator. Is this how you stumbled into the world of technology? With long rain coats and you know, stalking people in their private lives. Bob: Wow. You have really just painted quite a picture.No, but close. Even though at one time, I didn't have a rank though. I did have one of those coats. It was probably 20 years ago. I started out my career specializing in embezzlement for retailers. So I would be the guy in the company that they would hire when they were missing $10,000, $20,000, whatever.And then  I would bring in a forensic team or a surveillance team and would try to put the pieces of the puzzle together and find out who was embezzling. And then I would also help. Yeah. I would help with the prosecutions. If there were criminal charges, advise them my opinion on what they should do and how they should do it.And then also work with civil restitution recovery. Max: Wow. That's great. This is the great foundation, right? Because you have seen the crimes committed and with your own eyes, so you can really empathize with your customers. Bob: Yeah, well, yeah, I've done thousands of interrogations for the specific embezzlement type cases. I also work with employers when it comes to workplace investigations and always have whether it be discrimination of sexual harassment other types of things, my team and I will come in and put the pieces together and show what really has happened with all of the emotion out of it.But when I first started doing this was in the early nineties and background checks really weren't a thing then, and back in the nineties and you know, there wasn't even an internet. Really, the internet had just started. We had Netscape. Right. We had this world of background checks that was done, when we did do a background check, it was very expensive and it was done by paper.And you might call the local sheriff or even try to get you could walk into a courthouse. You couldn't, there was no technology then. And hiring. If you wanted to hire someone you needed a background check on them. It could take a month. it just was the way it was, had been done forever, but with technology and I was an early adopter in technology, you know we started doing background checks.What happened was I was doing embezzlement investigations. And in one region of the United States, I caught, I investigated, prosecuted, and put a person in jail that was stealing thousands and thousands and thousands of dollars. About a year or so later, another company called me and said, hey, We're losing thousands and thousands and thousands of dollars.And I said, well, okay, I can schedule to be down there. I'll start the investigation, but can you send me your employee list? Let's see who's working there now. I'd like to see. And there was on the employee list they sent, there was the same guy.And I said, well, you know, If they only would have known, you know 400 miles away, he just got out of jail.Max: you know, all the great embezzlement guys that should be working for you.Bob: Yeah, no, no. When you work that type of work, the only embezzlement guys and girls, I know are the unlucky ones or the ones that are not that smart. The good ones I've never met. Max: I was just thinking, yeah maybe there's a limit, right? If you embezzle $500, you never get caught.If you're inbezzlel, half a million, obviously you're the venture you'll get caught pretty soon. Maybe there's a sweet spot there. I don't know. Bob: I think it's like playing blackjack or gambling. If you quit, you might get away with it. But the longer you play, the odds are against you. Max: Okay, great.Well I suppose yeah, millions of dollars are being saved now by the retail sector because of providers such as yourself.  Have you been able to quantify that you know, for the industry or how do you put a number on it for your customers at the beginning of those discussions?I suppose now it's not so much.  I suspect someone is taking money from you, it's more, standardized, right? Bob: It's more standardized now. It's for safety, is really the big concern right now. Safety of customers, safety of other employees. And as the industry progressed in the early 2000s, I mean, basically it was this.If the company. Whether it was a hospital or a retailer down the street did background checks and you didn't, you only were really sure of one thing. The people that were afraid to get their background checked were not applying at the guy who does the background checks. They were coming to you.And we actually would see that. So when we would get a new client. We would do background checks on all the employees and to do that, they would have to sign a form. Well, we would get people that would just leave. Like they wouldn't come to work. It was over. And then once we looked into it further, we could see that they had, you know, quite a background and then they would go to the next company that didn't do background checks.And, and today it's 90%, 96% of employers in most industries do background checks. Max: I was thinking about that. So for those 4%, that's that don't do, you know, maybe they have a wonderful opportunity, right? Because then they really have to pick up the litter. They can choose between anybody who has a criminal record, they can choose between them and they can take the best ones, the ones that truly want to reform their lives and, you know, start fresh, the ones that quit like a blackjack.Bob: Yeah. Or the ones that had a type of crime that really doesn't have anything to do with the position. So in the world of finance, for example obviously embezzlement would be a very big concern. It would be a killer of any opportunity, but not necessarily let's say a bar fight or where you got drunk driving.Right. So You know, the industry has changed and it's still changing,  Now there's not only a demand.  When we first started out  in the 2000s and 2010s, there wasn't the emphasis on speed as there is now, or talent acquisition leaders now are driven by the need to hire and to hire at scale.You know, we've got a starting class. We need to have X number of people. Hundreds of people are coming in and I need these done now. And for a lot of organizations that can be scary because the person who's ordering and overseeing the selection of what company to use is in such a hurry. And it gets bonuses and it gets financial payments for getting people through the system.They don't necessarily care about the quality like it used to be. It's a strange relationship. Max: It's commoditized and it's looked as as a necessary, a mandatory step, as opposed to something, a selection that you make purposefully, just like you said, like someone, you should also select a vendor very carefully.And of course, nobody is very as educated on the art of selecting. A background checking company as they are on the art of selecting a candidates. And I suppose every vendor will propose the most thorough checks at the most competitive price. And I don't,  I've never personally gone through the tendering process of selecting between different vendors within your position.Bob: So many hidden, there's so many hidden secrets in it. You know what most talent acquisition and HR leaders, or procurement leaders don't realize is that we can draft a background check based on what you demand from us. You want it super cheap. Don't worry. We can do it. It's like walking into an ice cream store.And if you said to the person behind the ice cream  store,  I want an ice cream sundae, but I only want to pay $3. But I need it big and they're like, okay, well, they're probably going to select the ingredients that makes you happy, but it's not really the best. So there's things that background check companies do that the type of tools they use to find where a person has lived.So in the States we use a social security number, and a social security number is put into a database and the database then says, look, Max has lived in seven places around the world in the past seven years. And so we would send investigators or do our, have our technology going to the courthouses. In those seven geographic areas.Well, if your employer is demanding fast, they don't care. It's fast. They want fast. We can choose between one and probably 35 different social security number, locators, or address locators, including some that bring back, it will probably show that you lived in two places. Right. The quality of what a background check company does in the hiring process is actually negotiable.And it's demandable and you can put together service level agreements and demands that look, we need the best. We want to protect our employees.  What is the price going to be? Or most people just say, I want a background check. I want an ice cream sundae. It's the same thing. It's a commodity. Right? Give me one. Max: There's some of this background checking that is still being done in house. And then I guess increasingly it has been, I don't know, is it increasingly done? In-house are increasingly being outsourced?Bob: It's going more outsourced now. But you know what it is,  what a lot of recruiters do do, it's now starting to be outsourced. Is and most, and a lot of recruiters and a lot of  talent acquisition won't admit this probably let's see what next time you get some of your next guest, ask them if they've ever looked at Facebook or a social media profile for one of their applicants. Most of them secretly do. It's not part of the background check.Max: Oh, of course you have to. I mean if you're a hiring manager, that's what you would do. I would imagine. Yeah,Bob: But think about that. Is that part of the background check? Max: No, it's just, you know, curiosity. Yeah. Bob: That's part of the background check. It's part of the interview process that no one knows is going on. In the background check industry it's actually becoming a formal part where with technology, we go through your profile and look for keywords or phrases that may, that gives it brings back a score that says this person may not meet your profile. Based on 17 times using this word,  which is deemed offensive to most people.Right. Now there's a big argument if that's right or wrong, but that's really what's that, like you said, of course it's happening now. It's just now coming forward and becoming more I don't know, just more efficient.Max: Yeah. It's unfortunate that it's seen through the prism of basically the background check as a veto power to say no to a particular person, if they use a particular type of language as opposed to being a sourcing engine where you would match the tone of the people in your company with the tone of the people outside your company and find some commonalities and culture and attitudes. Bob: That's where it's going. I think I have one of my divisions, my background check it's called it's pretty simple. It's my background check. Because if you think about it, Max, what we do in the world is crazy.Talent acquisition goes out there and we pay a ton of money to put ads. To put out things saying, please come to work for us. So you have an ad that says, hey, I'm looking for someone like Bob, and I see your ad. And I'm like, hey, I might like working for you Max. And we start to do this relationship dance.You say, hey, here's my benefits. Here's what I'll pay. Here's the working environment. I say, look, here's my resume. Here's what I've done. I say, Max, I really like what I see. And you say, hey Bob, I really like what I see. We should form a business relationship and we should spend 40 hours a week together for a common goal.Let's do this. I'd be like, all right, let's do this. And then you say, Hey, stop. I want you to go pee in a cup so I can search your urine for drugs. And I need your name, your date of birth and your social security number. So I can search your background. It's a crazy world. It's like, I'll be like, Ooh,  max, wait a minute.Max: I just thought we were friends.Bob: Yeah. I was excited. Think what's happening and what we're doing with my background check. And I think over the next five or six years, you're going to see a flip in. What we're going to do is lead the charge to make a background check mine. And it's part of my resume.I'll show you a copy of my degree. I'll give you the name of my employers and I'll show you my background check. You can verify it, but let's get this done at the beginning. This is who I am. And you know, I had a DUI or I got in a bar fight, but this is who I am. You want to talk about it now?Max: Yeah, the first baby step was let's move our resumes to LinkedIn, which everybody did 20 years ago.Still, you know, 90% of the welders is not on LinkedIn, but of course, for me, it's more valuable to look at a profile, which is publicly available with, you know, references where, you know, I mean, I'm sure you can lie on LinkedIn, but it seems like you would lie a little bit more on the resume, right?Just you have a little bit more artistic expression? I like freedom.Bob: I can tell you stories, Max. Trust me. Max: Okay. We'll get there. They're bobs. But the point is, yeah, the baby step is  more validated content through third parties. And of course rather than making it awkward for you as an employer to ask for my urine sample, if you need to have access to it, why would I refuse it.I mean, I suppose some people would, by the way, if anybody feels they've got something to add to my company at Talkpush, but they don't want to take a urine test. They're welcome to join Talkpush, we don't check for that.Bob: What about background checks, max? Do you do. Max: We do not.But I'm not so proud of that. I suppose background checks do have a place even for a tech startup. Bob: Yeah.  you have to go with what, how you feel, what's right for your company. Max: I mean in our case, it's you know, we try to mimic what you just described, where it's a transactional approach to 40 hours a week and just , build trust on that and on outputs rather than background. But yeah. You seem like, I do think that there's some pushback. I mean, it is the world's plugging into not red state blue state, but you know, privacy, non privacy maniacs whereas some people will just, even though they have nothing to hide, they just refuse on principle to take part in some of these investigations?Bob: We don't see a lot of people who refuse to take part in investigations, but in the States we see a lot of legislation that is being pushed forward to do things like delete somebody's criminal record, once they're done and to  reduce access for an employer.But look if you've applied for a job, you probably need the job, and there's a compelling reason for you to comply with what the new employer is going to say. But you know, background checks to me, background checks should be part of the discussion, not a speed bump to recruiting. not something where you say, stop, I need to go dig into your background.And then you come back after we've spent all that time getting to know each other. Now I come back and say, oh, sorry that you know, this probably isn't going to be a fit because of this or that. It should be at the beginning of the process. You know, you wouldn't, interview me if I didn't put in an application.Right. If I just, if I walked up and said, hey, I'd like here, CFO job. You're like, all right, can I see something like, ah, no. No, we'll talk about it later. Let's why don't you waste your time and interview me? And then later I'll tell you about my experience, once we get into it. Max: So , you're an advocate of putting as much of that at the front of the funnel.Bob: I think somebody, yeah I think it's my background. I think it's my background check. I own it. And  I should share it with who I want when I want it to do it. And by the way, that's probably going to save you. It's going to save businesses about 9 billion a year in background checks, and it's going to speed up hiring Max: that's the size of the industry.Bob: Yeah, roughly it goes back and forth. No one knows for sure. Max: Yeah, it's big. We know it's big. It's probably bigger than the recruitment software industry.Bob: And that's big too though, but yeah, in a different way. Yeah. A different SAS model. Max: Yeah. Great. Well let's go into the horror stories.Bob: What do you want to know that I can talk about. Max: Well, we don't have to give names, but I, what do I want to know? I don't know what I want to know.  What's gonna keep me up at night?No, normally I ask the guests on the show to talk about a hiring mistake that they made. And it has nothing to, I mean, the stuff that's come out has generally not been tied back to background checking, but rather with, I mean, indirectly with, I didn't really check their qualification or I picked a friend instead of picking somebody who is right for the job, things like that. And well, I'm sure as you're a decade, plus, as an entrepreneur, you've made hiring mistakes too.Bob: I have, I've definitely made hiring mistakes. My biggest hiring mistakes have been salespeople that have sold me that they can sell and they can't. What happened? You sold me. I'm like, yeah, you are easy. If I go, well, I can, you at least call Max wants and see if he wants to do business?I've heard he doesn't do background checks. Max: That's universal.  We've all made those hiring mistakes. Bob: What I see from my clients is first of all, 99% of the people in the world are great people, you know, and their background and a background check mistake they've made in the past,  really has nothing to do with who they are now or who they're going to be.But there also are the career criminals and the really, really, really bad people. If you do a Google search right now, you'll see a Florida babysitter that was on several nanny websites, who was a child molester and was a teacher, another one that was a teacher for two year olds. And I think maybe five-year-olds. These are people that are predators, that have to go to a place that doesn't do a background check. The end. You can't, if you are a predator and in this case, a sexual predator, you can't have access to children for a place that does a background check. If you are a career criminal from embezzlement, you can't get access to cash, unless it's a place that doesn't do background checks.If you are a prescription drug stealer, we see this actually a lot. They'll find a place where they have access to elderly for home care purposes, and that they will do horrible things to elderly people besides stealing their prescriptions or part of their prescriptions. Max: Of course, all of this makes sense, but there's also a sense of futility about it because you know that 80- 90% of crimes and theft and you know, misdemeanors and all those actions committed are unrecorded. And that there's no trace left behind. Bob: Correct. Right. Yeah.Max: I mean, that's my estimate.Bob: Great. Thanks Max, now I'm depressed.No, you know, but for business reasons, there's also that if you don't do it, you're going to have tremendous lawsuits when something bad does happen that you could have prevened. Yeah. So there's not only that, you know, a lot of business, people don't necessarily care if they sleep good at night, they don't care.It's what's the bottom line and you can save a lot of money if you don't do background checks, or if you do cheap background checks, but the litigation that can come and the damage to your reputation and your company's reputation can be significant. Max: Well, of course, 9 billion in revenue didn't come out of nowhere. Obviously people can see the ROI. Bob: Yeah, and it's also can be used as a preventative. So, like I said, the bad people move on and you know, you can sleep a little better at night. Max: Okay. So. It doesn't make you a bad person to use these background checks.  It just makes sure that you don't end up with the leftovers, the people who self-select out of those companies, that'll be more vigilant.So look at what your peers do and at least try to align, unless you have made a conscious decision to attract a certain breed of  dangerous characters. Is the message from Bob. And where can people get a hold of you and connect with the Pre-employ.com? Well, you can find me on LinkedIn or my profile is accurate.And it's Bob,  M a T H E R. Or you can get a hold of me at any of my companies, pre employe.com or my backgroundcheck.com. So you can also find me on Twitter at @BobMather. Max: And then me as an individual I can create my background check Bob: Yeah. Max: Oh, great. So I can decide how much I want to share and decide my medical history or this history or that's and the other.Bob: Yeah, well we don't delve into medical history, but we do into you know, the background check, the verification part.Have you ever applied for a job that you had a background check done? Max: I don't know. Bob: It's an unnerving process. I'm telling you. It's unnerving.  It's weird. It's like this secret investigation and people sit there and go, what are they going to find? Are they going to call my mom?Like, what if they call my mom? Oh my God. My mom knows stuff that I did, like calm down. Because we deal with applicants who call us and they're like, what are you? You know, I did this in high school. You 15 years ago, like, no, we're not going to report anything like that.Yeah, it's a scary process for applicants. Max: So with my background check is it possible for an employer to direct, a candidate to my background check and say, just share with us what you're comfortable with sharing with us. We'll take care of the rest. Bob: Yeah, it is.Max:  It's more of an opt-in processBob: Depending on what country you're in. What state you're in in the States, what jurisdiction, if it's legal or not. To require that as an applicant, but basically yes. And that's my end goal. My end goal in five or six years, as the majority of people will want to know what's in their background check and really want to make sure it's accurate, you know, to make sure that somebody didn't put the wrong criminal record when my identity was stolen three years ago.What if someone did a crime with that name? You know, we find people, we have helped people all the time that have arrest records. That they said that's not me. Max: That it takes forever to get that wiped off. Right. Bob: You can't, it's almost impossible because there is a criminal record with your name, your date of birth, your driver's license. They stole your identity. You stopped your credit cards. That was smart. Good job. But then they walked around with a whole new identity and can do almost what they want. It's crazy. Max: Well, if that doesn't keep you up at night.All right. Thanks a lot, Bob. Thanks for scaring the bejesus out of us. No, thank you for setting up a nice direction for the industry where people  can have control  over their identity and all the best to Pre-employ.com.Bob: Thanks Max. It's great meeting you and I hope to meet many of your listeners.Max: That was Bob Mather from Pre-Employ, reminding us that a background screening is not strictly about who you want to employ proactively, but it's also a way to define who you are as an employer with regards to your competitive landscape. If ever yone of your competitors is screening for a particular type of criminal record, but you're aren't, you're most likely to end up with a talent pool filled with criminals. So look at your competitors and calibrate yourself accordingly. Hope you enjoyed the conversation with Bob and that you'll be back for more. Remember to subscribe to the Recruitment Hackers podcast.

FamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic MarriageDay 1 of 8Guest:                       Dennis RaineyFrom the series:       Why Romance is Important _______________________________________________________________ (Nat King Cole singing "L-O-V-E") Bob:                Believe it or not, this is FamilyLife Today.  Our host is best-selling author and conference speaker, Dennis Rainey.  I'm Bob Lepine.  Stay with us as we talk about L-O-V-E today on FamilyLife Today.                         And welcome to FamilyLife Today.  Thanks for joining us on the broadcast. Dennis:          Do you think our listeners know who Nat King Cole is, Bob? Bob:                Oh, yeah, everybody knows who Nat King Cole is.  I bought a two-record collection when I was in college, just because I thought, "He's got the smoothest voice, it's the most romantic music I've ever heard." Dennis:          Well, you know, we also have a lot of romantic adventures at our FamilyLife Marriage Conference, and I've got a letter here from a conferee couple who attended the Phoenix FamilyLife Marriage Conference – I think this was back in 1991.  This is a classic, keeper letter from the archives of the thousands of attendees who have been to our conference. Bob:                Now, this is on hotel stationery, right? Dennis:          That's right – the Hyatt Regency Scottsdale.  "Dear Dennis, when you suggested last night for us to be more creative in our romance, you never gave us the warning that it could be dangerous."  Then in all capital letters, it reads, "RULE NUMBER 1 – ALWAYS BE PREPARED!  AT LEAST WITH A SPARE KEY" – and now the rest of the story.                         "After dinner and the sunset, we decided to take your advice and to add a little romance and be a little daring.  Staying here at the hotel, we crept out onto our fourth-floor balcony for an incredibly romantic view, not to mention some privacy.  Unbeknown to us, while we were 'communicating' and 'learning more about each other,' the maid was inside our bedroom, turning down our bedsheets for us.  She did not know we were on the balcony.  We did not know she was in the room.  Maybe you can guess the rest.  She locked the sliding glass door."  It is signed, "Two lovers, romantic sky, and lots of privacy.  Embarrassed from California." Bob:                So you have no idea how they ever got back in, huh? Dennis:          Your mind is only left to wonder – how did they get back in, there on the fourth floor of the hotel? Bob:                Well, that is a part of what we hope will be a romantic evening for couples at the FamilyLife Marriage Conference, but we hope that's not the end of romantic evenings for couples. Dennis:          Well, we really talk about FamilyLife Marriage Conference, taking Saturday and making it an adventure.  That's not the kind of adventure we're talking about.  We are talking about adding romance to your relationship, and I think at our conferences across the United States, that's what a lot of couples really seen infused back into their marriage relationship through all the teachings of scripture that build intimacy in their marriage relationship, they better understand how to relate to each other as husband and wife, and what I wanted to do, Bob, was I wanted to take the next few days, prior to Valentine's Day, and I wanted us to talk about the all-important subject of romance. Bob:                Now, you call it an all-important subject.  You kind of get the feel that romance is something that's a part of the courtship process.  After marriage, romance just doesn't seem like it has the same, you know –  Dennis:          – sizzle. Bob:                Yeah, yeah. Dennis:          Yeah, that's right.  Well, let me just read something from Song of Solomon, okay?  Song of Solomon, chapter 1, verse 2 – "May he kiss me with the kisses of his mouth, for your love is better than wine; your oils have a pleasing fragrance; your name is like purified oil; therefore, the maidens love you.  Draw me after you."                         Now, here's the Shulamite woman who is attracted to Solomon.  She is wanting her husband as the bride, and, you know, it's interesting that our God devoted an entire book of the 66 books that are in the inspired Word of God to this subject of romantic love, and one of the reasons why I wanted to talk about this is I think Christians are afraid of the subject, Bob.  I think we're afraid to address this whole area of romantic love in marriage even though our God thought it all up in the first place. Bob:                Some people have suggested that Song of Solomon is a parable showing us God's love for Israel or Jesus' love for His church.  You're saying that God put it in the Bible to talk about the romantic relationship between a husband and wife? Dennis:          I wonder about the people who say that – if they really read the verses, because they've got to do away with a lot of physical imagery that doesn't leave that much to the imagination.  I mean, it's clear they're talking about the whole area of romantic and sexual love in a marriage relationship. Bob:                Is romance really important for a marriage?  I mean, can't a marriage survive just fine for 30 or 40 years and not have a whole lot of sizzle and spark to it? Dennis:          Well, I think marriages can survive, I think that's a key word, but will they be what God intended?  I say not.  One of the things that happens in a marriage relationship is if we don't have romance, something that adds excitement and adventure, intrigue, thrill, I think we get caught up in the negative about our spouse, and when you begin to focus on the negative and the faults of the other person, that relationship begins to spiral downward.  And one of the reasons why I think Valentine's is such an important time of the year, especially for the Christian marriages, is to remind us that we ought to be making this subject of romance a part of our everyday diet in our marriage relationship. The Bible speaks about, over in Proverbs, chapter 5, verse 15 and then 18 through 19, that a man was to be captured by his wife's sexual powers.  He was to be captivated by his wife.  That's a powerful image to be literally captured by your spouse.  The Bible is talking about this as far as thrill, excitement, adventure, an emotional excitement that I think sets a marriage apart from just a pure friendship.  I mean, Barbara is my friend, but there is a side of our friendship that goes way beyond just two friends who are pals to two people who, yes, share a marriage bed together and who dream thoughts and share intimacies that are shared with nobody else on this planet, and that's what God intended, I believe, in the marriage relationship. Bob:                Well, now, you've got 50 percent of your audience listening to you, goin', "Preach it, Brother Rainey.  Yes, amen."   Dennis:          And what sex might they be? Bob:                Well, some of 'em are women who are saying, "Yes, talk to my husband and teach him how to be more romantic with me," and others are men saying, "Yes, talk to my wife."  It's interesting that opposites attract in this area. Dennis:          Well, you know, therein lies a real problem in discussing this, because I'll just let our listeners in on some research we did out of our FamilyLife Marriage Conference.  We researched over 800 of our conferees at three different FamilyLife Marriage Conferences last spring about how they viewed romance, and, I've got to tell you, men and women view it through a different set of eyes.  A woman looks at romance through the eyes of intimacy, relationship, warmth.  It's that connectedness of the soul and emotions, heart-to-heart.  And the men looked at romance – well, how shall we say it?  It was one word – sex.  And you see what God is up to here, because he made us different.  We are to depend upon each other, and in the process of being different, I think what God wants to do is cause both of us to love each other where we are.                         You see what God is up to here, is I think God is wanting to knock the edges off of me, as a man, and our male listeners, learning how to love their wives in a way that communicates love so that she feels love – not how we feel about love or what communicates love to us as men but instead learning to put on the side of love that meets a wife at that relational point of need, and there are a lot of men today who I think are frustrated sexually in their marriage relationships, primarily – listen carefully – primarily because they still have not learned how to meet their wives' emotional needs so she can be released to meet her husband's needs. Bob:                Mm-hm.  I've had Mary Ann from time to time say to me, "I just don't feel like we've had an opportunity to talk with one another over the last two or three days," and for a wife that is a sign of drift in the marriage relationship, isn't it? Dennis:          Yeah, and I've had that same conversation with Barbara as well.  I think the reason God gave us romance is He gave us a mysterious emotional love that we were to experience together as a couple.  Even Webster's definition of romance, which talks about excitement, love, adventure – all those words, I think, are a part of what marriage ought to be – Christian marriage.  Our God designed these emotions.  I think romance – romantic love – is a part of the character of God.  May I quote a Christian statesman?  One of the most godly men who has ever lived who wrote a book, "My Utmost For His Highest."  It's been on the best-seller list for years – Oswald Chambers.  Listen to what he said about passion in Christian marriage.  "Human nature, if it is healthy, demands excitement, and if it does not obtain its thrilling excitement in the right way, it will seek it in the wrong.  God never made bloodless stoics.  He makes passionate saints." I love that quote, because I think that's the picture of a God who loves his people and who wired us to have excitement and thrill and adventure.  It's not just for the single people who are involved in courtship, or just for the newly married couple who are just starting out with the high-intensity, high-octane of fresh married love.  No, that romantic love, I believe, was meant to still pull us along and sweep us along in a steady current all the way through our married life. Bob:                And yet it's become almost a cliché, Dennis, to talk about the honeymoon being over.  It does seem that relationships go through some kind of stages. Dennis:          Well, at our FamilyLife Marriage Conference, we talk about there being five phases of marriage deterioration.  In other words, every marriage goes through some predictable phases where it begins to lose steam, and reality begins to set in.  The first phase is what we call the "romance phase," and that's usually dating, honeymoon – it's when we're spending hours to get ready for a date, hours to plan the date.  Each person sees each other at their very best, but it's not a real picture of a real relationship. This phase gives way to Phase 2, which we call the "transition phase," and this is honeymoon or early marriage, and I like to say at this phase – this is where reality begins to edit the illusion.  The illusion of what we thought was a relationship is now being snipped away at by the cold, hard realities of life, and couples begin to make adjustments to each other in their values, their habits, their expectations, and can give way to criticism and snipping at each other, and the feelings begin to lower during this period of time. Well, Phase 2 gives way to Phase 3, which is the full-blown reality phase and, frankly, this is where marriages are either won or lost.  Some of the things that press in against us during this reality phase – moving – a lot of couples move after they get married; differing friends; job changes and stress; conflicting material values – they start seeing how they handle the checkbook; children come along, there's parenting pressures; in-law interference; difficulties; health issues; problems in life – all of these things press in against the relationship and now the illusion has been fully edited. Bob:                And they begin to put a little chill on the romantic side of marriage, don't they? Dennis:          Well, romance is replaced by disappointment and discouragement, and when that begins to fuel the relationship, two people who had turned toward each other in the dating years now can turn against each other, and that really leads us to the fourth phase, the "retaliation phase," and that's where emotional and even physical retaliation becomes an alternative, and it's unthinkable that a couple who had held hands would now cut away at the person they said they wanted to spend the rest of their lives with.  Resentment and bitterness begin to take up residence where romance had once been.  A man begins to sell his life out to his job, because that's where he gets rewards; women to likewise, or she sells her life out to her children, and what begins to happen here is marriage is viewed with despair – no longer expectancy, excitement or thrill.  You don't look forward to getting home in the evening and spending the evening together or the weekends together.  You find a way to allow that relationship to be crowded out.  And that really gives way to the last phase, Phase 5 – that's the "rejection phase," and that's the death of a relationship in which there are really two alternatives – one which is legal divorce, where two people separate and go their own ways or, really, where most relationships end up dying, and that is emotional divorce, where two people just simply withdraw from each other, and there's a truce.  Bob:                It seems like in the early phases that you describe, Dennis, romance is easy.  In the last two phases, it's almost impossible, because of the anger or the bitterness or the other things that have begun to take root.  It's really in that middle phase, the reality phase, where, as you said, the battle for romance is won or lost. Dennis:          You know, that's where we've got to win the battle, is before you ever get to this time of resentment and retaliation and rejection, where you're at the tail-end of the relationship, and you've got to breathe so much life back into the marriage it almost seems hopeless.  But you know what?  I want to go back to that reality phase, because that's where all of us live.  We've all got to learn, in the midst of the time pressures with kids and finances and jobs and health issues – how do we hammer out a Christian life? You know, I've given the better part of two decades here at FamilyLife dedicating myself and this ministry to writing books like, "Staying Close," to helping couples deal with the reality phase, or "Building Your Mate's Self-Esteem," another book where we talked about how you can build up the other person so you don't ever get to the point where you're rejecting your spouse; or the FamilyLife Marriage Conference, which is a weekend to help couples go back to that reality phase, and give them a biblical game plan for how they can move through reality and move on to blessing, where their relationship and love for one another matures and grows, and I think that's exactly what God wants to do, as He instructs us to the scripture.  He is moving us to mature love, commitment, and it's nothing that's not spoken enough about today, and we're going to be talking about it a lot here in the coming days. Bob:                Well, Dennis, some of our listeners are thinkin', "The last thing on my mind is romance at this point.  We've moved into Phases 4 or 5 – retaliation or rejection, and the anger and the bitterness that is a part of this – I can't even think about romance.  Is this series going to apply to me?" Dennis:          I think it will, and we're going to be sensitive to those couples who are finding themselves in unequally yoked marriages where a person is married to someone who is not a believer or someone who is not growing spiritually.  Perhaps Psalm 27, verse 13 would bring some hope – "I would have despaired unless I had believed that I would see the goodness of the Lord in the land of the living.  Wait for the Lord, be strong, and let your heart take courage.  Yes, wait for the Lord."  And I think there's a time to wait in prayer, but there may be some things that a person can do in that situation, where you're married to a spouse who is totally apathetic about that relationship, and if you're in that situation, could I encourage you to, yes, do pray, and do ask God to deliver you from despair and begin to give you the courage that only He can give you to build into that marriage and perhaps by adding romance back into that relationship, perhaps that will be the missing ingredient to help your spouse come to faith in Jesus Christ.                         Let me just conclude our broadcast today with some action points that can help you be a better romantic lover of your spouse.  First of all, take a romantic inventory of your relationship.  On a scale of 1 to 10, 10 being excellent, how would you rate romance as a part of your marriage relationship?  Tonight ask your spouse to do that and then compare notes and see how you're doing.                         Secondly, and this comes from the questions book.  You shared about how listeners could get a copy of that – from the questions book, I like to ask Barbara this question all the time, because it really does spark romance in our relationship, and it sounds odd, but I ask her this question – What are the three most romantic times that we've shared together?  What brought those sparks originally?  What's caused romance?  Why would you select that?  And there's something about reliving those romantic moments that I think gives us insight into why our spouse chose that and can also add that excitement back to our relationship today.                         A third application point would be to pray and ask God to help you begin courting your spouse.  You know, there are some listeners who are in a hurting marriage, where that's where they need to start right there – is in prayer asking God to give them some hope, to begin to court their spouse once again. Bob:                Well, let me add a fourth, and that's to join us back here tomorrow at this same time, when we're going to talk about the "romance robbers" in a relationship – the foxes in the vineyard, right? Dennis:          That's right. Bob:                That's on tomorrow's edition of FamilyLife Today.  I hope you can join us for that.  Our engineer is Mark Whitlock, our host is Dennis Rainey, and I'm Bob Lepine.  We'll see you tomorrow for another edition of FamilyLife Today. (Nat King Cole singing "L-O-V-E")                         FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  ______________________________________________________________________We are so happy to provide these transcripts for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved.                             www.FamilyLife.com           

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating a More Romantic MarriageDay 1 of 8 Guest:                            Dennis Rainey From the Series:         The Most Romantic Thing________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Music:             Bob:                And, welcome to FamilyLife Today.  Thanks for joining us on the broadcast.  I did it yesterday; I went ahead and declared this the year of romance in my marriage.   Dennis:          All right. Bob:                So, we're going to kick off a year-long romantic adventure.  Dennis:          Should we call Mary Anne right now and see how you did on day one? Bob:                I don't know. Dennis:          We'll save that for a little later.  All right?  You know, I ran across something that, even though it's the day after Valentine's Day, I found it fascinating to go back and look at, really, the historical significance of this day.  Valentine was a Pagan priest who lived in the third century.  He was not a Christian, but he really found it very difficult to stomach that these Christians were being persecuted.  He put his foot down – so much so that they threw him into prison.  While he was in prison, he converted to Christianity and was asked to renounce his faith.  He didn't.  He stayed in prison for a long time.  One historian said that during his last days, Valentine often thought of his family and friends who were not allowed to come visit him.  Tradition has it that in order to communicate his love, he would reach out his window bars and pick the violets which grew outside.  He then pierced the heart-shaped leaves with a message like “Remember your Valentine.”  Then he sent the message home with some homing pigeons supplied by his family.  Toward the end of his life, the message changed to a simple “I love you.”  Finally, when he refused to renounce his faith in Christ, Valentine was clubbed to death in his cell February 14, 268 A.D.  You know, that's interesting that yesterday is a day that we celebrate love, but so much of the world's celebration of this love is not from an agape - God's love for us, which caused us to love him.  Instead, it's a narcissistic kind of love.  You know, if anybody ought to have the right kind of love on Valentine's Day, or for that matter, throughout the year, it ought to be Christians. Bob:                Yeah.  I would hope that over the last two and a half weeks, Dennis, as you and Barbara have shared on this series and on this subject of romance, that message has come crystal clear – that the foundation for romance in marriage has got to be the solid commitment between a husband and a wife.  If for any reason folks have not been able to be with us over the last two and a half weeks, I would encourage them to get the cassette tapes of these broadcasts, and together, with their spouse, listen to this discussion on romance.  It will give them an opportunity to interact over what romance ought to be in marriage. Dennis:          I really agree.  I think a lot of times in marriage, we really miss each other because we're communicating what communicates love to us, not what communicates love to my wife.  There are a lot of men who would really benefit from hearing Barbara talk straight about what a woman is looking for in romance from her husband. Bob:                Or, from hearing you talk straight to women about how men view romance.  If you're interested in getting this cassette series, call us toll free at 1-800-FL-TODAY.  We'll get you the information you need. Dennis:          Well, I'm excited about today because we're going to give our listeners the privilege of hearing the most creative ideas we've been able to gather from our FamilyLife marriage conference speaker team, from our FamilyLife staff here in Little Rock, and from some of our FamilyLife marriage conference messages that have been given over the past year.  What I would encourage you to do right now, if you're driving, pull out a 3 by 5 card or open your daytimes; or if you're at home, get yourself a piece of paper and a pencil, because you're going to hear at least a half dozen ideas that you ought to be able to use at some point in your marriage over the coming year. Bob:                If you're driving, please write these down only at stoplights when you come to an appropriate point. Dennis:          That's right.  There could be liability back here against FamilyLife Today. Bob:                Well, we kick things off with someone from our staff, Lance Coffman, sharing about the most romantic birthday he ever had. Lance:            “Yesterday was my birthday, and it was a very special time.  Just to show you how special I felt… I guess, to sum it up, she was thinking of me throughout the whole time.  What I mean by that, is Sunday she took me to the Macaroni Grill.  But, see, it was a gift certificate given to her, and it was just a special time that she would take that to spend on me for my birthday lunch.  She said, ‘Okay.  That's a [unintelligible] of what's to come.'  Anyway, we went to bed that night.  I woke up the next morning and went to the bathroom, and plastered all over the mirror was posters:  ‘Happy Birthday, Lance.  Happy Birthday, No. 30.'  Then she gave me a card and a present.  Then she cooked me breakfast.  I was off to work.  Around 10:30, the guys called me over, and Denise brought some oatmeal cookies.  They sang me ‘Happy Birthday,' and I went back to work.  But, Denise, said, ‘Lance, call me before you come home.'  I said, ‘Okay.'  So, I called her before I came home, saying ‘I'm coming home.'  So, I come home, and there's a note on the door.  It's around 5:15.  I don't leave work early.  The note said, ‘Lance, ring the doorbell before you come in.'  See, usually, I just come in.  This time, I was going to ring the doorbell.  So, I rang the doorbell, and Denise opens the door.  She's in a black tuxedo with tails.  She goes, ‘Mr. Coffman, happy birthday.  Your dinner's ready.'” Woman:         “This happened on Valentine's Day last year, when I'd asked Jeff to stop at the store and get me some groceries.  I really think that he forgot it was Valentine's Day, and I'd been on the phone with my friend.  She got flowers and a little necklace.  I thought to myself, ‘I know he forgot, and I'm not going to get anything.'  He came home from the grocery store, sat me down on the table and had this big bag of groceries.  He made me sit down, and he proceeded to take one thing out at a time.  It was all these different kinds of fruits and all these different groceries.  The ones that I remember in my mind was… As he took each item out, he'd say something sweet to me.  He grabbed the apple out, and he said, ‘Honey, you're the apple of my eye.'  He sat it on the table.  He grabbed the diapers out and said, ‘I love to get Huggies from you.'  He set it on the table.  He had a pear, and he put that on the table and said, ‘We're such a great pair.'  He had a little jar of that honey bear, and he said to me, ‘Your kisses drip with honey.'  Then, there was a little carton of milk, and he said, ‘I want to milk every moment God's given me with you.'  Then, the last thing I do remember that he pulled out of the bag was a whole bunch of bananas, and he said he wanted to go peel my clothes off.” Woman:         “Well, I just have to share with you how Dan totally outdid himself for my birthday this last year.  The media department knows all about it.  I've never, ever in all my years of marriage, and we've been married 21 years, ever been kept totally in surprise of a surprise.  Anyway, it was my birthday.  The morning of my birthday, Haman Cross was supposed to come in to be with student venture at [unintelligible], so the setting was so natural.  Dan was home.  We were going to take off to go together to the school and spend the morning there and everything.  For some reason, that morning… Usually we have our celebration at night, but we had this big breakfast in the morning, all decorated and everything.  The kids had helped him with it.  I thought, ‘Oh, well.  Yeah.  Tonight we have a meeting, so this is probably their celebration.'  Anyway, I had my birthday celebration and got to the school and all.  Dan just whispered in my ear while Haman Cross was speaking, ‘I have a package that has to get to the airport.'  He said, ‘It has to be there by such and such a time, so we need to leave just a little bit early.  Then I'll take you out to dinner.'  I thought, ‘Yeah.'  We don't get a whole lot of time just to spend relaxing over a dinner.  I was really excited about that.  We got up, we left early, got to the airport; and there was this package sitting between us on the way out to the airport.  I thought, ‘This is kind of strange,' but I know that he has all kind of strange errands to do, so I didn't really question it.  We got to the airport, and I watched him go to try to check it in.  I went to look at some magazines.  He came back, and he said, ‘Oh, it's going to be another half hour.  I can't check it in for another half hour.'  So, we went and got ice cream.  I thought, ‘This is going to ruin our lunch together.  Should we really be eating this?'  He goes, ‘Oh, it's fine.  You'll still have room for something else.'  So, anyway, it got to be about five minutes before the time, and he walked me over to this airlines.  I just thought he was going to put the box on the counter.  He sat me down, and he handed me the box.  I go, ‘What is this?'  I didn't have a clue what was going on.  I open the box, and in there was a gift bag just full of my favorite magazines, candy bars, a card from each one of the kids, a card from him.  I opened the card from him, and there was spending money and then a ticket to California to visit my best friend in California.  And, I totally lost it.  I cried.  I said, ‘I can't leave my agenda for this week.'  It was just packed with all kinds of really important events and everything.  I just said, ‘The girls can't do without me.'  ‘They can do without you, dear.  Honest.  Leave it with me.'  So, anyway, it took me until St. Louis to gain composure and stop crying.  The guy that sat next to me thought I was just totally out to lunch.  He couldn't understand.  I couldn't even gain composure to tell him what had happened.  Anyway, that is the biggest surprise, and it was a wonderful birthday.” Man:               “A few years ago, I had to leave my wonderful wife for about a month on a trip in Europe.  She, of course, helped me remember the things to pack, and we had a list to check off.  The first night that I was there, I opened my suitcase, and I found a large manila envelope.  In the envelope, there were smaller envelopes with each date that I would be gone.  As I went through that trip for a month, every evening I had a different envelope to open with some very sweet little poems or some Snickers bars or something else.  She had gone to all the trouble to think about the whole 30 days I'd be gone and to just communicate things to keep us close, at least in spirit.” Man:               “Letter B.  A wife feels cherished when there is romance in the relationship - little things and little comments.  You and I don't care if our wife says, ‘You sure look nice,' but our wives care very much if we would say, ‘Sweetheart, that really does you justice.  You really look good in hot pink or navy blue' or whatever – things that would never occur to us, but it means a lot to them to hear us express it.  You figure it out.  Learn to speak woman, because her needs are different.  One day, I remember thinking of my wife.  I lived out… We lived out on the east side of town, and the hospital that I had to make a pastoral call in was in the middle of town.  The town center - the shopping center where Linda was working at the time to help keep the boys in college was in between.  I thought, ‘I'm going to express my love for Linda.'  I stopped at Safeway on the way.  I grabbed one of those rosebud things (it probably cost me $5.00) and a card.  The card probably cost $5.00 too.  I knew where she parked her car because I'd been in the parking lot.  I grabbed the key, I opened the car door, I put the rosebud on the console between the seats and slipped the card on the seat.  I shut the car and locked it and went off about my pastoral call and back to work.  That evening we had a conversation about that little episode.  I said, ‘What did you think when you saw that there?'  She said, ‘Well, I started to put my key in the car, and I saw somebody had been in my car.  I knew it couldn't have been you.  So I checked behind the seat to make sure nobody was lurking there.'  Then, she said, ‘I opened the door, I appreciated the rose, I opened the card.'  She began to cry over a card that cost me $3.00.  One day… Friday was a day off.  I finally got a day off, and she was working that morning, but a half day.  So, I knew she'd be home around noon.  I figured, ‘Well, what would she do if she were there and if our roles were reversed?'  If I'd have looked through her lenses, she would fix lunch.  ‘I'll fix lunch.'  I don't do lunch.  When I go hunting with the guys, it's donut holes and milk.  We don't cook.  You know?  But, I thought, ‘what would Linda do?'  Well, she would not have lunch on the regular kitchen table because that's just the hoy paloy table.  She would have lunch in the dining room.  That means more to her – the dining room.  It's special.  So, I set the dining room table with the china, because you don't use the stoneware; you use the china when you're trying to give a message, at least you do when you're a woman.  So, I'm trying to learn to speak this language.  I set the china on the table.  Now, the real challenge.  You've got to put food on it.  I don't do much food, but I figured tuna fish.  I can handle tuna fish.  China and tuna.  It didn't matter.  It was an effort.  She understands.  So, I got some tuna, and I put it on half of an English muffin, and I set it on the plate.  It looked really bad.  You know, big china plate, little English muffin, and a pile of tuna.  I remembered on Sunday nights after church, she'll sometimes do that, and she'll melt some cheese with some pineapple and stuff and that sort of thing.  It looked a little bit better.  It still wasn't too cool, but it was a little bit better.  When she came in, she was overwhelmed.  She was absolutely overwhelmed.  She was struck by that.  The power of a woman to respond is incredible.  I would say we had the most powerful session of lovemaking that we had had in years, all because I was trying to learn to speak the language.  I wasn't doing it for the selfish reason of her responding like that.  That was a gift she gave to me, you see, with no strings attached.” Woman:         “[Unintelligible] when he's kind of quiet and creative both.  So, the things that I want to share fit both of those.  First of all, Blaine designed my wedding rings.  We had a friend that was a jeweler, and he carved them out of a piece of wax and had the jeweler cast the gold and set the diamond for us.  He totally surprised me with that.  I wasn't expecting it.  He didn't get the same thing.  I'm not quite that creative.  And, a few years ago, on Valentine's, we had, as many young couples do, struggled with finances.  Every year, we kept cutting out one more gift that we gave each other.  So, Valentine's was one that we decided we'd have to cut out.  That year, I wasn't expecting anything but maybe a card.  He bought one of those blank books that's bound.  Now, every year at Valentine's, he writes me a love letter.  That was really sweet.  Very special.  Something neat for our kids some day.” Woman:         “My husband brings me home flowers all the time.  He does laundry when I don't need it done.  He just does it.  But, one of the things that popped to my mind was he gave me the privilege of having two of his children.  And, over the years, I thought a lot about how much he does for me and how much he loves me.  But, the most romantic thing he's ever done is he's allowed me to have the privilege of being his wife and the mother of his children.  There isn't a day that goes by that he doesn't in some way express his love to me, whether it's doing the little things or whether it's doing the big things or whether it's bringing home flowers.  But, he does it every day.  For me, that's the most romantic thing my husband can do for me.” Bob:                Well, what a treat.  We've been listening together to members of our FamilyLife marriage conference speaker team and folks who are on the staff here at FamilyLife, all of these folks sharing about romance in their marriage.  I think this is a fitting conclusion to the last two and a half weeks as we've tried to peel back our hearts a little bit and look inside to see how we can re-ignite the romantic spark in marriage.   Dennis:          What we've talked about here is that romance is a need that every marriage has.  Men need romance because they need to be needed.  They need to be needed sexually by their wives, they need to be attracted to their wives, and they need their wives to be attracted to them.  Women need romance because they need a relationship with their husband, and they want a relationship with him.  They want to be courted and pursued by their husbands.  I think all too often, this is one area of the marriage relationship that we don't pay attention to.  So, it's no mistake that the fires begin to go out, and the coals grow cold.  A marriage ought to be a place that has excitement, fun and romance and some intrigue about it. Bob:                I think there are two things we can recommend to couples, Dennis, as a way to breath some romantic life back into a marriage.  One of them is the collection that we put together called “Simply Romantic.”  That was put together specifically to give couples a plan, give them a tool, give them something that they can use in their marriage relationship, some practical help for making romance come alive.  Frankly, all of us need that kind of help from time to time. Dennis:          Yeah.  We're a culture that kind of gets into games.  Although this isn't a game, it is a collection in a box.  We've got it right here in front of us.  It's got some cards just for men that help men communicate romance to their wives, fresh ideas for every month of the year.  Then, it's got some cards for the wife; again, ideas for each month that she can use to communicate romance to her husband.  It's got a little checklist that a guy can fill out on his wife.  I went shopping last Christmas, and I was thinking, “What size is Barbara?  Is it an 8 or a 6 that she wears in this one particular garment here?”  If I'd have had this little thing right here, Bob, this would have saved me a lot of trouble.  It's got love notes.  It's got a booklet that I've written on why romance is important to every marriage.  It's got mood music on a cassette tape on one side, and then on the other side, it's got ideas from our FamilyLife marriage conference speaker team where they shared the best ideas that they've ever had in their marriages to communicate romance to their spouses. Bob:                Yeah, like the ideas that we featured on the broadcast today.  We also have a questionnaire that a husband and wife can fill out that kind of is an inventory.  It's a romantic analysis of your mate.  It gives you an opportunity to understand them better in this critical area.  Really, you mentioned it's not a game, but it kind of feels like a game.  It's fun for couples to do this, and it gives them a way to bring romance alive.  I think sometimes ten years in or fifteen years into the marriage, you feel a little awkward trying to make romance come alive in your marriage. Dennis:          Okay.  Okay.  Okay.  Here's one of the cards that says, “For February – romancing your wife.”  Now, I'm hoping your wife is not listening to the broadcast right now. Bob:                This would be things that husbands can do that would… Dennis:          This is something you're going to do for Mary Anne this month.  I'm going to see which one of these you'd choose.  Idea number one:  “Tell your wife that being close to her still excites you.”  Hello.  Idea number two.  Well, it's too late for this one because it says, “On Valentine's Day, buy a pad of PostIt notes and write a brief message to your wife on each page.  Hide them in different places where she will find them.”  Oh, you did that before. Bob:                I've already done that one.  Dennis:          And she's still finding some of those notes in recipe books and other things.  That's a great idea.  Idea number three:  “Volunteer to do all the ironing for a week.”  Now, how is it I can't picture that right there?  Idea number four:  “Plan a romantic evening.  Dine at a nice restaurant, and then go to the theater or ballet.”  Hey, that's a good idea.  Idea number five:  “Have a bubble bath and favorite music.  Have a bubble bath and favorite music, or a book ready for your wife after she's had an especially hard day.  Then give her a massage.”  Now… You know, all of those are relationship builders. Bob:                I think I'll do all of them, except maybe that ironing thing.  I'm going to have to pray about that one.  Well, listen, if you're interested in getting a copy of “Simply Romantic,” simply call us here at FamilyLife Today.  The phone number is 1-800-FL-TODAY.  It's 1-800-F as in Family, L as in Life, and then the word TODAY.  The cost for this collection is $19.95, plus $3.00 for shipping and handling.  In addition to this collection, as I mentioned earlier, we also have audiotapes of this entire series available.  If you're interested in that, you can call us.  We also have other resources – a whole collection of books that are helpful tools for couples who want to build a more romantic marriage.  When you call, ask what resources are available to help with the maybe specific romantic needs you have in your marriage.  You can call us, again, toll free, 1-800-FL-TODAY.  Or, if you'd prefer to write, our address is FamilyLife Today, Box 8220, Little Rock, Arkansas.  Our zip code is 72221.  Once again, it's FamilyLife Today, Box 8220, Little Rock, Arkansas.  And our zip code is 72221.  When you call or write, please remember FamilyLife Today is a listener supported broadcast, and we appreciate those of you who stand with us with our financial needs for the ongoing work of this ministry.                          Well, tomorrow and Friday, Dennis, we're going to continue to talk about romantic feelings, but we're going to talk about what happens when they become misdirected.  Lois Raby [sp] is going to join us in the studio to talk about the snare that is laying in wait for men and women all across this culture. Dennis:          Don't miss these days with Lois Raby. Bob:                I hope you can join us for that.  Our engineer is Mark Whitlock; our host Dennis Rainey.  I'm Bob Lepine.  We'll see you tomorrow for another edition of FamilyLife Today. FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a Ministry of Campus Crusade for Christ.  __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, would   you consider donating today to help defray the costs?   Copyright © FamilyLife.  All rights reserved. www.FamilyLife.com    

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic Marriage Day 8 of 8 Guest:                            Dennis Rainey From the Series:         A Man's View of Romance________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Bob:                This is FamilyLife Today.  Our host is the Executive Director of FamilyLife, Dennis Rainey.  I'm Bob Lepine.  Happy Valentine's Day.  We're talking about romance on the broadcast today, I hope you can stay with us. (Music:  "My Funny Valentine")                         And welcome to FamilyLife Today, thanks for joining us on the broadcast as we continue looking at the subject of romance and, once again today, because of the nature of what we're going to be talking about, it may be inappropriate for younger listeners to be joining us.  Parents may want to use some discretion because we're talking about how men look at romance and, as you've said over the last couple of days, Dennis, men look at it – not exclusively – but primarily from the aspect of the sexual relationship.  In fact, on yesterday's broadcast, you mentioned that it is a wise woman who will assume some responsibility for affirming her husband in his sexuality.  You also talked about the fact that a lot of men don't understand themselves their need for the sexual relationship, and then you talked about how a man needs to be needed and needs to know that his wife desires him. Dennis:          Yeah, and even as you're going through that list we talked about yesterday – just revisiting that – you know, it feels risky to me, as a man, to talk to women about their husband's need sexually and certainly we're making some generalizations here that don't apply to every man, because God has made men differently, but I don't think we're too much off the mark when it comes to what men really desire from their wives.                         You know, I have counseled and interacted with men over the past 18 years at hundreds of FamilyLife Marriage Conferences, and their word to me, as you approach this subject, speaking to women, is "Just tell them how we feel.  Help us communicate to our wives what's going on inside of us," because I don't have a vested interest here.  I'm just after healthy marriages that are following Jesus Christ because I think our God made the sexual dimension of the marriage relationship. Bob:                And so a healthy marriage will necessarily involve a healthy sexual relationship. Dennis:          Yeah, and you would think Americans would be able to talk about this subject of sex, especially speaking to wives about their husband's sexuality, but I don't think it's that easy for wives to hear or for men to talk about.  Now, we're more comfortable talking about it in public, but really getting down past the superficial, down to the deep core issues, especially as it relates to a man's sexuality, I think that is very threatening for couples to discuss. Bob:                What do you think are some of those core issues for a husband or a wife? Dennis:          Well, I think a wife needs to know that her husband is not as strong and confident as he appears to be.  Now, he may look assertive, but in reality, most men, I think, when it comes to the sexual side of their relationship with their spouse, are unsure.  I think it's because we're marrying today without any clear passage into manhood.  For most men the passage from boyhood to manhood occurs when we get married, but in many cultures that passage has already occurred, and a young man has already had the opportunity to grapple with the issue of manhood and his sexuality.  But when men get married today, that's when they're confronted with the issue of performing sexually in marriage, and I think a lot of married men are really afraid of failing when it comes to the physical side of marital love. Bob:                What is it about these mystical passages that you refer to for a man?  Why are they so significant?  And what if a man has missed one? Dennis:          Well, I'll never forget a young man that became a close friend of mine over a period of time, and he'd grown up in a home where his father had deserted him as a young lad.  And as he began to have children and emerge as a husband in this new relationship with his wife, I could tell, from time to time, there was nothing on the screen that he could pull up by way of a memory of what a man ought to do or be or act like with his wife or with his kids as a man.  I mean, he didn't have that model, that mentor.                         And so I took that young man fishing one time, and in the darkness of that car as we drove to the fishing spot, which was an overnight trip, I began to talk to him about the passage from being a young man, moving on into manhood, and I told him – and I'll call him Chuck – I said, "Chuck, I want to bless you as a man, and I want you to know that, having observed you over the past four or five years, you own all the rights and privileges as a man, and I want you to know anytime you wonder what you're to do, how you're to behave, how you're to perform as a man, I want you to feel free to come back to me, because I want you to know, from this day forward, as an older man to a younger man, I want you to know that I am declaring and recognizing you and the full rights and privileges of manhood."                         You know, it was a number of months later that I got a phone call back from that young man, and he said, "You know, Dennis, it was interesting.  I did not realize what was occurring in the car that night until a few months later.  But now as I approach my roles and responsibilities of a man, I feel different about myself than I have in the past."                           And I think, to those women who may be looking at their husbands and looking at a young man who may feel very insecure or maybe an older man who is still driven out of his own insecurity, you know, you may be able to be an affirming part of his transition to manhood on a daily basis.  I think how a woman responds to a man sexually is a crowning celebration of a man's manhood.  I think a woman who is looking at a man, and she's feeling powerless to help him, perhaps needs to pray that God will bring older mentors into his life and perhaps encourage her husband to pursue some of them and maybe even ask for this blessing – perhaps ask them what he needs to become, what he needs to do, how he needs to act to be recognized as a man. Bob:                A woman may not be able to do what a father could have done for a son, but she can play a significant part in helping to supplement what may be missing. Dennis:          Yeah.  I'll say this about Barbara – when we were first married, there was a sense in which she affirmed me as a young man emerging into a mature man, and we've said on many occasions, I wasn't fully a man when I got married.  She finished the job of the transition from boyhood to manhood.  And it's the wise woman who realizes that when she gets married she may be marrying a boy in certain areas of his life.  He may have immaturities where he has not grown up and simply needs the belief, the affirmation, the support, the respect that only someone who knows him well and who loves him most can provide. Bob:                And romance and sexuality are tools, they're assets, for her, aren't they? Dennis:          They are, and it's the woman who understands that her response to her husband at that point is a crowning affirmation.  I don't know how to say it with any more dignity.  It is a very, very important part for a young man to feel affirmed by his wife.  George Gilder, in his book, "Men and Marriage," makes a great statement.  He says, "Women are puzzled by men's continual attempts to prove their manhood or ritualistically affirm it." Bob:                What is it, Dennis, about sexual performance that is affirming to a man's masculinity? Dennis:          Well, let me let George Gilder make a stab at this from his book, because he really states it clearly, as a sociologist, to help us better understand what's going on inside a man.  He writes, "Men must perform.  There is no shortcut to human fulfillment for men – just the short circuit of impotence.  Men can be creatively human only when they are confidently male and overcome their sexual insecurity by action."  Now listen to this next statement – "Nothing comes to them by waiting or being."  A man's got to initiate, and do you feel the risk that's there for a man as he initiates?  What's the woman's response?  He can't control it. Let me read on what Gilder says, "In general, therefore, the man is less secure sexually than the woman, because his sexuality is dependent on action, and he can act sexually only through a precarious process difficult to control.  Fear of impotence and inadequacy is a paramount fact of male sexuality.  For men, the desire for sex is not simply a quest for pleasure.  It is an indispensable test of identity."                         Now, did you hear that?  It is a test for a man to feel like a man, and when a wife can latch onto that idea, and she understands what is at risk for a man at that point, you know what?  The lights go on inside of here where, all of a sudden, she can now exercise the mystical powers God has given her in the marriage relationship for the health and the well being of the man.  Now, am I overstating the sex act for the man?  From the men I've talked to, I don't think so.  I think this is a core issue for men today.                         One last statement that Gilder writes about that I've got to read – he writes, "Unless men have an enduring relationship with a woman, a relationship that affords him sexual confidence, men will accept almost any convenient sexual offer."  Now, think about it.  Isn't that what the New Testament is trying to move men away from?  Isn't that what Paul wrote about in 1 Corinthians 7?  Because of immoralities let each man have a wife and please his wife?  I think so.  I think God recognizes that the way he has wired men today that they are susceptible in the marketplace to what Solomon warned his son about – that woman in the red light district who woos a man away from his home and offers him instant satisfaction – what's he trying to find there?  What's he trying to prove?  I think that man is trying to prove his masculinity. Bob:                Yeah, so it's less about sex and more about who a man is.  That's really what's behind it all, isn't it? Dennis:          That's exactly right, and let me just say here – it is not just the act of intercourse that makes a man a man.  If you read Song of Solomon, where the woman affirmed him, she started with his character.  What caused her to be attracted to him as a man was that he was a man above reproach.  He had integrity.  She had seen his character develop.  She talked about it being like olive oil being refined, which had to be crushed and go through a series of rocks so it could be purified.  That's the picture of a man becoming like Jesus Christ.  But you know what?  There are a lot of men today who are running around trying to prove their manhood outside of marriage through the sex act, and that doesn't make 'em a man at all. That's wrong.  God intended marriage to be the place where two people become one. Bob:                Well, you know, as you said, some of this may be difficult for both a man and a woman to hear, but you wouldn't be saying it if you didn't feel it was a critical part of the marriage relationship. Dennis:          Yeah, and, again, we're just talking straight about how to make a marriage last for a lifetime, and your husband wants you to approve of his physical and sexual approach to marital love – it's more than okay, it's good.  It's been given by God, designed by the Creator of the universe.  He made us different, and a woman is more relational, a man is more sexual.  One is not better than the other.  They were meant to complement one another.                         And I think what happens is the man is intended to deny his sexual needs, to love his wife relationally, and in the process of that he learns self-denial, and he learns sacrificial love.  I think also the same sacrificial act occurs by the wife on behalf of her husband.  Sometimes she has to be willing to give up some of her own emotional needs being met but I believe, again, it's the wise woman who can say to her husband, "Thank God you, as a man, are made the way you're made.  I welcome you as my man." Bob:                Dennis, don't you think the way the culture portrays the sex act has left a lot of Christians unable to separate the inappropriate way it's presented from the very appropriateness that God built into it? Dennis:          I think what God designed and has sought to protect by grace, the world has taken and integrated it and has twisted it and perverted it, and what results from that is shame.  But what God intends for us to experience in the marriage bed, he said it was good.                           I mean, think back to the Song of Solomon – in fact, let me just read a portion from that book, and this is King Solomon describing the Shulamite woman, his bride's body – "How beautiful your sandaled feet, O princess daughter.  Your graceful legs are like jewels, the work of a craftsman's hands.  Your navel is like a round goblet, which never lacks blended wine.  Your waist is a mound of wheat encircled by lilies.  Your breasts are like two fawns, twins of a gazelle.  How beautiful you are and how pleasing, O love, with your delights.  Your stature is like that of a palm and your breasts like the clusters of the fruit.  I said I will climb the palm tree, I will take hold of its fruit.  May your breasts be like the clusters of the vine, the fragrance of your breath like apples."  That is just as inspired as John 3:16 – the God who inspired the scripture inspired that – that's from Song of Solomon, chapter 7.                         You know, throughout the book, the Shulamite woman is responding to Solomon.  She is affirming him for who he is.  Listen to her words back to him.  "My lover is radiant and ruddy, outstanding among 10,000.  His head is purest gold, his hair is wavy and black as a raven.  His eyes are like doves beside the water's streams, washed in milk, mounded like jewels.  His cheeks are like beds of spice yielding perfume.  His lips are like lilies dripping with myrrh.  His hands are rods of gold set with crystallite, his body is like polished ivory decorated with sapphires.  His legs are pillars of marble set on bases of pure gold.  His appearance is like Lebanon – choice as the cedars.  This is my lover, this is my friend.  O daughters of Jerusalem, eat your heart out." Bob:                That's a loose translation there at the end. Dennis:          That last part was a loose translation, but I sense our listeners needed to laugh.  We may have some people turning around and going home on their way to work this morning.                         You know, the point is, God's not blushing.  He's not ashamed.  He made us different, but he made us to affirm one another in our differentness and, again, let us celebrate the way God has designed us sexually.                         Let me just make some applications for a woman who has been listening.  First of all, if she finds it difficult to accept herself, and she feels insecure about how God has made her sexually, she may find it very difficult to affirm her husband, and so that particular wife may need to spend some time in prayer, may need to get some counsel, find a wise counselor of the same sex who can advise her and help her work through some things.  Barbara and I have talked earlier in this series about those women who have been abused – read Dan Allender's book.  Talk about the real issues of female sexuality and accept who God has made you to be.                         Secondly, I think a wife needs to move out and take some risks.  Find a beginning step, however small that may be, to bless and affirm your husband in this sexual area of marriage love and, thirdly, for those who find that too risky, and you're just not ready to take any risks at this point, I would begin where the Shulamite woman was.  She verbally affirmed Solomon.  Perhaps write your own praise of your husband in a letter, perhaps state it verbally in a poem – find a way to affirm him and how God made him as a man.                         One last point – men are lonely today, and there's a reason for that.  Most men, throughout the history of their lives have not been able to sustain close relationships with another human being, and it's no wonder they are insecure as they begin to love their wives and, you know, that's why a woman who accepts her husband where he is and can encourage him when he does it right and just affirm him as a man for his efforts at loving you, because every man, I believe, is in the process of learning from God how to love and how to give his life for his wife. Bob:                Well, let me wish our listeners a Happy Valentine's Day.  Hopefully, the series that we've been doing here will help make this Valentine's Day a more romantic one for couples, and join us tomorrow as we conclude the series with members of our FamilyLife team talking about how they have been ministered to romantically by their mates.  I hope you can join us for that.                         Our engineer is Mark Whitlock.  Our host is Dennis Rainey.  I'm Bob Lepine.  We'll see you tomorrow for another edition of FamilyLife Today. (Music:  "My Funny Valentine")                         FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, could   you consider donating today to help defray the costs?  Copyright © FamilyLife.  All rights reserved.www.FamilyLife.com      

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic Marriage Day 7 of 8 Guest:                          Dennis Rainey                                From the Series:        A Man's View of Romance________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Bob:                This is FamilyLife Today with our host, Dennis Rainey.  Today we're talking about romance, and I believe the band is ready. (Music:  "It Had To Be You")                         And welcome to FamilyLife Today, thanks for joining us on the broadcast today as we continue looking at romance and today looking at how a man views that subject. Dennis:          And because of how he spells it, don't you think we ought to talk to the parents of some younger listeners who eavesdrop into FamilyLife Today occasionally, Bob? Bob:                Yeah, it would probably be a good idea for some of our younger listeners not to listen in on the broadcast today, because the nature of some of this material will be sensitive, and that's because husbands have kind of a one-track mind when it comes to romance. Dennis:          Yeah, we've been talking about how women view romance relationally, and we've hopefully done a good job on previous days of really equipping the men to know how to meet the relational needs of their wives so that their wives can have romance spelled on their hearts by men who really understand their language of love.                         But as we move to men, men spell romance differently.  They spell it s-e-x, and a lot of Christian marriages really suffer because they drift, and they become bored, and I think one of the best illustrations of how a man feels was written in Dr. Ed Wheat's book, "Love Life," and it was from a man who really shared how he felt.  He writes, "My wife and I need help.  I feel that all of our troubles stem from one cause – my wife does not want to have intercourse with me, and I cannot accept this.  The situation has existed all of our 18 years of marriage.  We currently have relations about once a month.  This occurs normally after many days of my frustrating attempts to have her respond.  Then it is not a love affair, but a surrender or duty attitude on her part.  I love my wife.  She's an outstanding wife, mother, and friend, except that she does not physically love me.  I'm afraid to face up to the fact that maybe my wife just doesn't love me and can't respond to me.  I have asked myself many times, 'What are you still married for?'  I have no answer.  I do not know what to do."                         That man is feeling rejection at the core of his manhood.  Now, on behalf of that wife, there may be causes for her that are inhibiting her own sex drive toward her husband that she needs to deal with.  But for that man, can you sense the rejection that he's feeling?  He's questioning the whole act of marriage, and that really points out the importance of this subject.  Romance is not an option for Christian marriage.  Romance ought to be a part of every Christian marriage.  Now, that doesn't mean there's not going to be times in a marriage relationship when you go through a valley or a drought, and there simply isn't a lot of time or a lot of feelings left over to experience romance, but I'm going to tell you something – that ought not to be the steady diet of a marriage relationship.  I believe God intended us to experience romantic love all of our married days. Bob:                Well, 1 Corinthians 7 speaks directly to that issue, doesn't it? Dennis:          Yeah, verse 2 says, "But because of immoralities, let each man have his own wife and let each woman have her own husband." Bob:                Now, what does that mean, "because of immoralities?" Dennis:          Well, I think Paul recognized the temptation that is in the marketplace, and realizing how, especially, men are wired, as well as women, by the way – they can be tempted even through relationships toward sexual immorality.  Paul was a realist.  He said because of the evil that lurks in the marketplace, you need to make your marriage bed a priority.                           Then there is a fascinating verse – in verse 5 it says, "Stop depriving one another."  That's a command – don't deprive one another sexual relations except by agreement.  Paul was realizing the need for us, as couples, to make our marriage bed a priority and specifically on this broadcast today I want to speak honestly and straightforwardly to the wives about helping them understand their husband's sex drive and his need for romantic love that only you, as his wife, can communicate. Bob:                I should interrupt you here just for a minute and let our listeners know, if they're tuning in for the first day, we've been talking about the subject of romance for several days.  We've talked about the foxes that interrupt romance in the marriage relationship.  You've talked to men about how they can be lovers of their wives and really treat them with dignity and respect and cherish them and romance them.  And then you spent a full day talking with men about what you're going to talk with their wives about on today's broadcast, and I think it's important for our listeners to realize that some of the hard things that you're going to say on today's broadcast fit into that context. Dennis:          Yeah, and I'm going to start right out with a hard thing to hear, and so, wives, please, I wish I could go back and give you the context of previous broadcasts, but I'm just talkin' to you straight, because I think today we really need to give you the benefit of hearing from a man how it really is.  And the first thing I want to say is you, as a wife, need to assume responsibility for your husband's sexual needs.                           You know, it was interesting, Bob, as I did a lot of hours of research and thinking and reading in preparation for this series, I reflected back that there are a number of books, there are a number of counselors that are telling the men how to romance their wives, and, really, there's a drought of writing about this subject of male sexuality helping women, helping wives, understand their responsibility to meet this area of physical need in their husbands lives.  And the interesting thing is, as I began to read, I began to feel like, more and more, the weight of romance fell squarely, nearly 100 percent, on the man's shoulders.  Now, do I think he primarily is responsible for this?  Yes.  But does that primary responsibility of the man absolve the woman of all responsibility?  Huh-huh.  I believe she has responsibility as well.                         Over in 1 Corinthians, chapter 7, verse 32 through 34, the command there is for husbands to please their wives and for wives to please their husbands, and if it was just the man's responsibility to please his wife, then the command of 1 Corinthians, chapter 7, would have stopped before verse 34 where it addresses the wife. Bob:                Okay, well, if the man is still to take primary responsibility over a couple's romantic relationship, then in what sense does a woman have a responsibility to be romantically involved with her husband?  What's her role in all of this? Dennis:          Well, I think she needs to be a part of creatively praying and thinking and actively pursuing her husband on his agenda, and we've stated that repeatedly over this series.  His agenda, for most men, is spelled s-e-x.  It's on the physical side of the love relationship.  Now, that doesn't mean she has to be preoccupied with sex all day long.  That's not going to be a part of her wiring and who she is.  It just means that she must make her husband a priority in this area of their marriage relationship.                           And let me just say to the ladies at this point – I don't want you to think, as we continue to move through these points, because over the next couple of days, these are going to get a little grittier and a little, perhaps, tougher to hear from a woman's perspective, but what I'm going to promise you is this will not be a superficial approach to a subject that, from a Christian perspective, I believe firmly must be dealt with from a biblical standpoint.                           The second point I want to make to ladies is that most men – now listen carefully – most men don't understand their own sex drive, and what is compelling them to pursue their wives physically.  Now, did you hear that?  Most men don't understand themselves sexually.  So you're wondering – how am I going to be able to understand him when he doesn't understand himself?                         You know, it's really interesting, as you listen to men talk, there are all kinds of sexual innuendoes in their jokes – and I'm not saying, by the way, that they're appropriate – but there's all kinds of statements made that just hint that they are horribly insecure about this subject.  And what a man needs is he needs the commitment, the strong commitment, the resilient love of a woman who says, "Sweetheart, I am yours, and I am proud to be yours.  You know what?  You can be real, and you can be frail, and you can be weak, and I will still respect you, and I will still love you."  But the problem is, is most men have a difficult time really hearing that message, because of the threat of this area of their own manhood. Bob:                All right, well, let me get this real practical, if I can.  Let's say it's 9:30 tonight, the kids are in bed – Dennis:          – that's ideal, that's not just practical – Bob:                – husband and wife have, oh, a few minutes together on the sofa before they go to bed, and a wife thinks to herself, "Now that thing Dennis was talkin' about on the radio, about how can a wife help her husband understand his own sexual desires" – what does she cuddle up next to him and say that will help initiate a conversation around that subject? Dennis:          Okay, first of all, the couch is a great spot to have this discussion.  Maybe even the dinner table or a walk.  Of course, if it's dark outside – of course, that may even be a better idea for men, because of the threat.  But I would suggest getting a book that Barbara and I wrote called, "The Questions Book."  Now this is a book that has 31 questions that I'll bet you've never asked your spouse, and one of the questions I think would really be appropriate here.  It's a question that will unlock, I think, what is really behind what communicates romance to your husband.  The question is this – what are the three most romantic times that we have shared together as a couple and why?                         Then what I would encourage you to do, as a wife, is just listen carefully to what he says and why he says that was romantic to him.  Listen to the messages that are behind the statements and listen to what really affirms him in the sexual dimension of your relationship, and if he doesn't mention sex in the first romantic adventure that you have, then that's okay.  There may be some things that communicate romance and love to him that are quite apart from a sex act, but I've got to believe that one of those three are going to include something that involved a romantic evening that was enchanting around the subject of sex.  And then I would begin to ask him – why that was affirming?  Why did that feel affirming?  And if conversation goes on, and he feels comfortable, I would talk about his fears.  What are your fears around the sex act?  Around how you feel about yourself as a man?  Talk about his doubts – does he have any?  Because most men do have doubts about their ability to perform and really be a great lover of their wives. Bob:                As a wife begins to attempt to open her husband up on this subject, she may meet with resistance either at the very start or anytime she begins to probe more deeply.  What should she do when she meets with that resistance? Dennis:          Well, that's the real world.  There are some men who, at that point, they're not going to want to talk, and I wouldn't press it at that point.  But what you can become sensitive to, as a woman, are those opportunities where perhaps he will be willing to talk and where you can better understand him and where you can begin to probe him with questions when he is willing to open up.                         I would also encourage couples around this subject to go to a FamilyLife Marriage Conference because sometimes it takes a whole weekend of a man getting away from his work, from household duties, and experiencing some romance with his wife at a quality hotel to really begin to unthaw the emotions. Bob:                And on Saturday afternoon, as they work through a project, that subject will come up, won't it? Dennis:          That's exactly right.  And at that point, the commitment in the relationship, I think, has been heightened, and the freedom that a man feels at that point in the FamilyLife Marriage Conference is a time when I think he may begin to open up. Bob:                Well, you've talked already on the broadcast today about how a woman needs to assume some responsibility in this area, and how most men just don't get it, even about their own sexuality.  What else? Dennis:          Well, I think a woman needs to understand that a man needs to be needed by his wife sexually.  If you want to see your husband literally go through the ceiling with excitement, express tonight that you need him sexually.  You can do that verbally, or you can do that by being friendly to him tonight – how else shall I say it?  Genesis 2:18 says, and this is God speaking, "It is not good for the man to be alone."  God points out that man needed a counterpart.                         I'll never forget a young seminary wife – I was speaking on the West Coast at a major evangelical seminary – and I was talking to the women at a wives' class about how they could communicate love to their husbands, and this young seminarian wife came up after I'd finished speaking, and she said, "Dennis," and she started giggling, she said, "We were driving home the other night from youth group, my husband is a youth pastor, and in the quiet of the car, we were just driving along there in the dark, and I turned to him, and I said, 'Sweetheart, what would really encourage you to be a man of God?'"  And she said, "Dennis, there was a moment of silence, and he said, 'Well, if I came home from seminary in the afternoon and found you at home with no clothes on welcoming me home.""  And she kinda giggled, and she said, "Do you think he really meant it?"  And I said, "I don't know.  Maybe you ought to try it."                         Now, isn't it interesting that here's a guy who is immersing himself in the study of the scriptures.  His wife asked him what can encourage you to become a man of God?  You'd think he would want maybe a theological set of books about the Bible, maybe some time with a great man of God.  Hm-mm.  He wants a time with his wife alone to just be affirmed sexually.  Now, that's a message that I think we need to be shouting from the mountaintops today. Bob:                You know, some wives would say, "I feel like I'm doing this for my husband, but at the same time that I'm trying to affirm him, I'm feeling unaffirmed.  I'm feeling used." Dennis:          Charlie Shedd in his book, "Letters to Karen," made a powerful statement – and this is a book from a father to his daughter about marriage, love, and about life.  He writes, "Be sexually aggressive some of the time.  Your husband longs to believe that he's wonderful enough for you to yearn for his sexual companionship.  It matters everything to a man if he has a home where he knows he has great value.  Your husband can stand much more of the rough-and-tumble of a cutthroat world if you have convinced him that his home is an emotional center where he is vitally important."  And did you hear what he was saying to do that?  A part of that is being creative and initiating sexually toward your husband. Bob:                I don't even know if you can do this.  Do you have any other ideas? Dennis:          I'm not going to go further as to how a woman can do that, graphically talking about that, but I do think what she needs to do is communicate her need of her husband – do that verbally.  Let him know that you are his lover.  Write him a note, maybe a surprise – let him know that he has occupied your thoughts today sexually.  That's good.  God would not be ashamed.  He would not be up in heaven right now hiding his face, blushing, that I'm saying this over Christian radio.  Our God made the whole sexual dimension of marriage, and He's for it.                         I think what we want to communicate here is that a woman who wants to please her husband can learn how to do that in a way that communicates love to him and, most likely, those gifts of pleasing your husband will involve sacrifice.  That's what makes them so valuable. Bob:                You know, Dennis, tomorrow is Valentine's Day, and I can imagine there are some wives who are listening to the broadcast who think, "I have tried to do what you've talked about today.  I have tried to affirm and esteem my husband and build him up, and yet when we are together romantically, when we're together sexually, I feel very unaffirmed.  I feel used," and she wonders, "Do I keep going?  Do I stay with it?" Dennis:          Boy, that's a tough one, because there are men that, for whatever reason, are unresponsive, and I would say if you're in a marriage like that, you need to seek out a friend of the same sex who can pray for you, who can encourage you, and you need to be vitally involved in your local church, growing spiritually. Bob:                And maybe the broadcasts that we did earlier, where we talked to husbands about how they can romance their wives – maybe that tape would be helpful for a husband. Dennis:          Yeah, and perhaps an invitation to your husband to write a letter explaining his lack of response.  Sometimes men can be threatened by verbally communicating, because they're so tangled in their own emotions, they can get free to share it.  And perhaps the open invitation to a man to write down his thoughts to his wife, just perhaps there's a man who is listening, or a wife who can use that to help her husband begin to really open up his heart and become vulnerable. Bob:                Are you going to talk more to wives on tomorrow's broadcast? Dennis:          We've got a long list here. Bob:                All right.  I hope our listeners can join us for that.  Our engineer is Mark Whitlock.  Dennis Rainey is our host.  I'm Bob Lepine.  We'll see you tomorrow for another edition of FamilyLife Today. (Music:  "It Had To Be You")                         FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.   __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, could   you consider donating today to help defray the costs?  Copyright © FamilyLife.  All rights reserved.www.FamilyLife.com     

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic Marriage Day 5 of 8 Guest:                        Dennis Rainey From the Series:     A Man's View of Romance ________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­(Music:  "Why Can't a Woman Be More Like a Man?") Bob:                This is FamilyLife Today.  Our host is the executive director of FamilyLife, Dennis Rainey, and if you've ever scratched your head and asked yourself the same question Henry Higgins asked himself, then stay with us for today's edition of FamilyLife Today. (Music:  "Why Can't a Woman Be More Like a Man?")                         And welcome to FamilyLife Today, and let me see if I can do a recap, Dennis, for our listeners here as we begin the broadcast.  Last week you talked with us about why romance is so important for a marriage relationship. Dennis:          Right. Bob:                You talked about the "romance robbers" that every relationship experiences.  Barbara joined us, and we spent three days talking to men about how wives view this issue of romance, and we just had a couple of days with the guy you describe as the "Michael Jordan of romance," who talked with us about some creative things that his group – that he calls the "Men of the Titanic" have done to communicate romance to their wives, and before we talk to wives about how their husbands view romance, you want to spend one more session talking to the men, right? Dennis:          Right.  You know, I think a lot of Christians are afraid to discuss the obvious.  There is a great struggle that is taking place in the Christian bedrooms of our nation, and if that struggle is going to be diminished, and Christian marriages are to emerge, then that means we've got to get honest and look at this biblically, we've got to look at it and speak out it forthrightly and, in the best way we know how to talk about it, be able to speak honestly first of all to men about what they're feeling when it comes to sexuality. Bob:                Now, is it okay for the wives to listen in as we talk to their husbands? Dennis:          I think, for today's broadcast, you ladies can just eavesdrop as I just have a heart-to-heart talk with the men, because I think a lot of us, as men, are really confused, and this first point I want to make with the husbands is you need to reserve romance and your sexuality for your wife only.  What I mean by that is God has blessed you and given you great sexual energy.  That ought to move you to serve her, to love her, to sacrificially give to her without resentment.                         Now, those last two words are very important – "without resentment" – because I think God gives us, as men, this urge to initiate toward our wives for a reason, because our wives are different.  They have relational needs, and what we do with our own sex drive, as we look at our wife's needs, can either move us to using our wives as an object or we, as men, can realize that we need to get on our wife's wavelength and how she views romance; that is, her need for relational love, and that means spending time with her, taking walks, some of the things we've talked about earlier in this series. Bob:                Are you saying here that if a man is failing in these areas, if he's not communicating love to his wife on her terms, then he really needs to make that a priority before he has any expectations from his own wife? Dennis:          I'm saying when Paul commanded husbands to love their wives, He commanded them to nourish and cherish their wives.  The picture is of bathing them in nutrition for their soul.  What is that for a woman?  It's a relationship.  It's sharing your life, as a man, with your wife, and if you don't do that, most likely your wife is going to feel like a sex object, and I think one of the best questions a man could ask his wife at this point, to see how he's doing, is say, "Sweetheart, when I make love to you, do you feel loved?" I'm convinced there are a lot of wives who would say, "No.  I may feel pleasure, I may feel sexual release, but somehow, sweetheart, you're not communicating real love to me, because you haven't met those relational needs." And it's not what the man is doing or not doing in the midst of the actual act of intercourse.  It's what he hasn't done to prepare that relationship with his wife and enable her to feast on having fun, on being nourished and cherished by someone who tenderly cares for his wife.   Now, this next thing I need to talk to men about at this point – this gets kind of tough to speak to men, but I've gotta do it – men sometimes have a higher felt need for sex than their wives, and I've got a couple of questions for you men who continually find yourself in overdrive in this area.   The first question is – are you feeding your sexual appetite throughout the day?  Your fantasies, what you look at, what you watch, what you allow your mind to feast on – are you feeding that regularly throughout the day in an unbridled fashion?  It is a wise man who, first of all, looks to himself in saying, "Am I really setting up our marriage to win here or am I somehow, because of what I'm allowing myself to think about all day, am I being selfish in arriving at the marriage bed almost setting my wife up to fail because I have so feasted in my mind on my sexual creativity?" Bob:                There needs to be some self control and discipline that a man exercises over his own thought life? Dennis:          Discipline is a part of the Christian life, and I think for a lot of men this goes down hard, because what we would like to say is we would like to have complete freedom to think about what we would like to think about and arrive home all sexually energized and charged up, but the problem is – what's our wife been thinking about all day?  She's had kids draped all over her legs and arms, tuggin' on her skirt, and here's the man arriving home.  He's had all these thoughts, and his wife is nowhere in the ballpark, let alone ready to go to bed with him.                         A third thing I'd like to encourage the men to do, and this is going to sound the riskiest of all, but it's absolutely important that you share your feelings about your own sexuality.  This is what women really don't understand about men, because men aren't in touch with what they're feeling about their own sexuality.  And a part of this, Bob, I believe, is a man must express to his wife the importance of his wife's response at the point where he initiates intercourse with his wife. Bob:                But you're saying before he does that, he needs to understand that importance himself? Dennis:          That's right.  First of all, he's got to understand what it is he's feeling, and then begin to put it in words with his wife, and this is the interesting thing – most men have never talked about this with anyone in their lifetimes.  It's interesting, America is a culture that is saturated with sex, and yet men, I believe, are more insecure, they've got more confusion, more anxieties, more temptations – I think they've got unreal expectations about themselves, about their spouse, and what may be the best vehicle for the man to discuss this is to simply write out a letter to his wife about how he feels about his own sexuality.  Include in there any anxiety you may feel, certain feelings you may have about your own performance, how you feel at the point when you are initiating, and then include a paragraph about how you feel when your wife says no.  Because I think sometimes the way men express their feelings is with anger.  They've been hurt, they've been disappointed, and what comes out is anger.  They kick wastecans.  I know one man who kicked a hole in his garage door.  That's a long way from the bedroom, so you've got to wonder how he got down there to do that, but the guy was ticked off.                         The time to communicate this is never in your bedroom.  It should always be in the midst and the context of a relationship – on a walk – it's not at 11:00 at night when you're both exhausted.  It's in a prime time of the day when you can talk about this and connect with your spouse.  I think there are a lot of women who really do want to understand their husbands, and what I would say to the women at this point – be patient with your man, because he, most likely, has never, ever talked with another man about this, let alone a woman.  And now you're his wife, and now you share this bed together, and you can't help but maybe feel it personally as well, as a woman, feeling like he's rejecting you. Bob:                One of the things that makes those discussions difficult for couples is what happens after that?  The next time you come together, there are all kinds of thoughts running through both of your heads, and it makes it awkward. Dennis:          Yes, and that's a part of a growing marriage relationship that I think young couples just need to relax and grow through – or a couple who has been married for 15 to 20 years, who may go through some discussions that they've never shared in the past.                           Yes, you may feel self-conscious, but do you know what I'd do at that point?  Learn to laugh and not be so serious about this thing called sex.  We're certainly devoting a lot of days to it here on the broadcast, and that's because it is a very serious subject, but one of the things Barbara and I have attempted to do is, we have attempted to keep laughter as a part of our marriage bed.  It takes some of the pressure off, it allows us the freedom to share some humor in the midst of what can be far too serious of a subject. Bob:                Mm-hm. Dennis:          Okay, men, this next point may not even sound like it relates to sexual intimacy, but it does, and that is you need to pray with your wife about this area of your relationship – pray for yourself that you'll be selfless, that you'll be a man who knows how to deny himself for your wife, and in many cases there can be no greater act of love on your wife's behalf than you denying your own desires for your wife.  Ask God to give you the strength to be able to do that.  Ask God to give you an understanding of how to love her and how to meet her needs.                         I want to tell you something – the Holy Spirit of God, if you're a believer in Jesus Christ – indwells you.  He can guide you and lead you into becoming a better lover.  Now, you may say, "The Holy Spirit wants to help me be a better lover?"  Absolutely.  You can't tell me the God of the Universe that created sexual love is not interested in helping us when we don't know how we need help, and I've found God has given me ways of loving Barbara at times when, truthfully, I was at a dead end.  I didn't know how to meet her needs.                         Pray for your wife.  Pray that she'll feel loved when you initiate sexual love with her.  That's an important part.  You know what?  I'd even pray with her before the act of intercourse that God might enable you to communicate love to her. Bob:                Now, you've got to know, Dennis, there are some folks who hear you say that and think, "That just feels strange – to pray together and then go to bed together." Dennis:          Well, if that sounds strange, then the next point I've got is going to sound stranger – and that would be to pray during the act of making love with one another.  Now, how strange does that sound? Bob:                Well, there are some folks who are probably thinking that sounds pretty strange, too. Dennis:          Well, let me ask you something – is God there in your bedroom in the midst of this? Bob:                Yeah, I guess He is. Dennis:          I think He is, and I believe sexual love is an act of worship.  I think it is the deepest form of emotion and feeling two people share together.  Who made that?  It wasn't man.  God made it.  Why not share in prayer together in the middle of marital love? Bob:                You know, I was talking about this with a Sunday School class one time, and I said that the sex act is an act of worship, and a guy came up to me the next week, and he said, "We went home and had a revival at our house after Sunday School last week."                         You know, I think there is a false sense of separation that most Christians feel between the spiritual side of life and the sexual side of life. Dennis:          Well, you know, there's one last point of prayer and, again, I'm just being realistic – after you've shared in love together – what finer moment than to say, "Lord Jesus, thank you for this woman You've given me."  And I've prayed that many times with Barbara – "Thank You for what we have just enjoyed together.  Thank You for her, thank You for her love, thank You for her trust of me as a man."    __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, could   you consider donating today to help defray the costs?  Copyright © FamilyLife.  All rights reserved.www.FamilyLife.com     

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic Marriage Day 4 of 8 Guest:                         Barbara Rainey From the Series:         A Woman's View of Romance_____________________________________________________________ Bob:                Welcome to FamilyLife Today.  Today we're speaking frankly about how a woman views romance. (Music:  "Love and Marriage")                         And welcome to FamilyLife Today.  Thanks for joining us on the broadcast.  We are beginning Week Number 2 of our look at Creating a More Romantic Marriage, and I just want to encourage folks, if you missed any of last week's programs, or if you're going to miss any of this week's programs, this is a series that husbands and wives ought to get and listen to together, and then they can talk, they can interact, about what they hear on the tapes. Dennis:          You know, this subject of developing and cultivating romance in a marriage relationship is a discussion that is long overdue among Christian couples, because we ought to have among the most passionate relationships on the planet.  Our God created romance in the first place. Bob:                Well, we're going to talk on today's broadcast about how men and women view romance, and we've brought your wife, Barbara, back in the studio with us today.  Barbara, welcome back to FamilyLife Today. Barbara:         Thanks, good to be here. Bob:                And one of the things that we want to do is look at research.   Dennis:          Right. Bob:                You commissioned that be done at our FamilyLife Marriage Conferences across the country – we had a researcher who talked with women about how they view romance, how they view it primarily, is that right? Dennis:          Actually, this Top 10 list of romantic acts came from both men and women. Bob:                Well, let me go over the list, Barbara.  I'm going to go from 10 to 1, and I'll read what people indicated expressed romance, and then I want to know, as a man, and I want to know how I can keep these ideas in front of me and sprinkle them into a relationship as a way to express romance – again, with no hidden agenda, no – not driving for anything.  Number 10, hands are romantic; holding hands, particularly, is romantic for a woman.  Do you like holding hands with Dennis? Barbara:         Mm-hm. Bob:                Why is that romantic for you? Barbara:         I do it because it says, "I want to be close to you, and I like you, and you're my friend, and I want to be next to you."  I mean, those are the kinds of things that communicates to me, and that's the reason that I initiate it, and I think that's probably the same for him, too.  So I think it's the closeness that it communicates. Bob:                Okay, how about Number 9, which is massaging one another – rubbing the neck.  Do you like when Dennis reaches over and rubs the back of your neck?  Dennis, massage oftentimes will have a sexual connotation, and some women may pull back from liking massage because they think it's just foreplay. Dennis:          Right. Barbara:         Exactly.  I think that's right. Bob:                So if it's non-sexual massage where it's just – "Let me rub your back, and you can fall asleep," then that's okay? Barbara:         Oh, I think so, yeah. Bob:                Number 8 on the list is serving – serving the other person – common courtesies – opening the door, holding a chair out for somebody, doing little acts of sacrifice.  Is that romantic for a woman? Barbara:         To me, I don't think of that as being as romantic, if I had to define them, as, say, holding hands but, again, I think it's important to do.  I think it says "I am denying myself for you.  I am going to serve you," and I think that anytime a husband can serve his wife sacrificially and do something for her, he's communicating to her that he cares about her and that he loves her and she's special, and he wants to make her feel special. Bob:                Okay. Dennis:          Let me make a comment on this next one – number 7 – because this made this spot in the combined list – 75 percent of the men picked this item as number 1 of what was most romantic.  So this, again, kind of lets you know the men viewed this substantially heavier and weightier than the women did because, together, it became number 7.   Bob:                So men had it at number 1, women – Barbara:         Someone must have had it a lot lower for the average to be seven. Dennis:          It must have been a lot lower. Bob:                And number 7 is a kiss – an unexpected kiss, a nibble on the back of the neck, or just kissing each other. Dennis:          Now, why do you think, Barbara, the women would have ranked that so much differently than the men? Barbara:         Because I think it probably, if the truth be known, they might have felt that he had another motive, and I just wonder if some of the women were feeling suspicious.  I think some of these other things might be able to be seen as an individual fact or as an individual gesture – Bob:                – so if he opens the door, she doesn't feel he's up to something, but if he kisses her, she wonders what's goin' on in the back of his mind. Barbara:         She might go, "Okay"—yeah, right – "I wonder what he's thinkin'?" Dennis:          And the rest of this list, really, if you look at it, with the exception of this and the massage – really, are statements of a relationship and women view romance through the eyes of a relationship.  They want to be loved, known – Barbara:         – understood – Dennis:          – there ya go – Barbara:         – accepted, valued, appreciated – Dennis:          – she knows the words – why did I even try, huh? Barbara:         Well, you did a good job. Bob:                It just wasn't complete.  All right, number 10 was holding hands; number 9, massage; number 8 serving one another, opening doors, common courtesies; number 7, kissing; number 6 was walking.  Now, there's a romantic 30 minutes – we went on a walk together – that's romantic for women? Barbara:         Well, it's very relational.  I think if you go for a walk, chances are you're going to go for a walk away from daily responsibilities – away from the telephone, away from the television, away from the children, away from work, away from whatever – and it allows you to focus on the relationship without having to sit on a couch and look at each other eye-to-eye and be relational, which is sometimes very threatening. Dennis:          And I think the reason why most men would respond just as you did, Bob, is because of what Barbara just said – it's not sexual.  When we think of what's romantic to us, and we really evaluate it, we would not put walking at the top of the list. Bob:                We're going to talk about this next week – but it is interesting, because I hear you saying in this – part of what speaks romance to a woman is "Get me outta here."  In the day-to-day of life with all of the kids and with all of the responsibilities – get me away from this for a little while, and that will be so refreshing to me, it will speak volumes.  That's at least a part of it, and then – have a relationship with me. Barbara:         I think that's part of it, mm-hm. Bob:                All right, number 5 on the list – something written – written notes or letters or poems or cards or notes on the bathroom mirror or just some written remind of affection – is that romantic? Barbara:         Mm-hm, I think it is.  In fact, I found this note, and I don't know how old it was, but Dennis had taped a note in the bathroom, and it said, "Have you found all the little notes around that say how much I love you?"  It was just fun to see that and read it again, and I thought, "You know, that's still true," and I don't know what the notes all were, but it was fun to see that. Bob:                As you said that, I was thinking it was years ago – I don't know how many years ago – but one night Mary Ann had gone to bed, she was exhausted, and I sat up, and I wrote a half a dozen of the notes, and I scattered them around the house in places where it might be weeks before she would find them, and one of them was in a recipe folder that she had for chicken dishes, and I just put it in there figuring, you know, it could be six months from now, but she'll find it, it will be a surprise.  Well, five, 10 years later, it's still in the same – every time I'm goin' through there, I go – Dennis:          – has she never seen it? Bob:                Oh, she's seen it. Barbara:         She's probably seen it and left it there. Bob:                But she's never thrown it away, and I keep – you know – why don't you throw this thing away?  I mean, it's old, it's on old stationery.                         All right, let me read through the list here again – number 10, hands; number 9, massage; number 8, serving one another; number 7, kiss; number 6, walking; number 5, something written; number 4, going out on a day – time away – dates with no kids, dinner out, a weekend at a bed and breakfast – just time alone together on dates.  Is that romantic? Barbara:         Yeah, mm-hm.  I think, for the same reason again, I think a wife feels that she is the focus of her husband's attention when she knows that he's doing this for her. Bob:                You two have made that a regular part of your relationship.  There is, as often as you're able, on a weekly basis, you have a date.  Does that make it less special? Barbara:         No. Bob:                It's routine? Barbara:         Huh-uh, not at all. Bob:                You look forward to Sunday night date night, even if it's every week? Barbara:         Yeah, I look forward to that moreso now than when we tried doing this when our kids were young.  We tried doing it when our children were young, and it was hard to do it, because it was hard to get babysitters, and it was hard to get away, and in those years, it was easier for us to spend time together at home because the kids all went to bed at 7:30 or 8, and we had two hours, at least, every evening.  Well, now that our children are older, it's really tough to get two seconds alone at home. Dennis:          Right, but when the kids were little, one of the ways we solved the problem of babysitters was we would go ahead and put the kids to bed, and then I would prepare the meal and would give Barbara 30, 45 minutes to run about doing her duties, and then I would take the meal upstairs to our bedroom and had a table at the foot of our bed that I put a nice tablecloth on and with the good plates and the napkins and the good silverware and had a beautiful candlelight dinner there, and when the meal was over, you didn't have to go anywhere and, frankly, we have some great memories of those conversations because at the end of the evening there was nothing to change the mood of the evening.  We didn't have to go anywhere – we were there, and I took the dishes downstairs while she got ready for bed and cleaned up the kitchen so she didn't come back downstairs the next morning to a dirty kitchen. Bob:                That really ties to number 3, which is meals.  Number 4 is a date together; number 3 is having meals together – special meals, candlelight, quiet dinner alone, picnics, a breakfast out together – those kinds of events, but what is it about a picnic away or Dennis saying, "Let's go out and have breakfast, just the two of us."  What is it about that that's romantic? Barbara:         Well, I think it's the unexpected.  The one that jumps off the list that you just read to me is picnic because that's one we've done so seldom, and that would be, to me, the most fun because that's one which is hardly ever done.  So I think keeping variety in it is really a good idea, but there's a lot (inaudible) – [crosstalk]  Bob:                – make note of that.  I'm just checkin' to see if you're makin' notes here. Barbara:         He knows.  We've talked about it.  It's just hard to pull off. Bob:                All right, number 2 is touch, and with this we're not talking about sexual touch, we're talking about holding or hugs or cuddling or affection in public and yet, even as I say that, I think, for a lot of women, being touched may always feel sexual to them.  They may, like with a kiss or with a massage, wonder what's really behind this, mightn't they? Barbara:         Well, I think so, but I think that's where a husband needs to know his wife, and he needs to ask her questions, he needs to seek to understand who she is and where she's coming from and why she feels the way she does and how she will respond to different things, because it may be that she will feel somewhat suspicious with physical touch.  And so he may need to assure her – "I just want to hug you because I love you – no strings attached, I'm just committed to you, and that's all I want you to know" – or something that helps her understand his meaning or his intent behind it, because I do think that, just like with holding hands, it communicates closeness, it communicates "I like you."  I think hugs and other kinds of affection that's non-sexual affection sends the same message.  It communicates I like you and I want to be close to you, and I think you're a neat person.   Dennis:          Yeah, one of the best-sellers at our FamilyLife Marriage Conference is Ed Wheat's book, "Love Life For Every Married Couple," and it's a book about romance, and when I first read this a number of years ago, I kind of laughed that he would need to take three pages in the book to give married couples exercises for learning how to touch one another.  But on page 184 through 186 he has 25 suggestions for touching, and I'll just read a couple of these, because they're really quite instructive, I think.                         "Number 1 – when dating, young people can scarcely be kept apart.  Most married couples have forgotten how much fun physical closeness can be.  So set aside practice times at night, at least once a week, to learn the delights of non-sexual body caressing."  At this point, in our marriage conference, when I read this, all the engaged people fall out of their chairs laughing.  The married people aren't laughing.  They're goin' "That's a good idea."                         "Number 2 – show each other where you like to be touched and the kind of touch that really pleases you.  Usually a light touch is the most thrilling.  Be imaginative in the way you caress."                         You know, I think he's onto something here to give us some practical thoughts about how to re-ignite exploration through tender touching of one another's bodies.  I think when we get married the familiarity with one another causes the loss of the intrigue, the exploration, and the excitement, and I think Dr. Wheat does a great job of giving us some practical projects that couples, I think, will find exciting. Bob:                I've got to imagine there are some men who are saying, "This sounds to me like a contradiction in terms – non-sexual touching.  I can do that, sure, but in the back of my mind, touching is, for me, sexually stimulating.  Whether it's holding hands, whether it's putting my arm around my wife, whether it's re-imagining the things we did on dates – that has a sexual dimension and for me not to have the sexual dimension fulfilled is a sacrifice on my part." Dennis:          That's the point.  I think to have those feelings is normal.  To deny that you have those feelings is not healthy.  I think it's okay to experience attraction, arousal, at that point.  I think what our wives are looking for is such a premium, such a value placed upon the relationship and who she is, that we are willing to set aside those desires and not take that touch toward what we, as men, would know would be the intended objective. Bob:                I remember the Ann Landers survey, you know, where they said, "Would you rather have sexual relations with your husband or just cuddle with him?"  And women, in droves, said, "I'd rather just cuddle with him," and I thought, "Do the women understand that cuddling with him is stimulating sexually?"  And that's the reason that it often goes on to sexual relations, because he's responding to what's going on inside of him, and you're saying he needs to put that to death from time to time. Dennis:          That's right – and not allow his mind to continue on.  He needs to build some limits that really communicate to his wife that "I'm willing to set aside my desires for you." Barbara:         Yeah, and I was just thinking, as you were saying about the survey that I think probably the reason a lot of women feel that way is they probably weren't loved and cuddled as children by their parents, and they missed that, and they have this deep longing to know that they are loved, and they want that from their husband, and if all they get from their husband is sexual initiation or sexual touching or cuddling, then they think, "Gosh, he doesn't really love me, he just needs me," or "He just wants me for his own pleasure, his own need," and so I think that's, again, another cue for a man to say, "I need to understand my wife.  I need to understand why she needs non-sexual affection," and I think we all need affection, because we need to know that we're valued as people, and that's a way to communicate that.  But I think that, for a husband, he needs to say, "Okay, why does she feel this way?  Why does my wife need non-sexual affection?"  And he needs to ask her, and they need to talk that through, and he needs to be willing to give it to her with no strings attached. Bob:                Mm-hm, okay, top 10 again – Number 10, holding hands; number 9, massage; number 8, serving one another; number 7, a kiss; number 6, walking together; number 5, written love notes to one another; number 4, going out on dates; number 3, having meals together; number 2 is non-sexual touching – Dennis:          – and number 1 is not diamonds. Bob:                Number 1, the most romantic act, according to respondents at the FamilyLife Marriage Conference – do you want to say what it was? Dennis:          Go ahead. Bob:                It's flowers – delivered, hand-picked, bringing them home – a single rose – it doesn't seem to matter.  I'll never forget being at a FamilyLife Marriage Conference where I was speaking, and I got – we were all waiting for the elevator, a whole group of us waiting for the elevator, and when the elevator car came, here came the guy holding a dozen roses, and he walked off – he was the flower delivery guy – and every woman at the elevator turned to watch, to see which room in the hotel he was going to, and they watched, and they watched – nobody got on the elevator, they just watched. Barbara:         How funny. Bob:                And finally, he went down the hall and finally he stopped at a room and as soon as he did, all these women kind of turned at their husband and glared at him, like, "That wasn't our room.  How come you didn't get me flowers?"  There is – what is it about flowers, Barbara? Barbara:         Well, I think flowers say that you're special.  I think it's the surprise that comes with flowers.  I think it's because they're unexpected.  I think because it's a frivolous thing, and I think it communicates love.  I think it says lots of things to a woman about love and about her being a special person, a valued person, an appreciated person – that her husband is willing to do that for her. Bob:                When Dennis brings home flowers do you immediately stop and think, "What's he up to?" Barbara:         I don't think I have.  I really don't think I have. Bob:                So we go through this top 10 list as men – we look at all of the non-sexual things that are on the list, and we say, "Are you sayin' I just need to keep doin' these over and over again, mixing 'em in, a little bit here, a little bit there, and expect nothing in return?" Barbara:         Yeah, but I think husbands need to ask the Lord to help them be creative and ask the Lord to help them think of their wives and ask God to help them understand and pursue, because it isn't – again, as we've talked about a formula several different times – but I think that the idea is that a woman wants to feel special and valued and appreciated and all of those words I've been using, and I think she needs to feel that from her husband in different ways at different times and unique opportunities. Bob:                You know, this is going to sound redundant, but just listening to all of this, I thought romance was supposed to be fun, and it this doesn't sound like as much fun as I had hoped it would be. Dennis:          But I think it is fun.  I think it is fun to find out what communicates romance to my wife. Barbara:         And it may not be fun in the way you've always defined fun, because I've learned to enjoy a lot of things through the years of being married to Dennis, because he has introduced me to things that I would have never done on my own and, likewise, he has learned to enjoy things that he would have never done if it weren't for me.  So I think we need to be willing to have our definition of fun broadened, because it will be fun, but it may be fun in a different way than what you're thinking and be willing to try something new.  You may like it. Bob:                Well, I just want to say thanks.  Can I thank your wife for being on the broadcast with us? Dennis:          Only after I do – honey, thanks for sharing your heart and being real for women, so – well – a lot of men can better understand how to communicate love and romance to their wives. Bob:                Yeah, and thanks for the insight I've gotten over the last three days of the broadcast on how women view romance.                           Well, on tomorrow's broadcast we're going to talk to – I don't know how to describe him – you described him as the "Michael Jordan of romance," right? Dennis:          Whatever you do, every man needs to listen to tomorrow.  You think you are a romantic husband – do not miss tomorrow, because you're going to be blown away by the guy we have the opportunity to talk to tomorrow. Bob:                I hope you can be here for it.  Our engineer is Mark Whitlock, our host Dennis Rainey, and I'm – Dennis:          – would you agree, Bob? Bob:                I would agree, absolutely.   Dennis:          All right, okay. Bob:                I'm Bob Lepine.  We'll see you tomorrow for another edition of FamilyLife Today. (Music:  "Love and Marriage")                         FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, could   you consider donating today to help defray the costs?  Copyright © FamilyLife.  All rights reserved.www.FamilyLife.com     

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic Marriage Day 3 off 8 Guest:                             Barbara Rainey From the Series:          A Woman's View of Romance________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Bob:                This is FamilyLife Today with your host, the executive director of FamilyLife, Dennis Rainey.  I'm Bob Lepine.  Today on the broadcast Barbara Rainey joins us to talk about what happens when a man loves a woman.  Stay with us for FamilyLife Today. (Music:  "When A Man Loves A Woman")                         And welcome to FamilyLife Today.  Thanks for joining us on the broadcast, and if you were not here with us yesterday, you're in big trouble is what you are – if you're a man, particularly. Dennis:          That's right. Bob:                I took notes on yesterday's broadcast, and I've got my pencil ready today, because we're learning how a woman views romance.  Dennis:          We're learning how a woman thinks. Bob:                That's right.  And women think differently – that's not wrong – they think differently than men, don't they? Dennis:          They do, and, well, we've got someone in the studio who is definitely a woman.  She is a great woman, she is my wife, and it's really fun to have Barbara back with us on the broadcast again today.  Bob:                Yeah, Barbara, welcome back to the broadcast. Barbara:         Thanks, glad to be here. Bob:                You know, yesterday – and I've been thinkin' about this all night.  I went home and just kinda mulled on this.  It's a little frustrating to know that once I have an idea of how my wife views romance, she's going to change the rules on me – that was one of the lessons from yesterday's broadcast ­– and to be aware that romance is going to get progressively harder as we continue in marriage.  It was easy in courtship, but it gets progressively harder as we're married.  Is that right? Dennis:          Absolutely.   Bob:                Well, that's lousy. Dennis:          Well, you think about – what's God up to here?  He is trying to rid us of selfishness and, if we could, we would kick it in neutral and just coast all the way in to year 50 of the marriage – we wouldn't have to work at it.  It would just be like jumpin' off the edge of a cliff.  We would romantically fall into each other's arms and hopelessly under the control of romance, like gravity, and not have to really work at knowing and loving and caring for and meeting the needs of the other person.  And I think that's why God created marriage – He created it to be redemptive.  He wants me to give up my life for my wife. Barbara:         Exactly. Dennis:          And that's why romance becomes really elusive in a marriage where a man is threatening to leave or a man is sending all kinds of signals that he's not committed, and he's putting fear in the marriage, not casting it out.  1 John, chapter 4, talks about "perfect love casting out all fear," and that's a man's assignment, and a lot of men want their wives to fall in a puddle at their feet and romantic love in a swoon, but they're not willing to give up their hobbies, their interests, their selfish desires for their wives.  Now, how do I know that?  Because I'm a man, and because I've done that. Barbara:         See, when I was thinkin', when you talked about it being redemptive, I was thinking that as you were saying that, and that, ultimately, is what is going to draw a wife to her husband, because when she sees him loving her unconditionally, seeking to understand her and know her and be involved in her life and help her and all of those things, then she is going to respond to him, and as she sees him giving up himself and denying himself and getting rid of his bad habits or putting away his hobbies or whatever for her, those kinds of things are redemptive, and so I think that, in the long haul of things, as we see marriage as being a redemptive relationship, that is the hope of responding to one another.  That is the hope of having romance – is growing together in Christ, denying yourselves for each other, and especially for a husband as the head of the home and the head of his wife, as he will deny himself for her, as he will love her, as he will sacrifice for her, if he will seek to understand her – why she is the way she is and accept her for that and not condemn her for it and not seek to understand her so he can get her to change so he can be happy with her, but all in pursuit of loving her, then she will respond to that ultimately.  Again, it has to be for the purpose, though, that God intended, and that is to love her as Christ loved the church. Dennis:          With no response in return. Barbara:         That's right – with no strings attached.  In other words, he can't say, "I'm going to do this, and then she's going to respond, and then I'll get what I want," because that defeats the purpose of sacrificial love, because then it's not self-sacrificing. Dennis:          And that's the difficulty for a man, because a man usually sets goals, and he is after something, and with romance it may be the sexual dimension of the marriage relationship that he is in pursuit of his wife on, and that's why, as you approach this subject of romance and learning how to speak it as a man to your wife, you've got to understand that you deny your agenda and let the goal be solely that she would feel love; that she would know she is valued, cared for, and cherished, and that she is seeing you nourish her, just as Ephesians 5 talks about. Bob:                But here's the rub in that – because a man is thinking to himself – "The way I'll know that, the way I'll know that she's been loved is she'll respond." Dennis:          Right. Bob:                So if she's not responding, then the message is – Dennis:          "I haven't done a good job loving her." Bob:                I haven't done a good job – Dennis:          – and we've had that conversation. Barbara:         You've said that to me many times. Dennis:          I have. Barbara:         "I must not be loving you right," and it's not just because I'm not responding sexually or in a particular way, but you're sensing from me a lack of response toward you, and it's because of areas in my life that you didn't understand or that you didn't know about me or that I was unable to trust at a particular phase, and so we've talked those things through.  And I think good, solid, marriage relationships need to take the risk of talking those things through, and I needed to hear you say that, and you needed to hear back from me why I was not feeling loved, why I was not feeling like I could respond, and those kinds of conversations are not easy to have.  I mean, they have been difficult conversations that we've had through the years, but because of our commitment to making this thing work is to making it be all that God intended it to be, we have had some of those really tough conversations, and they've not been fun but, in the long run, as we've had them and had them again, they have ultimately been productive in bringing understanding to each of us, but particularly to Dennis in understanding me and in better how to love me. Dennis:          You know, as you were talking, there were really two things that I was thinking about – number one, the process that we have been through of 22 years of dialog, and I mean, at points, fierce dialog, I mean heated dialog, and the second thing is what we're talking about here has come out of something that is most fundamental, and that is a commitment, a bedrock, granite-solid that is immovable. Barbara:         That's right. Dennis:          No escape clauses, no escape hatches, no way out. Barbara:         And no threats. Dennis:          And no threats – never a threat.  This freedom of discussion has come about as a result of two people who are committed – committed, first of all, to Jesus Christ, because without the fear of the Lord and a commitment to Him and setting ourselves apart unto Him first, deciding He will be our Lord and Savior of our lives, our Master, our Redeemer.  He sets the agenda.  It is Him that must be obeyed above all else.  That settles it.  But there have been some evenings that lasted long into the night and some mornings that came early as a result of the dialog.  When we got up in the morning, and we looked at each other, there was no thought of going anywhere.  It was two people deeply committed to Christ, and that commitment was mirrored in our commitment to one another. Bob:                Yeah, those are the late nights or the early mornings, I'll look at Mary Ann, and I'll say, "You are not my enemy," and she'll say, "You are not my enemy," and we'll keep going, we'll keep after it. Dennis:          And I think a lot of young couples that are listening to our broadcast today and who go through life – they think they're entering into real war at these points and, yeah, it's rugged.  You're climbing some craggy cliffs at this point, but you know what?  That's a part of a relationship.  I mean, if it was easy and there were no rocky points, I guess I would have to say, "Hm, I think I may fear for you a little bit.  Have you not had anything hard to work through?"  I mean, I really fear for the couple who say they haven't ever argued, who haven't really differed, who haven't really had to hammer some of these misunderstandings out, because it's in those discussions that you realize how different you are from one another, and what a gift God has given you in your spouse. Bob:                I can imagine that there are women who listen to this discussion and they're going, "Yes, somebody understands what it's like to be a woman.  Somebody understands what women want romantically in marriage," and men listen to it, and they go, "This is much harder work than I ever thought it would be."   Dennis:          That's right. Barbara:         That's right. Dennis:          You go back, and you look at the first year of marriage, and the first year of marriage is like falling off that cliff.  We just kind of fall into each other's arms, and you can't stay away from each other, and you fall helplessly under the control of gravity – romance – and you get married and, all of a sudden, you realize it's not as easy to create that over and over and over again, and then you have children, and you find out it's very difficult, and then you've got health problems and there's job issues and then there are emotional issues and there are extended-family issues, and life becomes cluttered and crowded – Barbara:         – and complicated – Dennis:          That's right – where the Lord Himself is at work in your life whittling away and, at that point, it's where the commitment has to kick in, and two people must say to one another – "I love you, I'm committed, we're goin' for it," because, in the end, they are going to have a real relationship with a real person who knows them.  And I've said this to Barbara, even in the middle of some of our heated discussions over the past 22 years – I would rather have the discussion and have the understanding in one another's lives than to go through life denying that I'm disappointed or denying that we have a disagreement or denying that I've got feelings and, as a man, stuff it and have her think she's winning, and you've got to get some of those things out. But that is a risky feeling because that means the other person has to hear this and must hear it without feeling threatened or like they are being attacked or like the commitment is falling into question.  And that's a real challenge – to let somebody know that you're upset in the middle of the moment but still let them know, "You know what? I'm not goin' anywhere.  I love you, I'm committed to you, but we've got to talk this thing out," and this is where I'd give the man's side of things toward a woman, as a man has tried to love his wife, and he's missed it, and a woman needs to understand that at those points he may be feeling like a failure as a man.  He may have done the best he knows how to do, and he's got to be coached, and the time to coach him is not right after he fails because at that point he's probably feeling like a failure already, anyway.  But write him a letter, somehow communicate to him, but let him know how can he win you and then realize you're going to probably have to re-write that letter again in two or three years after he's – moves it to an A+B=C. Barbara:         Well, and let him know that you appreciate him trying – I mean, even that is worth a lot, because I think a woman who understands that her husband is trying to love her and is trying to understand her, she needs to let him know that she appreciates that and that she values that. Bob:                Do you love Dennis more today than you did 22 years ago? Barbara:         Oh, gosh, yes. Dennis:          I wouldn't go back to that first year of marriage – Bob:                Well, now, wait – with that said, how come it doesn't feel like it?  I mean, back 22 years ago, when all of the feelings were there, was gravity fallin' off a cliff – how come if you loved him so much more 22 years later it doesn't feel like it did then? Barbara:         Well, I think because I know him more, and I know what his love means.  I mean, I know what it's cost him.  I mean, it's cost him a lot to love me, and he has denied himself a lot.  He has given a lot, he's done a lot, he's prayed a lot, he's tried a lot, he's failed a lot, and I know that it's not cheap.   Bob:                Do you think there will come a time in the future when it will feel more like it did at the beginning? Barbara:         I suppose that there's potential for that, just because circumstantially, as the kids are gone and there are less pressures with children and the things that right now are making life stressful for me, and we have more opportunity to spend one-on-one time together, I suppose that there's a potential for that, but I – you know – Bob:                – do you think it will?  Do you think as the years go on, some of that early romantic feeling will re-emerge? Dennis:          I think that we have probably gone through one of the toughest periods, or seasons, of our marriage.  We had six kids in 10 years.  I think those years are among the most challenging.  Now we've just gone through another season where we had four teenagers at one time.  That's another season incredibly challenging – maybe even moreso than the six kids in 10 years, because there were some health issues occurring in that period, as well, that were making that especially challenging, too. But I think, little by little, as the kids leave, and as Barbara's attention can come back again – not solely to me, because her life has never revolved totally around me – but more towards me, I think there will be more room for that to happen, because there will be more time for just the two of us in our relationship and being together.  Because we can't go together a lot of times right now on a plane because she needs to stay here and be a part of the PTA or ministry outreach that the kids are having – or be there just to take care of the kids. Bob:                And it's the couples who, during the time when the kids are growing, who kind of move everything to the back shelf or let the flame die out, who reach that later time, and there's nothin' there. Dennis:          Yeah, and that's why this series on romance is so important – I don't think the Christian community is talking enough about romance.  I mean, it is important to a marriage.  Now, we've talked about how difficult it is to achieve, and it's elusive, and it's hard, and it's difficult, and you can't be guaranteed of it.  Now make it important.  Now it almost sounds like a crazy maker, but I think God wants us to have fire in our friendship with our spouse, and I think romance is that fire that flows out of that commitment and that friendship, and I think we've got to pursue one another because I think God put it within us both to long for it, to want it.  And in the process of longing for that, for a man, I think it provides the motivation to pursue his wife.  I think God gave it to him to do that so that he would pursue her.  Otherwise, if a man didn't feel that, what would there be to draw the man toward his wife?  Toward giving up his agenda for her and his rights?  I would have to say I don't know what the motivation would be, other than just some super-spiritual definition. Barbara:         Yeah, just obey the command. Dennis:          And that just sounds bland.  Who wants to experience that?  Barbara and I have anything other than a boring marriage.  Is there a lot of romance in our relationship?  Yes.  But is it the kind that Hollywood depicts on the screen?  She's shaking her head no.  No, it's not.  It's not.  It is much deeper than that.  I mean, that's shallow. Barbara:         The relationship and the commitment and the knowing one another and growing closer and closer together – that's what defines the romance, and that's what it blossoms out of – is that relationship. Bob:                Well, have a great weekend.  Be back with us on Monday because Barbara's going to join us again, and we're going through Dennis Rainey's Top 10 list of romantic ideas, right – the Top 10 most romantic ideas in America. Dennis:          That's right.  Are we going to give any of 'em today just to tease 'em? Bob:                No, no, no – they've got to tune in Monday.  This is information that you got from research that we did – Dennis:          – that's right.  We surveyed over 800 couples.  So this is the best of the best, Bob. Bob:                Well, doing my best Casey Kasem impression – "we won't quit 'til we get all the way to Number 1."  That's Casey Kasem.  Come on, you remember American Top 40, don't you? Dennis:          Oh, yeah. Bob:                Yeah, that's on Monday's edition of FamilyLife Today.  Join us for that.  Our engineer is Mark Whitlock, our host Dennis Rainey – Dennis:          Do you have these out-of-body experiences often? Bob:                I'm Casey Kasem, we'll see you Monday on FamilyLife Today. (Music:  "When A Man Loves A Woman")                         FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, could   you consider donating today to help defray the costs?  Copyright © FamilyLife.  All rights reserved.www.FamilyLife.com     

FamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Creating A More Romantic Marriage Day 2 of 8 Guest:                             Barbara Rainey From the Series:          Woman's View of Romance________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Bob:                This is FamilyLife Today.  Your host is the executive director of FamilyLife, Dennis Rainey.  I'm Bob Lepine, and today we'll learn from Barbara Rainey just how a woman does view romance on FamilyLife Today. (Music:  "How To Handle A Woman")                         And welcome to FamilyLife Today.  Thanks for joining us on the broadcast. Dennis:          You know, Bob, because of who we have in the studio today, I've decided I'm just going to kind of push back from the microphone and get my notepad out and take notes. Bob:                Is that right? Dennis:          That's right.  I really feel, in due respect for my wife, she's an authority on the subject she's about to speak on and, in fact, you know what I'd like to do?  You can ask the questions – because of the nature of what we're going to talk about, it's pretty delicate, and for me to ask my wife these questions, I mean, this could get a little interesting.  So – Bob:                – well, I'm lookin' forward to this and, Barbara, by the way, welcome back to the broadcast.  It's great to have you on the program. Barbara:         You're welcome, it's good to be here. Bob:                And, Dennis, I'm going to get right to it, because we're going to be talking over the next couple of days about how a wife views romance, and I think the thing that husbands want to know, the thing that kind of puzzles us in this whole deal is what is it that we can do that causes our wives to go, "Ahhhh."  You know, just kind of look at us and melt.  I mean, does that happen with a woman? Barbara:         Well, I think it does, but I don't think it's necessarily a particular situation, because the things that are romantic to me aren't necessarily a situation or an act or a thing or a gift – all of those things communicate romance – but the particular situation isn't necessarily going to produce what you're talkin' about, which is what we've talked about a lot.                         You know what I think it is, I think it is the relationship that she has with her husband, and I have been reminded again, as I've been interacting with my family, and I have seen where I have come from and how desperately dysfunctional it was, and I'm thinking, "I am married to a man who has absolutely been a savior to me because of the love and acceptance and all that kind of stuff, and I have been attracted to him because I'm realizing what he's done for me relationally.  So it's not like he thought, "I want to romance my wife, so I'm going to go buy her flowers, and so A+B=C, and this is the reaction and the response I'm going to get," although I think that's very romantic, and I love it when he does those kinds of things, because that communicates sacrifice, it communicates he cares about me, he's willing to go out of his way, he's willing to spend money that, you know, we may or may not have in the budget for that – those are all things that are very meaningful, but it may not necessarily produce the desired response.  In other words, if he's doing it to produce the response, he is very often going to be disappointed.                         That's why I go back to the relationship – to me, it's the relationship that is ultimately going to fuel the romance.  And so when you ask what I thought of, my thought was – was the day that we spent together in September, and he took a whole day off work just to spend it with me to do what I wanted to do.  We worked in the yard, and we got in the car in the afternoon, we drove for four or five hours and just kinda took off, and we stopped when we wanted to, and we did what we wanted to.  I mean, it was like, in a sense, being on a honeymoon or being in those early days of marriage when we didn't have any responsibilities, and that was more fun, but it was romantic in the sense that it was just the two of us, and we could do what we wanted, and we focused on each other, and we didn't have the demands and the – I mean – we had to come back to it, but, you know – just for however many hours it was, it was really a treat to have him all to myself and to have him say, "I will do whatever you want to do," and we talked all day long.  It was wonderful.  It wasn't romantic in the typical sense of sweep her off her feet, carry her to the castle, and they lived happily ever after. Bob:                You know, as you said, the A+B+C, I thought – men want it to be algebra. Barbara:         That's right. Dennis:          They do, and therein lies the frustration as well as the intrigue. Bob:                And women don't want it to be algebra.  It's gotta be – Dennis:          ­– no, they don't want a book. Barbara:         But they don't want to be figured out.  See, I don't think women want to be figured out, because if they feel like they're figured out, then they feel like they're controlled and they're had, and they don't want to be figured out.  I think they want him to love her and be willing to pursue her and to continue to know who she is, because she's not that simple.  I think women don't want to feel like they're that easy to figure out and, "Oh, he's got me pegged," and A+B+=C, and it's going to always work that way.  I think she wants to be more complex and more intriguing and more – Dennis:          – of a challenge. Barbara:         Yes. Dennis:          Because if the man goes A+B=C, and he knows that's the way it works, then she knows – Barbara:         – that he'll do A+B=C every time, and that gets boring, and I think she would also begin to fear that she'd be taken advantage of and, see, women don't want to be taken advantage of, and I don't mean taken advantage of sexually.  I mean to be taken advantage of in any way – just assuming on the relationship and therefore there's no more motivation to continue to pursue, there's no more motivation – because if you've got it figure out, then why work at it? Bob:                So if a man says to himself, "I would like" – he's thinking, it's, you know, here it is Thursday, "I'd like a week from Friday to be a romantic evening together for me and my wife."  What can I do to foster that?  How can I create a romantic evening, something that will speak romance to her?  You're saying "Good luck, buster." Barbara:         No, I don't think it's that hopeless.  I think that a man can make some plans.  I think he can make dinner reservations.  I think he can bring her flowers.  I think he can do some things that are creative that will communicate to her that she's special, she's unique – "I love you, I'm willing to sacrifice for you."  But he needs to do it without the expectation of whatever it is his purpose is, because – see, the verse that I go back to all the time, as we've had these talks through the years – is I go back to the verse that says, "Husbands, love your wives as Christ loved the church."  And Christ gave himself up for the church.  He denied Himself, and I think when a woman sees that her husband is denying himself for her, she responds to that, just as the church then responds to Christ, and I think she sees that sacrifice, and she understands that it's because of love.                         But when a woman sees a husband doing that for what appears to her to be his own personal need, then she feels somewhat manipulated or somewhat controlled or less valued.   Dennis:          Used. Barbara:         Used – I mean, I think it complicates things, because I think that her ultimate need is to be loved as Christ loved the church and be loved unconditionally, and I think when she feels that, then she understands that commitment and that trust, then she can respond to her husband as he wants her to and as he needs her to, but it's just not as easy as bring home flowers and light the candles and have a dinner and A+B=C. Bob:                But I'm not even talking about her responding to his need necessarily.  I'm saying – let's say a husband with the purest of motives says, "I want you to feel special next Friday night, so I'm going to get the sitter, I'm going to take you out to dinner," and he's out with her, and it's just not happening for her – for whatever reason, she doesn't feel special, she doesn't feel warm toward him.  Maybe it's been a bad week.  Well, the husband is sittin' there goin', "This was a waste of time and money, because she doesn't feel special.  What do I do now?  I tried the babysitter and the dinner thing, and that doesn't work." Barbara:         Well, it may not work because of the circumstances but, see, he needs to understand his role is to continue to pursue his wife, and he may need to say to her, "I'm sorry this didn't work out.  I just want you to know I love you, anyway, and this may not have been good timing on my part" or whatever, but I think that part of the challenge for a husband is to understand his wife and understand what communicates love to her and figure that out and then do that. Dennis:          And if what communicates love to her is surprise, then that may be what you've got to heighten in that situation.  I mean, just setting down and spending some time – having fun over nothing of any significance but just spending time together and maybe talking as we play a game. Barbara:         Well, the reason that is helpful for us is because we sort of exit the world of reality in a sense and so often it's the pressures of real life and all the responsibility that we feel, especially as parents, it's such an ongoing thing, and I think that suppresses a relationship.  It suppresses romance, it suppresses interest in one another in doing something that is frivolous.  And I think "frivolous" is a good word that needs to be involved in the discussion of romance, because it's often the frivolous things, which we think of, naturally, as flowers and candy and dinners, but it could be something like taking an hour in the evening, when you really need to be doing the laundry, or you really need to be doing something else, and the two of you sit down and play a game of spades or something.  So I don't think it has to be expensive, it doesn't have to be planned out necessarily.  It can be impulsive. Dennis:          It's those things that we did when we dated, and a lot of things we did when we dated were dumb things. Barbara:         Well, and they didn't cost much because most of us didn't have money when we dated – so a lot of times we did things like picnics.  You and I did that a lot. Dennis:          And I think what happens when you get married is you fall into a rut, and you stop pursuing your spouse – men do – they think they've got her all figured out, and that insults the wife when she begins to feel like it is A+B=C, and then what he's gotta do is, he's got to pull back and go, "Now, wait a second, how can I court my wife?"  And even I find it's interesting, when Bob asked you what's the most romantic thing I've done recently in our marriage that you would pick a day where there was no – what I would call "enchanted moment" – of carrying her off to the castle.  It was a day of relationship and a time of friendship – Barbara:         – and it was focused on me and what I enjoy, and that might not be what you would enjoy, and that's what made it – that's what made it special, because that might not have been what you would have picked, but that communicated to me that you were willing to deny yourself and to do whatever I wanted, and that speaks volumes. Dennis:          What would you say to the husband who doesn't understand his wife?  He's not a good student.  He perhaps has heard 1 Peter 3:7 – "Husbands, live with your wives in an understanding way," and yet, let's say, he's been married six to 10 years, and he still hasn't gotten it. Barbara:         Well, I think it's okay.  I really think that it is a long, lifetime process, and I – Dennis:          – I'm glad you said that, because I haven't gotten it in (inaudible) – [crosstalk]  Barbara:         – well, I just think – you know, I just think that you and I, in our marriage, have continued to discover things about each other, and we've been married over 20 years now, and I feel that way, and I know you have felt that way, and I think it's just a lifetime process that God has us on of getting to know each other and, as we're changing, we're going to find out new things about each other.  So I would just encourage husbands to not give up and not lose heart and instead be encouraged by the challenge, because you wouldn't want to marry somebody, really, if it came right down to it, if you could figure her out that quickly.  I mean, I would think that a man would want – that that would be a challenge to him, to his manhood, to think, "You know, there's a lot about this woman that I don't know, and I've got years ahead to figure it out and, God, help me do this." Bob:                Well, and you've hit on a big thing, because it is a challenge to his manhood, and if he's going for long periods of time feeling like, "I'm not winning at this," he's feeling like less of a man if his wife is not responding to anything that he is doing to try to spark romance and, again, we're not just talking about how he views romance, but he's just trying to make her feel warm and appreciated and affectionate. Barbara:         Mm-hm. Bob:                And he doesn't seem to be getting it, and he goes, "This is a challenge to my manhood.  What's wrong with me?"   Barbara:         I think part of it is understanding that a woman is not going to be easy to understand, and I think he needs to pursue her and say, "What can I do to let you know that I love you?  What communicates love to you?"  And that's a question that Dennis has asked me lots of times and sometimes I don't even want to talk about it, which isn't very nice, I suppose, but I think that's a good question for husbands to ask their wives  -- what communicates love to you?  What is it?  And she may not have an answer right off the top of her head.  She probably hasn't had time to think about it, but that communicates that he is interested in meeting her where she is with her needs, and I think that will begin to open up some dialog, it will begin to communicate to her that he really cares about her, and he's interested in her, and that's how you gain understanding – is by talking and asking and pursuing and spending time together, and it isn't going to come real easy.  It's going to take some time, though. Dennis:          And there's another side to that question, too, that you've taught me – because sometimes what communicates love to you, you may not feel loved as a result of what I've done, and that's a tremendous puzzle to us, as men. Bob:                I'm not following – what are you talking about? Dennis:          Well, I think, as men, we find out what communicates love to our wives as we create this checklist again – A+B=C. Barbara:         Again – yeah, right. Dennis:          And we're doing the things where she should feel loved, and the reason she's not feeling loved is because she senses we're pushin' the buttons, and our heart's not in it.  Am I saying that right, honey? Barbara:         Well, I think that's right.  I think anytime she feels like she's been figured out, you've had it.  That sounds awful, it really does. Bob:                But it's true, isn't it? Barbara:         Well, I really do think it's true, I really do, and it's not that she doesn't want those things done again.  It's not that you bring her flowers two or three times, and she loves it, and then, all of a sudden, she feels like she's been pegged, and she doesn't ever want be gettin' it for the rest of her life, but I think that there needs to be variety, there needs to be creativity.  She needs to feel like he's thinking about her in different ways at different times and not just the same old prescribed pattern. Bob:                It sounds like there is an inherent distrust of men by women that you're always suspicious of our motives. Barbara:         Well, it may be, I don't know. Bob:                Well, maybe – Dennis:          – I think there is. Barbara:         Well, I don't know that you can say that about all women.  That's why I said there may be.  I think that, for sure, there is an inherent distrust in very many women today.  There have been too many abuses, whether it's happened to a particular woman or she's just heard about it.  There have just been too many stories, too many actual things that have happened for women not to be just a little bit skeptical.                          Now, I don't want to say that's true across the board, and I think there's varying degrees of mistrust, but I do think that is an element in many, many women's thinking.  So I do think that is true in many cases. Bob:                Well, if you feel secure in terms of Dennis's commitment to you, right, that's unquestioned.  You know he is committed to you. Barbara:         That's right. Bob:                Is trust still an issue? Barbara:         Well, see, I think that the commitment has to be tested.  See, I think women – it's like – years ago I remember Dennis sayin', you know, that he loved me.  I'd say, "Well, I know you do, but you're supposed to.  You're my husband."  You know, and it's almost like we begin to feel, after a while, that he has to say these things or he has to do these things because he's stuck with you.  So, in a sense, I think a woman wants to say, "Okay, I know you're committed to me, but are you glad you're committed to me?  Would you do this again?" Dennis:          Prove it. Barbara:         Yeah, I mean, do you really love me?  I mean, you say you do, but do you really love me?  I think it needs to be – I think, as she grows older and her life changes, there are so many issues that she continually faces as her life changes, that she needs to see, again and again, from her husband, "Yes, I'm committed to you; yes, I would marry you all over again; yes, I love you," and then he needs to demonstrate that in different ways.                         So, yes, I know Dennis is committed to me, but I have needed for him to prove that to me in many different ways at many different times.  And on the issue of trust, I think that is a parallel issue with commitment.  Yes, I trust him, but I've needed to see that he is worthy of trusting – that I can trust him with my life.  And I believed that at the beginning, when we first got married, but just as I've had to sort of test out the commitment through the years, I've sort of had to test out that trust factor, too, if that makes sense. Bob:                Yeah, you know, Dennis, it sounds like one of the things Barbara is saying here is that there will be seasons in a marriage, where, in spite of the awareness of the commitment, you know that you know that your husband is committed, but you feel like he's committed out of duty or obligation, not because he really wants to be committed to you, and those can be difficult seasons for romance. Dennis:          Yeah, but what you gotta do is move on through those, and what a husband especially needs to know is that he needs to be communicating that he is worthy of his wife's trust, and he needs to communicate to her that he loves her for who she is, not for what she can do for him, and what a wife is really expressing during those times, at least what Barbara has communicated to me, is that she just needs to feel like I love her, Barbara Rainey, for who she is as a woman and just set her apart from all other women in the world. Bob:                Well, on tomorrow's broadcast, more insight from your wife, Barbara, Dennis, on how men can understand a woman's view of romance, and I hope you can join us for that.                         Our engineer is Mark Whitlock, our host is Dennis Rainey, and I'm Bob Lepine.  We'll see you tomorrow for another edition of FamilyLife Today. (Music:  "How To Handle A Woman")                         FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.  __________________________________________________________________We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, would   you consider donating today to help defray the costs?  Copyright © FamilyLife.  All rights reserved. www.FamilyLife.com     

Imagine if you will, the following scenario. You’ve volunteered to take part in a psychology study, say, at your university. All you have to do is show up to the lab, sit by yourself in a little booth and play a very simple game of chance, something like flipping a coin, where there's no skill involved, only luck. You get paid one dollar just for showing up, that’s guaranteed. And if you’re lucky and win the game, you’ll get paid 5 dollars cash. But if you lose, you get nothing. Here’s the kicker: it's up to you to tell the researchers if you won or lost, they won't be able to tell. So there are three possible outcomes: you can win and get 5 dollars, you can lose and get nothing, or....you can lose, but lie and still get the 5 dollars. And nobody will know. What would you do? What do you think other people would do? As it happens, a recent study just looked at this, and there was a cunning little twist: those crafty researchers actually DID know if people won or lost. So they also knew if people told the truth about it or if they lied. The study, called "Cheaters, Liars, or Both? A New Classification of Dishonesty Profiles" is absolutely fascinating. And today you'll hear a conversation ‒ in American English – with some people discussing it. The conversation is from one of my favorite podcasts, The Skeptics' Guide to the Universe. It's a podcast featuring smart people having interesting discussions about science, technology, and critical thinking. If you are at all interested in those topics, I highly recommend it for your English listening practice. This is definitely a show that will make you smarter, and will teach you lots of vocabulary. The episodes don't always have transcripts, but I've transcribed the part you're going to hear today and put it in the show notes, which you can find at betteratenglish.com/transcripts. You know, if you like, you can turn this episode into a more challenging task for yourself. In the show notes you'll also find a link to a New York Times article about the study. In the conversation you'll hear a woman summarizing this same article to her friends. So before you continue listening, you can hit pause and go read the article yourself. Then imagine how you might summarize it for friend and what you might discuss. What language would you use? What vocabulary would you need? Spend a few moments imagining how you might talk about it with a group of friends. Then listen to the rest of this podcast and compare your ideas with what you hear in the conversation. All right, let's get to it. You'll hear a woman named Cara doing most of the talking. She explains the study's findings to her friends Steve, Bob, Jay, and Evan. They they all discuss what they make of it. Are you ready? Let's go: TRANSCRIPT PREVIEW Get the full transcript here Steve: All right, Cara, you're gonna tell us about the psychology of lying and cheating. Cara: Right! So this is a field of psychological inquiry that goes back basically to the beginning of experimental psychology, right? Psychologists, psychologists have always been interested in deception. So a new paper said, OK, well, we want to do is we want to see if we can sort of beef up and retest some old concepts in the kind of construct of lying, cheating deception, but we want to go beyond that. And we want to say, Okay, this is not an all or nothing phenomenon, right? Like, you could say, That person's a liar, or that person lied, or that person's a cheater, that person's dishonest, but there are shades of grey, aren't there? Steve: Mm hmm. Evan: Of course, of course. Bob: Yeah, absolutely. Little white lies. Cara: Totally. There lies that actually help us. Bob: There are lies that actually get people killed. Cara: Yep. Lies to get people killed and lies that we can't help but but commit, that's not a good word. But tell? Yeah, because they're the only they're the best of a bad situation we're dealing with or something like...

Philanthropy Misunderstood by Bob Hopkins The word PHILANTHROPY isn't new, but many think being a philanthropist is about money. In Bob Hopkins' new book, he assures us it IS NOT. He and 100 of his friends define, by way of their good deeds, that philanthropy is about LOVE OF MANKIND. Philanthropy Misunderstood is a 256-page coffee- table book that will surely entertain and inform you. You won't want to put it down. It is colorful and exciting. “Bob Hopkins Introduces us to 100 plus new best friends…people like you and me who give of themselves who actually LOVE others. What a joyful time Bob shares with us. Optimism and hope emerge from every page. Each person's story sparkles. Each one makes us prouder to be fellow ‘homo-sapiens'.” Dr. Claire Gaudiani, philanthropist, author and international lecturer. Bob recalls his first experience with his mother when he was five years old in Garden City, Kansas as they delivered groceries to a poor family during the holidays. He remembers the pat on the back he received from someone for doing good. “Maybe it was God,” he recalled. For more information, go to Philanthropy Misunderstood.   Read the Interview Hugh Ballou: Greetings. Welcome to this episode of The Nonprofit Exchange. Wow. This is going to open your mind to a whole new world. I just met Bob Hopkins recently on a recent trip to Dallas. Some of our previous guests that started Barefoot Winery said, “You have to meet Bob.” When I was in Dallas, I rang him up, and we met. They had shared his book with me called Philanthropy Misunderstood. I thought it was a nice book. When I started digging into the stories and what Bob knew about philanthropy, I said, “We have to share this with other people.” Bob, welcome to The Nonprofit Exchange. Tell people a little bit about you and your passion. Bob Hopkins: Thank you, Hugh. I am so honored to be invited to be here with you as your guest today. I am glad to know that there are some other people in the book in your audience today. I am an older person. I have been around for a long time. Every 20 years, I ask myself, “What am I doing, and where am I going?” I have divided myself into four different segments of my life. I am on the last 18 years. I give myself another 18 years to live. I am trying to figure out what to do, so I am probably going to go to a seminar called PSI in June to find out what I'm going to do next. But, Hugh, I have been involved with this word “philanthropy” for the last 45-50 years. I learn more about what it means all the time. Then I became confused and realized that what I thought philanthropy was is not. Or maybe it is part of, but that's why I had to dig into it and tell stories of 108 people who actually do philanthropic things for other people. That's what this book is about. Hugh: How long have you been engaged in the nonprofit arena with leaders and different kinds of organizations? Bob: I came to Dallas in 1984. I had just been involved as the director of development on the National Council of Alcoholism and learned all about this word called “fundraising” and philanthropy. Found out that the two of them are together as one word and one meaning, and they are also separate things. Some people get them mixed up. They think that fundraising is about money, but so is philanthropy. I have learned that philanthropy can be about money, but largely not. Instead, it's doing good things for others. That's how I got involved with this. I have been in Dallas for 38 years, and I have been working in raising money and now writing a book. I did a magazine called Philanthropy in Texas for a while. Every decade, I learned a little bit more about what that word means. Hugh: Bob, you and I are in our mid-70s, we'll say. We could be sitting back, chilling, and not doing anything. But you and I have a passion for being engaged. Why aren't you sitting around? You're teaching classes, and the stuff that you're asking your students is really profound. You're active with some local charities still. Why is this important to you? Bob: I don't know. I do it because I don't know what else to do. I do play tennis, and I do ride horses. Those are two of my hobbies. I do spend time doing those two things every week, so it's not like I'm constantly thinking about philanthropy, even though I have a horse named Philanthropy. I watch the USTA, and did you know the USTA is a nonprofit organization? They wouldn't survive if they didn't get contributions from people. They do good for others. I guess I'm involved with philanthropy pretty much all the time, even though it's my joy. I love doing it. I like talking about it. I like telling people about it. I like finding people who are doing different new things. I have found so many people over my 40 years that I decided to put them in a book. That's where Philanthropy Misunderstood came from. Hugh: I've had the joy of visiting a couple. The whole family does this water project. I won't get into it, but I want you to tell people. You called them up and said, “You have to meet Hugh.” I went over there, and it was an amazing visit with the whole family. I met the couple. I didn't meet the kids, but I have heard about them and their involvement. How about highlighting some of the stories? Let's talk about this one first; they will be guests on the show in June. It's folding paper. How does that help people? Bob: This is a crazy story, and it's a fabulous story. It's been so fabulous that it's been on Good Morning America. Neiman Marcus actually helped these girls sell these ornaments that are called origami that they make. Their church and schools make them with them. They have volunteers of hundreds of people who do nothing but help make origami, and they sell the origami for $50-$75 a piece. To date, they have raised over $2 million building water wells to actually give water around the world. 170 different water wells in 17 or 18 different countries. These girls are 15, 13, and 10 years old. They started it when they were 4, 5, and 6 because Daddy is part Japanese. He said, “We need to do some origami.” One thing led to the other. I'm not sure what the other is and how detailed you have to get in to find out what the thinking was of the parents, about involving their children in making these origami. That's their life. It is now their life. These girls are so smart because they are in a business. The 15-year-old is the president of the foundation. It's a cool thing. Hugh: I went to visit the whole house and the project. These volunteers come in to do the folding. It's engaged people in a focus. I don't know if the people come in and do that right now, but maybe the family can do more while the kids are out of school. There is another story in here that has a big picture, and it's Bonnie and Michael with Barefoot Winery. They were guests a couple months ago, and they were the ones who connected us. Tell the story about how you got connected and their story in the book. Bob: It's so interesting because Eric is actually the one who introduced me to Bonnie and Michael. He was the marketing director of Barefoot Wine. What Bonnie and Michael did, when they couldn't sell the wine, because nobody wanted to buy it because there was no place to buy it, and liquor stores didn't want to buy it because nobody was asking for it. They started giving it away to charities on the beach in beach towns, mainly starting in Florida. He would give it to them for free, and he said, “If you like it, go to your grocery stores and tell them to buy it.” Long story short, over 15 years, it became the #1 wine in America. Bonnie and Michael did it through giving wine away to charitable causes. I know that they had a marketing plan here. They said, “This is cause-related marketing,” which are words we used to use. They didn't really know it was philanthropy because they really wanted to sell wine. But it also made them feel good, too. I have taken Bonnie and Michael on a philanthropy trip to Mexico. So I got to watch them in action. It didn't have to do with wine; it had to do with building schools and painting houses for people in Mexico. It's a great story. They are in the book, and they should be. Hugh: The book is what you would call a coffee table book. It is hardbound. It's a $45 book. The quality of printing and the quality of the stories and an amazing layout and design. It should be $100. It's one of these treasures. My fourth book, which you have a copy of, Transforming Power, I teach people how to do things. I got to a point where I said, “Hmm, people want to be inspired by stories.” That's one of the premises behind this show is for people to tell their stories. There are people out there in the trenches who are struggling to make ends meet, to pull people together, to rally volunteers, to rally their boards, to rally their funders. Let's talk a bit about this title and what's behind it. What is the biggest misunderstanding on both sides, the funder and people seeking funding? Bob: It started with me. I was always told that philanthropy was about money. I started a magazine in Texas all about people who had money and gave it away. I would come into my staff and say, “I think we need to do Boone Pickens on the cover of the magazine. And the first question was, “How much money does he give away?” That was the common question. That was whether or not we were going to put him in the book on how much money they gave away. Finally, after a while, I realized, You know what? I know a lot of people who do so much more than writing a check. They're never recognized. I have this incredible woman from Houston named Carolyn Farb who spends 26 hours a day helping people learn how to raise money, but also build a hospital, and do all kinds of things. She is not known to be a huge giver, even though she is a giver; therefore, her picture would not be on the front cover of anything because of money. But it would be because of the word “philanthropy.” I realized, because of Carolyn, that I was talking to the wrong people. I needed to be talking to people who were in the book. The people in the book probably give money as well, but that wasn't what I wanted the focus on. I wanted them to tell me why they do what they do. Why do they build origami and build water wells around the world? They don't get any money for it, and they don't give any money. They give things. Well, they do give money because they raise money in their case. Bonnie and Michael, they give money, too. Instead, they gave wine. Chip Richey gives his time and effort and expertise in filmmaking. He's made lots of films about the Indians and Oklahoma. He did things for me for my philanthropy courses. There is Jordie Turk who was a student of mine, who volunteered on his own dime to come to Dallas and video my launch party. His name is not even on the piece. But he did it. He loved it. He is happy about it. I think that's what philanthropy does, moreso than what money does, is gives you joy. That's what everybody says. I get so much more out of what I did than what I gave. Hugh: Philanthropy is both. We have to run the organization. It's like having a car. You have to put gas in it. But there is a bigger piece to this. It's not money alone. Sometimes, people want to give money to save their conscience. They want to be doing something, and they're not really involved with it. So they want to buy a place. but buying a place and stepping up and working. Talk about the synergy of the two of those together. Bob: I'm a giver. But nobody would ever recognize me as a financial giver because I give $100 or $200 or $25 or $50 or whatever. I'm involved with a lot of organizations. I give not necessarily because I love the organization, but I love the person who is asking me. So I write a check in order to continue this relationship I have with this person as a friend or as a person who works with me. But when I actually take on a project and get my feet dirty and hands wet, and I go out and build something, or I paint, I come back tired, but for some reason, I give myself this secret pat on my shoulder and say, “You did good today, Bobby.” That's what happened to me when I was five years old. My mother and I went to give groceries in a trailer park in Garden City, Kansas. We walked away, and I felt this hand on my shoulder. It was patting my shoulder, and it said, “You did good today, Bobby.” I looked around, and there was nobody there. That is the feeling I have gotten because of giving my time and efforts, as opposed to writing a check to get you off my back to say, “Go. I put my name someplace.” They go, “Oh wow, $100. Thank you so much.” Then they come back the next year and do the same thing. There is just a real difference between the people who are in the trenches and the people who aren't. Hugh: I think it's important to give at any level. You say that you won't get recognized for $25 or $50. But if we get a lot of people who support us with their time, talent, and money—you give your time, talent, and money. There is a triage there that are all magnified by each other. If you have the synergy, if you have one person who gives $25, great. If you have 1,000 people who give $25, then you are paying salary and rent and some operating costs. Then you can rev up the engines and focus on your mission. I do find a lot of charities are compromised in many ways, but as you know, the story of SynerVision is we want to empower leaders to step up to the level that they can take the organization. I noticed some of your students are here from the class, and I want to talk about them as well. There is a synergy in those three. We spend time teaching leaders how to raise the bar on their performance so we know how to engage people who are philanthropic-minded. There is a whole lot of stuff there. Jeff, “Bob has given many of us the gift of learning to give, and it is life-changing.” What a quote that is. Talk about your students. I got to sit in on three classes last week. You're doing this Zoom group session education, which is quite remarkable. Your gracious spirit with them, and you see what's inside them, and you see potential that maybe some of them don't see in themselves. You said to me you challenged them to think about writing a eulogy, but you also mentioned doing some research on a nonprofit organization. There was a need for you to have to explain what that meant. What is a nonprofit organization? Talk a little bit about the class. Bob: I taught at a university here. I was teaching business and professional speaking. I decided I wanted to bring in my love and passion to the course. How am I going to bring my love and passion into the course when philanthropy is not in the syllabus? I included philanthropy in the syllabus. When you talk about business, you are going to talk about nonprofit businesses. They had never heard of a nonprofit business, even though they had. They knew what the Salvation Army and the Red Cross was. They knew what the Boys and Girls Club and Boy Scouts are. But they didn't know they were nonprofit organizations. They didn't know there were two million of them in the United States. They didn't know that half of the things that are positive about our country is philanthropy. I said, “Okay, let's have you all look at a nonprofit you are connected with.” They had no idea they were even connected with one. Landon is a new student this semester in my class right now. You asked him a question and asked him to talk when you were in my class. He did. He has a passion. You can feel it when he talks, about the things he does or can do and wants to do to serve people in our community. What I'm doing is there is maybe a small fire underneath them already, and I'm turning up the heat. They get passionate about it, and I empower them to do something about it once they learn about the fact that they can do it. They can do something on their own. Landon is one of those. He has several physical problems, and one of them is with his eyes. He picked a nonprofit organization that had to do with sight. He loves being involved with something he can connect with and understand. We all do. We all can. I am attention-deficit. There is a nonprofit organization and a school that has to do with children teaching children about dyslexia and Attention Deficit Disorders. There is something I can do. There is something everybody can do because we all have something that we are connected with, and we just didn't know it. Hugh: I was going to come in and say hello, and I stayed the whole class for two of them. We are recording this in the middle of being sequestered home. It's a time of refreshing, renewal, revising, and thinking about how when we go back to work, how we are going to define the new normal. We are leaders. We will reset the bar. I don't think we're going to go back to what we did before. Most of the people in the book didn't do things in ordinary ways; that's why they are in the book. These stories will inspire others not just to do the same old thing that they always had observed, but to think about what they bring to the table that's really special. What is the new opportunity? Bob, let's dig into some more of these stories. The book is divided into sections. Talk a little bit about why that is and why that's important. Bob: I had some great people working with me. Tom Dolphins from Kansas City designed the book. The book is so attractive that people want to find out what it is. It's not just the words, but it's the design. And Ann Vigola from Lawrence, Kansas started out as my editor. She happened to be a student of mine prior to that. Ann spent a lot of time figuring out how to organize this book because as being an attention-deficit person, I have all this information up here. I didn't know how to organize it. It was organized starting out with topics. We did One Day at a Time because I am a recovering alcoholic, and I wanted to talk a little bit about that topic. One Day at a Time also had to do with the AIDS epidemic. I had a brother who died of AIDS, and I wanted to focus on that. Every person in here has had something to do in my life. People would say, “You didn't do so-and-so. They are such a great person.” I said, “I know, but I didn't work with them.” All of these people, I worked with. All the stories in here, many of them, I had something to do with. Chip got me involved in the Phoenix Project, or maybe I got him involved, which was helping warriors coming home from war, connecting them with their spouses on retreats with horses and massages. Chip actually put together a video about this whole thing. I was involved with that. I went to the sweat lodges with these warriors and watched them connect and relate to each other. They are all stories I have been involved with in one way or another, and that's one story I like a lot. Jordie worked with me with the poorest of the poor kids in Mexico in Guanajuato, Mexico, Leon. We would go to the poorest school, and I would tell the teachers, “I want to take your kids for just an hour once a week and bring in 20 of my students. We will teach them philanthropy.” We watched children change because of a handshake. Jordie was able to volunteer his time, even though he was a student of mine, to put this fabulous piece together that is on YouTube. These are all stories we were able to capture. I wish I'd had these two men together with me for all of the stories because somebody's contacted me and said, “We need to make a movie here with these short stories.” Some of them still have long-lasting things. One of the people in Mexico said, “Just teaching a child to do a handshake and watch her change as a person week after week after week has changed me as a person,” she said. It does. When you do philanthropy, it changes you. Hugh: That's a great sound bite. Serving churches in music ministry for 40 years, I took many mission trips. We went to give them, but we came back having received a lot more than we tried to give away. There is a reciprocity to giving. You're a giver, but you're blessed by your giving. You're enriched by your giving. You give stuff away, but it really impacts you. When I am with you, you're just full of energy. You're this most passionate energized person purposeful person. What more about the book? Was there a story here delving into their story for the book, that really moved you more than any other story?   Bob: Yeah. We took a vote in our little group who put this book together, Ann, Tom, and I. There is one called “Bridging the Gap.” It is written by Morgan Herm. He is a schoolteacher. He talks about a bridge that is in Pennsylvania, where he lives. He would go and meditate there. On this bridge, he noticed that somebody had put in a letter between the planks. He opened the letter, and it was a letter that a person had written about them being able to become at peace with themselves because of meditating on this bridge. He put the letter back. Then there was a collection of letters that people would put in about how this bridge had brought them peace. It helped them through their divorce, or it helped them through their domestic violence. Morgan finally built a mailbox so people could put their letters in the mailbox. They could read each other's letters. That's philanthropy. That bridge serves as a philanthropic metaphor or example of peace and love. That's one of my favorites, and it's written so well because Morgan is an English teacher and writer. Hugh: Each contributor wrote their own story. Bob: They wrote their own stories. There was a couple of them that I wrote. There was a woman named Ruth Altschuter in Dallas who died last year. I wanted her in the book. So I went to her husband and said, “Would you write this for me?” He said, “No, I can't write anymore. I don't write.” I said, “Let me write Ruth's story, and you approve it.” He said okay. But most people wrote their own stories. One lady wrote a story that I told her should be 1,000 words. It was 5,000 words. I read it and realized I couldn't cut anything out. It's the history of Swiss Avenue, which is one of the oldest historic districts in the United States. She called it, “Philanthropy Built Her Neighborhood.” It's about how the mansions and big houses on Swiss Avenue became run-down in the ‘30s, ‘40s, and ‘50s. You could buy a piece of property here for $10 or 25,000, which are now going for $2 million, back in the old days. She wanted to tell the story about how it became a fabulous neighborhood that is looked upon as one of the premier places in the United States. It ended up being 10 pages, and I left the 5,000 words. It is the longest story. It wasn't meant to be that way, but it's really well done, so I didn't cut it out. Hugh: You said here. Is it in Dallas? Bob: Yes. I live in that district. I live in the Swiss Avenue historic district. Hugh: Wow, that's fascinating. Landon has a question. Landon, you're live, so if you have your mic on, do you want to talk to us? Landon Shepherd: My question is, let's say I have an idea for a nonprofit I would like to start. But I don't really know exactly how or where to start it, or who to talk to about getting started with what I want to do. What would be your advice to some of the students who may have these ideas, but don't know how to work out these ideas? Hugh: That question is for your professor? Landon: Either one of you guys. Hugh: We'll tag-team on it. Go ahead, Bob. Bob: He's a student of mine, and I will definitely have a talk about that. But we have in Dallas and in Fort Worth and every major city in the United States a center for nonprofit management. The centers for nonprofit management in each of the major cities are where people can go learn about giving and learn how to start an organization, a 501(c)3, the who, what, when, where, why. They have seminars all the time. You can go to the Community Foundation of Texas. You can go to the Dallas Foundation. These are other avenues of where people are experts in this. Yes, there is a way to do that. Landon, I will tell you who to contact here in Dallas. Hugh: There are centers like that in every city. There is also a universal presence called SynerVision Leadership Foundation. We have a blue button at the top of our page labeled, “Join.” We have this community with all kinds of resources. Sometimes, we find how to do strategy or how to do leadership or how to do fundraising or how to do a brand or marketing. We put it in one contiguous process so you don't have to look around. You can look at our site and see if that suits you. Combine working in person with one of these centers Bob is talking about. That would give you a leg up. Bob, I know half of the nonprofits started each year will close ultimately. My take on it is they haven't done a good job of looking at the market to make sure it's not being duplicated, and they haven't really activated their board and set themselves up for success. What is your idea of why some of those close? Bob: You're right. They usually are started by people who don't have any information. They have a passion, which you have to have for the topic. People who have cancer, they want to start a nonprofit organization that has to do with cancer and raise money in the name of somebody. The Susan G. Komen Foundation was started by Nancy Brinker here in Dallas because her sister Susan G. Komen had breast cancer. She told her before she died, “I am going to find you a cure for this.” What Nancy did was she surrounded herself with experts who knew how to put together a nonprofit. Now, it is the best one in the world. I can tell you five or six right off the top of my head that didn't last for more than a year because they didn't have a board of directors, they didn't know how to do their paperwork, they started raising money without knowing how to be a fundraiser. Let me tell Landon and everybody this. There is an association called the Association of Fundraising Professionals (AFP) in the United States. 35,000 professional fundraising people. I was a member of this group for most of my years as the president here in Dallas, and went to all the major conferences. There are conferences every year with AFP. There is a luncheon in most major cities every month that bring together all the people who raise money for the nonprofits in any city. There is a program with a speaker. It is a time to network, the people who have been there and done it before. That's how you do it. Hugh: Building a network around you. There is a peer-to-peer network, which is great, but you want to have a network of people who are even better than you. In my case, it's not hard to do. But hang around people who have been there, done that, and are experts. We have Jeffrey Fulgham watching who has a question. I want to allow you to talk. Jeffrey has been a member of that and is a certified fundraiser. Why is it important for you? You went through the certification process and studied development for so many years. Do you want to comment on the organization and why it's so important for people to understand now? Jeffrey Fulgham: I have always looked at it as a cliché of the good housekeeping seal of approval. I think this gets more important every day. This needs to be a profession, and it needs to be professional, not just in fundraisers but in nonprofits. There has to be some standard. We hope it's a standard of excellence, but there has to be some standard by which people can look and say, “Okay, this is an organization, or an individual, who is committed to certain principles, certain basic values, that transcend whatever it is that that organization is involved in.” Obviously, there are certain organizations whose values are going to be different than another one. But those values are related to the mission, not the operating strategy or the integrity of the entity or the integrity of the individuals working within it. What it allows us to do is create that standard. When someone looks at an organization, they have Guidestar to go to and the other metric organizations. But they also have a way to look and say, “Hey, this is what these organizations support. These are the values they support. This organization belongs to them and subscribes to these values. They subscribe to certain values. They set the standard.” Of course, the CFRE sets the standard as well. I think it's important for people who are giving, but also for people who want to get involved as volunteers, who want to go work somewhere. Do you want to work for an organization who subscribes to certain values and has that level of integrity? That's the main reason why I think it's all important. Hugh: Great. Before I let you go back into your listening mode, do you have a question for our guest today about philanthropy or about his book? Jeffrey: You know, that's the first time I've heard of this book. I'm definitely going to have to get a copy of it. I think it's really interesting that you mentioned that philanthropy is not necessarily about money. I always tell people that fundraising is not about money; it usually ends in money, but it's about relationships and about creating relationships that are long-lasting. Those relationships should transcend the money in that just because in a bad year, and we're having one by the way, where people are not going to make gifts to organizations they care about because they have to take care of their families and their friends. They will give more money to their church. They will make hard decisions about who they are giving to. If that person doesn't make a gift to my organization but they have been supporting me for 20 years, do I abandon them and ignore them because they are not giving money through our fundraising? No. Because I have a relationship with them that transcends their financial giving, or possibly their volunteerism. It becomes a different thing. Philanthropy is definitely a mindset beyond money, and I love that you are bringing that to the surface so people can understand what it's about. Hugh: I'm glad you asked me where to get the book. There is a website called PhilanthropyMisunderstood.org. You can find out how to get the book there. Bob: Thank you, Jeffrey. I want to know more about you as well. I am a member of AFP and of CFRE as well. There are a couple of people in the book who are CFRE, Scott Staub and Alfonse Brown. They have great stories in there not about fundraising. As you say, it was about relationship-building and the volunteerism they participated in as well. Hugh: Not everybody wrote a story in there. There is a story about a horse. Who wrote that? Bob: I wrote that one. It's my best story. I wanted Philanthropy to be on my front cover, and Philanthropy happens to be my horse. This woman by the name of Tracy Carruth, who is a big philanthropist in Dallas, breeds horses. I happen to have an Arabian horse. She breeds Arabian horses. Napatoff, who is her most beautiful world champion horse, was retiring. Before he died, or left the breeding ring, she wanted to make sure that I got an offspring from Napatoff. She gave me the semen from Napatoff to go into Sherry Rochesta, who was my Arabian. Through that, we got a beautiful horse that I named Philanthropy. I wanted to start that as my first story. My editor didn't like it, so we put it into the back. I am there with Tracy Carruth and our horses. That's the story. Hugh: The standards for everything, the quality of the writing and the photographs, the design of the book, all of these sections in the book. You start out with Circle of Influence. Jeffrey headed us that way. It's not about money; it's about relationship. When you and I had lunch recently, we talked about relationship. You now have a relationship with all these people, and they wanted to be in your book. Why is relationship important to our work? Relationship in our teaching at SynerVision, it's the underpinning of leadership and ministry, and it's the support for communications. Funding and philanthropy happens as a result of relationship. Say a little more about relationship and how it's important. Bob: Debbie Mrazek, who is one of the writers, wrote a part in the book called “Your Circle of Influence.” Who are all those people who will take care of you, who will take you to the airport and lend you sugar and tell you where to get the plumber? I had my students write down 100 people they know, wheedle it down to 25, and then 15 who will be in their circle of influence. I teach networking. It's not what you know; it's who you know. That's the first thing and last thing I say in my classes. My students, I say, “How many people do you know?” They didn't know 100 people. One of them knew seven. My family members. No, I don't want to meet anybody. No, I don't need people. I said to the class, “I'm going to take students to Nepal. It will cost $1,500. How many of you can raise the money to make it happen?” I went to this girl who said she knew seven people, and she didn't want to know any more people. She said, “I don't know anybody. I don't want to know anybody. I guess I'm not going to Nepal.” I said, “I guess you're not.” We took people to Nepal because my students most of the time realize that they have a great number of people around them who care about them, but there is a methodology of how to influence people and how to cultivate people and how to get them to be your friends, and more than friends, how to be a good friend, how to help people, and actually go around hunting for things to do for people. That's what I want my students to become. I don't think that we get anywhere in life without others. That's one of the key principles that I teach in my communication classes. Hugh: Your class that I sat in on is really about communications. You're really promoting good thinking skills. Communication to me is based on relationship. We can send a whole bunch of emails that nobody reads. It's not about data. Bob: No. I send emails, and I pick up the phone. We used to send faxes. We used to go knock on their door. We used to drive by. I think that this time right now, we're trying to figure out how to continue life in solitude since we are told to stay home, and stay home alone. I think we're finding this television and this computer even more important than ever since this is how we're able to stay in touch, through this cell phone we love so much and this computer. However, I can go next door and knock on the door and take them a cake and say, “I was thinking of you and realize you may not have any desserts at your house today.” Sometimes, I'll have my lawnmower man come out and next door, they don't mow their lawn very much. “Go mow their lawn. I'll pay you.” The people come home and say, “I can't believe you had somebody mow my lawn.” It was a philanthropic idea I had, was to love mankind and do something for the person next door. Hugh: Bob is an inspiration. My ideas are popping. You have 100 creative ideas every six seconds. You're prolific. In these stories, 100+ stories from people who helped change the world. We are all doing our part. It's not one person. But one person can start a movement. My friend in Lynchburg, he was the person who founded Stop Hunger Now, which is now Rise Against Hunger. Before we had a setback with coronavirus, they were on target to package 750 million meals. Their vision is to end hunger in our lifetime. It's not just about packaging the meals; it's about a lot more than that. One person thought of that and founded it, and it's now a major movement that will exist long past his lifetime, which is what he wanted. It's a legacy. What are the legacy possibilities for any of us who say, “I want to do something for humankind and have it keep going?” Are there possibilities for all of us? Bob: I always say, “What are you doing for the person who just passed away in your life? What will you do for your mother? What will you do for your father?” I got involved with building schools in Nepal with Don Wilkes. Let me tell you about Don Lueke since he is here. Don Lueke is from Kansas City; he and I met probably 30 years ago because he taught children at his school about giving. It's the Junior Leadership. It's similar to my PAVE program (Philanthropy and Volunteers Education). For the last 15-20 years, he and a man by the name of Steve O'Neill, who are businesspeople in Kansas City, take time out of their week every week to teach children at the Catholic school where their children go about giving back. This has become so sophisticated that this last year, I was a part of a seminar they had at the University of Missouri in Kansas City, where all of his students, maybe 30 or 40 of them, came and gave presentations on nonprofit organizations they had helped in the community. He does similar things to me: empower young people to get involved in the community. There is a double page about him and this group he is doing it with. Don Wilkes in Nepal for example. What can you do to honor somebody? He said, “If you can make a contribution of a couple thousand dollars, we will put someone's name on a classroom in a school we are building in Nepal.” I called my brother and sister and said, “For $2,000, we can put our mother's name on a classroom in Nepal.” My brother says, “I want to see a video of what it looks like.” I sent him the video, and he called me back immediately and said, “Let's do it.” My sister said, “Sight unseen, let's do it. We want to honor our mother.” For $2,000, our mother's name is on a school's room in Nepal. I know because I went to Nepal to see it. I had to go see my mother's name. When I got out of the car, and the children were clapping for me because I was amongst them, because I gave a simple $2,000 and put my mother's name on the deal, gave me such joy that we decided to do it again. I put my cousin's name and my aunt's name in another classroom on another school they are building in Nepal. That is a way you can provide not necessarily for yourself, but for somebody else that meant a lot in this society. Everybody we run around with meant a lot in this society. They did something in their lives that changed the world. Hugh: Absolutely. That's an inspiration. Are you willing to entertain questions if I open everybody's mic? Bob: Absolutely. Eric Groover: Bob, this is Eric Groover from the University of North Texas. How are you doing, Bob? Bob: Hi, Eric. It's good to see you again. Eric: Hugh, I just want to say thank you for hosting Bob. Bob and I are new acquaintances through some of our students at the Texas Academy of Mathematics and Science here at the University of North Texas in Denton. Just north of the DFW metroplex. Bob was actually scheduled to come speak to some students on our campus last week, and unfortunately we had to cancel that. Bob was gracious enough to bring up some of the books that we purchased for our students and faculty and staff. We spent a few minutes violating the university's shelter-in-place order, visiting in my office for 20-30 minutes. I just wanted to say, Bob, that it's been lovely watching you today and hearing your stories again. Just a huge thank-you to Hugh for hosting this event. He does you credit, and I'm glad for that. Thank you very much. Hugh: Thank you, Eric. Blessings. Nancy Hopkins: This is Nancy Carol Hopkins. Yes, I am Bob's sister. I am watching from Tucson, Arizona. Obviously, Bob has been an influence in a lot of people's lives, including mine and our younger brother. I wanted to make a comment on the volunteerism point. First of all, Bob gets asked frequently how come he stays so young and is so active at his age and has so much energy. If you look up and do some research on volunteerism, there is a lot of research that shows that volunteerism actually helps you medically, emotionally, physically, keeps you young literally. It does. There is medical research to prove that. If anybody wants to know how Bob stays so young and energetic, it has nothing to do with vitamins and pills he is taking. It has everything to do with the work that he does. Hugh: Very helpful, Nancy. Thank you so much for being here. Thank you for sharing that. Nancy: You're welcome. Hugh: You don't have to take tonic if you hang around Bob Hopkins. Nancy: That's right. You don't. Hugh: That's so rich. By the way, our governor slapped a stay-at-home order on us until June 10. The exception is volunteerism. If you volunteer for a charity, you can get out and do it. That was a good thing, I thought. Penny Rambacker: Hi, this is Penny Rambacker. How are you doing, Bob? Bob: They said Penny. I was hoping it was you. Penny: I'd like to make another comment about the idea of having purpose. I think Bob has a purpose, as many of us philanthropists have. I have been reading a book recently that said two of the things you can do to be the happiest in life are 1) to have a purpose and to feel needed, and that keeps you young and alive, and 2) is to be grateful. Those of us that practice gratitude and appreciate what we have are oftentimes people who are giving because they have seen other people with greater needs than their own. They become grateful for all of the things they have in their life. I had a huge gratitude lesson back when I first got into this. That was when I visited the garbage dump in Guatemala City. I saw children living there. It really touched my heart, and I had to do something about it. I found my purpose, and I felt grateful for the life I have. Two good things to think about when you are doing philanthropy. Yep, that's me and my kids. Hugh: What page is that on, Bob? Bob: Pages 48-49. Hugh: Love it. Great stories. Penny, where are you? Penny: I am in Naples, Florida. We work in Guatemala. My charity has built 57 schools in the mountains of Guatemala. We also sell handicrafts. We just sent an e-newsletter telling people to visit our store online. It's virus-free. You can go shopping for a greater good. If you want to go shopping, we have great things at Store.MiraclesInAction.org. Hugh: Good for you. I have been to Guatemala, and people are very poor. They have lots of wonderful natural resources. They do wonderful clothes with all these designs that are brilliant. What are you showing, Bob? Bob: This is Don Lueke's page. He is on pages 82-83. Hugh: Don, do you want to comment? Don Lueke: This is a great opportunity to showcase your work, Bob, and the work of everybody in that book. I appreciate the efforts on your part. Just want to add. We talk about having a purpose. I think that is what makes us get up every day, or at least get up quicker. I don't know if I have a lot more to add. I'm humbled by everybody's story in the book, so I think I am just one of many. Hugh: Thank you for sharing. I am humbled being part of Bob's network. *Sponsor message from Wordsprint* Bob, what is a parting thought you'd like to leave people with today? Bob: I am going to do another book called Philanthropy Understood. It's going to be new people. Some of the old people we want to expand upon, too. I'd like to do something with TAMS. I think TAMS is a great program that Eric Groover has been a part of before. There are so many people that I have been thinking about. That's what I'm doing right now, and that's why so many people are here who are in the book because I sent them a memo telling them all that we are needing to stay together on a monthly basis. We did have a man pass away yesterday in the book, Charles Lowe. He has spent 45 years working with the disease called neurofibromatosis, and I worked for them for eight years. I was able to tell all of the people in the book about his passing. So many people responded who didn't even know Charles, but did know his article in the book. I think the more we create this circle of influence around ourselves, the richer our lives are going to be. Also, the kinds of people we depend upon, I always try to find people who are smarter than you who have more things going on for them because they will lift me up instead of running around with people who will pull me down. My challenge to everyone is to continue these kinds of groups, and continue doing good together. That is the real fun about philanthropy and being volunteers. It's a togetherness thing. I did go with Penny to Guatemala, and I loved the experience. She is in the book. I went with her 20 years ago. I included her in the book because that experience changed my life 20 years ago. It's one of those many things that make up a person. It's so much fun going back in my history, in my family. My sister is the greatest philanthropist of our family. She is doing more than me even. I think that's the joy. I don't even say it's happy anymore; it's a joy to walk out on my front porch and say, “God, take me. What is my next step? What do I have to do next?” You know what. Somebody picks me up and takes me. I think that's the lesson I have learned more than anything: you have to be willing and tell people. Hugh: Bob Hopkins, you are a gift to humankind. Thank you so much for being our guest today. Bob: Thank you. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, I am very happy to have with me a former client of mine and he’s very brave to be willing to talk about fear of flying in a straightforward manner!   John: Hi. This is Doctor John Dacey with my weekly podcast, New Solutions to the Anxiety Epidemic. Today, I am very happy to have with me a former client of mine and he’s very brave to be willing to talk about everything straightforward. His name is Bob and I’m really happy to have him in the studio today. Hey Bob, how are you? Bob: Good, John. Glad to be here. John: Now the major thing when I typically deal with former clients, is I ask them the 8 kinds of anxiety and have them talk about what it felt like and what they did to be successful, but in your particular case, it was very clear what you needed to deal with was fear of flying. Could you talk a little bit, Bob, about how you came to be a fearful flyer? You were flying to France and a whole lot of places and then all of a sudden something happened, isn’t that right? Bob: Yeah, I never had trouble flying before. I few all over to Europe and had no trouble in planes whatsoever, but I got married, and this was quite a long time ago. John: Where did you get married then? Bob: I got married in Finland. John: Oh Finland. Ok. Bob: Finland. My wife was Finnish, we met in Paris, and then she went back to Finland and I went back to join her and we got married after knowing each other for about 2 months or so. We had a honeymoon, by cruise, in the Mediterranean, and then we flew back to the United States from Milan. It was on the flight back that I had a totally unexpected panic attack. I can explain what it was like but looking back I realize, I was very ambivalent about the marriage. I was really of the feeling that maybe it was a mistake, that we knew each other for too short a time. John: Now let me just ask you a question there, Bob. So, you’re married, you had your honeymoon, etcetera, etcetera, and everything seems to be okay and then all of the sudden, something happened on this trip on the way back. Is that right? Bob: Right. I mean I did have my doubts, even going into the flight back. It wasn’t as if everything was totally hunky-dory and then completely out of the blue this happened, but I certainly didn’t expect—I had never had anything like this before. John: On the other hand, this is the first time she’s going to be meeting your parents, your relatives, your friends, is this correct? Bob: Well actually my parents had flown over for the wedding. John: Oh I see. Ok. Bob: But you know, this is the first time that she’s coming to the states. She was a very successful journalist and artist in Finland and she gave all that up to come over here with me. John: Can I interrupt you once again? I’m sorry to do that. You’re rather accomplished yourself. Would you tell us a little bit about your own educational background? Bob: Yeah. Well, I’m a biochemist. I have a Ph.D. in chemistry from Yale. I graduated Columbia Undergraduate and I had post oped in a couple of places, one of them which was Paris. We were coming back here where I was going to take up a position at Boston University in the Chemistry department. John: So you have pretty high standards I can imagine. Bob: Well you might say. You know, I was very excited about everything and looking forward to an academic career and my wife had, again, given up everything to come here with me so I felt quite a sense of responsibility for her. I had to really introduce her to the United States, how to go shopping in markets, and just ordinary everyday things. And also, to help her get a job over here. But on the plane, suddenly I felt very strong claustrophobia. I felt trapped in the plane, that I couldn’t get out. These were feelings that I had never really had before. John: Why would you want to get out, Bob? Bob: Yeah, I mean I wouldn’t want to get out. There’s absolutely no reason. In that sense, it made no sense, but looking back on it, I was also feeling trapped in this marriage even right at the beginning and that maybe played into this feeling of being trapped in the airplane. And it was pretty awful. It was a kind of panic attack. My breathing got sort of short and I didn’t feel I was going to die. I just felt I was in an impossible situation where I was trapped and couldn’t get out. John: So, naturally, you assumed that being on the airplane was part of this whole thing. Bob: Yeah, right. John: And that’s why after being a fearless flyer for a long time—this is what amazes people—in one experience, it went from being perfectly comfortable to perfectly terrifying. Bob: Exactly right. Exactly right. That was part of the problem because it was so unexpected and I had never had anything like this before. I was not an anxious person, I didn’t have these kinds of anxieties before. I had the normal anxieties, you know, like before a final exam or something like that, that everybody has, but I never had these kinds of feelings before. So, we got back to the states and I had a number of phobias I guess you’d call them, that were connected, I suppose, to this that I had never had before: a phobia of heights, a fear of elevators, being trapped in a subway if it’s stopped between stations. A whole bunch of phobias that were kind of connected to being trapped in some way. John: So I can understand this. You sort of transferred being psychologically trapped in the marriage to being physically trapped in these various situations, which in fact you were. If you go up in an elevator, for a short time you are trapped. Bob: Right. That’s what they all had in common. John: And for a long time on an airplane, especially in an intercontinental flight like that, you’re trapped for quite a while. Bob: That’s right. The next summer, we went back to Finland, to visit her family, and it was pretty awful for me because I knew how awful the flight would be and it was. And it’s a long flight. The flight there and back was pretty bad. That was the beginning of all of these. As I mentioned, I never had these anxieties before and it all sort of came crashing down. Meanwhile, I had to continue my work which I wanted to do as a biochemist and had students working with me and was teaching classes and meanwhile dealing with all this so it was quite difficult. John: Now as I said to you, we have a limited amount of time and I wonder if we can jump right into what you and I did. You came to see me about this, which was a brilliant plan on your part. I’m just kidding. However, what we did—tell us a little about what we did to deal with the flying. Bob: Well, we sort of worked in stages. We first spoke about what brought all this on, which I kind of summarized, in the first place. Then, we tried to imagine what it would be like in the plane, and then I worked with John on a simulator, a flight simulator that tried to give me an even stronger feeling than just talking about it, an actual visual feeling for being in the plane. Going up then landing, flying and then landing. Then we went out to the small private plane field and we looked around and gradually worked up where we first went on an airplane and it was a small Cessna and sat in the plane for a while to give my self a feeling for sitting in the plane. The next step we were in the plane and we just taxied around the field, we didn’t take off. John: By the way, we have a pilot with us, I remember, because even though I was with you, I’m also a student pilot so I couldn’t really take you up if I wanted to, but we did have an instructor and the company that did this with us was very understanding and really wanted to see you be able to fly again so they were perfectly willing to do these things like traveling around the airport. They got permission and they traveled around the airport on the ground at first to get you back to being used to it. Bob: Yeah, they were very supportive. John: And by the way, I think it’s important to add that the big difference in being on a super liner and this little pane is that you get 270 degrees of view from where you’re sitting up in the front, I was sitting in the back. Also, we had a pilot who if you say to him, “I have to go down right now,” he will do it. If you say that to a 747 pilot, they probably won’t do it. Bob: You’re in big trouble right. John: That’s right. Bob: The next time we actually took off and we circled around the airport and came down, and each time it git a little hard, but a little easier in a way. John: By the way, I want to add that I think we went out and did a little celebrating afterward, and it’s very important that you do celebrate, that you do have some really nice reward for doing this because that’s what cements the success feeling. Bob: Yes. Absolutely. Then we moved up to taking shorter flights on a regular commercial plane. We took Cape Air once to Hyannis and once I think it was to Provincetown. That worked out quite well. They’re small planes, but they’re commercial flights. John: Well you did a great job. You were very nervous and I believe that if you don’t mind me saying this, that you took one small tranquilizer just to help a little bit and we didn’t do that every time, but we did it in the beginning. Bob: Yes, and it really did help. I took some Ativan and that did help. John: Ativan is a great drug for that. Bob: Yes. And then after those, we really graduated, I did to commercial jets, we took a flight to New York. I think we took two flights to New York and then I did one with my girlfriend without John and then I went to visit a friend in Washington, DC, which was for me a real triumph. John: By yourself. Bob: That was the longest one. Yeah, it was by myself. John: I was so proud of you because that was a really big jump and you did wonderfully well. Bob: I was a little trepidatious but it worked out fine and that was the last flight and you know it’s been a few years, but I wouldn’t have any trouble taking those flights again and I’m still hoping to reach for the stars in a way, and get back to my beloved Paris. John: We’re going to get you back to Paris, Bob. That’s the plan. Well, I want to thank you so much for giving your testimony here today. I’m sure there’s a lot of listeners, we have over 6 thousand listeners now, I don’t know if I told you. It’s just wonderful and of course, we’re talking about the Corona Virus sometimes, but mostly it’s about stories like yours. You’re proud of yourself and I have to say, I’m very proud of you also. Bob: And I’ve enjoyed working with you so much, John. You’ve made all the difference to me. All the difference. John: Well thank you so much. Thanks a million. And I’ll talk to you folks next week.

With COVID-19 upending our work and home lives, how does user experience need to change to reflect the "new normal"? This week on The Inbound Success Podcast, I dig into this question with guest Bob Berry, a virtual operations and user experience expert who is a principal at AnswerLab and founder of ItsTheUsers. Bob has helped some of the world's largest companies, including Google, Apple, Amazon, Facebook and others, to create new, optimal online experiences in the age of Coronavirus and in this interview, he explains why companies must relearn what their customers and prospects ant and expect as their lives are transformed by the pandemic.  Bob says that to not only survive, but compete and win in the future, businesses need to create optimal online experiences now. Check out the podcast to get his advance on how to go about doing that. Highlights from my conversation with Bob include: The sudden shift to working from home during the Coronavirus has put digital, virtual and online experiences front and center in a way that they have not been before. This makes it imperative that companies develop a deep understanding of what their customers' lives look like now in this new normal so that they can craft experiences that match that.  Bob believes that virtually everything that happens in business is a set of individual choices or decisions by real people and the sum total of those choices is what drives the global economy. This is why user experience design is so critical. Because of changes related to the pandemic, we're going to have to determine, as marketers, whether the assumptions we've made about how people buy are still valid. And if they're not, we're going to have to learn what the new patterns are. One area that Bob believes will change is how people think about data and privacy. He predicts we'll have a quicker movement to more stringent privacy rules, prompted in part by the need to do more contact tracing related to Coronavirus. Changing user experience require that you look holistically at a business. Bob gave the example of his work with Deluxe Corporation, where he undertook an omnichannel business assessment that looked at the entire lifecycle of a customer's experience with the company. The result of that assessment and the changes the company made drove an additional $3 million to the company's bottom line. Bob says the best way to get started is by doing an inventory of every touchpoint that a customer has with your business. From there, you can use that data to develop a new narrative around what the buying journey looks like today. Understanding customer buying journeys is not an event, according to Bob, but rather a process that must be undertaken on an ongoing basis. One way to accomplish this is through survey tools and diaries that require your customers to document their interactions with your business. Bob has used a tool called dscout to do this in the past. For now, the two things that businesses can focus on are how they will stay in touch with and maintain relationships with their customers in the future, and what their products/services need to look like going forward. Resources from this episode: Visit the ItsTheUsers website Visit the AnswerLab website Connect with Bob on LinkedIn Follow Bob on Twitter Listen to the podcast to learn how the keys to business success have shifted, and what companies need to know -- and do -- right now to create user experiences that will position them for success in the future. Transcript Kathleen Booth (Host): Welcome back to the Inbound Success Podcast. I'm your host Kathleen Booth. And this week my guest is Bob Barry who is the founder and principal of it's the users. Welcome to the podcast, Bob. Bob Berry (Guest): Thanks Kathleen. Glad to be here. Looking forward to this. Bob and Kathleen recording this episode. Kathleen: I am really looking forward to this because this is an interesting time and as we're recording this we're I don't even know how many weeks -- seven, eight weeks, what have you -- into pandemic quarantine. I guess it depends on where you live and et cetera, but it feels like forever and the world has undeniably changed quite a bit in that time. I think many people are just starting to kind of find their footing in what may or may not become the new normal. So we're going to talk a little bit about that and what that means for user experience. About Bob Berry and ItsTheUsers Kathleen: But before we do that, could you please tell my audience a little bit about what ItsTheUsers is and your background, and how you came to be doing what you're doing today? Bob: Certainly. So, my history goes actually back quite a ways. I originally got my degree in computer science and out of college, I actually worked for Hewlett Packard back in the day when bill and Dave were still alive. It was a very different company back then and I was one of their early eCommerce business managers when the internet and the web came along. And that's where I first started getting involved in this whole idea of experience and how experiences can really influence what we do in business. Back in those days, we developed some of the early social media, online learning, e-commerce and cloud based services before a lot of those terms even existed. I actually left HP to get involved in a number of startups during the dot com boom, and started a company that did a lot of training and learning and curriculum for youth. We actually embedded some pretty interesting experiences for young people to help them get ready for life. We were pretty far into that as we approached the great recession when a lot of the spending was starting to dry up and entrepreneurs like myself were struggling. My wife sat me down. We had five kids, four cats, and a dog at that time. And we were surviving on her teacher, principal income. She worked in public education. She sat me down and said, Hey, this isn't working. We need to find a way to have my income be more stable and more predictable. So I actually made a big shift at that point, that was around 2007, 2008 and actually became full time involved in user experience and really understanding what impact that has on business, what impact that has on people. And I've been doing user experience in one form or another since then, both as an independent and working in a corporate environment. Now I'm working for a company called AnswerLab. I do that in addition to ItsTheUsers.com. AnswerLab is really focused on working with a lot of major companies. We work with Google, Facebook, Amazon, and doing projects for all of those companies right now around user experience and helping them to figure out how to adapt what they're doing and shift their online presence and their digital strategies into this new world we're about to enter. ItsTheUsers.com is focused on bringing new people into the world of user experience and really understanding how to do that. So it's focused on a lot of people that may not have a tremendous amount of money to spend who can't pay the big ticket research studies that some of those big brands can. So it's a really interesting mix. I get to work with those big companies, you know, they invent a lot of cool new stuff and I get to work with them and put those out in the public and learn how real people react to things that those companies are inventing. And then with ItsTheUsers.com I get to work with a lot of small businesses, professionals, entrepreneurs and help introduce them to this whole world as well. And of course now we're entering this whole new phase. Like you say, we've only been a few weeks into this and we're all very interested to see how this is going to unfold and what's going to happen as we try to go back to work as we try to get our businesses restarted. I think we all have a lot to learn about how this new world is going to function. Kathleen: Absolutely. Boy, listening to you tell your story, I just have to share that it really hit close to home because when that recession hit in 2008/9, my husband and I owned a digital marketing agency together and we had four kids and two dogs. I'm listening to you tell the story and we looked at each other and we were like, Oh God, we're in the same company. We're totally in this boat together. It's either gonna sink or it's gonna float. You know, it was, those were some crazy times. I guess for that reason, my heart goes out to people who own businesses right now because I've been through that experience and I just remember so clearly the stress that that put us under at the time. So that could be a whole other podcast that we talk about, but we won't, it would probably be very stressful. It could be several podcasts, but you know, focusing on the situation that the world is in right now, it's such a unique situation, but it's also, in some very interesting ways, at least to me, it's presenting us with a unique, once in a lifetime opportunity because it's really speeding up some things that I think were going to happen anyway as far as movements to remote work and the acceleration of companies really doing more business online and all of these things that we were sort of creeping towards over time. But that process has accelerated dramatically as a result of what's happened, and I know a lot of companies are kind of scrambling to figure out what it means for them. So in terms of user experience, I'm just going to hand it over to you and I would love to hear what you're seeing as far as the changes and what you've seen done well and where companies need to improve. It's a big topic. So, you know, where do we start with this? How is COVID-19 changing user experience? Bob: Yeah, it's a big question and there are a lot of challenges wrapped up in this. I think one of the major effects that's happening right now is because of the need to quarantine, the social distance, all the lockdowns that are happening, you know, not just here in this country, but really all over the world. It's putting digital, virtual, online in the center of what we're all going to need to adapt to in a much bigger way. Fortunately, we've been working on this for a long time with the internet and the web and a lot of these virtual tools and platforms have been around long enough that all of us, or most of us, are pretty familiar with them. But as we drive that massive shift to digital and virtual, if you look at all the industries out there -- look at education, finance, entertainment, sports -- the ways we interact socially, you know? Medicine, commerce... So many things now are being transformed by this and digital and virtual really becomes the centerpiece of how we're going to have to conduct business and interact with one another. In the midst of that, there are going to be a lot of new innovations. Things are gonna change. So some of the old ways of doing things are going to go away and there are going to be a lot of new technologies. We're already seeing some of these now. A lot of new innovations are coming out just dealing with the virus. We're coming out with a lot of new technologies and new ways and of course people, as they're working remotely or as they're living and socializing remotely, we're inventing a lot of new ways to apply this technology. So to cope with all of that and deal with all of this change, the experience really is the centerpiece of all that. And so Kathleen, I kind of have this crazy idea that I promote, you know, both in my role with ItsTheUsers.com and then in my research role with AnswerLab, and the premise is that virtually everything that happens in business is a set of individual choices or decisions by real people. So certainly in inbound marketing, if somebody is going to respond to some content marketing, if they're going to react to a paid ad, if they're going to click on anything online, it's all about individual people making individual choices and decisions. And all of those decisions happen within whatever experience we put out there for them to encounter. And in fact, the other part of this theory for me is that the sum total of all of those choices is really what drives the global economy. So if that's really true, if experience is that centerpiece, if that's truly what happens, then all of it is being transformed right now. When I talk about user experience, it's more than just sort of the traditional usability. It's really about understanding people. Who are they? What are their lives like? What are their challenges? What's their personal narrative? So understanding that whole journey that they're on and therefore how do they accomplish what they need to -- that's a key part of the experience as well. So, those trends that the personal and business people that were going through this massive pivot to digital and all of the new innovations that are going to occur as a result of this, they all intersect in the experience. So we have to figure out how to invent better and new experiences so people can function, so business can function, so we can continue to run and do what we do. And we're going to have to find new ways of building, deploying and verifying all that, because now we have to do it all remotely. Kathleen: Yeah, it's so true. It's very interesting as I listen to you talk about it, I thought of a personal thing that happened in the last couple of days that I think for me at least illustrates part of what's changed. Everybody's talking about how the whole world is all of a sudden using Zoom. I've used them for years. I've worked remotely for a long time and sometimes I feel like I spend more time with Zoom than I do with my husband. So for me, Zoom has always felt very easy to use and very intuitive. I think it was designed for a person like me who is relatively, you know, technologically fluent, spends a lot of time on their computer, working remotely, et cetera. But in the last two months, the number of users of zoom has mushroomed and it includes a lot of people who are not as technologically fluent, who don't spend as much time on computers. And for me, the way this has really come to light is, I joke that my unpaid second job is that I'm now a Zoom tutor and I have taught my sister in law, my parents and my mother-in-law all how to use Zoom so that we could do these family calls. My mother in law in particular just is really reticent about it and you know, she's a little older. It was really interesting because I got her to the point where she could get on and join a call. But the other day she called me and said, I want to be able to start a call. And we went onto that little, the Zoom screen. I'm sure most people are familiar with it by now, where it says like, join, start, schedule, et cetera. And she didn't understand the difference between schedule and start and join. So I was listening to you talk. It got me thinking that Zoom is a great example, it has this new audience that doesn't just intuitively understand the differences in those meanings and it's almost like they need to change that little screen. Just say I want to start a meeting, schedule one for later, join someone else's meeting. It needs to be even more explicit now for those people who aren't as much digital natives as maybe it's prior user base wise. So I just wanted to share that story because it's so fresh in my mind and it's nothing that I ever would have thought of. To me, the interface of zoom just seems so easy and simple. But then when I was walking through it with her, I was able to see it through a different lens. Bob: Yeah. I have to laugh because I'm sure you've heard the Zoom story yesterday with the Supreme court. So the Supreme court is trying to hear cases and make decisions using Zoom and similar kind of situation, there are probably a lot of them in the same age group as your mom. Well, apparently somebody used the bathroom and there was the sound of a flushing toilet. That's now referred to as the flush heard round the world. And I haven't heard yet who exactly was. So here's these most distinguished members of our society and they're struggling with something as simple as remembering to hit mute when they do something personal or they're on zoom. So that's a really good example. Another really important dimension of this that I wanted to bring up and kind of get your perspective on as well, because we're so early in this process, speaking of inbound and I've been, you know, been around the internet and the web since the very beginning and I've seen so many changes and one of the major changes that of course has occurred is our access to data. In such a big way, data drives what so many inbound programs and capabilities do. I think we're in the beginning of a major shift in data. I've also done a lot of research around data privacy and personal data on how individuals deal with this. As we try to deal with this pandemic, I think one of the things that's coming is we have to increase our ability to test, trace and track who's got the virus, who's had the virus, et cetera. We're in the middle of this big experiment where big parts of the country are trying to go back to work, but we don't have that capability yet. Google and Apple have announced that their devices can communicate, and we hear about new apps now being launched that are supposed to provide this capability. Well, I suspect that people, in order to trust this process of gathering all this data to manage the virus, are going to have to be very confident that that data is protected in a whole different kind of way. If that happens, does that mean new regulations are going to come into effect, new practices, new principles around how we gather and use data and are those practices and principles now and probably going to be a lot more strict, are they going to apply to the data that we acquire for marketing purposes, for inbound marketing purposes? And so what does that future look like? And so it's really difficult to predict where that's going to go, but that's something I'm really keeping a close eye on to see what kind of data requirements are going to be needed. What influence is it going to have on all the other data that we have out there right now? And, you know, then I think it also begs the question of is the data that we have now on our customers that we use so widely in inbound marketing, is that data still valid? Is the world changing enough that we're going to have to relearn some of that because people's buying patterns or their preferences or their economics have changed? So there's some big issues at work that we're looking at. Kathleen: Oh, I, I totally agree with you. I think there's absolutely a heightened awareness around data now, especially health data as you pointed out. Interestingly, I think businesses and marketers in particular are having to rethink the whole notion of personalization and tracking because so much of it was done based on IP addresses, corporate IP addresses, which, with everybody working from home, you lose the ability to track that way. Not to mention then the whole topic of accessibility. You know, when you have people who are visually or hearing impaired, who might have been able to physically come into a business in the past more easily now really can't. There's always been this requirement that websites be built in a way that's accessible. But so few businesses have really done it. I just think it's going to happen on so many fronts that we have no idea the tidal wave of change that's going to hit us. Bob: Yeah, I agree. And I think one of the key aspects of this that we're trying to implement and that's really a lot of what we're trying to stay on the forefront of is to figure out ways to track all of this, to stay in touch with these people, to learn, you know, individuals in businesses. There are so many ways that individual businesses are trying to adapt. Now businesses are coming up with some very creative ways of reacting to this. And then, you know, how our individual lives are changing and you know, how are we going to keep our fingers on the pulse of everything that's going on. And there's, again, so many dimensions to this. So from a research standpoint, there's a lot that we need to pay attention to, and a lot of new tools and methods and approaches that we have to put in place in order to continue this relearning process. And again, it's what kind of new experiences are going to be required to help people that maybe have never used Zoom before that are now going to have to deal with new apps on their phones because they're going to be tracking health data or you know, they're not working in an office anymore. They're working at home and what does that mean about their whole set of digital experiences that they have to deal with? So being able to relearn it, retrack it, gather all the data that's required, create all the new experiences -- that's what we're trying to stay in front of and trying to help other companies and individuals figure out how to do that as well. How are companies changing user experience in response to the Coronavirus? Kathleen: Well, there's no doubt that the changes, it's not just coming, it's already started. So I'm curious to dive into some specifics. What are some, some specific things that you have seen or worked with? I know you probably can't talk about specific clients and what you're doing for them, but, in generalized terms, can you share any specific examples of things that have had to change already in order to adjust user experiences to the new environment? Bob: Yeah, so there's a lot going on out there right now. So again, being able to understand, first of all, who is your audience and how is that changing? So who are these individuals? What kind of things are they dealing with? I think it's important to make the distinction between whether you're talking to B2B or B2C, because those are different types of dynamics. There's a lot of business and instructional and operational changes that organizations have to deal with as far as how to go remote. So in this process of staying in touch with your customers and learning what they're up to, how are you going to manage your workforce? How are you going to manage whoever your teams are as you go through that process? I think there's also a tendency to want to stay in touch with the larger trends out there. So what's happening, you know, socially and politically, economically? There's money available from the government and how are you going to get access to that and how are your customers and your clients getting access to that and how does that change what you might be doing with them? An example that I can name, where we actually did a pretty massive business transformation process, maybe it's helpful in this context to give you an example of the kinds of things that we've done that will need to evolve but that are still very sound practices. So a few years ago I did a study for Deluxe Corporation.This was actually in the midst of the great recession. So they were in the process of doing a pretty major business transformation and their business is very much about financial documents and checks and related types of products. We did what was called an omni-channel business assessment, and this was something that took place over a couple of years. We looked at a number of different touch points. The reason it's called Omni channel is because we look at a variety of different ways that they interact with customers. So we looked at email, we looked at web, we looked at their call center, we looked at all of their print programs and we also assessed their direct sales force. This was a combination of both B2B and B2C. The problem with just looking at any one of those is, any one customer can touch multiple aspects of their business. Somebody can pick up a catalog and interact with that and then they may find a phone number and then dial the number and talk to somebody in the call center. They may get an email message with that, which then sends them to a website. So there's all sorts of aspects of inbound marketing involved with this. There's probably a few outbound aspects as well. And so long story short, over a couple of years, we assessed all of those different touch points and made sure that the overall experience was effective, that people could find their way around that, the pathways from one aspect of it to another were smooth, that the messaging was consistent, and that the people that different aspects of that you could hand a customer off effectively from one, one part to another. At the end of the day we were able to drive over $3 million of new business to their top line by optimizing all that. And this was in the midst of the great recession when things were financially very challenging. So that type of approach I think is going to be a really important, that sort of omni-channel, multi touchpoint approach is going to be really useful, really important as we enter this new world. Because in a lot of ways, all of those different touch points are going to be changing and evolving for businesses. And if you don't pay attention to all of them, you won't have the big picture of what's really going on and the different journeys and pathways that customers might be taking in interacting with your business. How to get started Kathleen: So where can companies get started? How do they begin? You know, if somebody is listening to this right now and they're thinking, okay, things are going to need to change. We don't maybe know how much permanent change that it's going to be, but obviously things need to change. How do they begin to wrap their heads around this and, and begin to figure out what's the right approach? Bob: I think you have to start, I think a lot of cases with where you are. So what do you know now about who your buyers, your prospects, your customers, your users? You have to start with them. If you haven't already, it's important to begin to develop some sense of their story, their narrative, and again, who they are, what they're challenged with, where do they live and work? Are they still in an office? Are they still in their store? Is that whole work environment now changing? How they make buying decisions -- is that still the same or how is that evolving? So you have to start by understanding what are those stories, those narratives, those journeys that people are going through. And there's a variety of ways to do that. There are a lot of a very effective tools out there right now because the demand for doing a lot of this remotely is increasing pretty rapidly as you can imagine. So you know, if you go out there and look, there's a lot of different ways that you can interact with these customers and gather a lot of information and survey them or really understand who they are and what type of interactions that they're dealing with. So once you have a sense of who they are, those journeys, those personas, those narratives about who they are, then it's a process of understanding. Again, what experiences do you need to put in front of them? Are those web experiences or those phone experiences? Are they mobile? Are they on an app? What are all the ways that you need to interact with them so that they can understand your business and what you offer? Do an inventory of all of your touch points, and certainly inbound marketing is a key part of that as well, and begin to measure how much business you're getting through those different channels and begin to put in place ways to actually understand and observe how they interact with those experiences. You're going to want to do this on an ongoing basis. This is a process and not an event. You want to make sure that over time you can start to identify what are some trends that are going on and begin to track those trends. Again, there are a lot of different ways and approaches to evaluate mobile experiences and a lot of different ways to evaluate in person or desktop or web based experiences. So there's a lot of different approaches and tools that are available to do that. Tools for doing audience research Kathleen: So you mentioned starting by learning more about your audience and your customers. Are there any particular tools that you've worked with that are favorites of yours? I imagine there are some that probably are better for larger companies with bigger budgets and some that are better for smaller guys with smaller budgets. Any, you know, sort of list of your favorite tools? Bob: Yeah, so there are various tools out there that can do a variety of what we consider like diaries. So we actually have tools that allow people to keep track over time of how different apps or devices or interfaces work within their lives. So, understanding a day in the life or a week in the life of somebody based on having them create a diary of how they interact with your business or your apps or your website gives you a good sense of putting those things into context of who they are and what they're dealing with. So diary tools are really important. One that we use is called Dscout and we have some of our own internal tools that we use as well.  Kathleen: How do you get somebody to follow through on it though? Because obviously you're asking them to spend time for you documenting how they interact with your business or your product. And I know just from experience myself and from working with other marketers that very often even just getting customers to agree to doing a 15 minute phone call or filling out a survey can sometimes be a battle. How have you found is the best way to get people to comply and follow through on keeping those kinds of records? Bob: We usually provide some kind of incentive. So in many cases we, they get paid for their time. Some companies, when they do this kind of research, they may provide some kind of in kind reward. So if it's a restaurant chain that's doing this kind of study, they might offer vouchers for food or something like that. It might include something simple like an Amazon gift card. And so usually we try and incent people, give them some kind of reward for whatever time they invest. And that can vary based on how much time you want them to participate, and how involved you want them to be. But that seems to be the best way. Kathleen: Any particular approaches that work well for B2B companies? Bob: We put quite a bit of effort into locating and recruiting the right people. So a lot of times in the recruiting phase, we have questionnaires that we put together, and we ask people about what they do and you can kind of gauge their level of interest or their level of willingness to participate in something like this. We have a lot of third party companies that we've worked with that have databases of people and companies that they've worked with. So we also have individuals that might be more inclined to want to be involved, make a contribution there and are willing to follow through on this kind of thing. How are companies adapting to the new normal? Kathleen: Got it. So I'm curious if you have any examples of specific changes that you've seen companies need to make as a result of Coronavirus and this new environment that we're living in? Bob: Yeah, so it varies a lot. So just in my own neighborhood here, I'm seeing companies become very creative. We have what used to be a cafe down the street. Because people can't go in and congregate there anymore, they've made the shift to providing produce. They obviously had suppliers that they used for doing whatever they were doing to serve their cafe. And so now they've evolved to actually using those food suppliers to providing fresh meat and cheese and produce to people in the neighborhood. And they restrict how many people can be in the store. So being able to adapt, looking at your available resources, supply chains, customer base, and being able to think of new ways, and doing a lot of this online. So now if you want something, you go online, you can order everything that you need. And the only time you need to spend physically in the store is just to go in and pick up your bag and leave. So all the ordering and payment and everything happens online. Another example is a local construction company. I have a videographer partner that I work with and he's doing work with them to take everything that they do and turn it into video. So if you want to do a remodel or if you want to do various types of home improvements, then you can go online and you can look at a lot of examples of things that they do with video. You can also take your phone and do a video walkthrough of your house and show the areas that you want to have remodeled. And then they will take that and turn it around and they'll provide another video that will describe to the homeowner exactly the steps that they're going to take and where they're going to be in the house or what they're going to do. And so the amount of time that they have to spend face to face is really minimal. There's so many examples of this, of companies figuring out how to adapt, and how to do things better, how to do things differently. Kathleen: That's really smart. Having now spent so much time in my house for the last several weeks, I would love to just have them come in and tell me what I should change in my house. Because I have found that being stuck at home through the Coronavirus, you start to see like every little maintenance project that you've ignored for so long becomes that much more in your face and annoying because you're spending so much time with it. So I imagine they're getting a lot of traction with that offer. Bob: Yeah, they are. And they'll even give you a video of when the work is actually going to occur. They'll kind of stage it out for you and say, you know, we need to be in your home on these days to do these steps. And obviously all the products and all the materials and colors and all that kind of stuff, they provide all that to make that available as well. So those are just a couple of examples of figuring out how to adapt and certainly digital and online creating those new kinds of experiences again, are going to be a critical part of how companies can do this. You know, at AnswerLab, we have offices in New York and San Francisco and in early March, like a lot of companies, we had to turn on a dime and figure out how to be remote. And so that's another aspect of this too. Depending on what your business is, you're going to have to get creative in building and managing and maintaining a remote workforce. Now obviously for some companies, this is going to be easy. Other companies, this is going to be a lot more challenging. So it varies a lot in how you might approach this and how you might go about doing that. If it would be helpful, I can share with you what we went through in this whole process of making our whole operation remote. And it's actually going quite well right now. And fortunately a lot of the companies that we work with have gone remote as well. So we've created a whole virtual culture and whole virtual operation that, right now is, is running quite smoothly. Kathleen: Oh, that's great. I think there are a lot of companies struggling with that, that weren't used to working remotely before. I've worked in places that have been almost entirely remote and there are definitely playbooks out there for how to do this and how to do it well. You just have to be willing to embrace them. It's things like being on video when you talk to other people and not everybody's ready for that, but, but it can really make a difference. Bob: Yeah. And we have what I like to say is a MacGyver kind of culture, which is, there's all these technical challenges and everybody's willing to jump in and just figure things out, trying out new tools, trying to figure out new ways of interacting with our clients. How do we share information? How do we conduct research? How do we do a lot of in person workshops and brainstorming sessions and, you know, how do you replicate that kind of team spirit and that kind collaboration interaction when you have to do it all through a computer screen? There are actually a lot of really creative ways to do it. So figuring it out, just jumping in with both feet, getting everybody involved, creating a culture of making it happen, is really important. Kathleen: Yeah. I think the same challenge is really facing the events industry. I've been parts of lots of calls with people who've been talking about how they used to hold in person events, conferences, et cetera, and now we're going to try to do them virtually. Let's not just make it into one long webinar. Let's try and capture some of that same feeling you get when you're there in person in a new way online. It's a similar challenge Bob: Yeah. And that's, that's another example of it. Entirely new excited experiences that we're going to have to figure out. I mean, there's so many large events. You know, before I got into podcasting, I used to do a lot of teaching and speaking at conferences and, you know, we have to completely rethink that now. And those are a whole new set of experiences that we're all going to have to figure out how to create. How to validate that they work and people are getting what they want out of them? And then we're gonna have to figure out how to participate in them and, and make them successful. What are some things you can do now to prepare your business for the future? Kathleen: Yeah. Well if there's a marketer or a business owner listening and they're thinking, okay, I need to focus on this for myself. Do you have like two or three key pieces of advice for them that they should really focus on in the next couple of weeks? Bob: So are you thinking about the whole process of going remote or the whole process of figuring out what this new digital world is gonna look like? Kathleen: The latter. Bob: I think a couple of things that people need to do is they need to figure out what are the ways that they're going to stay in touch with their customers. Who are your buyers, your purchasers, your prospects? How are you going to develop longterm connections with them as they evolve, as they adapt to what their new world is going to look like? And then to figure out how to put your business, whatever product or service you're offering, how are you going to evolve that along with them to stay relevant, to make sure that you're still something that they're going to need and be willing to pay for? Whatever those businesses and those individuals are going through, whatever is changing in their lives, that's going to determine how your business needs to evolve to stay with them. So number one, you need to figure out how you're going to maintain those connections and do that relearning that's necessary. And then the second part of it is, what kinds of experiences are going to be required? And of course a lot of those experiences are going to be virtual, digital, online. Does that mean you're going to need a new kind of app in order to communicate with them? Does that mean you're going to have to now, like with the example of the construction company or you're going to have to start developing new types of media, like video or audio, are you going to have to create new ways of selecting and ordering your products? Does that mean a new eCommerce system? So figure out who they are, where they're going, what they're up to, what they're experiencing, and then decide how you're going to create the right kind of virtual digital experiences that are going to be relevant and important to them and how you're going to make sure all that plays together. That's probably the most important thing right now because it's changing rapidly and now's the time to start relearning. Kathleen's two questions Kathleen: Good advice. Well, shifting gears, I have two questions I ask all of my guests and I'm curious to know your thoughts on these. The first is, is there a particular company or individual that you think sets the standard for inbound marketing? Bob: Yeah, I actually, I thought about that quite a while. As I mentioned, we work with a lot of the big brands, you know, Facebook and Amazon and Google and FedEx and they have obviously some great examples there. But another company that I worked with for a long time is actually a fairly small operation. They're based here in Colorado, and the leader is called Jeff Walker and he's in charge of something called Product Launch Formula and years ago, he developed an inbound system that allows you to go out and find a target audience and interact with them and provide them a lot of valuable content and draw them into your product or service through really effective content marketing. He does a lot of books and courses and affiliate programs and video and email and stuff like that. He does a lot of the things that work well. I think the number one thing that stands out for me though is so many organizations and companies that I see online are using his system, which to me is the greatest testimony. So you can tell your story through PR or marketing programs, but nothing speaks like success and the number of organizations and people and platforms out there that have adopted his model. I think if you look at a lot of the inbound programs now, they actually use a lot of the principles that he developed probably decades ago. So he's one that I pointed to it because he's had such, such a big influence on the whole digital and virtual marketing world. Kathleen: That's a great example. I'll definitely have to check that one out. Second question, marketers always talk about how difficult it is to stay abreast of the rapidly changing digital landscape. I think the conversation we just had is a perfect example of that. How do you personally stay up to date and keep yourself educated? Bob: Well, podcasts is certainly a big one. I listened to a lot of them. I listen to them pretty constantly. I do a lot of reading. LinkedIn is a big source for me as well. I do a lot in networking, so I learn from people and I get a lot of great information off of LinkedIn just from what's posted there in the form of learning and articles and also, another way is just really through my colleagues. I work with a lot of very talented people and they're constantly presenting new challenges and new technical things to solve. And so that, to me, is probably one of the best ways I learn is just sort of on the ground, you know, with my fingers in it and trying to figure out how to make it all work. That's probably a big one for me. Kathleen: Any particular podcasts that you really love? Bob: So I actually listen to a lot of historical podcasts. I'm also a big fan of Sam Harris. Right now I've been listening to a lot of podcasts on LinkedIn about LinkedIn to figure out how to do better as we now have to do a lot more things virtually. And we don't have to do as much face to face and really trying to get geared up for LinkedIn. I actually listened to a very interesting historical podcast yesterday about pandemics and putting all of this into context. It was very interesting to kind of see the big picture over history. Probably one of the big takeaways there is that there are a lot of people who hope we can get back to normal and I think they're thinking of the old normal, but we have to let go of the old normal because it's gone. We're looking at a new one and we have to figure out what that means. Kathleen: Yeah. It's amazing how quickly things can change, isn't it? How to connect with Bob Kathleen: Well this has been so fascinating and I think you're doing really interesting work with a lot of really interesting companies. If somebody is listening to this and they want to connect with you online or learn more, ask a question, what's the best way for them to do that? Bob: Certainly LinkedIn. So look up Bob Barry. That's B E R R Y on LinkedIn. And again, I'm associated with AnswerLab and with ItsTheUsers also. You can go to my homepage at inbound.itstheusers.com. You know what to do next... Kathleen: Awesome. All right. I'll put that link in the show notes. If you're listening and you liked what you heard today or you learn something new, I would really appreciate it if you would go to Apple podcasts and leave the podcast a five star review. That helps us get found by new listeners. And if you know someone who's doing great inbound marketing work, tweet me @workmommwork, because I would love to make them my next guest. Thank you so much for joining me this week, Bob. Bob: Kathleen, thank you very much. Good luck, so they say.  

Today's guest, location-based VR expert Bob Cooney, has been in the XR space since the early 1990s. He drops by the show to give Alan an update on all the newest tech advances he saw at the International Association of Amusement Parks and Attractions Expo, and explains how today is the most exciting time to be working in this industry. Alan: Welcome to the XR for Business podcast with your host, Alan Smithson. Today’s guest is always on the bleeding edge of technology. He’s able to predict both tech and business trends. Bob Cooney is widely considered one of the world’s foremost experts on location based virtual reality, and the author of the book “Real Money from Virtual Reality.” I’m really super excited to introduce my good friend and colleague, Bob Cooney to the show. Welcome, Bob. Bob: Oh, dude, I’m so happy to be here. Thanks for having me, Alan. Alan: It’s my absolute pleasure. It’s been a long time coming, this interview. But we’re here. We’re excited. And we just are coming off the heels of *the* major North American show, IAAPA — which for those of you listening and you haven’t been there — it’s basically Disney World for VR, AR, and out-of-home experiences. You were there. Let’s talk about what you saw, and what are the trends coming in out-of-home entertainment. Bob: Yeah, it’s an amazing show. I’ve been going this– I think this is my 27th IAAPA or something like that. And my first one was 1991. And over the last four or five years we’ve seen VR every year just grow in not only the number of companies bringing VR/AR solutions into the market — mostly VR at this point — but the quality is every year measurably increasing. And that’s the thing I think that has me so excited is three or four years ago there was just a literally handful of things that you would even remotely consider as an operator. And last year there was confusion now, because there was– you were starting to see a lot of good stuff and this year it was just overwhelming. And so, yeah, we’ve seen real quality come into the market. Alan: You’ve seen pretty much everything there is out there. What’s one thing that blew your mind this year? Bob: Good question. The rise of unattended virtual reality systems. There was a company called LAI Games, which has been around for decades. They’re based out of Asia. They build arcade games. And a couple of years ago, they took a license from Ubisoft: Raving Rabbids, which is a really popular IP. They merged it with a D-Box motion base and they created a VR ride for family entertainment centers, arcades, and theme parks. It’s a two player ride. It was fairly cost effective, but they recommended it be operated without an attendant, and it was the first VR attraction that came out where you didn’t need to staff it. And the profitability of that really made a big difference for operators. And now this year there was another company called VRsenal, that had an arcade game cabinet with– that was a VR based that was unattended, and it was running Beat Saber, which is obviously one of the most popular games out there. And so we’re starting to see companies realize that maybe we don’t need attendants. Maybe people are smarter than we give them credit for. Maybe they can figure out how to put a headset on their face. Maybe they will clean it by themselves if they care about that. And so I talk about a lot about the four-minute mile, once it was broken. People thought was impossible, people thought if you try to run a four-minute mile, you would die. And once it was proven that it could be done, hundreds of people have done

Today’s guest, location-based VR expert Bob Cooney, has been in the XR space since the early 1990s. He drops by the show to give Alan an update on all the newest tech advances he saw at the International Association of Amusement Parks and Attractions Expo, and explains how today is the most exciting time to be working in this industry. Alan: Welcome to the XR for Business podcast with your host, Alan Smithson. Today’s guest is always on the bleeding edge of technology. He’s able to predict both tech and business trends. Bob Cooney is widely considered one of the world’s foremost experts on location based virtual reality, and the author of the book “Real Money from Virtual Reality.” I’m really super excited to introduce my good friend and colleague, Bob Cooney to the show. Welcome, Bob. Bob: Oh, dude, I’m so happy to be here. Thanks for having me, Alan. Alan: It’s my absolute pleasure. It’s been a long time coming, this interview. But we’re here. We’re excited. And we just are coming off the heels of *the* major North American show, IAAPA — which for those of you listening and you haven’t been there — it’s basically Disney World for VR, AR, and out-of-home experiences. You were there. Let’s talk about what you saw, and what are the trends coming in out-of-home entertainment. Bob: Yeah, it’s an amazing show. I’ve been going this– I think this is my 27th IAAPA or something like that. And my first one was 1991. And over the last four or five years we’ve seen VR every year just grow in not only the number of companies bringing VR/AR solutions into the market — mostly VR at this point — but the quality is every year measurably increasing. And that’s the thing I think that has me so excited is three or four years ago there was just a literally handful of things that you would even remotely consider as an operator. And last year there was confusion now, because there was– you were starting to see a lot of good stuff and this year it was just overwhelming. And so, yeah, we’ve seen real quality come into the market. Alan: You’ve seen pretty much everything there is out there. What’s one thing that blew your mind this year? Bob: Good question. The rise of unattended virtual reality systems. There was a company called LAI Games, which has been around for decades. They’re based out of Asia. They build arcade games. And a couple of years ago, they took a license from Ubisoft: Raving Rabbids, which is a really popular IP. They merged it with a D-Box motion base and they created a VR ride for family entertainment centers, arcades, and theme parks. It’s a two player ride. It was fairly cost effective, but they recommended it be operated without an attendant, and it was the first VR attraction that came out where you didn’t need to staff it. And the profitability of that really made a big difference for operators. And now this year there was another company called VRsenal, that had an arcade game cabinet with– that was a VR based that was unattended, and it was running Beat Saber, which is obviously one of the most popular games out there. And so we’re starting to see companies realize that maybe we don’t need attendants. Maybe people are smarter than we give them credit for. Maybe they can figure out how to put a headset on their face. Maybe they will clean it by themselves if they care about that. And so I talk about a lot about the four-minute mile, once it was broken. People thought was impossible, people thought if you try to run a four-minute mile, you would die. And once it was proven that it could be done, hundreds of people have done

A Life Worth Living (Part 1) - Elisabeth ElliotA Life Worth Living (Part 2) - Elisabeth ElliotFamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. A Life Worth LivingDay 1 of 2 Guest:                        Elisabeth Elliott From the series:       What in Life is Worth Living For?        Bob:                Fifty years ago this week, five American missionaries were martyred by Quechua Indians in rural Ecuador.  Their deaths shook the world, but the legacy of their heroism continues to this day.  One of the people most profoundly impacted by those events 50 years ago this week is the widow of one of the martyred missionaries, Elisabeth Elliott, the wife of Jim Elliott.  As a young widow, she faced questions about the wisdom and the goodness of God, and she faced them head-on. Elisabeth:      Once upon a time, before you were born, there were, in Ecuador a tribe of so-called "savages."  Not very much was known about these people.  They were naked, they used stone tools, and they killed strangers.  One of the questions that people ask me more frequently than any other is how have you handled bitterness?  And usually they mean wasn't I bitter against God because of some of the things that have happened in my life.  Suffering is a gift.  Paul says, "Unto us it is given not only to believe but also to suffer."                         Is it worth it?  How many things can you think of that are worth suffering for?  He is Lord of my life, and when I asked Him, at the age of 12, to be Lord of my life, I turned over to Him all the rights.  There is nothing worth living for unless it's worth dying for. Bob:                And welcome to FamilyLife Today, thanks for joining us on the Tuesday edition, Tuesday, January 3rd.  I don't know about the rest of our listeners, but just hearing that voice … Dennis:          You're speaking of Elisabeth Elliott. Bob:                Yeah.  She has always been somebody that – when I listen to her, I feel like I'm being encouraged and scolded kind of at the same time.  You know what I mean?  She just has that sense she's calling you to the highest that God would have for your life. Dennis:          She always did that in my life and, as you know, Bob, she has become a good friend of ours.  Elisabeth and her husband, Lars – well, she's just a great friend.  And what we wanted to do in featuring her on today's broadcast is take our listeners back some 50 years, because this Sunday, January 8th, is the 50th anniversary of the martyrdom of five young men who, by faith, flew back into the jungle to lead an uncivilized tribe of people who had never heard the name of Jesus Christ, and who ultimately were murdered on behalf of their faith.  And Elisabeth Elliott, of course, is the widow of one of those men, Jim Elliott. Bob:                And as some listeners know, Elisabeth made the courageous decision many months after that, to go back into that jungle and to continue the work that her former husband had begun, and she helped to lead a number of those people to Christ including some of the men who had murdered her husband.  And with that historical perspective in mind, we thought it would be good today for our listeners to hear some of her reflections on her husband, his faith, his character, on that time in her life, and on her interaction with the Waodani tribe in Ecuador back in the late 1950s. Dennis:          I think it's going to be a spiritual wheel alignment for some of our listeners who are right now walking through a valley of sorts.  Maybe it's the valley of the shadow of death, maybe it's circumstances that can't be defined or explained or even understood after reading the Bible, but God can be trusted, and that's what you're going to hear from Elisabeth Elliott.                           A number of years ago, we had the privilege of interviewing her talking to single people, interestingly enough, about the quest for love, and in that interview, Bob, as you and I talked to her, she started talking about how she viewed those circumstances surrounding the loss of her husband.   Elisabeth:      In Deuteronomy 8, Moses is reviewing the history of the children of Israel, and he says, "He suffered you to hunger in order that He might know what was in your heart."  And you remember that the children of Israel were wailing and screaming and complaining because they didn't have the leeks and onions and garlic and watermelons and fish that they'd had back in Egypt, and they were sick and tired of this stuff they got every day – manna.  And it says that a company of strangers came in and said, in effect, "Is this all you've got here?"  And so instead of the Lord removing the desire for leeks and onions and garlic, He caused them to hunger for this purpose – that He might know what was in their hearts, and I don't know any situation in which we are more likely to find out what is really in our hearts than where we have been deprived of something that we thought we should have.  And, of course, I was deprived of my husband, Jim, and the Lord was saying to me, "Now I want you to glorify me as a single woman again, and I am giving you this gift, and I want you to fulfill this calling faithfully, gladly, and humbly."                           I would just get down on my knees and just say, "Lord, you know what my natural feelings are about this but, Lord, I have surrendered them all to you long ago.  It was when I was 12 years old that I prayed Betty Scott Stamm's prayer – "Lord, I give up all my own plans and purposes, all my own desires and hopes, and accept Thy will for my life in acceptance lieth peace," and I know that's true.  It happened again when Ad [ph] was taken from me.  He was prayed over, he was anointed, we had people coming from across the country telling me they had a word of knowledge that God wanted to heal Ad Leach.  He died, and the Lord is saying, "So here is the gift of widowhood again." Dennis:          One of the themes of your books that seems to be in all of them is the call for the Christian to endure in the midst of suffering.  You believe the Scripture calls us to remain faithful in the midst of circumstances that aren't working out to what we wish they would. Elisabeth:      Suffering is a gift, Dennis, it is a gift.  Paul says, "Unto us it is given not only to believe but also to suffer," and Jesus referred to the cup that my father has given me.  What was in that cup?  He was reviled, He was persecuted, He was hated, He was mocked, He was captured, He was flogged, He was blindfolded, He was stripped, and He was crucified.  That was the cup, and we know that his human nature was in agony over that.  He sweat, as it were, great drops of blood in Gethsemane and finally said, "Not my will," he said, "If it be possible, let this cup pass."  The cup didn't pass.  It wasn't possible because He could not save Himself and save you and me. Dennis:          One of the most memorable stories I've ever heard you tell is the story of Gladys Aylworth.  It illustrates what we're talking about here in a most profound way.  Would you share that with our listeners? Elisabeth:      Well, Gladys Aylworth was a London parlormaid with no education, and she believed that God was calling her to China, and when her brother found her studying a map, he said, "Well, Glad, where are we going?"  And she said, "To China."  And he said, "Glad, you must be out of your mind," and she said, "Jehovah God has spoken to me, and I am going to China.  Well," she said, "I didn't know where China was, but I got a map, and I studied."                         Then she tells the long story of how she took a train all the way across Europe and Russia and Mongolia and China, and she ended up standing on the wharf in Shanghai, and she said, "When I was a child, I had two great sorrows.  All my friends had beautiful golden curls, and mine was black.  And when all my friends were still growing, I stopped.  Well, I stood on a wharf, and I looked over all these people to whom Jehovah God had sent me, and every single one of them had black hair, and every single one of them had stopped growing when I did.  And I said, 'Lord God, you know what you're doing.'" Bob:                I just love hearing her. Dennis:          It's a great story.  In fact, that is one of my favorite stories because what she is illustrating there is what life is all about – are you going to trust Him that He really does know what He's doing when you are in the middle of circumstances that can't be explained humanly.  And Elisabeth Elliott, as she went through adulthood continued to find herself in unexplainable circumstances. Bob:                She married again.  Her husband, Ad – she was married to him for four years.  He developed cancer and died.  She was single again for a number of years until she married her third husband, Lars, and she often said that she was single more years in life than she was married.  She also often said that Lars hoped that he'd outlast the other husbands. Dennis:          And, you know, Bob, it was that aspect of Elisabeth Elliott that really resulted in me inviting her to come speak at a conference we had for singles.  It was called "The Keystone Caper." Bob:                This was more than 20 years ago, right? Dennis:          Right, right, in Keystone, Colorado.  It was over Thanksgiving, it was for singles, and I really had a passion for speaking to singles about giving their lives to Christ and then following Him as Elisabeth Elliott had done, and we actually went back into the archives and dusted off pieces of five messages she gave at the Keystone Caper back in the mid-'80s.  And, I'm telling you, it's just as relevant today as it was to those singles 20 years ago. Bob:                And she exhorted those singles to trust God to be Lord – that He is Lord, and you need to trust Him that He does know what He is doing, and she elaborated on the story that she'd told us in the studio about John and Betty Stamm and the impact they had had early on in her life. Elisabeth:      He is Lord of my life, and when I asked him, at the age of 12, to be Lord of my life, I turned over to Him all the rights.  I prayed a prayer written by a missionary to China, a woman by the name of Betty Scott Stamm.  But this prayer made a very deep impression on my life, and I copied it into my Bible, and it has become a part of my prayer life.  It's really just an expansion on those simple words in The Lord's Prayer, "Thy will be done."                           "Lord, I give up all my own plans and purposes, all my own desires and hopes and accept Thy will for my life.  I give myself, my life, my all, utterly to Thee to be Thine forever.  Fill me with Thy Holy Spirit, use me as Thou wilt, send me where Thou wilt, work out Thy whole will in my life at any cost now and forever," and Betty Scott Stamm and her husband, John, were beheaded by Chinese Communists.  She had been a guest in our home.  You can imagine what a deep impression the news item made on a little child.  "Work out Thy whole will in my life at any cost" – and if you and I could speak with John and Betty Stamm today, do you think they would be thankful for the ways of God with them?  Their praises would be ringing, no question about that.                         "He is Lord of my life, He holds all the rights" – when my husband, Jim Elliott, was killed, the words that came to my mind when I first knew that he was missing were from Isaiah 43, verse 2 – "When thou passes through the waters, I will be with thee."  And when, five days later, I learned that he was, in fact, dead, the words that came to me were from a poem that I had memorized many years before by F.W.H. Myers, a poem called "St. Paul," and the final stanza says this – "So through life, death, through sorrow and through sinning; Christ shall suffice me, for He has sufficed.  Christ is the end, for Christ was the beginning.  Christ, the beginning for the end is Christ."                           My life verse is Philippians 1:21 – "To me, to live, is Christ." Bob:                You know, as Elisabeth commented on getting the news as a child that this couple that had been in their home had been beheaded as missionaries, she had no way of knowing that her own husband, years later, would be speared as a missionary; that this was going to be a part of the story of her life – this kind of heroic engagement, the surrendering of your life for the service of God.  It marked her life from an early age. Dennis:          And, Bob, the thing our listeners need to hear on this – I think there's two very, very important lessons to not miss.  Number one, life can't be found outside of the Lordship of Christ, period.  If you want to live life the way the Creator of the Universe designed it to be lived, it's lived submitted to Jesus Christ and His will for your life.  You're never going to find it anywhere else.                           I was just reflecting as I was listening to Elisabeth, I was thinking, I don't think we're talking enough about this.  In fact, I can't remember the last time I heard a message from Romans, chapter 12, verse 1 and 2, where it challenges us to not be conformed to the world but be transformed by the renewing of your mind and presenting yourself a living sacrifice to God, giving it all to Him, giving your life to Him, giving up all rights of your life to Him. Bob:                That's what sacrifice means.  You're dead to self and alive to Christ. Dennis:          And I think there is a need in our homes, husbands and wives, parent to child, to remind one another where life is found, and that leads me to the second point of application here.  I think our children need to be exposed to the great saints.  If you have a chance to have a missionary in your home, or a preacher, or someone who walks with God with great faith, seize that opportunity.  Don't go out to eat at a fast-food restaurant, don't go anywhere busy, go somewhere where you won't have any distractions, where you can have conversation for another hour after the meal is over, and don't let your kids go play Nintendo.  Even though they act like they won't be listening, they'll hear.                           And I think as a result of that, what will happen is what occurred in Elisabeth Elliott's life.  The children will be challenged to give their lives wholly and totally to the Lordship of Christ, and what will result there is when they grow up they will not waste their lives.  They will live their lives to the glory of God. Bob:                And this theme of the Lordship of Christ and abandoning your own life for His service was something that was a constant theme in Elisabeth Elliott's life.  Not only was it a life message because of what she had experienced with the martyrdom of her husband and the others back in 1956, but it was a theme that continued to permeate her ministry.  In fact, when we had her on FamilyLife Today a number of years ago, she reinforced again for us this idea that Lordship is everything.   Elisabeth:      Jesus said, "If you want to be My disciple – you don't have to be – but if you want to be, these are the conditions.  Number one, give up your right to yourself.  Now, of course, that's difficult.  It is the most difficult thing that God could ever ask of us, especially in today's climate, where everybody says, "It's your life, it's your body, you have a right to yourself, if it feels good do it, if it doesn't feel good forget it, don't let anybody tell you what to do," and Jesus quietly continues to say to us, "If you want to be My disciple, give up your right to yourself.  Secondly, take up the cross."                         Now, in what form is that going to be presented?  It is going to be presented in the form of suffering.  What else do we expect?  The cross is an instrument of torture.  Why should we be surprised?  So, of course, we are going to have to get down on our knees again and again and ratify that once-in-a-lifetime surrender.  As I said, I had made that surrender when I was 12 years old, but there isn't a day that goes by, Dennis, and I am not exaggerating – there's not a day that goes by in which I do not have to consciously take up the cross in some form or other – usually in many forms in any given day. Bob:                That's a great reminder from Elisabeth Elliott.  We, daily, have to take up our cross.  Dennis:          And, Bob, as she said, it has many forms, and yet it's still lived out in the midst of humanity.  You know, Bob, the reason we're talking about this 50th anniversary of the martyrdom of these five young men who gave their lives in Ecuador is because we want to, first of all, honor their faith and their courage, and Elisabeth Elliott and the other widows who embraced that trial as well.                         But there is a second aspect I don't want our listeners to miss because we have a number of singles who listen to this broadcast, a number of parents who are raising the next generation and, for that matter, we have some who are empty-nesters, who are in prime time, who I think need to take stock of their lives and evaluate how they are going to live the rest of their lives.                         And we want to challenge folks to consider – has he called you to invest your life in the mission field?  And it could be right where you're living.  You don't have to go around the world to Ecuador or into a jungle.  The jungle may be just down the street in a housing project near your home, or it may be in some areas of your community that just needs someone to reach out and touch marriages that are decaying and falling apart – or in your church.                         But let me tell you something – the needs of our nation in the spiritual realm are great, and today, more than ever, we need to be challenging adults as well as the parents who are raising the next generation.  Give your kids a picture of world missions, of what it means to go to the world, but the greatest news – forgiveness of sins through Jesus Christ.  There is no greater privilege in life than giving your life for that cause. Bob:                I think you're right, we don't know what the Lord is going to call you to, whether it's here, whether it's there, but we do know what he's called all of us to, and it's what Elisabeth talked about today – to follow Him, to take up our cross, to die daily to our own flesh and our own desires. Dennis:          Then follow Christ. Bob:                To be about His mission, His agenda in the world today.  This past summer, I had my whole family watch with me the documentary that was made by the same company that produce the movie, "End of the Spear" that's coming out in a couple of weeks.  "End of the Spear" is a theatrical motion picture that is going to tell the story of the martyrdom of the missionaries.  It actually tells it from the perspective of the Waodanis, the tribe that did the spearing. Dennis:          Your children have to be old enough to read if they're going to go to the movie, because it's … Bob:                It's got subtitles.   Dennis:          Right.  It's not in English.   Bob:                But this summer, our family watched the documentary that was produced by the same company that tells the story of the martyrdom of the missionaries using historical archive video footage, photographs, interviews with those who were there, and it was a powerful evening.  We've got that documentary available on DVD.  It's called "Beyond the Gates of Splendor," and I'd encourage our listeners to get a copy of this DVD and to watch it as a family or to show it to the youth group at church, use it in a variety of settings.  It brings home the reality of what took place 50 years ago this week with the martyrdom of these missionaries.                           In addition, we have Elisabeth Elliott's book called "Through Gates of Splendor," which is her telling of that same story, which would be a book you could read to your children or a book that they could read on their own.  If you've never been acquainted with this story, maybe this is the first time you've heard about these events, Elisabeth's book is a classic.  It's one of those books that would be on my list of a book that every Christian ought to read.  Again, it's called "Through Gates of Splendor."  We have both her book and the DVD "Beyond the Gates of Splendor" in our FamilyLife Resource Center.                         Contact us by go online at FamilyLife.com.  Click on today's broadcast, and you'll find a link there to the various resources that are available.  You can order online, if you'd like, and if you order both Elisabeth's book and the DVD, we can send you at no additional cost the CD audio that includes the clips from Elisabeth Elliott we've been featuring here this week.                         Again, go to our website, FamilyLife.com, click on today's broadcast in the center of your screen, and that will take you right to the page where there is more information about the resources that are available from us here at FamilyLife Today.                         Let me, if I can, Dennis, just say a quick word of thanks to the folks we heard from at the end of the year.  Many of our listeners know we had a matching gift challenge in the month of December where every dollar we received was being matched on a dollar-for-dollar basis up to a total of $350,000, and I haven't seen the final numbers yet, but I do know we heard from many of our listeners, and I think it's safe to say at this point that we think we were able to take full advantage of that matching gift opportunity.  So thank you to those of you who called or who wrote or who donated online.  We appreciate your support, we appreciate you helping us meet the match, and we appreciate your ongoing investment in this ministry.                         Tomorrow we are going to be back with more insights from Elisabeth Elliott as she reflects on the events that took place 50 years ago this week with the martyrdom of five American missionaries.  I hope you can be back 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'll see you back tomorrow for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ. _______________________________________________________________We are so happy to provide these transcripts for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com                 

A Biblical Portrait of Womanhood (Part 1) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 2) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 3) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 4) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 5) - Nancy Leigh DeMossFamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. Responding to Your Husband Day 3 of 5 Guest:                        Nancy Leigh DeMoss From the series:       A Biblical Portrait of Womanhood Bob: A lot of women bristle at the idea of submission, which is talked about in the Bible.  In some cases, that's because the concept has been abused or misapplied.  Nancy Leigh DeMoss says one reason women bristle is because they haven't wrestled with the concept of surrendering to God and His purposes. Nancy: Proverbs tells us that the king's heart is in the hand of the Lord, and the Lord turns the heart of that king as the rivers of water.  The greatest evidence of how big I believe God is, is my willingness to trust God to work through authority that He's placed in my life and to give Him time to change the heart of that authority. Bob: This is FamilyLife Today for Wednesday, June 18th.  Our host is the president of FamilyLife, Dennis Rainey.  A lot of women and men struggle with the idea of submission and what that ought to look like in our lives.  Stay tuned. And welcome to FamilyLife Today, thanks for joining us on the Wednesday edition of our broadcast.  I was remembering, Dennis, the advertising campaign, that came out in the – oh, the early '70s for the Virginia Slims brand of cigarettes – "You've Come a Long Way, Baby," you remember that jingle?  Dennis: I do. Bob: And they used to sing in that jingle – "You've come a long way, you've got your own cigarette now, baby, you've come a long, long way,"  and I remember laughing at that , thinking, "Boy, that's a real sign of progress, huh?  When somebody finally has their own brand of cigarette, they've really come a long way. And yet over the last 30 or 40 years, we have looked at what it means to be a man and what it means to be a woman, it's all been in the context of coming a long way and digging ourselves out of our repressive past into our liberated future. Dennis: And, of course, in order to do that, a woman has got to roar.   Bob: That's right, that's right. Dennis: And so between cigarettes and roaring, we have redefined what it means to be a woman, and we're laughing about this here, but you know what?  It really is sad.  That definition and that roaring has occurred to great harm and detriment within the Christian community as we attempt to raise our daughters and, for that matter, our sons, with a true biblical imprint of God's image in them as male and as female.  And with us to help us perhaps counter that culture with a biblical portrait of what it means to be a woman, today on the broadcast, is Nancy Leigh DeMoss.   Nancy is a speaker to women's groups.  In fact, she has done that for the past 20 years, and this is a life message for you, isn't it, Nancy? Nancy: I just consider it an exciting challenge today to help women see that there is so much more that God has for us than perhaps what we've been enjoying. Bob: Well, and you get to do that every day on your daily radio program, "Revive Our Hearts," which is heard on many of the same stations that carry FamilyLife Today.  And you've done it through your writing, through the bestselling book, "Lies Women Believe," the Study Guide, "Seeking Him," the trilogy of books on surrender and holiness and brokenness that you've written and, this fall, you're going to be having an opportunity to challenge women on this very subject at a conference, a national conference you're doing in Chicago that is called True Woman '08."  My wife is planning to be there and really looking forward to it. Let me ask you – as we're talking about this subject of the differences between men and women, you really believe that there is a lot of confusion among Christians, both men and women, on this subject because of the messages we're getting from the culture, right? Nancy: Well, look around and see the dynamics of our culture are rooted in the twin vices of selfishness and rebellion.  Our culture is rooted in self-seeking, self-assertiveness, self-exaltation, selfishness – self-centeredness and rebellion.  We dislike authority.  We don't want to live under authority and, as women, this has been especially destructive as the feminist movement has built its case on self-seeking, self-assertiveness, and rebellion against authority. God's Word, on the other hand, teaches us the way of surrender, submission to Christ as Lord, and then to those of human authorities that God places in our lives.  Surrender versus rebellion and the way of love – being a giver rather than a taker, not self-seeking but self-denying. Dennis: Let's look at some important parts of this portrait of what it means to truly biblically feminine, of what God wants you to be as a woman.  Where do we begin as we look at this portrait? Nancy: We talked yesterday about the woman as a responder and the man as an initiator.  This becomes obvious to us as we go back again to the Genesis record and see what God designed for the man and for the woman, and then how the man and the woman distorted and perverted that design.  God made the man and said to the man, "Here is your responsibility.  Have dominion, subdue the earth, rule over it, be the king of the earth."  Then God gave to the man a helper, a woman, likewise created in the image of God but different than the man, made to complete him not to compete with him, and said to her, "You are to help him fulfill this responsibility." Then when we come to the serpent entering the scene, we find the first illustration of role reversal.  It's interesting that the serpent comes to the woman.  God had given the instruction to the man, but Satan comes to the woman independent of the man and challenges her to take the initiative; to find her declaration of independence.  To say, "I will make my own decision, I will be my own god."  He challenges her to step out from under the protection, the authority of her husband, and then when she gives the fruit to her husband, and he eats, he likewise is abdicating the headship, the responsibility for initiative that God has given to him. And from that point on, we find man and woman in a power struggle.  The woman, driven to control, to initiate, to be the head, to lead, and the man either passive or abusive but not fulfilling the God-given responsibility to initiate, which is not a consequence of the Fall but precedes the Fall that God ordained the man to be the leader, the head, the initiator.  The woman, by taking that role into her own hands in a sense emasculated the man.  Bob: That's interesting.  You're saying that Eve could have said to the Serpent, "I want to check this out with my husband.  Wait right here."  She could have gone to Adam whether he was standing there or not, but she could have looked at him and said, "Should we do this?" Nancy: What does the Scripture say in the New Testament?  If a woman has a question, let her ask her husband.  And I hear women so often today, "My husband doesn't know the Word of God.  I'm the woman, I've been sitting in the Bible studies listening to speakers and going to seminars.  My husband doesn't know all these things."  And I say to women, you'd be amazed if, with a learner's heart, a teachable spirit, a humble attitude, you are to begin to ask your husband questions, and he saw himself as being needed by you, how he might be motivated and prompted to begin to take initiative to learn the heart and the ways of God in these areas. Dennis: Today, Nancy, within the Christian community, there are those who would express that a woman shouldn't come back to her husband and ask him a question.  In fact, there are those who would even take issue with command for a wife to submit to her husband.  They would really have a problem with that. Nancy: Dennis, the entire universe created by God is structured in authority and submission relationships.  The Trinity itself models for us what it means for there to be authority and submission.  We see God the Father, who deeply loves His Son, and we see the Son saying, "I have come to this earth not to do my own will but to do the will of my Father."  We see Jesus, who was co-equal, co-eternal with God the Father, voluntarily placing Himself under the authority of His Heavenly Father so that the plan of redemption can be accomplished. So for a woman to come under the authority of her husband, under the authority of male leadership in the church, is not to be less than equal but is to say I am willing to function according to the design of God so that His purposes can be fulfilled in this earth. Dennis: And I don't want the moms and the dads who are raising the next generation of daughters and, for that matter, sons, to miss the profound statement that Nancy just made.  She is saying we've got to train our daughters to understand the importance of God's created order and of authority and of submitting to authority and that authority is not wrong. Nancy: And it is not negative.  You've got to come to see that authority, in whatever realm of life – employer, employee, elders, church leadership, and authority in the home – that these are God's means of providing protection for the lives of those who come under that authority. I had an experience a number of years ago that illustrated this to me in a helpful way.  At the time, I was traveling a great deal, and I was serving in a ministry where the authorities, the leadership in the ministry, had said that I should not fly in a single-engine airplane at night.  I loved flying, and I didn't care whether it was single-engine or twin-engine, but it wasn't an issue to me, but they felt that it was not wise for anyone to be flying in a single-engine airplane at night.  If the one engine you had went out, that was it. Well, that didn't cramp my style too much.  It wasn't often the case that that would be necessary, but I found myself one time traveling in one of those states that nobody uses, where nothing is near anything, and we had a very difficult itinerary, just one seminar to the next from one small town to the next over the period of a week.  And one of those days – I called in advance, as we were making the arrangement, and I said to the man who was setting up the logistics, "Now, I just need to let you" – he said, "We may need to charter a plane at some point to get us from one of these towns to the next where there is no commercial service available."  I said, "Well, that's fine, but you need to understand that I can't fly in a single-engine airplane at night." Well, he told me that would be fine.  He asked me if I was afraid to fly in a single-engine airplane at night, and I said, "No, that wasn't the case but that I was under authority."  Well, we got to the airport on one of those particular days, and there was one airplane at that airport, and it had one engine, and it was night.  And I said, "Carl, I can't go up in that plane."  He said, "It's the only plane we have."  I said, "Well, we can't go."  He said, "It will cost us a lot more to charter something different."  I said, "Well, we'll have to pay or we can't go."  And he tried to reason with me that there was no reason for me to be afraid to go up in that single-engine airplane at night.  They had a good pilot; he felt it was a safe plane. I said, "You know, Carl, that's not the issue.  I'm a woman under authority, and if I go up in that single-engine airplane tonight, out from under authority, I'm not safe.  And if you go up with me, you're not safe, either."  And, you know, he understood that.  And the question, then, I raise is, well, does that mean if I go up in that single-engine airplane that it's going to crash – probably not, I don't know.  But when you live under authority, it doesn't really matter.  You say, "Does a twin-engine airplane never crash?"  Yes, sometimes they do.  So you say, "What's the difference?" Well, in my mind, the difference is if a plane goes down, and I'm under authority, then I have the confidence that I'm right in the middle of God's will for my life.  But if I step out from under that covering and that protection that God has provided for me, then I make myself vulnerable to the realm, the influence, the attacks of Satan himself, which is why the Scripture says that rebellion is as the sin of witchcraft.  Because in stepping out from under God's protection and the authority he has placed into our lives, we open up our lives to the attack, the realm, the influence of Satan himself, and that's a dangerous place to be. Bob: In that moment, did you wrestle at all with the reasonableness of the restriction?  You're standing alone at the airport.  There is one plane.  You've got a mission to accomplish, you're trying to share the Gospel.  Did you think to yourself, "This was not a reasonable request in the first place, and maybe just this once I ought to violate it because it doesn't appear like we have any other options?" Nancy: I'm sure, although it was many years ago, I'm sure I did feel some of that at the time, and I know I have felt that way in many other instances.  But then I have to come back to what is the purpose of my life?  It's to glorify God.  How do I glorify God?  By obedience to His Word and His ways, and so many issues are simplified in my life if I will just go back to the Scripture and say, "What is God's way?  What is God's pattern?"  Not, "Do I like this?  Am I comfortable with it?  Does it make sense to me?"  But Jesus is Lord, so what does that mean for my life and for all of us in relationships where there is authority that has been established by God.  That means the willingness to bow, to surrender my will, and to say, "Not my will, but Your will be done." Dennis: Nancy, there are some of our listeners who are married to husbands who are not spiritual at all.  They don't trust their husbands' reasoning, his rationale, why he decided to do what he's done.  He's trying to take our kids fishing on Sunday morning; doesn't want them to go to church – not just one Sunday but Sunday after Sunday after Sunday.  Is there any appeal in that situation? Nancy: Well, certainly, there is, and let me back up to what you said – the woman does not trust her husband's reasoning.  Ultimately, as women, our trust is not in that husband or that man, but our trust is in God.  This is what 1 Peter 3 talks about – the holy women of old who trusted in God, and then it gives Sarah as an illustration.  Because she trusted in God, she obeyed her husband, Abraham, calling him "lord."  That's a pretty strong term, and we don't like that today, but she gave to him under – it was lowercase "L," lord, not capital "L."  God is Lord with a capital "L," but because her trust was in God the Lord, then she was able to obey her husband, to call him lord, little "L," and at times Abraham made decisions for his family that, at times, were not wise. Dennis: In fact, they were deceptive.  He asked Sarah to lie. Nancy: But Sarah found protection, and 1 Peter 3 tells us freedom from fear because her heart was to obey her husband.  Now, scripturally, we are not to sin in obeying an authority, and that's where, if we believe that authority is giving us direction that is clearly contrary to the Word of God, not just contrary to our personal preferences or feelings about things, but contrary to the Word of God that would cause us to sin, then we walk through the process of appeal.  And I think many of us don't have the patience to be willing to wait on God to change the heart of the authority.  You see, Proverbs tells us that the king's heart is in the hand of the Lord, and the Lord turns the heart of that king as the rivers of water.  The greatest evidence of how big I believe God is, is my willingness to trust God to work through authorities that He's placed in my life and to give Him time to change the heart of that authority.  I may be a part of that process by going to the authority, making an appeal, but even as we do, I think it's so important that our spirit be one of humility. Those who are parents know that when your child comes to you and says, "You've told me to do this, but I don't agree.  You're off the wall, get off my back, I'm not going to do this."  Well, the parent is going to tend to stiffen in response to an attitude like that on the part of a teenager.  But can you imagine one of your daughters, Dennis, coming to you and saying, "Dad, I know that you have my best interests at heart, and I know that you want what is best for my life, but I prayed about this decision, and I sense that perhaps God is giving me a different direction.  I'm going to obey what you've said, but would you be willing to reconsider, to think this through and to pray this through and see if God would give you a different answer." Well, you're going to fall on the floor first, and then, because of a humble and obedient spirit in that teenager, you're going to be willing to go back to the Lord and to say, "Did I really get the right direction here?" Bob: Is it okay, Nancy for a woman to be an active receiver?  And here is what I mean by that – sometimes Mary Ann will come to me, and she'll say, "I need your help on something.  I need you to think this through and let me know what you think I ought to do."  And I'll say, "Okay, I'll do that.  I'll pray about that, and I'll do that." And then I kind of set it aside, get distracted, don't really think about it.  A couple of days later she may come back to me and say, "You remember that issue?  I still need your help on that, and I'm looking for your direction." She is nudging me … Nancy: She is being your helper.   Bob: Yes, she is. Nancy: This is what God made her to be.  But I think, as women, we need to be careful that in doing that, we don't intimidate, and we have to know, as women, what is the heart, what are the needs, how can we best serve and help the men that God's placed us under? Bob: Yeah, I brought that up, Dennis, because I appreciate my wife coming back and nudging me a second or a third time, because I do get distracted, and just as Nancy said, she is being my helper when she asks me to initiate. Dennis: I think a lot of people listen to conversations like we're having here, and they equate responder and submission to weakness and to being a pushover. Nancy: Well, let me say this – the Scripture does say that the woman is the weaker vessel. Dennis: Well, she may be weaker physically, but in her role, she's powerful. Nancy: She's powerful by fulfilling the role of the responder and the one who comes under authority. Bob: Exactly. Dennis: And the question I wanted to get to right here is a friend of mine who has got a daughter who is college – she is stout, she is strong.  Now, she's still a woman, and she's still a weaker vessel, that's not the issue here.  But she is very gifted, a leader, and I think you can probably identify with this, Nancy.  She has a lot of abilities, but she is a girl, she is a woman.  And my friend, who is her father, is attempting to raise her to be God's woman, and he is struggling with how do I raise this young lady to be all that God intended while possessing these public gifts, these leadership gifts?  Are you saying, by being a responder, that you can't be a leader? Nancy: We're not saying that God is asking women not to utilize the strengths and the gifts that He has given to them but to do so within the framework of acknowledging that God made that husband or that father or that male leadership in the church to have the primary responsibility for leading, and that her role is in helping him, assisting him, coming under his covering and protection. Now, the wise man will receive input and will maximize the gifts, the abilities, that God has given to his wife, but, see, we're also operating on a very 20th century and Western mindset that we have a right to exercise all of our gifts and that our purpose in life is to fulfill all of our gifts.  My purpose in life is not to fulfill all my gifts.  My purpose in life is to bring glory to God.  And if, at times, that means that God's will is that some of those gifts and strengths be put on the shelf or not be as noticed or as utilized.  It's up to God.  I am surrendered to be used however God would be most glorified, and that may mean that I'm not at the forefront, that I'm not taking the leadership or the reigns if God would receive more glory through that.   Bob: And if that's going to happen, it means that women are going to have to be taking their cues not from the culture but from the Scriptures.  They are going to have to be renewing their mind on the truth of God's Word and what God has to say about what it means to be a woman and not taking their cues from the magazines that are in the racks at the supermarket as you're checking out. Nancy, you've written on this subject in a variety of settings.  You wrote a little booklet called "A Biblical Portrait of Womanhood," that tens of thousands of women have read and passed on and have found very helpful.  We've got in our FamilyLife Resource Center , and it's available to our listeners if you'd like to get a copy. Then you've also written a bestselling book called "Lies Women Believe and the Truth That Sets Them Free," along with a variety of books – a book on surrender, a book on holiness, a book on brokenness, a study guide called "Seeking Him, Experiencing the Joy of Personal Revival."  We have a number of your books in our FamilyLife Resource Center, and if our listeners are interested in getting more information about what's available, the easiest thing to do is go to our website, which is FamilyLife.com.  On the right side of the screen, you'll see a box that says "Today's Broadcast," and if you click where it says "Learn More," that will take you to an area of the site where you can get more information about the resources Nancy has written.  You can order them from our website, FamilyLife.com, or if it's easier to call 1-800-FLTODAY and place an order over the phone, you can do that as well. Again, the website is FamilyLife.com, the toll-free number is 1-800-FLTODAY, and then don't forget the conference that is coming up in Chicago in October – October 8th through the 11th.  It's a national conference for women called True Woman '08, and it features a number of speakers including Nancy Leigh DeMoss and Barbara Rainey, Joni Eareckson Tada, Janet Parshall, Pastor John Piper is going to be speaking there, Keith and Kristin Getty are going to be leading the worship at the conference, and it looks like it is on the way to being a sellout event. So if our listeners are interested, they ought to register as quickly as they can.  Again, our website is FamilyLife.com, and there is a link there that will take you to the True Woman '08 website where you can get registered and plan to attend this two-and-a-half-day national conference for women in Chicago in October. And I want to be quick to add here that women are not alone in terms of confusion about what it means to be what God created you to be.  Men are struggling with this as well, and this month we've been making available a CD for our listeners on the subject of masculinity and understanding it biblically and keeping it in biblical balance.  It's a message from our friend, Stu Weber, that we call "Applied Masculinity."  Stu is a pastor and a retired Army Ranger, a Green Beret, and this message is a terrific message for men.  We're making it available this month when you help support the ministry of FamilyLife Today with a donation of any amount.  Because we are listener-supported, these donations are essential to keep our program on the air on this station and on other stations all across the country. So we hope you'll consider making a donation, and if you'd like to receive the CD with the message from Stu Weber, as you fill out your donation form on the Internet, just type the word "Stu" in the keycode box.  That's s-t-u – again, you'll see a box that says "Keycode," and you just type s-t-u in there, or call 1-800-FLTODAY.  You can make a donation over the phone.  Again, it's 1-800-358-6329. When you make your donation just mention that you'd like a copy of the CD form Stu Weber called "Applied Masculinity," and we're happy to send it out to you.  We really do appreciate your financial partnership with us here in the ministry of FamilyLife Today. Tomorrow we're going to continue to look at what it means to be God's woman according to God's Word with our guest, Nancy Leigh DeMoss.  We hope you can be back with us as well. 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'll 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 for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com 

A Biblical Portrait of Womanhood (Part 1) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 2) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 3) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 4) - Nancy Leigh DeMossA Biblical Portrait of Womanhood (Part 5) - Nancy Leigh DeMossFamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. God's Woman in Today's Culture Day 1 of 5 Guest:                        Nancy Leigh DeMoss From the series:       A Biblical Portrait of Womanhood Bob: How should we understand womanhood biblically?  And why are we so confused about it, anyway?  Here is Nancy Leigh DeMoss. Nancy: Let me say that I think it is the nature, ever since the fall of man and woman, to chafe against God.  But, for me, the essence of femininity is to embrace the concept of surrender as a woman to become a receiver, a responder, and surrendered to the heart and the will of God. Bob: This is FamilyLife Today for Monday, June 16th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  How well does your understanding of womanhood line up with what the Bible teaches?  We'll talk about that today.  Stay tuned. And welcome to FamilyLife Today, thanks for joining us on the Monday edition.  You know, for the last many years, there has been a movement in our country where a lot of men are looking around and asking the question, "What does it mean to be a man?  What does the Scripture teach us about authentic biblical manhood?"  And I think that while that's been going on, Dennis, there have also been a lot of women who are beginning to say, "I'm not so sure I know what it means to be an authentic woman biblically.  I'm not sure I know what the Scriptures teach about biblical womanhood," and that's what we're going to take some time to focus on this week. Dennis: Yes, in Genesis, chapter 1, verse 27, it's clear – "And God created man in His own image, in the image of God, He created him – male and female, He created them."  And God's image is at stake in both men and women, and there has been a great deal of attention that has been given to defining manhood.  But at points it feels like there has been a little bit of a silence concerning a voice of trying to cast a portrait of what it means to be a woman.  And with us here on the broadcast is another man to help us define and paint a portrait of what it means to be a woman. Bob: Hang on, that would be a serious error on your part, technically. Dennis: Do you think that I would be flawed in my judgment, Bob, to bring another male species in here to do that? Bob: I think three men could sit around and attempt to define femininity … Dennis: And we would lose our entire female listening audience. Bob: There would be a lot of women who would say, "I'm not sure you know of what you speak." Dennis: Well, with us in the studio is Nancy Leigh DeMoss.  Nancy is a great friend.  She's been on FamilyLife Today before.  Nancy, welcome back to FamilyLife Today. Nancy: Thank you, Dennis. Dennis: She puts up with us a lot.  She just kind of looks at us and nods and says … Bob: … rolls her eyes … Dennis: … yeah, that's exactly right.  Nancy is a graduate of the University of Southern California.  She has a degree in piano performance.  Nancy, are you really that good?  I've heard you are. Nancy: Well, that's kind of a past-tense part of my life. Dennis: Oh, is it? Bob: I know you haven't had a whole lot of time to do much piano performing in the last several years.  As many of our listeners know, Dennis, Nancy hosts a daily radio program that's heard on many of these same stations.  It's called "Revive our Hearts."  You've been busy writing a number of books including the bestseller, Lies Women Believe," and the companion now, "Lies Young Women Believe."  There has also been a trilogy of books on surrender and brokenness and holiness, and this fall you're going to be involved in a national conference for women in Chicago called "True Woman '08."  Joni Eareckson Tada is going to be speaking there; so is Janet Parshall, John Piper is going to be there, you're going to be there, Dennis; your wife, Barbara, is speaking as part of that conference, and if our listeners are interested in finding out more about True Woman '08 they can go online at FamilyLife.com and click on "Today's Broadcast," and there is a link there that will get them information on how they can attend this national conference taking place in Chicago.  And with all of that going on, there's not a whole lot of time left for piano playing. Dennis: Nancy, we have laughed here early, but there is a great deal of tension when it comes to talking about what it means to being a man or a woman today, and a great deal of confusion.  What do you think has caused this confusion?  What's the greatest contributor to the confusion of what it means to be a woman today? Nancy: Well, let me just give a word of personal testimony here and say that being a woman is not something that I have always embraced with joy myself.  I did have the privilege of growing up in a godly home and under the strong ministry of the Word, but I can remember, as a teenager and young woman, feeling a measure of resentment … Dennis: Really? Nancy: … even, at the fact that God had made me a woman.  And the reason, in my case, was that I so wanted to serve the Lord, had a passion for Christ and for ministry, and in my young thinking, it was men who were best able to do that.  And I had this quiet sense in my heart that if God had made me a man, then I would be better able to serve Him.  I would be able to serve Him more effectively. Dennis: In other words, you viewed your womanhood as a limitation to being used by God in the way that you dreamed of being used. Nancy: I did.  But I want to say that God has been so gracious as I've gone back to the Word of God and sought to draw my understanding from God's Word to see my life as a woman from His point of view, I have come to see that being a woman is a great gift.  I've come to embrace with joy what it means for me to be a woman, and I think part of the difficulty for many of us, as women, as younger women, particularly, is that we've been raised in a culture that is very confused and that has been deeply influenced by the world's way of thinking about what it means to be male or female. Dennis: Well, that's what I was going to ask you.  Did you feel like the culture really contributed to you thinking less of being created as a woman? Nancy: I think there certainly has been a great deal of confusion in the world, and there has been a concerted, intentional effort on the part of many in our world to redefine womanhood; to steal from us, as women, God's purpose for our lives, and I feel, as a result, that women have been robbed of the wonder and the privilege of what it means to be made a woman. Bob: You're obviously not alone.  There are a lot of young women who looked at the landscape and saw it defined along male/female boundaries, and said there are things that the culture will not allow me to do because I am a woman.  And in the church, in the Scriptures, there seem to be indications that there are things that God has reserved for men to do and things that He has excluded women from doing.   So, at 15, or whenever it was that you were saying, "I'm not going to get to do some of the things that it seems my soul longs to do."  That has led a number of folks to say there must be something wrong here.  God would not give me the strong desire to do these things and then exclude me through the pages of Scripture from doing those very things. Nancy: I think the thing we have to remember is that things function poorly or not at all when they function contrary to their design.  We're sitting here in a studio, and there's a microphone in front of us, and this microphone works well when we use it for the purpose for which it was designed, but this microphone would not work well or at all if I tried to use it as, say, a book or a piano … Dennis: … or a ball bat. Nancy: It wasn't designed for any other purpose.  And Satan caused Eve to doubt not only the veracity of God's Word but also the goodness of God.  Has God put limitations on your happiness?  Has God put restraints on you?  Would you be freer and happier and more blessed if you operated outside of God's parameters?  And that is an essential deception, and so many of us daughters of Eve have listened since that day to the deception of the enemy and have begun to function contrary to the design for which God made us and, as a result, we have broken lives, broken hearts, broken marriages, broken homes, and miserable women in so many cases. Dennis: And, you know, I think God gives us illustrations every day of how we are involved in this same kind of protection of others by placing limitations in their lives.  When we used to live in town, we lived on a pretty busy street.  It wasn't a main thoroughfare, but there was a good deal of traffic that flowed back and forth, and we would take our toddlers out to the edge of the road, and we would point to the curb, and we would say, "Do not step off the curb.  Do not go near the curb, do not get in the street, this is a no-no."  And invariably, our children would look at the curb, they would look at the street, and they would look at the yard, and they would look up at us, and they'd put their foot down on the street.  And, at that point, they were testing us to see if, indeed, the boundary was, a, real and, secondly, did I really mean what I said?  And at that point, they found out rather swiftly that there was some discipline behind that. And I think, in the Garden, Eve found out very quickly what she lost when she stepped out from under God's design and disobeyed God.  At that point, she lost that created wonder, the beauty of femininity in its untainted form, unstained by sin and by selfishness.  And, you know, Nancy, I think what people are struggling to get back to today is what Eve lost in both men and women. Nancy: It really is paradise lost.  I think of the verse in Genesis 5, verse 2, reflecting back on the Creation, it says, "Male and female, He created them, and He blessed them."  He blessed them, and as you go through the early pages of the book of Genesis, you see that God's intent was to bless His Creation, and we forfeit that blessing when we step out from the distinctions, the roles, the design for which He made us as men and as women. Dennis: And I think one of the most practical things we can take away here at the beginning of this broadcast is, just as parents, that we must bless our children in their sexual identity.  It is within our power either to bless that or curse it or withhold blessing.  And what we're talking about here is a deeply profound theological principle, but it's intensely practical – very practical, as we raise the next generation. Nancy: We live in a generation that has tried to blur and eradicate, even, the distinctions between male and female and, to me, as you said, Dennis, we have, as women, been stripped of some of our most precious treasures as a result of moving into a unisex generation where men and women think alike, dress alike, have the same kinds of jobs, the same kinds of roles, the same kinds of responsibilities.  We have not gained from these measures as women.  I believe we have been robbed. Dennis: You know, this loss that you're talking about here, Nancy, hit me profoundly some time ago when we were watching the morning news with our kids, and it happened right before the big gathering they had in Washington, D.C. for Promise Keepers, and they had a pro-Promise Keepers speaker on, and then they had a nationally known feminist who was the president of NOW at the time, and we listened to those two go back and forth, and I had a deep sense of a profound sadness, as I listened to that representative from NOW who so wanted women to achieve and to be successful and yet she was doing it without a reference to God. And when all the debate was over, we turned the TV off, and it was right before school, and we have prayer before we go to school, and I gathered my three daughters who were there, and I put my arms around them, and I began to pray for them.  I don't know when the last time I began to weep when I prayed was, but I began to sob.  I just had a profound sense of sadness that my daughters and other daughters are growing up in a culture that is attempting to find happiness and hope and success and femininity and womanhood without reference to God. Bob: Nancy, I know, as you grew up, you talked about feeling limited by your femininity.  As you've come to understand what the Scriptures teach about womanhood, I'm sure there has been some of that that's been fairly easy to embrace and some of that that you've chafed against a little bit.  What has been difficult?  What has been hard to accept about God's portrait of womanhood? Nancy: For me, the essence of femininity is to embrace the concept of surrender as a woman to become a receiver, a responder, and surrendered to the heart and the will of God.  I love the example of Mary, the mother of Jesus.  And, to me, she is a portrait of what it means to be a woman of God.  When the angel came to Mary and explained to her that she was going to be a mother of the Son of God, Mary's response was, "I am the Lord's servant.  May it be unto me according as you have said."   And, for me, the difficulty – I think it's true for every human being – is to embrace what God has said.  Say "Let it be to me as you have said," and that means for all of us, male and female, that there are restrictions, that there are certain roles that we are not asked to play, that we are not designed to fulfill.  And, sure, my flesh has chafed against embracing those roles and those restrictions at times, but it's the enemy that causes us to see those as restrictions.  It's God's way to see those limitations as loving imitations, as wise limitations, and as a means of protection, even as you protect your children from the oncoming traffic by teaching them not to step off of that curb in front of the house. Dennis: And, Nancy, I think you've hit it.  Our assignment as parents or the assignment of today's broadcast for a single woman or a married woman is to embrace God's design, receive it as Mary received that call upon her life to become the mother of the Savior and not listen to the voices that would muddy the clear call of God and pull back to the big picture and say, "Wait a second, where does life come from?"  Is the feminist movement really going to offer life?  Is it found where they say it's going to be found by seeking your own rights?  By trying to find self-fulfillment?  Their definition of success is around self.  A Christian's definition of success in the roles of men and women is around God and in surrendering to that which God has called him to be and to do. And I wonder sometimes, Bob, even within the Christian community, how foolish we've become in buying into this trap as we raise our daughters, seemingly, to prop their ladders against the careerism wall just like we trained our sons.  It wasn't any more correct to do that for them but to turn around and take our daughters and to say that the goal of their education, the goal of their lives ought to be a career?  Wait a second – where is that in the Bible?  Where is the home here?  Where is relationships here?  Where is the next generation here? Nancy: And let me say that because of the influence of the world's way of thinking in our generation, I believe we are faced today with an incredible opportunity to help women discover the means of true freedom, true liberation.  I've been, for some 20 years, involved in ministry to women, and women in the church primarily, and I've found that women today, by and large, are frustrated, in many cases, angry, hurt, wounded, and hardened, in some cases.  It's not difficult to convince women today that the world's way has not worked.  The world has promised freedom and success and joy, but it hasn't delivered.  And so what a time for us to hold up the standard of God's Word and say, "Here is what God offers.  This is the means to true freedom." Dennis: And I know that most of our listeners are women, on the broadcast today, but there are some men who are listening, too, and I just want to speak to you guys for just a second.  It is our responsibility to protect and preserve our wives, to protect and preserve biblical femininity and womanhood.   It ought not to be that our churches are filled with frustrated, angry women at a culture that's confused the issue.  Who ought to be stepping forward and helping define these issues?  It's men.  We ought to help.  Now, I'm not saying we're the ones doing all the defining and telling wives what they ought to be.  I can almost see those letters coming right now, but calling together some godly women who get in the Scriptures, and they look at it from Genesis to Revelation and begin to say, "What is God's design in the Scriptures for a woman?  Is it limiting?  Has God called there to be a distinction between male and female?"  And I believe it's clear.  It doesn't take a Hebrew or a Greek scholar to see there is a difference between men and women. Nancy: Only by restoring the sense of those distinctions and showing how they must be protected and preserved and celebrated will we be able to rear a new generation who understand the joy and the blessing of fulfilling God's role for them. Bob: You know, we're going to be talking this week about the portrait of femininity, what it means for a woman to be a woman according to the Scriptures, and just on the basis of what we've said today, I can imagine there are some listeners who say, "I hear it coming, and I already don't like it, because it's going to tie me up in such a restrictive knot that I can't function outside the home, I can't have any fulfillment in using my spiritual gifts except at a ladies' Bible study.  I've heard it before, I didn't like it the first time I heard it, and I'm not sure I want to listen this week, because I don't think I'm going to like it this week." Nancy: You know, Bob, I can imagine a fish in the water feeling that it's limited by having to live in the water, and that fish, if it could speak, perhaps could say, "I'm going to get out of the water."  And the fish can get out of the water, but the fish can't live or survive out of the water.  And so many times they have men and women trying to escape from the realm, the sphere in which God created us to be blessed and successful.  We can get out of that realm, but we can't survive out of that realm. Dennis: Nancy, I couldn't agree more, and as Bob was articulating what some are feeling right now, I couldn't help but think that the serpent had a good bass voice like that, too, and was saying, "Hey, shed the restraints.  You don't have to put up with these God standards any longer.  Get out from under it, find a new way, find a better way, you can be all you were intended to be without reference or without depending upon God," and, you know, life is full.  I mean, look in your neighborhoods, look around your community at what happens to people who ignore the Ten Commandments.  Their lives are destroyed. And I just want to tell you, around this issue, this is a major issue for our nation, for our churches, and for every Christian family that is raising the next generation of boys and girls who will be the next civilization in America. Bob: Yeah, there is massive confusion on this subject, especially among this emerging generation.  The whole question of gender has been muddled, and it leaves a lot of young men and a lot of young women questioning what it means to be a boy, what it means to be a girl. Nancy, you wrote a little booklet a number of years ago called "A Biblical Portrait of Womanhood," and it's a booklet that we've got in our FamilyLife Resource Center along with a number of the books you've written.  In fact, I would just encourage our listeners, if you have resonated with what you've heard Nancy talking about today, get a copy of the booklet, "A Biblical Portrait of Womanhood," and then get Nancy's book, "Lies Women Believe," as well, if you haven't read that yet.  They are both in our FamilyLife Resource Center, and you can go online at FamilyLife.com and order copies, if you'd like.  Again, our website is FamilyLife.com, and when you get to the home page, on the right side of the screen, there's a box that says "Today's Broadcast," and if you click where it says "Learn More," it will take you to an area of the site where there is information about these books and other resources from Nancy Leigh DeMoss.  There are transcripts of the program that you've heard today, and there is a place where you can leave comments about what you've heard or about what you read in the transcripts.  Again, our website is FamilyLife.com, and you'll need to click on the right side of the screen where it says "Today's Broadcast" to get to the area where there is information about the resources from Nancy Leigh DeMoss, and there is a link there to the True Woman '08 conference that we've talked about today that's happening in Chicago October 8th through the 11th.  A great lineup of speakers, and our friends, Keith and Kristyn Getty are going to be there helping to lead worship as well. If you'd like to attend the national True Woman '08 conference in Chicago in October, go to our website, FamilyLife.com, and you can get more information.  Or you can click through and register online at the True Woman '08 website.   You know, while woman are wrestling with this subject, there are a lot of guys who are wrestling with what it means to be a man biblically, and this month we have been making available to our listeners a CD of a great message from Stu Weber called "Applied Masculinity."  It's a message that looks at what's at the core of being a man, and how to keep masculinity in its appropriate biblical balance, and we'd love to send you a copy of that CD this month when you make a donation of any amount for the ministry of FamilyLife Today. We are listener-supported, your donations are what keep this program on the air here in this city and in other cities across the country, and you can make your donation online at FamilyLife.com, or you can call 1-800-FLTODAY to make a donation.  If you're online, and you'd like to receive the CD from Stu Weber on manhood, just type the word "Stu" s-t-u, in the keycode box on the donation form, or you can call 1-800-FLTODAY and make a donation over the phone and just say, "I'd like the CD on manhood."  We're happy to make it available to you as our way of saying thank you for your generous support of the ministry of FamilyLife Today.  We appreciate you. Now, tomorrow we're going to continue to unpack what is at the essence of femininity from a biblical perspective, and 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'll see you 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 for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com 

Storm Stories: Charlie's Victory (Part 1) - Charlie & Lucy WedemeyerStorm Stories: Charlie's Victory (Part 2) - Charlie & Lucy WedemeyerFamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Storm Stories:  Charlie's VictoryDay 1 of 2 Guest:                        Lucy and Charlie Wedemeyer From the series:       Storm Stories:  Charlie's Victory Part 1        Bob: Lucy Wedemeyer was a young wife, a young mom with two small children.  She had married her high school sweetheart, the star of the football team.  Things were going perfect for Lucy until one day her husband came home from the doctor. Lucy: I mean, it was very obvious to me something was really wrong, and when he said that the doctor told him he had this terminal disease, I couldn't say anything.  I couldn't even respond.  We just stood there kind of clinging to each other. [musical transition]  Bob: This is FamilyLife Today for Thursday, August 7th.   Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  How does a marriage survive and stand strong in the midst of storms?  Stay tuned. [musical transition]  And welcome to FamilyLife Today, thanks for joining us on the Thursday edition.  When we began this week, when you told our listeners that the story they were going to hear was one of the top five all-time FamilyLife Today stories, and I think you're right.  I think what we've heard already this week has been powerful and profound.  But we thought we ought to revisit another one of those top-five moments before the week is over.  And so our listeners are going to get to hear another remarkable couple on today's program. Dennis: A great story of unsurpassing love between a football star and his adoring wife, Charlie and Lucy Wedemeyer tell a story that I think our listeners will never forget.  Charlie was a standout high school football star in Hawaii.  He ended up getting a scholarship to Michigan State University, where he had never seen a snowflake before being from Hawaii, and there he met Lucy.  They were married and not long after that he had become head coach of Los Gatos High School in Northern California in the Bay Area, and it was during that time he was diagnosed with a terminal illness, at least he was told by his doctor that he had months to live. Bob: And when we sat down and talked to them, it had been years since he had received that diagnosis, and Charlie was in a wheelchair, the only parts of his body that he could move were his lips and his eyes, and that's how he communicated with his wife, Lucy.  In fact, our listeners may be able to hear the ventilator that he's on.  They won't hear Charlie's voice, but Lucy will be able to share some of his thoughts and some of his words as she reads his lips and as she walks us through this incredible story. Lucy: Charlie was diagnosed with amyotrophic lateral sclerosis, which is commonly known as Lou Gehrig's disease.  The doctors told him at the time of the diagnosis he had maybe a year to live, and Charlie's adding here, "The doctors didn't realize that Dr. Jesus had other plans for me." Dennis: Well, I want to take you all back to how you met because you met in Hawaii, isn't that correct, where you grew up? Lucy: Charlie and I met in high school at Punahau Academy on the beautiful island of Oahu under just a gorgeous blue sky and waving palm trees.  I mean, just the most romantic place.  He had just finished football practice, and I was standing in line at the bookstore – uh-oh, "No, no, no.  I was standing in line when I saw this gorgeous blond" – oh I like this – "walking up the steps, and I immediately fell in love."  Is that why you ran over to get in line?  I see. [laughter]  Dennis: Well, you, at that time, were a cheerleader, and he was a star football player – the player of the decade in high school? Lucy: Yes, he was, he was, in the '60s, yes, yes. Dennis: Well, it was in 1977, after you had been married for 11 years.  You'd had a daughter and a son that you were at the chalkboard, and you were having difficulty holding onto a piece of chalk, and at first it didn't seem that it was out of the ordinary that you were having to squeeze the chalk extra hard, but in the weeks that followed instead of two or three fingers you found yourselves really gripping the chalk, and some bad news came your way.  Lucy, can you bring us into those first conversations around that? Lucy: Charlie is saying, "At first I thought it was old football injuries, since I'd had so many."  He played not only high school and college but semi-pro there with the Lansing All-Stars for several years.  So it wasn't uncommon to think that maybe it was arthritis setting in or – he'd had a multitude of injuries all his career, and it was disconcerting, but Charlie just kind of said, "Oh, well, it's probably, you know, just those old injuries," and we really didn't concern ourselves with it that much at that point in time.  And Charlie's saying, "Until it became more difficult for me to button my shirts, to shave, and tie my shoes."  And, actually, what happened was the team doctor noticed some problems and started to ask Charlie and said, "Why don't we go up and have some tests done," and he took us up to Stanford University and ran us through some tests.  He said they were basically inconclusive, and we really didn't think a lot about it.  It's kind of funny, we, I think, preferred to bury our head in the sand at the time and just assume that it was part of his – part of the old injuries. Bob: Charlie, did you bring Lucy in?  Did you let her know you were having trouble with the chalk and buttoning your shirt? Lucy: "Oh, yes, in fact, she always had to correct all his math papers for his math students" and do all those things – the fine dexterity things.  But, again, we weren't – I don't think we were extremely alarmed, and our family has always been very close.  Any of Charlie's football games or basketball games when he was coaching basketball or playing softball.  We'd all be together.  The children were always there, a part of the scene. Dennis: Well, that Christmas season, the team doctor, who was a good friend of yours, paid your way back to the islands for all four of you to go back and see your family.  You were suspicious that he knew something that he wasn't sharing with you. Lucy: "Oh, yes," Charlie is saying.  "In fact, you are absolutely right about that.  When he made that generous offer, I thought something was distinctly wrong with me, and after watching that movie on Lou Gehrig's disease, I was convinced that that was what it was." Dennis: Did you ever ask the doctor why he didn't tell you earlier? Lucy: Yes, we did, Charlie did ask him, and really it came down to he didn't know how.  He did not know how to tell Charlie he was going to die, and it was very, very hard for him.  In fact, I was mad at him for a while because I had told him that when he did come upon a diagnosis, that I wanted to be there, that we wanted to be there together.  And the day that I called him about – or he happened to call us, and I mentioned about seeing that movie, and a lot of similarities, he said, "Oh, well, have Charlie stop by," and he'd talk to him. Dennis: Wasn't this February? Lucy: Yes. Dennis: So he'd kept it a secret … Lucy: Yes, for many months, many months. Dennis: What did Charlie do then? Lucy: Well, he stopped by the doctor's office, and I had told the doctor, I said, "Please, I want to be there."  And Charlie's saying, "Actually, one day when I was planning to go to the coaching clinic, I walked out of the gym, and he happened to be there and he told me that he wanted to see me in his office, and at that point I knew that something was wrong.  But when he told me what it was I really didn't believe him because I felt fine, and I looked fine.  And I didn't see how he could possibly be telling me this." Bob: Lucy, when a doctor comes to you and says, "Your husband's got a year to live."  I'm sure there's a numbness, there's a sense of denial.  It's hard – you go through a process of thinking, "This can't be true.  I'm going to wake up, it will be all over," but at some point the reality of that diagnosis sets in, and you begin to think, "What do we do?"  Tell us what you guys talked about at that point. Lucy:  Charlie's saying – oh, Charlie wanted to say that when he left the doctor's office that day, "I was driving home, and the more I thought about it, the inevitable, I thought that someday I wouldn't be able to see my children grow up and not be with my wife and I started to cry and, in fact, I actually drove right through a red light, and I had to pull over, and I was overcome with emotion."  It's very hard to go back.  Charlie is saying that when he got home and came in the door, I mean, it was very obvious to me something was really wrong, and when he said that the doctor told him that he had this terminal disease, I couldn't say anything, I couldn't even respond.  We just stood there kind of clinging to each other in bewilderment and from that point I remember kind of being in a state of denial, definitely a state of uncertainty and then he went off to the football clinic. [laughter]  I was so mad!  But I realized if that helped him keep focused, that helped him so he didn't have to dwell on it, and I got to sit home and worry about it. Bob: Yeah, I'm thinking that left you at home alone, didn't it? Lucy: Yes, yes.  And I remember the next morning when I opened the draperies, and I looked outside, and it was a gorgeous day.  I wanted to know why – why were the birds singing, why were people smiling and happy?  It's, like, wait a minute, something is very wrong here.  How can life just go on when we've just been hit with a ton of bricks? Bob: In that timeframe of those first few months after the diagnosis, did you wonder where is God in all of this? Lucy: Actually, we remember talking about the fact that the coach of the rival high school was also going through some extreme physical problems with his back and not really being able to diagnosis his problem, and so we kind of – I remember sitting up one night, and we kind of laughed, and we said, "Well, God must need some coaches," you know, "this is obvious." You know, I don't think we ever sat there and said "God, why me?"  Mostly because even at that moment, Charlie still looked fine.  There was no discerning sign of disease or, you know, the word "terminal."  It just wasn't there, and I remember at that point saying, "Charlie, you know, this is not just your disease.  This is our disease, and we're going to fight it together."   The only sad thing is, although, I don't know, it worked out quite well, but a lot of people said to us, "Well, you're going to tell the children, right?  You're going to tell the children.  You have to tell the children."  And I said "Why?  Why?"  What do you do?  Sit down with your six-year-old and say, "Hey, guess what?  Dad's going to die in a year."  We couldn't do that because we honestly believed we could fight it, and what I had to do in my own mind was believe that we were going to fight it one day at a time.  I couldn't think about the fact that one day he'd not be able to use his arms at all, or he'd not be able to walk, or he'd be confined to a wheelchair, he couldn't go to the bathroom by himself.  I didn't want to dwell on that, and so I just kind of erased it, and I can see now how the Lord helped us deal in those early days, and it was a very slow, methodical process – when Charlie could no longer use his right hand, he'd use his left.  When he could no longer walk, we had the wheelchair.  It was tough, but he was never willing to give up, and I think that's what strengthened me and buoyed me in trying to keep Charlie going. I do remember wondering, though, "How do you encourage someone that's just been told they're going to die?  What do you say?"  And so we sort of began what we now call "handicap humor."  And we began to say – Charlie was very fastidious, and still is, about every hair on his head.  And I said, "Well, dear, you know, if you had cancer, hey, you'd be bald, and wouldn't that be horrifying?"   And so it lent some humor there, and we began to bring back the humor, because for a lot of times, a lot of days, they were pretty dark.  The uncertainty just can be a real killer.  And even today whenever Charlie hears the name Dr. Kevorkian, oh, he really would like to have a chat with him, because there were times when Charlie felt that it was so hard on him and the family, and we had to rely on so many people to help us that he would – Charlie is saying, "I will always remember when I saw the physical and emotional strain I was causing my wife and my children that I told you" Charlie said to me, "maybe it would be better if I just died." And I can remember sitting next to Charlie when he voiced those words in a voice that was barely even then – oh, and Charlie's saying, "I will never forget your response when you said" – well, I'm going to tell you before I responded to what Charlie said, I had to take a deep breath and I remember sitting there saying, "God, please tell me what to say.  Give me the words," and I told Charlie that we'd rather have him like this than not at all. Bob: Well, we have heard today part 1 of a conversation that took place now more than a decade ago with Charlie and Lucy Wedemeyer and, by the way, Charlie is still alive and the miracle continues. But, again, this is a profound real-life story, Dennis. Dennis: And, Bob, I remember, as we were talking to Charlie and Lucy that I turned to them and quoted 2 Corinthians, Chapter 4, verse 16, because it's a passage of Scripture that really brings perspective to circumstances like only Scripture can and like they were facing.  I just want to read this to our listeners because it's a great reminder.  "Therefore, we do not lose heart but though the outer man is decaying, yet the inner man is being renewed day-by-day.  For a momentary light affliction" – boy – "for a momentary light affliction is producing for us an eternal way to glory far beyond all comparison. While we look not at all the things, which are seen but at the things which are not seen, for the things that are seen are temporal, but the things that are not seen are eternal.   And if – I just remember looking at them and thinking about the love story that we had heard that they've given us a great gift.  It was a gift of a reminder of what is eternal and of real value, and that's character.  That's our choice in the midst of circumstances when they're standing against us in the most fierce storm we've ever faced, and even though Charlie slowly lost his speech, his muscles weakened, and his outer man was helpless, yet because of his trust in God and Lucy's tenacious love, his inner man, her inner man, gained strength, and they found a source of strength in God and in the person of Jesus Christ.  And you know what?  That's the message for you, as a listener today.  Whatever you're facing, whatever you're up against, will you place your faith, your trust, your hope, in Jesus Christ?  I don't know where else you're going to turn.  I think the Wedemeyers have demonstrated there really is hope in no one else. Bob: Yeah, I think a lot of couples come to a point where they ask themselves, "Would our marriage stand up against something like this?  Is the commitment strong?  Is it bedrock to who we are?"  And I think they provide a personal example of what real love looks like in a marriage relationship – commitment, self-sacrifice, genuine caring about another person.  I know their story has been told in a book called "Charlie's Victory," and we have a limited supply of those books in our FamilyLife Resource Center.  If our listeners are interested, they may want to contact us to see how they can secure a copy of that book. But I also want to encourage our listeners to attend one of our upcoming Weekend to Remember Marriage Conferences this fall so that you can strengthen and pour into your marriage relationship because you don't know what the path ahead may bring for you, and it's building today that helps your marriage stand strong against whatever comes. You can find out more about the FamilyLife Weekend to Remember Marriage Conference on our website at FamilyLife.com.  When you go to the website, on the right side of the home page, you'll see a box that says "Today's Broadcast."  Click where it says "Learn More."  That will take you to an area of the site where you can review a transcript of today's program, you can stream the audio online, if you'd like.  You can find out more about the FamilyLife Weekend to Remember Marriage Conference and about other books and resources we have available to help couples pour this kind of a biblical foundation in their marriage.  Again, our website is FamilyLife.com, or you can contact us by phone at 1-800-FLTODAY.  We've got folks who can answer any questions you have about upcoming conferences or resources available, and they can make arrangements to get you registered or to send the resources you need to you.  Again, our toll-free number, 1-800-358-6329, that's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY.  We have said many times here that one of the ways you continue to build a strong marriage relationship is by spending time together each day with God – spending time praying together, spending time looking at His Word, talking about what's going on in your marriage, in your family, and about God's priorities in those important arenas. And one way that couples can continue to grow closer to one another and grow in their relationship with God is by spending time in the daily devotional book that Dennis and Barbara Rainey have written called "Moments With You."  This month we are making copies of this book available for listeners when you make a donation of any amount to the ministry of FamilyLife Today.  We want you to feel free to request a copy of this book.  We're a listener-supported program so we depend on your financial support to be able to continue the ministry of FamilyLife Today on this station and on other stations all around the country. If you are making a donation online at FamilyLife.com, and you'd like to receive the book, "Moments With You," just type the word "You," y-o-u, into the keycode box that you find on the donation form or call 1-800-FLTODAY.  You can make a donation over the phone and mention that you'd like the devotional guide, "Moments With You," and, again, we're happy to send it to you as our way of saying thank you for your financial support of this ministry, and we appreciate your partnership with us. Now, tomorrow we'll hear more from Charlie and Lucy Wedemeyer about how a couple perseveres in the midst of incredible circumstances.  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'll see you back next time 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 for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com                 

Don't Waste Your Life (Part 1) - John PiperDon't Waste Your Life (Part 2) - John PiperDon't Waste Your Life (Part 3) - John PiperFamilyLife Today® Radio TranscriptReferences to conferences, resources, or other special promotions may be obsolete. Don't Waste Your LifeDay 3 of 3 Guest:                            John Piper From the Series:         Boasting in the Cross ________________________________________________________________ Bob:                On days other than Good Friday is the cross central to your thinking?  Is it central to your life?  Here's Dr. John Piper with thoughts about the cross. John:              The word "cross" might mean something you're crucified on, or it might mean a piece of jewelry, or it might mean the last name of somebody you know, but in redemptive historical terms Jesus Christ the Son of God came into the world, He lived a perfect life, He laid Himself out voluntarily to be slaughtered on a cross.  He breathed his last breath in obedience to the Father so that He was a perfectly righteous substitute.  Then He raised Himself from the dead, He was taken up, sits at the right hand of God, intercedes for us.  When I say "the cross," I mean that great redemptive work from incarnation to the installation at God's right hand.  Yeah, that's really crucial to see. Bob:                This is FamilyLife Today for Friday, July 28th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  Today we'll look at the implications of the cross, why it still matters for your life 2,000 years later.                         And welcome to FamilyLife Today, thanks for joining us on the Friday edition.  You know, Dennis, I don't know that I will ever forget something that I heard our guest today say.  I remember where I was.  I was driving along on a highway on my way to Mount Ida, Arkansas.  I was tooling along listening to John Piper on tape, and he was saying that the world is not going to look at Christians in times of prosperity and say "I want to be a Christian," because you know what?  When Christians are blessed, they say "Praise the Lord," and when pagans are blessed, all we say is, "Boy, wasn't that lucky?"  He said, "No, the world is going to sit up and take notice when we go through adversity, and we still have a confidence in God; when we go through trials, and when we live the kind of radical life, then the world will say, 'Where does that come from?'"  And I thought, "He's right.  I am too comfortable, I am too content."  In fact, I should say here at the very beginning there needs to be a surgeon general warning on today's program. Dennis:          Mm-hm, I'll tell you that. Bob:                This program will create conviction in your soul and could bring you to a point of personal repentance yourself. Dennis:          It could bring you to the conclusion that you are dangerously close, too close, to the world. Bob:                Yeah, and it might bring you to the point where you need to get more dangerously involved in the Gospel.  And so let me introduce the pastor of Bethlehem Baptist Church and the person who has brought me under conviction many times, John Piper, who is back with us for a third day.  Welcome back to FamilyLife Today. John:              Thanks, I'm real glad to be here. Bob:                And this book, "Don't Waste Your Life," you felt so strongly about this book you went to the publisher and said, "I want to give 50,000 copies of this book away." John:              Yeah, we created a website just to give it away called "Don't Waste Your Life."  You can go there now, but we don't give them away anymore, because people took them, and we got a special deal because we just wanted to jumpstart the impact of the book and give as many away as we could, so we raised the money and people took them. Bob:                Gave away 50,000?  Do you have any idea – any of the stories of folks who wrote to get a copy of this book? John:              Not yet. Dennis:          John, at the end of the broadcast yesterday, we challenged the listener to consider writing a title deed and transferring ownership over to Jesus Christ to become a disciple, a learner, a follower, a pursuer of God and His agenda for their lives.  And this is really at the core of what "Don't Waste Your Life" is all about.  In fact, you quote 1 Corinthians 6:19-20, as really one of the seminal passages in the New Testament calling people to deny themselves, take up their cross, and follow Christ. John:              Yeah, the link that I heard, what you ended the program that way, was between signing your life off so that it belongs now to another and the glory of God, which is the ultimate value of the universe and the value that we live to display, and the link is made there in that verse in 1 Corinthians 6 because Paul says you are not your own, you were bought with a price, therefore glorify God in your bodies, which are God's.  So he made the link between being owned by God and glorifying God.  And so I think you're absolutely right – every person should be challenged to sign the title of their lives over to another who will not then say, "Ah, now I have a slave."  He will say, "No longer do I call you slaves.  I call you friends.  And now, come on, let's live together to magnify my glory in the world, thus says the Lord."                         So that was the link I heard, and I thought it was crucial because the cross is right at the center of this book, and that's what I thought it might be helpful to think about a little bit – in what way is the cross center, because this book grew out of the one-day event in Memphis, Tennessee, in the year 2000, I think it was, where I delivered a message called "Boasting Only in the Cross," and told the illustration of the shells and so on that we talked about a couple of days ago.  That message was taken from Galatians 6:14, which says, "God forbid that I should glory except in the cross of our Lord Jesus Christ by which the world was crucified to me and I to the world," and I raised the question, "Really?  How can you only boast in the cross, only glory, only enjoy the cross?  What about your family?  What about your health?  What about your job?  I mean, aren't these good things that the Lord has given us?  Shouldn't we be glad that we have them?"  And my answer was, "Yes, you should be glad that you have them, but you should realize that as a sinner you only have them to enjoy forever because Christ died to take away the penalty of judgment and to become your righteousness and to become your sacrifice."                         So the cross is relevant for every single delight in my life.  If it's a beautiful blue sky day outside, and I have eyes to see it, I should be glad because of the cross, because apart from the cross I'd be in hell today.  He would snuff me out of existence because I deserved to be judged.  So the cross really is an absolutely central reality in everything I think about and everything we all do. Dennis:          And the passage that commands us as followers after Christ to take up our cross and follow after Him – what do you think He's challenging us to do at that point, John?  If the cross is to be central, and we're focusing on Christ-finished work, the love that is poured out there, the grace, forgiveness, the purpose, the peace with God, the relationship with God, all that's found in the cross, and He commands us to pick up our own cross, it seems to me at points it's almost like the fine print in the contract.  It's like now that he's got me, hello, there's a cross that I must carry. John:              Yeah, the whole text, in fact, uses the words "deny."  If anyone would be my disciple and deny himself and take up His cross and follow me, but the argument that he gives following that verse is "For he who seeks to save his life will lose it, and he who loses his life for My sake and the Gospels will find it," and you do want to find it, don't you?  Therefore, lose it.                         So you've got this paradoxical call from the Lord saying, "Look, I have come to give you life.  I will give you everlasting joy in My presence at My Father's right hand if you join me on the Calvary road of self-denial and love."  Now, what does that mean?  I think it means assess all the things that stand in the way of making Jesus look more valuable than life and get rid of them.                         In other words, it might be your car, it might be your house, it might be the job you presently have.  Whatever is standing between you and an effective display of the superior worth of Jesus in your life, let it go.  That's what I think self-denial is. Dennis:          Isn't it interesting how we, as believers, can find something or someone or some activity that we enjoy and become enslaved to other than God?  It's just fascinating to me.  He made us to know Him, walk with Him, enjoy Him, interact with Him, and yet it's as though we're running from the hound of heaven in pursuit of all these different things, even the ministry.  And you've experienced this as a pastor, I'm sure – even the ministry can be addictive. John:              Right, it can be.  And how to move away from that without contradicting the goodness of creation is a challenge.  Because most of the idols that we have are good, they just shouldn't be idols.  And so to move away from them, you can swing to the ascetic side where you become a creation-denying person, and do you know who I got a lot of help from on that, is St. Augustine, and it's a prayer that he made.  He said, "He loves Thee too little who loves anything together with Thee, which he loves not for Thy sake."  I found that very helpful, because it's saying anything can be an idol, any good thing can be an idol.  "He loves thee too little who loves anything together with Thee," and then he qualifies it by saying, "Which he loves not for Thy sake," which means that any good thing that is an idol can be deposed from its idolatrous position and become an instrument of worship.  So you might be worshiping food, and the solution to that is not to starve yourself to death with an eating disorder, but rather to say it's a precious gift from God to be used in moderation for the joy it brings and the strength it brings, and I will now turn all my eating back in thanks and worship to God and eat in moderation.  That's the kind of thing that he wants the shift to involve. Bob:                We started talking about not the cross that we pick up and carry but about the one that He carried for us.  I don't know that I can go through the day consciously aware of the cross.  Is that something that comes to mind on a conscious level for you, hour by hour, throughout a day? John:              I wish it came more often.  I think, to be honest there, I'd have to say no.  But my prayer is that when Paul said, "God forbid that I should glory, exalt, boast, rejoice, save in the cross, he meant, I think, number one, the cross bought all my joys as a believer.  It bought all my joys.  Therefore, as I rejoice in anything, that joy should be attached to the cross.  It doesn't, I'm sure, have to consciously be at every moment but probably more often than we do.  If we could realize the magnitude in the history, in the universe, of what happened when Christ, the Son of God, died in the place of sinners and provided a righteousness for us ungodly people, I think we would be more ravished with it than we are, and it would be more constant in our thinking than it is.  So, to be honest, no, but to express my longing, I wish it were. Dennis:          And so, for you, when you say, "I want to glory in the cross, I want to focus on the cross, I want to be caught up in the cross," you are caught up with the presence of God, His righteousness, His incarnation, His death on the cross on behalf of your sins, His burial and resurrection and ascension into heaven.  Have I done a good job of paraphrasing or describing what you are caught up with as we describe the cross?  Because a lot of people wear it as jewelry, and it's an event.  It's not just an event, though, is it, John? John:              That's a very helpful observation for the radio, especially, because the word "cross" might mean something you're crucified on, or it might mean a piece of jewelry, or it might mean the last name of somebody you know, but you summed it up – in redemptive historical terms, that's right – Jesus Christ the Son of God came into the world, He lived a perfect life becoming a holy, perfect lamb of God, He laid Himself out voluntarily to be slaughtered on a cross.  He poured out his forgiveness on us – "Father, forgive them, they don't know what they're doing" – He breathed his last breath in obedience to the Father so that He was a perfectly righteous substitute, and then He raised Himself from the dead.  I say that, even though the Father raised Him, it says in Romans 6, because He said, "Nobody takes my life from me.  I'll lay it down, and if I lay it down, I can take it again."  Jesus Almighty raised Himself from the dead, He was taken up, sits at the right hand of God, intercedes for us.  When I say "the cross," I mean that great redemptive work from incarnation to the installation at God's right hand.  Yeah, that's really crucial to see. Dennis:          And to that person who is listening to us right now, who does not have the awe, who does not have the wonder, who looks at the cross and said, "Yeah, that was an event in history," but who doesn't know the Savior, who doesn't know God's forgiveness, the peace with God that passes all understanding, what would you say to that person right now?   John:              Depending on how much they know, I would say, "Get to know Him by looking at the Scriptures, reading the Gospels, and once you see Him crucified, risen, then do what the Bible says – "Believe on the Lord Jesus Christ, and you will be saved."  And if you say, "Believe on Him," what does that mean?  What does that involved – believe on Him?                         I would say take these three words – it means trust Him or accept Him or embrace Him as Savior from your sin and judgment, as Lord of your life who has the right to dictate what is healthy and good and right for you to do, and the third and maybe just as important as the other three is embrace Him as your treasure, because I find that many people today will talk about Jesus as Savior or Jesus as Lord, and it's such worn-out language, they don't really realize the impact it must have in the transformation of their values.  But when I say, "Is He your treasure?  Are you accepting Him as your treasure," to as many as received Him, to them gave me power to become the children of God, receive Him as what, that I say, "Treasure, the treasure of your life."  Then they say, "Whoa, maybe He's not."                         And so I would say to every listener, get to know Him well enough to see that He is a Savior.  He is a wonderful Lord.  He's not a hard taskmaster, and He is a treasure that is so valuable that you can "let goods and kindred go, this mortal life, old soul, the body they may kill, God's truth abided still," and you can live a radical God-glorifying lifestyle because He's the treasure that will never fail. Dennis:          We have people listening from all types of denominations, and when you just went through what you explained, immediately they thought, "Well, do I need to pray to be able to move into that right relationship with God?  Do I need to kneel?  Do I need to go to a church or a cathedral?  Where do I need to go, how do I go about establishing this right relationship with God?" John:              One of the most beautiful things to me about the coming of Jesus Christ into the world is that He de-localized and de-externalized worship.  Because when He met the woman at the well, and she said, "Well, now, help me to understand this worship issue, Jesus.  Do we worship in this mountain or do we worship in Jerusalem?"  And Jesus said, "The day is coming and now is when you will not worship in this mountain or in Jerusalem, but you will worship in spirit and in truth."                         Notice the shift in categories from geography to spirit, and the reason he shifted from mountain in Jerusalem to truth in spirit is because truth in spirit can be anywhere, anytime.  In fact, Jesus Himself becomes the new temple.  Christianity is the one religion that has no geographic center.  We have no shrine.  You don't have to go anywhere or move one single muscle to get right with God through Jesus Christ because Jesus Christ is here, now, whenever He is called upon.                          And so I would say, "Call upon the name of the Lord, and you will be saved" – Romans 10:13.  And you can do that without moving your tongue.  A paralyzed person lying in bed unable to move eyelash or tongue can call upon the name of the Lord in their heart, and He promises you, "Call upon me as Savior, as Lord, as treasure, and you'll have all your sins forgiven, and you will have a righteousness imputed to you.  You'll have a home in heaven with me forever, because you've just honored me as a great Savior." Dennis:          And what I would say to the listener after the compelling picture you've presented to them of the love of God, poured out in the person of Jesus Christ, after we've spent an entire broadcast describing the cross and how attractive it is – if right now that picture, the person of Jesus Christ and all the cross represents is attractive to you as Savior, Lord, and treasure, right now, don't drive another mile, don't do another activity at work or at home or wherever you are listening to this broadcast.  Right now stop and make it right with God.  Do business with Him. John:              And, you know, I would just add when you use the word "attractive," they're going to feel that as yes and no, aren't they? Dennis:          Uh-huh, they are. John:              The cross is horrific.  It is ugly.  In fact, we've seen it recently in the movie.  It's really ugly.  Mel Gibson's, "The Passion of Christ," portrays Gethsemane and the cross for what it really was and yet in that very substitutionary ugliness is the attraction.  I mean, my only hope is that that didn't happen to me, it happened to Him for me, and so I'm both repulsed by it.  I've talked to people who say they can't watch more than a third of that movie, it's so horrible, and yet others are drawn to that movie because that it happened is my only hope.                         And so I hope that my effort to describe the meaning of that suffering will really help people see what that's all about. Bob:                You know, I was in the audience with about 3,000 others back in April when you spoke at the "Together for the Gospel" conference in Louisville, and you talked about how the cross is really the centerpiece of the Gospel, and if we're going to present the Gospel, we have to present the reality of the cross.  And if that's the centerpiece of our life, then our life is not going to be a wasted life.                         I really want to encourage our listeners, get a copy of John's book, "Don't Waste Your Life," which we have in our FamilyLife Resource Center.  This would be a good book to read together with your teenagers over the summer or just hand it off to them as a reading assignment and pay them $15, $20, whatever it takes, to get them to read it.  Maybe there's some other incentive you can use to get them to go through this book, and have them write a book report on it and report back to you on what they learned from the book.                         We have it, again, in our FamilyLife Resource Center.  Go to our website, FamilyLife.com, and in the center of the home page, you'll see a little button that says "Go."  Click on that button, it will take you right to the page where you can get more information about John's book, "Don't Waste Your Life."  You can order online if you'd like.  Again, it's FamilyLife.com or you can call 1-800-358-6329; that's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY, and someone on our team can let you know how you can have a copy of this book sent out to you.                         I've already mentioned this week that my daughter had a chance to hear you speak at one of the Passion Conferences a few years ago.  In fact, she heard you twice – one year – I think it was in Texas, and the next year it was in Tennessee, and she brought back CDs, and I listened to them as well, and both of us profited from your teaching ministry during those conferences.                         She also heard Beth Moore speak at those same events with you and was struck by Beth's passion that our lives would be cross-centered, spiritually centered and, Dennis, you and I had the opportunity to talk to Beth several months ago.  We talked about her marriage and her family.  She's been married to her husband Keith for 25 years and, of course, tens of thousands of women have done her Bible studies in churches all around the country.                          Our conversation with her, I described it to my wife later and said she was one of the most highly caffeinated people I've ever met.  It was an energetic conversation, a lot of fun, and this month we'd like to make a CD of that conversation available to any of our listeners who can help support the ministry of FamilyLife Today with a donation of any amount.  We are a listener-supported ministry, and we depend on your financial support in order to continue the ministry of FamilyLife Today.                         If you can help us with a donation of any amount, you can request the CD of our conversation with Beth Moore.  You can go online at FamilyLife.com, fill out the donation form that you find there.  As you do that, you'll come to a keycode box, and if you type the word "free" into that keycode box, we'll know that you're interested in getting a copy of the CD with Beth Moore or call us at 1-800-F-as-in-family, L-as-in-life, and then the word TODAY, and make a donation over the phone and, again, mention you'd like the CD with Beth Moore, and we'll be happy to send it out to you.  It's our way of saying thanks for your financial support of the ministry of FamilyLife Today.  We appreciate hearing from you.                         Well, I hope you have a great weekend.  I hope you and your family are able to worship together this weekend, and I hope you can be back with us on Monday when we're going to begin to look at the kind of a foundation that needs to be poured underneath a family to make sure that it grows to become a spiritually strong family.  I hope you can join us to be part of that conversation.                         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'll see you next time for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ.   We are so happy to provide these transcripts to you.  However, there is a cost to transcribe, create, and produce them for our website.  If you've benefited from the broadcast transcripts, would   you consider donating today to help defray the costs?   Copyright © FamilyLife.  All rights reserved. www.FamilyLife.com      

FamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. The Deadly Traps of Adolescence Day 5 of 10 Guest:                        Dennis and Barbara Rainey From the series:       Dating  Bob:                There are times when a conversation between a father and his daughter can be a little awkward. Dad:                Hi, Jules, how was gymnastics? Julie:               Good.  I landed the double tonight. Dad:                All right, way to go.  Jules, how are you doing with the guys? Julie:               Okay. Dad:                You know, your mom and I have been talking about you and all those boys who call on the phone. Julie:               Great. Dad:                Your mom and I just want to make sure you know what you stand for as you get old enough to date, you know what I mean? Julie:               I know, Dad. Dad:                I want to ask you a very personal question and, listen, you've got the freedom not to answer if you don't want to, okay? Julie:               Sure, Dad, why not? Dad:                Have you thought through how far you're going to go physically with the opposite sex? Julie:               Uh-huh. Dad:                Well, then, would you mind telling me how far you intend to go? Julie:               I know, Dad. Dad:                Where are you going to draw your boundaries, Jules?  Your limits? Julie:               Dad, I know what's right and what's wrong, okay? Dad:                Okay, I'll take that for an answer – for now. Bob:                And welcome to FamilyLife Today.  Thanks for joining us on the Friday edition of our broadcast.  Our host is the president of FamilyLife, Dennis Rainey, and, Dennis, your wife Barbara joining us this week as well.  I'm Bob Lepine, and the tension in that car between that dad and that daughter … Dennis:          … did you hear her keep turning that radio up? Bob:                She did not want to talk. Dennis:          I've been there. Bob:                I've been there, too – got a few radios turned up on me in the conversation.  This is a particularly difficult issue for parents to deal with, with their children.  We've talked on the last couple of broadcasts about how we've got to press through some of that negative static we get from our kids, and get to the core issues around physical involvement, sexual involvement.                          But one of the other traps facing our children as they walk through the teenage years is a trap that is right alongside the trap of sexual intimacy.  It's the trap of dating.  In fact, it may be the gateway.  I think you probably have to step in the dating trap before you usually ever get to the sexual relationship trap, and that's where a lot of parents have got to be shrewd in this culture. Dennis:          You know, parents have got to realize that as our children grow up and into the teenage years, there are going to be these hidden traps, these hidden snares, that will be set for them, and I think one of the biggest ones that they will face is this issue of dating.                           I think of the verse over in Psalm 142, verse 3 – it says, "When my spirit grows faint within me, it is you who know my way.  In the path where I walk, men have hidden a snare for me.  Look to my right and see no one is concerned for me.  I have no refuge.  No one cares for my life."                         Well, the psalmist didn't feel that, but a teenager ought to be able to say, "I have a parent.  I have a mom and a dad.  I have a mom, a dad, and a grandparent who care about my way and who are looking out for the hidden snare of dating and the attraction to the opposite sex." Bob:                I think the big question, Barbara, for a lot of kids, as they approach junior high, and they start to develop some interest in members of the opposite sex is – when can I start?  How soon can I start dating?  And that question might creep up on you. Barbara:         Oh, I think it does creep up on you, just like a lot of this other stuff creeps up on parents of adolescents.  We discovered that early on with Ashley, our oldest.  We were at a conference, and we were there with another family, and this other family had a son who was a year older than Ashley, and they had been friends for years, and we just didn't think a whole lot about it.  But they decided one day they wanted to take a walk together and go get a Coke, and we let them go, and then kind of later on we realized they spent some time together alone.  They're 12 and 13 years old. Dennis:          Yeah, she was 12 years old. Barbara:         Yeah, and she kind of likes him, and he kind of likes her and, gosh, I think she just had a date, and we just kind of realized, all of a sudden, that we had allowed her to spend time alone with a boy, and that seemed to be a good definition of a date, and we weren't prepared for that.  But, in essence, that is what happened with Ashley, is she was alone with a boy that she liked, and he liked her, and she really had her first date at 12. Bob:                Dating today has become just the accepted practice of American teenagers.  It's just what you do when you're in junior high and in senior high, and many parents have said, "Well, I guess that's the way it is, and yet you all see some real dangers in the way we do dating today with our kids, don't you? Dennis:          Yeah, what we call the "dating game" is currently being played in most Christian families, and it cultivates romantic fantasy love before children are emotionally, physically, and spiritually mature enough to have a relationship with the opposite sex.  And one-on-one dating leads couples to spending too much time alone at the time when the sex drive is at an all all-time peak for a young man.  I mean, it's like taking gunpowder and striking a match, leaving them alone to experience some of these feelings. Barbara:         Another thing, too, that we've seen with our kids is that they don't have the maturity to make a wise choice about who to spend time with.  They often make their choices of who they're going to like based on just who is available, because everybody else has a boyfriend or a girlfriend, and so they decide they need to have somebody, and so they just sort of pick somebody.  They don't think through – what is this person's values?  They don't think through is this person good for me or not good for me or what kind of family does he or she come from?  They're just kind of desperate, and so they just pick somebody. Dennis:          And it looks like child's play, because they're children, they're not even, in many cases, into puberty yet, and yet they have these emotional attachments that they develop, romance begins to stir the soul, and it looks for a way to express itself, and the way that romance expresses itself in most people is physically.  We begin to show physical affection and appreciation for the other person, and once that starts, where does that lead?  And I think that, alone, is one of the biggest cases against allowing your child to date before they're spiritually mature enough and emotionally mature enough to handle the feelings that come with adolescence. Barbara:         Another thing that happens when kids begin to pair off is they begin to have their needs met by that other person, and even if your child comes from a strong home, where you and your spouse are giving that child the attention and the affection and everything that he needs or she needs to be secure, once an attachment takes place with someone else, and your child hooks up with another boy or girl, and they become an item at school – even with the best that you're doing at home, they're going to choose to get their needs met from that other person, because that's more convenient.                           They're at school together all day long, so even in the best of homes these kids can hook up with another boy or girl and get those emotional needs met for love and security and attention and everything through that relationship, and then they come home and spend all evening on the phone, and Mom and Dad's influence is cut to nothing. Dennis:          And you wonder why you don't have the influence on them, and you know what?  We've experienced this.  We've watched some of our children establish these exclusive relationships, and we've experienced the loss.  We wonder, "What's going to happen to my relationship with that child?"  Well, the reality is someone else is getting that relationship, and someone else is having the influence, and someone else is shaping the values, and someone else is charting a course for that young person's life.                         You know what?  It's not their husband or their wife, they're not married.  But, in many cases, a lot of these teenagers are acting like they're married, and they're sharing things emotionally and physically that were only intended to be shared in marriage. Bob:                Okay, well, with all of this stuff that you've talked about – dangers in dating – why go anywhere near it?  Why let your kids anywhere near it?  Why don't you just seal them up until they're 19, put them in a closet somewhere, and then let them get out and start … Barbara:         Mm-hm, I think that's a good idea. [laughter]  Dennis:          Because they lock people up for that, Bob.  I think every parent listening to us says, "Yeah, I'll vote for that," but you can go to jail for that, you know, today.                         I think what we want to do is we want to look at how we can help our children begin to have a healthy respect for the opposite sex, have a healthy respect for their own identity, and then begin to learn how to relate to the opposite sex and develop relationships that don't … Barbara:         Friendships.  Dennis:          Yeah, that don't necessarily become romantic relationships. Bob:                Yeah, your children, Barbara, have been on dates, but it's been different than what we think of when we think of kids dating or going together.  You've really tried to ride herd on not letting them become romantically attached. Barbara:         Yeah, and the big thing is to make sure that they're not alone, because that is when all the dangerous stuff happens, is when they're alone.  So what we've tried to do with all of our kids and increasingly so with our younger ones – we're getting more and more involved in this area, we're becoming more and more proactive in this area than we even were with our older ones – we are now with our younger kids, and that is when we do allow them to go out, and it is a good bit later than what probably is the norm in the culture, we've tried to create an environment where they go with another group of kids, and they have activities that they do together that are group-centered so that they're never alone.                           They don't have the opportunity to enter into those temptations and then yield to them.  So they go as a group, and they come home as a group, and they do things at our house with groups, and we're trying to foster the idea of developing a friendship with another guy, rather than developing a romance. Dennis:          Some parents, at this point, probably wonder if we're making too big a deal out of this.  I don't think so, I really don't.  I think one of the most dangerous things that's occurring today is giving our young people too much freedom before they are emotionally or physically or spiritually mature enough to make these life-altering decisions.                         And moms and dads – it's us – we are the ones responsible.  We must assume the responsibility God has given to us as being the guardians and the protectors of our children all the way through adolescence. Bob:                Barbara, let's say it's spring break week, and one of your children comes to you and says, "Hey, Mom, there's a group of kids going to the mall to see a movie," and let's assume it's a movie that's acceptable – there are a few of those out these days, but let's just assume there's an acceptable film there.  There's a group going, and they called and "they want to know if I can go."  And you ask the question – "Is it boys and girls?"  And the answer is yes.  How old does the child have to be before the answer is, "Yes, you can go." Barbara:         Well, there isn't really a specific age limit, although, generally, it would be 15 or 16 in our family. Dennis:          At the earliest. Barbara:         Right.  Primarily the decision would be based upon the maturity level of that child.  Has this kid demonstrated to us that he or she can be trusted to be alone with a bunch of kids unsupervised by adults?  Then I would want to know who those kids are, how they're getting there, how they're getting back, how long they're going to be there, and just all the details – and do I need to be driving and all that kind of stuff.  But if we let one of our kids go and do that with a group we would want to know those specifics about the situation, but it would all depend on that child and their responsiveness to us. Dennis:          Over in the Song of Solomon, chapter 8, verses 8 through 10, Solomon speaks of what's called "a little sister."  And there were actually two of them in that passage.  One who was spoken of as a wall, the other one spoken of as a gate.                           The wall was the sexually pure, the one who was in control of her own emotions and one that was managing adolescence well, I think.  And the gate is the girl – or for that matter, a guy – who would be too sexually open or too free with the opposite sex.                           What happened in that passage was Solomon celebrated the wall, and he built a cedar barricade around the gate.  He didn't give the gate freedom, he protected the gate.  He celebrated the right choices of the girl who was the wall, and I think, as parents, what we've got to do is truly watch how our sons and our daughters are, and that's what Barbara is talking about here, and give them additional responsibility, additional freedom as they've been a wall, and then if they show tendencies to being the gate, pull out the cedar and start hammering away at that barricade. Bob:                You've got kids, though, in high school before they can go watch a movie in the middle of the afternoon with a mixed group of kids unsupervised – high school. Barbara:         Yeah, we do. Dennis:          And she didn't blink, either. Bob:                No, she didn't, and I'm sure some of your kids have looked at you and said, "Mom, I've got to wait until high school?" Barbara:         Well, and a lot of it, too, depends on who the kids are.  Because, see, if I'm involved with my children, like I am, I know who their friends are and who might be somebody that they would be interested in romantically.  So it's one thing to send my kids off in a mixed group with a bunch of truly buddy friends, and it's another thing to send them off to a movie in a mixed group where there might be somebody that they're really interested in.                           So that's why I want to know who it is and who is going and how they're getting there, so you've got to ask 50 zillion questions to finally find out what the facts are. Dennis:          A couple of nights ago we had some friends over at the house, Scott and Theresa, and our daughters were all just huddled up around the table.  It was a fascinating evening, and we got off talking about this.  And our teenage daughters were all there, talking, and Scott asked our oldest about dating.                         And both Barbara and I had our jaws nearly drop to the floor, Bob, as our teenage daughter, Rebecca, who is 17 years old, said to Scott, she said, "Well, as you raise your girls, don't let them date until they get out of high school."                         Hello?  And, I mean, this – this … Bob:                You ran for the tape recorder, didn't you?  Dennis:          I said, "Can we get fingerprints – we've got eyewitnesses, can we get this in writing?  They do begin to get the point after a while.  They begin to understand, you know what?  Dating ends up in heartbreaking situations where you lose your boyfriend, and you cry for nights on end, and there's … Barbara:         It's just not worth it. Dennis:          It's not worth it. Barbara:         They finally figure it out. Dennis:          It really isn't, and it's worth far more to teach them how to develop a friendship and to keep relationships at that level. Bob:                What age do they have to be before they can go on a double date with somebody, you know – to the prom in the car? Barbara:         Well, probably, it would be 17.  We used to say 16, but we're getting tighter on this.  It's probably going to be more like 17. Bob:                Junior year? Barbara:         Mm-hm, mm-hm. Dennis:          At the earliest, again. Bob:                What about a single date, where you just go out with a young man for dinner for the evening? Dennis:          Probably – right now, where we are on that, we would probably not encourage that to happen. Bob:                At all ever? Dennis:          In high school. Barbara:         In high school, yeah.  Although, you know, there – we might make an exception, depending on who the young man is and if they really – we really feel like we can trust him and her, and this really is just going to be a friendship kind of thing, and it's not going to be – turn into anything else.  You know, we might do that, but it takes an enormous amount of time and energy to figure out if that really is the case. Dennis:          And even as I said that I'm thinking our daughter, who is 17, has gone and gotten coffee with "a friend,"  Barbara:         Mm-hm, a couple of times. Dennis:          And has sat there talking, but it's not a friend that she has any kind of romantic interest in.  Now, here is an important point as parents ride herd on this issue.  Your kids are going to look you in the eye and they say, "But I'm not interested in them romantically."  If that's so, why are you holding their hand?  I don't hold my best friend's hand.  Holding hands is not a sign of friendship in this culture.  It may be over in Europe, but it's not yet in America.  It is usually a sign of affection. Barbara:         Romantic affection. Dennis:          That's right, and you know what?  It's astounding, as parents, how dumb I can be.  I have had our children look me back in the eye and say, "But it's just a friendship."  And I go, "Yeah, just a friendship."  Then I get back, and I go, "Wait a second – no, no, no.  They were sitting beside each other.  They were holding hands on the bus.  Hold it, wait a second" … Bob:                … there's more going on here. Dennis:          What's wrong with this picture?  And it's – as a parent, what is there about us that we question ourselves and our own judgment?  Our judgment is not in question here.  Hold it.  I'm the parent.  I'm counseling myself, by the way, right now – but I am the parent, and I have to be reminded from time to time that I need to reassert myself and it's almost – pull the sword out and put it on my shoulders and say, "You are the one that has the authority in this situation, don't back off, don't become a wimp, don't lack courage.  Step into that relationship, and when they give you some baloney like that and tell you it's just a friendship, call their cards out and say, "Oh, come on, no way, Jose.  That's more than just a friendship." Bob:                Aren't these kinds of restrictions or rules going to make your kids the nerds of the world in the school where they're going? Barbara:         Well, it may be but, you know, I think that's okay.  I think that it's more important for our kids, we've decided, to protect them as best we can from being hurt and wounded in relationships that they are not mature enough to handle.                           And you can do some things to help ensure that they don't feel unduly punished by this.  I mean, you invite kids over to your house, and you have lots of friends around, and you encourage them to have their same-sex friends spend the night, you know, all that kind of stuff so that they don't feel that they're isolated and left alone and stuck in a tower until they're 18 … Dennis:          … instead of the closet. Barbara:         But, you know, I just think it's important enough for us – we've decided it's important enough that I will risk that my kids will feel strange and different, and I think that's okay.  I would rather they feel strange, different, feel like a nerd, and be safe than let them ride with all the other kids in the herd and get hurt and get tangled up in emotional and physical relationships that they don't need. Dennis:          Here is where a mom and a dad need to be as shrewd as they can be – single parents, same deal – you ought to rally some other parents with you.  See if you can't go set up a parents' meeting and say, "Can we huddle up here?  Can we all agree to something where we kind of share some common values?"  And maybe you don't agree all the way down to the nth degree and, Bob, that's one of the things that concerns me about some of the movements that are occurring within the Christian community right now. They get so exclusive, so nailed down, so tight, that anybody who is outside their own little prescribed way of doing things, they fracture and fragment and can't fellowship with them, and that's not the kind of unity we need today.  Christian families need to be bonding together and banding together and helping one another raise these children on into maturity, because you know what?  These teenagers today desperately need the community of Christians to make it and to finish the process of adolescence and to make it to adulthood and to become God's man and God's woman, and I just think it's time for all of us to come alongside each other and to help one another raise these children. Bob:                Well, and that's what I think you and Barbara have done in the book, "Parenting Today's Adolescent." You've come alongside us, and you're helping us think through our own convictions in this area and help us decide how we're going to live out those convictions, and how we're going to help guide our sons and daughters through these difficult and dangerous water as they go through adolescence.                         And I appreciate the fact that you guys, along with people like Joshua Harris and Elizabeth Elliot and others have said, "Let's hold a high standard here for moral purity.  Let's not just make the standard a standard of virginity, but let's make it a more biblical standard of purity.                                     There may be some listeners who think, "Oh, you're out of touch," or "You're old-fashioned," or "You don't know the culture our kids are living in today," and, again, that's where you say "All right, you don't have to buy our standard, but you have to decide for yourself what your standard is going to be and what you're going to try to guide your sons and daughters with.                         And whatever you decide, the book, "Parenting Today's Adolescent," will be a helpful resource in that regard.  You can get more information about the book on our website at FamilyLife.com. When you get to the home page, you'll see a red button in the middle of the screen that says "Go," and if you click that button, it will take you to an area of the site where there is information not only about the book, "Parenting Today's Adolescent," but other resources for parents of teens and of preteens because, actually, you ought to be looking at this material prior to your children's teenage years.                         Again, the resources are available online, and you can order online, if you'd like, or get more information.  If you prefer to call to order, it's 1-800-FLTODAY, that's 1-800-358-6329.  Someone on our team can answer any questions you have about these resources we've talked about, or they can take your order over the phone, and we'll get the resources you need sent out to you.                         And then this month we have an additional resource we'd love to send to you.  It's a new book by Dennis Rainey called "Interviewing Your Daughter's Date."  It's designed to help us, as parents, have a strategy in place so that when a young man does begin to show some kind of interest in our daughter, and maybe our daughter is showing some interest back, we can know how to engage both of them in that subject and help set up some boundaries around what the relationship ought to look like at this stage of their life, and if they are going to go out on a date at some point, to have some parameters around that event as well.                           The book is new, and this month, again, it's our thank you gift when you help support the ministry of FamilyLife Today with a donation of any amount.  We are listener-supported, and we appreciate your financial partnership with us when you make a donation to FamilyLife Today.                           If you're donating online, and you'd like a copy of Dennis's book, just write the word "date" in the keycode box on the donation form online.  Or if you call 1-800-FLTODAY to make a donation, you can just request a copy of Dennis Rainey's new book, "Interviewing Your Daughter's Date," and we'll be happy to send it out to you.  Again, the toll-free number is 1-800-FLTODAY, and you can donate online at FamilyLife.com                         Well, we hope you have a great weekend, and we hope you can be back with us on Monday when we're going to continue to look at some of the deadly traps that are facing our children as they go through the adolescent years, and we're going to continue to look at this subject of dating.  Also, next week we're going to look at pornography and substance abuse and media, and we're going to look at unresolved anger and how that can explode in the life of a teenager.  I hope you can be with us for all of 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'll see you back next time for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ. _______________________________________________________________We are so happy to provide these transcripts for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com                  

FamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. The Deadly Traps of Adolescence Day 3 of 10 Guest:                        Dennis and Barbara Rainey From the series:       Sex________________________________________________________________   Bob:                If you're a parent, have you challenged your son or your daughter to wait until marriage to become sexually active?  Barbara Rainey says maybe you haven't given enough of a challenge. Barbara:         We've realized with our kids that the standard of maintaining their virginity is not enough, because when a young girl and a young boy get together, and they decide they like each other, and they begin holding hands and hugging and kissing and other things, what's happening is they're damaging their purity; they're losing their innocence. Bob:                This is FamilyLife Today for Wednesday, July 11th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  As parents, how can we challenge our teenagers to a high standard of moral purity?  We'll talk about that today.                         And welcome to FamilyLife Today, thanks for joining us on the Wednesday edition.  This week we are spending some time looking at the traps that have been set for our teenagers throughout our culture and what we can do as parents to help steer our children around these traps so that they don't become ensnared.  And what we're talking about comes from a book by Dennis and Barbara Rainey called "Parenting Today's Adolescent," and Barbara joins us in the studio today.  Hi, Barbara, nice to have you back with us. Barbara:         Thanks, Bob. Bob:                Dennis, these traps that face our teenagers can be invisible to us, as parents, but they can also be deadly to our kids. Dennis:          They can, in fact, I think that's why much of the scripture is warning us about snares and traps.  There are more than 50 references in the Old Testament and New Testament to avoiding the snare of the enemy, or the trap of the evil person, and over in Proverbs, chapter 7, there's the warning against the adulteress, and although it's talking about a married man, I think it relates to our teenagers as we help them navigate the dangers of all the traps set before them.                         It's speaking of the adulteress here in verse 21, "With persuasive words, she led him astray.  She seduced him with her smooth talk.  All at once, he followed her like an ox going to the slaughter, like a deer stepping into a noose, 'til an arrow pierces his liver like a bird darting into a snare, little knowing it will cost him his life."                           Then Solomon says, "Now, then, my sons, listen up, listen to me, pay attention to what I say.  Do not let your heart turn to her ways or stray into her path."  Why?  Because there's a snare there – there's a trap there, and it may cost you your soul.  It may destroy your life. And, Bob, I think, as parents, we need to assume the responsibility that Solomon was with his son when he penned this book and sought to instruct his son in the way of righteousness.  We need to help our children isolate and determine what those snares are, where the traps are being laid, and then help them understand how it happens, and he described the harlot here of persuading the young man with her words and then with her eyes, and he explained to his son how it all happened, and, you know, that's a picture of how we, as parents, are to help our children around these traps. Bob:                And, Barbara, the trap that Dennis has illustrated from the scriptures for us is the one that we're going to be spending time with today and tomorrow – it's the trap of illicit or premarital sexual relations, and whether it's a young lady who is subtly enticing our sons to be sexually involved with her, or a young man who is putting pressure on our daughters to be sexually involved with him, our kids are undoubtedly going to experience, going to face this temptation, this snare, of how involved they're going to be with a member of the opposite sex. Barbara:         And it starts earlier than many of us would ever expect, and that's what I think catches us, as parents, off guard, is that it begins in junior high, and our kids, our girls and our boys, our sons, are faced with this temptation very early on by children who are more grown up, who are raised in a more promiscuous background than we were, who have been exposed to more things in the sexual area than our children have been, and our kids are exposed to that, and they need to know what to do, they need to know what their standards are, they need to know how to make a decision about it. Dennis:          One of the reasons why we have come up with this material, Bob, is out of our sixth grade Sunday school class.  We taught that class for more than 11 years and taught more than 500 11- and 12-year-olds.  Now, that's a lot of sixth graders, and when we started teaching that class, we looked out over them, and we made a wrong assumption.                           We thought, "They're little, they're small, they're young, they're not ready to be challenged in some of the most fundamental areas of life."  And I'm going to tell you, over the 11 years we taught that, if those children taught me anything, it was that assumption was dead wrong.  Eleven and 12-year-old children, and I believe even down to the age of 10, are capable of beginning to hear some very mature material around building their own convictions and beliefs and taking a stand for certain things.                          In fact, one of the things that shocked me was, one of the times when I was teaching about sex to these kids, and I wouldn't talk about the birds and the bees – I always talked about the character issues – your choices and what are you going to do with the opposite sex when you get alone with them?                           I asked them how far they would go with the opposite sex, and I'll share later on, in the next couple of broadcasts, what they said, but what shocked me was they already knew.  They had already drawn some lines in their mind of how far they were going to go in terms of physical involvement with the opposite sex, and what hit me about this is that, here they are, many of them haven't even broken into puberty yet.  They haven't experienced electricity, and they're already figuring out how to turn on the light bulb.                         What's going to happen when the electricity is turned on?  What's going to happen to their standards then?  And it so shocked me and so took me back that I began to restructure everything I was teaching and began to challenge them much as I would challenge a high school senior – challenging them to think through what their convictions were as they related to the opposite sex.                          And the bottom line for a parent right here is you need to look at that son or daughter who may be 9, 10, 11, 12 – not quite a teenager yet, doesn't have a teenage body, not gone through puberty at all – let me tell you something – you have a wonderful opportunity now – not two years from now, not six months from now – today, right now, to begin to instruct them and to shape their convictions around one of the biggest temptations a human being will ever face. Bob:                Barbara, at the core of what you and Dennis have encouraged your kids to do in this area is a conviction that the standards most people are setting today are way too low. Barbara:         Yes, we've realized with our kids that the standard of maintaining their virginity is not enough, because when a young girl and a young boy get together, and they decide they like each other, and they begin holding hands and hugging and kissing and other things, what's happening is they're damaging their purity, they're losing their innocence, they're getting involved with each other emotionally.  They're giving away part of themselves to another person that was not intended to be done until marriage.                         And so we realized that we wanted to challenge our kids to a much, much higher standard of purity.  We didn't want them to just end up in marriage as a virgin, we wanted them to enter marriage pure, we wanted them to enter marriage with everything that God wanted them to have intact still there to give to their marriage partner.                         So we began challenging our kids with the idea of not getting involved physically at all – not kissing, not holding hands, not hugging, those kinds of things, and we began to talk to them about what that does to them physically and emotionally and how that makes them feel, and what's happening, what's going on when – if they would do those things and why we feel that way and what our standards are, and it's provided lots and lots of interesting conversations, because that is dramatically, radically opposed to what the world is saying. Bob:                Yeah, how long did it take, Dennis, before the word got out at the kids' school or in church that the Rainey kids are really weird, and their parents are really strange, too? Dennis:          You know, it's interesting, Bob, I don't know that the word's out yet. Bob:                Oh, is that right? Barbara:         Not as much as we'd like, I think. Dennis:          Well, you know, that may be true, too, but I think what children are looking for today are some standards that build security.  When you build a fence around a playground, that enables the children to use the whole playground, and teenagers are no different.  They need to learn how to establish relationships without defining those relationships physically.                           Teenagers, given their natural bent, are not going to define and develop relationships verbally and emotionally – they're going to define and develop those relationships romantically and physically, and so what Barbara and I had to determine was, hey, we can either take our teenager head-on and say, you know what?  We're going to tell it to you like it is. We're going to challenge you with what we believe is the right standard for you, as a young person, and it's a high standard, it's a holy standard, but it's the right standard for today, and you know what?  We're not going to compromise by mumbling or stuttering or stammering.   We're going to step up, and we're going to tell it to you straight, because we believe, as we do that, that's going to liberate you and free you to be able to get on with what you need to be focusing in on right now, which is developing relationships and friendship on a casual basis and not on this in-depth romantic basis that all teens naturally move to.  What insanity. I mean, think about it – that Christian parents would be herding their children off down this path into the gaping jaws of romance, dating, and sex.  I want to tell you something, that's what a lot of them are doing as we move our children even into our Christian groups.  We're encouraging these kinds of relationships.  And it's the parents who need to seize the high ground.  It's the parents who need to take the child by the arm and guide them through these traps. Bob:                Barbara, as you have challenged your children in these areas, have they thought about it for a second and then said, "Boy, I can see the wisdom of that, Mom and Dad, and I'm with you 100 percent.  No kissing for me until I get to the altar." Barbara:         Never.  Well, it's so different from what they're seeing and hearing that it's taken them a long time to kind of swallow, but, you know, I was just thinking of the old adage, "Rather be safe than sorry," and I would much rather battle my kids and go over and over and over this than have them have regrets someday.  I don't want them living with regrets.                           If there's any way that we, as parents, can help them avoid making mistakes that they're going to regret for the rest of their lives, I'm going to do it, and so what it means is that we stay after it, and we go over it and over it and over it and continue to reinforce those things and continue to reteach and explain why, because they're out there in the culture all the time, and the culture has given them all these other signals, and so you're having to battle all that, and it just takes a lot of time and a lot of energy to continue to do that and guide them in the right direction. Dennis:          I think if a parent who is raising an adolescent today was asked – what are you challenging your teenager to?  What's the standard when it comes to sex?  I think most parents would say, "Well, we want them to be virgins when they get married."  And yet I think that goal, as such, sets our children up to get much closer to intercourse than if we were building a fence at the top of the cliff that is a ways away from the edge.                         And you may disagree with our little challenge that we've given our children, but, you know, whether or not you agree with us is not really the issue here.  The issue is what do you believe and where do you draw the line?                         I fear today that the Christian community is being conformed to the world and doesn't want to draw any lines, and the reality is the culture is drawing the lines or it's erasing them.  Really, the culture is erasing those lines, and our teens are being pressed further and further and closer to the edge.  And meanwhile the parents – what are we doing?  We're stepping off to the side and going, "Well, kids will be kids."                          God gave children to us, as parents.  We're to be the protectors of our children's sexual purity, of their emotional purity, of their sexual innocence, and the issue – what are we doing with that?  Are we leaving them to their own devices, or are we going to challenge them with a standard that forces them to think long and hard about the culture and about who they are and about their decision to follow Christ. And I wonder, Bob, if some of these decisions that we've made haven't resulted in our older teenagers – who have now moved on into their 20s – if it hasn't resulted in them – of them taking a stronger stand for Christ because they had to courageously begin to adopt some of these standards. Bob:                Barbara, Dennis talked about not only their sexual purity, but their emotional purity as well.  How far, physically, do young men and young women need to go before their heart begins to get swept away? Barbara:         Well, they don't need to go very far at all, and even these junior high kids can get paired up with another guy or a girl, and just the contact that they can have in a school setting is enough for them to be giving their emotions – where they begin to feel attached to that person, where they need to talk to that person, and that's what we're talking about – it's the sense that these kids have of, "I have to be with him," "I have to have his attention, and if he doesn't give me that attention, then I feel lost or I feel insecure," and that's what begins to develop, and we don't want our children's security dependent on another kid at school.  Their security needs to be in who they are as a person and who God created them to be.                          So it does not take much physical interaction at all for that emotional side of them to get caught up in it, and then, all of a sudden, they're hooked on this person, and they have to have that person. Dennis:          The Bible is so wise.  It recognizes the emotional connection that occurs when two people get involved sexually, and I think that's why it warns us over and over again to avoid it.  1 Corinthians, chapter 6, verse 18 through 20 –  "Flee sexual immorality.  Every sin that a man does is outside the body, but he who commits sexual immorality sins against his own body."                           Let me just say there – where are the emotions in our body?  That's what the scripture is warning us about.  "Do you not know that your body is the temple of the Holy Spirit who is in you whom you have from God and that you are not your own?  For you were bought with a price.  Therefore, glorify God in your body."                           2 Timothy 2:22 also says, "Flee also youthful lusts but pursue righteousness, faith, love, peace with those who call upon the Lord out of a pure heart."  What's God after here?  He wants a pure heart.                         I want to read you something from our book.  It's something we wanted to capture in words just to give parents a picture of what our goal ought to be –  "Picture a beautiful, exquisitely wrapped package.  Inside is the most delightful, untainted pleasures you could imagine.  Now, wouldn't you want to be able to give that gift to your child?  Wouldn't you love to give your child a gift that would be good, wholesome, something to treasure for a lifetime?  That's what this gift of innocence is all about – helping your child understand who they are as a sexual creature reflecting the image of God.  That's your goal, and once you make it your goal, it will begin to change the way you think about how you guide your teenager down through the dangerous, trap-infested street through Teensville."                         Bob, I think every parent is jealous for our children to experience all of life that God intended, and it needs to be experienced in God's timing, and I believe sex, and that is all of sex, was intended to be experienced in marriage. Bob:                Barbara, I can think of two big reasons why parents are intimidated in talking about high standards with their children.  The first reason is because they feel like hypocrites, because they compromised their own standards when they were young people.                           The second reason is because they know it may cause them to have to change some things about their own behavior today – movies they're watching, television shows, or even their interaction with members of the opposite sex, even in the context of marriage. Barbara:         Well, I think parents need to just evaluate what's more important – is your child's life more important than your life and your pleasures and your interests?  Is your past going to keep you from doing what's right?  I mean, most of us grew up and lied, but do we ever say that we shouldn't teach our children not to lie just because we made that mistake?  I mean, we've all made mistakes in different areas of our lives, but that doesn't meant that we can't teach our children what is right and hold them to a standard of godliness.                         I don't have a problem at all with holding my kids to a higher standard in all kinds of areas and in ways that I didn't live life the way I should have, because I know more now than I did when I was a teenager.  I'm much more mature in Christ than I was then, and I want my kids to experience all that God intends for them to experience, and that is more important to me than my own interests or my own pleasures, so to speak, today.  So I think parents need to pull back and say, "What is my goal?  What's more important in life?  Is the life of your child more important than your life or not? Bob:                And if they say to you – "Well, what about you when you were a teenager?  What did you do?  How far did you go?"  How do you answer? Barbara:         If my children ask me that question?  Well, I think that needs to be answered very, very carefully, because different parents are going to have different answers to that question, and I think that there may come a time when a parent may need to say to a child – but it would need to be when the child is much older – "Here are the mistakes that I made, and I am trying my best to preserve your innocence so that you don't make the mistakes that I made," but I think parents need to be very careful in what they say, when they say it, and how much they say. Dennis:          Yeah, I'd be careful about ever sharing a great deal of detail around sexual failures that you may have made as a teenager, a college student, or as an adult.  Children at this age need models and heroes and, emotionally, I don't think they're ready to hear the whole truth and nothing but the truth from their parents.  They need you to stand strong on behalf of the standard.  Now, that doesn't mean you lie to them. Barbara:         Or that you act like you're perfect and never do anything wrong, either.  They need a role model, but they need someone that they know that – you know – you've made some mistakes, but you don't have to enumerate them and spell them out. Dennis:          I might say something to a child to the effect, "You know, that's a great question, and someday you and I will have a conversation around that, but right now here is what I want you to focus on as a young man or a young lady, and move the focus off of you back where it needs to be – on the Scripture and on the young person who is beginning to develop his or her convictions.                         All of these things we're talking about begin as convictions in the parent, but it can't stop there.  It needs to be implanted in the heart of a child. Bob:                This is a significant enough issue that you devoted two chapters in your book, "Parenting Today's Adolescent," to this subject because there's a lot for parents to think through and be alert to and be prepared for.  This is one of the big traps facing teenagers today, and we want to make sure that, as parents, we address this issue in a healthy, godly, biblical way promoting the standard of purity with our teenagers and helping them see that this is a good gift from God for husbands and wives in a marriage relationship.                         You know, a couple of weeks ago we mentioned to our listeners a couple of classic books by Elizabeth Elliot that deal with this issue of purity.  Her book, "Passion and Purity," and then the follow-up book, "Quest for Love" are books that are really timeless classics that promote a healthy, biblical view of romance and passion and intimacy and helps young people see how that can be lived out and some of the destructive things that can happen if someone violates God's standards for sexuality.                         In addition to your book, "Parenting Today's Adolescent," we have Elizabeth Elliot's books also in our FamilyLife Resource Center.  And I just want to encourage our listeners, go to our website, FamilyLife.com, and if you click the red button that says "Go" in the middle of the screen, that will take you to an area of the site where you can get more information on recources that we have available here at FamilyLife designed to help you, as a parent, not only wrestle with your own convictions but help you challenge your sons and your daughters to a biblical standard in this area.                         Again, our website is FamilyLife.com, and you click the red button that says "Go."  It will take you to the area of the site where you can order copies of these books that I've mentioned or get more information about them.  You can also call 1-800-FLTODAY.  That's 1-800-358-6329, and someone on our team will let you know how you can get copies of these resources sent out to you.                         And then if you're a father, let me also encourage you to consider getting a copy of Dennis Rainey's new book, "Interviewing Your Daughter's Date."  It's available in our FamilyLife Resource Center as well, but this month we also want to make it available to you as a thank you gift when you support the ministry of FamilyLife Today with a donation of any amount.                           We are listener-supported.  We depend on donations from our listeners to be able to continue this ministry on this station and on other stations all across the country, and we thought this month a good way to say thank you for your financial support would be to make available Dennis's new book.  You can request it when you donate online at FamilyLife.com by typing the word "date" into the keycode box that you find on the donation form.  You type that in there, and we'll send you a copy of the book.                              Or call 1-800-FLTODAY, that's 1-800-358-6329, and make your donation over the phone and just mention that you'd like a copy of Dennis's book, "Interviewing Your Daughter's Date," and we'll be happy to send it out to you as our way of saying thanks for your financial support of the ministry of FamilyLife Today.                         Well, we're going to look at this subject of sex and intimacy and how we can raise a standard of purity with our teens on tomorrow's program.  I hope you can be back with us for that.                         I want to thank our engineer on today's broadcast, Keith Lynch, and our entire broadcast production team.  On behalf of our host, Dennis Rainey, I'm Bob Lepine.  We'll see you back next time for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ._____________________________________________________________We are so happy to provide these transcripts for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com        

FamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. The Deadly Traps of AdolescenceDay 1 of 10 Guest:                        Dennis and Barbara Rainey From the series:       What are the Deadly Traps?______________________________________________________________  Bob:                The road along which a teenager travels has traps on either side. Teenager:      Dad?  Dad?  Slow down.  I can't see.  Well, I know you can.  Dad, are you sure this blindfold doesn't come off?  What traps?  Huh?  Where?  Hey, Dad, I'm going to let go for a second.  I'll be okay, don't worry.  I'm just going right over here.  See?  See, I'm fine.  There, see?  Nothing happened.  There weren't any traps.  Huh?  Where am I going?  Just out.  Dad, I know, I still have the blindfold on, and you've been down this – I know, I know – bye. (footsteps and then teenager yells)                         Dad? Bob:                Ouch.  This is FamilyLife Today for Monday, July 9th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  The road to adolescence is paved with deadly traps.  Stay tuned.                         And welcome to FamilyLife Today, thanks for joining us on the Monday edition, and there you have it.  You heard the sound of another teenager in the snare. Dennis:          Yeah, and did you hear that cry – "Hey, Dad."  Have you ever done that? Bob:                I've been off in some of those snares as I wandered my way through adolescence.  Dennis:          That's right, and I've cried out, and sometimes I've been too far away from home, Bob, yeah, and it's a serious matter, though.  We're laughing about it – these snares that are in existence today for teenagers are all too real and all too dangerous. Bob:                We're going to be talking this week about some of the deadlier snares that are laid for our teenagers in our culture today, and this is material that comes out of a book that you and your wife, Barbara, have written recently.  In fact, Barbara is in the studio with us.  Hi, Barbara. Barbara:         Hi, Bob. Bob:                The name of the book is … Dennis:          … oh, no, you've got to do more than that, Bob.  I mean, she is denying all types of motherly and wifely duties to be in here, and I just feel like (applauds). Bob:                That's right.  We're glad you're along, our listeners are glad you're along …                         … good … Dennis:          … yeah, back by popular demand.  You know, we were having dinner last night with a couple and they said, "You know, we really like it when Barbara is on the broadcast." Bob:                And I really appreciate, too, and I know Barbara does, that you have offered, Dennis, to do a lot of the laundry and a lot of the dishes as a result of Barbara … Barbara:         … yeah, dinner is the big thing. Dennis:          I don't remember that. [laughter]  Bob:                We're going to be talking about things that come out of a book that the two of you have recently written.  It's entitled, "Parenting Today's Adolescent," and remind us of what are the big concepts that parents need to be aware of as we go through the process of raising our children. Dennis:          Well, the book is really built around three underlying assumptions, and the first one is so important.  In fact, over the next few days the listeners are going to hear us over and over again pound the table about being relationally involved in our children's lives – not merely being at their events, not just going with them but having our hearts connected soul-to-soul. Bob:                Barbara, if you don't have the relationship in place, you're really headed for some turbulent waters as you head into adolescence, aren't you? Barbara:         Yeah, because it's so easy for our teenagers to get involved in myriads of activities – just thing after thing after thing, and they're after school at practices, and they're going to ball games at night, and they're getting up early to do things, and you just don't see them anymore, and unless you've got connecting points, unless you're pursuing that teenager and asking questions constantly – where are you going?  What are you doing?  What's happening in your life?  Who are you hanging out with? and pursuing that child to get to know that child and stay after it, you're going to end up going your separate ways. Dennis:          Yeah, in fact, last night Barbara and I were both up late with a teenager on our bed, and it was fascinating, because we were having a discussion around one of these traps that gets an adolescent.  It's the trap of deceit.  And our daughter was on the edge of the bed down near one corner, and I looked at her, and I said, "Sweetheart, you need to understand that it's not you in one corner of life and us in the other corner, and that we, as your parents are adversaries.  We are in your corner, and we're fighting for you, and we want to keep you out of these deadly traps that are going to get teenagers."                           And I just need you to know and need you to understand that, as parents, the reason we love you and are going to battle for you is because we want to save you from the pain that we just heard at the beginning of the broadcast of that teenager walking off into that trap.                           And I said to that teenage daughter, "Do you understand what we're saying?  We're really pulling for you?  We're not against you.  And, finally, all too late last night, she nodded her head and said, "Yes, Daddy."                           And it was an acknowledgement that only came about after a 30-minute conversation, Bob, that the easiest thing to have done would have been to gone to sleep.  I mean, both of us were dead on our feet.  We were whipped, but it was one of those magical moments that God orchestrates where if you don't fight it through and go ahead and love that child and stay relationally connected, you're going to miss a phenomenal teaching opportunity with that child. Bob:                And that "Yes, Daddy," was resignation that, "I know this is true intellectually but, boy, it doesn't always feel like we're in the same corner, and you're fighting for me." Dennis:          No, it doesn't, but we've got to hang in there.  A second assumption that we think every parent of a preteen or a teen needs to have today as they raise these adolescents to maturity is that they've got to have their own convictions.  They need to know what their values are, what they believe, and then they need to know how to build those convictions, that they possess as parents, into the life of the child.  And that means you have to shape those convictions in the soul of that child and then end up testing those convictions over the next six, seven years all the way through adolescence. Bob:                That's, really, Barbara, at the heart of what we're doing, as parents, with adolescent children.  We are transferring convictions to them, helping them establish a bedrock of core convictions. Barbara:         Mm-hm, and if parents don't know what they believe to start with, it is so easy to be blindsided by all the choices that our kids face, and if you haven't thought through what you're going to do about this or about that, all of a sudden, a kid comes home and says, "Can I go do this?"  And parents are so caught off guard that they kind of cave and go, "Well, I guess," and then later on they may go, "Well, that wasn't such a great idea, but" … Bob:                … but now, all of a sudden, a precedent has been set. Barbara:         They're stuck, that's right.  Dennis:          That's right, and when the doctor handed us a little baby by the name of Ashley, back in 1974, the doctor didn't say to us, "You know, Dennis, Barbara, you better establish a few convictions, because this child is going to need boundaries.  This child is going to need fences around her life to protect her from evil but also to give her a chance to formulate her own beliefs and her own convictions before she leaves the yard, moves out through the gate to the big, bad world out there."                         And I believe that the whole process of pre-adolescence and adolescence is one long process of taking our convictions that we've come to and implanting them in our children, watering them, nourishing them, cheering them on, picking them up when they fail, and then sending them out, finally, to the world to have those convictions have an impact on a world that desperately needs to see men and women today who stand for something, who have boundaries in their lives, and who are standing upon the Word of God. Bob:                That really takes courage on the part of parents. Dennis:          Yeah, and that's the third thing that parents need to have today, and I hope this book can literally reach through its pages to the hearts and heavy hands of parents and say to you, you know what?  It can be done.  You can do it.  With the strength that God supplies, with the truth in His Word, with the Holy Spirit guiding you, you, as a parent, can raise a teenager that has the courage to stand for his convictions, for her beliefs, for his values, and they can have a sense of a spiritual mission about their lives that will carry them through some early years of adulthood and on into maturity when they establish their own homes. Bob:                Barbara, one of the things, as I read through the book that I kept reminding myself and highlighting, were the parts where you and Dennis say, "Remember, you're the parent.  You have not only the right but the responsibility to do these things."  Why is it, as parents, that we lose sight of that and forget that we're in charge, and we can say yes and no and you've got to live with that? Barbara:         I don't know exactly why it is, but it is so true. Dennis:          It's real, isn't it? Barbara:         It's very, very true, yeah.  I think part of it is is that we, I think, deep down inside, wish it were not so hard.  I think we wish that we could teach our kids a principle or a lesson and have them learn it and be done with it and not have to reteach the same thing over and over and over, and I think it's that weariness that we begin to feel after three or four years into the process, thinking, "My gosh, are they going to ever get it?  Are they going to ever understand?  Am I not making sense?  What's the problem here?"  And after a while we just get battle weary, because it is a struggle. Dennis:          I think there's something about the human spirit that wears down, and that's why a good bit of the New Testament is directed to our hearts to give us courage and not lose heart.  Galatians, chapter 6, verse 9 is, I think, just a great verse for every parent –  "Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up."                         Bob, I think it's so easy for parents today to give up.  The number of traps that our teenagers face, the swift current of the culture, the lack of support in the community for people who hold to any kind of convictions – I mean, you're looked upon as weird if you have any kind of statement of belief today, and yet that's what teenagers desperately need, and they need it from parents who have not grown weary in well doing. Bob:                We've got five kids – only two who have moved into adolescence.  We're already weary.  You've had three already pass through.  How do you keep from getting weary? Barbara:         Well, I don't think you can prevent getting weary.  I mean, I've been weary the last few days, because I'm looking at our kids and thinking, "I don't think they're getting it.  I'm not sure we're communicating right," and it's that feeling like a failure as a parent that wears you down, because you know what you want in the end.  You know what the goal is, but sometimes you're not so sure how to get there.  And so the process, that race that we're running, is a long one, and I just think it wears us down.  And the only solution is is to just take some time and get away and remind ourselves of what the truth is and that God is for us, and that if we'll continue to seek Him and trust and pray – I'm praying more than I've ever prayed in my life for my kids. Bob:                This week we're going to look at seven of the 14 traps that the two of you have outlined in the book, and these seven are probably the more obvious and, in some cases, the more dangerous, or the more deadly traps that are laid for teenagers.  And the first one that we're going to be looking at this week is the trap of peer pressure, which is something that all of us face, whether we're adolescents or adults – really, it's a challenge for all people, isn't it? Dennis:          1 Corinthians, 15:33 says, "Bad company corrupts good morals."  That's true whether you're 12, 22, or 52, it doesn't matter and, as parents, what we've got to do is we have to anticipate that the teenage years are the most peer-dependent period in any person's life, and we have to be there, alongside our child, guiding them around these traps so that the enemy of their souls does not ensnare them into evil. Bob:                Barbara, one of the big traps that parents are acutely aware of, particularly in this culture, is the trap of premarital sexual involvement. Barbara:         Yeah, Bob, it's because it's so prevalent in our culture, and we see it everywhere, and we know about kids everywhere who are experimenting in this area, and I think parents are very aware of this trap, and they're scared to death and, as a result, we need to really think through – what do we believe?  What are we going to do about this with our kids?  What are our standards going to be?  How are we going to teach our kids to avoid this trap, because we know it's deadly. Dennis:          1 Thessalonians, chapter 4, says abstain from sexual immorality, period.  And, as parents, we are to guide our children around this snare, helping them stay out and away from any form of sexual immorality and, frankly, these are some of the most controversial chapters in the entire book, Bob, because we challenge parents to decide what do you believe about sex prior to marriage, and if your child comes and asks you a question, how will you draw the line for him or for her?                           In my opinion today, this is where we're using our young people – when parents don't know what they believe around life's most fundamental drive – the sex drive.  It's like if you can't define life around that, then will you define it around anything?                           The answer is no and, personally, nothing has caused us more agony and time with our teenagers than getting involved in this area, talking to them straight about their character, their choices, what they're going to do, what they're not going to do, challenging them to the highest standard.  And nothing sounds stranger today in this culture than to be in this area with your teenager, tracking with them, involved with them, and cheering them on to purity and a biblical word called "holiness."   Bob:                Barbara, right next to that huge bear trap of sexual immorality there is another trap that's a little bit smaller, but it kind of triggers the second trap, and that's the trap of dating. Barbara:         Yeah, they're kind of in tandem, they kind of go together, and they're often laid right next to each other, and you step in one, and you're in the other one.  The whole thing of dating is it's such an issue with kids because it, too, sneaks up on parents.  We tend to think that our kids can't date until they're old enough to drive or be out in a car, but the whole idea of pairing up – of girls and boys pairing up and kind of becoming exclusive with one another and belonging to one another – all that starts, sometimes, in elementary school but, for sure, in junior high. Bob:                Oh, for sure. Barbara:         For sure.  You're nodding like you know. Bob:                Yeah, for sure. Dennis:          Had a few phone calls at the Lepine house. Bob:                A few e-mails, a few phone calls, for sure. Barbara:         That's a knowing for sure, isn't it?  Well, I think what parents need to be aware of is that they need to be tracking with their kids and being involved with their kids on this issue, too, because this pairing up business, to the kids, is serious, and what it is, it's the foot in the door to dating, and then it becomes a foot in the door to the sexual temptations because, all of a sudden, they're seeing all these other little couples at school holding hands and hugging in the hall and maybe sitting on somebody's lap in the lunchroom or whatever.                           And that begins to look normal to our children because that's where they are all day, and so they begin to think, in their minds, there's nothing wrong with that.  So-and-so does it and everybody else is doing it, and so they, all of a sudden, assume that standard for themselves unless they've been taught otherwise. Bob:                And they think, "I'm not normal if I'm not doing it."  And, Dennis, even if young people stay out of the trap of sexual immorality, the dating trap has some challenges of its own apart from the issue of sexual involvement. Dennis:          Yeah, exactly, the whole issue of romance is a biggie, and I'm just grateful for Barbara, who has been tracking on this one from the beginning with our children, really trying to protect them from developing this romanticized view of relationships that's so prevalent among teenagers.                          It's been said puppy love may be puppy love, but it's real to the puppy and, I'm tell you, to a teenager, that romantic view of life – they fall into that and, I'm telling you, they just want to be in love with being in love. Bob:                Mm-hm, some of that comes out of one of the other traps that you talk about – that's the trap of media, because we're constantly fed in the media a diet of romance and sexual immorality. Barbara:         There's no doubt that the media strongly influences that whole concept of dating, because every movie has got a romantic line in it of some kind, whether it's the major theme in the movie or it's a small theme, it doesn't matter.  It's in every movie that these kids see, and they've been seeing them since they were young so this has kind of been building, this whole idea of romance and being in love and having somebody that's my own has been building in their thinking for years and years.  It's in every book, it's in every song they listen to, it's just everywhere. Dennis:          When we were writing this chapter in the book, I chuckled out loud, because there were so many distractions.  I was working on the computer at home, and my teenagers all wanted to get in the computer to get their e-mail.  There was telephone, there was TV, there were movies, there was music – I mean, all these things were happening in our house, and I could hear it.  I was going, "There is an amazing amount of media that is shaping and influencing my teenagers."                         And most parents are not proactive, we are being overtaken by it, and we're in a defensive mode when it comes to all these forms of media. Bob:                There are other traps that are laid for our kids that we're going to be talking about during this series – the trap of pornography, there's the trap of substance abuse, and then there's a deadly trap of unresolved anger in our kids. Dennis:          We don't realize how important our relationship is with each of our teenagers, and if we don't train our teenager in how to resolve conflict as he experiences it, then that teenager can be isolated from the people that love him the most and that can guide him through the most perilous period of his entire life.  Most teenage boys are angry.  They're just ticked off at the world.  I don't understand what testosterone does to them, but I'm telling you, they just get ticked, and guess who bears the brunt of that anger?  It's mom.                         And if mom's not careful, mom will get hurt, mom will get angry, she'll get in one corner, they'll get in the other corner, and instead of the parent being in the teenager's corner, they're coming out at the ring of the bell, starting another round of arguing, of words flying around, and the very relationship that teen needs is not in place to protect him or to protect her. Bob:                You know, I can't see our listeners, but I imagine the number of heads nodding as we go through these issues.  We all live with these very present issues daily as we're raising our kids, and it's hard not to become weary as we talked about earlier in the broadcast.                           Over the next few days as we go through each of these issues, you're going to help us understand how you have come to the some of the convictions you've come to, what they are, and then how you press those convictions toward your children. Dennis:          Each of these 14 traps that we talk about has a description of the problem, then we share what our convictions are about this particular issue – like sex, like dating, like pornography, like media, and after we help the parent understand what our convictions are and how we came to them, then we come alongside the parent and equip that mom and dad to be able to shape those convictions that they hold into the life of their preteen and teenager, so that when that teenager begins to face the issues around each of these traps, he already has some convictions that need to be shaped. Bob:                I know many of our listeners have a copy already of your book, "Parenting Today's Adolescent."  But I also know there are some moms and dads who have children who are 9, 10, 11, in what you two refer to as "the golden years."  And they're thinking, "Well, I don't need a book like this now because I'm not facing these issues.  And, probably, the perfect time to start reading a book like this is when your son or daughter is in those preteen years, because you need a proactive game plan.  You need to anticipate some of these issues rather than having them just pop up on you, and you hadn't even thought about them as issues.                         I remember when our oldest daughter, Amy, was a teenager, and she had gone over to a friend's house to spend the night, and it turned out that a group of them had been out of the home past midnight.  Well, we'd never thought about curfew issues.  We'd never thought about those kinds of restrictions, and we had to address that – not proactively but reactively.  It took us by surprise.                         And what you help us do in the book, "Parenting Today's Adolescent," is start thinking about those issues and develop, as you said, the convictions we have as parents and then determine how we want to help shape our children's convictions as they grow through adolescence as well.                         You can to go our website, FamilyLife.com, if you are interested in getting a copy of the book.  Again, it's called "Parenting Today's Adolescent."  Go to FamilyLife.com and click the red button you see in the middle of the home page that says "Go."  That will take you to the area of the site where there is more information about that resource and other resources we have for parents of teenagers.                         Again, the website is FamilyLife.com, click the red button that says "Go," and find out more about the book, "Parenting Today's Adolescent."  You can order online, if you'd like, or if it's easier, you can call 1-800-FLTODAY.  That's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY, and someone on our team can make arrangements to have a copy of the book, "Parenting Today's Adolescent" send out to you.                           By the way, when you get in touch with us, if you are able to help us this month with a donation of any amount for the ministry of FamilyLife Today, we would like to send you as a thank you gift the new book by Dennis Rainey that is called "Interviewing Your Daughter's Date," and this is a great guidebook for dads, especially those dads who have a daughter who is beginning to be pursued by young men.  We'll send this book to you as our way of saying thank you this month when you make a donation of any amount for the ministry of FamilyLife Today.                         Go to our website to donate, FamilyLife.com, and as you fill out the donation form, when you get to the keycode box on the form, type the word "date" in there, d-a-t-e.  Or call 1-800-FLTODAY, you can make your donation over the phone and just mention that you'd like Dennis's new book, "Interviewing Your Daughter's Date," and we'll be happy to send it to you.  Again, it's one way that we can say thanks for your participation with us in this ministry and your partnership with us here eon FamilyLife Today.                         Well, tomorrow we want to talk about one of the traps that our teenagers face – actually, this really starts before they become teenagers, but it intensifies in the teen years.  That's the issue of peer pressure and how that can be a deadly trap for our teens.  I hope you can be back 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'll see you back next time for another edition of FamilyLife Today.                          FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ._______________________________________________________________We are so happy to provide these transcripts for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com         

FamilyLife Today® Radio Transcript  References to conferences, resources, or other special promotions may be obsolete. The Deadly Traps of Adolescence Day 8 of 10 Guest:                        Dennis and Barbara Rainey From the series:       Pornography         Bob:                Hi, this is Bob Lepine from FamilyLife Today.  The subject matter we'll be dealing with on today's broadcast is of a sensitive nature and probably not one that you'll want to have children listening to.  It's really aimed at more mature audiences, so let me encourage you to usher your children away from the radio and then join us for today's edition of FamilyLife Today.                         A lot of guys today think of pornography of something that's essentially a harmless indulgence.  I mean, it's not hurting anybody else, right?  That's how they rationalize it.  Whether it's sites visited on the Internet or magazines that are kept hidden away, pornography can have an impact not just on your heart, but it can also be visited to the next generation.  Here is Dennis Rainey. Dennis:          I include in our book, "Parenting Today's Adolescent," a story of a young man who found pornography because his father had a stack of it in his closet, and his dad was sampling this stuff, and the boy found it, and it started a pattern in this young man's life that impacted his marriage, his family, and almost destroyed him as a man. Bob:                This is FamilyLife Today for Wednesday, July 18th.  Our host is the president of FamilyLife, Dennis Rainey, and I'm Bob Lepine.  What can we do, as parents, to attempt to protect our children against the devastating damage of pornography?                           And welcome to FamilyLife Today, thanks for joining us on the Wednesday edition.  Last week and again this week, we have been talking about some of the traps that have been laid for our teenagers as they walk through the teenage years and about the things that we can do, as parents, to be proactive in trying to help our teens navigate around these traps so that they don't become ensnared.                          And the trap we're going to be talking about today, Dennis, is a dangerous trap.  It's the trap of pornography. Dennis:          You know, Proverbs 4:23 says, "Watch over your heart with all diligence, for from it flow the springs of life."  What Solomon is talking about there is protecting the headwaters of the soul, because once you pollute the headwaters, the stream all the way out into the life of that person is impacted by that poison.                         You know, Bob, you came in one day when we were working on the book, and we'd been talking around this issue about pornography, and you shared a story about how a leader in a church had been impacted by pornography that found its way into his life through Christian families. Bob:                Yeah, this particular individual had grown up in a Christian home and had not been exposed to anything like this at home, but he'd gone to babysit for other families in the church and, again, his parents assumed these families were good churchgoing families.  There was nothing to concern them there.                          But after the children were in bed, he found, hidden away in some of these homes, pornographic material, and it was his first exposure, and it grabbed hold of him and, Dennis, there is something about pornography that it just seems to get its claws on the soul of a man, and it won't let go. Dennis:          And it's that curiosity, I think, that the enemy uses with men and, I believe, with women as well, that hook them and where they develop a compulsive behavior that begins to habitually get into pornography and sample it, and it poisons the soul.  It poisons the heart.                           And what we have to do as parents, I believe, we are the guardians of our children's hearts.  We are the ones who are to protect them from this evil, but it starts all the way back with our model, what we watch, what we do, what we bring into our homes. I include in our book, "Parenting Today's Adolescent," a story of a young man who found pornography because his father had a stack of it in his closet, and his dad was sampling this stuff, and the boy found it, and it started a pattern in this young man's life that impacted his marriage, his family, and almost destroyed him as a man. Bob:                Barbara, that's one of the challenges that parents face today.  In Solomon's day, as we read in Proverbs, chapter 5, 6, and 7, you could pretty much warn your kids, "Stay out of this part of town, don't go in establishments like this, and you'll be protected from these images and from pornography."  It has been so mainstreamed today that we can hardly let our kids out of the house. Barbara:         Well, we don't have to let our kids out of the house with the Internet.  I mean, you know, that kind of stuff is everywhere, and that's what's so scary.  But parents really need to be on guard, as Dennis was saying, in protecting our kids and watching where they are, where they're going, and even in letting them to go somebody else's house, like that story you told about that man when he was a young boy, finding it another Christian's home.  We have to be so careful where we let our kids go and who we let them spend time with. Bob:                Then we've got to be asking a lot of questions at the same time, like the question you asked your son Benjamin one day when he came home from school. Dennis:          Yeah, and I asked him if he'd been looking at anything he ought not to be looking at, and he was about 12 or 13 years of age. Bob:                That's a pretty bold question for a dad just to grab his son and say, "Hey, have you been looking at anything you shouldn't be looking at?" Dennis:          Well, I think the spirit of God prompted me to do that, and I think what I want to encourage our listeners to do is when the Lord begins to burden you with something with your children, step on in there and ask the question.                          Benjamin had come home from school.  We were in the kitchen, and I asked him that question, and it was like he was struck with lightning.  It's, like, "Dad, have you been reading my mail or something?"  And he said – he looked at me after he paused for a moment, and he got this little grin that he has, and he said, "Well, as a matter of fact, today at lunch I was sitting in the back of the classroom eating my sandwich, and some guys had some pornographic literature up front at the teacher's desk, and they were all huddled around it, looking at it, and they said, 'Hey, Ben, come on up and look at this.'"  And he said, "I finished my sandwich, stuffed it all in the sack, and I walked up past the desk and on out into the hall and left the room."  And I said, "You did what?"  He said, "That's right.  I didn't look at it.  I left the room."                         Well, at that point, it was like my son had scored the winning touchdown … Barbara:         … in the Super Bowl. Dennis:          In the Super Bowl, there you go, and I went berserk.  I mean, I started screaming, yelling, going, "Yes, way to go, son, that's a phenomenal step," and you know, I don't know to this day if he remembers his Dad going bonkers there in the kitchen over his choice, but I think if there's anything we ought to be getting excited today about, it's young men, young women, who are taking steps away from evil and toward that which is right.                         You know, Bob, I think what we're talking about here is parents being involved in their sons' and in their daughters' lives, because there are so many ways these images can gain entrance into our children's soul and poison the headwaters. Bob:                Barbara, when my son Jimmy was about seven years old, we were driving around one day, and there are a series of stores in our community that we've just chosen not to patronize because they sell pornographic magazines.  And so as we drove past one of these stores, he said, "Now, Dad, we don't shop there because of some of the magazines they sell, is that right?"  I said, "That's right."  And he said, "What kind of magazines are they?"  And he's seven – and here's the tension for a dad – how much detail do you share in order to protect your son's innocence and keep him away from the destruction?  How do parents navigate that kind of a tightrope? Barbara:         Well, I think parents – again, it goes back to being involved, and it's the word we've talked about over and over again in the book, and as we've been talking through these traps – Moms and Dads have to be involved in their child's life, and that means asking questions all the time and then responding to the questions they ask us like you did with Jimmy, and saying, "You know, it's something that is degrading to what God created."                          Or bring it back to the scripture to God's blueprint and God's plan for marriage and family and just let them know that this material is not wholesome, and it's not healthy.  But we need to be careful that we do it in such a way that we don't increase their curiosity so that they want to go find out what this is.                           And I think, as parents, as we continue to pray, that God will give us wisdom to answer these questions and to ask our kids questions, too, to find out what they're seeing and what they're hearing, I think the Lord will grant that wisdom. Bob:                You know, a number of years ago, one of my sons had a friend come over and spend the night, and Mary Ann and I had gone on to bed and, of course, they stayed up later.  I think they were watching something on TV or watching a video or something.                         And the next morning when I got up, I was on the computer, and I saw a site that I didn't recognize in our history file.  I went there and as soon as it popped up, I went "Uh-oh," and clicked out of it, and then I realized that this had to be something that the kids had gone to while we'd gone to bed.                         And so I called to my son, and I said, "Son, can you come into the other room for just a second?"  And I sat him down, and I said, "Did you guys look at something last night on the Internet that you shouldn't have looked at?"  And he realized immediately that he'd been found out, there was nowhere to run, nowhere to hide, so he just kind of dropped his head and said, "Yeah, we did."                         And I said, "Well, tell me about it.  What happened?"  And it turned out that someone at school had given my son's friend an address for the Internet and said, "You ought to check out this site."  And they didn't know what was there, they didn't know anything about it.  It had been, I think, relatively innocent, at least that when we called the other young man in, and I asked him about that, that's what he told me.  He said, "I didn't know all that was going to be there.  Somebody told me I should look at it, and so we looked at it."                         And I said, "Well, I've got to call your dad and let him know what we looked at, and we've just got to be on the same page, and he allowed that that would be okay.  And we didn't make a big deal out of it because I think they had come across this relatively innocently, but we did say, "Look, there is danger here.  It's not just something innocent it's not harmless.  You've got to be very careful.  You don't want to be going to these sites.  Looking at this stuff can damage your soul."                         And, you know, when we think about this issue of pornography, we typically think about our teenage sons and the pictures and images that they're seeing, but, I'll tell you, there is a growing trend of teenage girls going on the website to look at particular kinds of pictures or images.  And even if they're not looking at what we would technically refer to as pornography, they are going to sites, or they're reading literature, or they're viewing things that can have the same kind of influence on their soul. Barbara:         Yeah, I think there are two things that girls are most susceptible to.  One would be magazines and the kinds of images – the way they portray women and teenagers in magazines, the kinds of things that they wear.  And all of that can desensitize their perspective of who they are as young women and how they are to act and what their standards need to be.                          And the other thing would be novels that girls read, because there are a lot of novels out there, even Christian novels, that are romance novels that stir up all kinds of longings and passions and desires and interests along those lines that are not necessary for these girls to be experiencing.  It's not something that they need at this age in their lives.                           They need to be doing things that are much more wholesome and relational with girlfriends and family, rather than feasting their eyes and their minds on these magazines and books that are all about things that they have no business being involved in. Bob:                Some of the magazines that you subscribed to when you were in high school and had hoped you might subscribe to someday with your daughters you found were wholly inappropriate. Barbara:         Yeah, I remember discovering that and what a shock it was when our oldest daughter was a teenager and I thought, "Well, I'll just subscribe to this magazine for her," and went and bought a copy at the newsstand for her to have and was just amazed at how it had changed over those years from when I was a teenager to when she became a teenager, and that was even about 10 years ago, and the content was awful, it really was. Bob:                Dennis, in the same way that men are stimulated visually, women are stimulated emotionally – what they read in romance novels and magazines can gain a grip on their soul. Dennis:          I think it's the wise parent who understands that this problem is not just a male problem.  I think many of the soap operas today, a lot of advertising, other things, are trying to gain entrance into a woman's soul and pollute her much as diabolical forces are trying to do the same thing with men, and it's why we've got to maintain a good connection with our daughters as well as our sons and be tracking with them, asking them how they're doing.                         One of the things, Bob, that I think is very important to discuss with our teens and preteens, is just a good definition of what pornography is.  I think a lot of times we can classify pornography at such an end of the spectrum that we fail to recognize where pornography starts, and our definition that we use is that pornography is any type of media – words, photographs, movies, or music, that stimulates sexual excitement.                         Now, if you start with that definition, all of a sudden, that opens the door to all types of advertisements, whether it be on TV, whether it be on the radio or in print media and, frankly, some of the advertisements that are used even in major news magazines or even in the newspaper is absolutely pornographic.                           And, as parents, I think we've got to start with our own basic conviction of what is pornography?  What are we going to classify as pornographic literature?  Pornographic images?  And I believe pornography is that which perverts the beauty of what God said was very good.                         The sex drive and sex in marriage is all appropriate and good and blessed by God, but pornography is an appeal to the fantasy.  It calls men and women away from real relationships to these fantasy relationships that don't exist.                           A second thing that's very important is, without being explicit, you talked about this with your son, Jimmy – we have to explain to our young people that pornography has certain steps associated with it.  There's a slow, gradual, slippery slope that you start walking down, and it starts with just a little bit of curiosity, and then there has to be more stimulation to satisfy that curiosity, and it can be so powerful, so alluring that it can take an innocent encounter like I had one time of opening a trash bin to dump our garbage in the trash bin, and there was, opened in the trash bin, a pornographic magazine.                         Well, at that point, I could either decide to walk away or pick it up and stuff it in my trash bag and take it back into my home.  I left it where it was and didn't look, but it's those types of little steps that determine who we become. Bob:                We were driving along the other night with a friend of my daughter's, and they have an Internet service, one of the large, national Internet services, and we were talking about e-mail, and she said, "We routinely get e-mails sent to us inviting us to visit all these icky-sounding sites," and it's happening innocently where your children are a click away from an image that will burn into their soul and will never leave. Dennis:          Yeah, and that's why parents have got to be involved, and they've got to use some of the resources that are being created to protect our families.  There's an Internet service that we list in the book that is filtering out pornographic sites from ever even making it to your computer.                           There's software available that's mentioned in the book as well to talk about how to filter these images and words from ever making it into your home, and I think, as parents, we've got to use all these resources that help us protect and guard our children's hearts, because we've been given that responsibility, and your child doesn't have the maturity to be able to discern what to do with that Russian sex site that pops up on your screen. Bob:                Dennis, what should a mom or a dad do if they come across files that they know have been downloaded onto the computer that they realize are inappropriate? Dennis:          Well, first of all, you're making the assumption that they found them casually.  I would empower every parent listening who is raising a teenager to take the freedom to look.  I wouldn't hesitate to look in my son or my daughter's room or where they've been tracking on the computer if I suspected anything and you know what?  Even if you haven't suspected anything, it might not be a bad idea if you just go and look and just check it out. Now, is that invading the child's privacy?  I don't think so.  That child is under your care.  You are protecting that child.  If you came home and were afraid somebody was hiding in your child's room, wouldn't you go look in that room first to see if somebody was in there, if there was evil in there, if there was harm going to come to him?  You wouldn't think anything about that.  Well, I think the same thing is true of this.  I think we need to look at see if our children are sampling.                         Secondly, if you do find it, I think immediately you offer grace.  You know, that's at the core of the Gospel.  Ephesians 2, 8 and 9 says, "For by grace you have been saved through faith and that not of yourselves, it's the gift of God, not as a result of works that no one should boast."                           We're all sinners, we've all broken God's laws, we need grace to be able to rightly relate to God and to one another.  You forgive your child, and you go armed with that grace and forgiveness, but you take a step beyond that, and you call that young man or that young lady to be accountable.  You ask them to step forward and to submit to some actions like not being on the computer late at night after Mom and Dad have gone to bed; not having a computer in their bedroom with the door closed.  The idea is, is bring their lives out into the light and let them walk in the light.                         Then, I think, third, ask your child questions – are you looking at anything you ought not to be looking at?  Are you allowing your mind to feast on anything that could pollute your soul as a young man or as a young lady? Bob:    I think it can be helpful for parents, too, to have software on the computer, things like on our computer at home, we use something called "Safe Eyes," that's a program you buy, and a service then you subscribe to that provides a level of safety. There is also monitoring software.  We've talked before about a program called "Desktop Surveillance," that gives you snapshots of where your children have been, where anybody has been on your computer.  And all of these kinds of computer programs can be helpful but, again, we have to remind ourselves that there is no computer program that will keep a teenager away from something they shouldn't be looking at if they really want to look at it. They can go to a friend's house or a cyber café somewhere, they can find a computer that's available and, I guarantee you, if they go off to college, unless they're in a situation where the college actually filters the Internet, they're going to have access wide open.  You've got to make sure that you're not just dealing with the problem by putting boundaries around your teenagers, but you're helping your teenager cultivate the personal boundaries, the personal convictions, the self-discipline to stay away from these sites that we've talked about today. And to do that, you need the kind of guidance that the two of you provide in your book, "Parenting Today's Adolescent."  I think you give us, as parents, a good game plan for how to address these issues, how to have an ongoing conversation with our teenagers so that we can raise this issue regularly as our children go through the teen years.   This is one of the more than a dozen traps you talk about in the book "Parenting Today's Adolescent."  And I think it's a particularly helpful resource for parents who have preteens.  You're right on the verge of your children becoming teenagers.  Maybe you're not dealing with these issues now, but they're just around the corner and now is the time for you to be engaging in these issues, developing some convictions and being ready to have some standards in place that you can interact with your teen about as they start to move into their teenage years. Again, we've got copies of the book, "Parenting Today's Adolescent," in our FamilyLife Resource Center.  Go to our website, FamilyLife.com.  In the middle of the home page, you'll see a red button that says "Go," and if you click that button, it will take you to an area of the site where you can get more information about the book, or you can order a copy online, if you'd like. Again, the website if FamilyLife.com, click the red "Go" button so that you can get a copy of Dennis and Barbara's book, or call 1-800-FLTODAY, that's 1-800-358-6329, that's 1-800-F-as-in-family, L-as-in-life, and then the word TODAY, and someone on our team will make arrangements to have a copy of this book sent to you. You know, a common theme that we've had throughout this week as we've talked about the traps that are facing our teenagers is the theme of how important it is for parents to be proactive, to be involved, and to make sure you have a relationship in place with your teenager as you move into the teenage years so that you can have some of these challenging conversations. I was just thinking about the book that you wrote recently, Dennis, called "Interviewing Your Daughter's Date," and if a dad is going to step up and take on that responsibility, he needs to do it on the foundation of a healthy relationship with his daughter. This month we wanted to make a copy of your new book available to any of our listeners who could help with a donation of any amount for the ministry of FamilyLife Today.  We are listener-supported, and so we depend on those donations to be able to continue the work of this radio ministry and the other outreach ministries of FamilyLife Today. And if you can help us this month with a donation of any amount, we want you to feel free to request a copy of the book, "Interviewing Your Daughter's Date."  If you're donating online at FamilyLife.com, when you come to the keycode box on the donation form, just type the word "date" in there, and we'll know to send you a copy of Dennis's book as a thank you gift. Or if you call 1-800-FLTODAY to make a donation over the phone, just mention that you'd like Dennis's new book, "Interviewing Your Daughter's Date."  We're happy to send it out to you.  It's our way of saying thanks for your partnership with us in this ministry.  We appreciate your financial involvement, and we're also glad you listen to FamilyLife Today. Now, we hope you can be back with us tomorrow for FamilyLife Today.  We want to talk about one of the other issues that faces teenagers today – it's the issue of drug use, substance abuse, alcohol, marijuana – what can we do, as parents, to try to proactively deal with this issue and help our teen avoid that trap?  We're going to talk about it 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'll see you next time for another edition of FamilyLife Today.  FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas, a ministry of Campus Crusade for Christ. _____________________________________________________We are so happy to provide these transcripts for you. However, there is a cost to transcribe, create, and produce them for our website. If you've benefited from the broadcast transcripts, would you consider donating today to help defray the costs?Copyright © FamilyLife. All rights reserved. www.FamilyLife.com         

What is the American Bar Association (ABA) doing to ensure there is a national voice for, not just the legal profession, but for vulnerable people and communities that we serve, to make sure that the Constitution is protected? As his term comes to an end, current ABA President Bob Carlson sits down with ALPS Executive Vice President Chris Newbold to discuss the ABA's work to move the needle on tough topics like lawyer wellbeing, natural disaster relief, immigration, diversity and inclusion, and the vision of global stewardship. Transcript:   CHRIS NEWBOLD:              Good afternoon. This is Chris Newbold, executive vice president of ALPS. Welcome to ALPS in Brief podcast. I'm actually here today in Missoula, Montana. It's July 19, 2019, and I have a very special guest here in our offices. Current ABA president in America, attorney Bob Carlson. Bob Carlson is a former past president of the state bar of Montana and is the second Montanan to ever hold the post of ABA President. Bob, thank you for joining us today. BOB CARLSON:                       Well Chris, thanks for having me. And just to tell your viewers, we just completed another successful ALPS leadership retreat here in Missoula, and had bar leaders and executive directors from around the country. It was inspirational as always, so thank you. CHRIS:                 Yeah, obviously ALPS, in our malpractice insurance, one of the strong partnerships that we enjoy is our relationship with state bars and, and Bob was actually, back in his state bar is, was a major force in the creation of ALPS. And so we obviously appreciate his longtime support of ALPS. Bob, let's talk, I want to talk a little bit about ... Let's talk one year ago today, right? So you were on the cusp of going into the annual meeting in which you were going to be sworn in as president of the ABA, right? Talk to our listeners about just kind of what you were thinking about before you went into the post. Obviously, you went through a pretty long cycle of leadership positions in the ABA, but there's, there's probably nothing like kind of getting ready for the actual year itself. And so talk to us about your mindset, about what you were thinking about going into the year as ABA president. BOB:                          Well, a few things. First of all, my predecessor, Hilarie Bass had started some programs that we wanted the association to continue. Going back a couple of years before that with Linda Klein and Paula Brown, they had started some programs that as an association, we wanted to continue. What we didn't want to do is just start something new, start a fresh initiative that was Bob Carlson's initiative. And I think that Hilarie had a similar mindset and we had worked well together and an issue that was very, very important to both of us was attorney wellness and wellbeing. We were bound and determined to continue to spread the message about the work that the association and state local bars were doing in that area. The second thing was to try to continue to spread the message about what the ABA and its young lawyers division does in the area of disaster relief and disaster resiliency. In the last two years, we've had disasters, significant devastating disasters, whether it's hurricanes or tornadoes or wildfires or earthquakes from the US Virgin Islands to American Samoa. So literally one end of this country to the other, and we wanted to continue to focus on that. Immigration was a critical issue. The ABA has significant policy in this area to try to assist in making sure that, number one, the children that were removed from their families were reunited. We're still working on that. Number two, that unaccompanied minors got a fair hearing and got as much representation, whether direct representation or pro bono representation, that we could provide or at a minimum that they had been provided with some information about what their rights were and also to assist people seeking asylum. We continue to work on that even though the landscape seems to change on a regular basis. And finally we were rolling out a new website and a new membership model. I come from a very small firm in a rural state and I wanted to make sure that we had Hilarie and Judy and some other, Judy Perry Martinez, my successor, and others speaking for the larger firms. Hillary's firm was 2000 lawyers. At the start of my year, we had five or six. We're now three due to a couple of moves out of state of a couple of associates. But wanted to really show to lawyers in small firms around the country that the ABA was relevant to them. And that was a great value in terms of making them a better practitioner, providing them the right tools they needed to assist their clients, and to make it more affordable and accessible. On the eve last, almost what is a 49 weeks ago today? That was the thought. Had a lot of momentum going into the year from things that my predecessors had done, and I think we've kept the momentum up and, and moved the ball forward on a lot of areas. CHRIS:               That's a really interesting thing to kind of note because I think in the governance model of the ABA, there has been a little bit, what's the president's initiative? Best practices in nonprofit governance would tell you that, you know, there's a strategic plan, right? And there's a vision of a board and the president is just the steward of the vision, right? As opposed to, and it seems like there's been a lot of progress with the last couple of leaders of the ABA in terms of executing a coherent, sustainable vision for the organization. BOB:                        And that's been the goal. I grew up in the bar world in the state bar, Montana. When I first became a member of the board, we were just starting, this was back in the 80s, we were just starting our strategic planning process and when I became president we were five, six years into that process and the presidents were moving things forward. A strategic plan keeps getting evolved every year. You look at it every year. You've done retreats, the [inaudible 00:06:43] retreats for the state bar and others, that you know, what have you accomplished but needs more work? What new issues have arisen on the landscape? The legal profession is constantly evolving. Issues constantly evolve, so you have to figure out a way to meet that. Most of the state bars though don't have the turnover, complete turnover in leadership that the ABA does. So you have a board at the ABA that rolls over completely, is a new board every three years We have a strategic plan now for the board that Hilarie pushed through. We have done some reorganization internally, but the mindset has to be at the top. The leaders at the top have to say, listen, we support the association moving forward. This is not about the individuals that are the presidents. This is about the association. This is about the profession. This is about the independence of the judiciary, and diversity and inclusion. What are we going to do to move those things forward? And the way you do it is you sort of have a relay. It's not a sprint. It's not, I'm going to do as much as I can in one year. It is confident in the knowledge that you keep moving the baton forward. That I took it from Hilarie and I'm giving it to Judy and she's giving it to Patricia Refo from Arizona, and we're going to continue to move the association forward in a strategic way, and in an organized way. This gives you the flex. This allows you to meet the ongoing programs, to continue to expand and work on programs, but also meet the new things that happen in every presidency. Whether you're a state bar president or the president of the largest voluntary legal association in the world, every year there's going to be something that happens that you're going to have to react to on behalf of your members and on behalf of the profession. CHRIS:                 So you have those expectations, right? There's continuity in the goals one year later. How do feel like things at one? BOB:                    I actually feel really good. We have moved. We have made progress in a number of areas, and I think the association as a whole has strengthened. We did a lot of things last year to strengthen and we did a number of more to strengthen it, and we are positioned to really have a very strong national association for the future. I think for the listener that's critically important to the independence of the judiciary. It's critically important to due process and the rule of law that you have a national voice for, it's not just for the legal profession, it's for vulnerable people and communities that we serve to make sure that the message gets delivered, to make sure that the Constitution is protected. I feel like we really as an association have made a lot of progress, and one area that we've made significant progress in is the area of lawyer wellness and wellbeing. Thanks a lot in no small part to your work and assistance as the co-chair of the ABA working group on lawyer wellbeing in the profession. I'm sure I've totally messed up the title but we have really created a movement. Primarily my job is taking in as many groups as possible about the issues concerning lawyer wellbeing and lawyer wellness, whether it's a state bar, or a local bar, or law schools, or meetings of managing partners, or to regional bar associations. Not only what the ABA is doing, but how we can partner with all the other stakeholders, including companies like ALPS, who write legal malpractice insurance and have been big supporters of the organized bar since ALPS inception. So I feel really good. We created a pledge we have for legal employers to talk about and think about lawyer wellness and wellbeing for their employees. We've got 120 legal employers that have signed up both law schools, in-house counsel, some of the largest law firms in the country, and then a small firm like myself. So it's not just for big firms, and it's not a one size fits all. It's what can you do to make sure that the consciousness of the law firms and the employers are raised so that they are more aware of the issues that their employees are going through. So if somebody needs help, they know the resources they can get to, the toolkit on lawyer wellbeing with the 80 tips, a [inaudible 00:11:53] that you can download on your phone. I mean that's tremendous progress in an area where we needed something to say, listen, this is okay to talk about. It is okay to get help. It is imperative that you get help. And we're trying to make sure that publicly, every day, everywhere I've gone this year to every audience, those words come out of my mouth. If you need help, we have the resources to get you help. Because to be a good lawyer, you need to be a healthy lawyer. CHRIS:                Yeah. And how would you characterize the state of attorney wellbeing right now if you had to kind of step back and reflect a little bit? Because obviously, we have a long way to go. The numbers are not favorable, right? But education and discussion and as you say, the creation of a movement dedicated to the betterment of the profession is a noble direction for us to take. BOB:                        It is, and we've made progress. I do think we've made progress. The conversations over the past year, I sort of lost track of the count, but I think I spoke in 17, 18, 19 law schools primarily on the topic of lawyer and law student wellbeing, urging law schools to think about it. And there's a number of law schools that are doing great things. There's number of law schools that within an hour after leaving the lunch with the students, they created a working group to discuss how they could do things in their law school, which included faculty, interested faculty members and deans. So I think we've kept this as sort of a fear thing for so long. People were afraid that if they identified as having a problem, whether it's a mental disease problem, anxiety, depression, bipolar, whatever, or if it's a substance issue, they felt that if they sought help that they'd have to report themselves and that they would be stigmatized, and they would be penalized for that either in their admission to the law school or their admission to the bar. So we increased the bandwidth of the stakeholders where we have regular discussions with the conference of chief justices. So the 50 chief justices from every state who can basically oversee the practice of law and the admission to law and to practice in their states. We've had discussions in law schools. We've had discussions with managing partners of big firms, medium firms, and small firms. There was a national summit where educators, lawyers, legal malpractice insurance companies got together to talk about how to move this message forward. I'd say the most important thing we've done is we talked about it every day, and I think that's made a big difference. There's a lot of things, there's a lot of positive things that the legal profession is doing today. A lot of, whether it's volunteering a for pro-Bono in disaster relief areas, whether it's volunteering to assist people seeking asylum at the border or in their communities, whether it's volunteering to help people with their veterans benefits, or the elderly. Whether it's lobbying for legal services, adequate funding and the Legal Services Corporation or the public service loan forgiveness program. All things that the profession is doing, the great things. Those things provide you satisfaction as lawyers. Helping somebody pro bono, for free, provides satisfaction. So we're trying to provide as many opportunities to younger lawyers to do that, as well as more seasoned lawyers like myself. At the same time, it's sort of an individual decision about how you want your life as a legal practitioner to unfold. Do you want to be a professor? Do you want to work in government? Do you want to be in a big firm or small firm? When I taught in law school, since I come from a small firm, and Hilarie comes from a very large firm before me, and Judy comes from a medium-sized firm, I make that analysis. Here's the world's largest legal association. Here's three totally separate, 2000 lawyer firm from Miami, three to five lawyer firm at the time I started from Butte Montana, a few hundred lawyers from New Orleans, Louisiana. That's pretty diverse in terms of practice areas, in terms of scope. You lay that out to people saying these are things that you can do. You can choose to practice where you want, and you need to make part of that decision to make yourself feel like you're giving back. CHRIS:               In many respects, you know, the attorney wellbeing is a one attorney at a time progression. Right? And the more that we're raising the visibility of the issue, willing to have meaningful conversations, be vulnerable at times. Right? And be able to look out for one another. It's amazing how much impact you can have, one lawyer can have, on the people around them. BOB:                       Yeah. And I think for a long time, people were either embarrassed or didn't want to interfere. But if you look at it in terms of if you saw somebody that was stepping out in front of a bus, you know, you'd reach out and grab the person. And people that are suffering from either addiction or anxiety, depression, other mental diseases, that's that equipment. And do you have to at least say something, be willing to raise the issue, not to embarrass them, not to demean them, to treat it as a part of society. These things are in society. Unfortunately, the legal profession has way higher averages of people suffering from these issues than the average population and way more than the other professions. And so we need to be able to speak up. And I think part of it historically was, oh, that was a sign of honor to, I could party hard and then still get up and go to work and be a great a lawyer or I, you know, I feel bad so I'm not going to go help because that would make me seem weak. So I'm going to, you know, ignore it for self-medicate, which compounds the problem. And the more you can normalize this, or de-stigmatize it, the more you can say, this is part of life. We're here to help you. You need to get help and we are not going to judge you when you do it. CHRIS:              Yeah. And one of the things that also I think is interesting is that you know, there seems to be more willingness as a society for us to talk about these issues, right? I mean, you, you hear top 40 songs talking about suicide hotlineS, and you see a lot more stars coming out and being more vulnerable about things that are affecting them. And then you have generational change. Right? And so talk about what you see in terms of just, you know, you spent a lot of time in law schools. I mean, I think the generational shift in terms of the millennials are soon going to be, you know, the majority of lawyers out there. Right? And what that means in terms of the awareness of worK-life balance, professional satisfaction and willingness to talk about these issues more openly and honestly. BOB:                          Yeah, I think the trend is, I think we're seeing some positive results in the more experienced, the baby boomer generation, getting help and being willing to talk about it. But I really do see a great hope for the profession with our younger lawyers and with the law students coming out because they are more willing to seek help. They're more willing to seek fulfillment in both their day jobs, whatever they are, but also volunteering on issues of importance to them. And as an association, we're trying to provide as many opportunities for them as possible so they can volunteer their time and talents to the communities where they live. And I think that is going to pay dividends in terms of their self-fulfillment, their enjoyment of their job. I've practiced law now for, I graduated 40 years ago, and there's been some tough times. The practice of law is difficult, but I've always enjoyed doing this. I've always enjoyed being a lawyer, helping clients. But I think part of what's given me the fulfillment in this is this. I mean I've been active in the state and national bar, you know, since the early eighties, so not too long after I got a law school. And that sense of giving back to the profession, that sense of being around talented lawyers from all over the country, and having that experience has really been fulfilling in not only my life but my family's life. My wife and I have great friends all over the country, that but for doing this volunteer work, we would've never met these people. And I think that part of the thing is to, and I come from a small firm, we've always been a small firm and we've always been committed to giving back to both the bar and the community. But that sense of fulfillment is something that if we can convince more lawyers starting in law school and more young lawyers to participate in that, to take that time and provide more opportunities. You don't have to do this. I mean being the president of this association has been great, but you know, not everybody's going to do this. I do know that in every classroom, every group of young lawyers that I talk to, I say the same thing. There is somebody in this room that in the next 20 years is going to be standing up giving this set of remarks to the next generation of lawyers. Because I do believe that. I believe that you have to be open to the possibilities that one thing you do, one day, one volunteer effort somewhere, you have to be open to the possibility that that is not only going to change the person's life that you're helping, that it's going to change your life. And I think our generation has done a pretty good job. But this next generation I think is ready, willing and able to step up to the plate. And I have great confidence. Is it perfect yet? No, but are we making progress? Did we move the needle this year in a number of areas as an association of profession? Absolutely yes. CHRIS:             That's great. That's great. Tell me how has your small firm perspective been important in your leadership perspective? Not that it's unusual that a small firm lawyer becomes president of the ABA. But when you look at the numbers, right? 49% of, you know, the ABA statistics, 49% of lawyers in private practice are solo practitioners. Right? And then the next, you know, 24, 26% are in firms of two to five. Right? So it's fairly unusual to find somebody who has the capacity, the commitment to step forward and bring that perspective from a leadership perspective. And so I'm wondering how you reflect now about how that perspective has been part of your leadership journey. BOB:                    Well, I certainly think it's helped. It's helped keep me grounded. I've never taken myself too seriously, although I tried to learn something every day and lay awake at night thinking could I have done this better or differently. But I think that being from a smaller firm, when you're out talking to groups of lawyers, most of them are going to be in that category. And I know what they're going through. I mean, I know the day to day ups and downs, and joys and sort of a downside of being in a small firm and being part of the fabric of a community. And being from a rural state, that sort of amplifies that. Because lawyers volunteer everywhere, but if you're in a big city that shouldn't, but it sort of gets lost in the whole, there's a lot of people doing a lot of things. If you're in a small town or from a rural state, you see lawyers on every board. You see lawyers coaching soccer and baseball and refereeing and they're part of the fabric, the literal fabrics of their communities. And to be from that background, I think gives you a better voice when you're talking to those folks. I think the association as a whole and the leaders have always done a great job trying to assist solo and small firm lawyers be better lawyers. We've got great tools for that. We've worked hard over the last several years to expand that. And maybe it was in part because of comments or suggestions that I brought to the table being from that perspective. And so I think that it allows you to walk up and say, listen, I get it. Now the larger firm lawyers who have been president, they're empathetic. They do get it. They want to help everybody there. Their job, you're leading this association, you want to help all the members and you want to increase membership. You want to gain more people so you can help more people help more clients. And so they get it. But it's like when I walk into the room with 50 managing partners of these major law firms, I get it because I've been in those discussions, some of them I've known for a long time, but I don't know what it is they're going through managing 59 offices in 30 countries or whatever it is. I mean I empathize but they're like looking at me like what do you know? And I think that now there's a face because there's been this misperception that the ABA is only for big law firms and coastal law firms. And that's just not true. A vast number of our members are from solo and small firms and, but now they know that you can lead this. Now they know that number one, leadership is for everybody. It's very diverse across all categories. And they know that there's somebody here that they could pick up the phone and say, I'm having this issue, what programs are the ABA running or do you have to help me? And they know that I know what I'm talking about when I'm talking to them. It's just a matter of expanding the bandwidth and pushing the envelope that we have all sorts of people who've risen to the top and leadership of this association. This association is a big tent and it is for everybody, no matter where you come from, no matter what your practice, no matter what your firm size, no matter what your gender, race, social or sexual orientation, ethnicity, religion, whatever. This association is for them. We have done I think a better job over the last several years of moving that message, in part because of who we've selected to be the president of this association. CHRIS:                 Well, you sit now in the home stretch of your tenure as president, just a few short weeks you'll be handing off the baton. Have you had any time to reflect on the year? You've, you've been go, go, go, go, go. I'm just curious about the personal side of this type of service, commitment to the profession. I'm sure you'll have a decompression time at some point here in the near future. But you've been in enough airplanes where you probably get some time to think as well. BOB:                         Yeah. I've been trying to take it one hour at a time, literally. Get to the next commitment, be in the moment for the people that I'm speaking to or having conversations with at the time, and then keep moving. I've done some reflection on the plains, but a lot of it is how can I do a better job and the time that's remaining in this term to deliver the message better. Trying to learn from every set of remarks, how could I make more of an impact on the audience? How can I make this work? How can we make a broader impact on other issues facing the profession and the judiciary in the United States and frankly the world? So what can you do to move that forward? And I've been very fortunate. My very small law firm has supported me. I have still practiced law this year, not as much as maybe I would have liked to help my partner out and help the law firm out in our clients, but I've done some, which is a little unusual for an ABA president. And I think I've had great support from my wife Cindy. Because we have two dogs who miss us and we miss them. We haven't traveled a lot together and plus this job is sort of like being on a rock band tour without the band. You're sometimes in multiple cities in a handful of days and she prefers to go to a location to sort of be there for a few days, three or four days at a time. And there's times when you're in a city for two hours. So it's been a little difficult at times. But she's been great. But we've been in this for the whole run. We're going to be 34 years of marriage, but we dated before that. So she's my entire career or bar service, my entire career at my law firm, which I started in 1981, she's been in the picture. And she's got a lot of friends in the state bars, and in the national bar, and people that she's met around the world. This has been a fabulous experience. I'll sit back and reflect later, but we still have three weeks give or take to go and there's still more stuff to do. We're still trying to every day look at things and say, how can we do good today and continue to move the association forward? CHRIS:               Well thank you Bob, obviously for your service. I think anybody who ultimately serves in a service capacity, in a leadership role, I think our ultimate goals that leave the organization better than we found it. Right? And I think that if that's the benchmark versus success, I think you should certainly be proud of what you've been able to achieve in your year as ABA President. And again, there's a lot of people around you. There's an incredible ABA staff, right? This is an organization that's committed to betterment. And you know, while you're the steward of the vision at this point, I know it's got to be fulfilling for you to begin to think about the fact that you've ideally move the needle forward and you're going to leave at a stronger organization than you found it. BOB:                          Yeah, you sort of stole my last set of comments. But yeah, we do have a great, not only a great staff, they're tremendous and they provide a great deal of support. But we have a tremendous number of volunteer members, volunteer lawyer leaders around the country that participate like yourself, on working groups, committees, task force commissions, the sections that provide the substantive practice. We have such a great wealth of talent in this association. We are definitely moving the needle in a number of areas. Do we have more work to do? Yes, but we will continue to do that. We'll continue to speak out where it's necessary in defense of, not only the profession, not only the judiciary, but in defense of due process and rule of law, both in this country and around the world. That's what the association has been doing. I am fortunate enough to be the 142nd president. We've been doing this for 142 years, three years, and we're going to keep doing it. So thanks for your time. I appreciate all that you've done and all that ALPS has done as a company to support the organized bar. CHRIS:                 Bob, it's been fun. I appreciate you taking a couple of minutes on a late Friday afternoon at the conclusion of our ALPS bar leaders retreat. Again, Bob's been a great friend of mine and our organization. We thank him for his service and leadership of this great profession. So thank you Bob. BOB:                        Thank you. Appreciate it. CHRIS:                 That will conclude our ALPS in Brief a podcast. If you have any thoughts or suggestions, please let us know for future topics, and that's it. Have a great weekend. Thanks.  

  FUll Transcript Below Show Summary: Serina Gilbert is always coming across great stories and this one from Erin and Bob at White Cane Coffee is as good as it gets. Taking a Bad Day and transferring that into the launching of a new company, Erin and Bob, a daughter and son team, tell us why they wanted to start White Cane Coffee and how they want to impact others with the opportunity through the affiliate program coming soon. You can check out the line of White Cane Coffee on the web at www.WhiteCaneCoffee.comand find the coffee that best suits you.  Here is an overview of White Cane Coffee taken from the web: Hi, I’m Erin from White Cane Coffee. I, with the help of my parents, started this company to provide great coffee to our customers and provide self sustaining jobs for people with disabilities. We have a variety of coffee roasts for your enjoyment. Colombian Supremo is sweet, smooth and bold. We also have a Colombian Supremo Decaf which gives you all the same great flavor without all the caffeine. But, if you want that caffeine boost, try our High Octane. Our Donut Shop blend gives you that fruity, clean taste you expect to find in your neighborhood pastry shop. If you like a bold, earthy cup of joe, try our Dark Roast, it is roasted from 100% Indonesian Sumatra beans. French Roast gives you that rich, robust flavor you may crave. Or if you prefer a Breakfast Blend, ours will give you that tangy, fruity flavor you will love. All of our beans are organic and micro-roasted, using hot air to give you the very best quality and flavor. There is nothing worse than waking up in the morning and discovering you are out of coffee. (I shudder at the mere thought of it). So, that is why we offer a subscription service so you can receive your favorite White Cane Coffee right on your door step every month. If you make your subscription for a full year, we will cover your shipping. You will also notice that, other than our sample box, (which I highly recommend so you find the right blend for you), our coffee arrives in 1 pound and 2 pound packages. You will actually get what you expect you are paying for. Now a bit about White Cane Coffee, and why we standout. The reason I wanted to start White Cane Coffee is because, number one, “Who doesn’t love coffee.”. But most importantly, my brothers and I are all on the Autism Spectrum and I am also blind. We have found that finding jobs extremely difficult. In our experience, employers didn’t want to provide full time or a living wages to handicapped individuals. Or because of bullying on the job site staying at some jobs unbearable. So, at 22, I started to ask, “When you have the right people around you, the question stops being, What can I do? but What’s stopping me”. So here we are. Our goal is to provide a welcoming environment to all people and provide jobs to the handicapped community at a living wage. Most of all, we want to provide you with a Great cup of coffee! Check out this episode of Job Insights and send us your feedback and topic suggestions by email. Follow the Job Insights team on twitter @JobInsightsVIP Job Insights is part of the Blind Abilities network. Contact: Thank you for listening! You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Full Transcript   Jeff Thompson: I saw one on there that was called the high octane.   Bob: Yeah, that one's double the caffeine, double have fun.   Serena Gilbert: Do not ship that one to Jeff.   Jeff Thompson: Job Insights, a podcast to help you carve out your career pathway and enhance the opportunities for gainful employment.   Serena Gilbert: I saw a post from White Cane Coffee, and I was intrigued because the name, I think it's like a super awesome name for a company.   Jeff Thompson: Learn about resources for training, education and employment opportunities.   Erin: I swear, the excitement for me is just constant, because again, I'm just branching out on new things, I'm meeting with people in the community, I'm on podcast now. There's always new things that we're doing, so one part of it may not be as flashy or exciting as it was, but there's a new part that's brand sparkling new and just like, yeah.   Jeff Thompson: You will hear from people seeking careers, employment from professionals in the educational field, teachers, and innovators in this ever changing world of technology.   Speaker 5:          That's an easy one to remember, because everyone knows the white game, everyone loves coffee and.com there you go.   Jeff Thompson: For more podcasts with the blindness perspective, check us out on the web at www.blindabilities.com, on Twitter @BlindAbilities and download our free Blind Abilities App from the APP store, that's two words, blind abilities. Now please welcome Serena Gilbert and Jeff Thompson with Job Insights.   Erin: If they do find work, it's for absolutely a pittance amount of money, so we're just like, let's employ them and pay them fairly.   Jeff Thompson: Welcome to the Job Insights. I'm Jeff Thompson and with me is Serena Gilbert. How are you doing Serena?   Serena Gilbert: I am doing absolutely fantastic, Jeff, how are you?   Jeff Thompson: I'm doing good. You came across a great company on Facebook and invited them on. Tell us a little bit about it.   Serena Gilbert: I was scrolling through Facebook like I do for, I don't even know how many hours a day at this point, and I saw a post from White Cane Coffee and I was intrigued because, well of course, first the name, I think it's like a super awesome name for a company, and secondly, what their mission was and how they started a company to be able to have nice jobs for individuals with disabilities to be able to be a little bit more self-sustaining. I really, really liked that idea.   Jeff Thompson: Entrepreneurship right there. I like it.   Serena Gilbert: Of course.   Jeff Thompson: Well we got them here in the studio. Let's welcome. Erin and Bob from White Cane Coffee. How are you guys doing?   Erin: We're doing well.   Bob: Doing wonderful, glad to be here.   Jeff Thompson: Well, thank you for taking the time, coming on to Job Insights. It's exciting, it's exciting. I read Erin's article on Facebook and yeah, I really liked it. Bang, here we are. Let's start it out by what got you started with White Cane Coffee?   Erin: Well, honestly it started with me having a bad day, and so just it's hard when you're disabled and trying to find a job and just, it's frustrating. When I'm frustrated like that, me and my dad will play games, like we'll create [inaudible] or in this case we were just like, if you had x amount of money, what would you do to grow it? And so one day we started with a coffee company and then we just kept talking about this coffee company just like, well, what would you do with this, or what would you do with that? It's just like, well, why not hire people with disabilities for one thing, and just it kept growing until eventually were just like, Oh, we're actually doing this, aren't we?   Bob: Yeah. That was about six months ago, and so then it was just doing research, figuring out exactly what it was going to take to create this coffee company. And so that meant we needed an accountant, we needed an attorney, we needed to figure out how we were going to get our coffee roasted, packaging, getting the shipping, getting the website up. It became a creature unto itself, but the best part was we had fun doing it and right now, I mean, the response we're getting, even from our local community, they love our coffee. We did a couple of hundred sample bags or whatever, and we just gave them out to everyone, and everyone said, "Oh isn't that [inaudible]."   Bob: And then they called back and said, "You know, that was really good coffee. I need more."   Bob: Now every time we turn around, somebody's calling us up saying, "We need more." That's our whole thing is getting the word out, letting people know we have great coffee.   Serena Gilbert: That's fantastic, Bob, and I know you have kind of a unique business model. Do you want to share with us some of the services that customers can receive from your coffee business?   Bob: The key is, they can go online at whitecanecoffee.com, and one of the first things that shows up, the first item there is a sample box because people always say, what is your best coffee? Well, they're all great, so it all depends on the customer. We suggest to them, order up the sample box, try them all, find the one that fits your likes, then order whether it's subscription or it's a [inaudible], whatever the case may be, but we want them to find the one they like the best. That's really our model, that in a nutshell is our coffee is roasted fresh for them. Most coffees that you get, say at a grocery store and some of the big names that I'm not going to mention but we all know who they are, those sit in a warehouse for up to a year before they even get to the store. We like our coffee what, how old Erin?   Erin: About a week fresh, so from the time we package that to the point where it gets to your door, it's only about a week old, so you know you're going to get the freshest cup of coffee that you are able to have.   Jeff Thompson: I couldn't help it but I saw one on there that was called high octane.   Bob: Yeah, that one's double the caffeine, double the fun.   Serena Gilbert: Do not ship that one too Jeff, Oh my goodness.   Bob: Don't ship that one. That one is actually very popular, especially the people work like third shifts or you know-   Erin: The mid night hour [inaudible].   Bob: They're the ones who order it and they go, the flavor's great [inaudible] and we're awake. And I said, well that's pretty much what it does.   Erin: [inaudible] through testing.   Bob: Yeah, that one was hard.   Jeff Thompson: You mentioned earlier you had a tough three weeks of testing coffee and that must've been fun, because none of these go out without you guys knowing what exactly you're selling.   Erin: Exactly.   Bob: Exactly, that's I mean each time ... We roaster whatever, we sample it. It doesn't just like oh it's good enough. The good enough is never good enough. The product has to be right every time it goes out, because that's our reputation that's on the line here. We're not some huge mega corporation where you get a bad pot of coffee and lose a customer they go, eh. With us, that doesn't work that way. Every customer needs to be happy.   Jeff Thompson: And they can find this at whitecanecoffee.com.   Bob: Correct.   Erin: Yup.   Jeff Thompson: That's an easy one to remember, because knows the White Cane, everyone loves coffee and .com, there you go.   Bob: That was even our reasoning of naming the company and with our logo, with the young girl, with the white cane, we want people to know exactly who we are, when they see our logo, they know.   Erin: It was [inaudible] a blind disabled person or blind disabled people, people and just disabled people, and people, people.   Jeff Thompson: People, people. I like it.   Bob: But that was it. We want people to know exactly who we are and what we're about, the transparency, I guess is the new buzzword that everybody uses, but that is important. They need to know who we are. When they go on our Facebook page or whatever, and even once the about page is done finally on the website, there's a picture of Erin right there. She is the face of our company, this is her baby. There's no big corporate board room back here where everybody's hanging out.   Jeff Thompson: Yeah.   Erin: Home grown.   Jeff Thompson: It's amazing the way you can start by just having a bad day, right Erin?   Erin: I know.   Bob: Isn't that how all the great companies have started though, is somebody sitting around saying there's a problem and then eventually somebody says, Hey, I think we can fix it.   Jeff Thompson: Solution based, there you go.   Serena Gilbert: Well, I understand that you guys employ a few individuals that also have disabilities. Is that correct?   Erin: Yes.   Bob: Yes.   Serena Gilbert: Tell us a little bit about what made you design your business in that way?   Erin: Well, if I was having trouble finding a job for my disability, and there is a huge population in our town of disabled people on who just cannot find work, or if they do find work, it's for absolutely a pittance amount of money, so we're just like, let's employ them and pay them fairly.   Jeff Thompson: I like that.   Bob: We're all about living wage. People sit in and say, well, like I said, you know, if you have a sheltered workshop, there's no bottom to how much they can pay their employees. Like ours, we have one here nearby and they pay about a dollar, dollar 10 an hour is what they pay their employees. You can't live on that. And second of all, with social security at 750 a month, I think it is, you can't live on that. I mean, you can't pay rent, you can't pay utilities, you can't do anything. They're all into survival mode. Well, there's more to life than just survival mode. We want people to have a decent wage, so at the end of the week they can pay all their bills and you know what, there's still some money left-over to do what they want to do and have some fun.   Jeff Thompson: And buy some coffee.   Bob: Buy more.   Jeff Thompson: There you go.   Serena Gilbert: Very smart business model there.   Bob: That's what it really was all about. Not only have we found work for Erin and her brothers now, but we're finding work for people who are just like her because that's what you're supposed to do.   Jeff Thompson: Erin, on your picture on Facebook, you do have a cane here wearing sunglasses, so you are blind?   Erin: Correct. I only have 5% of my vision left.   Jeff Thompson: When did that start?   Erin: I started to lose my vision when I was about 15.   Jeff Thompson: Did it affect you in how you did your education at school?   Erin: Yes actually. I had to, with assistance, essence basically people reading me the questions on the test. I graduated high school at 15.   Serena Gilbert: Look at that, wow. That's not an easy accomplishment. That's awesome, Erin.   Erin: Thank you.   Serena Gilbert: Yeah, I could not imagine.   Jeff Thompson: That's awesome for anybody.   Serena Gilbert: Yeah, it's a big deal.   Jeff Thompson: Wow.   Bob: Well, Erin was in the gifted program when she was in school, and so it wasn't much of a challenge for the school just to allow her basically to test out. It was interesting and it's like, okay, here's all the subjects you can pass everything, you can graduate and she did.   Erin: Through the first try and they're just like, yeah, okay, that's fair.   Bob: She had her diploma and we moved on.   Jeff Thompson: There you go. You might want to give that college thing a try, that might be a piece of cake too.   Bob: Someday.   Jeff Thompson: There you go.   Bob: But right now, like I said, we're challenged in what we're doing and I think right now as this company is growing here, this is going to keep her busy for many, many years to come.   Jeff Thompson: That's great.   Erin: We're hoping the best for this.   Jeff Thompson: It's nice to have a challenge, and to challenge yourself and that's what we all kind of look for, is to accept the challenges and it keeps you waking up in the morning with a good cup of coffee, that helps too, right Serena?   Serena Gilbert: Of course. Now if you guys start shipping out hot chocolate I'm in, because I'm not much of a coffee drinker because it makes me completely stay up for days. But some hot chocolate, I'll be totally about it.   Erin: [inaudible] considered it yet, but maybe in the distant future, we're thinking maybe hot chocolate or teas or something like that, but for right now we're strictly coffee.   Jeff Thompson: Yeah, I'm sorry, I didn't know she wasn't a coffee drinker. I would've got someone else to come on the podcast, sorry Bob.   Serena Gilbert: Oh Jeff.   Bob: On of the other things we are trying to do here is, hopefully within the next week is we are setting up affiliate programs so that other people who are blind and disabled all across the country can also be a part of this company, because we would love to see White Cane Coffee basically in every town, business, home across this nation. I want people, no matter where they go, they're going to see White Cane Coffee on Facebook, on Instagram, Twitter. That's the name of this game here. We have a great product, and we want to be able to share that with everyone in the United States, and we also want people to be able to earn a living as affiliates across the country, because let's face it, people like Erin and you guys or whatever all over, and so that the name of the game is let's create as many jobs as we can.   Bob: People who will be able to sign up as affiliates on the website and what will happen is, they'll be given basically their own code that'll go on the end of whitecanecoffee.com, it'll be like, let's say in Jeff's case it might be whitecanecoffee.com/Jeff. Now Jeff's going to sit there and say, hey, all my friends, guess what? White Cane Coffee, great stuff, give it a shot. Here's their email address, and it'll be that one there. Any sales that those make, Jeff would then get a commission on. Does that make sense?   Serena Gilbert: Yeah. I think that's awesome that you're building that, because a lot of the big company, like obviously Amazon, they have an affiliate program, target all kinds of places. I think it's great that you're seizing that opportunity to allow some of our audience to be able to have some fairly passive income coming in with being able to share their affiliate links and things like that. That's very unique to small businesses and I like that.   Bob: Yeah, because we all have our own networks. I have my friends who are on Facebook and on Twitter and everything like that. You have your friends and acquaintances and business contacts on yours and Jeff does. We all have these little things, that's why they call it the web. The more that web over it goes on each other, then guess what? That's when the company grows.   Erin: This way, we're not just helping our towns own disabled group, we're helping other towns and the State disabled groups.   Jeff Thompson: Oh, that's great. I like that idea. It gives me something, you know, I never wanted to do an Avon, Mary Kay or stuff like that, Tupperware. Now I can do White Cane Coffee.   Serena Gilbert: But just this morning, Jeff, you were giving me some makeup tips, so I don't know.   Bob: That's one of the things that people always, you know, because we've talked to a few people on the go, well, what's it going to cost us? It doesn't cost you anything. I mean that's the whole key. We'd like you to try our coffee, but if you don't drink coffee or whatever, that doesn't stop you from-   Erin: Getting the word out there.   Bob: And being involved.   Jeff Thompson: Awesome. I like it.   Serena Gilbert: I for one, when you guys get that up and running, please send us a link or message in that group chat that we have going, because I will definitely spread the word for you guys. I think that's awesome what you're doing.   Bob: Absolutely. We'll make sure you guys get the invite to it and that, and that's the goal, we want as many people as we can. If 10,000 people sign up as affiliates, fantastic. Because that's 10,000 people who are going to try to do something and that's what we want to see.   Jeff Thompson: I like it. Let's check it out, whitecanecofee.com, you go there, it says buy coffee. I clicked on buy coffee and I had eight choices. The first one was the package box and for $20, no tax, no shipping, it's delivered to your door. You can sample all the flavors, and the flavors come in, Colombian Supremo, Colombian Supremo Decaf, Breakfast Blend, Dark Roast, Doughnut Shop, French Roast, and my future favorite, High Octane. You have a choice of 16 ounces or 32 ounces. 16 ounces is going to run you $14.99, and 32 ounces is discounted a little bit at $27.99 and you can opt for a one month, three month, six month up to a 12 month subscription. That means it will be delivered to your door once a month and you don't have to lift a finger.   Jeff Thompson: An incentive to do the 12 months subscription is there's no shipping costs, thus allowing you to save $7 and 50 cents every month just by subscribing to a 12 month. That's quite a savings. At $14.99 I think it's very affordable. When you click on one of these flavors such as the High Octane, it'll take you to the page and they'll do a write up on what that flavor is all about, probably high octane I imagine, or the French Roast, or the Breakfast Blend. They'll all have a description there. Check out the about page, because that talk about Erin and her story and what the company's all about and it'll have some of this information then it just relayed to you. With that in mind, let's get back to the show.   Jeff Thompson: Erin, I want to go back to something, do you use an iPhone?   Erin: I use an iPad, it seems to work best for me.   Jeff Thompson: Oh, that's good. With voiceover.   Erin: Oh my gosh, yes.   Jeff Thompson: There you go.   Erin: So much voiceover.   Jeff Thompson: Yeah, we're all about tech and we love our voiceover stuff with the iPhones. Not knocking any of the android stuff, it's coming along.   Erin: Yeah, but Apple just seems to have, it has everything that you need for that.   Jeff Thompson: Yep, they're doing good, and so are you guys whitecanecoffee.com, everyone go check it out, go sign up, get the sample pack, you can figure it out which one you like best and then place your orders. It comes once a month, right to your doorstep, and if you order annually, they knock off the price of shipping so you can save a little money there. Erin, Bob, I want to thank you for taking the time to coming onto Job Insights and sharing with us your, well Erin's bad day innovation, her entrepreneurship and starting this company. Serena, do you have anything else you want to ask?   Serena Gilbert: Just do us a favor and tell our audience where they can find you on Facebook and Twitter and Instagram.   Erin: You can find us at White Cane Coffee on Facebook. You can find this on White Cane Coffee on Tumbler, weirdly enough.   Bob: We're setting up our Twitter and Instagram pages because Instagram and Facebook kind of work hand in hand together now, so when you advertise on one, you advertise on both. It's always funny, we always say, we need to get some of the big influencers on Instagram or something of that nature, one of the Kardashians. [inaudible] say, hey White Cane Coffee, and things would go insane at that point, but no, the goal is we're getting the word out and we're really happy that you guys contacted us and wanted to hear what we're doing.   Serena Gilbert: We absolutely love sharing what individuals in our community are doing, especially when it comes to employment and being able to live a little bit more independently, so we were happy to have you on.   Erin: We were absolutely ecstatic to be on.   Serena Gilbert: Do you guys have any questions or any additional information that you'd like to share?   Bob: We look forward to seeing your podcast, because you're on YouTube, is that correct?   Jeff Thompson: We're on YouTube, we're on Apple, you can download the Blind Abilities App right to your iPad and iPhone, any device like that. Pod Catchers just search for Blind Abilities, that's two words, Blind Abilities.   Serena Gilbert: He's so trained over there. Oh my goodness.   Bob: Sounds great, we look forward to that. Keep in touch with us, we like talking to people who are in the community, kind of how we find out what's going on. We hope that these conversations will go on for long time in the future.   Serena Gilbert: Of course.   Bob: It's funny, since we went on Facebook and started doing this, you guys just kind of caught our attention. It's like okay let's do this and-   Erin: Nothing ventured, nothing gained.   Bob: Absolutely.   Serena Gilbert: Next step is shark tank, right?   Bob: Oh God no. No, never Shark Tank. Venture capitalists are about making money, we're about making a difference and so that would probably never happen.   Jeff Thompson: I like that line. Put it on my tee shirt, or my coffee cup. There you go.   Serena Gilbert: I will definitely be checking out your guys' website because I do have coffee drinkers in my family, so I might even show it to my husband, because we have a Keurig, but we have the little thing where you can put the coffee beans or in it and trick it.   Jeff Thompson: Well, Serena, if you check out the website, they do have a coffee that has low caffeine.   Serena Gilbert: Even for you, that would be too much caffeine.   Bob: I'll tell you, if your husband likes that robust flavor, get the Colombian. If you like a coffee that's real smooth, you don't need milk or anything, look at the Dark Roast, it is so smooth. There's no bitterness to it.   Serena Gilbert: Oh Wow.   Jeff Thompson: Well I think I'm going to try the sample because I've always liked looking for that coffee that it tastes good and it does everything that you want it to do in the flavor without having to add the cream or this or the other thing. I just want that perfect blend.   Erin: Yeah. We hope you like it.   Bob: Yeah, get online after you're done with us, just go right to White Cane Coffee, you order tonight, they'll be out in the mail in the morning.   Serena Gilbert: Oh Wow. That's fast.   Jeff Thompson: There we go. The UPS or FedEx, one of those businesses know where you live, right?   Bob: Absolutely. They're here up quite a bit, picking up boxes.   Jeff Thompson: That's cool.   Bob: They're happy, it keeps them working I guess.   Serena Gilbert: Exactly.   Erin: [inaudible] when we first started, they were so confused.   Bob: They really were, but now they're just kind of used to it, they bring the truck up and get the boxes.   Jeff Thompson: Is the excitement gone? I mean, usually if the UPS truck pulls up in front of my place, I'm like, oh.   Serena Gilbert: What did I order?   Jeff Thompson: Yeah, I'm like rubbing my hands together.   Erin: I swear, the excitement for me is just constant because again, I'm branching out on new things, I'm meeting with people in the community, I'm on podcast now. There's always new things that we're doing in the company to sort of get the word out, so yeah, it's just like, okay, so one part of it may not be as flashy or exciting as it was, but there's a new part that's brand sparkling new and just like yeah.   Bob: Like in November, the Pennsylvania National Federation for the Blind has their convention in Harrisburg, Pennsylvania. Well now they're talking about having Erin come and speak at the convention.   Jeff Thompson: Oh, that's great.   Serena Gilbert: That's huge. That's awesome.   Bob: I wish she can make a difference. We really are looking forward to this, it's amazing. Everyone in this country drinks coffee, 90% of the people truly do have coffee first thing in the morning, that's what starts their day.   Jeff Thompson: Take notes Serena.   Erin: It's something that's so ingrained into our society, that coffee [inaudible] to help people with disabilities was just a no brainer. How many times have you heard in cartoons like, don't talk to me before I've had my coffee. I mean, when I was a little kid, on Christmas, we weren't allowed to open our presents until mum and dad had their coffee. I learned how to make coffee at age eight.   Bob: No coffee, no presents.   Erin: Just like brothers have already sorted out the gifts, specialized mugs in each hand they come downstairs, here you go, let's open presents.   Jeff Thompson: There you go, and now you can do it with White Cane Coffee.   Serena Gilbert: Exactly.   Bob: Exactly. It's fun for everyone. I like seeing Erin excited. I like seeing her brother's excited. I like seeing the other workers excited because when they come to work, they're excited to be useful and to have a purpose. You know, that when they're here that they're welcome here, and we adapt to their needs instead of like a lot of jobs you have to adapt to the company. We kind of do it the other way around, we adapt to each person individually. What are their needs, what's going to make their experience here working better for them because we found if they're happy, they're much more productive, and so it's a win-win on both sides   Erin: This may sound odd, but with some people's disabilities they have such strengths and others are like one of our workers, even though they are very autistic, they are also very hyper focused and are perfectionists, so we know every label is going to be on perfectly just like, alright, you do you man.   Jeff Thompson: There you go. I like that where you're creating opportunities and not limiting them but enhancing their opportunities by embracing their set of skills that they have.   Bob: Oh exactly.   Erin: Exactly, and once you have the right people around you, it really is, you can do almost anything with it.   Jeff Thompson: I like what you're doing Erin.   Bob: We don't sit around and say, oh, what can I do? It's more of what's stopping us from moving on, changing things and making things better for everyone involved, and coffee is that venue that is allowing us to do that.   Jeff Thompson: Oh, I tip my cup to you guys.   Serena Gilbert: We really appreciate your time.   Bob: Absolutely.   Jeff Thompson: Thanks Bob. Thanks Erin.   Bob: You all have a good evening.   Erin: It was great talking to you guys.   Jeff Thompson: All right.     [Music]  [Transition noise]  -When we share -What we see -Through each other's eyes...   [Multiple voices overlapping, in unison, to form a single sentence]   ...We can then begin to bridge the gap between the limited expectations, and the realities of Blind Abilities.   Jeff Thompson: For more podcasts with the blindness perspective: Check us out on the web at www.BlindAbilities.com On Twitter @BlindAbilities Download our app from the App store:  'Blind Abilities'; that's two words. Or send us an e-mail at: info@blindabilities.com Thanks for listening.  

Dr. Lonny Shavelson is the founder of Bay Area End of Life Options, a medical practice in Northern California devoted to educating about medical aid in dying and supporting patients and families through this process. Contact Bay Area End of Life Options Transcript 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. Please note there is some content that is explicit in this episode. Dr. Bob: Dr. Lonny Shavelson is the founder of Bay Area End of Life Options, a medical practice in Northern California, devoted to educating medical providers about medical aid and dying, and supporting patients and families through this process. As you'll soon discover, Dr. Shavelson is an intelligent, articulation and passionate physician, who has a huge heart and is committed to providing excellent care to people dealing with terminal illnesses. He and I are bonded by a similar commitment. We also share a bond in that we were both emergency physicians in the past. We've seen the standard way people are cared for at the end of life, which is often not very pretty, and often not aligned with how they've lived their life. As you'll hear in this interview, Dr. Shavelson has experienced his own brush with death, which has created far more understanding and empathy than he could've imagined. I hope you find this discussion as informative and interesting as I did. Well, Lonny, I've been looking forward to this conversation with you for quite some time. I saw it coming up on my calendar. I was excited and woke up today really energized to have this conversation and be able to explore deeply, what it's like for you to be a physician that's in the same realm as I am, in support of medical aid and dying. Thank you for taking the time to speak to me and my listeners today. Dr. Shavelson: You're really welcome, I'm glad to be here. Dr. Bob: Yeah. So, just maybe give me a little bit of ... Give all of us a little bit of background, as to how you came to be the physician with Bay Area End of Life Options. What was your journey leading up to that, and what made you decide to venture into this? Dr. Shavelson: Let's see if I can condense this a little bit. When my interest in going into medicine in general, as happens with many people who go into medicine, comes from a family history of dealing with illness. I think many people in medicine if you ask them this question, why you went in, they'll start off with the, "I want to help people," answer. And if you dig a little bit deeper, you'll find there was some illness in the family in their prior history. So mine, very specifically, was my mother had Crohn's Disease. It's an inflammatory disease of the bowel. And because of that disease, imagine having cramps and diarrhea all of your life every day and having multiple surgeries on your bowel to try to accommodate it and bowel obstructions and all that. She was a pretty miserable person, and also in retrospect, severely depressed. So when I was starting at the age of about 14, I became not only aware of the fact that my mother was suicidal, but she enrolled me in pacts for her death. Part of the reason that I was guided toward medical school was because of the, my mother sort of wanting to know that I would be available, not only to help her in her illness but also to help her die. Dr. Bob: Wow. Dr. Shavelson: So we used to have conversations around the dinner table about my mother's dying. And I thought that was the normal way people grew up. I didn't, you know ... You know, if you grow up in a certain way, you assume that that's the way it is. You don't have any other experience of any other childhood to compare it with. So I thought discussions about death and dying were what people talked about during dinner. Dr. Bob: Not me, it wasn't happening at my dinner table, I'll tell you that much. Dr. Shavelson: Yeah, now I realize that [inaudible 00:03:48] doing that. We didn't have football and baseball on the TV. We had sort of philosophical conversations about death and dying, including suicide. Dr. Bob: Wow. Dr. Shavelson: So my mother- Dr. Bob: We had the Dick Van Dyke show, and the Andy Griffith Show. Dr. Shavelson: Well, we did some of that too. It falls short to what it was. So anyway, I grew up with death and dying discussions, including the potential for suicide as a rational way out of an illness. That was one thing that guided me, certainly into medicine, and when I got into medicine, I kind of left that behind for a long time, realizing it was pathological. It wasn't reasonable, especially in my mother's case. She was severely depressed I was her son. She had asked me to help her kill herself a number of times, and I had turned that down. But in the end, I knew that if she was very sick, and if that was what she did, and if it was more reasonable that I would then help her. And this was way before anything like medical aid in dying or what was then called physician-assisted suicide, was even thought to be legal at any time in the future. We were back in the 1970s by the time I went to medical school. Anyways, so that led up to ... You know, I got into my medical career as an emergency medicine doctor. Over time, I developed a dual career as a journalist and a photographer, as well as a medical doctor. So I worked about half time at each and actually moved fairly advanced in journalism with writing some books, with working with NPR as a reporter. So my journalism career took off in the same way that my medical career did, pretty much advancing over time. And to cut this to the chase, in 1996, I wanted to explore this question about what was then called physician-assisted suicide more deeply on an official level. The reason was that Jack Kevorkian was starting his nonsense, killing patients. And I always change that to killing patients who weren't his patients. And I thought that that was not a very good model of what we could look at for helping people die in the United States. But it really struck me that there was a significant underground, where ... You know, and I know, Bob, that before anything was legalized, if somebody were close to death and were really suffering, we would turn up morphine drips, we would increase medications in such a way that we knew we were participating in aid in dying. But with a wink and a nod to the families saying, "Give him morphine once an hour," type of thing. Knowing that would bring on the death. Because the patient was having severe suffering and was nearly unconscious and just needed to be helped along. That, and the presence of the ... I was going to say [inaudible 00:06:38] presence of the AIDS community. People were dying of Autoimmune deficiency disease. And they were really actively participating, but in the underground, of hoarding medication. So if you had AIDS, you could easily tap into the AIDS community and get thousands of tablets of morphine or methadone. It wasn't hard to do, because people were hoarding their medications with the intent of using it themselves. And if they end up not needing it, then they would pass it on to this sort of medical bank where medications were stored. That was the beginning of an interest I had in the pharmacology because they had the pharmacology to really try to do this right. Whereas individuals in their homes and in darkened bedrooms were talking with their family about wanting to die and then taking all of their, let's say their hospice medications. That often did not work. Anyways, this led to a book I wrote, called A Chosen Death, in 1996. And it was called the Dying Confront Assisted Suicide. It was about this underground ... I found families and doctors and nurses, and various people who were participating in a very significant underground. Where they were helping people, who requested aid in dying. They were doing it without charting a note; they were doing it without keeping any record of what happened. But I was able to write the story of five different families as they progressed through this. And in 1996, A Chosen Death came out. And the conclusion was very, very simple. When you look at what I call dark bedroom suicides when you look at those dark bedroom suicides, hidden, and nobody could talk about them, there were so many things wrong. One was that often because of inexperience; the wrong people were taking the wrong medications at the wrong times for the wrong reasons. And then taking medications that didn't work and having disasters follow. It just was a terrible scene, actually. And my conclusion was, this is going to go on like ... Comparison with abortion is very strong, is that there were back-alley abortions, and we were having dark bedroom suicides. What's wrong with the back alley abortions is that they were terrible, they were not supervised, they were not done well. And they would continue no matter what. What's wrong with the dark bedroom suicides was the same. So I made a very strong, I think argument in the book for legalization. Based on the fact that making this illegal was not working, was creating a disaster for families at the most important parts of their loved one's lives. That started, my political involvement for about three, four years I stayed very politically involved as the supreme court was writing its decision. In 1998, the Supreme Court made a decision where all nine justices decided this was not a constitutional right. But that the states had the right to do this. So in other words, there's nothing in the constitution that says that legal medical aid in dying should exist. But there's also nothing that prohibits the states from doing it. So one by one, I watched the states Oregon, Washington, Montana. It took 22 years more after I wrote the book A Chosen Death before we got this all legalized in California. And then, to bring it up to the present, when the law was legalized, I thought the way of starting it up was terrible. There was not enough primary education happening. Doctors were confused about what it was. The people who were looking at it were like, medical risk advisors and hospitals, and lawyers in hospitals trying to figure out their policy. And nobody was looking at the clinical practice of how this would work. So I decided to start up a practice with the intent of a couple of things. One was that I would be available to patients who could not find another doctor to do medical aid in dying with them. So if a patient had a desire for medical aid in dying or at least a question about it, and they approached all of their physicians, and the physicians said, "No," for a variety of reasons ... And Bob, I'd like to talk to you more about that in a bit. But if they couldn't find another doctor, then I would become their doctor and help them with the physician aid in dying. And that started up in day one of the new law, on June 16, 2016, and has been going ever since. And has grown so much, the request for services from my practice Bay Area End of Life Options has grown so significantly that I had to take on another doctor. So I now have Linda Spengler working with me, another physician. And then we took on a wonderful nurse, Thelia De Wolf, who is a hospice nurse. And we sort of borrowed her permanently and brought her into our practice. So we have a practice of three people now. To date, we have taken over 800 requests for medical aid in dying from different patients across the state of California. And for various reasons, we sort of brought that down by referring patients to other doctors or talking to their doctors about participating. There are lots of ways we'd windle that number down. So right now, about 240 patients have been in our practice, where we follow them for a request for medical aid in dying. And to be clear, when somebody calls us for medical aid in dying, it doesn't mean that we just give them medical aid in dying. There's a long, evaluative process. We work with them about their palliative care, we work with them with their hospices. We talk to them about ways they may die, and that this is just one of the ways that they may die or choose to die. And what that's resulted in now, we stay at the bedside when a patient takes the medication. It's the hallmark of their practice. Is that we don't feel that this should be the responsibility of the patient or the family to be taking medications at such a difficult and anxious day, the day that somebody is about to die. And everybody's worried about it. And when we walk in the door, the worry just goes out the window and they're able to do what they should be doing, which is pay attention to their loved one who's dying. And pay attention to themselves and how they're reacting, instead of being the ones who are mixing up medications and worrying if it's right, and worrying how it's going to go. And they're all alone doing this medical procedure, with the patient. We have been at every one of the bedside deaths. We'd been, I'm sorry, at the bedside of every one of our deaths, which are now 114 deaths at the bedside. The advantage of that is that we've been able to get really good at this. We get a sense of the social aspect; we get a sense of the family aspects. We get as a sense for the need of how much palliative care, and how to talk with the patient about alternatives. They don't have to do medical aid and dying. But if they really do decide that they want medical aid in dying, we are there for them. And that's the fundamental part of our practice. The other thing that having such experience does is it lets us travel the state a lot. We get requests from all over, and we travel quite a bit in order to help patients. And every time we go to a place where there's no access, where the patients ask all of their doctors, and they couldn't find anyone. We would then talk to the doctors in that community and usually find two or three. So a great example is we found that we were having to go very far up north for us to Paradise, California, near Chico. It's a three-hour drive. We get tired doing three-hour drives and coming back. So we started looking around and beating the bushes, and finding docs in Chico who might be open to it. And we now have a group of three doctors in Chico who are very open to starting their ... To adding to their own practices, their family practitioners. And they are now going to add to their practices medical aid in dying. And we are going to train them. And soon, we will not have to go to that part of the state again. And that's the wonderful part of this. Is that we don't want to have this practice of medical aid in dying become centralized to a small practice like ours. We want many, many doctors around the state to be doing this. And slowly we're seeing that happen, where there are areas of Northern California where we no longer go because we know the doctors up there who will. Dr. Bob: And that's phenomenal. Just being able to expand the access for people. And of course ... First of all, thank you for sharing that background, and kind of expressing in such great detail what your practice entails, how you support patients. Thank you for doing the work. I know that it's not easy. It can be extremely challenging, emotionally, and taxing in many ways. Because I'm also doing a very similar style of practice. As much as it's challenging and taxing, it's also very gratifying, right. I know that you feel the same way. That there are people who are suffering and struggling, and they've been shut down by many physicians, and they're just so grateful to find someone who's willing to not just support them in going through the process, but truly support them. And truly support their families, and make sure that they have all their questions answered, that they know all the options. And that the fear of this is, if not completely removed, certainly lessened. Dr. Shavelson: Yeah. You know the most common, repeated expression I hear is about what you just talked about. Is about fear. Commonly when somebody's dying, they've never done that before. And so they're quite afraid, what does it feel like when I get that close? I mean, you may know you have your cancer and all that. You know what it feels like. But when you're that close to dying, you don't quite know. It's really frightening as to where do you go, and how does it work, and how much suffering is entailed in the process of dying. So I'll sit down with a patient for an hour or two. And we will talk about what I call the how you die conversation. And the thing that, the response that's most common, is that they will tell me, this is the first time that I'm not afraid of how I may die. That nobody has explained that to them, and given them all of the options, including medical aid in dying. And really explain, this is how the process works. You may slip into a coma, and be quite comfortable. Or you may have an anginal agitation. Or you may be short of breath, and that can be treated symptomatically, but not completely. And we go through the how you may die conversation, and then every individual. And then they take a deep breath, and say, "My god, this is the first time since my diagnosis that I am not sitting here afraid of how I die. I know that I control it now." And that is the most moving, and tearful moment that I've ever experienced. Dr. Bob: Yeah, what a beautiful thing that is. And it's kind of crazy to think about, but I have that same experience over and over again. No one has told me, no one has talked to me about this. No one has actually talked to me about my death. All they talk about is how they can palliate me, and how they can comfort me and everything leading up to it. Dr. Shavelson: That's right. Dr. Bob: But even hospice folks. For some reason, there's just this reluctance. It's a fear on the part of the providers to actually engage in that conversation. Maybe it's their own fear; maybe they're afraid they're going to upset people. But it's just the opposite. Dr. Shavelson: Yeah. You know, I think Bob, that in a lot of ways, the entity of the legalization of medical aid in dying, has made it so, that before you offer somebody such a serious option, you have a real conversation with them. It's kind of almost built into the law, though I don't think that's necessarily the reason. The law really says that we have to explain all alternatives before we can accept a patient for medical aid in dying. And that's not what drives my conversations with the patients. What drives my conversations with he patients, is that they really should know what's up in their future, and how they're going to die. But that conversation about, how will dying happen, is oddly enough in legislature for the first time. And I think that's a healthy thing. There are many bad things about this law, but there are some good things about this law. And as it sounds like, your practice sounds very similar to mine, in that we spend time because we are not going to have this decision taken lightly, to take medications to end your life. We don't want that to be a casual decision. And therefore, we're going to have a really in-depth and truthful conversation with our patients. Dr. Bob: Right. And really, by setting up our practices the way that we have, it really facilitates that. I understand the limitations that a lot of providers have, a lot of physicians. They don't have the time, or it's very difficult to make the time to have the depth of conversation that is required to work through all of these different aspects of life and death. There have been a number of occasions where I have been asked to come and speak with someone who's requesting support through aid and dying. And after exploring all of the things that are leading up to it, and their reasoning, and what they're going through, they've actually made the decision to not request medical aid in dying. But to choose a different route, which in several cases, has meant bringing things into their life which will enhance the quality of their life. To try, some of the integrative therapies that we offer. They'll bring in a music therapist to do some legacy work. They'll bring in exercise, or physical therapist to provide them a little bit more human touch and connection. The conversations that sometimes occur unexpectedly have been so meaningful and profound. And then they may come back, in another month or two, or may not. But I think the opportunity to explore this option, for many people, has allowed them to look at things in a different light. And I think as you've experienced as well, sometimes people just want the option available to them just in case. They have a clearly terminal illness. They know what's coming in their future. But they're not in the point where they're ready to check out. But once they have this available to them, they have such a dramatic shift. And part of it is- Dr. Shavelson: It's a shift in thinking and feeling. They become comfortable to explore. I'm right with you, is that what happens sometimes when you tell them that medical aid in dying is available when I sit at the bedside and I hold somebody's hand, and say, "It's okay. We're here if you want that we will do that." And agree with them, which is the first time they've had agreement rather than battles about it. And I say, "It's okay if you want to do medical aid in dying, I'm here. I will do that if you get to the point where you're suffering enough." And that allows them to go back into treatment. I'll give you a very specific example we had just recently. We had a 58-year-old guy with lymphoma mass in his chest, who was quite uncomfortable from it, that turned out to be cancer in a lymphoma, which is quite treatable. But the treatment takes chemotherapy and radiation, and he had seen the path that some people with chemotherapy or therapy and radiation go. And it's really suffering and uncomfortable for some people. So he turned it down. He said, "Okay, I'm deciding not to have that treatment." They told him it was still treatable; they told him he could live with it. But he decided, no I'm not going to do all those nasty chemicals and the radiation. And he was sent home to hospice because that time he was getting sicker. And then it took him a month to get somebody to agree that they would help him in medical aid in dying, which was what he was asking for. So he was in a hospice that didn't participate, and the family found my practice on the web. I came down to see him. And he ... You know, we had the long conversation about how you die, and why he wanted to reject treatment. And he was just fundamentally scared of dying, and he wanted not to have these sort of dangerous, and difficult treatments on the way that would make him even more uncomfortable and give him more agony. He just didn't get it. So, I agreed. I said, "Okay. You can, if you want, have medical aid in dying. We will be there if you're suffering. And it's not there yet, but we will be there if you're suffering in any way, shape or form gets too bad that you want medical aid in dying. We will be there for you. And oddly enough, he turned back around, decided to go back and have chemotherapy and radiation. He knew that if the chemotherapy and radiation got so bad for him, he could turn to us and have medical aid in dying. He knew if he's dying eventually got so bad. So he went back, and he had chemotherapy and radiation, and lived for another year and a half as a result of that decision, always knowing that he had the ability, if things got so bad, to have medical aid in dying. That we would help him die. And then it took a year and a half, and then three months after that when he went back into hospice after the treatment stopped working it was another three months before he finally got to the point of saying, "I'm now uncomfortable enough." And we helped him to die probably about 18 months after his initial diagnosis when he was dying within weeks when we first met him. So these turnarounds can be very dramatic by just saying, "If things happen that are bad, we'll be there for you." We actually have two patients now on the transplant list. One for a bone marrow transplant, and one for a liver transplant, who are keeping us just sort of in the sideline. Dr. Bob: Yeah, in the wings. Dr. Shavelson: Where they're, in case ... The bone marrow transplant especially, because if a bone marrow transplant fails, it can fail spectacularly. So he's starting the bone marrow transplant only because he knows that if things really go down fast, if he gets very, very sick very quickly during the transplant process, that we will be there to help him die. And that's allowing him to move forward with the transplant. I think those are phenomenal stories. They're not the typical death that we do, but they happen often enough, that I can tell you taking away the fear of death allows you to really push forward with your life. Dr. Bob: And that happens from the very first conversation, right. And it's so profound; it's palpable. It's palpable when you walk ... And sometimes it happens from the first phone call when they know that you're going to be coming out to meet with them. There's already this sense of, oh my goodness; someone is on my side. They're willing to hear me. It's been ... There's been so many conversations that have been so touching. And it affects not just the individual, but their entire family. Dr. Shavelson: Of course. Dr. Bob: You know, one of the things that we talked about, and I think you wanted to come back to this as well, was why physicians say, "No." Why they're ... So there are two parts to this. One is, what's going on, why are physicians reluctant or unable to provide support? And then the other part of that, is what's the danger of having more physicians participating, who haven't gone through a training process, or who don't have the experience that people like us have. Dr. Shavelson: Yeah, you hit this on the nail. This is exactly the dilemma of how to deal with the access problem. So let me take that on if I can. The major problem we're having in California now is lack of access for patients who want medical aid in dying. There just aren't enough doctors participating, in order to do this. And I think when you look at the data, and everybody says well if you look at California in 2017, there are only 376 deaths from medical aid in dying. It's a tiny number relative to the total number of deaths. My answer to that is that's not because so few people want medical aid in dying. It's because so few people can access medical aid in dying. If you really wanted to do a survey, you have to find how many people have requested medical aid in dying, and then were turned down and just couldn't find anybody else. And I think that's a huge number. So it's a problem of supply, not demand. The demand for medical access in dying ... Medical aid in dying, I think is quite significant. The supply is not that high. So let's get into that. There is the most common reason that I hear that a doctor says to a patient. And these patients relay these conversations to us. They'll say, "I called my doctor up, and he said you know what, I understand your position, but I don't know how to do this. I have no experience in it. It's not that I'm morally opposed. In fact, if I knew I could do it, I'd be glad to help you. But there's been no training; there's been nothing that I know about it. In fact, you're my first patient asking for it." Is really common. And so, I don't know, and I'm not comfortable doing a procedure I've never been trained in. I get that comment from doctors, more commonly than I get that the doctor is morally opposed. So many, many, many patients tell me about their doctors who say, "Yeah, I understand what you want, but I can't do it because I've never been trained." Doctors, as a rule, like to do things they've been trained in and don't like to do things they haven't been trained in. And this law never incorporated anything about training. Bob and I can tell this audience, that you don't want to do this without knowing what you're doing. We've heard some strange stories about doctors using the wrong medicines because nobody told them what to do. And they sort of thought, well this is logical. I've got a hundred tablets of Ativan here; I'll just give them that. And that leads to a potential disaster because Ativan will not bring on death. It will bring on a deep sleep for a long time, but you will not die. So anyways, mistakes happen. The answer of that, from my point of view of practice, is that we have a policy where any doctor that says that I don't know how to do this, but I don't mind doing it, we'll call them up. And we'll say, "Can we help you through the process?" And we have done that with a number of doctors who said, "Wow, you do that?" And we don't charge a fee for it. We will just talk them through the process of what we've learned, and how this works. That could be the minimal amount of training that somebody needs. And at times, we'll do this thing where I become the attending physician for that patient. The doctor who was hesitant becomes the consulting physician, which is just the confirm diagnosis and prognosis and mental capacity. So that doctor basically sits there and watches while I help the patient to die, and watches how we do the paperwork. And watches how we write the prescriptions and what the pharmacology is. And then the next time, we'll do it again together, but we'll switch roles. And that doctor will be the attending and controlling physician who supervises the process, and I'll be the consulting physician. And so we switch roles, and we've done two cases together. And then after that, they're on their own. They've learned. And so, I have found that if one by one, we can train doctors who are interested in doing this, and then have the experience. I think you and I both know this is the average doctor in the United States probably has maybe five to 10 of their patients die in a year. So if you think about that, if maybe one out of every will ... Make a very high number, let's say one out of every 500 people who dies wants medical aid in dying, that means the average doctor in the United States who sees five to ten patients a year, will only have maybe one request for medical aid in dying every three to four years. And in my opinion, that's not enough to get good at what you're doing. If a doctor does one medical procedure every three or five years, they never ever have enough patients to really get good at it. And then that brings on the debate of who should be doing this. I can't say I have the answer for that. I think that patients who have a lot of ... I'm sorry, doctors who have a lot of patients who die, like oncologists, like maybe ALS doctors. They certainly would have enough patients die in a year, that they could get pretty good at doing this and they would know what they're doing. Mostly for me, I believe it should be hospice doctors. Because they're the doctors who see the most patients die of anybody in the country, and they're the best at seeing people die. They have access to nursing care; they have access to home visits, which are crucial. Because these patients are sick, and they can't get to their doctor's office for help. So I actually think this should be incorporated into the hospice model as one of the things that happens if you go into hospice you can get wonderful palliative care. You can get wonderful social workers, and chaplains. And if you want medical aid in dying, that's just one of the things that hospices offer. That hospice offers. And that's the ideal. We now have, Bob you've got a hospice in San Diego, I know, where there's a doctor who's the attending physician. There's your medical practice which models that. And I know that we have three hospices up here, where the hospice just if they get a request for medical aid in dying, they take care of it. It's part of hospice care. So that's kind of where I go. I actually think, in some ways, it should be a specialty care. Because it's much more complicated than most doctors think it is. It's not as simple as writing a prescription, and you're done. Dr. Bob: Right. And that's been my concern. And I've heard about some stories ... And at the beginning of our experience, we discovered some things that we weren't aware of. It was a learning process, and we discovered that different counties, medical examiners approach medical aid in dying differently. Certainly, at the beginning, they were unfamiliar with it. And there were some situations that occurred in patients' homes that were very traumatic for families when the police showed up at 2:00 am in the morning and asked a whole bunch of questions because they just weren't prepared and familiar. Different counties have different rules regarding the involvement of the medical examiner. Different hospices have different approaches. There are so many nuances that, if you're just doing this once in a while, you may actually be doing the patient and family a great disservice, if you're not aware of these nuances. So I think as you've been doing, we've also been trying to guide and train some of the physicians who've expressed a willingness. One of the things that I love is when I have a patient who tells me ... Who comes to me, because they want this to be done properly. And they know that they can trust us, and will get very intimately involved and provide a high level of support throughout the process. And they tell me that they don't know if their doctor's willing to be the consulting physician. Or to be involved in any way. They're not even comfortable necessarily approaching it. And we've had, as I'm sure you've done, we've had the opportunity to call and speak with these physicians. And help them understand more about the process. Help them understand what involved to be the attending physician, what it would involve to be the consulting physician, and to offer that support and to try to, I guess in a sense, convert. Because these are people, who may be open to it. They're not morally opposed; they don't have a religious opposition. They just aren't familiar. Dr. Shavelson: That's right, that's right. And I think convert is the right word. Dr. Bob: I think that's exciting for me when I get to speak to another physician and help them understand what the process is, and then become a resource for them, whether they're willing to take it on and receive guidance and training and make this a part of their practice. Or just know that there's a resource, there's someone else to reach out to when somebody does bring up this possibility to them. Dr. Shavelson: Right. You know, I think guys like me and you, we become ambassadors. Dr. Bob: Exactly. Dr. Shavelson: And that's a significant part of my practice, and I love it. The things that, to move this to a very positive note if I may. When I started, it was disastrous. There was just an overwhelming need, and a lack of response because nobody knew what they were doing. When you look at the beginning of when this started up, it was hospices we're against, and everybody I talked to said we don't know how to do this. So we don't agree with it. And over time, what's wonderful to watch, is how patients have been the leading force in making this expand and work and get better every single year. And you see what I've seen with our hospices in Northern California. Is as they've started getting patient requests, they couldn't just keep saying, "No." Hospices are fundamentally a loving and caring and responsive organization. And with so many patients asking for help with medical aid in dying or the way I phrase it better, to consider medical aid in dying, the hospices had to do something. And what we see now, is that something like 60 to 80 percent of the hospices in my area have now come over and say, "Yes, of course, we respond to requests from medical aid and dying. We'll do referrals." Or we'll be the consulting doctors. Or we'll refer to your practice if we can't find that their regular doctors do that. And so I have watched, number one, in terms of hospice care over two years, watched most of the hospices completely change their attitude, because of patients' desires and the need of the hospice to respond to the patient's autonomy requests in making their own decisions. And that's been very gratifying to watch. As well geographically, I've now seen that there are areas of the state that we no longer have to go to in Northern California, because they have enough doctors in that area, and doctors that we know that if we get a call from Chico, we now say, "Oh, don't use us. Call Doctor so-and-so. He's in your area; he can be close to you. You'll probably even know him." And most of the time, they actually know the doc. Dr. Bob: Because smaller communities than ... Yeah. Dr. Shavelson: Exactly. Exactly. So I'm gratified by the amount of progress we've made, and I'm shocked by how much more there is still to go. Dr. Bob: Yeah. And you are a phenomenal ambassador. Every time I hear you speak, and it's been several times now in various capacities, I'm inspired, I'm grateful that I get to be part of this world, alongside people like you. Dr. Shavelson: Thank you. Dr. Bob: No, absolutely. And Lonny, you actually not long ago went through your own medical challenge. And I'd be interested to know ... I'd like you to share a little bit about that. I know you indicated that you'd be willing to do that. And I'm also interested in how the awareness that this was potentially, if it ever came to that, available to you. How that impacted you. Did you see it from a different perspective? Having been going through your own cancer journey? Dr. Shavelson: Yeah, well. So just a year ago, I'm actually one year out of the end of my treatment now. So I had a cancer development. An [inaudible 00:40:33] cancer that this thing was located at the back of my tongue, not where I felt it. I found it because I had a swollen gland in my neck, and realized that it was unusual to have that gland in that space, even though it was tiny. So I got it quite early because I went immediately to the hospital. And being a doc, I can order up my own tests. Silly of me, but that's the way I work. Walked in, and had the interventional radiologist that I knew to do a biopsy, get a piece of this thing. And it turned out to be a squeamish cell cancer that was metastasis from my tongue. So I had a bunch of lymph nodes involved, and a primary cancer in my tongue. And took a rather, I went down to Stanford and had a rather hellish treatment, to put it mildly. I don't want to scare people away from good treatment, but we did a significant amount of radiation and chemotherapy to knock this thing down. And it did, it worked. But during the six months of treatment, I became quite delusional, paranoid. I just got very, very, very sick. It was an awful experience. Nonetheless, at the end of that experience and a very slow recovery. It's surprising how long it takes to recover from that. I'm now well, and back to full speed and have a couple of long-term side effects from the chemotherapy, like a dry mouth and some toe numbness. But otherwise, I'm healthy and full strength and all that. And it's now a year and a half after full diagnosis. And a year after the end of the last radiation treatment. So how did that affect me? One, it scared the shit out of me. It made me feel vulnerable. I had been ... This was diagnosed when I was 65 years old, thank god for Medicare. It was two months after I crossed the Medicare threshold. I was covered for all of this; it would've been a disaster even with my good health insurance. But it took away my feeling of having had a life of lack of fear. Just felt like things were going well in my life always. And suddenly it became, I'm the cancer patient. So the vulnerability persists. And the feeling that bad news can happen at any time. You know, it's not like I didn't know that. I've been a ... I was an emergency doctor for 30 years before I started that as I think you were, Bob. We don't have to be taught that bad things can happen quickly. But they hadn't happened to me, and I was feeling pretty good. And the feeling of vulnerability persists. The feeling of medical aid in dying being available, well I've been a pill hoarder for the potentiality for this since I was probably 22. Again, I grew up in a family that confronted death very early, and we all had our hoard of pills in case anything would happen. So there's no news in that for me. I like the idea that it's freely available, and that I won't have to do it myself. But in terms of empathy, I think I gained a whole lot about being with patients and kind of knowing the information they want. And how truthful and calm the information has to be delivered, and it's not like I didn't know a lot of this beforehand. I kind of like to think I was a fairly empathetic doctor before this. But the tone is different. And I let all my patients know that I just came through this cancer experience. It creates this different bond with us. And I think that's important. It's a new tool. For me to talk to them from a patient perspective, as well as from their perspective, from the doctor perspective. Dr. Bob: Yeah. I can just see that being so incredibly valuable, and such a point of connection with the patients. Because that's what they want. I think in many cases, that's what patients, that's what people had been lacking, and are looking for in the relationship with a healthcare provider. Is just this sense of connection and understanding. And so knowing that you went through an experience, where you stared at your mortality and feared for what the outcome was going to be, suffered through the treatments. I think that was very comforting and probably endearing. Having lost both my parents in a short time a few years ago to cancer, gave me a different degree in insight and empathy to what family members are going through. Which has really been a gift. But having not faced the illness from a personal perspective, I think that adds something to your toolbox. There's no replacement for that. There's no way to substitute for that. I know that given the choice, you probably wouldn't' have chosen it, to go through that. But as it turns out, it's probably quite a gift for you. Dr. Shavelson: Yeah. You know, the other part of that interestingly, and I haven't thought this through as I probably should, is that the level of suffering that I went through was pretty intense. It wasn't a fun treatment, to put it mildly. But I had the very, very high rate ... there was an 85 percent chance of cure with this particular cancer that I had. So I had in my mind at least through the delusions that I was having in the really bad side effects of the chemotherapy hit my mind very badly. But even at all times, I knew that I was going to have a continued life. An 85 percent chance was pretty high. So there was a real motivation to go through that suffering. That, I want to make very, very clear. When people use the term assisted suicide, let me differentiate assisted suicide from physician aid in dying. Had I chosen during my treatment when the suffering was worse, was most severe, to do a medical aid in dying, it would've been a suicide. And the reason is because I consider a suicide to be when you end your life and you can still have the potential to live. So when somebody has the potential to keep living, and then chooses and decides to end their life, that's a suicide. However, when patients are having the kind of suffering that I was having, and they know that that's the route to dying. That they're close to death. And so they're having the same symptoms that I was having, severe pain. My pain was so severe that I was on a really high dose of opiates. I couldn't swallow, it was a terrible thing. My throat was closing up; it was hard to breathe. And yet I knew that I could live if I could just get through it. The patients who are at the end of their lives, having symptoms like that, severe pain, hard to breathe. Existential angst. Those patients don't know what I knew, which is that I could go on and live. They know that they're about to die. And so the value of going through the suffering is diminished for them. There is no value because their death is imminent. Those are not suicides. Those are decisions about how they're going to die, because they will die soon, no matter how they do it. That's a very different circumstance. I've come to understand that there's a level of suffering you endure if you know the outcome is good. That's very different than the level of suffering you endure if you know the outcome is not good. And those are really different things. Dr. Bob: And that's a fascinating conversation. And actually, I think I'd like to have a follow-up call podcast with you. Because this is something, I don't think we can cover in the next few minutes that we have. But those nuances, those situations where a person could actually go on living if they make certain choices. That they may not be willing to make, because they understand the impact on the quality of life. And I speak predominately of neurological conditions. Circumstances where people are experiencing dramatic suffering. The actual timing and course of their illness may not be quite as clear as with an aggressive cancer. But the suffering is different. Those are the cases that really require so much exploration, and a lot of time and ... They're difficult. Nothing simple about them. Dr. Shavelson: Yeah, you're talking probably mostly about the neurodegenerative diseases. ALS, multiple sclerosis, multiple strokes. Those are ... Those neurologic diseases, when I walk into any other room for those patients, I take a really deep breath, because they are not easy. And you know you're going to have to spend a lot of time with that patient, trying to figure out what's going on. What's the prognosis. Cancer's easy. Neurologic diseases are hard. Dr. Bob: And those people are looking for support, they're looking for resolution. And a lot of times, it's really ... It's not because they are trying to immediately get out of their suffering and their struggle. They know that things will change dramatically. And they're also always terrified that they will lose the opportunity if they take too long. And I think that's not just within our logic conditions. But there are so many nuances to this. I think I've taken enough of your day. This has been fascinating. It's really wonderful to listen. You're so articulation and obviously passionate about this because you know it's the right thing. But you're also responsible. You're taking a very responsible approach to it, recognizing that it's a delicate issue. It's a controversial issue. We know what our stance is, we would never want to try to force our position on anybody else. But I really, I feel a real kinship, and there's a clearer I don't know, a brotherhood of willingness to help people reduce their suffering even if it's not the easy thing to do. Dr. Shavelson: Yeah, and it's wonderful to have you as a colleague, much appreciated. Dr. Bob: Well Lonny, thank you. This has been wonderful. I'm looking forward to listening to it again, and I'm sure that there's a lot of people who will get some great value out of listening to it as well. Keep up the great work, and we'll be back in touch soon. Dr. Shavelson: Thanks, Bob. Keep doing this.  

Debbie Ziegler's daughter, Brittany Maynard at the age of 29 was diagnosed with a terminal brain tumor she chose to end her life. Her story was controversial and painful. Debbie shares her daughter's journey in life and how she ended hers. Photo credit: Simon & Schuster Contact Debbie Ziegler website – Get a copy of her book, Wild and Precious Life 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. Transcript Dr. Bob: Well, Debbie, thank you. I can't tell you how much I appreciate you coming and spending time. We've had a number of conversations over, since we met, which was probably a year or two ago. Debbie Ziegler: Yes. Dr. Bob: I think each time we talk, we get a little bit deeper into the conversations, and I think we both are very aligned in what we're trying to do with our time here. Debbie Ziegler: Absolutely. Dr. Bob: Yeah. I would love to use this time for you to share a bit about Brittany so people can really know who Brittany was. I think a lot of people know the name, Brittany Maynard. It's become, in many areas, a household name, and I think certainly in California, and a lot of people think of her as groundbreaking, but they don't really know Brittany. Hopefully, after this, after people hear this, they'll get your book, and they'll learn a lot about Brittany and about her journey, but I'm hoping that you can share a bit about that, because I think it would be really valuable for people to understand who Brittany was, what she did, and then what you've been doing to carry on her legacy and honor her, so ... Debbie Ziegler: Well, thank you for asking me to speak with you today. Brittany is remembered for the last act of her life, and those last minutes of her life are relived over and over again and spoken of over and over again. She knew they would be, and before she died, she asked me ... She said, "Mama, make sure people remember me for how I lived as much as they remember me for how I died." That is something that I try to honor her by doing, and one of the ways that I honored her was by writing a book about the way she lived, and I titled it Wild and Precious Life because Brittany did live a wild and precious life. She was very much in love with this world, and when she was terminally ill, she would say to me, "The world is so beautiful, Mom. It's just so beautiful, and I'm going to miss it so much." She did not want to leave this earth. Nothing inside of her desired that, but the fact was that she was terminally ill, and she had a terrible and gigantic brain tumor that had been growing for over a decade. When I look back at Brittany's life, I try to focus on the brain and how marvelous and plastic it was to tolerate the growth of a tumor for 10 years and to, as that tumor slowly grew, her plastic, resilient brain transferred function. I try to remember that. Even when I first find out she was sick, she had already lived a miracle, and it's important to focus that. The miracle I wanted to happen, which, of course, was that she wouldn't die, didn't happen, but a miracle had already happened in that she had lived 10 years with the brain tumor growing. Dr. Bob: What a beautiful awareness and a gift. It's so interesting because many people don't have that. Many people have a, are diagnosed relatively quickly after something that starts developing because it's created issues that can't be ignored or- Debbie Ziegler: Yes. Dr. Bob: ... their plasticity won't happen, and so everything changes from that moment on. Right? They're thrown into the health care system and start having procedures and treatments, and so ... You know that this is a fatal illness, even when it's caught early. Debbie Ziegler: Yes. I think that one thing that Brittany and I talked about quite frequently is that every person's disease is different, and it annoyed Brittany that people felt that just because their uncle, cousin, niece, had had a brain tumor, that they somehow knew her journey. The same thing happens to, I think, cancer patients with any kind of cancer. We have to remember, as we interface and speak with and try to love these people through their illness, that every body's illness is different. Just as our bodies are different, our cancer is different. It can be very, very frustrating for a patient to be told, "Oh, well, my aunt did this," or, "My uncle did that." Let's just try to take each patient alone and single and look at their disease and look at their illness separately and try not to bring in all these other judgments based on other stories. Brittany's illness, she had been living with, and the tumor had been growing very slowly, and so that allowed for that plasticity. If a tumor grows in your brain in a quick fashion, a much, much smaller tumor could kill you. Dr. Bob: Yeah, or in a different position, a different location in the brain. Debbie Ziegler: This would be the same for other cancers. It would be the same for people with any kind of cancer. Depending on how that cancer, how that tumor's growing, it takes its own cruel path, and so one of my big hot buttons is that we stop and remember that everybody's journey is different, and everybody faces their illness in a different way. The way my daughter faced it was by getting all the information she could get. She was almost an encyclopedia about brain tumors, about the types of cells that make brain tumors, about how those tumors progress in people of certain age groups. She read white papers. She had a good education, so she was lucky enough to be able to read that kind of paper that might put some of us to sleep. She was able to read it and really extract information for it, so when she entered a doctor's office, she was speaking their terminology, and she was very well read, so that is a different kind of patient. Dr. Bob: Yeah. I would imagine that for certain doctors, that would be a little bit ... I'm not sure if "intimidating" would be the right word, but they're not used to that. They're used to having, to doing the education and kind of doing it on their own terms. Debbie Ziegler: Yes. There is, and there is this paternal mold of medicine that's been in the United States for a long time where, for many years, we looked at our doctors as sort of an extra father in the family that what he said was how it went. We had this paternal model where we never even asked the doctor, "Well, what are my options," and we didn't have the internet, and we didn't have this quick way to get information. In the case of my daughter, she was actually checking out medical documents online and reading medical documents. We're in a different place, and we're in a different time. We're struggling with this old, paternal medical model, which isn't working for us well anymore. Then you add on top of that that if a doctor got a scan of Brittany's brain, one doctor said, "I expected her to be wheeled in on a gurney and unable to speak," because the tumor was in that portion of her brain that allows you to speak and vocalize, and it looked like that must, those skill sets must be gone, but because it had grown so slowly, those skillsets had moved, and she was able not only to speak but to speak very articulately. I do think it was a shock, and a little bit more difficult to deal with, with a patient who's very well read and very outspoken. My daughter was, even from a young child, a very purpose-filled person. I remember they observed her playing when they were analyzing whether she was ready for kindergarten, and they wrote in the report that her playing was purpose-filled. That came back to me as I watched her negotiate her illness, and I thought, "Okay, well, those things that made it difficult to mother her, that purpose-filled, stubborn, willful sort of way, was a wonderful asset to her when she was ill and needed to navigate her illness." People ask me all the time about how Brittany could make a decision like this so confidently, and my answer is that she had the innate personality to question and to, and she also had the educational background that she could absorb the scientific information and accept it on a factual level. The emotional part, matching her ability to be emotionally strong, matching her background to be able to understand the information that is terribly frightening, and which, honestly, I mean, I taught science. I couldn't read it in the beginning. It took me about a month to be able to read about brain tumors. I just couldn't do it. [inaudible 00:11:20]. Dr. Bob: You mean you couldn't do it because it was too difficult emotionally or because it was too, the information was too- Debbie Ziegler: It was emotionally. Dr. Bob: Okay. Debbie Ziegler: I also have a science background, and I taught science, so I could read it, and I could interpret it, but as her mother, having just heard that she had a terminal diagnosis with a brain tumor, emotionally I was unable to read about brain tumors for well over a month. This is a part of what happens to the family of the terminally ill person. Sometimes, they're knocked back into a period of denial where they're unable to look at the truths; they're unable to look at the facts. I think that makes it more difficult in some ways, and yet I'm told by psychologists that denial is something that helps us deal with crisis and eventually move on, as long as we move through it and don't stay in that place. I can testify to the strength of denial, and I can certainly say, from my experience, that it is very important to overcome it if you're going to help your loved one. It's something you must battle through and get to the other side. Dr. Bob: I think that's so powerful, and, I guess, recognizing that it's happening, being open to recognizing that, and that it's normal, and you don't have to rush yourself through it, because it is a process, but if you're not aware that that's what's happening, then it seems like it's the reality and it's appropriate, and would be much more difficult to get through it and be of support as you ultimately want and need to be, so ... Debbie Ziegler: Particularly if the patient gets to the point where they are out of denial. Many terminally ill people quietly, but firmly, believe that they have a pretty good handle on how much time they have. Something inside them says it's not going to be more than a few months, but they, if they're surrounded by people who are in denial, they have no one to discuss that with. They have no one to say, "Look, I'm dying." My daughter, because of her youth and because of who she was, said to me in the hospital one night, she was in her bed, and I was climbing on to a gurney next to her, and she said to me, "Mama, you get that I'm dying, don't you? I need you to get this." It just ripped my heart out, but at the same time, I realized, "Oh, my goodness. I have to look at this. I have to turn around. I have to stop running and pretending that I can find some miraculous doctor in some other country," which is what I was dreaming of at that point. "I have to turn around and look at my child who is telling me, 'I'm dying.' I have to be with her in that moment." I'm telling you, it's hard, and I'm also telling you it's really important for the patient, really important for the patient to be able to say, "The people that love me get it. They get it. I'm dying, and they get it." Dr. Bob: "And stop wasting my time." Right? "I'm-" Debbie Ziegler: Yes. Dr. Bob: "Be here with me, because we don't have a lot of time for what we need to do." Debbie Ziegler: In her case, she wanted us to listen to what her desire was for the rest of her life, what it was going to look like, because being told that she had about six months to live, Brittany immediately sprang into her list of, she had a bucket list of places she wanted to visit. She had a list of people she wanted to talk to before she died. She had a list of accomplishments that she wanted to be able to be a part of, which included, in the beginning, she wanted to write some articles. She decided she wanted to write articles because the medication she was on to keep the pressure in her cranium down from this gigantic tumor causing this pressure, she was taking a lot of steroids, strong steroid medication, and steroid medication at that level has some pretty gnarly side effects. It makes you get this round, very full face, which they refer to in medicine as a moon face. Brittany thought, "All right, because I don't want anybody taking pictures of my moon face, and that way, I can write an article and still have an impact and advocate for other terminally ill patients, but I won't be seen." Then as it turned out, and as many people know, that is not the path that it took, and she was asked to have her photograph taken, and then she was asked to be filmed, and then she was asked to be interviewed. All of this was done when Brittany didn't look like Brittany anymore, and she cried, and she said, "I just see cancer in that face. That doesn't look like my face. That looks like the face of cancer." I know what a sacrifice she made to do this for people. We talked about how it was normal at 29 to feel feelings of vanity, yeah, a little bit, as you're a woman and you don't want to look bad, and how she was going to overcome that. Of course, as her mother, I kept saying, "You're so beautiful, Brittany. You are still beautiful. It's just a different beautiful." She would be like, "Oh, Mama, you're my mom," but I just want people who are ill to know that those last six months that my daughter had were some of the most productive month of her life. She had a sense of urgency and joy. In between sadness and terror, there were these moments of great joy and satisfaction, as we walked through a particular place in nature that spoke to her. She'd call me, "Mama, come and look. Come and look at the banana slug. Come and look at the starfish. Come and ... " We shared those moments of joy because she faced her illness, and she was not going to waste that time. That required decision-making. That required saying, "No," to some treatments that she felt, after reading about them, we're not going to buy her any significant amount of time, and while she did those treatments and did not receive significant time, the treatment itself was going to deteriorate her lifestyle. Her quality of life was very important to her, and she said, "If I'm not getting any measurable upside here in the way of extended life, then I need to be looking at the quality of the little life that I have left," and so she remained focused on that, and she remained strong in the face of some pretty persuasive and, in some cases, almost bullying that went on in the medical system of, "You must do chemotherapy. You must start it on Monday." Even her oncologist, after doing DNA testing, told Brittany, "You aren't a good candidate for chemo." She said, "Your DNA, your markers, are indicating that you're not a good candidate. There's a very, very small percentage of chance that chemo would do you any good, and there is some chance that chemo could actually make your tumor grow faster because you have a glioblastoma now." Dr. Bob: Certainly, it would deteriorate her quality of life, which she knew, and yet still there were physicians who were part of her team who were pushing her. Debbie Ziegler: Definitely pushing that. She stayed with her oncologist, who she felt understood chemo the best more than the surgeon, and she said, "Your own hospital just wrote a paper about chemo not always being the right answer for the brain tumor patient, and so I'm saying, 'No.' I know that you know this within these halls, and I'm not going to do it. It doesn't have enough of a possibility of upside for me, and it has a definite downside that's very well known. The symptoms that will take away my ability to do some things that are very important to me," one of being that she wanted to travel to Alaska, and she wanted to ride in a helicopter in Alaska and land on a glacier. She wanted to go on a dog sled and cross a glacier. She wanted to move in a dog sled on a glacier that was moving on a planet that was moving in a solar system that was moving. We wanted to be moving in time and space, and we did it. Dr. Bob: That's wonderful. That's awesome. Debbie, at what point, at what point after the diagnosis, did the whole concept of medical aid in dying come into her awareness and start becoming a bit of a focus? Debbie Ziegler: For Brittany, her focus on aid and dying came much more quickly than anyone else in her family, because, at Berkeley, she had been in a psychology class where they had had a discussion about end-of-life options. Her class had heatedly argued about end-of-life options, and so Brittany had already thought about this, discussed it, and, quite frankly, been a participant in a conversation at a high level. As soon as she was told, and she did ask directly, none of her family could or would, because we were all in denial, she's the one that forced the conversation and said, "Is this brain tumor going to kill me? Is this a terminal brain tumor?" She was told, "Yes, it is terminal. At this point, until we have tested this cell structure, we don't know how long, but we do know this is what you will die of." As soon as they told her that, she began discussing end-of-life options. She did not know how long her life would be, but she did know that the tumor was going to take her life, and she knew enough from her science background of the course of action that a brain tumor takes that she knew she wanted to be looking into other options rather than just following a natural course. Dr. Bob: How fortuitous for her, not maybe fortuitous at all, but that she had had, been exposed to it. Debbie Ziegler: Yes. Dr. Bob: Not a lot of 28, 29-year-olds are- Debbie Ziegler: No. Dr. Bob: ... and so it could have been a very different process, and path had that not happened. Debbie Ziegler: The way she introduced the topic into conversation was, I think she was trying to spare us until she could discuss it with her parents, but she said to the doctor, "How can I get transferred into the Oregon medical system?" That, of course, to everyone in the room, seemed like an odd question, and in the back of my mind, because I am a science teacher and, of course, had read articles, I thought, "Oregon. Oh, my goodness. I know why she's talking about Oregon." I couldn't have told you the details, but I knew that it had to do with the right to die, and I knew what she was talking about the very first time she mentioned it. I knew where she was going. Within seconds, there were two people in the room. I'm sure the doctor knew what she was talking about, although he chose, at that moment in time, to not recognize it, to say, "Well, why would you want to do that? You're in a fine medical system here in California." It wasn't until days later that we had open conversations about why she was interested in Oregon. Of course, since that time, California has passed an End of Life Option bill. I feel that that is my daughter's legacy. I believe that it was her story of having to move out of California in order to die, in order to die peacefully, that touched a lot of hearts and made history in California. I smile when I think of our End of Life Option Act because, in my heart, it's Brittany's act. Dr. Bob: Well, it was Brittany's act, but she couldn't have done it without you. Right? You- Debbie Ziegler: She- Dr. Bob: You were her partner in that. Debbie Ziegler: She had help, and she had many, many volunteers who loved her, who loved her spunk, her feistiness, her story, who immediately gravitated towards supporting her. I have had letters written from all over the world, from all over the world. I now speak with people in an ongoing relationship, some of whom I have met face to face now, and some of whom I haven't, from countries all over the world about Brittany, and some of these faithful people write me every time it's her birthday, every anniversary of her death, every anniversary of the bill being passed, and they tell me how much my daughter means to them, and that they live in a place where there is no law, and that she stands for hope to them, that she stands for hope that one day, all of humanity will treat each other with love and kindness and will not be so afraid of death. It's such a beautiful legacy that it helps me accept that she's gone. She's gone physically from me. Those first few years, grief was so difficult, and I've met so many grieving people, and as I was grieving, I would literally be knocked down to my knees sometimes. I'd be crying on my knees in the hall, or in the living room, or in the kitchen, or one time in a park, another time in a store, like a T.J. Maxx. Here's this lady down on her knees, crying. I would always smile through my tears and know that Brittany would be saying, "Get up. Get up, right now, because you're on your knees crying. It means there's something that needs to be done. Look around. See what needs to be done." The first time, I got up, and I thought, "Oh, my goodness. I just opened an email about how dire the blood shortage was," so I went and donated blood, and now I try to donate blood twice a year in Brittany's name. I pick times of the year when that is hardest for me. I pick the times of year when I know the grief is going to wash over me again. Times, holidays, her birthday, the day of her death, the beginning of the year. I pick times to do the donations when I know that giving blood is going to be this beautiful gift that's going to lift me out of my sorrow. Then I look around and see other things that need to be done. I see an elderly person that needs a visitor or flowers. I see a friend who needs a visit who is fighting breast cancer. When I go into my worst grief, I always hear her saying, "Get up and look around. There must be something you need to do." That is one of the ways I've dealt with grief is by getting up and looking around. Dr. Bob: And doing what, and doing what is- Debbie Ziegler: And doing something- Dr. Bob: ... right there, immediate, in your awareness. Debbie Ziegler: Yes. Dr. Bob: I'm going to, so can we stay with this for a moment? Debbie Ziegler: Yes. Dr. Bob: I know that I've been with you, and you've shared some of your other tools, tips, ways of working through the grief. Debbie Ziegler: Grief, yes. Dr. Bob: I think I would love for you to share if you're up for it, a couple more, just a little bit more about how you've managed to work through your grief or work with your grief as a guide here for some of our listeners. Debbie Ziegler: Well, in the beginning, I have to admit that grief was like, it was a black ocean sucking me under, and I thought, "If I don't do something, I'm not going to make it." I really, first of all, I admitted this to the people I loved who began searching for things that might help me. My sister came to me with a treatment that's called ... I don't know the letters for it. I think it's PTSD, but it's an eye treatment. Dr. Bob: Oh, EMDR? Debbie Ziegler: EMDR. Dr. Bob: Emotional freedom release, yeah. Debbie Ziegler: It is EMDR, and it's rapid eye movement treatment. Because I told people, "I can't talk my way through this. Talk therapy is not going to be enough. I can't do this." This is a scientific treatment where you are asked to follow a light with your eyes. I was probably the most skeptical person on earth that it would help me, but it did, and rather rapidly. It took me out of this circular, negative thinking that I had. I had a few broken records that revolved around Brittany's illness and Brittany's death, and those records would come on and play over and over again, and this treatment of causing my eyes to move while I thought about this, or while I thought about a very stressful day or the actual day of her death, while I thought or discussed about that, my eyes were moving, and it causes your brain to use both sides, the right and left, and your own brain helps you heal and stop that broken record from playing. That is one treatment that I feel very strongly about. I also used the treatment of touch, of various therapies that have to do with massage and different types of massage, to kind of work the tightness that was in my muscles. After being with Brittany and anticipating her death for six months, there was a lot of muscle difficulty, and so I used that. I also have a sister-in-law who sent me ... I also have a sister-in-law who sent me various scents, an aromatherapist, and she sent me a mister. She sent this to us before Brittany died, and Brittany used it all the time to help her try to sleep. That was a difficult part of the last month of her life was getting any sleep, so both she and I used aromatherapy, which is another thing that I sort of, as a scientist, was sort of like, "How can I possibly help?" Yet- Dr. Bob: It did. Debbie Ziegler: It did. In fact- Dr. Bob: Undeniably. Debbie Ziegler: ... my daughter said the two therapies that helped her the most, she said, "Look at all the doctors we've been to, Mom. Look at all the specialists, the high-paid brain surgeons, neurologists, oncologists," and she said, "Look what I'm down to in the last weeks of my life. I'm down to massage and aromatherapy, and these are the two things that soothe me and help me." She used them right up to the end, and she developed a relationship with her masseuse, and she developed a relationship with my sister-in-law, who sent the aromatherapy. Along with these treatments came this human touch and caring that's so important. Dr. Bob: You're singing my tune. I mean, those are the things, of course, that we try to, and it's just, I didn't know that about Brittany's- Debbie Ziegler: [inaudible 00:35:07]. Dr. Bob: ... about what brought her comfort, so it was really, it's, I guess, confirmation, more confirmation about how incredibly valuable these therapies and are ... Not to throw out every other treatment that is being offered through the traditional medical system, because sometimes those are very important, but the value of some of these- Debbie Ziegler: Simpler- Dr. Bob: ... high-touch- Debbie Ziegler: ... natural- Dr. Bob: Yeah. No side effects. What are the side effects of massage therapy? I'm so happy to hear that that was comforting for her, and also for you, afterward. Debbie Ziegler: It was, and we would go together, and friends would send her massage gift certificates. It was a way for them to reach out to her and to give her some solace. We had a special place that we went to and a special group of women who knew her and knew our story, and so it was a safe place that felt safe to go to, and ... Dr. Bob: And that connection. Right? The connection that she made, which was not, didn't revolve around her illness. Debbie Ziegler: No. Dr. Bob: It wasn't going to get a treatment or for someone to check and see how she's progressing. It was a human connection, which people at all stages need, and when we can provide that, it normalizes things. It enhances the feelings of well-being, so this is another pretty powerful reminder of that. Debbie Ziegler: The people that worked in the area that we went to, which was Portland, Oregon, we went to a place there, they never questioned her. They never argued with her. They just said, "How are you today? Where do you feel that ... Do you have places that we need to concentrate on? Do you have places where you have some knots in your shoulders, you just want ... How much pressure?" It was all about, "What feels good to you, Brittany, today? Because we just want to send you out of here feeling a little bit better than you came in." There was no lofty goal to cure cancer. There was no lofty goal to fix this girl who had this gigantic brain tumor. It was just, "From where you start to where you leave, we promise you're going to feel a little bit better." Dr. Bob: In that moment. Debbie Ziegler: And she did. Dr. Bob: Yeah. Debbie Ziegler: And she did. Dr. Bob: That's wonderful. Debbie Ziegler: Yeah. That's a beautiful thing. Dr. Bob: We talked a bit about some of the ways that you moved through grief, which I'm sure part of that was what you, basically what's become your life's work as well. Debbie Ziegler: That was very fulfilling. To be able to testify was very fulfilling, and I felt that my testimony came from a place that was a little bit extraordinary in that, as Brittany's mother, this was not my first choice. This was not; I did not readily gravitate to this end-of-life option idea. I stayed in denial for a period of time. I had to work through this in my head. I had to analyze some childhood beliefs that I grew up with in Texas, so when I spoke with senators face to face, or representatives face to face, and they were reticent, or they had some childhood religious beliefs that were kind of interfering with their ability to even hear Brittany's story, I could relate to them, and I told them that. I told them, "I was you. I was you. The look on your face, my poor daughter had to see. I see you avoiding this subject. I see you turning away from death. I see you turning away from this idea. My daughter had to watch me do that, and that must have been so hard for her to have her own mother not be able to discuss it, to be in denial for a period of time." I felt that my testimony was from a place of, a commonplace that we had, and I felt that in some cases, minds were able to change, or people were able to look inside and say, "Hey, maybe I do need to look at this a little, from a little bit of a different angle." I felt that that was an important truth that I could share was that I didn't start out all gung-ho about this. I knew what she was talking about, and it scared me to death. It really did. It's an important common ground that we had. Then as I went on and spoke in different environments and different countries, I recently came back from Africa, where I spoke at a conference there where people from 23 different countries met in Africa to discuss our human right worldwide to die peacefully when we are terminally ill, to seek a peaceful death. It was very empowering to meet these people who are; literally, you could almost feel the room vibrating with the love and excitement that these people have about making the end of someone's life more tolerable. Coming back from something like that is just, infuses me more with energy and confidence, and inspires me that this is important work, and that I believe that sharing the hardest parts of how it happened and the hardest parts of what we went through in the public eye and as a family who really didn't have very much of a help and assistance ... In fact, we kind of had to claw our way into a situation where my daughter could use the law. I feel like telling those hard parts and just kind of opening my kimono and letting people see the pain, that maybe they will have confidence when, and if, something happens in their own family, that they can say, "Oh, I read about this one time, and you know what? She was in denial, too. That's what I'm in. I'm in denial. I recognize this." Maybe it will help someone get out of denial. Maybe it will help someone not feel so alone. Maybe it will help someone support a patient and say, "What do you think? You are the one who's dying. Let's make a plan, your plan, your plan, because this is your life, and I want to hear what you want to do." Maybe it will help someone look into the patient's eyes instead of running out of the room and making phone calls to try to make something that can never happen. I just, I think that if we don't tell our story and share the humanness of dying, that we're not going to move forward. The more we keep hiding and not talking about it, the less likely we are to be able to face the end of life, which should be a beautiful time. My daughter showed me that. She showed me that, "Yeah, Mom, it's not always beautiful, because I'm 29, and I'm pissed off that I'm dying, but in between being pissed off, I want to live, and I want to experience joy, and I want to go places, and I want to meet people that I haven't seen in a while, and I want to finish things. I want to feel that I've finished some jobs and some relationships and before I go." She wanted a plan, and I think a dying person's plan, no matter what it is, because it may not be what you, as their relative, want it to be, but their plan is really all they have, and so let's support that plan. Let's talk about that plan and what it's going to look like, and how are we going to get it put in place. I think people don't plan. They wait too late. A hospice is called, sometimes, too late. People end up saying, "Oh, I want to use the End of Life Option Act," but it's too late. They haven't left themselves enough time to get the prescription, to write the letters, to wait for the waiting period. The more we can normalize this and discuss this with our families, with our loved ones, with our friends, the more they can plan and make a good plan, and we can help them put that plan into place, but it's not our job to make the plan for them. It's not our job to get in there and say, "Oh, you need to do this, and you need to do that." We need to stop. After they've been told, "You have a terminal illness," we need to slow down a little minute, and we need to absorb that information with them, and then we need to listen. "What do you want to do? How do you want to live these last months?" It can be beautiful. Dr. Bob: And, "How do you want to die?" Debbie Ziegler: Yes. "How do you want to die?" Dr. Bob: "How do you want to die?" Wow. Okay. I think we came to a beautiful place to pause. You and I are not done with our conversations. Debbie Ziegler: No. Dr. Bob: By a long shot. Debbie Ziegler: California's not finished with this conversation, and I think we're committed to- Dr. Bob: Co-create it. Debbie Ziegler: ... making the best of this that we can. Dr. Bob: Yeah. There's a lot of work to be done. There's a lot of lives to support, and so we will have, you and I will have more conversations, and I would love ... I know we talked a bit about what came out of this conference in South Africa. Another podcast devoted to that would be wonderful- Debbie Ziegler: That would be great. Dr. Bob: ... because that would be very educational for people to see what's going on in the rest of the world and what we have to aspire to. Can you share how people can read more about the story and get more information about you and Brittany? Debbie Ziegler: Oh, the book I wrote about Brittany was published by Simon & Schuster, and it is available on all the major online vehicles that you can buy books, I mean, every single one. Amazon, all the bookstores. The title is Wild and Precious Life. I hope that when you read it, it will make you want to live a wild and precious life, because we just have this little bit of time, and we might as well make it wild and precious. I'm Deborah Ziegler, Brittany Maynard's mother. My greatest achievement in my life, my daughter, who I love dearly, was a great model of living a wild and precious life. I would urge you to read her story and benefit from it. Dr. Bob: Yeah. I agree. I second that wholeheartedly. It's a wonderful story. It's hard to read, at times, for sure, but it is a, it's well worth it, and I think you'll gain some really great insights. Thank you for writing it. Thank you for all that you do. Thank you for being here. It's an honor. Debbie Ziegler: Thank you.

Dr. Michael Fratkin founded ResolutionCare to insure capable and soulful care of everyone, everywhere as they approach the completion of life. Learn how telehealth applications are bringing a greater quality of living and dying to those in need. Contact ResolutionCare website Transcript 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. Please note there is some content that is explicit in this episode. Dr. Bob: Dr. Michael Fratkin is the President and Founder of Resolution Care. Dr. Fratkin is a father, a husband, a brother, a son, a physician, and a very dear friend of mine. Dr. Fratkin is dedicated to the well-being of his community and the community of all human beings. Since completing his training, he's made his home and built his family in rural Northern California. He's served his community as a primary care physician in the community health system, as a medical director of the local hospice, as a leader in the community hospital medical staff, and has been a transformative voice for improving the experience for people facing the end of life. At a time of great demographic and cultural change in our society, Dr. Fratkin has created Resolution Care to ensure capable and soulful care of everyone, everywhere, as they approach the completion of their life. Resolution Care is leveraging partnerships with existing healthcare providers and payers to provide telehealth services that bring a greater quality of life and greater quality of dying. The palliative care team at Resolution Care openly shares their expertise and mentorship so that people can receive the care they need, where they live, and on their own terms. In this podcast interview, Dr. Fratkin shares his passion and his intimate experience as a provider of care. He's innovative; he's creative, he's dedicated beyond what I've experienced with just about anybody else who I've communicated with about palliative care and end-of-life care. I think you're gonna find this podcast to be incredibly informative and really interesting. Okay, Michael, thank you so much for taking time out of your day. I know you've got lots of irons in the fire and lots of people vying for your attention. So I really appreciate having time to connect with you. Yeah. You know, it's interesting. I always enjoy talking with you. We connect sporadically, not as much as either of us would probably want, but we have been pretty consistent in finding times to connect and catch each other up on what's happening with our lives and our different enterprises. And what's interesting is, after our conversations, I always think to myself, "I wish other people could have heard that. I wish other people had a chance to listen in and hear what we're developing, and sort of the passion that comes out in these conversations." They're so informative, for me, and I find it so inspiring to hear what you're doing and the service that you're providing and creating. So today we have that opportunity so that people are going to be able to listen in on our conversation. In the introduction, I shared a bit about what you're doing, who you are, but I'd like to have you just do a little synopsis of what Resolution Care is doing currently, where it started from its humble beginnings, and what your vision is for where this is heading. Dr. Fratkin: I'm a dad, I'm a husband, I'm a brother, I'm a son, I'm a whole lot of stuff. But I'm also what's called a palliative care doctor. And your group of listeners probably know a little bit about what that is, but the way that I describe it for people is that there are really three central elements. That number one, we don't take care of any patients. We support people as they find their way through serious illness. We support people with a team; we support their families. Our team includes nurses, doctors, social workers, chaplains, nurse practitioners, community health workers, and all the people that they don't necessarily see, but that are just as important to creating a container for our care, the back office, and operational people. So the first principle is, is that we are a person-centered, not a patient-centered, but a person-centered initiative. And that those persons, the reason I distinguish it ... It's not just the patients or their families, but the people providing the care that are centrally important to everything that we do. And then we build out from there. So the first thing is, we're a person-centered organization, using a team to accompany people with serious illness as they navigate it, right? Dr. Bob: I love it. Dr. Fratkin: So the second thing that we do is that we're really damn good at managing symptoms. Our team has quite a bag of tricks around the treatment of pain and nausea, breathlessness, and various other physical manifestations of illness. And we know how to use that bag of tricks. So symptom control is the second thing. And the third thing is, we help people and their families to navigate what is a completely dysfunctional, fucked up if you don't mind me saying so- Dr. Bob: Let's call that like it is. Dr. Fratkin: Of fragments and silos and conflicting interests, and stakes held. We help people navigate, somewhat, through the complications of their illness, but more so, we recognize that people are trying to make their way through a human experience, not a medical one. And so, we help them navigate through that, bringing the personhood that we are to accompany them with the wisdom, skills, and shortcuts and strategies that we know about navigating. So it's person-centered around the people we care for and us as well. We matter, too. It's impeccable symptom control, and it's navigational assistance. And really tough times of life in a really complicated health care system. So Resolution Care does that. And we use some technology tricks, video conferencing, all of our care is based in the home. And that's that. But I think I also wanna tell you about how I got here and why. Dr. Bob: Please do. Dr. Fratkin: So I came to far Northern California, Humboldt County, in 1996 and joined a community clinic environment as the only internist in a five-clinic system. And my job was to take on all the patient V patients and all the complicated conditions that provided kind of complex case management approach for the heavy hitters, the outliers, the hot spotters. They're called lots of things now, but they were just languishing without the attention they needed when I showed up in town. And for six years, I took the hardest cases in the system, and helped with diagnosis and treatment planning, and burned out rather quickly, because I didn't have a team. I then sort of shifted my attention to my deep connection with hospice work and became a hospice medical director, where I did have a team. But I also had a very constraining box around me, a structure of hospice defined by the Medicare benefit that was limiting our ability to do what made sense, rather than meeting all of the regulation and compliance that continues to accumulate in the hospice model of care. And I burned out again. And then, I did some hospital work. When I started, I was seeing 9-12 people in a day, and I really enjoyed being at the point of the sphere where people were sick enough to be hospitalized and to attend to them both with good medicine, as well as a respect, and frankly, love in the face of what they're going through. And that was great until they started to push me to see 15 or 18. And now, it's 22 patients in a 12-hour shift. And I burned out again. And all the while, paying attention to the rising credibility and relevance of the palliative care movement. So I became first certificated in 2000, and board-certified a few years after that, in palliative care. In 2007, I worked with the hospital to launch a guided care consultation service in the hospital. And as soon as I got started doing that, there was almost immediately, four or five times as many people as I could care for. And I wasn't able to scare up the resources in the hospital to build out a team. So for a period of years, I wrote business plans, I went to committee meetings, I tried to advocate for greater resources to do this good work correctly, and failed to do that. So in 2014, I had had it. Exasperated, fatigued, burned out, I guess for the fourth or fifth time. God knows I can't keep track. I was looking for a job. I figured I couldn't stay here in this beautiful community, because I couldn't figure out how to get a sustainable job with a team that builds capacity over time. And so, I looked for work. And as you know, Bob, a palliative care doctor these days doesn't have to go too far to get too many interviews. I had three interviews in three weeks in the Bay area, and on the way to the Bay area. And they offered me three jobs, quickly, were better resourced, better compensated, more controlled work hours, but none of them were where I lived, where I made my home, where my kids were born in my house. I live on this five-acre piece of redwood forest. My kids were born there. My dogs and cats are buried in the yard. And I didn't wanna leave. So come around spring of 2014, I started to think about maybe there's a way to build capacity, build a team, and share what I know to others so that they could make that work for the people they're caring for. And so, the three ideas were video conferencing, Project Echo, which we could talk about later, it's a telementoring structure that allows a specialist to share information to primary care providers, et cetera. We can talk about that later if you want. And then the third thing was crowdfunding. So in November 1st or 2nd in 2014, we launched an Indiegogo campaign and based on all of my relationships in the community and people's trust in my work, we were able to raise $140,000 in a little over a month. And in January 2015, myself and one other person walked into a donated office space and turned on the lights. Dr. Bob: What a great story, and a great confluence of ... And you being true to your vision, being true to yourself, to what you knew was the absolute right way to practice the ... And you took a risk, right? And you continue every day, taking a risk. I know it. We've had these conversations. I'm trying to remember when we first connected because I've watched this thing go from birth to flourishing. And flourishing may not mean the same thing to you that it does to me, because I know your vision is grander. Dr. Fratkin: Well I know where we met. We met around ... There's a group in San Diego of one old-timer, one mid-timer, but some folks that have been inspired for more comprehensive cancer care in the community for a long time. A fellow by the name of Dan Vicario and the dear, dear friend of mine. I call him my grand brother, Paul Brenner, a psychologist with a deep connection. A psychologist and physician with deep connections to really thoughtful and complete approach to people with serious illness. And it was through them that they connected me to you. Dr. Bob: Right. And I remember that part very clearly. And I've had the honor and the privilege of collaborating on patients with both of them. And it is really; it's magical to be part of that with all of their combined years of wisdom and their just beautiful energy. But I'm trying to remember the stage that you were at. It was probably early on, and- Dr. Fratkin: It was probably in 2015. And without getting too wonkish about enterprise development so that we can get to the topic at hand, 2015 was the year of getting rolling and getting the team. And we did that. By September, we had a nurse, a social worker, chaplain, and office staff, as well as a little bit of a head of steam, with a group of patients. 2016, we really started to grow. And 2017, we continued to grow and sort of learned how to be a business that was sustainable. And coming into 2018, I'll just tell you today, Resolution Care network is tending to about 164 people in their homes, from the Oregon border to the north, the Pacific Ocean to the west, all the way to the ... I guess it's the Idaho/Nevada border to the east, south, pretty much to the Bay area with a couple of other folks a little bit further south. We've got 29 employees. We have contracts with four health plans. And we're making an impact with this model of care that we're developing. Yeah. Dr. Bob: That's beautiful. And of those 164 current patients, how many of those are receiving physical ... Are you able to get to visit physically, versus doing it entirely through video conferencing? Dr. Fratkin: It's variable. The key element is, is we really do what makes sense. So if a person lives down the street, it makes sense just to drop in and see them and sit on their couch and eat their cookies and chat with them that way. If they live 150 miles away from HQ, we're much more likely to engage with them by video conference. And it's really ... That's kind of what we built into the model. It's a hybrid model, both boots-on-the-ground, face-to-face encounters, with teleconferencing or video conferencing. And we do that in a really nimble fashion so that there are some people who really can't wrap their head around it. And if they're close enough, we provide them with a more traditional home care model. We have people who are right down the street who are very comfortable, in fact, prefer not having somebody knock on the door and walk into their house, but prefer to control the framework of the encounter. And then, different specialties. For my fellow providers and me, we're probably in the 85-90% video conferencing channel. Our nurses are probably in the 50-60% of their direct encounters are done by video. Our community health workers, the other end of the polarity, do very little video conferencing, because that's kind of what their value proposition is, is to be right there in the home with time and engagement to suss out what's needed. Our community health workers extend the reach of our doctors, our nurses, our social workers, and our chaplains. And they're given a lot of room to figure out what makes sense for each person and their family. So it's a variable ratio of boots-on-the-ground to remote engagement. Dr. Bob: Right. And what's cool about it is each situation is unique, and it probably changes over time as well. And I think it's fascinating; the different disciplines have the option of doing it whichever way makes the most sense for the provider as well as for the patient and family. Dr. Fratkin: For sure. At an organizational level for organization people who might be listening, it makes such great sense to use the technologies to eliminate the inefficiencies of travel. What's interesting ... I think we've talked about this before, but when I started to do initial consultations with people, first encounters to carry the arc of ... Oh, there are 8 or 10 elements that I've gotten accustomed to, to feel complete within an initial encounter. When I did it in a clinic setting, or at home, it was a 90 to 120-minute encounter, easily, and really exhausting. But when I started doing those same initial encounters by video conferencing, over and over and over again, they came to a place of completion in about half the time. Dr. Bob: Why is that? Dr. Fratkin: I think it's because we are primates. I think that when you walk into a person's home, there's a whole lot of social primate behavior. There's a whole lot of framing that includes so much more than just the relational engagement, one-on-one, with another person. There's the environment; there's the space, there's how the person feels about inviting a person into their home. There's their level of attention to, let's say, housekeeping, or their level of anxiety about how much energy they have to do housekeeping. There are the dogs; there's the feeling like you're hosting a doctor in your home, or a social worker, whoever. There are the elements of ... If you're really, really sick, maybe you just didn't feel like taking a shower this morning, but the doctor's coming, so you have to put yourself through a whole preparation mode. All of those things are, frankly, in the way of a relationship of trust. They're complications. So I've come to accept that actually doing care virtually is better than real life. Dr. Bob: Fascinating. I find that fascinating, because I do some care, some visits remotely that way. The vast majority, 95+% of them are in patient's homes. So those social, primal, primate behaviors, to me, I find those really endearing. And I think it's almost like a friendship is developing at the same time as a doctor-patient relationship. But I'm not seeing the same volume as you, so I have the luxury of being able to do that at this stage of the game. Dr. Fratkin: I think that's true. I think there are some other things that are hidden in plain sight that relate to it. I'm sure you'll agree that one of the great challenges for hospice work, palliative care work, complex conditions, where people with huge loads of social challenges with sensitive, inspired, caring caregivers and healthcare professionals ... One of the greatest challenges to this work is learning about the nature of boundaries. It shows up in every hospice organization, every palliative care organization, in the hospital, where people get confused about where they begin and where the people that they're attending to begin, or where they begin and end. The I and Thou, to quote Martin Buber. That is very interesting and hard to teach. The way that most of us learn is that we screw it up. We get caught up with the other person's energies. We end up feeling we must keep them pleased. We don't necessarily ... Well, here's the teaching metaphor that I use. I'll see if I can create a visual of this for you and the listeners. Bob, do you remember way back when, in the dark ages, when you took Physics? Dr. Bob: Yes, vaguely. Dr. Fratkin: Vaguely. And do you remember studying the components of an electronic circuit? Dr. Bob: Even more vaguely. Dr. Fratkin: Okay. Things like resistors and transistors. Dr. Bob: Capacitors. Dr. Fratkin: Capacitors and stuff, right? Now, I bet you don't quite remember. Maybe you do. You're a smart guy. What a capacitor actually is. Do you remember what a capacitor is? Dr. Bob: In the interest of time, I'm gonna let you- Dr. Fratkin: That's good. Good call, Doc. A capacitor is this: it's two plates. Imagine tiny little squares. One of them's a positive, anode; the other is the cathode. I think that's right, a negative. And they sit inside of a circuit with a proximity to each other and a surface area. And the closer they are together, and the more surface area they have in association with each other, the higher the capacitance. Whatever the stuff of capacitance is that contributes to doing what's needed to an electronic circuit, which is way above my pay grade, is proportional to the surface area and the proximity. And I think that that's better than thinking about staying professionally or technically detached from the people we care for. What we've built is a system that constructs ... All I'm here to do is to give you the technically, medically best treatment. And I can't really allow myself to engage with the truth of what's going on for you as a human being, because that'll make my hands shake in the operating room. That'll make me not make the right choices on your behalf, or provide you with the right recommendations. And I think what that done is it's alienated healthcare professionals from the people that have medical challenges, right? Dr. Bob: Absolutely. Dr. Fratkin: Professional detachment is a 20th century, obsolete concept. My concept is that what we're called to do, especially for people who are feeling the threat to their very existence, is to open as much of ourselves as we can, create a greater surface area, and have the courage to maintain the closest proximity to their circumstances. To understand what's going on. But what happens with the capacitor ... If the two plates touch- Dr. Bob: Kaboom. Dr. Fratkin: Circuit's completed, and there's no capacitance. If you get caught up in people's shit, then you lose the ability to really create the magic that lives between those two plates in close proximity. In human encounters, I say that it's not capacitance that arises with proximity and willingness to be open. What arises is empathy. And empathy is the secret sauce of understanding how to be of service to another person. But if you're caught up in them, if their happiness or well-being becomes relevant to your own happiness or well-being, then you've completed the circuit, and you lose the capacity to have the perspective of being of service to them. It's a long and involved metaphor. Dr. Bob: Yeah, but it's a great one. It's a great one. I'm gonna- Dr. Fratkin: Here's an example. With your wife ... Or actually, with my wife, being with my wife, not you with my wife, but me with my wife ... We are intertwangled. And we sometimes struggle to have enough individuation to understand what each other needs. But we're necessarily, intimately one. One circuit, my family, right? And so I struggle with different kinds of things there than I do in work. It's not a matter of distance; it's a matter of entanglement. When I, for example, being asked to see a 56-year-old person with a brain tumor and two children, the distance I can get in proximity to him is greater than with an old woman who doesn't look anything like my own life. So I have a little bit more room. Others on my team may be able to step right into tending to that father. But for me, I have to create a little bit less proximity in order to make sure that I don't get entangled in the reality of what's going on for him because it so resonates with my own fears and worries about myself. So I can manage the proximity consciously, and by having a team that has a whole different set of concerns and triggers. There, we're intentionally talking about the distance we can tolerate. The best possible scenario is you're almost touching, but not quite. So we have to manage that consciously, and that is one of the ways that I train people around boundaries. This is a very circular way to talk about what I think one of the great advantages of video conferencing in a frame, is that it's literally a frame around the encounter, around the relationship and development. It's necessarily a division. It's necessarily a boundary. And while I can get very close and understand empathically what that person is having, I'm not sitting on their bed. I'm not reacting to their place on the political spectrum, which may be revealed by their red baseball caps or bookshelf. I'm not struggling with my own biases. They are in their most comfortable place as a person, not having had to prepare, go to a clinic, and deal with the waiting room and all the rest of it. They're just at home, as themselves. And I am similarly in a work environment that I've constructed, that I'm very comfortable with. And so, in some ways, the frame around which we ... within which we encounter and develop a relationship, has this necessarily built-in boundary. And so I think that's part of why, rather than two hours, it takes one hour to get to the same place. And that once people have the experience, it's much, much more comfortable for them than home invasions. Dr. Bob: Fascinating. What's interesting is, I'm assuming ... Correct me if I'm wrong, but I'm assuming that this has all just been learned as you built this. The rationale and the initial inspiration for doing video conferencing, I'm assuming, was efficiency and being able to connect with people who are in more remote areas. I'm sure that you had very little awareness or understanding about all these additional benefits and advantages that you've come to, that you're just describing. Dr. Fratkin: Yeah. Well, just like I don't have any idea what benefits and nuances and subtleties I'm yet to discover over the next few years. But yeah, you're right. I mean, I started because I noticed that I have had this amazing smartphone and that I'm using it to text and to call and to talk to people on the phone and all the rest. But I realized that it was worth exploring, whether or not a synchronous audiovisual experience with two people in two different places, working on the same thing together, whether that would work. Because I have this crazy, amazing supercomputer in my pocket called an iPhone. So a lot of it was curiosity. I didn't really quite get the efficiencies and the network development until I started playing around with it. The way that I discovered it was, a friend of mine who works at Google told me about a project that came and went over about 11 months, called "Helpouts." And Google had this project where they were setting up a platform that included video conferencing, the "Hangouts" app, a webpage that you could tell your story about what expertise you wanted to share with other people, a scheduling function, a wallet function, and a messaging function, all on one little webpage. And if you had Chinese cooking that you wanted to teach, you could put your page up there, invite people to take a look, and if they wanted to schedule you, they could. And you'd charge them $15 for a half hour or whatever you wanted to charge. If you wanted to help people with their business plans or filling out their tax forms or whatever other expertise you might wanna share, you were out on the sort of open market, and direct consumer engagement would allow you to do it. So he asked me, would I wanna do it for palliative care. And I said, "Yeah, sure." So I spent two hours throwing up a little thing, and within a month, I had five people reach out to me. And the first person that did was a woman who was in a hospital in the Bronx, in terrible pain, from a metastatic cancer problem. And she was miserable and interested in talking. So we connected, and about five minutes, five seconds, the technology itself disappeared, and there I was, doing my thing. And within 30 or 40 minutes, we're both kind of in tears about the big picture of things. And it was really clear that some basic fundamentals of managing her symptoms would make a big difference. So I got her permission to reach out to the hospitalist tending to her. He was willing to talk to me. I told him, "Do x, y, and z." And the following day, she was discharged from the hospital. And I connected again, and she was so grateful for that advocacy and the difference that it made in her life. And I knew that this could so work. Dr. Bob: Yeah. What a beautiful story to spearhead and show you the impact. Dr. Fratkin: So it was more about just curiosity of what can I do with this crazy iPhone in my pocket? I hadn't really put it together that I was gonna build a social enterprise called Resolution Care at that point. I was just trying to figure out why are we not using this tool? And so I started using it, and it worked. Dr. Bob: That's great. So hey, I have a question. You and I, we're both palliative care physicians. We both specialize and are passionate about bringing people the best possible and holistic support to deal with their struggles and their challenges. And we know what works, right? And anyone who's involved in palliative care understands the value, sees the value on so many levels. On the human level, the financial level, the social level. Why are we having ... Why do you think we're having such a hard time getting traction and seeing palliative care become what it needs to become? Because you're working within the system. You're working with insurers, and you're working with the whole Medicare and insurance billing component, as well as contracting. What's your take on it? What's going on? I know it's a big question. And it's not a simple answer, but I really wanna hear your thoughts on it. Dr. Fratkin: Yeah, no. I think I would probably disagree with you. And only because- Dr. Bob: That's good. I'm happy to hear that, too. Dr. Fratkin: Only because this morning I happened to have a little bit of perspective. I don't know why that is. It might be just; I hit the number of cups of coffee just right. But I think what I would say is it's happening at an almost spectacular pace. It's amazing what's occurred for our society as it relates to our mortality in the last few years. That there's a transformative change in the public conversation around death and dying. I just happen to be pretty well-timed to get up on my surfboard and ride that wave, while also contributing to that wave through having conversations like this one. But let's go back to 2014. In 2014 in October, the Institute of Medicines Dying in America study, the second version was published. It was, I think, 10 or 11 years after they did it the first time, where they did a very deep dive into how people in America finished their lives. And what they basically said in that report was it sucks, and it hasn't changed in 12 years. It talked about how much bias there was and how little capacity there was for palliative care in cancer patients. But they also talked about the aging population, the demographic shifts that are intensifying this sort of tsunami, silver tsunami of people with a greater burden of illness, and the cost of health care, and the absence of focused and targeted support structures for people as they completed their life. And they said, "Why hasn't it changed for 12 years?" A month later, Atul Gawande published "Being Mortal," a blowout success that surprised even him, about bringing this conversation to "How do we die in America?" To a more narrative discussion. And you and I, in our field, we've been talking about these issues for 20 years, maybe longer. And I ask myself ... Well, actually, when Atul Gawande presented to the American Economy of Hospice and Palliative Medicine in 2015, he was interviewed by the Philadelphia Inquirer. And before his presentation, he says, "Gosh, Dr. Gawande, you have this blowout New York Times bestseller. Everybody's reading your book. What are you gonna tell all these hospice and palliative care doctors when you talk to them tomorrow?" And he said, "Well, I'm gonna say thank you. And I'm gonna ask the question, 'Why haven't they been listening to you?" And I was disappointed the next day when he actually didn't ask that question. He [inaudible 00:40:34] from his prepared remarks. But I found myself, for the next few days, thinking about that question [inaudible 00:40:42]. Why haven't they been listening to those of us that have been doing hospice or working with death and dying, working with families very closely, learning what brings value to them? Why haven't they been listening to us? And I think the answer is that we were talking to ourselves, talking to each other, thinking in terms of big health care delivery systems and academic papers and elevating our own careers through the accumulation of initials and prestige and all the rest. The academy of hospice and palliative medicine was academic, an ivory tower, and not really directing its attention outward. And I told Gawande, his voice was completely outward-directed, and it wasn't because he was such a great doctor. It was because he was a son. And being mortal, he's a clueless ears, nose, and throat surgeon who was getting it wrong. Then he, as a son, experienced the challenges that his father faced. And that transformed his perspective as a physician. So his story of conversion was related not to his role as world-famous, world-renowned surgeon. It was related to his role as a son. And so he ... And he's such a brilliant communicator and journalist. Now fast-forward three years later. He is selected by Berkshire Hathaway, Amazon, and whoever the heck, to lead an organization as a symbol of what's possible by thinking out of the box. And as a symbol, that his orientation is grounded, his career has exploded so that he is the leading, most exciting CEO in health care. And he's completely grounded in an understanding of what person-centered care must turn out to be. Dr. Bob: Yeah. That is exciting. That's an exciting development. Dr. Fratkin: And then there's BJ Miller and the traction that he got telling his story as a TED Talk. And then there's Jessica Zitter with her book, called "Extreme Measures." And then there's Shoshana Ungerleider, working in the Bay area, kind of behind-the-scenes, producing powerful documentary films, one of which, "Extremis," was nominated for an Academy Award. But these powerful experiences taking the public into places that we've been populating for decades. The intensive care unit, or the hospital-based palliative care program. And bringing people into that, that wouldn't otherwise look. Not to mention, the millennial spirit of younger people is that they don't blink. They don't avert their gaze at what's difficult. They tend to be drawn towards things that represented shadows for the previous generations. So I think there's a lot happening, that's happening very fast. And in three-and-a-half years, we built this organization kind of on the strength of that, and with the advantage of being an outsider like you, Bob. Dr. Bob: Well, I appreciate that perspective. And hearing you speak, it's inspiring. And it's true. Things are happening. There is a groundswell. I guess my perspective, A) I'm just, in general, a very impatient person. And B) I'm out here in the community speaking. And my of the talks are really focused on older groups, and I still have rooms that are filled with people who just don't really know about palliative care. And when there is palliative care in the community outpatient setting discussed, a lot of times, people have felt that it couldn't fulfill their needs. Because there's A) not enough providers, B) the offerings are not complete enough. And a lot of that has to do with the payment, the reimbursement models. So on the one hand, I do see that we are moving in the right direction, and that's exciting. And at the same time, I'm frustrated because I still ... And as I know, you see this as well. We still see people who are day-in and day-out, struggling, because their needs are not getting met. And we know what they need, and it's just not available to enough people today. Dr. Fratkin: No. It's super true, Bob. I mean, I feel exactly the same way. And for my own psychic well-being, there was a long time ago that I had to make the choice that I wasn't gonna focus on the unmet need or demand as the target of my attention. I was gonna focus on building capacity. And that I was gonna not worry about the fact that I could have burned myself out again trying to deal with one out of four people that I could get to in the hospital. I could have stayed inside of that, like most of us do, just trying to push that boulder up the hill. But what I had to do was to take a risk and say, "For those three or four people I don't get to, in their interest, not the same people but the next three or four or five or six or 12 or 250, it's gonna take some strategic thinking to build capacity." And there are so many sad stories. And as soon as I hear their names or hear some element of their stories, my heart starts to break and be frustrated with them that they don't get the service or don't know that there's a service that would help them. But my focus is not so much on those people; as it is, I know there are so many of them out there that my best efforts are to build capacity to manage and to set the tone of what palliative care capacity building looks like. We believe that it's not just whatever you could cobble together with crappy resources from whoever your institutional home is. Palliative care is best provided by a team of individuals who are well-supported in sustainable, soulful workplaces, but include a nursing perspective, a chaplaincy perspective, a social work perspective, and provider perspective. We are committed to that. So what we provide is actually pretty expensive. And the good news is, is that what we provide delivers to our health plan partners, a three to five x return on investment. Every dollar they spend turns into three to five that they saved. And they can measure those dollars. So they're interested in program development and building capacity for us. We think in the state of California, less than .5% of people who would benefit from palliative care support are getting it. If I focus on that 99.5 % of people who are suffering terribly- Dr. Bob: You'll be paralyzed, right? Dr. Fratkin: It breaks me down. Dr. Bob: Yeah. Dr. Fratkin: But I'm trying to get from .5 to 1. And I'm trying to do it by providing soulful, sustainable, meaningful experiences for my treasured colleagues. Nurses and all these people who, 100 years ago or 500 years ago or 5,000 years ago, would still be doing the same thing. They wouldn't be called nurses; they would be called neighbors. They would be called aunties. They would be called "the ones you call for help when you need it." It's been a part of human society forever, and we are burning out those people in a terrible way. So I'm just as loyal to creating incredible work experiences for those folks, as I am to building capacity to tend to the needs of sick folks, too. Dr. Bob: Yeah. And that's a beautiful thing. And that's how this will grow, sustain itself, by nurturing those who are serving others. Because this work, it's difficult, it's challenging, it is emotionally trying, and as I think we both experienced this, it is such ... It also fills us up in a way that nothing else does. And we don't throw the word "love" around enough. We had a meeting with my team a couple days ago. And when you try to really identify the essence of what we do, and really what we do is we love people, and then we take our skills and our experience and our wisdom, and we apply those in the way that we express our love for them. Dr. Fratkin: For sure. I was talking to a Native American fellow who lives up in the hills. And I was exploring with him his relationship to tribe and culture. And I'm not sure how we got there, and I wish I could remember the pronunciation of the word, but I won't massacre it. But he was explaining to me that there's a word that's being used by the tribe and others that kind of means "thank you," but it's being used in the "thank you" way. In a very, sort of, superficial way. But he said that the word itself is very much more specific. It's the kind of thank you or gratitude that's offered to someone who showed up to meet a need you had. If you're old and someone brings you food, it's the thank you for that. If your roof is leaking, but you can't fix it or afford it, and the guys hop in the truck and start throwing shingles on your roof, it's the thank you for that. It's the thank you for showing up and meeting a need for someone in your community. It's not "Thanks." It's deeper than that. And the presence that we bring, the willingness to love while preserving boundary, the willingness to respect the otherness of these people that we care for. And the willingness to drink a lot of coffee and build out a system to create beautiful jobs and keep the vision as clean and clear as possible. It's the thank you I feel from the community, even if I don't hear it said. I'm so proud of what this team has done for so many people we've touched. 1100, 1200 people who wouldn't otherwise have gotten this care. And that means there are 5-10,000 people who we didn't touch. I'm sad about that, but I'm proud of the work that this incredible team has done over these last three years with very little resource and a ton of coffee. Dr. Bob: Yeah. And a ton of passion and a ton of- Dr. Fratkin: Love. Dr. Bob: Love and determination. And proud you should be, my friend. And I'm excited to continue to follow your progress and the progress of Resolution Care and the impact that you're having. And your model is a model that I'm sure many will want to learn and try to apply in their communities. So before we sign off, I would love for the listeners to go and check out your website. That's resolutioncare.com. And in addition, there's a foundation and an opportunity to help support this amazing, so, so needed care. So you have a 501C3, I understand. Dr. Fratkin: It's called Resolution Care Institute, and there's a page on our website. And if people have a few dollars, they wanna donate, that's absolutely welcome. Yeah. And also, I guess I would ask them, too ... We create maybe once or twice a month what I consider to be pretty high-valued content in a newsletter. And I would love to build the community, so on the website, all you have to do is put in your name and email address, and we'll send you stuff. And if you don't think it has value, you just unsubscribe to it. But I suspect you'll enjoy being a part of our community. We tend to ... We're trying to figure out how to tell stories about the impact of the work that we're doing while getting ourselves out of the way. Just letting people tell their own stories. So we've done that with some videos, and we've done that with some blog posts and other newsletters. And the response we get is favorable. So I'd really like to build that community out if people are inclined. Dr. Bob: Yeah. Awesome. Well, we'll fully try to support that, and to everyone's benefit. And we'll also have the links for Michael's site and the ways to connect with him on our website, integratedmdcare.com. Michael, thank you. You're so passionate, articulate. I could listen to you all day, describing your views and your excitement about what you're doing. And I would love to try to connect again. And I know that there are several things that we wanted to touch on that we didn't have time to, but hopefully- Dr. Fratkin: I'm happy to do this anytime, Bob. This is how we're making an impact, is by telling the truth and sharing that.    

Diane Forster is an Intentional Living Expert and author of "I Have Today". Diane talks about her attempted suicide, how she changed her life and is now helping others. Hear what helped turn her life around.     Contact Diane Forster website Transcript Dr. Bob: I'm here with my guest, Diane Forster, and I'm really excited about having this conversation with Diane. She's an incredibly dynamic woman. I was only recently introduced to Diane through a mutual friend, and this friend somehow knew that Diane and I were kind of kindred spirits and would hit it off and have a lot in common, and I'm excited about where this friendship is going, and I just immediately felt that Diane would be somebody who our listeners would really like to hear from. She has a very interesting story. She's made quite a dramatic shift in her life that was inspired by things that she'll be willing and happy to share with you. Diane, she calls herself an intentional living expert, and she's a coach, mentor, and facilitates masterminds. She is very well educated and trained in NLP and human interaction technology. She works with clients privately in their professional and personal goals, has really helped transform many lives, and it really comes from having hard her own transformation in her life. She's an author, a best-selling author of a book called I Have Today, Find Your Passion, Purpose and Smile Finally, and is the founder of I Have Today, which really focuses on helping women living more empowered, fulfilling lives. Interestingly, Diane's also an inventor, and I will let her share more about how that has happened and what being an inventor has brought to her life and means to her. So Diane, thank you so much for being here. I'm really looking forward to this conversation. Diane Forster: Thank you so much, Bob. Thank you for having me. I'm honored to be here, and I feel the same way, kindred spirits immediately. Dr. Bob: So, we're talking about life and death. As you know, my focus is on ... I mean, I think we have a lot of alignment. My focus is on helping people live a more peaceful and meaningful life in the face of challenges. I didn't necessarily come to this calling, or I didn't find it, it didn't find me for a while, but once it did, it's been driving me, inspiring me, pretty much every moment of my life, and it's about having a meaningful life, and it's about having a peaceful and self-determined end of life. So, you ... In our initial meeting, you really kind of blew me away with where you came from and what you were experiencing and where you are now. So, would you be willing to share a little bit about that? Diane Forster: Of course. I'm happy to. You know when I was in my late 20's, I got married, and I married a man that, we weren't really in love with each other, but we loved each other, and it just seemed like the timing to ... It was the time of life to do that, and I grew up with a mom and a dad who really, didn't really love each other ... Weren't in love with each other, but did love each other. Let me say that better. And so I never really witnessed any real romantic, intimate connection between the two of them, so I grew up thinking that's what marriage looked like.  So, of course, I attracted a man into my life who was similar, and while we had a deep love for each other in some ways, we didn't have that connection, and I struggled in that marriage for many, many years, trying to make it work. And what was happening to me is I just didn't want to walk away. I didn't want to be a failure. I didn't want to give up on it. I thought I could make it work, and it just was not working, and my soul and spirit were chipping away, day after day, month after month, year after year until many years into it, almost 20 years into it, I just couldn't take it anymore, and one night, in June of 2011, I attempted to take my life. I just thought I can't feel this pain and loneliness anymore. And so what happened to me in the bathroom that night, was I had two full bottles of pills in my hand, and I was ready to end it all, and they got knocked out of my hand, and the voice that I heard told me, "You are not ending your life this way, Diane. You need to go get help. You need to tell your story because you need to help others." And being a very intuitive person, I just threw my hands up and said, "Well, you need to show me the way." And so, that was a pivotal moment in my life, and that lowest, lowest point for me was the thing that needed to happen for me to catapult me out of that state and out of that place in my life and really reach out for help. And so I did the next day and reached out to a therapist, and I said, "I need your help. I need to change my life." And so it took about six more months to get out of that relationship, but when I did, after a brief grief period, I went into a deep introspection and personal development and spiritual awakening and ownership of my part of that relationship not working and where I was in my life at that moment, the condition of my life, and I decided in that moment, I want an extraordinary life. I don't want to live this way, and so I really delved deep into everything that I could get my hands on to read and to watch and to attend and listen to, and what was happening to me, Bob, was I really starting to heal in a very profound way and live in a very different way than I had been living before. I was alive. I was awake. My spirit was nurtured and felt loved and what it was that I came to was I had no self love. I had such low self-esteem and low self love for myself, and I developed it in this process.   I started writing a lot. Getting all these downloads, and so I would get this hits of inspiration in the middle of the night, and I would write poetry stories, and one night, in August of 2013, I woke up with a poem I Have Today in my head, and so I got up. I wrote it down right away, and it was I have today to love and be loved. I have today to start fresh anew, and it went on and on and on, and when I finished the poem, I looked at it, and I said, "This is way more than a poem. This is a movement. This is what God was talking to me about that night in the bathroom in June of 2011."  And that's the moment that the idea of I Have Today was birthed where I really wanted to help and support mostly women because I knew so many women were feeling the same way I was, and I see this every day, so that was really where I started back in June of 2011 and where I am fast-forward to today.  I'm now living a life that I've completely manifested, and I've completely reinvented myself, and am living the life of my dreams really intentional and purposeful every single day, and now I help others to do the same thing. Dr. Bob: Wow. I don't know that there's really another word that would actually be appropriate right now, but wow. I mean, you shared this with me the first time we met, and I remember having this feeling, the same feeling, but I'd forgotten part of that story, and it just kind of came back to me powerfully. So number one. Good for you. Phenomenal how beautiful that you went from this place of despair where you were really on the brink of death to where you are now, and not just having sort of reinvented yourself and found your own bliss, but taking that experience and taking that incredible pain that you were going through and using that to fuel the career that has now, I'm sure, been able to inspire and support many, many other people in finding their path out of that. Diane Forster: Yes. Dr. Bob: And not just taking people who are in despair and considering suicide, but taking people who are living an average life or what they feel is a mediocre life and being able to decide that they're going to have an extraordinary life too. Diane Forster: You said the magic word. It's a decision, and it is a choice, and it takes a lot of help. It takes a lot of support, but yes, it is something that you really have to decide for yourself, how do you want to live every day? How do you want to feel every day? And so along my path with it, I've developed a lot of different processes, a lot of three-step processes that I've made it easy for me to catch myself when I'm not living in the present moment and to help and support me on this journey to keep that positive momentum going every single day, moving it forward, feeling alive, feeling fulfilled, feeling the expansion and the growth and all of that. For me, I could've never imaged that my life would've taken the turn that it's taken, but I feel such fulfillment and joy every day helping and serving others to help them create the life of their dreams. Dr. Bob: Yeah. Well, so we were so aligned there, and what's interesting as well is that our journeys have been parallel. I don't remember ever being at that place of despair. I've been married for going on 30 years, and I love my wife more today than I did when we first got married, and I feel very incredibly blessed. It hasn't always been easy. I would be lying if I said that there haven't been challenges and struggles along the way, so I haven't had to deal with that, but I've had career burnout and stress and of course, my own struggles, and in 2011, is when I decided that I'd had enough of the life that I was living and settling for and decided that I needed more, and that's when I got inspired and started doing a lot of soul searching and a lot of reading and a lot of self development and became more spiritual and started on this journey, which has led me to the place where I am now. And then you mentioned August of 2013 as a ... What happened on August 13, remind me? Diane Forster: That was the birth of "I Have Today" when I wrote the poem. Dr. Bob: Okay. That's when you woke up with that poem. So, in April of 2013, just a couple months before that, I had my epiphany where I became very clear that I'm here to help people die, and from that moment on, providence has opened up incredible opportunities and allowed me to then take who I've become and what I've learned to be in this place of supporting people through complex and terminal illnesses. We are working in a different model in many cases with different people, but I feel like we've both received something so meaningful and deep that has allowed us to live with this ... To live on purpose. Diane Forster: Yes, yes. Dr. Bob: To live on purpose. To have recognized that we're here for something bigger and that we just put ourselves into it, learn what we can, and become vessels for people to have the kind of life that they desire and ultimately the kind of death that they wish for. Diane Forster: Yeah. That's beautiful. Really beautiful. Dr. Bob: So, thank you so much for sharing that, and I know I still have stills. I don't know ... When I get goosebumps and chills, it really feels to me that this is a universal truth, there's something really deep, connection that's happening. Diane Forster: Well, I feel it too, and it blows me away. It's cause it's so big. It's so big. My mission is so big, but I'm open to it and receptive to it and willing participant in the journey of it, and why not me? And why not you? This is our ... This has become our path. We've discovered it, and our mission on this physical journey is to do this sort of work and serve in such a powerful, and I feel blessed to be chosen. I know you do too. Dr. Bob: Yeah. Yeah. And I think one of the things that I'd like to put out there for everyone who's listening is we're not any different than you. Right? Diane Forster: Exactly. Exactly. Dr. Bob: You have a path. You have a calling, a purpose that's within you wanting to get out, and if you don't feel it yet, if you don't know what it is, keep looking for it. Keep searching. Keep reading. Keep meditating. Change things that aren't working for you because you're no different than us. You have the ability to have a major impact and to feel like you're in the flow of the universe. So that's what I wish that. Interestingly, I put a post on Facebook; I think it was yesterday about this. I went to buy my son a bicycle the other day. He's 11, and it was a birthday present, and I feel bad because we had put it off for a couple weeks, and he kept asking, "Where's my bicycle?" Well, it's coming. So I went to the store finally to get the bicycle, and the guy who was behind the counter was really friendly, and at some point, he just said, "What do you do for a living?" And I said, "I'm a physician." And he said, "Oh what kind of physician?" And I said, "I help take care of people in their homes with complex and terminal illnesses and make sure that they have the most support and the most peace and comfort possible." And he asked a couple more questions about that, and the kind of dragged out me that I feel like it's my calling that I'm doing what I'm here to do. And he was so ... He immediately kind of latched on to that, and he said, "What does that feel like? I want to know what that feels like because I want to be following my passion. I want to know what my calling is, and I think I might know, but I'm struggling against it." And so he emailed me, and he asked me if I'd have lunch and talk about that further. So it's just another example of when you're living in alignment with your purpose, and what you're here to do, people see it. They feel it, and they're drawn to it because that's what they want as well. Diane Forster: They do. They want to feel alive. They want to feel purpose-driven, and this is a lot of the work that I do too. I do these transformational sessions with people as well because they feel the pull. They pull the call, but they can't identify what it is quite yet, but they know they're meant to do something more with their life and their time here on this planet. They know it, and they feel that gap, that missing link, that piece there, and I get it. I see it every day with people, and I work with people all the time on it because, as you know, now that you're living it, me too, how it drives you. You don't drive it. It propels us forward. And you're right, Bob. Every single person has a purpose, and most of our purposes are defined from our pain. Like mine was defined from your pain, and yours was defined from a frustration and a pain point as well, and that's really where it comes from is through your pain, you might be able to identify what your purpose is. Dr. Bob: So that's where you need to start the search. Diane Forster: Start. Yes. Dr. Bob: Not to give up. Not to feel sorry for yourself, not to stay down and lick your wounds, but to use that as the fuel to inspire, to catapult you towards where you're meant to be. I love that. I feel inspired because we're talking about this concept. I read to my team yesterday. We have team meetings, and I have myself, my nurse practitioner, nurse, outreach director, practice director, and we're all very much on this path of ... We're all just incredibly excited about what we get to do every day, what we get to bring to our patients and to our families, and I read them this excerpt, which I'm sure you have read from Mary Ann Williamson, so I just feel like now would be a good time to do that. Diane Forster: Okay. Dr. Bob: To take a moment here and to let people who have not heard this excerpt from ... It was actually read by Nelson Mandela in his 1994 inaugural speech, and it's called ... I know you're familiar with it. It's called Let Your Light Shine. Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves who am I to be brilliant, gorgeous, talented and fabulous. Actually, who are you not be? You are a child of God. You're playing small doesn't serve the world. I want to read that again. I love that. You are a child of God. Your playing small doesn't serve the wall. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We were born to make manifest the glory of God that is within us. It's not just in some of us. It's in everyone, and as we let our light shine, we unconsciously give other people permission to do the same. As we are liberated from our fear, our presence automatically liberates others. Diane Forster: Just love it. Of course, I love it. Dr. Bob: I know. Diane Forster: In fact, it's my favorite book. That book was so instrumental on my journey, a return to love. It was incredible. Dr. Bob: Me too. It's right up there on top. So phenomenal, incredible. Well, let's ... This is a life and death conversation, and we've been talking a lot about life, right? Diane Forster: We have. Dr. Bob: And I think that's appropriate. In this conversation, the majority of what we talk about is going to be about life, how to enrich life. How to have a fulfilling life. How to get through the fear and have the most joy and meaning and life, but the death part of it can't be ignored. Diane Forster: Right. I agree. Dr. Bob: And so for me personally, that sort of the punctuation mark. I see that we have this amazing life, that we have all this opportunity, and death is sort of the finale. It's the grand finale. We need to be celebrating death, life too, but celebrating death instead of fearing it, developing a more comfortable relationship with it, and preparing for it. Diane Forster: Right. Dr. Bob: And then, we get to have a more peaceful fulfilling life without having to worry so much about what comes at the end. Diane Forster: I couldn't agree more. I could not agree more with that, and I have had my own experience with death. I lost my mom. She was 53 years old, and I'm actually 53 right now, so I can't even imagine that experience for her. So that was over 20 years ago, and she passed away from colon cancer, and nowadays, it would've not taken her life, but back then, that was her path, that was her journey, and I noticed a lot of things transpired within my family and our nucleus during that time because my ... We were living in different states, but what happened in that journey and that time together for all of us, it really does bring out the best and worst in people. When I say that, I don't mean worst like the bad in them. It's just their level and capacity of dealing with something like this, something so big like that, and so a lot of what I teach is in my processes is about that every single moment of your life is a gift, even those different moments, and the way my mother got sick in her journey and her passing was such a gift in my life. I felt her love. I knew how much she loved me. She knew how much I loved her, and what came out of that was my father and my sisters and I became incredibly close. Now we were close before, but we came incredibly close and formed family traditions that we've been carrying on. My kids have grown up with them. My nieces sand nephews have grown up with them, and it really changed our relationship. I told you I'm really intuitive, and I believe it was my mother who knocked the pills out of my pills that night without question, and what I'd want to say to your listeners is that even though they cross over, and they die, and they stop their physical experience, their human experience, they are still around and aware, and you can still have a relationship even though you can't see them. You can still feel their presence and their essence around you, and that it's their journey. It's their path, and there's really nothing you could've done about it anyway. It's that guilt that we take on, but that's their contract with their experience of how much time they're supposed to have here, and so just to live intentionally, live in the present moment, and really just embrace them for exactly who they are and what their journey and their path is. So anyway, I just wanted you to know that I've had first-hand experience with losing somebody that I loved deeply, early on in my life, and what I got out of that experience for all of us. Dr. Bob: Thank you so much for sharing that. I could actually almost feel your mom's presence as you were describing that and talking about how she impacted that ... How she knocked the pills out of your hand. I believe that as well. Diane Forster: Yes. Dr. Bob: You know the interesting thing, what you were saying about people being more present with you after they pass. I had that same feeling with my parents. When they were alive, and both my parents died in the past two or three years. When they were alive, we were very close, and I was fortunate that for the last seven years of their life, we lived really close to each other, but I would only connect with them when I called them, or we were together, and we were either talking on the phone or together in person, and that's when we would be connected. Otherwise, I kind of felt like I was on my own, and they didn't really know what was happening in my life, and I can kind of get away with stuff. Diane Forster: Right, right. Dr. Bob: After they died, each of them ... And they died about a year apart, but after they were gone, I felt so completely aware of their presence all the time, that they were no longer ... There as no longer any disconnect. There was no longer any separation which means that they were there, aware of everything that I was doing, thinking, saying, and I became a better person because I felt like I couldn't get away with anything anymore, and it was really ... It was so comforting for me, and also a little bit disconcerting. Diane Forster: Right, right. Dr. Bob: You know, you can't get away with anything anymore. So, of course, I would rather have them physically here so that I could touch them, hug them, and have that type of connection, but I know that we are not separated. Diane Forster: No. No, and there's only love. That's all that they have for you is love, so don't worry about not getting away with anything. They don't care. Dr. Bob: I get it. I feel that too. There's a little bit of that kind of self, just self regulation or whatever, and I guess I use it. Have you heard about the idea of living your life as if you're always being video ... As if the whole world is watching. Diane Forster: Yes, yes. Dr. Bob: And I can imagine that they would get a little old after a while. Diane Forster: Yes, yes. Dr. Bob: But mostly. Every once in a while we got to turn off the video. Anyway, I feel like ... Well, first of all, everything that you've shared has been incredibly valuable, and do you ever ... In your work with clients, do you ever approach issues or concerns about death and where that might create blocks or anxiety or fear for them? Diane Forster: I do. I do actually. In fact, a recent client of mine is caretaker to her mom, and a lot of guilt and challenges come up around that for her, so yes. So I do work with that, and I do my part to really have her just own her journey and her piece of it and to value the relationship that she has with her mother and see her mother for who she is, and that she is the same person she has always been. That spirit is still the same, and that there are challenges that come up, and I'm sure you see this all time. When you're dealing with something like this ... Like I said, it brings out the best and worst in people, and some people just really don't know how to process that in a way, and so I do a three-step process called breathe, think, praise, and it really allows you to let yourself off the hook and let the other person off the hook no matter what it is, and just breathe in the moment. Take the other person ... Don't take anything personally, what's coming at you, and then allow them to be in their grace of exactly who they are, doing the best they can, in that given moment because that is really what they're doing. That is the best that they have in that moment. So I'm dealing it more with the ... You do too, but I haven't dealt with the crossing over quite yet too much, but what they're still alive and dealing with those situations and the stress that comes along with that. If that makes sense? Dr. Bob: Totally. It totally makes sense because your principles are applicable for every phase of life and every type of challenge that people are facing dealing with illness and dealing with people who are dying is obviously one of the most substantial challenges that any of us ever face. Well Diane, I kind of feel like we can just basically stay on the phone and have this conversation for hours and hours, and I will relish the opportunity to do this again, both in this format and in person and any other way that we can connect because I do think that we're kindred spirits, so it's wonderful. Diane Forster: Absolutely. I'm happy to do it any time. Dr. Bob: Great. So I know that there are people listening who are resonating with your message, with your style, with who you are. I would love for them to have a way to connect with you. So can you share how people can connect and anything else you would like to share about how people can gain value from what you've created? Diane Forster: I'd love to. One of the best ways to get ahold of me is go to my website at DianeForster.com. And then on Facebook, I'm at I Have Today with Diane Forster. And then all other social media is here. But what I'd like you to do is, I have a freebie on there, it's a great gift, three tips on how to get everything you want. So all you do is scroll down and add your name and email address, and it'll get delivered to you, but I have different products and services. I do transformational strategy sessions. I also do a personalized mantra with a session. So if it's somebody who mediates or wants to meditate but hasn't really found their thing that's fitting them, what we do is I take ... Through our strategy session, I put together a personalized, customized mantra just for you. It's specific to you and your life, your fears, your doubts, your goals, your dreams. All of it. So just different things like that, that I do that are really focused on that person's individual needs. Dr. Bob: Fantastic. Well, sign me up for that one. Diane Forster: Okay. Dr. Bob: I want some of that.

Dr. Rob Jonquière is the Executive Director of the International Federation for Right to Die Societies. He shares how euthanasia is helping people who want to die in the Netherlands. Now, assisted suicide is also legal. Hear how this is impacting the country.       Contact World Federation of Right To Die Societies website  San Diego Hemlock Society website 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. Transcript Dr. Bob: Welcome to another episode of Life and Death Conversation. I'm Dr. Bob Uslander, and I'm here today with a guest who I'm anxious to hear from. He's got a rich experience in caring for people at the end of life, and he's really on the forefront of the movement to assist people in having a more peaceful and dignified end of life worldwide. So, welcome Dr. Rob. Jonquière. Thank you for joining me today. Dr. Rob Jonquière: Good evening, yes. Dr. Bob: Yes. It is evening. For me, it's morning, for you it's evening. Dr. Rob Jonquiere: Sorry. Dr. Bob: Can you tell us where you're calling, where we're talking from? DrRob Jonquière: Amsterdam, in the Netherlands. It's evening here at this moment. Dr. Bob: Very nice, and you were just mentioning to me that you're in the midst of winter, but you're having some- Dr. Rob Jonquière: It's not a real winter, unfortunately. It's too hot. They are expecting a little bit colder next week, of course, in my youth, I used to go skating outside, and it is a long time since we have been able to do that, so probably the climate change, I'm afraid. Dr. Bob: Well, as you know, I'm in sunny San Diego right now, having grown up in the Midwest in Chicago, I had my fair share of snowy, cold winters, so I'm feeling fairly blessed knowing what's happening in the Midwest and the East Coast right now. Well, again, thanks for taking time. We met not long ago, a month or two ago, when you were here in San Diego at a conference, and I got to a chance to hear a bit about your background and what you're involved with, and I think we are kind of birds of a feather. We seem to share a belief system and philosophy about how people should be cared for and supported at the end of life. You live in a very progressive country, with respect to this, and you've been a pioneer for many years, so I'd love for you to share a bit about what you're doing and kind of give us a sense of how you came to be in this position. What was the path that brought you here? Dr. Rob Jonquière: Yeah. Well, actually, at this moment, I'm involved in the international movement as it is called, the Federation for Right to Die Societies, which is an international federation of 52 societies, like the Hemlock Society of San Diego is one of the members, and I am the executive director of that federation, which implies actually looking after the website of the federation and assisting the committee or the board of the Board of Directors of the federation, and I came there after I was retired. I had been retired from my work at the Dutch Right to Die Society, NVVE as the name is, and in my retirement, I'm not used to sitting still, doing nothing, and I'm very interested in the whole movement, not only in the Netherlands but also worldwide. When I was working at the NVVE, I was started work there about five days after the health minister brought her bill, an euthanasia bill in the Parliament, so I have been involved in all the debates actually right from the beginning in the parliamentary debates, and as Chief Executive Officer of the NVVE, I've been for eight, nine years involved in the practical situation after the bill was approved in the Parliament, and now we have our official euthanasia law since 2002, and having a law is not the end of ... Well, it is the end of a process, but it's the beginning of a new process, to get people to accustomed to the fact that we have a law where it is legal for a doctor to assist in euthanasia, and aid in dying as it is called today, and we have to see the patients get what they want and that the law is used as it should be. And, of course, it's interesting how I became to be the executive officer because my original profession is a family medicine, so I have been working as a family doctor in the eastern part of the country, and I know from the beginning, I always have been very interested in ... Well, let's say, not the patient with colds, or a little complaints or things like that, but especially the situations in which patients needed guidance, whatever they need guidance in, so I have been delivering babies on the one side of the life, and I also became involved in the end of life guidance, where automatically, in that period, first careful questions came from patients especially patients working in the healthcare field, about my position regarding euthanasia as it was known, but as it was illegal at that moment. And, of course, I had never got training on what euthanasia was, how you do it, or what kind of medication you use, so it's using your experience and trying to sort of help people die in a peaceful and dignified way, and of course having been given this kind of help, I have never reported it, because if I had reported it, I would have been persecuted and probably get before the courts, and I didn't want to do that- Dr. Bob: Of course not. Dr. Rob Jonquière: No, and my patients didn't want to have me in front of courts. They asked me to help. They said not if you're getting trouble, and of course, in the situations I'm talking about, it has been patients with terminal cancer situations, who actually were really at the end of their lives, suffering from their cancer situations, although we have been treating with all kinds of care and medication and help we could. Dr. Bob: So, I want to touch on that, I want to clarify a bit for anybody who would like that, this was occurring when you were a practicing family doctor. Dr. Rob Jonquière: Yes, the '70s, '80s. Dr. Bob: Okay, and you were doing the whole full spectrum of caring for people from birth to death, and you recognized that there were people who were suffering, and you obviously philosophically felt comfortable with providing that support, even though it was not legal. So, first of all, the statute of limitations, I'm assuming the statute of limitations, for that type of activity, is past so that you can speak freely about it- Dr. Rob Jonquière: Yes. Dr. Bob: About your experiences back then. Dr. Rob Jonquière: Well, I can, and I mean, even you can say that is kind of a Dutch culture. I mean, at that moment, I could not go to the authorities and say, listen, I've terminated a life of a patient because she was suffering terribly, so I just said, in my records, that she died because of her cancer, which was actually the case. I only speed up the dying process a little bit. Dr. Bob: Which is the same as the aid of dying laws here in the United States, where the patients are dying. Anyone who is eligible for physician aid in dying is dying. Dr. Rob Jonquière: Certainly. That is now, and of course, in the Netherlands, it is now absolutely normal practice in terminal cancer situations. People are in such a situation, and don't want to go to the real end of the suffering can ask for it, and will get euthanasia without any problem. Dr. Bob: Okay, so let's go back. So you ended your clinical practice. What drove you at that point to stop practicing in the way that you were in that practice? Dr. Rob Jonquière: Well, you know, the main reason is I have always been interested to not only do my work as a family doctor, but I always liked to work in organization, to support, to develop things, to do on education, or research, or whatever, so I did many things besides my practice, and actually that became a little bit too much for a work situation, and then I got the opportunity to become the head of the vocational training program for family doctors, which actually meant that I could go to work on a university. I had the opportunity to be involved in research, in education, in organization, and it was still inside the field of the job and the kind of work I liked, which is family medicine. So, not specifically my work in the field of end of life, just a change of work from being a, let's say a medical practitioner into a person on university working on a higher level. Dr. Bob: Got it, and through that period, were you still working in the end of life arena, helping patients at end of life? Dr. Rob Jonquière: Not intentionally. Not as a kind of idea. There were other things that I was focusing on. You can say that I developed, in that period, the vocational training scheme for nursing home physicians, which is a little bit that way, and whenever in the curriculum of the vocational training, the topic was end of life or palliative care, although they didn't give it that name at that moment, but end of life care, guiding dying people, yes, of course, I was interested in that because it touched a part of my practical work. Dr. Bob: Wonderful. And, then additional sort of responsibilities and opportunities, and then eventually found yourself really diving fully into the Right to Die organization, is that right? Dr. Rob Jonquière: That was also, actually, accidentally. I was looking for ... I don't know whether you know the issue of middle management. Working at a university, I was all the time in a middle management position, and I wanted to take one step further at being, having the end responsibility of something, and then I was invited, actually, to applicate for the job of the chief executive officer of the Dutch Right to Die Society, and of course, the main question they asked me, what is your opinion on end of life and euthanasia, because they were, at that moment, advocating. It's a large advocacy group for euthanasia in the Netherlands, and I could say, I'm in favor of it. I did practice the issue, and I thought it, indeed, should be legalized because I practiced when it was not legal, and I knew what difficult situation that was, doing something, which is very emotional but being allowed to officially talk about it. So that was is where I applicated for a job of the Dutch Right to Die Society, and from that moment I was indeed more than 100% into end of life, euthanasia, medical aid to dying, and all of the developments. Dr. Bob: And, you were there, you mentioned, that euthanasia has been legal since 2002. Dr. Rob Jonquière: Since 2002, yes. Dr. Bob: This was all happening right at the beginning of your tenure there. Dr. Rob Jonquière: Yeah. Dr. Bob: Well, fantastic. Can you describe for people who are listening what the different terms refer to? Dr. Rob Jonquière: The official translation of euthanasia is a good death, but in the Netherlands, we have since the middle '80s, the commission has looked into, and we have, in the Netherlands, defined euthanasia as the intentional termination of life on request of the person who is going to die. So it means that you do something, and the only aim of your action is that the patient is going die, and you only do that if the patient asks for it. So, if there is no request, you cannot practice euthanasia. You cannot practice euthanasia by giving medication, which, as a side effect, will terminate life of someone. Next, to euthanasia, which is an action by giving an injection, we have what we call assisted suicide. I know there is a lot of problems with the term suicide in the world, but we call it assisted suicide. There, as a doctor, you prescribe the medication, which causes death of the patient, but the patient takes the medication him or herself and legally- Dr. Bob: And, is that happening? Is that happening in the Netherlands as well, or has that pretty much gone by the wayside because of euthanasia being legal? Dr. Rob Jonquière: Well, the funny thing is that I've been speaking with my doctors of course, after the legalization, and all those doctors I spoke to said, well, I always want the patient to take the medication himself, so practice physician assisted suicide, still if we look at the figures in the Netherlands, we are lucky in the Netherlands that there is a very quality research and surveys going on what is happening, and there you see that between 85% and 90% or even more of the actions at the end of life is euthanasia, and only 5% is assisted suicide. So, officially, euthanasia is the main, so that's the reason why when we discuss the issue, we always talk only about euthanasia, but assisted suicide is the same, and you see that now some of the patients rather want to do it themselves. Some of the doctors, indeed, say if you want to die, you have to do something about it yourself, and I'm only prepared to give you the medication as you do in California. Dr. Bob: Okay. Is the medication being administered in the euthanasia cases, is that regulated? Is there a specific medication that everyone has access to? Dr. Rob Jonquière: Well, yes, it is officially one of an anesthesiologist, Pieter Admiraal, who you could call the inventor of the euthanasia medication, which is actually you bring the patient in a real deep coma, mostly by injecting barbiturates, an overdose of barbiturates, and after you have checked that patient really is in coma, and doesn't feel anything at all, you give again an overdose of a muscle relaxant, the medication anesthesiologist use when the patient is operated on. Dr. Bob: Okay. Dr. Rob Jonquière: Yeah, and that is now more or less a kind of protocol, and even if you look at our laws at this moment, it says, if you do it, you have to do it the proper way, which is you have to do it according to the medical standard, which is using that protocol, and the assisted suicide is just barbiturate, nine grams or 10 grams or so in a cloud of water. Dr. Bob: That's the same medication being used here, for the most part, the Seconal. Are there specific physicians who are trained in this, or what's that process like? How does a physician get certified or be allowed to do this? Dr. Rob Jonquière: Yeah, in the Netherlands and the Dutch law doesn't say that it has to be a certification. You have to be a doctor. That's the only thing you have to be. You have to follow the criteria of the law. The only certificate doctors are a group of second opinion doctors. Their obligation is, one of the criteria is that you have to consult a second independent doctor about case before you can perform the euthanasia, and these doctors are trained. Yes, of course, about the practicalities, about legal issues, but mainly about what kind of problems there are, and how to give a consultation to a colleague, if they are asked for it, but every doctor can actually practice euthanasia. Dr. Bob: Okay, like in California with the aid in dying, and the end of life option, it just requires a medical license, and the hope then is the physicians who are participating are becoming familiar, are becoming experts on their own. That's what we would hope. Dr. Rob Jonquière: I think that's what's happening. I mean, if you see in the Netherlands, we have of course what is it, 13, 14,000 family doctors, 85% of euthanasia is performed by family doctors, and you see of those family doctors, some 30%, 40% do it more regularly, which is still not more than two or three times a year in the average. So, they get used to how to do it, and there are manuals. We have papers or documents they can consult, and of course, that is where the second independent doctor can help. That doctor is trained. When that doctor comes, they can say, well, everything is okay, but, these and these things are not yet okay, and then the doctor can change that. We see more or less now, that sometimes, especially younger doctors don't go alone if they have to do it, but take an older colleague with them, so train themselves. Dr. Bob: Sure, we have mentors to help guide them. Is there opposition? Dr. Rob Jonquière: And, of course, that is also important of having a law. They are legally allowed to discuss their case. They can openly talk about, instead of having the fear that someone is listening and saying, hey, you have done something illegal and go to the police. Dr. Bob: Is there opposition in the Netherlands that is of significance? DrRob Jonquiere: There is. I don't think it is of significance. The main opposition is from the Orthodox-Protestant churches, and of course, we have the official opposition from the Catholic Church, the higher institutions. We see lower ... What do you call it? Clergy. Dr. Bob: Clergy, mm-hmm (affirmative). Dr. Rob Jonquière: Clergy working with family doctors, and then guiding their dying patients as well, but officially, the Church is against it, and practically we see 10% to 12% of doctors, mostly on religious situations, are not doing it principally, and then you have some 30%, 40% of doctors who are afraid, well, you know, don't know what to do, how to do, and don't want to go into that field. Dr. Bob: They just don't want to stretch themselves in that way. They don't feel comfortable for whatever reason. Dr. Rob Jonquière: Yeah. Dr. Bob: Well, that's fascinating. I that there's a lot of people around the world, and a lot of people in the United States that are clearly in favor of laws that are more favorable towards helping people having a peaceful end of life, you know, I hear so often when I'm taking care of people who are struggling with end of life challenges that we take better care of our animals than we do of our people here in this country, and of course, they are referring to the ease of which we can have animals euthanized but not allowing humans to have their suffering end that way. Dr. Rob Jonquière: What I have heard from one of my opponents once, as well, that's why there is a difference between a dog and a man, a human. Dr. Bob: Easy to throw that out, but just sort of deflect the conversation. So I appreciate ... I know that a lot of people will be very interested in just hearing more of the specifics of what is happening in the Netherlands. Dr. Rob Jonquière: Well, you know, the funny thing is, Bob, if you look at the attitudes in the population, yes, of course, maybe in the Netherlands it is a little bit higher than in other countries, but what I see in my function as executive officer of the World Federation now is that in practically all countries, even in what is seen as Catholic countries, you see a population of over 60% to 70% who are in favor of it. So, it is not the population which is a problem, it is the politician, and the politicians who many times have, of course, have broader responsibilities. You see in some countries, and I think in the United States certainly, you see more influence from the churches on politicians because they are dependent on that kind of situations, and that is the situation we don't know in the Netherlands, and in some other countries in Europe as well. Dr. Bob: The ability to influence politicians that way? Dr. Rob Jonquière: Yeah. Dr. Bob: With financial incentives and other types of influence. That is a problem ... and I know it is not unique to the United States, but it is especially problematic those influences, and in many cases, it comes down to fear and greed and how do you feel that the pharmaceutical industry or the insurance industry, the financial industry, how do you feel that they factor into this conversation? Dr. Rob Jonquière: As far as I know in the Netherlands, it's practically has no influence at all. That's of course because our system is based that if, as a doctor, you prescribe your medication, and the medication is known and accepted, it's being paid out of the insurance money, so what I hear from the States, where you pay, what is it, $3.5 thousand for a shot of Seconal, I don't know what it costs here, but maybe not more than 80, 90, or 100 euro which is paid by the insurance. So, there is no reason for patients not to have euthanasia because it is too expensive. Dr. Bob: Yeah, and that's in the Netherlands. I'm kind of trying to get the sense of the impact in the countries that don't have, you know, a national health service that covers the cost of care, and I'm sure there is some- Dr. Rob Jonquière: Then, it's what you see in the States, where actually, again, it is something which can only be done by patients who have the money for the medication. Dr. Bob: Well, can you give a sense of where you think things are heading worldwide? What's your prediction? Dr. Rob Jonquière: Well, I see the last years, there are changes going on. You see gradual changes, if you look at the United States, of course, you see more and more states getting over to laws, and unfortunately, there are impediments of financial reasons, but we see a change happening. I don't hope, actually, your new president will change something in the federal situation, because your Supreme Court is now more conservative, so if it comes to federal Supreme Court things, then you'll have some problems, but I see changing in the States, of course, changing Canada has an important push into America, I think. I see changes in Australia since Victoria has now a bill which will be in effect in 2019, I think, in June, and think that Victoria having passed a bill will mean the other states will also pass bills. They have been trying to do that, so there you see a gradual change and the only thing is I have no idea about Africa, which is, of course, a large continent, except South Africa, but that is practically not what I would call an African continental nation, but there is no movement at all in those countries as far as I know. And, in South America, we see Columbia having a law, and I know that countries like Ecuador or Chile who have even, in these kinds of laws, are more progressive than the Netherlands sometimes. So, I could imagine that maybe if they want that they would be able to change laws in this direction sooner. Dr. Bob: Well, it does seem like we're in general moving in that direction- Dr. Rob Jonquière: Yes, I think so. Dr. Bob: Many states have bills that are being discussed, and when you refer to Australia, I'm interested in that. I just read a book called Dying, which was a fascinating account of a woman dying of metastatic melanoma, who was living in Australia, and had actually obtained medication through an online source, but was very reluctant to utilize it or let anyone know she had it because without there being a law in Australia, anybody who had knowledge of this, or who supported her, would potentially be susceptible to being prosecuted for aiding in a suicide. The law in Victoria that you were referring to is that euthanasia or- Dr. Rob Jonquière: Yes, it is euthanasia. Dr. Bob: It is euthanasia. Dr. Rob Jonquière: And, the law is called Medical Aid In Dying, so euthanasia is a possibility, so where doctors actively apply medication and also assisted or giving medication which they take themselves, so they really have a law in the direction of euthanasia. The only thing there is, and that is what you see, is that because they wanted to take the wind out of the sails of the opposition, they brought in a huge number of criteria and safeguards. So, even I have seen somewhere they said this law is the most safeguarded law in the world. You have to comply, what is it, about 68 or 72 safeguards, so it is very complicated, and fortunately, what I see for example is that more and more, just because they are in their fight against opponents, people say you must be ill. It must be a terminal illness. We see in the Netherlands, many people are maybe not terminal because we have what's terminal, I mean, everybody is going to die, so in a way, we are all terminal. So, terminal illness is involved. There's expectation that you have to die within a certain amount of months, so it takes away the whole idea that it is, and that's what I think is important. It has to go about the suffering of the patient. Dr. Bob: And, that's similar to our law here in California. There is that requirement that there is a six months prognosis, which is sometimes difficult to ascertain. Dr. Rob Jonquière: You know, probably like me that the worst issue for the doctor is to say how long you're going to live. Dr. Bob: We're not good at it. Dr. Rob Jonquière: And, you also know patients who you say, you won't live a month, and they're still alive after 10 years, and the other way around. Dr. Bob: So, in the Netherlands, with the euthanasia law, there is not a requirement for the person to have a terminal illness, is that correct? Dr. Rob Jonquière: No. The requirement is that you ask for it, and you have welcomed the request, and you have a well-considered request, and the request must be voluntary. You must be suffering, and the suffering must be unbearable and hopeless, and I always say that is a major issue in our law, the unbearability of suffering is only the patient can say, this is for me unbearable, and the hopelessness is reason for the doctor to say, I cannot make your suffering bearable, so in that way, it is hopeless. And, if you together say, you're suffering is unbearable and hopeless, then you have fulfilled the criteria in that field, and then you have your second independent doctor. You must have no real alternatives et cetera, et cetera. Dr. Bob: And, that really just gives the ... it gives the responsibility back to the patient. It allows them to determine what is bearable or unbearable for them. Dr. Rob Jonquière: For that issue, of course, in the Netherlands, our population, our members of the Right to Die Society are not very happy about the law, because as they say, it is a doctor's law. The law protects doctors against prosecution if they comply with the request for euthanasia, and the patients say, okay, I have to ask for it. That's my responsibility. Okay, I have to tell the doctor it is unbearable, but I'm dependent of a doctor who says, yes, I will do it. And, many people, and certainly, I think that is a kind of why you can't call it progress in our culture, say, if I say have ... my life finished. I'm suffering too much. I want to end my life. I have the right to have my life ended. There the problem always is that if you want to end your life well, and dignified, and humanely, you have the possibility of having the right medication, or pharmaceuticals, and the only way to have the right one is to go to your doctor and ask a prescription. Dr. Bob: So, it's still not perfect, at least according to the eyes of the people, but it's- Dr. Rob Jonquière: It's not perfect if you look at autonomy, things like that, and that is the kind of development I see at this moment in the Netherlands going on, where organizations are trying to find out, and maybe you know Phillip Nitschke from Australia. They're trying to find stuff, well you can't call it medication, but organics, or bills, or substances which can end your life in a humane, quick way, which you get outside the help of a doctor. You can do it yourself. I don't know whether that's good. That's my personal ... I hesitate. Dr. Bob: That opens an entirely different can of worms, and that could be another conversation. Do you have a sense of how many people in the Netherlands make a request, but are not found to qualify according to the physicians who are they are requesting it of? Dr. Rob Jonquière: It is more or less, already for years, we see that about 10 to 12,000 requests every year, a third of them are refused for all sorts of reasons because the request is not well-considered because doctor sees there is no real suffering, or there are alternatives. A third is honored the requests, so between three and four and it's getting a little bit more thousand cases every year died by euthanasia, and then the other third, there the patient dies sometimes before the actually the whole process is started, because the nature of thing is, which we didn't speak about, I think one of the things when I talked to my patients, and I told them, if they really thought their suffering was unbearable, and I could do something more, and they asked, then, in the end, I would really help them. Then I saw, that actually they lived much longer in a rather good quality of life, and died in a natural way, just because they knew they were going be helped if it got really bad. Dr. Bob: Yeah, I had that experience where just the knowledge that the patients have this option available improves their quality of life from the moment I had that first conversation. Dr. Rob Jonquière: Yeah, that maybe is a major positive effect of having a law. Dr. Bob: Yeah. It's one of them, for sure. Do you know the statistics, I'm assuming that you do, but if you don't that's understandable, of what percentage of deaths that have occurred in the Netherland occur as a result of euthanasia? Dr. Rob Jonquière: The latest report ... you must know that every five years, we do a large survey asking doctors about their actions at the end of life, and we have such large and solid responses on it that you can extrapolate your whole population, so you see that the last time, it was a little more than 3%, and I think in the last year, when we had the report from the committees, it was practically 4% of all deaths cases in the Netherlands. Dr. Bob: Okay. Does that seem low to you? It seems a little low to me, for some reason. Dr. Rob Jonquière: Yes. Well, it is low, as many people think. Sometimes, if you don't know the numbers, they give you the idea that in the Netherlands, when you walk in the street, and you look a bit ill, you are killed by euthanasia. That is not happening at all, and I would say it is only 4%. We see a gradual increase in the numbers and in the percentage. I think it is too early yet to see whether that is going be a steady phase, or whether we're still growing, growing further, but certainly, it is not as many, especially opponents suggested, as soon as you legalize, you open the door to thousands of- Dr. Bob: The floodgates come in, and people are knocking down the doors looking to be euthanized. Dr. Rob Jonquière: But, of course, I realized when I was working with the Dutch Society that since we are a rather small country, so our total death cases are about 140,000 every year if you talk about 4 percent, you talk about 6,000 euthanasia cases every year. If you live in a country like the States, where you have millions more, probably a higher death number, and then you talk about only 4%, you're talking about a large, larger numbers which are, if you look at what papers or communications say about it, it is, of course, more impressive than when we started to talk. We had 2,000 cases every year, which you can say, oh it's only 2,000. Dr. Bob: Well, this has been really educational, and I think fascinating, and I know many of the listeners will appreciate what you shared, now you're speaking around the world. You go to the Federation meetings, and is their information or issues that you feel would be important to bring out that I didn't have a chance to ask about? Is there anything that you think that you hear questions over and over again that you feel would be valuable? Dr. Rob Jonquière: Oh, I think what we addressed today is more or less what is generally felt. It's of course important that if you talk, if you're interested in the issue that you should orient yourself on the right arguments and don't listen too much to the opponents, because many times, I see opponents misusing ... for example, the numbers we produce in the Netherlands, just to give you a small example, we had in '85 or '90, the first large survey and it appeared at that moment that a thousand times every year, a doctor terminates the life of a patient without having a request from the patient. Of course, everybody said that is wrong. I mean, you only do it if there's a request. If you don't do it on request, you're actually committing a murder. We see that number getting down to the last time, I think it was about 100 cases every year, and even there, we know those 100 cases were no murders but were specific situations, for example, very small children who were suffering enormously where doctors terminated life or terminated suffering actually, and officially, performing euthanasia without request, because a small child cannot ask it, so it is a very small number, and even that small number can be explained from humane actions by doctors, and still our opponents tell that in the Netherlands, they kill a thousand patients without request, and that kind of messages, I see everywhere in the world getting around, and getting first at patients or people who are interested in the issue. So, one of the things I mostly do when I speak around the world is explaining our situation in the Netherlands, and say, it is different from what you hear from the papers because they use those wrong figures. Dr. Bob: Well, that's really helpful, and I think it is important to caution people to be careful about the information that you are letting and- Dr. Rob Jonquière: Especially nowadays, don't take in fake news. Dr. Bob: Yeah. And if people want to get more information or learn more about you and the Federation, the website is www.worldrtd.net. Right? Dr. Rob Jonquière: Yes. That's right, and there you can get every information. You can get general information of what's happening around the world, and of course, you can find the addresses of the 52 national societies with emails and with website addresses, so from there on, you can click wherever you want to go.    

Cathy Spatuzzi is a yoga and fitness instructor who works with Integrated MD Care. She shares how she helps patients and her views on why she doesn't fear death and, instead, makes sure she is living in every moment.   Books on End of Life Being Mortal, Atul Gawande Knocking on Heaven's Door, Katy Butler Find more in this blog post, here. 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. Transcript Dr. Bob: Hello and welcome to A Life and Death Conversation. I'm here today with a good friend and a really valued member of my Integrated MD Care team Cathy Spatuzzi. I'm very excited to introduce you to Cathy and to hear some of her insights. Cathy and I have known each other for a bit, and we've shared some incredible experiences with our patients. We're going to touch on some of those, let you know what Cathy does and how she does it because I think she's really quite an expert in her field and I know that she loves what she does. So, Cathy, thank you for being here and joining us. Cathy Spatuzzi: Hello, Dr. Bob. Thank you for having me. Dr. Bob: Yeah, my pleasure. It's great to see you. I'll share that trying something new, our podcasts, the ones that I've done previously have all been recorded on the phone. Today Cathy is in the office, and we're doing it together. It's really nice to be able to look at her in the eyes as we do this. Cathy Spatuzzi: Yeah, I agree, face-to-face is very nice. Dr. Bob: Yeah. So Cathy is … her title is yoga and fitness instructor. I know that there's probably a lot of yoga and fitness instructors out there who work in various capacities but that doesn't really begin to explain quite what Cathy does because I've seen her in action and I've seen the results of her work. It's nothing short of magical; I have to say. Cathy goes in and works with some of our sickest and most frail patients. She works with people who have dementia. She works with people of all ages and abilities. They don't even know they're exercising. They actually just think they're playing games and meeting a really cool, fun, person. So Cathy, can you just share a little bit about how that happens, what you do, how you approach your patients and just share a little bit about how that magic happens? Cathy Spatuzzi: Sure. So I got my yoga instructor certificate, and I started teaching seniors. I took an extra class in teaching seniors, and I really loved it. Then I met Dr. Bob, and I've always been a physical exercising person myself, and so I've made up my own little program where I go into a person's home, and we have a whole hour of exercise. So we do physical weights, and whatever that person needs at the time, that's how I meet their needs. So we do dancing, we do marching. I bring some music sometimes. I have little balls that we do exercise with. They're bright and colorful. We play games with the balls. I also have just blown up regular balloons, and we hit the balloon back and forth and play a game that way. A lot of people that used to do tennis or volleyball, they remember that, and their muscles and cells remember that and they really get a lot of fun exercise just hitting the balloon back and forth. They tell me lovely stories. Most of my people are 80 to 90, some are a 100 years old, and they tell me fabulous stories. They all have a very positive attitude in life. Dr. Bob: I've met with people, I've been there after you've been with them and it really is pretty dramatic. A lot of our patients, because a lot of times they don't feel well, they don't have a lot of energy, they're dealing with pain, they're dealing with other challenges, and exercise is not something that they necessarily prioritize or look forward to, but that's not the case with you. They obviously don't feel like they're doing exercise. They don't feel like they're working. There's something else. There's another piece that obviously you're bringing to it, which, to me, it feels like you're just really connecting with them very deeply and appreciating them as human beings, and the exercise just happens as on the side. Cathy Spatuzzi: Yes, I agree. I don't think of it as exercise myself. I go in, and I have fun, yes, and I connect with that person one-on-one, find out what they like, what else do they like, then I bring that in with them. Dr. Bob: We've shared a couple of patients that had had some pretty remarkable experiences, people who were not expected to live more than a month or two who through combined efforts have gone on to live for a couple years, people who were not walking who are now walking half a mile to a mile without difficulty. Can you share maybe a little bit about what that's like for you to be part of that? Cathy Spatuzzi: It's a gift. I love all my clients, but to work one-on-one and to see a person that was maybe almost on their deathbed to come back and is living and they want to have a life. One of my sayings is motion lotion. If you don't move your body, you're going to get stiff, and you're not going to feel like moving so let's just keep moving. Some of my other seniors that are more fit, that's what they say, you have to keep moving, you have to keep moving, you have to keep moving. So I keep them moving. Dr. Bob: You keep on moving, and you keep it fun. Cathy Spatuzzi: Yeah. Well, you have to have fun in life, so why not bring it to your work? Dr. Bob: Yup, I agree 100%. So this is A Life and Death Conversation, and part of what we're trying to do is give people just a look into how we can have an easier time talking about topics that can be difficult: death, illness, debility. So as an example, we are doing that there. We're talking about things that might not come up in normal conversation. I, as you know, go right to the point. I don't mince words. I don't hold back a whole lot. I just want to ask you and get some of your personal perspectives on some of these things, if that's okay. Cathy Spatuzzi: Sure. Dr. Bob: All right. Tell me, do you have … and this is a question I ask all my guests. Are you afraid of dying? Cathy Spatuzzi: No, I'm not afraid of dying. Dr. Bob: You're not afraid of dying. Cathy Spatuzzi: No. Dr. Bob: Well, why? Can you share why you're not afraid of dying? Cathy Spatuzzi: My maternal grandmother always talked to me about death. Dr. Bob: Really? Cathy Spatuzzi: It wasn't morbid. It wasn't like, "Oh, I …" I don't know, she just always talked about it. It wasn't something under the covers. Dr. Bob: Just kept in awareness of it in the home? Cathy Spatuzzi: Yeah, like when somebody died, we'd talk about it, or when- Dr. Bob: Okay, how healthy. Cathy Spatuzzi: Yes, uh-huh (affirmative), and so I think I've just adopted her attitude and calmness about it. For me, thinking about dying, I think about living. So I'm alive. I can walk and talk, and do all these beautiful things, but let's be present doing it. If you're just walking through life in a fog, then you're not living, but when you think about you're going to die, maybe that's a point where you're going to wake up and start being present in your life. Dr. Bob: Do you feel like thinking about dying, talking about dying is responsible for you having a greater awareness of and maybe gratitude for life? Cathy Spatuzzi: Yes. I think I have gratitude every night before I go to bed. Dr. Bob: I guess, not being dead is a part of that, right? Cathy Spatuzzi: Right. Driving around and you see the beautiful clouds. You might see an airplane. Let's take each moment for today because maybe you will die tomorrow. Let's be grateful for what we have today, not think about what if, what if, what if it's going to happen. I pray that I have a beautiful day and then I have a beautiful meal and then I go to sleep and die. Not tomorrow. Dr. Bob: Not tonight, yeah. Cathy Spatuzzi: Not tomorrow. I got- Dr. Bob: Because I know you have some things to do this weekend. I know you have some plans. Cathy Spatuzzi: I know, yeah. I have plenty more years ahead of me, but that's what I've always thought about, nice and peaceful. Dr. Bob: Beautiful. Interesting. We both are spending time now with people who believe that they may not have a lot of time left, some of them because they're elderly and some of them because they have a terminal illness, and in some of those conversations, I hear people talking about how their time is so limited. Occasionally, they get into this pattern of feeling bad about it, and I wouldn't say necessarily feeling sorry for themselves, but focusing on how their life is going to be shortened and they're aware of that. I always accept that. I never try to convince them to think differently. That's their thought, and I would never judge that, but what I'm aware of is that there's no guarantee for any of us. I may have a patient who has a prognosis, a life expectancy of three or four weeks. There's a lot of people who are going to die unexpectedly before that person dies. We may be one of them. We have no guarantees, and so focusing on what we have today like you're talking about like you're suggesting being grateful for the fact that we are alive and that most of what's going on in our life is good, may not be perfect. Jon Kabat-Zinn, the creator of the mindfulness-based stress reduction program, had a phrase that I love and I repeated often. It's, "As long as you're breathing, there's more right with you than wrong with you." Cathy Spatuzzi: Yes, I agree. Dr. Bob: Yeah. Cathy Spatuzzi: That's beautiful. Dr. Bob: Sometimes if somebody is lamenting about the pain that they're having, the limitations that they're having, just remembering how many trillions of things are happening simultaneously in our body, the chemical process, the cellular division, the fact that everything is working as it's designed to, except for a few things, which could be significant things, it's still a magical design. Cathy Spatuzzi: Yeah, the body is an amazing piece of work. Dr. Bob: Yeah, and you're doing a great job of keeping it amazing. Cathy Spatuzzi: Thank you. Dr. Bob: Yeah. Cathy Spatuzzi: I love working with the clients, yeah. Dr. Bob: Yeah. Some of our clients die, right? Cathy Spatuzzi: Yes, they do. Dr. Bob: Yeah, they do. How do you deal with that? Cathy Spatuzzi: It's difficult at first. Dr. Bob: Because you spend more time with them even than I do. You're with them sometimes two or three times a week and getting very close, getting very connected with them. Cathy Spatuzzi: Yes. When they die, going into this though, I mean that's part of life, and I knew that but when they die, I go into myself and remember all the good times that we had together, but then that also brings up for me my own experience with my own family and dying. So then it's almost like I grieve all of them: my parents, my grandparents, a friend all over again, which isn't a bad thing. Yes, it's sad and, yes, I cry, but there's another layer of deepening, of healing, of comfort for me. Dr. Bob: So when a patient dies, when somebody who you've been working with a client, it sounds like you're allowing that experience to create another layer of connection with other people who have gone before them, with your family. It allows you to grieve all of death, all of the people who have gone. Cathy Spatuzzi: Yes, I grieve all of the people that have died that I know and then I think about where did they go … all the same, questions come up for me. Where did they go? Where does the spirit go? Where does the soul go? Where does the brain …? I've read a lot of books, and I still don't have any answers. Dr. Bob: Oh, darn it. I was hoping that you were going to give me the answer now. Cathy Spatuzzi: No, I don't have any answers, and that's okay. I'm comfortable with that. Dr. Bob: So you don't know but what do you think? Where do you think … what's your thought about what happens after we die? Cathy Spatuzzi: Well, I believe that the physical body dies. I would like to believe that there is an after realm, rather you call it heaven or reincarnation. Those are the things I don't know, but it would be nice to see some people again that have gone before me. Dr. Bob: So you're not positive. Cathy Spatuzzi: No, I'm not positive. Dr. Bob: What percentage of certainty are you that there's something else? Cathy Spatuzzi: 50/50. Dr. Bob: 50/50. Cathy Spatuzzi: Yeah, and I'm comfortable with that. It's because I've thought about it so much. Dr. Bob: Well, if there is … Oh, that's nice. You're like right on the 50-yard line there. So if there is something else, then that's great, and we'll be hopefully very pleased to find out, and if there isn't, well then we will never know, right? Cathy Spatuzzi: Right. I've asked some of my relatives that were dying. I said, "Now, when you get wherever you're going, wherever that is, give me a sign." Dr. Bob: And? Cathy Spatuzzi: I haven't gotten anything. Dr. Bob: You haven't gotten anything. I have. I think I've shared that, my dragonfly connection. Cathy Spatuzzi: I did have a feeling, but not necessarily like a physical sign, like a picture or something, but I've had feelings of my grandmother touching my hand. I knew it was her. Dr. Bob: Yeah. Cathy Spatuzzi: I knew it was her. Dr. Bob: Okay. So then- Cathy Spatuzzi: So maybe yeah. Dr. Bob: Yeah, I'll go with that. Cathy Spatuzzi: Yeah, yeah, yeah. Yeah. Dr. Bob: Cool. It's interesting because there are … I hear that people are very uncomfortable talking about death. I hear that all the time. People don't want to talk about it. They want to ignore it, pretend it's never going to happen. I don't have that experience with people, and maybe it's just because I draw it out. But in the conversations that I or maybe people who … Maybe those people like walk away when they see me coming; I don't know. But I actually find that people want to talk about it and given the opportunity, they're drawn to the conversation. It's interesting because I find some people want to talk about a bad experience and maybe it's because I'm a physician and I make it safe, but they want to share how traumatic this was and complain … not complain, but just put it out there and it seems like it's little cathartic when they talk about how difficult an experience was. Then there's another group of people who were really transformed by a beautiful experience around death and dying of a friend or a loved one, and they also want … it's cathartic for those people as well. I find it really fascinating how much people want to have this conversation when it's brought up in a way that's safe, and someone clearly wants to hear what they have to say, what their thoughts are. Cathy Spatuzzi: I have found that some people just need somebody else to listen. They haven't found that person, and maybe that's you. Dr. Bob: Yeah, maybe, maybe. I'll tell you that sometimes my wife, Sandy, it gets a little overwhelming for her because she's with me and we'll be either at dinner, we'll be at a party, and I start talking to somebody and she goes away and comes back, and we're deep into this conversation about how their mother passed away or the complexities of certain situations. I just find that that's sort of a natural thing that's happening. Cathy Spatuzzi: You have a gift. Dr. Bob: I don't know it's a gift, but it's an interesting phenomenon, so. Cathy Spatuzzi: Yeah. Dr. Bob: Do you have any experiences that were either challenging or really beautiful that you want to share? Cathy Spatuzzi: My maternal grandmother, Jenny, she was 80 years old. She fell and broke her hip. I was her guardian because my mother had already passed away years ago, which is a whole another story. But I was in the nursing home room right beside my grandmother, and she was dying. I could see her coming in and out of what I call crossing the veil. She wasn't exactly sleeping, but she was testing the veil and then coming back. She'd come back, and she'd say, "Oh, Cathy, you're here," and then we would talk and I was able to tell her how grateful I was for all the time that I got to spend with her closely after my mother died. She said, "Oh, I want to die," and I said, "Okay, I don't want you to suffer. It's okay." She said, "But I don't want to leave you." I said, "Grandma, it's okay. I'm going to be fine." Then the next day she died. So, and I've heard this similar kind of story from several other people and the person that's dying just needs permission. Dr. Bob: But you weren't there when she actually died? Cathy Spatuzzi: No, I wasn't in the room when she died. I was there the day before. Sometimes they don't want to die with you in the room. Dr. Bob: Yup, that happens frequently. Cathy Spatuzzi: Yes, yes. Dr. Bob: Which is hard, which is a challenge because you don't want to leave. A lot of times people don't want to leave. They feel like they're supposed to be there through the very end, to the last breath, and it's hard to know what's happening. So there are times when someone does step away, they go to the bathroom, they run out to get something for somebody, and they slip away, and that's the way it's meant to be. Cathy Spatuzzi: Yes, I agree. Dr. Bob: Yeah. When you describe … what was the word you used? Cathy Spatuzzi: Crossing the veil or testing, testing the veil. Dr. Bob: Crossing the veil. Testing the veil. Can you share a bit more about that? What made you believe that she was testing the veil and not just like napping or falling asleep briefly? Cathy Spatuzzi: I can't describe it any other way, but I could feel her body, her spirit, not really her physical body, but her spirit, her soul, and I didn't … I could see something but it's kind of this feel-see type of a thing, and I knew she wasn't exactly sleeping because I could feel it going out, this energy, and then coming back in. When she would come back in, you would see her body be more alert and then she'd open her eyes and then we'd talk a little bit and then … I could tell if she was sleeping versus doing this testing. Dr. Bob: Fascinating. Cathy Spatuzzi: Yeah. Dr. Bob: Yeah. Cathy Spatuzzi: It was great. Dr. Bob: That's great, yeah. I hear about, read about and I've seen people who I believe are in that place. Testing the veil, I haven't heard that description, but I like it. I truly believe that as people get closer to death, they're in two worlds, right? Cathy Spatuzzi: Yes. Dr. Bob: They cross. They slip back and forth. So if we really believe that, then it certainly gives us a little bit more comfort and assurance that there is something on the other side because that's what they're testing, that's what they're exploring. I've seen people in the last moments or hours of life reaching out, talking about people who they see, loved ones, and I know that a lot of people would write that off as hallucinations, as due to medications. They're not really there. But I completely believe that they are making a connection with the spirit world and those who they are going to be reunited with on the other side. I can't prove it. I know that there are books written about it, a number of good books, and we can put some of those resources on the website to share, but I implore people, I welcome you to read some of these things because it really does provide quite a bit of comfort. If you're uncertain or you're worried about everything just ending or what might happen after death, reading about the experiences of people who fully believe that they were on the other side and came back to be able to tell about it can be very reassuring. Cathy Spatuzzi: Even the people that have been in terrible car accidents and then they've been rushed into the surgical room, and they have a story that they're up on the ceiling watching their body being operated on and then after that, they come back in, and they come and tell their story. Dr. Bob: Yeah. Cathy Spatuzzi: So, yes, it seems like a very pleasant place. Dr. Bob: Yeah. Cathy Spatuzzi: Yeah, but I guess- Dr. Bob: No, I don't think I have ever heard anybody come back and say, "Wow, that was really bad. I mean that was like fire and brimstone, and I don't want to go there." Of course, as a physician, I'm supposed to be very scientifically minded. I know there's a lot of cynics, a lot of skeptics, and everyone is welcome to their own beliefs and opinions. I choose to believe that there is something beautiful waiting for us and you have the ability; we have the ability to access it on this side. I do believe that the walls become more permeable, the closer we get to death. I feel that comforts me and apparently, you've had experiences where you feel the same. Cathy Spatuzzi: Yes. Yes. Dr. Bob: Yeah. So I just want to ask one last question before we wrap it up. What's most important to you in life? Because this is life and death. We talked about death. We've also talked about the way that you enhance people's lives, which is incredible. But for you personally, what is the most important thing for you in life that makes life really beautiful for you? Cathy Spatuzzi: Being present as best I can in the moment and being kind to myself and being kind to others. Dr. Bob: That's a good way to be, and you are doing that incredibly well. Cathy Spatuzzi: Thank you, Dr. Bob. It's a pleasure. Dr. Bob: Yeah. Thank you for being with us. I look forward to having you back on another time if you're willing? Cathy Spatuzzi: Sure, yeah. Thanks for inviting me. Dr. Bob: All right, you have a good day. Thanks, everybody for tuning in. Cathy Spatuzzi: Bye. Dr. Bob: Bye-bye.

A long-time nurse shares her personal story about her father's end-of-life experience. Hear what the aid-in-dying process was like for her and her family.       Transcript Dr. Bob: The person I'm going to introduce you to today and have a conversation with is a woman who I haven't known very long but in the short time that we have known each other we've become very close friends and co-creators on this journey around exploring how to make the best out of life and helping to support people through complex illnesses and approaching the end of life. Her name is Jillian Alexander and I'm just going to tell you a little bit about Jillian and then I'm going to turn it over and let Jillian tell you more about herself. I think it'll be a fascinating discussion. Jillian has an amount of experience both from a professional standpoint and from a personal standpoint. We've had many conversations and I'm excited to introduce her to you. Before I go on and talk a little bit more about you, Jillian, why don't you just say hello? Jillian: Hello Dr. Bob, nice to talk to you. Dr. Bob: It's wonderful. Thank you so much for taking time to be with me. Jillian is a nurse, she's a registered nurse and has been for 35 years though if you look at her you would think that she actually finished nursing school when she was eight, so it's hard to believe that. She's been a registered nurse and has worked in both pediatric intensive care units and neonatal intensive care units, so a lot of her clinical work has been in the pediatric setting. In 2012, she completed a Master's of Science in nursing and she specialized in education. Now, she's doing a lot of educating of other nurses in obstetrics and pediatrics. Her personal experience with supporting people has been like many of us in the healthcare profession, we take care of anybody who asks us to and especially family members. Eight years ago Jillian's sister, Lauren, her younger sister was diagnosed with ovarian cancer and at that point Jillian took a leave from her job and spent three months with her sister when she underwent surgery with a port placed in her abdominal cavity so that they could administer chemotherapy directly into the area where the cancer was. She went to all of her sister's treatments and after that, her sister actually did really well, Lauren did well and had five years during which time she was in remission.  But in 2014 the ovarian cancer returned and they started together as a family looking at treatment options, doing a lot of research, looking into clinical trials, traveling. Lauren was blessed to have fairly extensive resources available to her so she was really able to find the best care that was available at the time. Despite that, the cancer continued to spread and in 2016 it became apparent that the treatments were not effective, she was getting extremely weak, and having issues with bowel obstructions. That's about the time that I was brought into the picture, so this was late in 2016. Jillian continued to live in the San Diego area, taking an extensive leave from her career, from the family that she had out there, and was an amazing advocate for her sister, to try to give her the best possible quality of life and support during what she knew to be the final phase of Lauren's life. Lauren passed away, I believe it was in January 2017, is that correct? Jillian: Correct. Dr. Bob: It was truly an incredible experience to be a) working that closely with Lauren and support her, but I was completely blown away and amazed by the level of commitment that Jillian showed by her sensitivity.  We created something almost like a little hospital/hospice setting and we were able to give Lauren a very beautiful and very supportive environment for the final weeks, months of her life. Since that time Jillian's her life has taken a completely different turn and I'm going to turn it over now and I'm going to allow Jillian to talk a little bit about what that experience was like and what's happened in her life since then. Jillian, a) thank you for being my friend, b) thank you for what you bring to people, and c) let's hear what's been happening for you. Jillian: Thank you, Dr. Bob. That was really sweet. The first thing I really want to say is that, even though I had been a nurse for 35 years, I really didn't know what to do to help my sister. She was so ill, she had a couple of extensive stays in the hospital where they would do another CAT scan and ended up putting a port into her lungs because they had to drain fluid from her lungs every day so she could breathe.  I was really struggling to find her palliative care. I didn't really know exactly what it was and my sister was a real fighter. She didn't want to hear and she would say, "I hope they don't give me my hospice card this time." The “H” word was a bad word and so I didn't know what to do because outside of hospice how do I find someone to help me? I started searching and I had a friend, who happens to be a palliative care physician, who said, "They have to have palliative care, ask them." I started asking her oncologist to get me palliative care and they set me up for an appointment.  But it was three weeks away and my sister was so sick, and I didn't know what to do to help her because she couldn't be at home in her condition without, like Bob said, a hospital type room in her home. I wanted her to be at home and she wanted to be at home. When they gave me Dr. Bob's phone number and I had the first conversation with him, I knew right away I had found the right person. I can't explain how desperate I was and how many dead ends I was facing when I tried to advocate for my sister even something as simple as helping control her pain.  Because she had a bowel obstruction, she couldn't take medicine by mouth, and I knew that a fentanyl patch would help her, but the oncologist said she had to be in hospice to get a fentanyl patch. I said, "Well, why?" I couldn't get her the help. When I finally met Dr. Bob, within 24 hours we had her at home, on a fentanyl patch, with IV medication to control her pain when that didn't work, and everything we needed to keep her comfortable. Every medication and it changed everything from this aura of suffering and fear to there's somebody here that's going to help us go through the next phase of our journey. Finally, someone ... Honestly, Dr. Bob, you were the first one who said to my sister, "You're too sick to have treatment. Maybe if you get stronger,…” because she just wanted treatment, treatment, treatment, and nobody said that to her. Nobody said you can't have treatment;  it was a relief to stop trying to find treatment somewhere. She was ready to go to Mexico and try anything she could because, like you said, she had the resources and the fight in her to try to stay alive.  But you can't always win. Sometimes you're going to cause more suffering than you need to and that's where you helped us to make a bridge, so to speak, for that next experience, and made it palatable, and made her understand and accept what was going to happen. Dr. Bob:    Jillian: It really was beautiful. Dr. Bob: From my perspective, I didn't know her that well, and we just met, and it was a really challenging.  It was challenging on many levels but, knowing what a fighter she was and hearing from everybody and her husband who would not hear anything other than full charge, whatever it takes we're going to do it and we were not going to quit. I don't think we mentioned how old she was at the time. She was very young, she was 53, is that- Jillian: Mm-hmm (affirmative). Dr. Bob: I knew that she wasn't ready to just throw in the towel, but I think as we discussed the best approach we had to keep hope alive for her that there was a possibility that she could resume treatment at some time so we never ... I wouldn't say no treatment is going to help you. It was really no treatment is going to help you right now and it's likely to harm you. Now, the focus is on finding a way to be comfortable, to build yourself back up if that is possible,  and we'll do everything we can to keep that possibility open. She was incredible. She had a naturopath coming in, she was getting infusions of amino acids and other types of supplements that would be beneficial. She had a masseuse coming in and helping to keep her muscles relaxed and she had a team. You were a major part of building this team, but I think what you are lacking and what I was able to come in and provide was a leader of the team, a captain of the ship, to help  coordinate all  the things that needed to be put in place and keep you and the family from being so incredibly overwhelmed. It was a gift for me and you stepped up like nobody I've ever seen. An incredible champion for her in an incredibly complicated environment. You were my teacher as well and I think. Jillian: I think what I would say about that is sometimes you have to meet patients where they are. It's not about you; it's about the patient and, even though I would've dealt with it differently because I know so much and I knew what was happening, we really tried to meet her where she was. She knew she was dying; she would say little things like, "I don't want a funeral,”—just blurt it out all of a sudden—or other things that she would want to happen if she died. She told me her dying wishes for her siblings and family members, but she didn't want to accept it and actually was taking a medication up until two days before she died that was maybe going to help her. I supported her in that too because I felt it was her journey and her decision to try as hard as she felt she wanted to try. Dr. Bob: Yeah, and she wasn't doing it for herself. She was doing it for her family because she had children, the youngest of which was 12, and leaving him was the main thing that was causing her so much angst. We weighed that when we looked at the pros and cons of that medication.  We all came together and we felt like, well, this is a medicine that's probably not going to cause much harm. It's unlikely to provide many benefits, but emotionally, psychologically there was value in it for her. Jillian: Right. I actually felt like the medication might cause her harm but that it was still her decision to try to take it if she wanted. Dr. Bob: If it's okay to mention—one of her wishes, before she died, was to see you married, right? Jillian: Mm-hmm (affirmative). Dr. Bob: This was a pretty special moment because ... Is it okay if we share that? Jillian: Yes. Dr. Bob: Jillian had been divorced for some time and she had a man in her life who she was anticipating marrying at some point, but Lauren, she wanted to see her sister married and she didn't want to miss that. Literally a week before she died, she coordinated the family to come together at the home and was able to see Jillian and her husband share their vows and get married, which was just an incredibly beautiful experience and I was honored to be part of it. Jillian: You were the minister. You said, "And the power invested in me by Lauren," but she had been so sick I didn't know if she was going to be well enough to be participating.  But she had this rejuvenation and had more energy than I'd seen her have in probably two weeks. Stayed up for four hours, and had a smile on her face all night, and was so happy. I'm not really sure why that was so, so important to her. I think she wanted my family, my mother, my siblings, my children to love my husband as much as she had come to love him. I think she wanted them to accept him and I think she wanted to thank him because he also had come to San Diego and was doing whatever she needed because that's the kind of person he is and she had just fallen in love with him. It was really amazing. It was New Year's Eve and I remember saying to her, "Why don't you want a normal dying wish? Like having Bon Jovi come to your house or something?" I was a little uncomfortable with all of the attention but it really was a beautiful night and I think any of us who were there will never forget how special it was. Dr. Bob: That's for sure. I will never forget it. She did, she rallied, and she was beautiful and radiant, and it was, I think this final celebration that she was able to create and make incredibly meaningful. Then she, like we said, she died less than a week later. You were with her there, supporting her in her last moments. Let's talk a little bit about what's happened for you since that time. Out of this tragedy that was able to ultimately be a beautiful and peaceful end-of-life experience, what's happened for you since then? Jillian: After that happened I think that what came together for me was the challenge of finding you and finding a way to give my sister a peaceful death at home.  It started to really bother me that people were dying in hospitals and ICUs, and families were being asked silly questions like, "Do you want us to do everything with your 85-year-old mother who has pneumonia," and people were dying on ventilators. It really started bothering me that we weren't allowing people to be at home.  I did a lot of reading and I thought, "I think that this is really what I want to do. I want to help people at the end of their life," because being at the end of your life and having a peaceful death and exit from life is as important as being born, which is where I practice on the other end of my spectrum. I do obstetric clinicals and I take nursing students to see deliveries of new babies. I feel like entering the world and exiting the world are both equally important and we are not doing a good job at helping people exit the world because our education with nurses and doctors is focused on not letting people die and keeping people alive rather than the inevitable. Since everybody's going to die, we need to spend a little time thinking about how that should happen and how we might want it to happen for ourselves. I'm getting my advanced practice degree in palliative care and that's what I really want to focus my career on because it's so important. I'm trying to get it embedded into nursing curriculums so that nurses learn about palliative care and how to get those resources at the end of life and don't have to feel so alone the way that I did when my sister was so sick. Dr. Bob: I think that's so beautiful and I know that Lauren is proud that her experience has motivated you to follow this passion, to follow this guidance, and put yourself in a position to be able to truly help people who are so desperate for the kind of support that you're talking about. I'm thrilled that someone like you —because I've seen your dedication, a senior level of commitment—is going to be entering this field to be furthering the mission and furthering their education of the next wave, the next generation of nurses and doctors. Good on you. Jillian: Thank you. Dr. Bob: You shared with me you have some other personal experience prior to what you went through with Lauren and I wanted to just ask you if you would share it.  because I think it was a poignant story and it brings up a lot of the issues that we're still facing in most of the country with respect to helping to honor people's wishes at the end of life. There are now a few states including California that allow physician aid in dying for people who are competent and terminal, but the majority of the country is still without that support and the laws that allow that. You shared with me a bit about an experience with your father that highlights the challenges that come when somebody knows that they're dying and doesn't want to allow the condition to decimate their body and take them down the way that it usually does. Can you share a little bit about that experience with your father? Jillian: Sure. In 2000 my father was 71-years-old and I was living on the East Coast. He was living in California and he got sick, really sick and he was told that he had some type of problem with his liver but that he could get a liver transplant. My dad told me, "I think I'm going to be okay but I might need a liver transplant." The liver transplant is a huge operation especially for someone who's 71 years old. I hadn't seen him but was planning to go see him and my mom called and said, "He's so sick; I need you to come home right now." She was really freaked out and so I flew home that night and when I saw my dad he was extremely jaundiced and I knew he was sick. It was a Friday night that I got home and I was just really shocked. He had lost maybe 15 pounds in a couple of months since I'd seen him. His skin was bright he was weak.   He had a lot of his medical records there, and I started reading them on Saturday. I thought, "Oh my gosh!”  He had a very elevated liver tumor marker, alpha-fetoprotein levels. Back then, Web MD was a little bit newer and Dr. G. wasn't as advanced as he is now, but I could tell that it looked like my dad had liver cancer and so I decided that we needed to take him to UCLA where he was being treated. I called to get him admitted through a friend of mine that worked there. She said, "Sure. Come on in." I was getting my dad ready to go and she called me back and said the liver surgeon on call wanted to talk to me. I said, "Absolutely," and when I talked to him he said, "Your dad has hepatic cellular cancer," which is liver cancer, which is really bad. I knew it was really bad but I didn't know how bad. I said, "Well, what are we going to do? How can we treat it?" Imagining my dad was going to get chemotherapy or whatever they do for these bad cancers.  But he said, "There's really nothing we can do and I don't really think your dad will even live for two weeks." I was shocked and I said, "What are you talking about?" That's a whole long story, but the point is that we stayed in town, my dad had a liver biopsy, and we found out that he, in fact, did have liver cancer. When I found out my dad had liver cancer from the doctor at UCLA it was a Sunday and it happened to be Father's Day but the doctor told me my dad only had 10 days to two weeks to live and I thought, Well, I have to tell my dad right away. He hardly has any time left if this doctor is right and he deserves to know.”  On Father's Day, I told my dad I had bad news for him and it looked like he had liver cancer and there wasn't anything they could do to treat it. My dad got the biopsy and when he saw that valid and true he was so brave and he said, “Well, Jillian, not very many people get to know when they're going to die and how they're going to die.”  He privately told me, "I don't want to be alive in a coma for five or six days. Will you help me?" He was too weak and too tired to do it himself. He asked me to help him get a lethal dose of medication so that he could take it when the time was right. He said, "I don't want you to feel guilty and if you don't want to do it I understand." Of course, I wanted to do it, it was my dad. I would feel the same way, but in 2000 this was not legal in California so I talked to an oncologist and I found out what he told me would be a lethal dose of an opiate and basically an anti-seizure medication. He told me how it would work. I discussed it with my dad, we got the medication in an elixir form, and it was about two ounces, and we put it in an unlabeled container vial by his bed. I didn't feel bad about it at all. I just wanted to make sure that my dad would know when to take it or that he wouldn't suffer, that I wouldn't have to make those decisions, and he kept telling me, "Don't worry, I'll know when to take it." One morning when I woke up he had been really sick the night before and every morning I would open the door and see if the medicine was there, open the drawer and see if the medicine was there. One morning when I opened the drawer the medicine wasn't there and I knew he had taken it. Other people in my family didn't know because my dad didn't want them to know. It was a really personal decision for him. He asked me because I'm was a nurse and he knew I could figure it out but I wanted to honor him. He didn't want my mom, for example, to know that that was what he did. He just wanted to spare himself and her really the suffering of being in a coma and all of the things that go along with that. He died at the end of that day. He died not as quickly as I would've liked. I kept thinking, "I wish I had an IV of Valium or something to help him," because he was struggling and it was really, really hard.  I didn't have you then and I didn't have the medicine then. It was a little more drawn-out than we probably would've liked but I was with him when he passed and it's similar to when my sister passed. I felt this amazing energy of almost like his body floating across the room. I knew when his spirit left his body if that makes sense. He wasn't dead yet and neither was my sister in that their heart was still beating, but I knew they weren't there anymore. Those are the two most personal experiences I've had, but I have had to be with children and babies and families as they died and there is something very spiritual and magical that happens especially when someone isn't suffering and all of those horrible things, choking and dying in that really difficult way. Everybody's going to die someday.  I think you just need, depending on if you have a difficult diagnosis, what you're comfortable with. As palliative care professionals and patient advocates, we need to support patients wherever they are on that spectrum and we need to work to make sure that what is legal to do in California is legal to do in other states or make it easier for people who have that option to choose it. People do choose it in other ways. People literally blow their heads off to stop their suffering or to prevent suffering, and it doesn't have to be that way or I don't believe it should have to be that way is my personal belief. Dr. Bob: As you know, that's my personal belief and I completely agree.  We hear about it people are finding more violent and, unfortunately, ineffective ways to try to end their suffering. Taking overdoses and things that just end up creating more trauma, and more struggle, and guilt for the family. Jillian, thank you so much for sharing that incredibly personal story. Your dad was a physician, right? so he knew what he was facing. I believe that he gave everybody a gift by making that decision. I just want to say I think you're an amazing human being and one of the most compassionate and sensitive people I've ever met. I do believe that we will have many opportunities to collaborate and to work together in support of progress in this arena, and supporting people through challenging illnesses, and having a more peaceful and beautiful end-of-life because it is possible. I truly believe that everybody can have a peaceful and dignified death. We are part of the answer and part of the tribe of people who are working towards making that possible for more people and raising awareness around that. Thank you for being part of the tribe. Dr. Bob: I think this has been a wonderful episode and I'm sure that many people have been touched deeply and learned some really valuable things. Anything that you would like to say in closing before we finish up? Jillian: I think I would just like to say that there are some really wonderful resources and books that are important for people to read whether they're healthy and young or they have an illness because it isn't something that you want to give no thought to until you're put into the position of needing something. You want to think about it and have conversations with your loved ones. I would say that 'Being Mortal' by Atul Gawande is a wonderful book about life and death. He also describes his personal experiences with his parents and as a physician. On the Internet [Andre-as Val-an-dez 34:26 has a YouTube called 'The Conversation', which talks about having those conversations with your parents, with people that are older in your life so that you know how to support them and what they want. What you'll find when you do have those conversations is nobody really wants to die on a ventilator, unconscious, in a hospital. People don't choose that. People end up getting that because doctors are like I said, so much better at keeping you alive than they are at allowing you to die. The other thing that I would recommend is 'Extremis,' which is a short documentary, which really shows what end-of-life can really be when you are in a hospital and intensive care situation. There's also an article called 'At His Own Wake, Celebrating Life and the Gift of Death,' which is in [The New York Times, which is a beautiful article. I can send you the links to all of those so you can post them on your website if you like. Dr. Bob: Absolutely. Jillian: They're just some nice things for anybody to read and be aware of because the fact of the matter is we're all going to die someday, no one's gotten out of it yet. You have opportunities to be proactive but you need to have conversations with people so people know what you want. Dr. Bob: Awesome. That's wonderful. Thank you. Those recommendations, resources we will have available on our website as well. Just having shared that information for those who follow-up and access those resources it can have a profound impact so you're continuing your beautiful work and supporting people. Again, I want to thank you for taking the time and sharing so deeply from your heart. I'm so glad that you and I met. I am forever grateful to Lauren for allowing me in her world and being part of the team and to you for being such an incredible partner in that and for everything that you're doing and will do. Thank you, Jillian, and hopefully, we will have an opportunity to have you back on here and explore more of what's happened along your journey. Jillian: Thank you. It's awesome to be working with you, Dr. Bob, and to have somebody who's brave enough to advocate for patients and to allow what's legal in California to happen because a lot of people it's too controversial for them to want to touch and that's not helping the people who would like to have access to these legal remedies. I commend you for your work and, if it weren't for people who are willing to stand up in tough times, things would never change and I think that we really need to change how we're letting people die in our great country. Dr. Bob: You're doing it; you're not just talking about it, you're doing it. All right, you take care and we'll talk soon.

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.

Dr. Ken Druck's work in personal transformation, male psychology, parenting, and grief literacy has awakened readers to their absolute best selves for almost four decades. In this episode, Dr. Druck and Dr. Bob talk about healing after a loss.     Contact Dr. Ken Druck website Transcript Dr. Bob: I'm here with a good friend of mine who I'm excited to have this conversation with. Ken Druck and I have had many conversations over the years, most of which end up being fairly deep and a lot of insights come out of them. I think we're just both in this space of really contemplating life as well as death just because of who we are and our experiences. I'm excited to have Ken share some of his insights. He'll do that in just a moment, but I'd like to introduce him to you. Ken's work in personal transformation, parenting, psychology, and the literacy of grief has really helped people become, I think, their best selves for almost 40 years now. When you look at Ken, you can't believe he's been doing this work for that long. He's the recipient of numerous awards including a Distinguished Contribution to Psychology, Visionary Leadership Award. He has really a lifetime of service to the community. He's recognized really as a lifeline to people all over the world, to individuals, families, and communities through his work, which includes the founding of the Jenna Druck Center to honor the life and spirit of his daughter, Jenna; and we'll talk a bit about Jenna and the foundation that he created. Ken really has kind of set a new standard of care and healing out of tragedies like 9/11, Columbine, Katrina, and Sandy Hook, and I look forward to having him talk a little bit about how those experiences have shaped his life and his perspective. Ken has recently come out with a new book called Courageous Aging: Your Best Years Ever Reimagined. In this book, Dr. Ken explores the fears, some of the myths and biases in our culture about aging, so it's a perfect setup here for this conversation. In the book, he also kind of debunks a lot of the myths and offers a path to help people immerse themselves in the wisdom that we've cultivated over the course of our lives. With that introduction, I would like to introduce and ask Ken to say hello. Dr. Ken Druck: Greetings, Bob. So good to be with you and in a conversation, in a life and death conversation. My goodness. What a wonderful forum you've created to be able to talk openly and safely about all these important issues that so directly improve the quality of our lives and the quality of our deaths. Dr. Bob: Yeah. Well, I appreciate that. The inspiration for this really comes from life, from just being in this space. You're the same way. You're having conversations with people, both personal and in your professional life. I think, like me, there are many times when you think, wow, if somebody else had been able to listen in on this conversation, how much value would they have received, how much insight into their own issues and their own struggles and their own sort of triumphs. The conversations I have with my patients, with their families, with people like you, I think are so valuable, and I don't want to keep it to ourselves, right? I feel compelled and pulled to really allow people in on these conversations, so thank you for being willing to join in. Dr. Ken Druck: Thank you for having me. Dr. Bob: Yeah, absolutely. In your introduction, I abbreviated it. There's so much more, and I think we're going to have a conversation that will last about 30 minutes. I know that the wealth of information that you have and the experiences and insights could go on for 30 hours or potentially 30 days. It's going to be a challenge, but we're going to try to keep this concise enough, and then probably have follow- up conversations as time goes on. I posed some questions to you in advance of our conversation, and I want to jump right in. I don't mince words, and I don't pull back. I just want to get this out there because I want this to be part of our conversation, and I want it to inform and infuse our conversation. What are your thoughts about death? Are you afraid of dying? Do you have fear about dying? When you think about death, what comes up for you? Dr. Ken Druck: Well, it's a great question that does go right to the core. For me, the fear or the feelings about death are a moving target. It's not as though you run a marathon and you cross the 26-mile line and it's done. I think things that happen over the seasons and the course of our lives ask us or challenge us or force us to confront how we feel about death, and I'm no different. The death of my daughter 21 years ago was an opportunity as well as a tragedy—  the opportunity to face down my biggest fears of death. My daughter had died. I had to come face-to-face with that reality, starting with holding her body in my hands, in my arms, facing the idea that her life as we knew it had ended. I thought going all the way back to last year where my 92-year-old mother passed, and I had a chance to help her die. I think the things that happen that we react to or the losses we suffer effect and change and create opportunities for us to face down our biggest fears of death, to comes to terms with our life as it really is, life on its terms as it is, and to settle some of those fears. Now, are they going to be settled forever? Are we going to find peace or make peace and have peace forever and it's a done deal? No. Those concerns, those feelings, the sorrow, the love, the complex of emotions that come with dealing with death are going to bubble up and resurface. We want to make sure not just to wait for death to arrive or somebody we love to pass.  We want to be proactive and take steps to get ahead of the pain curve, to get ahead of the fear curve. Dr. Bob: That's awesome. How do you do that? I know it might be hard just to distill it down into a sentence or two, but how do you get ahead of that? If there's somebody who maybe has fear because of an experience because maybe somebody in your family had a tragic death or a difficult death and, like many people, you live with this underlying anxiety or fear about this mystery and when is it going to happen and how painful is it going to be. How do you think people can get ahead of that? Dr. Ken Druck: Well, I boiled it down to what I call the five ideals of courageous living and how we face down the fear of death. I've got basically five things that I recommend. Number one, stay humble, find peace in your unknowingness because there're  sometimes in life where we just don't know, and we have to hold that unknowingness in gentle hands rather than trying to force and will it into knowingness. We're basically part of something so big that at times it's unfathomable. The true nature of the universe—where life comes from, where it goes when we die—is an unfolding mystery. All we have to do is look up at the stars to understand that. The second thing is to cultivate a calm mind that allows naturally arising fears and doubts to come and go and learn to breathe and release even those primordial fears. It's kind of a form of surrender, and we can learn how to make peace with life as it really is by summoning courage, by facing in. Third is to take the elephant out of the room by opening the lines of conversation, just as you and I are doing today by talking about death and discussing our thoughts and feelings with people we trust. Fourth, keeping the faith of whatever we believe in our heart to be true or what we wish to be true. It's okay to abide by a hoped-for narrative without knowing that it's 100% accurate or not. We don't have to know with complete certainty that oh, here's what it is, here's the program for death, I read it somewhere or somebody told me this is what it is, or this is my sense of it. It's okay to keep the faith, to have it be a gesture of faith, to believe whatever we believe in our heart is true. Lastly, it's also just fine to have faith in a divine truth without apology or justification. We can do that while respecting and honoring the rights of other people who have different views or different religion or different spiritual path that they're on and a different view of things. Those are the things that I believe we can do to cultivate a courageous attitude towards living and to face down the fear of death. Dr. Bob: That's beautiful, so really this is universal. I mean, it's regarding any fear or anything that might be challenging us or limiting us in our life, not specifically around a fear of death, but that seems to be a big one for a lot of people, right? Dr. Ken Druck: Yeah. You know, Bob. We've got these brilliant emotional systems. They're as sophisticated if not more so in some ways than all the other systems that sustain life. We have this emotional system, which gives us internal signals, radar signals, from inside of ourselves, right inside of our hearts, showing up as our emotions. When these feelings turn up, it's our job to learn how to manage them, to decipher them, to decode them, to understand them, and to utilize them as part of our radar, as part of our self management, and to use them to our advantage rather than oh, that's a negative feeling, I better shoot it. That's negative. We've been brainwashed into believing that there are negative feelings rather than understanding that some feelings that bubble up and surface are going to be sorrow, fear, anxiety, worry, frustration, that we need to read these feelings, not become prisoners to them, but to read them and to have them inform us about what action to take, to inform us that it's time to vent those feelings. We're not built to hold them in steel compartments inside of our bodies, but to vent them in a healthy and constructive way and to turn those feelings into something good. Dr. Bob: Yeah. I think that's powerful. I think people need to be given permission to feel, right? My sense is that so many people when they start to feel something that might be uncomfortable for them, and this is a pattern that develops over time, they feel something, they don't how to navigate that, they don't know how to manage it, and so they just choose not to feel it. They turn away from it. Dr. Ken Druck: They become flooded. Exactly. They become emotionally flooded. This is particularly true of us as guys. We learned at a very early age basic training as a male shows us that to feel is to fail. If you're feeling something unless it's anger because anger is a good. Dr. Bob: Yeah, that's acceptable. Dr. Ken Druck: If you're feeling something, it means you're not handling it, you're weak, you're dependent, you're less of a man. You're less of a guy if you're feeling something because sensitivity and emotionality are perceived as signs of weakness. We got to fess up. We got to suck it up and deal with those feelings. We shouldn't be feeling those things. We become self-denying, self-rejecting creatures. We push our feelings away to the point that we lose our radar. We lose contact with our own radar. When somebody says, "Hey, what are you feeling?" We don't know what they're talking about. What are you feeling? You mean, what am I thinking? No, what are you feeling? How is this working for you? You just got a diagnosis, a bad diagnosis. How are you doing with that? When it comes to some of the most challenging moments, the moments of truth in life, relationships and our health and how long we're going to be here in our living and dying process, those emotions are what gets us through. Those emotions are the very tools and knowing them, reading them, and processing those emotions keeps us alive every moment of whatever time we have rather than us beginning to die emotionally long before our time and disconnect from those people we love. Dr. Bob: Yes. I get it. I think most people who hear this will resonate to some degree with that but obviously, it's not easy, right? Dr. Ken Druck: No, not to summon courage. Just like every other work ethic, everything else, there are times that all of us can look back and count that we summoned more courage, newfound courage to face into becoming a mom or dad, face into taking a job or starting a career or going to college or, even as parents, letting our kids go to kindergarten or sending them off to college. We had to summon courage. We have to summon even greater courage to face into some of the fears and some of the issues that arise naturally in the second half of life, including facing into our own impermanence, the fact that life is a package deal, we don't get to live forever, at least not in this form, and we have to deal with that. How we summon that courage is clear. We do it the same way we've done it before. We face something. We talk openly about it. We air out. We don't try to do it all at once. We strengthen ourselves. We get ourselves into game shape and improve the condition we're in, our mental toughness by doing this, by talking about it, by taking moments of reflection, by summoning all of our abilities to comprehend, to surrender, to let go, and to arrive in the season of life that we're presently living rather than dragging the past around and regrets, remorse, unforgiveness, harsh criticism. Rather than dragging, we have to learn how to let that go. There's a whole university and school of thought about how to summon greater courage because it is a process that occurs over time that we can all plug into, and it's going to be different for every one of us. Dr. Bob: I feel like there's so much incredible value in what you've shared so far. I want to encourage people, the listeners, to go back and listen again. There's no way that anybody will be able to take in what's been shared here in one listen. I really especially, well, the whole thing—but I'd also like to kind of summarize because I think it's so critical. There are so many people who find themselves in this space of despair, of feeling like they can't climb out of that place, it's dark, it's pulling them in, and they don't know how they're going to do that, and to give them those tools to help people understand that even if they can't look at their own experience in the times when they've found the courage to look at others around them, to see that yes, people have been in this space before, and they have found a way out. I think that looking at the whole of human experience and finding examples of people in your own community or that can inspire you. Obviously, if you can find your own inner kind of compass and go back and identify those times of your own life, you'll hopefully connect with that. I see people who have just lost somebody or they're dealing with these terrible challenges from an illness or an injury, and they say, "I can't do this. I don't have the strength. I'm not going to make it. I can't get through this." I help them see, if possible, other people have done this. This experience is an experience that people have had for thousands or tens of thousands of years, and people get through it. It's not easy, it doesn't happen immediately, but you are part of this human race. You have the same inner strength and capacity as anybody else, but I want- Dr. Ken Druck: I like what you're saying. I want to add to that. Dr. Bob: Yeah, please. Dr. Ken Druck: Asking for help. Help is the least utilized four-letter word in the English language. Asking for help. When I think about all the people that I know that I've sent to you for help, you have been an inspiration. Sometimes we can't do this alone. It's okay to ask for help, to call in support, asking others how they did it, whether that's reading... I mean, I wrote the Courageous Aging book so that people would have something to refer to be able to see how others have done it, how other people have tried to run from some of these things and fail, and how other people have courageously learned to face into whatever they were dealing with. So reading a book, reading articles. I think also seeking inspiration. There's music that I play every day because without words it inspires me. It's music that comes from a source of inspiration that's coming through a great composer, so I listen to music. There are all kinds of ways of nourishing ourselves, whether it's music or great food or walking in nature. I think what you said before about remembering the past seasons of our lives where we had great courage and remembering I can do this, look what I did. I can do this. Lastly, it's surrendering at times. There are times where we're standing in a moment of inescapable sorrow or facing into unknowingness or feeling emptiness. Those are moments where it's okay to surrender into tears. It's okay to surrender to feelings of helplessness and powerlessness. Also, that surrender sometimes takes us into a sense of what's beyond this life— of what I call the great beyond, the enormity, to have a sense that we are joining. Wherever my daughter is, I'm going to be with her. Wherever she is or isn't, I'm going to be there. Wherever my ancestors, those who have gone before me are.  And with those feelings, it's not only to make peace with ourselves, but it's to free up the next and final phase of our lives, which is paying it forward, paying the gratitude for the blessing that we've had, being given this life, being able to experience all the things that we sometimes take for granted. Being able to give our gratitude by paying it forward, planting a tree that we won't necessarily ever get to sit in the shade of, but that our children, our grandchildren, and future generations will be able to sit in the shade of that giving tree. That is one of the most important aspects of making peace and understanding that it's okay. Yes, it's scary. Yes, it's terrifying at times. Yes, it requires courage that I haven't had to summon before, but that I can do this, and I will go forward. This is the nature and the way of life. I don't get to play God, I don't get to live forever in the way that I know, and I surrender to it. Dr. Bob: It's no wonder why you are being asked to come and be with people who are experiencing tragic loss. You have such a gift of sharing that perspective, sharing the understanding of one who's been there and who has learned how to navigate it. I know that you would be the first person to admit that you're not finished with your growth and working through your sorrow that will never end, right? Dr. Ken Druck: It's okay. You know what, Bob, a mom once said it to me—she had lost her only son— and she told me after a couple of years I hadn't seen her. She said, "Ken, the most important thing I've learned is that it's okay that it's not okay." She said, "It's not okay. I reject the idea that my son had to die so young, that he didn't get to live out his life the way we had all planned. That was my dream, that was what I had put my heart and soul into. That was my future as well, and it's been lost to him. His life has been lost to him and to me and his father." She said, "But I've learned over time that it's okay that it's not okay. Some things in life aren't okay. I'm never going to accept that history as good." It sucked is what she said. "It just sucks that this is the way it is. This is the way it turned out. This is the way history will write it." She said, "But I also have found peace that this is the way of life. I'm not the only one who's suffered a loss of a child way before their time and had to face into the challenge of living out the rest of my life as an expression of love rather than despair. I accept that challenge and I've faced into it, and I'm learning how to live forward in my life and to make my life an expression of the love that never dies rather than to despair over the fact that my son died young." Dr. Bob: Conceptually it's powerful, but really in practicality, it is as well. I'm around, as you are as well, a lot of people who are anticipating an upcoming loss of a loved one or who have experienced the loss of a loved one. I think one of the most powerful and valuable ways for them to go forward is with the understanding that their loved one, their son, their daughter, their brother, sister, wife, husband, father, that they would never want that person, those loved ones who are left behind, to hold back, to be held back because of that loss. It's honoring those who have gone by living your life as completely, fully, forcefully, intentionally as possible. Dr. Ken Druck: Exactly. You and I talked about it, and I have my code of honor, my five honorings, and that is the core of those five honorings—that we somehow summon the courage to go on with our lives, to write new chapters of life even though they will not be here to write those chapters with us, that we're going to go ahead and we're going to live forward. We're going to go on, and we're going to make the rest of our days meaningful and purposeful, and we're going to keep our love alive by doing one of the other honorings, which is to create a spiritual relationship with them. What I mean by spiritual is that it's the unseen, unknown conversation we have purely out of faith. When I tell my daughter, Jenna, I love her every day, do I know that I'm connecting with her? No, but it's an act of faith. I'm not going to let that love go unexpressed. When I feel she is close and she's loving me and something wonderful has happened and she's celebrating with me, am I going to deny that arrogantly? You know, I know what life is, I know what death is. She's gone. That's not really her. I'm a delusional father. No. I'm going to allow that love to flow to me. The five honorings are writing new chapters of life; creating a spiritual relationship with them even though it's not what we signed up for. Survival, our own survival, is an honoring, finding a way to get to the next breath even though at times we are so lost and feel so empty and so sad; then embodying some element of their spirit that will live on with us. It could be their kindness, their sense of humor, something they loved. Whatever it is, embodying that and becoming more of that as we grow up and as we grow older. Lastly, it really has to do with how we treat other people, that we treat those people in our lives as an expression of our love because many families unravel at the time of loss. We're so raw, the emotions are so raw. After 9/11 we instituted a program that had to do with the way we treated one another and was an expression of our love for the person we lost, and it was called Take the High Road. Taking the high road, even though there's that rawness of emotion in our families and people want to resort to blame or who loved who or who did what. To step outside of that. Let it go, be forgiving, be patient, be kind to one another in that moment of rawness, and treat our families as an expression of love to the person we're either losing or have lost. Dr. Bob: I love it. Those are awesome, the honorings. For somebody who wants to read more about those five honorings, where would they find that? Dr. Ken Druck: They'd go right to my website. It's www.kendruck.com. They can go onto my Dr. Ken Druck Facebook page. That's facebook.com/kendruck. I welcome a phone call in our offices in Del Mar and San Diego. Any way I can be of help, I'm honored and privileged to be able to continue working with you on teams. You and I find our way to helping families together, and I'm always honored to be of assistance to families that you're working with that, frankly, would be lost without you as a lifeline. I'm so glad that we've had a chance to have this conversation to be able to share it. Dr. Bob: Yeah. I am too as well. Again, we touched on some really poignant and important topics and kind of scratched the surface a little bit. I think there were some really great highlights. Again, I think people will benefit from re-listening to this and having it be available. Your website has a wealth of information and support. Before we get off, I want to ask just briefly about your new book because I know that it's been taking up an enormous amount of your time, getting the book out, getting the book promoted, getting it into people's hands, letting people know about it. It's phenomenal. It's called Courageous Aging. I just want you to share a bit about the inspiration for putting this book together and just give a few of the highlights if you could. Dr. Ken Druck: Yeah, Bob. The Courageous Aging book wrote me. This season in my life, all the issues, all the challenges that come up as we get older, especially when we wake up and we realize that we've been sold a bill of goods, myths, and misconceptions about getting older and that many of our imaginings of our future are really saturated with dread and fear and cultural biases. We look at other cultures around the world. In India, when you turn 60, you're just waking up. Life is just beginning. For us, you turn 60 and you're on the back nine of life. Your life is over. You're supposed to retire and become irrelevant. Yet I'm at age 68. I've entered the most creative phase of my life. I've never been more creative. I'm writing books, I'm writing articles, I'm speaking. My work with people has never been better, more focused, more loving, more caring and compassionate. I decided that, as I have in other seasons of life, that the best way for me to learn was to ride the horse in the direction it was going and to write. My meditation is writing, and I write myself into greater awareness. I also share the awarenesses that I'm coming across, and then I'm learning from other people. Courageous Aging is really a formula for aging positively, successfully, in a robust way and reimagining our best possible future and creating a critical path so that we can realize that future. Every chapter deals with a different element and challenge of aging. The first chapters are a self-audit where you could actually test yourself. How am I doing on getting older? Where are my hot spots? Where am I struggling? Where am I doing great and soaring? We can take inventory because everything good starts with a little self-reflection. I think once we've taken inventory we can begin to focus and fashion our course to have our best possible future, and every chapter deals with a different element of what it takes to create that best possible future. Dr. Bob: Timing is amazing, right? I mean, there's so many of us who are moving into this space, this space of, I guess, aging and trying to figure out what does the future hold. How do I continue to find value, having meaning? Like you said, I'm not ready to hang it up and just start golfing and rocking on my rocking chair. I think that Dr. Ken Druck: By the way, you know who I'm getting feedback from? I'm getting feedback from 40-year-olds who read the book, 50-year-olds. We think of aging as an issue for people past 60, 65. The aging angst and biases infect people who are turning 30. They're dreading, "Oh my god!  I'm turning 30." The dread of getting older and the invitation to lose our vitality, our passion, our energy, and to kind of shut it down is there at every turn, at every turn of life and every changing season. It's no different for those of us turning 70 in some ways than it is for those of us turning 50. We all have to face it and really take charge of creating the future that we want rather than buying into the cultural norm, which is being sent out to pasture or having to give up things we love. Dr. Bob: I love it, and I would imagine that it wouldn't need a whole lot of modification to be really appropriate for and valuable for people who are 20, right? Dr. Ken Druck: It really isn't because you're going to be changing seasons. Dr. Bob: All the time. Dr. Ken Druck: ...and how you do that and how you go about that should be dictated on the basis of how you feel, not what somebody else tells you that you should feel or do. We all need to set our own course, and we change. That's okay. It's okay to grieve the younger version of yourself. That's all right. It's okay. Grieve it and then move forward because this new season, you're going to miss it if you're so obsessed with what you lost and what's past. You're going to miss the opportunity of this new season of life. Even if it's towards the end of your life, don't miss out on the best part of your life. It may be that the coming weeks, months, and years of your life, if you're given that, are going to be the best ones ever, so show up for it, be there, let go of the past, grieve the past self, and embrace what's right under your nose, what's right here now. Dr. Bob: How do people get a copy of the book? Dr. Ken Druck: They can go on amazon.com, they can go to their favorite bookstore and order it, amazon.com. If you have a Kindle or something, you can download it for, I think, 7 or 8 dollars right away, or they'll get it to your house in a day or two on amazon.com and, of course, it's available in the bookstores. If you have any trouble getting a hold of the book, just contact our offices or go to our website. You can order it directly from our website too at kendruck.com. Dr. Bob: All right, my friend. Well, I think for this podcast, we have moved past the time that I was anticipating, not surprisingly. We will Dr. Bob: Yeah. If you're open to it, Ken, I'd love to have you back another time to Dr. Ken Druck: Always an honor, Bob. Always an honor to talk with you and work with you. Dr. Bob: And you as well, my friend. I just want to share that I find you so refreshing. You are a brilliant, loving, compassionate servant of mankind. I'm inspired and humbled by the work that you're doing and by having you in my life. I want you to know that. Dr. Ken Druck: Bless you. The feeling is completely mutual. I thank you so much. I'm learning how to receive. That's one of my goals in this point of life is to open my heart, touch my heart, and learn how to receive. What's you've just given me is beautiful. I'm going to take that in and savor it today. Dr. Bob: All right. Beautiful, my friend. Love you. Thank you for being part of my life and thank you for sharing all this beautiful insight for our listeners. Dr. Ken Druck: Thank you. Love you too, my brother.

Alive Inside" is a wonderful film and movement that awakens the Alzheimer's mind and connects generations, comforting elders and rescuing youth. The film's Director, Michael Rossato-Bennett, shares how it all began. IntegratedMDCare.com " 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 Alive Inside website Alive Inside Facebook Page Transcript Dr. Bob: Today's guest is Michael Rossato-Bennett-Bennett, the director of the film, Alive Inside, and the founder and executive director of the Alive Inside Foundation. Alive Inside is a phenomenal film, and I highly recommend you find a way to watch it. The Alive Inside Foundation is dedicated to healing loneliness and disconnection in all of our lives, but especially in the lives of the very young and the very old who are living with dementia. They partner with communities to connect the generations and shift our relationship with life, aging and growing up. The Foundation seeks to end loneliness using empathy, music, life story, and film. This interview with Michael is an intimate exploration into the mind and heart of a man who seems to have stumbled upon his purpose and has been inspired to create in a much more expansive way since doing so. I hope you enjoy it. So, Michael, your life has changed pretty significantly in the last several years. From what I can gather, what started as a project that you couldn't really foresee a whole lot coming out of, to what has been created in your life now and looks amazing. What's it like? Tell me the journey a little bit. Michael Rossato-Bennett: Well, like every life, probably the most important things are your failures. Those are what you learn from, like your woundings, your emptiness, your hungers. These are the things that actually fuel you. When nothing else makes sense, I'm deeply interested in what makes sense when nothing else makes sense, and I think that's a very apt conversation to have in this time because I'm sure I'm not alone. I think if everyone were honest, they would just say right now, "What the heck is going on?" Dr. Bob: How did we get here? Michael Rossato-Bennett: How did we get here? How do we tell our children your president doesn't tell the truth all the time? How do we say your government isn't really trying to protect you? We're confused. I mean I am, and I have been many times in my life. I'm going to get a little philosophical here, but I think anyone living in a predatory culture that doesn't quite know that they're living in a predatory culture, has a feeling of disquiet and confusion, and like all of us who are trying to do something in the world, our efforts are constantly called into question. What am I doing? Am I helping create a just world? Am I helping create a world where life is recognizing and aiding life, or am I deeply investing in a system that is reducing the quality of life, literally for the planet at this time? I think every one of our occupations, from farmer to doctor, has to wrestle with these questions right now, what is my place in this world that we've created, and, unfortunately, we don't get to remove ourselves from it I don't think. Dr. Bob: It's interesting. As you're talking about this, and I don't know if you have children or not, but as you're talking about this, I'm flashing on my 11-year-old son, who is right at the verge ... If I asked him what does it feel like to live in a predatory world, I think he would know enough about what I'm asking to form an opinion and connect with it. But I, also, feel like he's still living in this other world where he can slip back into this sense of comfort and not allow that to influence his day to day existence. Michael Rossato-Bennett: I mean this is at the core of everything I'm working on, and it's simply the recognition of the idea that we actually do mature, that there is actually an arc to our lives. When I was 21, I was competing my ass off to win the steak knives at my job for Cool Vent Aluminum telephone salesmen. I wanted to be the best Cool Vent Aluminum salesman because the sales manager told me that I was nothing if I couldn't book these appointments for his salesmen to sell this poor, older people aluminum siding and new windows. Dr. Bob: And you believed that? You believed that story. Michael Rossato-Bennett: I believed it. Dr. Bob: Yeah, you did. Michael Rossato-Bennett: I believed it, and really, honestly at that point, all I wanted to do was be good, be recognized, to succeed, to have some validation, and honestly, I didn't think that the people who were in authority, that the people who were older than I was, I didn't think that they didn't know what they were doing. I thought they knew what they were doing. But your 11-year-old son, he's awakening in a world where it's obvious that we don't know what's going on, that something is happening, and it's amazing what's happening. I mean basically what's happening is we're going through a major psychic, intellectual, spiritual, existential definition of what it means to be human, and what it means to be human together, and ideas that we've had for thousands of years are no longer functional in the face of these incredible tools that we've created in the last 20 or 30 years. The computer has just turned human culture on its head, and we are not ready for it. Dr. Bob: Right. Michael Rossato-Bennett: And we're innocents, and I think in a hundred years we'll look back and this and go ... Just like slavery. At one point, slavery seemed to be a pretty good business model. We try not to do that anymore, at least in a recognizable form. But in a non-recognizable form, we haven't given up that business model, and that's what we're dealing with. I mean you're a doctor, and I work in healthcare to some degree as well, and Marshall McLuhan is a great media thinker, a thinker about media, and he said years and ... Maybe 60 years ago or 50 years ago, he said, "The medium is the message," and I never understood what that meant, but I understand what that means now, that basically, the structures that we create determine the outcomes, no matter who is in them, or no matter what the outcomes are. When you have a lot of people making money on petroleum, you get plastic in the ocean. It doesn't matter what people do. In 50 years, we won't be relying on petroleum. We won't have the pressure to create as much plastic, and maybe we can solve that problem. Dr. Bob: Well, so fascinating. Great perspective. Love it. Not exactly where I was anticipating the conversation was going to go, but I love it, and I want to hear ... So you take that. I'm sure that your awareness is continuing to mature, to evolve, and it's influenced by and influencing what you are doing day to day to improve the lives of the human beings that you're concerned about, as we both are. What's happening in your life? I want to know what you're doing. What's the Foundation doing? How are you right now serving in a way that is trying to achieve the most benefit for humankind? Michael Rossato-Bennett: Well, I mean that's a big thing to say. Dr. Bob: I know. Because it's happening. What you're doing is serving humankind in a positive way. Michael Rossato-Bennett: Right, right. I'm not young. I'm not a child anymore, and you get to a certain point in your life, and you ask yourself, "Okay. What can I do to help other people," because helping yourself is kind of boring after a while. It just becomes boring. So you want to expand your relationships with other people, and it's interesting. Dr. Bob: I lost you for a second there. You said interesting, and then I lost you. Michael Rossato-Bennett: I was relating to these thoughts. Okay. Sorry. All of my thinking comes out of working with these elders with dementia and meeting them. You're right when you say my life has transformed. I mean I walked into my first nursing home, and I wanted to run because I'd had really some very traumatic experiences in hospitals when I was a child. They put that ether on my face. I don't think they do that anymore, and I struggled and screamed, and yelled, and fought. They finally just gave me shots in my butt. But that smell of health care, of the hospital, I swore I would never, ever step inside a hospital or a healthcare facility, place forever. I promised myself I would never, ever do that. Then here I am. I had been hired to make a website for a guy who was bringing iPods into nursing homes, and he thought that it would be a good, new thing to do, and so I did it. There I was sitting in front of a man, Henry. He was the first one that I really saw the power of music to wake the hidden vitality of a mind, a mind that had lost its capacity to connect with itself and with others. I didn't want to be there. It was very sad for me to see this human being, this shell, if you will, of a human being, who didn't seem to be able to come out of that shell. Then we gave him ... Millions of people have seen this clip. Actually, over 100 million people have seen this clip. Dr. Bob: Really. That's where it's at, at this point. Incredible. Michael Rossato-Bennett: Well, it was actually one of the earlier clips to go viral on Facebook. So it was still back when Facebook was becoming before they put all these clamps and started monetizing everyone's life. It was back when they were giving it away so that people would join, and so it's a completely different animal now, and that's what we're discovering right now, and a very dangerous animal as well. But anyway, so here's Henry, and we give him some Cab Calloway, and I get to experience a human being awakening. This guy, he starts moving, and his eyes light up, and he starts singing. He starts making poetry. When I took the music away, I thought he would turn off like a ragdoll. Dr. Bob: Like a light switch going off. Michael Rossato-Bennett: Yeah. Like the electricity was going off. But, no, there was this residual aliveness and connection, and he talked to me, and he was so beautiful. The whole world saw this. I mean I went to bed that night and my son ... That I posted it. No, I didn't post it. I put it on my friend, Dan Cohen's website, and some kid found it and started spreading it in the Reddit community. I don't know if you know what Reddit is. Dr. Bob: I'm a little bit familiar with it, yeah. Michael Rossato-Bennett: It's a community of young people on the internet, and my son is in that community, and he saw ... He came into my room. He said, "Dad, they're talking about your film on Reddit," and I was like, "Really," and he goes, "Yeah. It's gone from 300 views to 400 views," and I was like, "Oh, my God. That's amazing." Oh, my God, and then we went to bed. We woke up the next morning, and it was at 180,000 views. On the next day, like a million views. It just kept going. But the amazing thing was, for me, I mean I thought we'd discovered the cure for Alzheimer's Disease. I was like, oh, all you got to do is give them music, and it makes their Alzheimer's go away. Then there's, of course, a sad realization that, no, you're just waking up some very deep pathways that are actually spared. They're pathways that are very deep in this elemental brain. Not in the forebrain, which is really the core of I think what I'm working with right now, and that is that when you don't know where to go, sometimes the deepest parts of ourselves hold profound and unexplored wisdom, and I constantly go to those deepest places, like music. Music, by now, it's part of our DNA. It's literally been adapted to our DNA. I mean a child, an infant, a human infant will respond to a beat and other primates won't in the same way. Yes. Dr. Bob: I watched the film a couple times, Alive Inside. I've watched it a couple times. I just watched it again last night. I was, again, just blown away by the little toddler who was conducting. Michael Rossato-Bennett: Oh, my God. Dr. Bob: The natural instinct in him, and he's a little performer. But I agree, you can see it in almost every child from the time that they're able to interact with the world, that they respond to music, and they've been responding to it since they were in utero. Michael Rossato-Bennett: Yeah. Dr. Bob: And that never goes away, unless you lose your hearing. Michael Rossato-Bennett: Which is another enormous problem. About half of the people who staff thinks have dementia, they probably have a little bit, but more, they have hearing problems. It's an enormous problem in elder care. So what are we doing now? At first, I was like, "Oh, my God, let's get everybody who has dementia their music, and let's make that happen." In some ways, that's happening. Michael Rossato-Bennett: It's hard to realize what we don't know, right, or what we didn't know. When I was making Alive Inside, we had so much trouble getting people to try this, to give these elders their music, and it was really a struggle because it was a new idea. But then the hundredth monkey syndrome kicked in a couple of years ago, and now this idea has literally spread like wildfire across the world, and to such a degree that I think ... I was joking with a friend way back then. I said what's going to happen is some day I'm going to say I made this movie about how you can play music for people that's their music, that gives them an emotional reaction, and if they have Alzheimer's it will awaken parts of their brain that have been forgotten, and I said in five years, I have this feeling that people will go why did you make a movie about that? Everyone knows that. Dr. Bob: Yeah. Right, what's so different. Michael Rossato-Bennett: Everybody knows that. We know that, and that's where we are. Everyone in the world knows this now. I mean I had some part to play with it, but it's that hundredth monkey thing. When something is important, and you have a disease like Alzheimer's where there is no cure, and if you have something that can help, it's going to spread like wildfire, and I think that's what's happened. Dr. Bob: Well, of course, it's very helpful for people who have Alzheimer's to try to awaken that and to bring them a sense of joy and connection, but it's, also, incredibly beneficial for people without Alzheimer's, who are just lonely, right? They're just the people throughout the nation, the world, who are isolated or limited in their own homes, or in assisted living communities, or in nursing homes. The ability to give somebody, to connect them with the music that has been meaningful for them at various points of their life, brings joy, brings comfort, brings connection. There's no way to understate the impact. So understanding that I'm curious ... I'm in San Diego. I have a concierge practice, and I take care of people who are in their homes who are dealing with end-of-life issues. They have dementia. They have cancer. They have heart disease. It's a small practice. It's like a concierge practice for people with complex illnesses and who are approaching the end of their life. As part of that, we have integrated therapies, and I have a couple of music therapists who go out. They're angels. They connect with the patients, and we see them flower. We see them blossom. Some of our patients, with these therapies, music, massage, acupuncture, reiki, they go from being bedbound, and miserable, and wanting to die, to get re-engaged with life and getting- Michael Rossato-Bennett: And it makes sense. Dr. Bob: And it makes sense, total, and I go into nursing homes, and I'll see people there, and we just created a foundation. We just got the 501c3 determination from the IRS, so we're ready to make this thing happen. How do we take advantage of what you have created to implement and leverage that in San Diego? Let's talk about how this is actually happening on the ground. Michael Rossato-Bennett: Okay. Well, first of all, you've opened up some really big cans of worms here. Dr. Bob: I have a knack for doing that. Michael Rossato-Bennett: Most of the people who have dementia and Alzheimer's, they are not in institutions. They live at home, and we have a culture that defines people as valuable to the degree that they're productive, and it's deeply ingrained in us. It's ingrained in our religion, and our morality, and our laws, even to the point where we've created lots of meaningless work, just because people want to be working, and the dark side of that, not the meaningless work, but this idea that we have no value unless we're productive, is the elders that you're finding. What is their productivity when they're just sitting? They can see their death, and they probably feel they're not contributing. As a matter of fact, they might even feel that they're a burden, which is a horrible thing for a human being to feel. One of the things that I've been so intrigued about, about people with Alzheimer's, is they forget so much, but it's strange what they don't forget. They don't forget what they used to be. They don't forget that they're having trouble communicating, and they used to be able to communicate, or at least it seems like that to me. You opened up another can of worms, which is loneliness. The UK just appointed a minister of loneliness. 40% of Americans report problems with feeling lonely. We're discovering the dark side of social media, which is this capacity that it has to make people judge themselves, their real life against the sort of phony life that's presented one snapshot at a time and edited and Photoshopped. People feel this kind of not being good enough, and when you feel not good enough, you feel separate, and when you feel separate, you feel alone, and that is one of the greatest pains a human being can ever feel, and that's really ... I had a very hard time growing up and a lot of isolation, and I shut myself down in many ways, and that's why when I saw this older man, Henry, wake up, I was like, "Oh, my goodness. Oh, my God, we can wake up. We can be awakened," and that's what you've described with your music therapists go in, and these people are like, "Oh, wow, yes. There are rhythms of life that I can share with you, and we can sing, and we can do music, and it can even go back into my memory, and oh, I have these stories I could tell you." I decided that the place that I wanted to play with was trying to reduce pain. Like you, as a doctor, you want to reduce- You want to reduce the pain and the struggle, and one of the greatest struggles that I see is loneliness and disconnection. I feel like our culture ... There are things we all need to survive, and to live, and to thrive, and sometimes commercial society says, "All right. You want those things; you got to pay for them." So it puts walls between what we want and what there is, and that's not really the way life works. If you swim in the ocean and you grab a fish, it's not like you paid for it. Well, you swam for it. That's for sure. Or you pluck a pear from a tree. It's not like you grew that tree. I'm not sure that this sort of way we are creating safety for ourselves is working, and I think it's falling apart in many ways, and so, again, I go to the very deepest place. So I developed these headphones that you could give to somebody with dementia, and it has a little hole in it, and you can put their music in it, and you can plug your headphones into their headphones, and so you can listen together, and your eyes can meet, and you can be in the music together, and I thought that was beautiful. Then I made an app so that anyone could sit with another person and try and figure out what is that deep music that's inside the soul of another person. So you can do that. But the key thing I feel is that what I've learned. If you watch Alive Inside, you see all these people awakening. But what you don't see is me on the other side of the camera going, "Oh, tell me that story. Oh, my God, you're so beautiful. Oh, yes, I want to know more and tell me. Flower. Let me see you flower." We are creatures that are called into becoming. You take a child, and you just put them in a room, and you leave them there for 14 years, you're not going to have a great kid, but if you go in there every day and you teach them how to be human, and you teach them the rules of being human, you bond with other people, you connect to them, you be kind to them, you look in their eyes, you learn to feel what comes out of another person's eyes, and you learn to give to another person through your eyes. I mean the eyes is the only organ that goes both ways. There are both receptors and apparently ... I was reading the other day ... I wish I could quote it better. But apparently, there's something that comes out of the eyes. That's why we call the eyes the windows of the soul. You're a doctor. Dr. Bob: I'm not sure what emanates from the eyes, but it kind of feels like when you're in somebody's gaze, when you're looking deep into their eyes, that there's something either reflecting back or coming out of it for sure. Michael Rossato-Bennett: At the very least, there's expression. At the very least, there are tears. Something is coming out, even if it isn't a ray. But that's the amazing thing that we're understanding now, and this goes back to the illusion of loneliness. We've created the structure where you can be lonely, where you can be a separate entity that doesn't connect with other entities, and the terrible thing is that's engineered. The truth is that we are not separate. We're talking over Skype, and my ideas are affecting your brain, and your ideas are affecting me. But if we were sitting in the same room for the amount of time that we've been sitting, your cells would be in my body, and my cells would be in yours. Every cell in your body I think changes every seven years, and the building blocks of you have been white people, and black people, and brown people, and hippos, and dogs, and ducks, and dinosaurs, and fish. I was reading this amazing book about old growth forests, like dirt. There's no such thing as dirt. There are rocks, and there's whatever, but every single piece of nutrition that has ever passed through your lips only has nutrition because vegetable matter has gone through the butt of a bug. Dirt is bug pooh, and without bug pooh, there is no nutrition in anything that grows. So we're not special. We are part of everything, and we've just created this system that ends up taking our children and putting them in these institutions, and telling them to stay there for 20 years and to compete for a few little remaining spots at some big colleges. As children, we're forgetting how to be children. And we have our elders, and, oh, my God, have we abandoned them. Oh, you're worthless. You just go sit in the little room over there. I'm sorry. Now you got a little emotion running in me, and so I said let's bring these two groups together. Let's bring the very old and the very young together, and what you do when you do that, it's like a magnet. These groups are meant to be together, and they're engineered apart. So basically a lot of people have seen Alive Inside, and they call me, and they say, "Hey, let's do something." I'm like, "Okay. Let's do something." So we're down in Mexico, and there are these abandoned elders, who are literally taken off the streets by this foundation, and of the thousands and thousands that they could help, they can help 250 a year or something, or actually more at a time, because the population changes, but it's only 250 at a time, and they were bringing in these young psychology students who sit with them for 14 weeks for an hour or two, and they detective. They use the app, and they find the music of these elders of their youth, and they listen to it together, and they learn their life stories. We've created another thing called Memories, which is this ... It's a very simple computer program that basically lets you create a digital, communally create a digital scrapbook for somebody. My vision is it's going to happen I the next year, is I want every hospital room, every nursing home, that you're going to be able to go and some volunteer will have created the life story for these elders, so that anyone in the healthcare community can just scan the QR code on their picture ... We're making these necklaces for them, and you'll know their life story in two minutes. You'll know where they came from, who they loved, what they did. Dr. Bob: I love that. Michael Rossato-Bennett: What their music was because it's just crazy. I've seen so many healthcare situations, where I've seen people care for people for 10 years, and love them, and not know who they were. Dr. Bob: Exactly. Not know a thing about them. Michael Rossato-Bennett: Not know a thing about them. Dr. Bob: Right. And that's what drove me crazy for years and years. I was an emergency physician, and I see these incredible people coming through, and they're a shell. They're in this shell, and if someone takes the time to actually connect with them and ask them something beyond when's the last time you have a bowel movement? Where does it hurt? But to actually be interested in who they are. I was just memorized, fascinated by what would come out, and that's a lot of why I transitioned in my career into doing something where I got to honor these people for the person they are and always have been, even though at this stage, it's physically they're different. The spirit inside of them, the essence of that person is unchanged from where it was when they were flying bombers in World War II, or dancing in competitions at 18 in the 1930s. And so what we do, I think we are aligned in the work that we're doing. I will want to connect with you further because I really do want to talk about how to bring the programs that you're talking about, especially the program with the youth together with the elders, and sharing this. Michael Rossato-Bennett: Oh, I would love to talk. Dr. Bob: So we may end up trying to schedule a second call. I'm going to wrap it up soon, and I just really appreciate your honest, thoroughly passionate view that you were able to share. I do want to make sure that people know how to get more information, and there will be links on my website to the Alive Inside Foundation site, and I'm happy to connect people with you. If you want, you just let me know. Michael Rossato-Bennett: Yeah. Dr. Bob: What kind of connections you're looking for, how we can help to support your passion and your movement because it's life-changing and it's revolutionary. It shouldn't seem revolutionary, because it's pretty simple basic stuff, make connections, and you create joy, right? Michael Rossato-Bennett: Well, I think it's revolutionary. We call it an empathy revolution, because certain things in our human vocabulary have been devalued, and a lot of people, myself included, it's taken long life journeys to be able to just honor the treasure that I have inside my chest. The fact that I am alive is such a treasure, and it's so devalued in our culture. The children, we don't honor the life in children. We don't honor the life on the planet. We don't honor the life in our elders, and it's all there is, and we only get it for a very brief time, and it breaks my heart to think of how many years I spent beating myself up and not enjoying life, and I look around, and I see so many people who are not able to really ... They only get this brief time with this incredible treasure called life. And that's why I bring the elders and the kids together because I think the elders actually teach the kids, "Hey, you're alive, and you're not going to alive for much longer, and look at me. This is what the end of life looks like, and guess what? I'm engaged here. I've only got a short time left, and I'm engaged." It's been shown that older people live with incredible pain and smile, whereas middle-aged people if their back goes out and they lay in their bed for a week. Dr. Bob: That's right. And they bitch and moan about how miserable they are. Michael Rossato-Bennett: Yes. Dr. Bob: Well, don't beat yourself up too badly about time that you've lost. You have lots of time left to contribute, and you're obviously doing a great job of that. So Michael Rossato-Bennett-Bennett, thank you so much for taking time and sharing your passion and more about your project and your mission, and best of luck to you, and hopefully, you'll be willing to come back, and we'll do some followup on another episode. Michael Rossato-Bennett: Well, thank you for calling me, Bob. That was very sweet.    

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.

Hear beautiful stories about end of life. Dr. Bob and Veterinarian, Liz Fernandez, discuss how there are similarities in their end-of-life work that helps people, pets, and families who are dealing with end-of-life issues. 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 Liz Fernandez website Dr. Bob: Liz Fernandez is a doctor who makes house calls. She gets to know her patients and families intimately, and she frequently provides counsel and guidance as her patients head toward the natural end of their lives. In many circumstances, she lovingly administers medication through an IV that allows her patients to fall asleep and die peacefully usually in the arms of their loved ones. What Dr. Fernandez does is legal and acceptable because she's a doctor of veterinarian medicine and her patients are mostly dogs and cats. Although I don't perform euthanasia which is illegal in this country, I am with many patients as they die peacefully after self-ingesting medication that allows them to have a quick and peaceful death. In many respects, Dr. Fernandez's practice is very similar to mine. We both drive all over the place to make house calls, we both develop very intimate relationships with our patients and families, and we both help to guide and counsel as our patients approach the natural end of their lives. In this episode, we share some of the beautiful and some of the challenging experiences that we've had, and we discuss how it affects us to be in these emotionally complex circumstances so often. I hope you find it interesting, informative, and meaningful in some way. Liz, thanks for coming on the show, and I'm looking forward to having you share some of your insights from your really fascinating career. Can you just share with me a little bit what is it like? You have a unique model of practice for a vet, and what's a typical day or typical few days for you? Liz Fernandez: I practice in Ventura County. I work with small animals, and I do house calls, and most of what I do is Chinese medicine acupuncture, so most of my clients, my patients are older. I may see anywhere between three to six patients a day, and I drive all over the county. Sometimes I keep it localized in a smaller area, but my radius is about 60 miles from my house so it could be anywhere in that to give you an idea. Yes, I drive about 30,000 miles a year- Dr. Bob: Which is kind of similar to me. It sounds like your work is in many ways similar to mine; going out and meeting with older patients and addressing the concerns that they and their families have and supporting them. Liz Fernandez: Right, and so I have ... Since I see them ... I see them. I'll spend an hour or so. Each appointment is about an hour unless it's an initial appointment and it's usually about two hours. I may be seeing them once a week, or once every other week, or once a month, so I get to know the clients quite well and as their animals, either dogs or cats, for the most part, start to age and get near to that point when they're going to have to make some decision, we've already had probably at least a few discussions if not more; just some in general and some more specific. It's nice because I do have that connection already with most of the clients that I work with, and that makes it a lot easier to move into that idea of now we may not be trying to get them better, we're just trying to keep them comfortable. Dr. Bob: Got it. So you have the conversations ideally upstream about what will happen when things change, and you're looking now at a comfort-focused end of life scenario. It's interesting because you have an option to help create a very peaceful end of life for your patients that we don't necessarily have. Not necessarily have, we don't have. We don't have euthanasia. It's not legal; it's not available. Fortunately in California now we do have the medical aid in dying through the end of life option app, so there is another conversation that can happen when people are open to it, but everybody is aware that euthanasia is a viable and acceptable option at the end of an animal's life. Liz Fernandez: Yeah, and I find it fascinating because with the animals, we almost more often than not, people demand it for a multitude of reasons; the most common being, "I don't want my pet to suffer." That I totally understand and I agree with, and I support them in those decisions. It's just fascinating that ... And part of it I guess is with people we have more options in terms of supportive care to keep people comfortable and just have somebody there 24/7. That's pretty very challenging for most people. I have had clients that have the ability to have somebody with their pet 24/7 offer doing whatever it is that they need to have done in a home situation. It's not like they're putting him in the hospital or something and not being with them, it's just that they can manage all of those little things like if they can't get up from by themselves that somebody can take them and help them to get up and go outside and if they're not continent then they can take care of that in terms of changing the bedding and that sort of thing in helping them. But that's not the norm. For most people, it's just not an option. What do you do if you can't be there or if don't know someone who can be there or afford to pay someone to be there, what do you do? This other option is available especially when there's no hope of improvement. And so that's what happens. Dr. Bob: It's interesting to think about those scenarios because it's just natural to make the comparisons, right? This is between people and animals, and if you have a person who needs care to manage their ADLs because they can't get up by themselves, they can't clean themselves. That's not enough to justify having their life end. For some people, it may be that the complexities of creating care- Liz Fernandez: The other part of that is that a lot of times, it's emotional least distressful for the clients because they realize their own limitations whether that be physical, emotional, financial. All of those things factor in, and so they wind up making a decision because not that they think it's what is necessary that the animal is that near to death that that's what is appropriate, but because the entire situation is such that they can't handle it. If you have an 85-year-old woman who's got 100-pound dog and she doesn't have anybody else to help or take care of it, she may be healthy within herself, but to be able to meet all the needs of a big dog- Dr. Bob: That's dangerous. Liz Fernandez: Yeah, it's dangerous. Or even somebody who's 50, but they have a bad back. Dr. Bob: That part like knowing that the dog is not or the animal is not necessarily imminent, that close to death, or maybe it's not even suffering that much, right? It may not be in pain, it may just have these limitations, and if the family was able to meet those needs even though the dog is not living its ideal life like a human being who's 90- Liz Fernandez: Right. A lot of people feel like if they can't get up if they can't do those things, that they are suffering, that it is not a life that they would want, so there is that. I would say that with most of my clients they do a really good job of trying to make things work, but on the other hand, most of them have co-morbidities that are ... Like if their back legs aren't working anymore, there's a good chance that they probably have some other issues going on whether that be kidney disease or sometimes some underlying, whether it's cancer or heart disease or other things that make it even more challenging. I honestly can say that I don't find myself in situations where I feel that it's inappropriate. Dr. Bob: Well, imagine if you did then you would find other solution. Liz Fernandez: Exactly. I mean, we each have to do what we feel in our heart is right or for us, but I also try and tell people that there's not necessarily an objective right or wrong. There's a right or wrong for you in this moment, but not necessarily a right or wrong that is somewhere posted in a book somewhere that says that this is the way you have to proceed. Because we have to be honest and compassionate with ourselves as well as in the whole situation. Dr. Bob: Well, I read your book Sacred Gifts of a Short Life: Uncovering the Wisdom of Our Pets End of Life Journeys, and it's really touching, it's really well done and smart. Liz Fernandez: Thank you. Dr. Bob: It was great stories and as I'm reading it, I so often I'm finding corollaries to my life and my practice and my thought processes. One of the things that was really poignant for me is your ... One of the stories, I think it comes up a number of times when people ask how they'll know when it's the right time. For me being a physician who assists some patients through medical aid in dying, there are times when people get a prescription for a life-ending medication, and one of the big questions that they have and that their families have is when will I know it's time? When will I know that it's the time to take this? What their experience or if they're struggling to go through is what your families are dealing with. The difference, I guess the difference in my situation with human beings is that they're the ones making these decisions for themselves, no one can make it for them. And they recognize that when they do take this medication, they may be robbing themselves or ... They're clearly shortening their life, but they may be robbing themselves of some relatively reasonable time, and they don't know. There's no way to absolutely predict what the future is going to hold and sometimes they'll be inclined to take the medication sooner because they're afraid that things will change and they'll lose their ability. They'll lose their mental ability, the physical ability, so there's this back and forth dialogue they have with themselves and questioning. Almost every single time, I've told them, "You'll know when it's time. No one's going to tell you it's time. You're going to know, and when you know it, you know it. There's been a couple of people out of the many dozen who I have been with who have still been slightly, slightly, hesitant, reluctant questioning it and even to the last hours. What I recognize is those people are the ones who have younger children. No matter what they do, separating any moment sooner than they absolutely have to is a challenge. Those are the ones that tend to be a struggle. But like you said, they know when it's time, sounds like your families come to a place where they just know now is the time. Liz Fernandez: Yeah, and I have definitely tried to work with people and something that I do talk about in the book as far as just ... Because even in our profession we have a tendency to, and as a profession, this is so, and I have tried to steer away from this, but we're the ones that like to tell people when it's time, and people like us to tell them oftentimes. What I have found throughout my career is that if there is not complete 100% choice that's made by the person who's involved with the pet, then they sometimes feel guilty, feel pushed, feel resentful that someone else told them that they needed to do something when they weren't ready. I try to avoid that and make sure that they are comfortable and that they are listening to that place within themselves that we each have that I think it's so important not just to listen in this situation but throughout our lives, that we start listening to that, that we begin to trust it, and then we can act on it. This is a situation that really invites us to do this in a wholehearted way, and if we have practice doing that throughout our lives, it becomes much easier. What I ask people to do is to try and get very quiet and feel into their body and have someone else perhaps even present with them and feel into their body with the idea that, "I'm going to euthanize my pet today," and then just feel what happens to them. The person who's with them can watch whether there's a tenseness that happens, whether there's a clenching or a contraction, or if there's a relaxation and opening up because the body is reacting to the deepest truth. I think that can be very helpful. I had had a couple of situations where I've been with somebody as we move through that process and I've reflected to them what I have seen, and in one situation I said when you get your poll body relaxed when you thought about just going ahead and letting Sophie go today. Then we talked a little bit longer because it didn't seem like she was ready to go ahead with that. But what I told her and what we talked about was that it really was okay that she felt that way. That it was getting really challenging and very difficult to take care of her. When she actually accepted the idea, so her body was just asking, inviting her to become okay with that as a possibility, and recognizing it and forgiving herself for having that feeling, for feeling like I can't do this another day. And yet there were some things that we could try, and we wound up trying them. And then would about two weeks later, things have deteriorated further, and she was very clear, and she had no question. But what her body actually was doing when she relaxed was not saying that it needed to happen today as much as it was saying that she needed to accept that as a possibility and that it was okay that she felt the way she did. Once she became okay with this feeling that, "I can't do it anymore," she actually found the strength to be able to go on a little longer. But he had to accept that within himself first. Very interesting. And the opposite happened. Both of these situations happened within probably two or three months of each other, and the other situation was that the lady just did not want to euthanize her pet. And she knew. I mean, there were all sorts of signs from the universe, and from her husband, and her husband had a dream, and all of these different things and she just knew, and he was really not doing well, but she just couldn't let go. I said to her because again when we went through the process, not doing it is what gave her the most relaxation in her body. And I said, okay. Consciously and in her brain, I said, "Be okay with that. It's okay that you can't do it today. Because sooner or later if you don't do it for him, he's going to do it himself." And he's not really suffering; he was just in a point of not really eating anymore, but just not moving. You know what I mean? He wasn't in any kind of excruciating pain that we needed to address or anything. And once she could finally just say to herself that it was okay, she could forgive yourself for not being able to do what she really felt was the best interest of her pet. Because she just loved him so much and just, it's like ... When she completely surrendered to that, she sat with him for a few minutes and then she said, "Let's go ahead." Dr. Bob: It's beautiful. Liz Fernandez: Yeah, it's quite fascinating, but again if you start to listen deeply and can accept whatever happens or whatever wants to happen and trust it, then I think that we do have the answers within ourselves to make these difficult decisions. Dr. Bob: Actually I appreciate that you shared that. Because on a couple of levels, I think what you're sharing is so vitally important. On the one hand, I think that's what we need. Everybody needs ... Moving to the human realm, we all need to be able to go deep inside and become comfortable with the idea that one day we're going to die. Liz Fernandez: Yes, just have a good relationship with death. Dr. Bob: Yes. And not to say, "Okay, I'm ready to die." Not to say that I've got everything prepared or that emotionally, financially, legally, or whatever. But to just understand and feel this sense of acceptance and a sense of calm about it, and if you can't get there, then the work needs to revolve around figuring out why what is it that's keeping you from feeling that sense of acceptance or calm about it. But once you can get there, then everything is a bit easier, I think it's brighter, a little bit more ... It's almost like it's bonus time. Now I've accepted this; there's my ultimate endpoint, now let's get on with life. Liz Fernandez: Right. Part of why I wrote the book was not only just for clients, but for practitioners and then just the general public. Because the whole idea is what my book tries to talk about and what I'm passionate about is just that. It's the idea of having a relationship with death that makes it less scary. Be able to embrace it, to dance with it, to recognize it everywhere. Things are dying all the time. We push it away so much we deny even the idea. No one wants to say the word. It becomes this big scary boogeyman and the big monster under the bed. Dr. Bob: It does not have to be that way. Liz Fernandez: That's a cultural thing. It's like can we just start just have a keep the conversation going. Dr. Bob: And I think we are. I mean, that's part of what we're doing, right? That's why we have this ... That's why I have a life and death conversation. There are people like us who are not only comfortable talking about it but shine when we're talking about it. Because it's like being part of a club where you understand where this is coming from, where this conversation comes from. Not because we're morbid or want to talk about dying or don't love life, it's because we do love life. And we love life enough to say, "And one day this is going to end." And that's going to be okay too because that's We can maybe by doing this, by having these conversations and people listen to it and they think, "Wow, that's an interesting way of looking at it." Liz Fernandez: Broadening the perspectives because there is a sacredness to it. There is this deep sense of ... I mean, it pulls us into silence. I had the opportunity a couple of weeks ago to speak to a group of high school students who are interested in veterinarian medicine, and this is the topic we talked about. We talked about ... I just described the state that one gets into when one watches a sunset, and you're just completely present. That's kind of what meditation is, but it's also what happens when we are communing with death if you will. I mean, if we're present with someone who's dying, and that silence, it's just so full. There's so much life and love there. Dr. Bob: And sadness, right? There's loss, there's all of it, but it's the whole continuum. Liz Fernandez: It's all of it, exactly. And that's the other thing that I try and really focus on. It's the idea that it's not either or. You don't have to deny anything. You don't have to deny that you feel devastated or just horrible for whatever the experience is, and at the same time at some point, everyone who's ever gone through a grieving process knows that there is this ... All of a sudden flash will get in your head, and you'll start smiling and laughing when you're thinking of this person who you miss so dearly. You're feeling it all. That's what I mean I think it's important. That we allow ourselves to feel all of that. It's like clouds. They come, and they go, and your feelings and your emotions are going to be all over the map as part of the grieving process. One of the [inaudible 00:26:09], a friend of mine recently who passed away. She was very aware, and she lived so fully. I have another client whose dog is ... They called me a month ago thinking it was time and it's not yet, and they're just kind of writing with it. The idea to be able to live fully knowing very clearly because you have a terminal diagnosis, that your time is very limited, is ... I've seen only either in animals because they don't get all hung up, but in people, those that have really, really accepted the idea, they're older, and they can live like you said, very fully because of that. Dr. Bob: Yeah. For me that's a big part of my mission, and it sounds like of yours, is to create this comfort to allow the loved ones who are part of this experience to have it be as peaceful and potentially transformative as possible, so they can go on the rest of their lives feeling a sense of peace about it, feeling a sense that they did everything right, that they did the best possible in support of their loved one. Yes, it's important to make it comfortable for the person who's dying and to reduce the fear and to reduce the struggle, but so much the loved ones go on for years or decades having to carry that experience with them. It's a beautiful experience if it has been well explained and accepted, and the processing has been allowed to happen, it can be amazing what it opens up for them or allows them to experience. Which is why it's so it's so unfortunate and challenging one when people die suddenly. Or animals when death happens suddenly, and people haven't been able to prepare. You know what my solution for that is? Always be prepared. I think about that. I was in [inaudible 00:28:38] for 20 plus years. From early on in my career and in my adulthood, it became very clear to me how quickly things could change, how random things were, and so I guess I got comfortable with this idea that I could be just removed from life instantly or traumatized. I made a very conscious decision to tell people what I wanted them to know. To not leave things hanging. I'm almost to the point where my kids when I would leave the house they, "I know dad, I know you love me. I know. Okay." We have to hug again, and ... Liz Fernandez: They say when they're 13, right? Dr. Bob: Yeah, but I don't care. This is my thing. Liz Fernandez: They will appreciate it. Dr. Bob: Let's hope so. Liz Fernandez: No, I absolutely agree. That is hard when people leave us suddenly. It is wise to be really authentic in your feelings and leave things ... What makes your people know. I have always done the same. It's like, is there anything I need to say to anybody that I know? I try and do that. Dr. Bob: Well, who knows. Maybe this is just a reminder for somebody just to do it a little bit more. I feel like people who ... Well, anyone who has a pet certainly, or anybody who is interested in exploring the experiences in the mind and insights of someone like you who's around death on a daily bases would benefit from getting a hold of your book. We'll put a link to the book on our website, which is integratedmdcare.com. Once this episode airs, then it will be available. I thought it was wonderful. I gained a lot of insights out of it. I'm sure many other people have as well. Liz Fernandez: Well, great. I am so pleased to hear that and thank you for offering to put it on the website. Dr. Bob: Well, Liz, thank you again for taking the time out of your day. Liz Fernandez: And thank you. I really appreciate it. All right. Dr. Bob: All right. Thanks, everyone for tuning in. We'll talk to you soon.

For decades Kathryn Tucker has been supporting people's rights to have a peaceful and dignified death. She's fought to protect the medical aid in dying laws. Listen to learn more about the End of Life Liberty Project. 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 End of Life Liberty Project Dr. Bob: Katheryn Tucker is an attorney who's dedicated almost 30 years to supporting the right of individuals to have a peaceful and dignified death in a manner that's consistent with their values. In this work, and in this effort, she and I are very aligned. She helped initiate and protect the medical aid in dying laws in Oregon and Washington State as well as California, and has continued to be a fierce advocate for this right on a state and national level. Katheryn's a graduate of Georgetown University Law School, and she's currently serving as the executive director of the End Of Life Liberty Project, which is now based at the UCSF/UC Hastings Consortium on law, science and health policy. Katheryn is recognized as a national leader in spearheading creative and effective efforts to promote improved care for people who are seriously ill and dying. And on this episode, Katheryn is discussing her passion for supporting and protecting people's right to a peaceful and dignified death. As well as her views on the current laws in place in certain states that allow terminally ill people to access physician aid in dying or otherwise known as death with dignity. I personally found this conversation to be highly informative, a bit provocative and incredibly interesting. I hope you do too. Well. Katheryn, I am so happy to have this conversation with you. And I really appreciate you taking time. I know you're a busy lady, and involved in lots of important things. So, again, thanks for sharing your time and your expertise with my listeners. Kathryn Tucker: Well, thank you for having me. My pleasure. Dr. Bob: Yeah. I feel like we have so many different things that we could talk about that are important, but I'd like to start out, you're a passionate advocate for people having the most peaceful, dignified end of life as am I. We have we approach it from different angles, but with the same kind of general mission, which is to allow people to be self-determining and have more control. You've been doing this for a long time, how did you become such a passionate advocate for this? Kathryn Tucker: I started doing this work when I was a brand new lawyer back in 1990, and I was the outside counsel to the first initiative campaign in the country to put before voters the question of whether dying patients should be able to receive physician assistants in dying. So, my work started that year with that campaign. I did become passionate about empowering patients with information and choices as a civil liberty, and one of the most profoundly personal decisions a person can make in a lifetime. Dr. Bob: So, was this something that you ... Is this a direction that you chose at that time back in 1990, or did it just fall into your purview based on where you were working and what you were doing? Kathryn Tucker: I was a young lawyer in a big law firm in Seattle, Perkins Cooley that supported its lawyers taking on pro bono work. So, I actually was casting about for some public interest work and came upon the campaign, Washington Citizens For Death With Dignity, and just volunteered to provide some legal support. Right at that moment, the initiative was being drafted. So, I got involved with that drafting. Then we had a long campaign that involved the defense of the ballot title in court, that's the words that the voters will see when they go to make their vote and is very important to the outcome of the vote. So, we had litigation about that. We had litigation around false political advertising because some of the claims that were being made about what the law would allow were so outrageously wrong that we challenged those in court. So, it turned out to be a year and a half working to get this in front of the voters. And it very nearly passed even though it was quite a broad measure, much broader than what was passed in Oregon a few years later. So, my work on that then rolled forward into doing some work on the Oregon Effort in 1994. But also the orchestrating of two federal lawsuits that were seeking to have the federal courts and ultimately the United States Supreme Court recognize that the choice of a dying patient for a more peaceful death with physician assistants was an interest that should be protected by provisions of the United States Constitution. So, that work then got underway, and 25 years later I'm still doing this role. Dr. Bob: You're still doing that. Do you ever wonder what would have happened if you never were asked to participate in that back in 1990- Kathryn Tucker: It would probably have been a less interesting and satisfying career. I think that this question which is that the intersection of law, medicine, bioethics is very fascinating, and there are so many perspectives and so many complexities that 25 years later it says interesting as it was when I first got started. So, I'm very grateful and privileged to be able to do this work.Dr. Bob: I completely get that. This work has been part of my life only for the past couple of years since the end of Life Option Act passed in California, but it's so complex, and it makes me feel so, I guess, alive and invigorated to be able to provide such a high level of support at such an incredible and vulnerable and intense time in people's lives. Kathryn Tucker: Right, absolutely. Dr. Bob: So, I commend you, and you're partly responsible for what's transpired and what's now allowing people to have this kind of control and peace. And so I thank you for all the efforts that you've put in. I know that you've gone way above and beyond, you've created a nonprofit to additionally provide support. So, 25 years after you began, what are you currently focusing your energy and attention on right now? Kathryn Tucker: Well, one of the things that I constantly try to do is have some perspective on whether the efforts that we have been engaging to expand end of life liberty are actually achieving that. My current view is that while the work we did with the Oregon Death With Dignity [inaudible 00:07:50] which became the first statute to permitted and dying, enacted by voter initiative in 1994 by the Oregon voters. But then subsequently followed in many other states that have essentially what's referred to as the Oregon model. Which is a very heavy-handed government regulation of the practice of medicine with regard to aid and dying. That very heavy-handed government regulation may have been appropriate and necessary in 1994 when no state had an open practice of aid and dying. And there were many unanswered questions about how an open practice would impact patients and the practice of medicine. So, the Oregon enactment was designed first to actually be able to run the gauntlet of the political process. So, it needed to have a tremendous number of what are referred to as safeguards. You'll recall that the Oregon measure followed a failed attempt in Washington State in '91, and then a failed attempt in California in '92. So, by the time we were working in Oregon in '94, it was the kitchen sink approach to protection, regulation and safeguard so that the contentions of opponents that this would be dangerous could be effectively combated by showing how many safeguards, in fact, were in place. So, that's the backdrop of why the Oregon measure has the multitude of restrictions, requirements, and constraints that it does. Following Oregon's enactment. Other states adopted virtually the same but in some cases even more burdensome measures. Because at that point they could say well, the Oregon approach has worked well. So, everyone in this forum can feel comfortable voting for this. That's been effective. We saw Washington State and Vermont and Colorado and California and Hawaii adopt what are called Oregon style aid in dying measures. The problem is we're now more than 20 years later; we've got abundant data that shows who chooses aid in dying and why, and how it impacts patients in the practice of medicine. So, we now know a lot more than we knew in the early '90s. I think it's time to move away from the Oregon model because what we have also seen, and a multitude of studies are starting to report is that very heavy-handed government regulation comes at a tremendous cost. It creates barriers to patient access, which I know you've seen in your practice. And it creates tremendous burdens for physicians, which of course you're also aware of, which means few doctors are willing, and patients find difficulty finding doctors, and it's very problematic. So, the advocacy that I am embarking into now is really to move the practice of aid in dying into a standard of care approach, which is how all of medicine is practiced Dr. Bob: Awesome. You are really gifted at articulating all of that, and I think you did a great job of sharing how things got to be as they are today. Could you go a little deeper into what the heavy-handed government regulations you're referring to are? Kathryn Tucker: Sure, and I know you know them very well. Dr. Bob: Right? I want our audience to be aware of what we're talking about. Kathryn Tucker: Right. Well, so, on the eligibility side, and I don't really quibble with this because I think this is where our culture accepts the practice of aided dying. The patient must be diagnosed with six months or less life expectancy. They must be mentally competent. So, this is a decision that can only be made by a patient who has the ability to make their own informed medical decisions. Then the physician involvement is limited to providing the prescription for medication which the patient can self-administer. Those three bright lines, terminal illness, mental competency and patient self-administration, I think are what this culture accepts and are appropriate however the practice is conducted. Whether it's subject to statute, or standard of care. But then beyond that, what these regulatory statutes require is a tremendous amount of process and procedure. The patient must make multiple requests. It must be oral and written; they must be witnessed. They must have a minimum 15-day waiting period, although in the case of Hawaii that's now been extended to a minimum waiting period of 20 days. There's a tremendous amount of requirement for the collection and recording of data. And all of that is apparent to the practice of medicine. And most medical practices, even practices that result in the death of the patient and in fact, can be anticipated to precipitate the death of the patient are practice subject to standard of care. Which means the practice and procedures that govern are those that have been shown to be most efficacious and to deliver the best care to the patient. That is something that can evolve over time as clinicians discover what is most efficacious. So, it's an evolving standard, which best serves the patient. Here, just to bring it into a concrete example, I think we can all see that a 15-day mandatory state regulated waiting period causes a tremendous amount of suffering that standard of care would likely not impose. Clinicians free to determine whether there should be a waiting period would likely have it be much shorter. They might say to the patient, and Dr. Bob, you can say what you might say. You might turn to your patient and say, "Why don't you sleep on this, and we'll talk about it at our visit next Tuesday, or we'll talk about it tomorrow on the phone." It wouldn't be an additional 15 days. Because remember, patients come to this choice when the cumulative burden of suffering is so horrific that they feel that achieving death is their best option. So, they're in tremendous suffering when they're ready to make that choice, and then mandating waiting another 15 days, which many patients don't even live long enough is just cruel. Dr. Bob: Agreed. I completely agree. So, that does seem to be the most significant burdensome aspect. It's interesting, I hear about how often people have these multiple struggles trying to find a physician who will support them. Once they do find somebody, often it's because they're part of a hospital system, and they've been referred to so and so, or their own doctor has finally agreed to. But they also have these processes in place that mandatorily referral to an ethics counselor or a psychologist or psychiatrist even though they've never had any hint of mental illness throughout their entire life. But when people find me, and I know there are other physicians, Lonny Shavelson, and there are other physicians who are truly focused on providing support and honoring the patient and not primarily focused on protecting themselves and worrying about the liability or the hassle factor. The process really can be very streamlined. It doesn't feel in many cases for the patients that we care for, overly burdensome aside from the 15-day waiting period. So, I know we've had conversations about that- Kathryn Tucker: You are to be commended for your willingness to put up with so much procedure. Because doctors are busy people, and to create additional burdens on the clinician as these statutes do, well beyond what would be done for example, with the provision of palliative sedation, of course, is another medical choice that patients can make, and physicians can provide. Where death is the certain outcome after some considerable period of time, while the patient essentially dehydrates to death without any of that paperwork, without any of that reporting of data. It just happens within normal medical practice, which I think is where most physicians are comfortable practicing. That's a difficult enough job as it is without layering a tremendous additional level of process procedure and second-guessing on top. Dr. Bob: Yeah. I'm in agreement. What I've come to discover since becoming willing to participate and support patients and families is, I have concerns about this becoming a more ... About having a lot more physicians support participating. I want patients to have easier access, and not struggle to find the support that they need. But knowing how much time and energy goes into providing that support, the questions the patients have, the families have, the multiple, multiple phone calls and emails and communications as this is moving forward, I'm very concerned that most physicians in a traditional practice don't have the mechanism or don't have the wherewithal to provide that support. So, we would certainly have to be able to address that. Because otherwise, people are going to be struggling not having the information they need, not having the support they need. What are your thoughts about a process that can be put in place to ensure that that's happening? Kathryn Tucker: Well, I certainly think that clinicians who are willing to expand their practice to include aid in dying are going to be those that are highly motivated to respect their patients autonomy and to want to make sure that the patient is able to make the journey to death in the manner that is most consistent with their very personal preferences and values and beliefs. So, this is a fairly unusual subset of clinicians that will feel strongly about that. I think that they will take the responsibility of ensuring that the patient's request is voluntary and considered and enduring. I think they will take that all very seriously in a standard of care practice. Those clinicians will provide it. So, it will self-select. Certainly, not everyone is going to make this part of their practice. And we know that, for example, 20% of surveyed physicians in a New England Journal of Medicine survey were unwilling to discuss palliative sedation with their patients. That's an option that is clearly accepted by both law and medicine, and it should be available to patients in all 50 states. Yet, a fifth of doctors don't inform their patients about it. So, we know that physicians self-select what they're willing to provide in terms of care, and not all physicians would provide aid in dying. I'd like to see the model that we've been able to open the door to in Montana, considered by other states. And that's the one state that now has nearly a decade of aid in dying practice subject to standard of care, not subject to statute. I think that that model should be more closely looked at by other states and by advocates. Because it's much more normal in the practice of medicine than to have statutory governance. Dr. Bob: Yeah, it's an interesting model. Do you know how ... Of course, Montana is not a very populous state. Is there any data on the numbers of patients that are taking advantage of that right in Montana? Kathryn Tucker: Right. Well, you asked the question that we all ask, and the answer is no. Which is as it should be, because, absent a statute, clinicians are not required to collect and report data to a state agency, which then publishes the data for public review. So, we don't know the answer to that question. We do know anecdotally, from talking to clinicians who have embraced aid in dying in their medical practice, that some clinicians are practicing, and some have been very public about that, and have been willing to talk about their experience in other forums, including in lawsuits, trying to expand and have life, liberty and other states. So, we have the experience and the testimony of participating clinicians, but we don't have survey information. And in fact, I've been working with some researchers who do research into the practice of aid in dying in various states and published studies that you'd probably read about that practice. To encourage them to embark into the kind of surveying that would allow us to answer that question in Montana. It's really, they're excited to do it, it's a question of finding the funding to support their work, and we are also planning a symposium in the state of Montana to bring forward the experience there, and hopefully interested clinicians and patients and health policy researchers from around the country will come to that symposium to learn more about the Montana experience. Dr. Bob: Great. Do you know when that's going to be happening? Kathryn Tucker: We have just chosen the date. It will be September 6, 2019. Dr. Bob: Okay, so about a year plus in the planning. Sounds good. I'll put that on my calendar. Kathryn Tucker: Great. Dr. Bob: Another model that I find interesting, we were talking about the concern about physicians, if more physicians were participating in supporting aid in dying, do they have the wherewithal to truly support the patients? I did an interview with Robert John Keir in the Netherlands, and we talked about the model there, which of course allows euthanasia, in a much broader scope. But they allowed physicians to serve as an attending physician without any specialized training or background. But every patient is required to be seen by a specialist in this infield. There's a select number of physicians who are trained to be able to do the assessment and to provide the guidance and support. So, they provide support for not only the patient but for the physicians who have the relationship with the patient. So, what it does, is it assures that every patient has the adequate support that they would need, which would be an interesting model to be looking at here as well. Because one of the reasons that physicians, many physicians are reluctant is because they were concerned about the burden. They're concerned about the time involvement that they don't know enough to make sure that they're doing everything properly. So, what are your thoughts about that? Kathryn Tucker: Yeah, I don't favor having an extremely specialized small cadre of physicians who do this work. I much favor that the patient can turn to their own physician in the context of hopefully, a long-standing doctor, patient relationship, which can be very rich in terms of what the doctor knows about this individual, and their values, their beliefs, their preferences, and that that can inform the care the physician is able to provide the patient. Rather than having the patient come into contact at a difficult, vulnerable, burdened time of life to meet a new professional, and try to ramp that person up in explaining who they are, and why this is important to them. That's a complex dialogue that one would hope has gone over some period of time. And I think that's why it's so difficult Of course, to extrapolate cross-culturally. But I think it accounts for when you take a look at the data from the Netherlands where it is common that there are these long-standing doctor-patient relationships. And that that then allows the clinician to feel comfortable actually administering life-ending medication to the patient, which is not permitted in the States. But when you're in a situation with a very long-standing relationship, and there's a lot of clarity and understanding about the patient's wishes, the clinician then feels comfortable doing that, and the society feels comfortable supporting it. So, I tend to favor the physician assistants coming from a position with a long-standing relationship with the patient. Dr. Bob: I couldn't agree more. I absolutely believe that that is the ideal version and the ideal scenario. But realistically, I'm also aware of what life is like for physicians, and what that relationship has become. And unfortunately, it would be a long time, which I think many things would have to change for that to become reality. And I think we're both aware of that. That's the idealized version, which would be phenomenal, and it does happen at times. There are times when I have a physician who will contact me and say, my patient is requesting this, I want to support them, I don't really know what to do. It's my first time, and they request my support in guiding them to allow them to be the attending physician, and I may become the consulting physician, but providing additional guidance and support. Kathryn Tucker: That's exactly as it seems it should be, which is that's how standard of care and best practices are established, is clinicians who are new to a practice will look to peers for guidance. That's the beauty of standard of care governance is, hopefully, the more experienced clinician helps the beginner understand what best practices are. And those can, in a normal environment be allowed to evolve as the clinicians learn in providing care. So, I think that's the direction we should be moving, and much of my work now is oriented toward bringing that about. Dr. Bob: That's wonderful. I'm fully supportive of that aspect. I'd like to ... Again, we could speak for hours and just barely scratch the surface of all the things that we might want to talk about. And I am hopeful that you'll be willing to come back and do another podcast with me at some point in the future. But before we close, I just want to give you an opportunity to share whatever it is that's bubbling up for you, if there's something that you want to make sure that you articulate to the listeners, I'd like to give you that opportunity. Kathryn Tucker: Well, I will close by thanking you for offering me this opportunity to share some insight into the work of the End Of Life Liberty Project. And for any listeners who don't know the work with that project, you can find out more by visiting our website, which I hope you will do. We are based out of the UCSF/UC Hastings Consortium on law, science and health policy. But if you just Google End Of Life Liberty Project, you'll come to our website where there's information about our work. There's also a handy donate button. Because of course, this work is the work of a nonprofit and can only happen when donors support the work. So, if any of your listeners are in a position to support this work, we're always grateful and make tremendous mileage out of every dollar donated. You can also like us on Facebook, and get updates on the work of the project through following us on Facebook. Dr. Bob: Fantastic. And we'll make sure that the links for the sites and the Facebook page are on the website where we post all the podcasts. And that's at integratedmdcare.com/newsite1. Again, this was fascinating. I'm always fascinated and grateful to speak with you. I feel like we are in partnership in something incredibly meaningful. The patients and families that we get to care for are benefiting from your tireless efforts. And again, thank you for giving us some of your time and wisdom. Kathryn Tucker: Thanks for the opportunity Bob, and for all of your good work as well. So, congratulations to you.

Bill Palmer has dedicated much of his life to helping people get comfortable with death. Hear why he has hosted more than 75 Death Cafes and what he's learned from them and the people who attend. 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 Death Cafe website Transcript Dr. Bob: My guest on today's podcast has been on a really interesting journey over the past several years. Bill Palmer is a successful executive coach and management consultant who lives in Oakland, California. After a personal experience with a loved one who died while being supported by an excellent hospice organization, Bill was inspired to come home to Oakland and start volunteering with other people on hospice. And then he began hosting Death Cafes. To date, Bill's hosted over 75 Death Cafes for members of his community up in Oakland. If you're not familiar with Death Cafes, you will be after listening to this very informative podcast. Bill has had incredible insights through many, many hours spent with hundreds of people openly discussing death and dying. From the very practical aspects to the emotional and spiritual issues. On this podcast, he shares some of the insights that he's gained with us. I believe this can help you become more comfortable having those meaningful and really important conversations that you should be having with your loved ones and with yourself. I hope you're as grateful for these insights and reminders as I was, as I was speaking to them. Bill, thank you so much for being willing to spend some time with us and share a bit of your experience and knowledge with the listeners. Bill Palmer: Sure you're welcome. Dr. Bob: You have an interesting life, I'm assuming. For some reason, you have chosen to dedicate yourself to helping people get more comfortable talking about death. How did that come about? What was the ... My understanding is that you're a business coach and that you're coaching people through different aspects of business and leadership. How do you become a Death Cafe leader from that place? What was your journey? Bill Palmer: The journey really started actually, quite a few years ago when my mother was admitted as a hospice patient in Florida. She received incredibly good care at the Hospice of Palm Beach County where she lived at the time. As a business coach, and as an organizational development consultant, I was struck mostly by the wonderful care that she and my family received, but I was also struck by the incredible business alignment and sense of higher purpose in that hospice. At the time, I thought it was unique. And since then I volunteered in several different hospices. I found that to be more the rule than the exception. Somehow, rather, and I don't recall exactly how I came across a guy named John Underwood who lived in London, and who was the founder of Death Café. It just seemed like a great idea to me at the time. I became a hospice volunteer because I wanted to give something back. It didn't especially require any special skill to be a hospice volunteer. Sometimes just sitting with somebody, visiting, doing a respite visit something like that. But Death Cafe appealed to me because I could bring to bear some of the skills that I feel I have in terms of leading groups and speaking with individuals in an open and honest and kind of free, willing environment. So, I decided I would take John's advice and example and do a Death Café, which is actually pretty easy to do. Dr. Bob: You have the model, right? He shared the model with you and ... From my understanding ... Tell us what a Death Cafe for people who don't really understand it. Bill Palmer: Well, first of all, there's a website called www.deathcafe.com, and it gives a full explanation not only of what a Death Cafe is but how to start one if you want to in your own community. A Death Cafe is simply a free and open ... Free meaning there's no fee to attend, a group meeting of people, whoever wants to come, who want to talk about any aspect of death that interests them. That could be anything from where do I get a will to, deep philosophical and religious concerns to, what are the regulations about scattering ashes to, my companion died 40 years ago and I'm still grieving to, my spouse died last week and I feel nothing. There's an incredible richness of experience and this is going to sound really strange, but they're actually fun. There's a lot of laughter in a Death Cafe. Some of that laughter is just nervousness about speaking about a taboo subject, but some of it is just appreciation of life. If I could make one generalization about the Death Cafes, people leave feeling strongly that what they're doing in their lives right now, whether they're close to death or whether they feel like they're very far away, takes on an added significance if they can find a way to accept the fact that we're all going to die. One thing that surprised me about the 75 Death Cafes I've led is the number of people who apparently, intelligent, responsible, normal people who actually don't really think they're going to die. Dr. Bob: They certainly act like that, right? Bill Palmer: Yeah. Like I said, responsible, taxpaying, voting, civic-minded people who don't have a will, who don't have an advanced care directive, who've never discussed their wishes for their care towards the end of their lives. It is just an indication of the power of the taboo that people who in most every other aspect of their lives behave quite responsibly. But in this one area, even after they see and hear about the chaos that ensues if you die without a will, if you die without an advanced care directive, if you die or become disabled, even after they hear stories about that, it doesn't seem to get them. Dr. Bob: Do you think that people are denying that they're going to die or that they just think somehow things are going to work out? They just don't want to ... They don't feel like they need to do the preparation because things just have a way of working out? Bill Palmer: Well, I guess on an intellectual level, of course, they know they're going to die. But I think on some kind of emotional level, like a child, they don't really believe it. But I think it's probably a little bit of both, is just if you've never sat down and filled out an advance care directives, and you're using a good one, I'd ask some pretty tough questions. For example, if you don't really know what resuscitation is like, you might think sure, resuscitate me. And if you find out what resuscitation is actually really like in many cases, you might decide something very different. Dr. Bob: Right, in most cases. I think people, they watch TV shows, they watch ER or St. Elsewhere, these shows that depict somebody having a cardiac arrest. They do a couple of things and then a few seconds later they sit up and everyone's relieved, and it doesn't depict the absolute horror that ensues when somebody's doing chest compressions and ribs are breaking, and there's virtually no chance of survival in the vast majority of cases. So, yeah, are those kinds of things discussed even at that kind of graphic level? Are people open to hearing those kinds of things when they show up for the Death Cafes? Bill Palmer: Yeah, I think so. Anyone who leads a Death Cafe, including myself, leads it with a very light touch. There's no schedule of activities. There are no small groups. There are no icebreakers or anything like that. It's just open conversation. If somebody brings that up, people listen, and I think people are affected by it. There is a great deal of information that gets shared. A common statement is, my family won't discuss my death with me. I will or someone else in the group will say, "Well, here are some great resources." The conversation project, for example, can give you some tips and guidelines and do's and don'ts for, how do you have this conversation with people that don't want to talk about it? It's not an easy thing. So, I think there's that and there's a sense of comfort and community and that people find out well, gosh, I'm not alone in this. Other people feel this way too, or are afraid of the same thing, or have had a similar experience. I think it's comforting to people. Dr. Bob: Yeah. Oh, it's rich, and like you say, it's a safe space. Interestingly, I haven't been to one for a bit, but when I went to a few Death Cafes here in San Diego, and they did break up into small groups like four people and then there were some sample questions to stimulate conversation. There was a little bit of discussion as a group. I think as I remember, representatives from the small groups talked about some of the insights that came out. But I felt like there were so many people in the room, there were maybe 50 to 60 people in the room, and I felt like we missed getting the insight from more people in that space. So, I feel like maybe the open format like you're describing could be even more effective if everybody who wants to speak has a chance to. Bill Palmer: Well, anyone who's interested in starting a Death Cafe can read on the Death Cafe website, very specific and clear instructions for leading one. I think that if someone is fortunate enough to get 50 or 60 people at a Death Cafe, that's nice, but I think it's an unwieldy number. I know that I've always limited the attendance of Death Cafe to 20. Even at 20, it can be a bit unwieldy. So, I think the smaller group dynamic works. I know I was asked to help with a Death Cafe that was being sponsored in a retirement community here in the East Bay in California. 40, 50 people showed up. Yeah, we split up into small groups, but it just wasn't as satisfying. It is just really difficult to manage. If anybody's considering doing it, I would strongly recommend that you limit the attendance. You can use a website like Eventbrite which is a free ... It's like Evite, or Eventbrite, one, they're pretty much the same. You can invite people to purchase free tickets, or just sign up for registration. Then you can limit it to 15 or 20. Dr. Bob: How did you go about finding a location? Because if you're there's no fee, I'm assuming you've done 75 of these, I'm assuming that you're trying to avoid spending a lot of your own money on these. Is there money available from any organization to help defray costs of putting these on? Bill Palmer: Actually, to be specific, The Death Cafe, you can charge a fee if it's to reimburse the cost. For example, if you rent some space or if you provide some refreshments, you can recoup the cost with nominal fees. I was very fortunate. There's a funeral home here in Oakland called Chapel of the Chimes. They have a long, long history of community involvement and a beautiful setting. They have a lovely acreage and their buildings are fantastic. They have a high commitment to community service. So, I called him up and I said, "Would you sponsor a Death Cafe? I.e. give us free publicity, give us free space?" They said, "Yeah, we'll do that, and we'll also provide coffee and cookies and donuts for you. Because it's right in line with the way that we want to be involved with the community." Death Cafe Oakland gets free space and a little bit of free publicity. They get 20 people a month walking in there who maybe otherwise wouldn't know about Chapel of the Chimes. They've just been great to us. Churches are likely spots, community centers are likely spots. Synagogues are likely spots, and funeral homes I think. There's an obvious disincentive for certain people, well, I don't want to go to a funeral home ever for any reason, but it's worked for us very well. Dr. Bob: Right? Well, my sense ... So, a great alignment, it seems like a great partnership as long as everybody's approaching it with the right intention, and it's comfortable. You don't want to partner with somebody who's going to be pushy and pushing their services. It sounds like that's clearly not happening. But the people who are coming to Death Cafes are probably the same people who don't mind walking into a funeral home. Bill Palmer: That's probable. Dr. Bob: You've got a bit of a self-selected group. Well, that's helpful. I appreciate that. So, you've done 75 of the Death Cafes. When was your first one? Do remember- Bill Palmer: March, of 2013. We actually had our 76th last night. Dr. Bob: Fantastic. So, you've spent 76, and then they're probably what, an hour and a half to two hours each? Bill Palmer: Two hours, yeah. Dr. Bob: Okay. You've had a lot of time to hear people sharing. I'm sure that you are well aware of some of the gaps and the challenges and the struggles around living and dying. Can you share some of the top insights that you've gained from the experience, and offer some of those to the listeners? Bill Palmer: I've thought about this a lot. Something that jumps out at me is that how we die in America is largely a function of race and wealth. Death Cafe in Oakland or the part of Oakland that we're in is a very different thing than a Death Cafe might be in a very different part of Oakland. That jumps out at me constantly. Another thing that jumps out at me is, we live in a secular world, many of us do. Certainly, here in California, at least in the East Bay, in the Bay Area. I'm not sure that that's a bad thing but another thing that jumps out at me is that the loss of rituals, of customs, and community, most religions supply ... Things are taking their place but if you look at the Jewish religion, or you look at Islam, or you look at Catholicism, really any of the major world's religions, Hindu, there are very specific rituals and customs around death that are a comfort, and that allow people to navigate or at least help them to navigate through what is painful and difficult. So, I think that a lot of the interest in Death Cafe and in the conversation around death, it's much larger than Death Café, is around some of the loss of those rituals and the lack of replacements for them. Dr. Bob: I started to write down the statement because I'm sure it was going to be something really valuable. Could you finish the statement, the loss of rituals, customs and community around the time of death has- Bill Palmer: Left a vacuum where people are alone. They don't have a way to navigate through that first, terrible few days, weeks, months. I just think it makes it harder. Dr. Bob: It's a vacuum, I can see that. So, people were coming to the Death Cafes in part to help to fill that void, that vacuum, or because they're afraid that that will be there? Bill Palmer: Yeah, I think on two levels. One is simply, what are rituals that I could participate in that I no longer an observant and fill in the blank. Catholic or Jew or Muslim or whatever. There are rituals that people have created in this country or reinvented in this country about dying at home, and how to care for the body of someone who has just died, against the medicalization and hospitalization, and institutionalization of death. So, I think it's both those things. Some of it is just information. What am I supposed to do? Where can I go to find some community around it? Dr. Bob: The practical issues that can really lead to a lot of stress and anxiety if they're not addressed or planned for. Bill Palmer: Yeah, exactly. Dr. Bob: Any other big insights that are jumping out for you? Bill Palmer: Unfinished business. I can't tell you. I haven't done an exact count, but probably in the 75 Death Cafes, we've had, oh gosh, 500, 600 people come through there. What I constantly hear is five years, 10 years, 20 years after someone died, that the unfinished business that I had with that person haunts me. I never forgave them, or they never forgave me. I had a sister, brothers, spouse, father, mother, son, daughter, and I never resolved what it was that drove us apart. To me, unfinished business in our relationships is the gasoline that gets thrown on the fire of grief. It just makes it all that much worse because you can't fix it once they're gone, they're gone. So, that's something that I hear over and over again. Dr. Bob: Do you offer resources ... it seems to me like ... I think one of the things that felt a little bit dissatisfying for me about the Death Cafes, was that there were people who are clearly looking for support and needing additional help and resources, and there wasn't ... Because it's not promotional, you're not giving out pamphlets or directing people specifically to resources. It feels like there would be an opportunity to bring in some experts and to have people bring in their specific questions to get that kind of guidance. What's the thinking on that? Bill Palmer: Well, I think the thinking is, and it may be flawed is that, above all, John Underwood the founder of Death Cafe did not want to commercialize. I've had any number of invitations from perfectly respectable, fine people who have a book, they have a program they have this, that or the other thing, and they want to come in and in effect, make a sales pitch. Under normal circumstances, I'd say that'd be fine. But I think it leaves us open to having to vet them, having to know what they say. My solution has been to, I've created a Facebook page for Death Cafe Oakland. I post resources there. If somebody says, "Well, gee, how do I start this conversation with my spouse?" I can mention the conversation project. I can also tell people to look on that Facebook page, which is open to the public. You don't have to have attended Death Cafe Oakland to see it. You can find wills, you can find an Advance Care Directive. You can find lots and lots of research. So, I agree with you that the one thing I do specify is that, and I say this at the beginning of every Death Café, is this is not grief counseling. So, if you're grieving, what I say is, please talk about if you want to, we will support you, but it's not grief counseling in the sense that I personally cannot offer you continuing support. Dr. Bob: Yes, it's not a support group. It's a forum, right? With a lot of people coming for different reasons? Bill Palmer: Right. I can refer them ... They can do a Google search as easily as I can on bereavement groups. There's many of them. But I agree with you, my solution is a bit of a compromise, and hopefully, it's workable, but probably every single person who ever came to Death Cafe Oakland who wanted a specific resource for a specific need sometimes didn't get it. Dr. Bob: You're staying true to a mission and that's honorable and it makes sense because you could open it up for all kinds of challenges if you don't keep the boundaries clear, and you're providing ... Again, you're doing this all as a volunteer, right? You have a career and you have to divide your time between things that allow you to pursue that and to ... I really applaud you, commend you for your passion and commitment to this. It's really remarkable. Bill Palmer: The irony is I get more than I give. I appreciate you for saying that, thank you. Dr. Bob: Just to quickly follow up on that, what have you gotten? How has it changed you to have this experience and to be part of this movement? Bill Palmer: Well on a very practical level, to avoid any hint of hypocrisy, I have filled out every form known to humanity with regard to my death, and I'm closer in terms of age, I've got a lot more behind me than I do ahead of me. I think that what I've gotten, the most valuable thing I've gotten about that is, if not an acceptance of it, but a clear idea of, if I have my way, how I want it to go to know exactly what I think is right for me in terms of end of life care. If I'm not able to make decisions or to be mentally competent, a great deal of faith in the agreements that I have with my family, specifically my daughter and my son, who I 100% trust will carry out my wishes should I not be able to act on my own. So, that's a huge gift, that really is. Just the incredible richness and variety of the people who show up, I'm always interested in groups of people. I'm never bored in a group because I'm always watching to see and hear and feel what's going on, and they never disappoint me. It's always fascinating. Dr. Bob: Yeah, I couldn't agree more, especially when they're talking about issues that are so vital and important to them. Do you still have any fear or concerns about what lies ahead for you? Bill Palmer: Sure. I think the idea of gradually losing capabilities is what bothers me and bothers most people that I talk to. Not that I'll be dead, but that I won't be able to move, or I won't be able to speak, or I won't be able to hear, or see, and then that gradual loss of capability, of mobility. Of course, I'm afraid of that. I've also been a hospice volunteer and seen people who seem to live with a quality of life, whose lost a lot. So, I take a little comfort in that. But yeah, that scares me. Dr. Bob: That is such an interesting awareness, right? That some people when they lose certain capabilities, certain degrees of independence, when they're dealing with challenges, some people are ready to die because they've lost these things and it's intolerable for them and they're ready to check out as soon as possible. Then there are others who just handle it with such grace and acceptance and even joy. I don't know what the secret formula is, I'm looking for it. Because I want to be able to A, have it for myself, and B, be able to prescribe it for my patients. But it's such a unique individual, I guess, a way of being in the world. I try to figure it out, but I haven't been able to, and I'm still working on that. Bill Palmer: Let me know when you do. Dr. Bob: Yeah, I will. You'll be one of the first ones. As far as ... I think most of us share a little bit of the fear of the unknown of what's coming. I guess one of the things that I'm really passionate about now is helping to give people a greater sense of understanding, a greater sense of control over the circumstances that they may find themselves in. Part of that is by doing all the right preparation, filling out all the right paperwork, having the conversations with those who will be responsible for making those decisions if you can't. But also, I think ... Do you feel like you have a medical team, do you feel like you have a physician who if and when things become really challenging or intolerable for you, will engage at the level that you need to support you through that difficult challenging last journey? Bill Palmer: Yeah, I do. I am a Kaiser Permanente member. And one of the criteria for my primary care physician that I insisted on was somebody who would not only understand my wishes about that but who would act upon them. The interviews that I did, I found a physician who I'm reasonably certain will honor my wishes. My advanced care directive is scanned into my medical record there... it's a crapshoot a little bit- Dr. Bob: A little bit, it always is. Bill Palmer: You fall down on the street and nobody knows who you are, and they take you to whatever hospital, the ER people are bound by law and by custom to do everything that they can to resuscitate you. Is there a chance it could all go sideways? Yeah, but I feel like ... I've taken every precaution I could to try to make it go the way that I want, and my physician she seems like she's just fine with it. So that's important. Dr. Bob: Well, let's hope whenever it happens, many many years in the future, she'll probably be retired, and you'll have to have a new person who comes on ... I guess that's a good reason to try to find younger doctors so that you connect with. Well, this has been great. I feel like we've given people a great overview of what the Death Cafes are designed to do, and hopefully given some insight into where some of the challenges and struggles people face are, and how to try to mitigate those. I appreciate your time. If you have any burning thoughts that you want to share before we sign off, I am all ears. If you feel like you're complete with what we've discussed, that's totally cool too. Bill Palmer: No burning thoughts, but I want to thank you for the time, and for your thoughtful questions and statements. It was great to connect with you and someday, some way I hope our paths will cross. Thank you again. Dr. Bob: Thank you, Bill. Bill Palmer, founder and curator of Death Cafe Oakland, and I'm sure our paths will cross hopefully fairly soon.

Lydia Lombardi Good is a licensed clinical social worker. She shares the importance of self-compassion, what it is, and how to get comfortable with it and how it helps the grieving process. 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 Lydia Lombardi Good, Pier View Counseling Transcript How Self-Compassion Helps The Grieving Process Dr. Bob: Yeah. That's my pleasure. This is a Life and Death Conversation, and we talk about things that we can do to enhance life and bring more joy and peace to life, and of course, we talk about death. We don't shy away from the topic of death. We always explore a bit about how our guests feel about the whole end of life, death and dying, what experiences they've had, how the awareness of death seems to show up in your life. For people who come on and have these conversations, most of the time they're pretty comfortable speaking about death and sharing their experiences and thoughts about it. I'm just going to open it up and let you share a little bit. I know that you do a lot of work in grief and loss, and you've been in hospice, and have a lot of experience. So share a little bit about what the idea of death and dying means to you, and how it shows up in your life. Lydia Lombardi Good: What I learned from my experience with death and dying, working with clients, having my own personal experience losing close loved ones, is the more we think about death and understand that it is inevitable, and we are all dying a little bit every day, I think the richer a life we are able to live, and we are more mindful of the choices we make, and the people we choose to surround ourselves with, and the life we want to live, knowing that nothing is permanent. Everything is impermanent. And if we live a life without regrets and can be more present to our lives instead of staying maybe stuck in the past, or focused too much on the future, we can look back and say, "You know, I fully experienced all that. I don't wish to be back there again. I wish to be right here, right now, to live my life fully," knowing that we really only have one shot at that. So that's how it's changed me a lot in terms of my own choices, the way I live my life, the way I try to stay compassionate. A lot of it's talked today, and what I really am passionate about is teaching people to embody self-compassion and treat yourself kindly, the way you would treat a close friend. And the more we can do that, the better life we can have. The more chances we take, the more we can just fix up things as they are, instead of always wishing things to be another way, or for us to be another way. And when we do that, we're missing what's happening right now. Dr. Bob: Yeah. That's beautiful. And I think it's pretty common to hear people share that when they contemplate death, when they recognize, like you say, the impermanence of everything, it really allows us to stay more focused on what's happening right now, and feel gratitude, and just feel very present. I want to talk about the mindfulness, the self-compassion, and the mindfulness, because mindfulness meditation, self-compassion have figured prominently in my life and I've done my work there, I've gone through courses in mindfulness. And it's so interesting what you said, to treat yourself the way that you would treat a close friend. Do we do that? I mean, do we really do that? The stuff that we lay on ourselves, and the way that we diss ourselves, which is so common. Like, if we were doing that to a friend, would they stick around? Would we still- Lydia Lombardi Good: We wouldn't have any. Dr. Bob: We wouldn't have any friends. Share a little bit more about that, about how you came to that, what your journey has been to become a teacher of self-compassion and mindfulness. Lydia Lombardi Good: Yes. Yeah. So, I was working in hospice since about 2007, 2008. Right out of graduate school I started this work, and I think I understood it to the best of my knowledge. I'd had a lot of loss in my past, and a lot of trauma that I thought I had worked through and had done a lot of healing around and was in this work. And I think I had as much compassion for the experiences of my clients and patients as I could have at the time, for that point I was in my life where I was at and what experiences I had been a part of at that point. And then it was 2012; I lost my dad to cancer. He died of prostate cancer and endocrine cancer. So the three years prior to that, we were taking care of him, and it was a real aggressive form, so it was a really difficult dying process. So that following year I was in charge of settling what I call closing out someone's life. That process of closing up his home, preparing it for the next chapter, getting his belongings and setting up beneficiaries, that kind of thing, and doing my grief as best as I could, as much as I knew how at that time. And then, shortly before the one year anniversary, I got a call from the medical examiner's office that my uncle, who was one of my father's primary caregivers aside from myself, had taken his life. So then I embarked on that next journey. I was his only family here, so helping to then close out another person's life. And then two months later, I get a call. My husband's out of state at a bachelor party. And I get a call that he's had an accident and I need to fly out immediately to Arizona and be with him because he's had a traumatic brain injury. So I fly out there and spend 10 days in ICU with him until we were basically told that we need to consider letting him go because he was not going to recover at that point. So my real journey I think began there. I could make sense that my dad was in his late 70's, although for some that is still young, but he had lived a really full life. My uncle, I wasn't as close with. It was a different type of grief, but losing my own husband was a total ... knocked me off my feet. It was a total life-changer. So basically, learning about self-compassion and mindfulness started the year before, when my dad was going through his dying process, but really kicked into high gear after I lost my husband, simply for just survival. I was in survival mode- Dr. Bob: Yeah, self-preservation. Lydia Lombardi Good: ... trying to figure out, yeah, how do I survive all this. Three in a row, I'm totally alone, feeling like I'm totally alone. How do I keep going? How do I keep going? How do I make sense of ... if this can happen to my 32-year-old husband, what's going to happen to me? This feeling of just total lack of safety and security and anything that I once knew. So that's when things really, really kicked into high gear for me. And a couple of years later I ended up leaving hospice. I was working out as a bereavement manager, and I decided to start my own practice, focusing on grief and trauma. A lot of it because of all the work I did with amazing clinicians, and spiritual healers, and energy healers, and the amazing, amazing people that supported me through my past, inspired me so much that I felt I really needed to do this myself and work with individuals again, and step away from the program planning and go back to pure clinical work. And it's been amazing. Dr. Bob: I bet. Wow. And like many people, your journey has taken you someplace because of your own personal experience. I mean, you have the training, you have the structure of having worked in a company, but once you had your own personal experience and were down in the depths, and then figured out what you needed to do to survive, and then I'm assuming beyond surviving, starting to thrive again, you recognized that you needed to be in a position to share that on a deeper level. Lydia Lombardi Good: Yeah. It's been tremendously healing, although I didn't jump into it necessarily to do it for my own healing. I wanted to make sure that was taken care of on its own, so I wasn't coming to work with clients doing my own work. But feeling complete and on a really steady path with my own healing empowered me to know the tools that work for people, and to empower others to consider some of these healing modalities. And mindfulness and self-compassion were right up there. They were the primary methods for me in terms of my healing. A lot of people as what does that mean. When I heard, "Self-compassion," I frankly, four, five, or six years ago I never knew what that even meant. It's not a term a lot of people in western culture understand or use. So really learning what that meant, and practicing it for myself, so I could know how to show others to do that. Dr. Bob: So why don't you try to explain it and let people know, because there's probably a lot of people here who ... you know, the self-compassionate conjures up some images and some thoughts, but I think you could probably do a really good job of helping people see what it really is to learn self-compassion. Lydia Lombardi Good: Yeah. So, self-compassion defined more is bringing yourself to the same attitude and understanding that you would do for others, or a beloved friend. So asking, how can I care for and comfort myself at this moment, instead of judging and criticizing. How can I bring kindness and understanding, and patience, when I'm confronted with a personal feeling or loss, instead of beating myself up. And then honoring and accepting your humanness. And with grief, I think where I see a lot of people, and I did this myself, we put ourselves in a timeline immediately. I was talking to a woman the other day, and she said to me she just lost her fiance a week ago. And she said, "I'm trying to be happy. I know I need to be happy, so I'm just going to be happy, and I cry when I need to, but I just want to be happy." And I said, "You know, why do you have to be happy? You just lost your fiance. Can you just honor what's really happening with you? You're sad, you're angry, you're all these feelings ..." that she was telling me before she said she felt she had to be happy. We try to pressure ourselves to move faster than we actually it's reasonable for our healing. And this is actually what stuns our healing when we try to pretend it's another way. We try to pretend that ... you know, you'll hear people saying, "In a year you should be better. Just give yourself that year." Well, for some people a year it's just begun. The trauma is just starting to settle, and now all of the sudden there is space for grief. Or the realization or the beginnings of acceptance begin to occur after a year, for some people longer. None of that's wrong; it's just is. But with self-compassion, we can give ourselves that space to say, "Whatever's happening is just right for me. As long as I'm not hurting myself or I'm hurting another person, this is what I need to do in order to move forward and to heal, step by step." Dr. Bob: So how does that happen? How does somebody learn self-compassion? How do you go from having the normal chatter, the typical berating and judging that most people have ... has become sort of their pattern, to having this self-compassion, and what's the process? Lydia Lombardi: I think the first part is learning you're being able to become aware of the voice inside you and what it's saying, so really listening to that. So if you start to notice your pattern of self-deprecation, or being really hard and punitive with yourself in difficult times, starting to become an observer of those thoughts instead of allowing yourself to become hooked to them. The problem is, a lot of us, me included again, we get so used to those thoughts, they just become ... we get on autopilot with them, which becomes kind of a way of being. But by practicing things like mindfulness, or meditation, we allow ourselves to slow down a little bit, take a breath in between thoughts, and start to notice the thoughts instead of getting hooked. For example, I used to notice I would get really frustrated with myself when I would get really, really down. Like, a year or two after my husband had died, I would all of a sudden have a really bad day, a really bad grief day, and I used to think to myself, "Gosh, where is this coming from? What's going on? Why am I feeling this? Gosh, I've done all this healing, and I've done all this work. Why am I sobbing now? Something must be wrong with me. Maybe I'm just not doing enough work to heal." And all these questions, instead of just catching the thought and saying, "You know what? There I go again. Can I just have the feeling that I'm feeling and let it rise and fall naturally, instead of resisting?" Because we find, when we push against it, and we create this resistance, we actually create more suffering for ourselves. And this is a real Buddhist concept as well, that pain is inevitable, but pain with resistance equals the suffering. When we can just settle into the pain and just feel it, it's like when we have a good cry. When you're stuffing it down, and it's that nod in your throat, it hurts so bad, it's so uncomfortable, but then when we just let ourselves ball, all of a sudden you notice you come out of it and it's like, wow, I feel so much better. Why didn't I just let myself do that before? Dr. Bob: It's a catharsis, yeah. Lydia Lombardi Good: Yeah. Dr. Bob: I think we need to allow for more of that. So, a big thing that's coming up for me as you're describing this process is awareness, self-awareness. That's the first step, right? Because if you're not aware, if you don't have an awareness of what's truly taking place, there's no way that you can influence it, or impact it. Lydia Lombardi Good: Exactly. Dr. Bob: And again, going back to this, sort of the analogy of treating yourself like you would treat a friend, imagine if you were with somebody and they said something just kind of off the cuff, and your response was, "Well, you're an idiot. Like, what a stupid thing to say." Or, "There you go again, making a fool of yourself," those kinds of things that people are so comfortable saying to themselves, thinking to themselves, that if they were being said out loud to a friend, they would never tolerate that. Lydia Lombardi Good: That's right. That's right. That's exactly right. Why is that okay to do to ourselves? Dr. Bob: Yeah. It's not, but we do it, and we keep doing it. And I think we just believe that this is the way that it is. People become so accustomed, and I think it deflates you just like if you have a teacher who's always telling you how stupid you are, or a parent who's always telling you how disobedient you are, or sloppy, or whatever. That has an impact, and it will keep us from really feeling the depth of I guess the beauty and the magic of life. Lydia Lombardi Good: Yes. And it holds you back from that experience that you deserve to grief. And sometimes that sounds really strange when I say that to people, the love you had for that person needs to be expressed through your grieving process. Someone told me years ago grief is the twin of love. You can't have one without the other. So, why are we suppressing this grief expression if it's simply an expression of our love? And whatever that grief presentation looks like. For some it's crying, for some it's sharing stories with family, or memories, or whatever that looks like, memorializing, ritualizing the person. But you're entitled to that experience. That's how we're able to move forward. But when you don't allow that experience to yourself, it's still there; it's still going to be there. A lot of people will say time heals everything. It's actually time and attention. Time alone doesn't do a thing if we're not giving it the attention that it needs to do the healing that we deserve. Dr. Bob: Time can actually just cause more festering and the wounds to deepen. Lydia Lombardi Good: Right. Dr. Bob: Yeah, if you think about it kind of like an infection in your system, yes, there are some self-limited infections that will get better over time, but there are some that if they're not addressed, if you're not aware of them, and deal with them, they'll eventually cause incredible suffering and ultimately kill you. Lydia Lombardi Good: Exactly. Exactly. I use that wound example a lot. Dr. Bob: Yeah. Interesting. And one of the other things that came up, and I'm sure that this is something that's very much in your awareness and in some of what you teach, is the concept of the gap, the space, that most people just remain unaware of. So we go back to awareness. And I think it was Victor Frankl who originally made this quote. I actually saw it in one of Steven Covey's books, but it's a quote about between stimulus and response, there is a gap, there's a space. And it's within that space that our freedom and our power come from. And the fact that we have that space to choose what to do with, how to respond, if we're going to respond, what to do with that stimulus, that feeling that came, the words that someone spoke, if we recognize that we have this power, everybody has this power to take a space, take some time, and choose what to do with it, it is too incredibly empowering. Most of us are just reacting all the time without giving any honor to that space. Lydia Lombardi Good: You're right, you're right, and that space is where all the magic happens ... Dr. Bob: That's where all the magic happens. Lydia Lombardi Good: ... where physiologically we can settle our nervous system, we can move into a more parasympathetic nervous system and really think critically, shift those thoughts to a different part of the brain and be more skillful in our actions, exactly. Dr. Bob: Yeah. Lydia Lombardi Good: And maybe that just means that we still don't know what to do, and maybe skillful means stepping away and just taking a break and thinking more about what to do next, instead of jumping right in and just making a reactionary decision that could actually lead to more harm. Dr. Bob: Right. Yeah. That awareness, and it's something that I've tried to teach with my children, with others, and of course I forget. I still at times react ... Lydia Lombardi Good: Sure. Dr. Bob: ... and then when I realize that I've given up my power, I'm giving up my power to choose a response, then I actually exaggerate it, where I start ... I'll give it a full two or three seconds, when somebody says something, rather than having an immediate response prepared and going right into it, I will exaggerate the space. And sometimes it can almost be a little awkward. People wonder what you're doing and why you're not answering, but it just kind of reminds me and allows me to feel empowered and to feel a sense of peace and control again. That's a really great exercise. Lydia Lombardi Good: Absolutely. Absolutely. We're not used to that in our culture. You're very right. We always feel like we need to fill the space. And I think that's a big part of the problem too; even when we're consoling a person who's grieving, we have a hard time just sitting with their raw emotion or the feeling, or just saying nothing and just being present to their experience. We have a hard time with that. We feel like we have to say the right thing, or jump in and fix it, or push the tissue box to them real quick, to make sure their tears don't get out of control. We can be messy and just sit with snout rolling down our face. Just say it's okay. This is what's happening right now; it's okay. We don't have to fix it; we don't have to talk over it and make it pretty, put a bow on it. Dr. Bob: That's one of the things that's been such a gift for me, working with people, especially at end of life, people who are approaching the last days or weeks of life, is I get to visit them in their homes and spend time with the patient, the family, the person. And sometimes I will just be there. The conversation will stop, and as you say, so many people want just to fill the... it's uncomfortable, so they just want to fill it and find something to say, and think that that's going to make it better. But what I'm recognizing is, people will want to know that you're comfortable just being present, and just holding that space, maybe holding their hand, having a head on the shoulder, or just being in that space so you can feel what it is that's happening, and maybe reflect back just some concerns, some love and support. As an ER doc, for the 20+ years, I was an ER doc, you don't have much time to do that. But now being in people's own home, it has been such a gift. And it's a gift for me, and I think it's a gift for them to know that there's a certain comfort with just being present. Lydia Lombardi Good: Yeah. Yeah. Absolutely. And it's so humbling for you as the individual, to just allow yourself that humility to know that you don't have the right answer. And people really respect that I find. They can tell when you're just trying to fill the space, or trying to fix it. But when you have enough humility just to say, "You know what? God, I don't have the answer to this. Maybe there isn't an answer to this." Dr. Bob: Right. So let's just be together for a moment. Lydia Lombardi Good: I'll just be here. Dr. Bob: Yeah. Let's just be. Lydia Lombardi Good: Yeah. Dr. Bob: Yeah. That's powerful. Lydia Lombardi Good: Yeah. I'll tell you just a quick story. My husband died in November, and a month after I was [inaudible 00:25:17] mother and it was Christmas night. And my neighbor comes. This is a neighbor who I grew up on that street with for my whole life, and he had a son who had died. I think five years prior, in a really tragic accident. And he showed up at the door, and I open the door, and I said, "Paul, what are you doing here?" And he opens his arms, and he said, "There are no words. There are no words." He says, "I just came here to give you a hug." And every time I tell this story I get teary-eyed again because I just think, I'll never forget that. I'll never forget that. Tons of people told me all sorts of stuff, but that simple act of just, listen, I'm just here to give you a hug and to hold you. I don't have answers; I don't have anything to tell you what to do or not to do. I just want to be here, was so profound and I'll never forget that. I try to remember that very clearly, to remember of my own action, how to be with others, how important that was. We forget. We forget the importance of that simplicity, that human connection. We're looking for the next intervention. Dr. Bob: Yeah. And that goes back to a little bit of that self-talk. It's like, "I don't know enough words. I can't be consoling or comforting. My presence isn't ... that's just not enough." So it's complex, and I think it takes time for someone to learn this too. It's not innate. For some people maybe it is, but for most of us, it's learned over time. And sometimes it's through those personal experiences as well. Lydia Lombardi Good: Right. Right. And what we do know is that actually the more we practice it, it actually can restructure parts of our limbic system in our brain and help us ... it's like building a muscle. The more we practice, the better we get at it. Or we're making new neural connections, and over time it becomes easier to tap into. But you're right. It takes time. It's a skill. It's a skill. Dr. Bob: It's an interesting thing. I was just realizing that some of what has changed for me, some of the learning that I've had through being with people in this state, in this condition, it spills over into other parts of your life, where I now feel more comfortable in other relationships with silence, with just being present and not always thinking that I have to fill the space with my wife, or with my children, that there's a deeper connection that can exist just by sharing a space together, which is interesting because a lot of time I'm someone who has kind of felt like if we're together, we should be talking. Like, we should be communicating about something in some way, and if not, then it's because we don't have anything to say. Lydia Lombardi Good: Right. Right. Dr. Bob: So I'd become much more comfortable, which is nice. Lydia Lombardi Good: Yes. Yeah. It's so beautiful that when we get better at this in our work, it does spill over and makes all of our relationships and experiences, as I said in the beginning, so much richer. Yeah. Dr. Bob: So you're in San Diego, right? Or in San Diego County. Do you have an office where people come to see you? Or do you go- Lydia Lombardi: Yes. Dr. Bob: ... see people at home? How does your practice work? Lydia Lombardi Good: I have a practice in Vista, North County San Diego, Pier View Counseling. Pier like the pier in the ocean. And I specialize in supporting people who are experiencing grief, trauma. And my subspecialty is really working with partner loss. But all ages. I actually have a group as well in Vista, at Vista Library, the second Saturday of every month. It's a grief support group. Anyone's welcome to come. We've been going on for about almost three years now, and people come and go and use the space as needed, and it's a really nice complement to some of the individual work I do, where people either who just aren't interested in individual work right now, or just looking for others who are going through a same life transition they are and are just, again, wanting to tap into that common humanity, which is part of that self-compassion piece, knowing others are experiencing what you're experiencing too, although it looks a little different, we're all going through something. So yes. People come to me at my practice. And I do some Saturday hours at another office in Oceanside, but mostly Vista. Dr. Bob: All right. Great. And I'm assuming that you have some resources for people on your website, that can help them get a little more information about you, and a little bit about some of the topics that we've been covering? Lydia Lombardi Good: Yes. PierViewCounseling.com. Dr. Bob: We'll have links for that on the podcast as well, integratedmdcare.com. So there are lots of ways for people to find you, which is wonderful. Lydia Lombardi Good: Great. Dr. Bob: I have a feeling, now that we've had a chance to connect, for me to learn more about your background and how you approach things, I certainly feel that there will be opportunities for us to collaborate with some of the patients and families that we're supporting as well. Lydia Lombardi Good: Well, I'd be honored. Dr. Bob: Yeah. I look forward to that. I really, really appreciate you taking the time and sharing some of your experience and your wisdom with our listeners, and I'm hopeful that maybe there will be another opportunity to bring you back on and revisit some of this in the future. Lydia Lombardi: Thank you. And thank you for everything you do. So important. I could say that from working in the field, but then when you actually have it, when my dad was dying, having that experience in our home, it changed everything. I saw it from a whole another light, how critical that support is when a family member is dying. So thank you for what you do. Dr. Bob: It's my honor, and I imagine having you there for your father who was an incredible gift for him. So he was very fortunate in that. Lydia Lombardi Good: Yeah. Grateful. Dr. Bob: Yeah. Thanks, everybody for tuning in, and we'll talk with you very soon. Have a great day.

Chelsea Berler is a successful entrepreneur, and author and an inspiration for many people. Tragically, she is also dying from breast cancer at the age of 34, but you won't hear Chelsea describe what she's going through as a tragedy nor is she a victim. Listen and please share this episode with others who need to hear it.   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 Learn more about Chelsea's nonprofit organization, The Foye Belle Foundation, by watching the video below and visiting her website:  Foyebelle website Transcript Dr. Bob: Chelsea Berler is a friend, a successful entrepreneur, and author and an inspiration for many people. Tragically, she is also dying from breast cancer at the age of 34, but you won't hear Chelsea describe what she's going through as a tragedy and she certainly isn't a victim. Dr. Bob: She has an amazing perspective on life and on death, which she shares with me during this interview. Anyone dealing with life challenges or has a loved one who is will certainly benefit from listening to Chelsea's heartfelt and loving words. As well as from the book that she recently published 'The Yellow House on the Left'. Listen in. Dr. Bob: Looking at your picture, your Skype profile and it looks exactly like you, but I'm assuming that that's ... I wouldn't see all that flowing blonde hair. Chelsea Berler: I look very different right now, I'd probably look like a teenager going through puberty because I am on some massive steroids and I'm getting hair where I haven't had hair before, and of course my hair's starting to grow back from the chemo. So I'm looking mighty, mighty different these days. Dr. Bob: Yeah. Well, I imagine that that's just one of the many lessons, right? Chelsea Berler: Absolutely. Dr. Bob: To learn humility not get too attached to certain appearances. Chelsea Berler: You're right. Dr. Bob: Well Chelsea, thanks for reaching out. I mean we're having this conversation because you had reached out to me recently just to touch base and honestly, I didn't know that you were dealing with any of this. That was a big surprise to learn that you were on this journey and I appreciate it in the thing that stuck out what your phrase that you wrote was, I would love to see you do more with people that are directly in the path of your work. Dr. Bob: Would you be willing to share a little bit about what that means to you? What's your thinking around wanting to connect with people who are directly in the path? What does that look like? Chelsea Berler: You know, it was so interesting how it kind of came to be is, of course, we've been connected for years and had worked together in some capacity or the next, and we play in the same circle of really great people. You were on my mind the other day because I was ... One thing I've been spending a lot of time doing is listening to podcasts and one of the biggest reasons is, is because of my current state, I have this ringing in my ears pretty consistently. Chelsea Berler: What helps is listening to something or listening to music or things of that sort, I was actually on the podcast app and just trying to search for a podcast that was inspirational, podcast about death and dying and all that. And I thought, "Oh, Bob has one." I went and looked up, and I started listening to all men. I really enjoyed them, and then I got to thinking, you know, it'd be so great to listen into other people's stories that are going through death and dying. Chelsea Berler: I'm assuming, in some situations people often aren't in the mood to be sharing any stories or feeling good enough to do that, oh who knows, young or old. But I thought maybe there was, and maybe there was an opportunity for you to be able to add some of those stories, and I thought, oh, I would also love to share mine just because it's rather unique to in hopes that it will also help someone else that may be in that same situation looking for a podcast or trying to find something like that, that kind of helps them with the process as well. So that's kind of how I came to reach out and be like, "Hey, Bob!" Dr. Bob: I'm so glad that you did and I'm so glad that you were open and that you're feeling up to doing it, I know that it's kind of day by day in terms of how that goes and so thank you. I spent a little time over the last couple of days reading some of your posts and the articles that you have on Huffington Post and just kind of getting more familiar with your journey. Dr. Bob: So first of all, you're an amazing writer and I knew that before but I'm seeing a different style, and it's a different theme of course but your ability to express yourself and the pain of it, the wonder of it, all of it, just the full catastrophe in the middle of the night. So I appreciate that you're willing to share and I know that there are people who are benefiting from that, everything that you've put out there. Dr. Bob: A lot of people just kind of shrink into their own world and don't want to contribute it anymore. Thank you for being somebody who's not doing that, who's continuing to shine your light out in the world despite the challenges that you're dealing with daily. Chelsea Berler: Yeah, and something to piggyback off that and I know that we'll get into this story a bit, but I actually decided right when I found out I have been writing and so I have another book with that, it's going to be done this week, I'm having helped from a writer that actually helped me write my last one, and it's basically on death and dying. So in all the right ways and it was mostly because I had these Huffington Post articles that I never in a million years thought I would be dying from this cancer. We all were focusing on a cure, which was very much the what was going to happen. Chelsea Berler: Since that didn't we pulled together these Huffington Post articles and wrote, she's been helping write this next book that will be out soon too, and I think that it'll be a really great contributor. It's going to be called 'The Yellow House on the Left,' so that'll be fun too. So I'll keep you posted on that. Dr. Bob: When do you anticipate that it'll be available? Chelsea Berler: I think that it'll go to print end of next week and then it'll be about two weeks until we can get that in our hands. We've been rocking and rolling on that, and I think it was just one of those things where I thought, it now is time to put all of these things into writing because I do think that there will be people that would be helped by these stories and my story and I wanted to get it out as quickly as I could, but I was like, "Gosh, could I actually make this happen?" Because day-to-day my challenges get worse for sure and so I think we'll make it. Dr. Bob: Awesome. I can't wait in that, and I'm looking forward to seeing it and reading it, and of course trying to spread it, spread it out to those who will benefit from it. Chelsea Berler: Thank you. Dr. Bob: Why don't you tell listeners what's going on, what do you, what are you dealing with day-to-day right now? Chelsea Berler: I turned 33 last year in March and my husband at that time was traveling every week to Europe for work, so he would spend basically Monday through Friday in London and Paris for work and then he comes home every week. That's been our life forever, he travels during the week, and we see each other on the weekends, and it's been lovely, that's the life that we love to live. Chelsea Berler: He was traveling a lot, and so we decided I'd love to take a big trip and go to Europe, and in lieu of him having to come home for a couple of weeks and kind of see his life there, following him around, enjoy some time in Europe because I had never been, and so we were really excited about that. Chelsea Berler: So came May, I flew over there, and I had the best trip of my life, it was truly so much fun. It was great to just see not only how busy, and crazy his life and lifestyle was over there–like the guy is like the energizer bunny–but it was just fun to just immerse yourself in another country for a while, and so we did that. That was a lot of fun. But I noticed while I was there, I was like, I could not keep up with him and to be honest, I can barely keep up with him and how like he does have high energy and I'm probably more chill. Chelsea Berler: I just noticed I was really tired and I thought, it could be jet lag and the time difference. We were between London and Paris, so it's six, seven hours difference and maybe I was trying to kind of get used to it. Then when I got back, there was about a month in between where I was still really tired. But again, I just thought, maybe I wasn't eating well or whatever, and so I started working on a program with a friend [Christie Smear 00:10:26], you probably know her. Dr. Bob: I do know her. Chelsea Berler: Wells Fargo or The Wealthy Thought Leader can. Anyways, I started doing like a cleanse with her and like I was feeling really good, and my energy was a little backup, so I was excited about that. Then in July I noticed a lump in my armpit, and it literally like, just was like in my armpit and I thought, "Well, that's weird," I'm young, you know, at the time of 33 years old and so it didn't even phase me that it could be like something crazy, but I thought, "I'll get it checked out and see what's up." Chelsea Berler: So I had just a regular gynecologist appointment that was already scheduled like my yearly exam because when you're 33, they don't have you do mammograms or anything until you're at least 40. I went in for it in end of July, I think, and she's like, "You know, it's probably nothing." Like she felt around, made sure everything looked okay. She's like, "This is probably just a lump that it's no big deal." So she said, but of course, we want to go ahead and by protocol and have them check it out, do an ultrasound on it, and maybe a biopsy just depending. Chelsea Berler: I was like, "Yeah, no problem," so we weren't really quick on scheduling it. I think I had it scheduled like a week later and they did a biopsy, and when the doctor went in and did it, he said, "You know, I'm going to do a couple more." I didn't really think much of it. So he did a couple of different biopsies in that area, and then about a week later, the doctor called my gynecologist called and said, "Do you want to come in and talk about your results?" I was like, "That's weird. Can you just let me know, you know, what you found?" She said, "Well, it all came back cancer," and I said, "What does that mean? Like cancer? Like what?" Chelsea Berler: She goes like, "I don't know, I can't interpret the results, but I need to put you in touch with an oncologist that you can meet with to discuss the outcome." At that point, I just broke down in tears, and I handed the phone to my husband who was drifting fully, and he had, of course, a lot of questions. "Can you give us more ..." I don't know anything other than these biopsies tested positive for cancer and she didn't know too much about the type or whatever. Chelsea Berler: We ended up connecting with, so she gave us a referral for an oncologist, and so it was a week after that, that we were to meet them. So we, of course, were like for an entire week, knew nothing other than we just have to meet with this doctor and we'd go to meet with her, and there was actually, we live in the Gulf of Mexico, and there was a hurricane before that ended up not hitting us. But of course when something like that happens, everything closes, and we didn't even think two thinks about it. So we went to the doctor's office, and there's a big sign that says they're closed. Chelsea Berler: The day we were supposed to figure out what was going on, we were standing in front of the doctor's office with like, "Sorry, hurricane happened last night. We're not open today." We came back home, and we were just like, this is the worst feeling in the world to know like someone found cancer and you hang, don't know anything about it and you can't get into the doctor. Chelsea Berler: The next morning we called of course and said we had an appointment, it looks like yeah, we're closed. No one called us. And they said, "Well, come in today at 4:00," because we basically begged them like, "Can someone just tell us what's going on at this point?" That was kind of a frustrating moment because it just felt like we were in limbo a bit for a couple of weeks. Chelsea Berler: Finally we met with her that next day at 4:00. She is amazing; we have the best oncologist ever. Basically, she sat there and said, "Tell me what you know so far so I can fill in the gaps." She told us that I would test it positive for triple negative breast cancer, and she wanted to go ahead and do all the genetic testing and figure out this type of cancer and rate it and all of that. She couldn't do that until we did like a full PET Scan and did all of the more specific test to kind of understand what we were dealing with. Chelsea Berler: We went ahead and did a pretty extensive genetic testing that all came back negative. Thankfully, because I also have several sisters, a mom, it had been impacted, so we know that I didn't have it genetically. Thankfully that was great. But it also stumped us because she said, for me being so young and we're having triple negative, it's awfully confusing how one like me would get something like this. Chelsea Berler: Then the other thing was we went ahead and did the PET Scan, and it looked to be pretty severe. One thing about triple negative breast cancer is it's a pretty aggressive cancer. Triple-negative breast cancer is probably the hardest one I think to combat a bit because it's not hormonal based and a lot of people like that I did chemo with were much older than me and all hormonal based breast cancer. Chelsea Berler: We were kind of dealing with that from both ends, but we ended up having the PET Scan, and everything, and she called it initially early stage 3C, but basically I'm stage four because I could have done clinical trials and all of this other stuff. We basically classified as stage for triple negative breast cancer at the time. Dr. Bob: Where else was it in addition to the lump that they had biopsied in the breast, where else at that point? Chelsea Berler: It was in my lymph nodes or is in my lymph nodes in my armpit, and then also we saw activity above the clavicle, and it was pretty tiny activity above the clavicle. They felt really confident in my care because we could do a double mastectomy although it was only in one breast, I told them right away I was like, if we're taking one, take it both. What we were going to do, the plan was is to do six months of chemo to shrink everything, and we felt really confident about that, and then we wanted to do a double mastectomy, remove the lymph nodes and then the rest of the tiny activity we saw above the clavicle we wanted to hit with radiation, and so I had a team of a surgeon, the oncologist, and the radiologist, and we all got together, they all were like super confident, like kick this. Chelsea Berler: We did the six months of chemo, I started that in September and not only did it go well, I mean I was sick as a dog and it was awful, but it went so well that when we met with our surgeon, because we were meeting with our surgeons several times, like once a month we would go in and get a mammogram and check everything and see how things are progressing. This last time when I was finishing chemo, not only did the tumors shrink so much that she said, "You don't even need a mastectomy anymore, I can do a lumpectomy and remove everything." She felt so confident, and our surgeon is amazing, she's like in her early, I think she's in her early 70's, she has seen it all it's just like, well-recommended around here are amazing. Chelsea Berler: She was just like so confident, like don't worry about thing, I think let's do a lumpectomy. We left that appointment thinking, "Holy crap, this is amazing," and they were raving about how amazing chemo is in that situation because should I have not want the chemo away we would be removing all kinds of things trying to get this cancer out. Chelsea Berler: Anyway, so my last mammogram I did was December or January. No, wait, February. That was when my last chemo was February 14th actually Valentine's Day. We did that last mammogram, and we got to go in and see it, she's like, "Come and look at this." She literally put like the pictures of the mammogram, but there was never a moment that we talked about, it was so tiny for a moment. We're excited. We had to talk about death or dying, because it wasn't even on this entire journey, because no one has been talking about that potentially happen. Chelsea Berler: There was never a moment where we talked about this could kill me, there was never a moment where we had to talk about death or dying because it wasn't even on the table. Like there was no one talking about that as being something that could potentially happen because the plan and what they were working with they just felt really confident about it. Dr. Bob: That's really interesting. I wonder if you were 73 instead of 33 if that conversation would have been different. Chelsea Berler: Yeah. Maybe. Maybe I had a lot of issues through the chemotherapy process like my white blood count was ... I was struggling a lot, so I ended up having to skip several chemos, and so they called me this unicorn. They were like, you know how you meet people and like for example, you hear a herd of horses, and you know their horses, you hear, you can hear what they sound like, right? But then you look back, and there are horses, but there's one unicorn. This unicorn that's not quite fitting in any pot, and so I was basically a bit of a problem child for them from the start when it came to even the chemo process because of course I'm with all these other patients that are going through this process, and mostly they're going through the way they need to be going through it. Chelsea Berler: I felt like almost every time I would go I would have these issues of like not being able to get chemo or being too weak or whatever. I'm like, "I'm the youngest one here by like a lot." Like I would say the next person in line in terms of age was probably in their 50's that I was with, so I was like, "Why is the young person, am I having so many problems?" I got through it, and it was so successful that we were also a bit surprised because we were worried that it wouldn't be because of the issues that I had been having. Chelsea Berler: My tumors and lymph nodes are shrunk so much that it was just amazing. At that point we scheduled surgery, so we have to wait at least four weeks after your last chemo to have surgery, so I think we scheduled it for like five and a half weeks after that. I had my birthday March 13th, I turned 34, and two days after that I got put in the hospital because ... A week prior I started getting these really weird headaches, and they would come on for about five minutes, and they would be just extremely painful for like five minutes, almost like I was having a contraction in my head, and then it would eat often go away. Chelsea Berler: It would happen like almost 10 times a day, and I was feeling like I kept saying to people like, I'm having these weird headaches, I'm having these weird headaches. I was telling the doctor, and she said, it could be, or coming off of chemo. It could be then the anxiety I was kinda having from going through this for the last six months, we couldn't quite put our finger on it. But because as a cancer patient you're always high priority and may want to make sure they're running every test possible. Chelsea Berler: She's like, "Let's do an MRI. Let's make sure nothing's going on in there. Let's scan your brain, whatever." I did a couple of MRIs; nothing showed up. I did an MRV, nothing showed up, and I was beginning to be really frustrated because everyone kept saying to me like, we can't find anything. I started feeling a little crazy like something is not right, I don't get headaches. I've never been someone to get headaches ever in my life. Chelsea Berler: To be honest, I've been a very healthy person my whole life, not ever breaking a bone or having any major issues but they couldn't quite figure it out. We went and saw a neurologist and just to meet with them, and of course he looks at me and he's like, "I don't know what's wrong with you," but basically our last resort, I talked to oncologist, and we're going to do a spinal tap and see if anything comes up. Chelsea Berler: He said, "It probably doesn't, and it's probably something that's causing some issues. It could be from coming off the chemo, we don't know, but everyone's kind of like give it some time." They had put me on some medicine right away just to try and help with the headaches; I think they might've put me on steroids right away. I did the spinal tap, and it was a Friday morning, so it was basically two days after my 34th birthday, and the neurologist actually called me and said, "I need to check you into the emergency room, the hospital, because it's possible you might have fungal meningitis." Chelsea Berler: They weren't entirely sure, but they were sending off a pathology report, but it came back with what they had so far until they could have someone else read it that it could be fungal meningitis. He said, "That's something that you have to be really careful of." So come in, and I didn't really think too thinks about it. But that morning my husband, my stepson plays for Mizzou, and he was playing in Louisiana, and I was encouraging my husband to fly to Louisiana for the day and night to see him play baseball because I've been sick, we've missed so many of his ballgames. Chelsea Berler: I was like, I'm fine. We've been doing all these tests to figure out these headaches. I'll go do this by tap, like no biggie. Please go, you know, so I spent the day with my mom, thank goodness she's local here, so I get to see her every day. So she came with me, it was no big deal. We came home, the neurologist called and said, "Come in, we need to check you in." Chelsea Berler: I didn't think anything of it, so we get checked in the hospital, and everyone's wearing masks, and I'm realizing, oh, so they think like if I have this meningitis that it could spread. Like I didn't know much about fungal meningitis. Dr. Bob: Not many people do–don't feel bad. It's not something the general population knows much about. Chelsea Berler: It was so weird, and so I realized that when we pulled in to the hospital to the emergency area, the neurologist came out and met us and brought us in and so then I thought, "Oh, so this might be kind of a big deal." I called my husband. I was like, "Listen, I'm okay and fine and good. I want you to go to this game." He just landed in Louisiana, he had flown there, and he's like, "Heck no. I'm turning around and coming back." He literally walked off the plane, walk down another one and started flying home. Chelsea Berler: At this time we got checked into the hospital, everyone's wearing mask, they had to put these like, and mind you, this is the first time I've ever been in a hospital bed before. I've never been in an ER, nothing like that. Dr. Bob: Even through all of this, even throughout the treatments and everything. You never ended up in that ER, that's wonderful. Chelsea Berler: That was definitely one thing I never ever had to do, but they had to pad each side of the bed just in case I had a seizure because they said, "This is fungal meningitis, that's pus," I'm like, this is blowing my mind right now. But no one's really telling us anything other than that, and with my Google searches, I'm like, "Okay, so if I have this meningitis, okay, we'll figure this out, whatever." Chelsea Berler: I got there, it was probably about 2:00 when we checked in, and we spent, of course, all day there, and we didn't hear back from the doctor. She's waiting on this pathology report, same with a neurologist. So we haven't heard anything other than they're giving me some steroids, they're just making me comfortable, they're helping with my headaches and my mom, and I just hung out there. Chelsea Berler: Finally, we took over a mask because we were like, "Oh, we can't even breathe through these things," and mom's like, "If you have it, I already have it because I've been with you." We just kinda chilled out and Mark, my husband arrived around 5:30, so he comes in, and we're still sitting there visiting and then, of course, my doctor comes in. I was surprised to see her because it was, gosh, it was late, it was after dinner time I think. I was thinking, "Well, I'll probably just see her in the morning because it's so late." Chelsea Berler: Well anyways, I think what really happened was she found out the results of my spinal tap, which was that the cancer spread to my brain and spinal fluid and that was causing these massive headaches. She, I think was, to be honest with you, heartbroken and I think it was hard for her to come visit us at the hospital because she came in and she normally is like all done up, and she's just amazing, and she had no makeup on. You could tell she had been crying. Chelsea Berler: She leaned over, and she had the mask on, and she said, "I'm taking this off because you don't have fungal meningitis. I'm pretty sure you don't have fungal meningitis, and I can't talk through it." She took off her mask, and she was explaining what they call LC to us, which is where the cancer spreads to your spinal and brain fluid. It was that moment where, of course, my husband had a million questions, and I'm sitting there like, "What is happening?" Chelsea Berler: My mom, she does a little laid on top of me, like a hen and just wanted to just lay on me and she was of course crying, and I was crying, and I wasn't really processing like what she was saying. The doctor was crying, and finally, Mark said to her, "Can we step outside?" Because I think he was just, I have so many questions, and I think he wanted to understand what was going on before they could finish talking to me about it. I told them to of course go out and talk about it, he and the doctor and so he did and kind of learned what this LC is and what to expect and what that means. Chelsea Berler: That was literally the first point where we were like, wow, like, so there's no option, this is terminal. We were shocked that especially given the news that we had just gotten. Dr. Bob: Yeah, a little incredible roller coaster that you had to be hanging onto. Chelsea Berler: Yeah. I mean and surgery was scheduled for that Friday, so we were actually going to have surgery that Friday. It literally happened like we just found out before that, and I think it's like this, the LC is like a two percent chance, super rare, super crazy. Again, you hear a herd of horses; you think they're all horses and there's one unicorn that's me that just has never really quite made sense through this whole process. Dr. Bob: Chelsea, that was just like six weeks ago?  Chelsea Berler: Yeah, so my birthday was March 13th, I was in the hospital March 15th is when we found out. Yeah, I think. It was just recently. Dr. Bob: LC is the actual name for it, it's leptomeningeal carcinomatosis, and I think there's another name called neoplastic meningitis and essentially it's when tumor has gotten through that barrier, through the blood-brain barrier and it's around the brain and the different, the little sheets that cover the brain and the spinal cord. I imagined what they saw in that spinal tap was a lot of protein and a lot of things that didn't belong there and probably some cells, the cancer cells and that might've just really confused them so they couldn't quite figure out what to make of it at first. Dr. Bob: Wow. What's it? You went from like totally thrilled that all the struggle that you had gone through with the chemotherapy and all of that was worth it. You were now looking at the next phase which was a surgery, and you know feeling hopeful about having eaten this. Then a few days later you're given the news that it's terminal and there's no cure. Chelsea Berler: Yeah, it's crazy. It was really interesting and as I've been writing this book, reflecting on the whole process again, just like going through it, knowing that there was that here like we were all very much like a focus on that. There was never this like other option or other like that this could kill you. It was, of course, surprising, to say the least, but also it's one of those things that I think about too, and know that nothing is promised. Your life isn't promised and your days aren't promised, and no one said you're going to live to be 100 or 90 or whatever the case might be. Chelsea Berler: I think people assume, of course, we all assume we'll have a big long life, but the reality is, that's not the case. The more I thought about it, the more I thought I've had such an amazing life, I have done such amazing things. I got to live as long as I could, and I continued to, and I'm so thankful for that. I think that it's really opened my eyes even more so to just a life well lived and sharing that with people, knowing that your tomorrow is never promised and the next day isn't either. Chelsea Berler: For people that walk around thinking that they're going to live a long life, I hope they do but knowing that ... that's not the case, sometimes for people and it's not for me. So really reflecting on the time I still have left, it has been fun, to say the least in terms of just living each day, however, I want to live it and no restrictions right now. I have been eating a lot of pizza rolls, and that's been fun. Pop tarts, I bring it back to pop tart. Dr. Bob: I think it's good as they used to be. Chelsea Berler: Funny story is I thought to myself, what are some things that I remember as a child that I just love so much that I've refrained from, from so many years because I've eaten healthy because I wanted to be a really healthy person. Of course, when I was a teenager I ate all that junk food and I thought, there are these things that I really wanted to eat like lucky charms. Chelsea Berler: Then, of course, I wanted to get some pop tarts and Oreos and things like that. I was showing my husband, there are things that we're transitioning to him like how to order groceries online to make his life easier, so I've been showing him those types of things, and it's kind of dangerous because now that I'm on steroids too, [inaudible 00:38:09]. So I'm always ordering groceries. Dr. Bob: Do you have Uber Eats by you? Chelsea Berler: We do, but we have not used it, I should set that up. I ordered pop tarts, and I was so excited, and I sat down, and I opened the first one, and I started eating it. I had toasted the first one, and I was like, "Gosh, this doesn't near as good as I thought it was going to be," like I was really excited about it. And then I thought it was a little bit of a Debbie Downer; I was like, this I thought used to be so much better. Chelsea Berler: As I started eating them then I was like, "Okay, they're kind of delicious." Yeah, I've been doing that in divulging a bit in food, but you know it's funny because you think about those things and you refrain from so many things because you want to be healthier, to be better, to be good at it. I think that absolutely we should all be healthier and not be eating pop tarts. Dr. Bob: Every day at least. Chelsea Berler: Exactly, but I do think that, as humans, we need to enjoy the simple delegacies of life and not refrain from too much because I think there's so much happiness and little silly things like that, that I think can bring someone great joy just even in little morsel, even a little chocolate here and there, whatever. But it brings me back to those things that I think, gosh, I didn't, I have a pop tart if I wanted a pop tart. I think more people should probably have that mindset with things these days because again, you just don't know what could happen. I mean, you can go from one extreme to the next. Chelsea Berler: The other thing that I am so fortunate about is there are so many tragedies in life. There were people die suddenly and quickly, and you can't say goodbye, you can't prepare. They're just gone. I am so thankful that I have this time with my family, my close friends. I have been so enjoying being able to reconnect with people and share things with people and talk about memories and all of those things. Chelsea Berler: I'm also in that place of a great deal of peace, being able to have peace with people and have this time with the LC diagnosis. It can be weeks; it could potentially be months. We actually stopped treatment; we were doing spinal taps where we were doing chemo in my spine and then chemo pills. But none of that is proven to be effective, it could possibly be effective in terms of lengthening my life maybe a little bit, but it was actually causing a great deal of pain. Chelsea Berler: The spinal taps were really painful for me because I have a lot of inflammation. We were spending three out of five days at the hospital between doctors' appointments and the treatments. We decided to stop everything about a week ago just because it was just like, this is not how I want to spend my time. Dr. Bob: And that happens, I think it happens so frequently as people or they continue on this path because that's what's recommended and there's no other option, and this is sort of direct or directed down this path with uncertainty, there's a very uncertain benefit and likely not a great benefit, but what's definite is that you are giving up your time, the time that you have the precious time that you have with your family and your friends and the piece of just being able to stay in the environment that's comforting to you and to ... Dr. Bob: I honor you for making that decision, and I imagine that has given you some additional sense of peace of not being back in that world. Chelsea Berler: It's been good. My husband and I discussed it at great detail because we basically asked the question to the doctor if I continue to do these treatments, is there a greater than 50% chance that they're working or less than 50% chance they're working? She said, "Less than 50% chance," and she's like, "I'm not even sure they're doing anything," and because this LC is so rare that it's basically, she's basically saying, "Let's just try it and see if it extends your life," and I was just like, "Let's just stop."  Dr. Bob: Let's just not, yeah. Chelsea Berler: She was really cool about it, she's been just amazing at like, "What do you guys want at this point?" I was so sick of taking so many pills and all of that that I was just like, I'm throwing in the towel. Especially, I mean if there were ... if she could prove to us that it was helping clearly I'd want to extend my life but of course not. I've noticed, daily I am declining just in little things like my legs aren't working as great as they should be working and stuff like that. Chelsea Berler: We started hospice this week, but mostly it's we decided to do that because I want to be as independent as possible in our home while I can. So getting the help that I need with walkers or things like that to be able to continue to get around as much as I can. Between my mom and my husband, of course, they're taking care of us or taking care of me, so I don't need the nurse and the CNA here or anything like that right now. Chelsea Berler: Being able to have their help just with this advice and stuff around the house has been really great. We started that process, which has been really amazing by the way, that kind of care. I think more than anything like just being able to decide how I want to spend today and whether that be, this interview or listening to podcasts or reading something or my husband has been taking me for drives, and that's been fun just to get out. Chelsea Berler: I get tired pretty quickly, but being able to just get out and get some sun on my face has been awesome but just choosing how I want to spend that time is really important I think for anyone probably in this situation. Dr. Bob: Yeah. I imagine your husband has working less, kind of, at this point, spending more time with you. Chelsea Berler: Actually, when we found out in September of my diagnosis he stopped traveling completely, he has just been working from home, and he works with such an amazing company that has just been supporting him and like you do whatever you need to do, work from home, whatever. So he's actually been home full time, and that's been amazing, and we've both been trying to ... I own my company, and so I've been working as much as I can, we're working on transitioning it to someone that's been with me for seven years. Chelsea Berler: That is my heart, and he's taking over my company, and I'm going to be running it going forward in that has been so amazing, so I've been helping with that and just doing as much as I can during the day to get him set. When all that's good and finished, he's good to go. My husband's been trying to live, a bit of a normal life I guess, if you will, just I'm encouraging him to do a little bit of work in the morning, and while we can, I think that it's good to feel human in that way. Chelsea Berler: But we've been spending a lot of really great quality time together where we talk about the best conversations that we've just never had to talk about before, like death and dying. About an afterlife, about spirituality and it's, of course, deepened our relationship together and having those conversations, things that some people probably have them I'd assume, but I guess we just had never talked a lot about it. Chelsea Berler: He's older than I am and so in my head I always thought that I would be his caregiver and take care of him and of course everything's changed, and so now I'm worried about leaving him because there's so many things he doesn't know about, just household stuff and add order groceries and dog food that we have on auto pay, those kinds of things that I've been working really hard to make sure he is set because I worry about him because he hasn't had to really manage those things. Dr. Bob: That's really sweet of you, you worried about him. Chelsea Berler: I always thought in my head that, I love being a caregiver for and I'm a very compassionate person, and so I just always like to take care of people, of other people, and I never thought that it would be people taking care of me, I guess. It's been a little bit hard to get used to that, but he has done an amazing job. I can't imagine going through something like this with anyone else, and it's really interesting how you look at a relationship when something like this happens and how things changed in such a dramatic way and how you're cared for and how amazing he's been as a husband all these years that we've been together. But just how he has to take care of a dying wife now. Chelsea Berler: He has just been so phenomenal and amazing, I can't imagine doing it with anyone else. So one thing that was really important to me when I first started this process was when I was going into this chemo room is one thing that was super shocking was, there was a lot of people that didn't have insurance, almost everyone. There was a lot of people that didn't have anyone with them. There were a lot of people that didn't have any kind of supplies like I had, meaning when I first found out I had cancer, I had this outpouring of love and support of people sending me things like lotions and beanies and bath soaps and like all these healing things to get me through. Like, "Oh my gosh, my friend or family member just found out they have cancer, like what can I do?" Chelsea Berler: I was getting all of this stuff, and it was so much stuff that it was great, it was like books and coloring books and things to pass the time because when you go to chemo you're there like almost six hours sometimes just not only waiting for your drugs but then getting your drugs and it like it's just such a process. I felt like I would walk in there with, Mark would come with me every single time, he sits with me the whole time. I would come in with a bag of this stuff that I could use playing cards and like I said, books and coloring books and things that would just help me get through this process. Chelsea Berler: As I was looking around, I was heartbroken because no one ... like I literally, I felt like I was the only one that had it, it really did, and it broke my heart because how many people a day are going through this and having to sit there every day. I thought to myself, there's got to be something that I could do to help these people. I thought, I'm going to take all this stuff that was given to me that I had extras of which was a ton, and I'm just going to bring it all in here and ask the nurses if I can just put it on this back shelf and anyone can have it, whatever they want. Chelsea Berler: I asked him, and I said, "Great, absolutely bring it in," and so I literally just dumped out a ton of stuff that I had extra stuff. The end of that day it was all gone, everything that in like the women that are in there, of course, are bald, and some of them didn't have beanies and some of them, you know, I just don't have anything. Chelsea Berler: Then it got me thinking, like there are all these really great nonprofits that help raise money for research and help do this or that within the cancer funding foundations, but there isn't that I know of a place where you can go where you can get support meaning these types of things that help you pass the time, and there isn't a place where you can do it for free. I mean, you have to buy it, or someone is going to buy it for you. Chelsea Berler: I thought, I am going to start a nonprofit where it'll be based on donation, and I'm going to put together bags of things, I'm going to curate them based off of what I used. Every single thing in what we're calling a blue bag because blue is, I feel like more adequate than pink, it is stuff that I have personally used. Like things like oatmeal that it was really all that I could eat for a while, ginger candies helped with nausea, the coloring books, the reading books, the warm socks, the lotions, the bath soaps, all of those things that I personally use that I know used, that I used well. Chelsea Berler: I put these bags together, and I thought, I don't know how this is going to go. I don't know if people will understand it but I'm going to start this blue big movement, and I am going to allow people to request them if they want to request them on their own, and like for themselves if they're going through cancer treatment, or someone can request for them, and we'll ship them. Because my business is web design, we were able to put up a website. I was able to curate these products, design a bag that it's really amazing. Chelsea Berler: I was like, "Okay, we're gonna do this, we're going to police together," and the donations just started coming in. I think we're probably at about $50,000 that we've raised, and that's not even corporate donations, that's literally personal community people we've known like it's been amazing. We've been able to ship these blue bags all around the world, they've gone to the UK, they've gone to the US. Chelsea Berler: We just shipped some time to Honolulu, there's a map that for bell.org where you can see where the blue bags have gone so far. It's been amazing, and it's also very sad because there are so many people that are going through this process that need this kind of support and we get to ship these out for free, and it is awesome. Chelsea Berler: What we're doing right now as we're transitioning the foundation, so my husband is going to run it when I'm gone, and I have a really great group of people here that friends and family that they help curate and put these blue bags together every month. What we try and do is do 50 at a time, we probably will start doing 100 at a time because it's going so well. It's a lot of work and so what we have to do right now is, we make enough, and then people request them on the website and then you have to take the request form down when we run out so we can make more. We're kind of trying to get into the rhythm of that. It's been amazing; it's been so awesome.  Dr. Bob: That is incredible. I mean, with all the other things that you've got going on in your life to have been to have the wherewithal. The desire to create something to help other people just truly speaks to the depth of who you are. So that's incredible, so there'll be a link on our website, integratedmdcare.com/newsite1 where people can get access to this podcast. We'll also have a link to bell.org so that they can go in and get on and see how they can contribute or request a bag for someone who they know that would benefit from it. That is just, wow, Chelsea, you're awesome, and it does sound like you have lived about three lifetimes and your short 30, 40 years. Chelsea Berler: I know, it's like a cat, right? Dr. Bob: I mean you've shared a lot of obviously from some very, very deep and personal, intimate things and you'd given, I know some of your wisdom that that's come to you and through you, anything that you feel is just kind of needing to bubble out before we say for this particular episode?  Chelsea Berler: I think more than anything I appreciate you taking the time and understanding why that maybe this would be helpful for others to include in your podcast. Just having the being one that's going through the dying process and being at peace with it and being in a good place with it, I think is really great. I think that part of that is just knowing that life is short and I hope that people will really take tune to know that life, live a little harder, live a little bigger, live a little more fierce, and eat a pop tart if you want to eat a pop tart. Chelsea Berler: I think those are all really important pieces to living a good life and not worrying so much about saving all your money and maybe take more trips and have more memories, and maybe less things and more good stuff that you can add to your life that will just add to those sweet memories that you can keep a hold of. I think all that's really important. Just as a takeaway for it, for anyone that thinks they have a long life to live, which I hope they do. I hope they live each day as if it were their last because I think that that's important. Dr. Bob: No doubt. Awesome. Well, thank you again, and I'm so glad that we're reconnected, and I'm hoping that we can use the time that you have left to continue to add value and stay connected and promote your book and the nonprofit, and you're amazing. I knew you were amazing before. Now I see an entirely a whole other realm of amazing in you. So thank you for being you and for sharing you. Chelsea Berler: Thank you. I appreciate it very much. I adore and love you and your work, and I think that what you do is so important. So thank you for that.

Hansa Bergwall is the creator of a new app called "WeCroak". Out of his own personal meditation practice, he determined that death contemplation could be beneficial, not just for him, but for many people.      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 You can download the app from your iPhone or Android device. You can also visit Hansa's website to learn more and download his app. WeCroak website Transcript Dr. Bob: So, Hansa, I'm totally curious about this. What prompted you to put an app out there that is going to notify people several times a day to think about death? What was the impetus for that? It's fascinating to me. How did that all come about? Hansa Bergwall: So I'm a daily meditator and have been for a while now. And regular death contemplation is actually a really millennia old part of most serious meditation practices. So that's how I first got ... I learned about some of these ideas. And some of them are pretty intense, much more intense than what I'm doing, meditating in [inaudible 00:01:19] grounds, where bodies decompose as a way of laying them to rest, to know about your impermanent nature. Stuff that would be hard to do today living in New York City. Hansa Bergwall: And then I came across the Bhutanese formulation of the practice that was, one, recommended for everyone and just really simple. It was just think about it five times a day that you're impermanent, that one day you will die. And you must do that in order to be a happy person. Immediately, it appealed to me as the kind of death contemplation that I wanted to add as a compliment to my meditation practice. So I just tried to do it myself. I thought, oh, this will be easy. I'll just think about it five times a day. And what I found was it was actually really hard. We have this pretty stubborn cognitive bias that we don't want to think about mortality all that often and it's hard to do, so I would get through my day and get to the end of the day and realize I hadn't done it even once. Hansa Bergwall: So that was when the idea of something to remind me came about and the idea of WeCroak, the app, which sort of fell into my head as a fully formed idea that honestly I never thought would go anywhere 'cause I'm not a coder and had no way of making it a reality until Ian Thomas, my cofounder, happened to rent my extra room on AirBnB and we got to talking one night and I basically told him/pitched him my idea for WeCroak and he wanted it on his phone, too. He never thought it would go anywhere. And we made it together for the next couple of months, so it happened really quickly and really fortuitously, organically out of me trying to do something that I thought would help. Dr. Bob: That's crazy. So if Ian hadn't rented your room, there's probably a pretty good chance that this never would've come to fruition, right? Were you going to go out and seek an app developer? Had you gotten to that point? Hansa Bergwall: I had. I made a couple of inquiries, and it was going to cost me $10,000 or something like that if I wanted to develop this on my own. And I didn't have that kind of money sitting around, first of all. And, second of all, sounded like a lot of money to spend on something that I was quite skeptical would be broadly popular. So really we made this kind of as almost ... We were talking about it when we started as it was like an art project or something that we really wanted for ourselves, maybe to share with our friends, and we wanted it in the world. That was how we went about it. Dr. Bob: Great. Without any huge expectations or goals that would potentially disappoint you if you didn't achieve them. That's usually the best way to start something. Hansa Bergwall: Yeah, and what it allowed us to do is we stuck to our guns a little bit, the Bhutanese folk saying is five times a day. So we had a lot of people asking, like, oh, shouldn't you toggle it, so people only want one? We're like, but that's not the recommendation. We're going to do this tradition. We're going to do it right. So because we have our day jobs and other ways of making money, we could really make it be something that we thought would be a real mindfulness tool. Dr. Bob: Great. So when did it actually become available? When did you complete the development process and put it up there for people to download? Hansa Bergwall: So I first had it on my phone in August of 2017, and it started right away reminding me five times a day that I'm going to die with a quote that I had picked out. And it was really fun. It was this creation that we had done. There had never been anything like it before. For the first few months, it was just a few of our friends and us. I think there were 80 people on it tops as of a few months later, kind of working with it and enjoying it. And then I do communication and PR for a living, and so I had reached out to just a couple people about the idea, and the Atlantic magazine covered it in December, and that was when it really started to take off in the world, and it has to a huge degree since then, beyond our wildest expectations. Dr. Bob: That's awesome. So how many downloads? I'm sure you're able to track that. How many people have downloaded it at this point? Hansa Bergwall: Yeah, so as of a couple of weeks ago, we just crossed our 40,000th download. Dr. Bob: Wow! Hansa Bergwall: So that means that 40,000 people around the world have elected to pay 99 cents for an app to remind them that they're going to die five times a day and we estimate we're going to deliver our seven millionth reminder on May 7th. There's been a lot of these little reminders going out, interrupting people's days. They happen at randomized times, and that has been the journey since December. It touched a nerve somehow. [inaudible 00:06:53] not the only people that wanted these reminders, wanted to remember that life is precious and time is limited. Dr. Bob: Have you gotten feedback from people? Have you had people who have shared any of what's come up for them or any interesting stories that have come out? Hansa Bergwall: Yeah, of course. It's a strange thing because we know these reminders are going out, seven million of them, and mostly it's like we have no idea how these are affecting people. Except when you hear back from people every once in a while. A very common response is that it helps pull people back to what's important, gives them a little bit of perspective and they use that for everything from getting off addictive social media or technology, to getting out of anger or having better relationships just by not sweating the small stuff as much, to seize the day kind of moments of, hey, I'm just gonna go do this thing I wanted to do because otherwise I may not do it in my life and I want to. Hansa Bergwall: So that's the most common response is people just using reminders to live a little bit better. And then there's this other category of people using it in much more serious positions and those, to be honest, moved me to tears a few times where I'll hear from people who are using it to help them in the grieving process for this woman said her son had passed away, and somehow it was helping. Another woman reached out to say she was having a hard time dealing with a mother dying of dementia and that it was helping her appreciate the time that they did have at the capability that they did, rather than just get into the poor me and my life kind of story. Hansa Bergwall: Just last week I had a young man reach out of the blue to tell me he'd been using it and mourning the death of 20 friends to the opioid epidemic over the last year. It gets out there in the world, and you realize that this kind of information is pretty powerful in that it's useful whether you're just trying to live a little bit better or if you're really facing some of life's hardest moments. Dr. Bob: Such a simple, simple concept to imagine having that kind of impact. Are you getting a sense that it's the reminders that are making more of an impact or the quotes that people are reading and that are touching them? What are your thoughts on that? Or what are you hearing? Hansa Bergwall: I think it's the whole thing. First, we're doing the Bhutanese formulation of just think about it often. Five times a day. That alone is powerful enough if that was all it did. And then the quote part of it is we live in a society where there's a tremendous amount of noise, distraction, technology, addiction, screens, everywhere that keep us from being really present where we are often. So in order to keep it fresh and keep it interesting, we introduced the quotes as well as the randomization of the timing so that it would interrupt you at times you couldn't predict. Kind of like the idea of how an eight ball, it only has maybe eight answers, and yet it can be interesting for quite a long time just because of the randomness of you don't know which one you're going to get. Hansa Bergwall: So that aspect keeps people engaged, on their toes, where just the many coincidences of life, there are those moments where the randomness of the time and the randomness of the quotes selected feels like it's speaking directly to that moment because we have a database of quotes. They're all worth looking at I think, but people never know what kind of quote they're going to get. We have quotes from people writing from the palliative care community or poets or philosophers or meditation teachers or even comedians. So people really don't know are they going to get a funny quote, are they going to get a quote about what it's like at the end of life. So that aspect of surprise I think keeps people from just glazing over and tuning out as quickly as they otherwise might. Dr. Bob: Yeah. I think that's an interesting aspect of it as well, the randomness, the just being open and receptive to receiving something that is kind of unexpected. And it probably says something about each of the people who are willing to pay the 99 cents and download the app is that they are looking for, I guess, input from the universe that could be valuable. My alert went off not long ago and the quote that came up this morning was, "If a man has not discovered something that he dies for, he isn't fit to live." And you know who that was? Hansa Bergwall: I think it's Martin Luther King. Dr. Bob: Exactly, yeah. Hansa Bergwall: Jr, yeah. I do know my quotes. I have a lot of them in there. Dr. Bob: This was a test, and you passed it, but I imagine ... How long will it go before I would see that quote again? Is it months? Hansa Bergwall: Right. Just to give you a little backdoor to the programming stuff. So every time it selects a quote at random from a database of about 400, we're updating to about 500 very soon. And you can get any random quote within that database at any time. However, we make it so that you don't get a repeat within, I think, it's a two week period right now, and I might have to double check that for you, but it's a little while. You can see it again in just a couple weeks if, by luck, that's the one that it selects, but there might be others that you haven't seen at all. We try to keep it so that you can't predict, that you're just on a loop or something like that. Sometimes you might get one every couple weeks just because that's what the ghost in the machine wants to give you, to really put that one in your face. Other times there'll be one that you just haven't gotten because of that randomness. Dr. Bob: Because of randomness. And that's part of the beauty of it. It reminds us of the random nature of life. So it's achieving two things. It's reminding us of our mortality and that we need to be looking at this day as something very special to be grateful for or this hour or this moment. And it also reminds us that, man, things are just random, and as much as we might want to control and predict, that's not really the way it works. Hansa Bergwall: Yeah, we like to say that the reminders can happen any time, just like death. Dr. Bob: Yeah, in my experience, I was an ER doc for 20 plus years, and very early on in my career, I became very clear about just how random life is. I like to say that the vast majority of the people who ended up in the ER that day woke up that morning not expecting that that's how their day was going to go and that's where they were going to end up. It was great life lessons early on for me. And now I'm at the other side of it taking care of people who are at the very end of their life, which is also an incredible classroom for me to be in. So how has this affected your life? What's different now in your life than it was in August when you started this project? Aside from being more aware of the fragility and randomness and that there are people out there who are interested in this. Any other major differences or new trajectories? Hansa Bergwall: Yeah, there are a lot actually. I would say that the wonderful thing about thinking of death often is that it's always true and it's amazing how few things that we know for sure are true in this world that we can really hang a hat on, but this is one. That our time's limited by an unknown amount. We might get the full natural human life cycle or might be much shorter. We don't know. Any decision we make every day, if we're not keeping that close, we're not living on true ground. That makes a big difference, to live life on ground that's more real. I think I'm making better decisions on a day to day basis in a number of areas and there are particular qualities that people have used death contemplation to nurture for a long time that I'm noticing coming up in my own life. I'll give you an example of some things that I've learned. Hansa Bergwall: One is courage, just the courage to do what I want to do, talk about what I want to talk to, make a big move that I want. It's one of those elusive things. Sometimes I think even having an awkward conversation or calling someone out on something that hurt you, or something can feel like an insurmountable burden, but death contemplation kind of gets you there. And I've learned since that samurai used to do daily meditation on all the horrible ways you could die on a battlefield because they knew to truly be the best on a real battlefield, which fighting on true terms meant that you could die any number of ways at any time no matter how good you are and accepting what a battlefield is and that you could die at any time. And by accepting that, you can really find the courage to do what you needed to do. So that's an extreme case, of course, but I'm noticing that I have more courage to just face the daily things that come at me in life. Dr. Bob: But what about the small battles? Hansa Bergwall: The small battles. Battlefields are not part of my life, but everyone has fear to a certain extent, and the courage to get through it is important. Just the sense of appreciation and thankfulness of I'll get a reminder, and I'm walking down the street, and I realize, oh, I'm walking really fast. I think I'm an in a habitual hurry. I'm actually not late for any appointment or anything. Maybe I'll slow down. And it's spring here in New York, and that happened to me just the other day and all the sudden I'm noticing daffodils by the side of the road and birdsong and all the sudden my life is filled with this richness that I was about to just habitually rush through. Hansa Bergwall: And there are others as well. Compassion, to a certain extent. When you are constantly remembering that you are going to die and that is the nature of life, and some misfortune follow someone that you know or something like that, you feel it in the heart a little faster than I did before at least. So all these things that I'm now learning about that people have used, these kinds of practices to nurture, slowly, bit by bit, start to happen in your own life. So I'm more a proponent of this kind of practice than when I started. I think it makes a big material difference in my life and I'm still discovering to all the possibilities of how that's true. Hansa Bergwall: And I think it's a great compliment to things like yoga or meditation practice or these other kinds of things, which are great things to do. I do them. And I think it compliments it because it's that grounded, feet on the ground, real-world kind of stuff, rather than getting off into, say, positive thinking or these things that can maybe take us a little bit away from the truth, which I think can be problematic. Dr. Bob: Yeah, when you contemplate truths, there really is no greater or more concrete truth than I'm going to die. There are no gradients. We don't know how, when, where, but that fact and, like you said earlier, alluded to, there are two absolute truths in life. That we're going to be born, that we were born. We wouldn't be here unless we were. And that we're going to die. And everything else really is kind of up for grabs. They used to say taxes, but we know that that's not necessarily true. So I like that. So, for you, the things that have really become more relevant or solidified in your life are the sense of courage, a sense of gratitude and appreciation in the moment and then compassion, which, if people ... For 99 cents, if people get that without a whole lot of other effort involved other than looking at your phone or device a few times a day, that's a pretty sweet deal. Hansa Bergwall: Yeah, and one thing we're proud of is, because we didn't make this like some of the big tech firms, to make money off of people's attention 'cause it's free with advertising or this or that, we're actually really proud that even though people are getting five notifications a day, even our people who are opening it all the time are spending less than a minute in the app per day. They just read the quote. We're having a pretty big effect for a very small Hansa Bergwall: amount of time. We're really proud of that because there's just so many things that can eat up our precious time, which is or limited life when you really think about it. The average person checks their smartphone 85 times per day, and I think the latest numbers that I heard were people were spending as much as four hours on their mobile devices and computers. Just on their mobile devices, not even computers like that, per day. You can leave 24-hour news on all the time. So there are all these things that can take up so much of your attention all the time, and we can get lost in them, so I'm kinda proud how it just grabs your attention and then lets it go immediately so that you can decide what you want to do with that information. Hansa Bergwall: There are other apps out there that maybe remind you to breathe or notice that you're on social media and like, hey, do you want to stop? To me, that would feel like nagging. I wouldn't tolerate it. Dr. Bob: Yeah, little judgmental. Hansa Bergwall: Yeah, and this is just telling something that's true, and then it's up to you, whoever you are, each person, to decide what you want to do in that moment. Whether to pat yourself on the back, you're doing exactly what you want to be doing, or switch course. Dr. Bob: I love it. I love the simplicity of it and that everybody can take what they choose from it. Are you developing anything else or are you ... Is this going to be leapfrogging you into other realms around this space or are you kinda just going about your other business and allowing this to just be? Hansa Bergwall: This is all so new right now. It's only been a few months that this has been in the world and people such as yourself have wanted to talk to me on such deep and important issues, so I'm still just enjoying the conversation started with this first thing. We have some ideas that are sort of in a square one idea phase right now of ways we could create other fun things for people to play within the mindfulness space, but right now it's a really worthwhile and passion project that I enjoy spending time on. Because of the one time 99 cents download fee, it makes just enough to support the time that I spent on it so that I can easily do it and then the rest ... So far on this project, we like having other sources of income so that this can be, I think, what's really useful as opposed to what will sell really well. Dr. Bob: Yeah, I get it. Well, good for you. I'm excited. Just being part of this space now, you can see that there's so much interest, there's so much need for people to move away from fear and move towards this openness, acceptance, and be part of this broad conversation. So I applaud you for putting it out there and having the courage to ... Even though it started out as more of just a fun project, I think what you've put into the world is meaningful, and you should feel proud ... Or not proud necessarily, but just feel really great about knowing that your efforts are bringing some peace and greater understanding and comfort to people potentially all over the world. Good on you. Hansa Bergwall: Thank you. And I also wanna say that some of the most popular quotes, in terms of people taking screenshots of them so that they can look at them later or share them, are from people writing from the palliative care perspective about common things that people say on their death beds or this conversation of what it's really like to be near the end. I think these perspectives and these conversations are really valuable to people and I'm just honored to pick up on some of the conversations people like yourself are having and get them to more people because people are really responding to them and they're really important. And I've learned a lot from listening to people like you and reading and part of this has been like, wow, there's some amazing thinking and just life philosophy coming out of these people giving care to end of life. Dr. Bob: I really appreciate your time. I know you're busy with your work and your contemplation and anybody who is interested, the app store is waiting for you and just go ahead and search for WeCroak, right? That's pretty much as simple as that. Hansa Bergwall: Yeah, WeCroak. One word. It'll pop up, it's the strawberry frog. Enjoy. Dr. Bob: So, Hansa, thank you so much for your time. You can also access, we'll have a link to this on the Integrated MD Care website. Thank you for your time. Look forward to any future endeavors, and I'm happy to have you as part of this tribe of people that's trying to move the conversation forward. Hansa Bergwall: Yeah, thank you so much.

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  

District Attorney Summer Stephan shares what San Diego initiatives are in the works to protect seniors from abuse and fraud. She shares information about her programs and efforts to help keep our most vulnerable citizens safe.   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 San Diego District Attorney website Transcript Dr. Bob: In this episode, I speak with San Diego County District Attorney Summer Stephan, about her passion for protecting elders from abuse and fraud. Summer is leading the way to create a blueprint for a program that brings together many agencies and organizations throughout the county that typically work in silos, including the medical community, in an effort to create programs that protect our most vulnerable members of the population. I for one was inspired by her passion and her commitment, and I will be joining in this effort. I hope you enjoy the conversation. Summer, thank you so much for taking time out of your busy day. I'm sure that you have a pretty packed schedule most days, huh? DA Stephan: Oh, well, it is. As a district attorney for the second largest county in the state of California and the fifth largest in the country, we are hopping at all times, but protecting seniors is really a passion for me, so any chance I can get to talk about it and share information and things we've done, I love to do it. Dr. Bob: Fantastic. Well, I'm excited to hear some of ... I've read up and gotten familiar with some of the initiatives in your areas that you're really committed to and devoted to. I mean it spans of course from children to seniors, the whole gamut, but I understand needing to place emphasis on protecting seniors, because there's so many, and the numbers are growing, and I think that they're becoming more and more vulnerable over time. And you mentioned while we were talking a bit ago about really wanting to engage the medical community in partnership to help with these protections. Can you expand on that a little bit? What are your thoughts about how we as physicians who are working with the senior community, can be of support? DA Stephan: Well, I think that we're finding in a lot of our obstinate crimes or ones where the victims are especially vulnerable, that engaging the medical community is of really big value. And I've come at this through a 28-year journey of public safety and prosecution and working with vulnerable children, domestic violence, sexual abuse, and elder abuse. And we find that whenever you can get a well-educated and trained medical community to spot the warning signs, you can really do a lot better. It's something that I've done consistently in sexual trauma of having doctors really be able to detect that. In human trafficking, we are engaging the medical community on the warning signs of sex trafficking and human trafficking with our victims. And in domestic violence, we've done it for years to look for those telltale signs, document them, and engage police where necessary. But we've kinda left out the elder abuse area. And it is just as important if not more important. Seniors, generally they are so vulnerable to crime because their contacts with the community become less and less as they age. They're not showing up to work necessarily on a daily basis, they're not at school, so the regular places where people may spot those signs are not there. And so the ability ... But they often do still keep a medical appointment, or they have to be seen by a doctor for their eyes, or some issue with their health. And I feel, and my team of experts feel that that is a perfect opportunity to really touch base on the whole well-being of the senior, make sure that they are doing well. Really asking additional questions if there were signs of malnourishment or pain, it's incredible that amount of intersection that medical professionals can find. I mean we are ... Something as simple as even the pain killers or medications for some of our seniors that are suffering from cancer and different pain ailments is getting stolen by caretakers. And our seniors are left to stand for their pain. So that's just one thing. Sometimes they seem like their financial situation has really changed, and they're talking about moving from their home and poverty and things like that, that are also tell-tale signs. So we really believe that the medical engagement is gonna be critical. Dr. Bob: I can see that. I mean it makes so much sense. As you're talking about some of these things, that's actually ... I'm getting chills to think about how vulnerable some of these people are. And they're at a point in life when they become so trusting and dependent. And then if somebody is taking advantage, there is just reluctance to call them out on it, because then they're even more isolated or they're at that person's mercy. So there are so many factors at play that would keep people from getting out from under some sort of abuse of relationship. So, really, we need to look at any advantage that we can find and the physicians and the nurses and the people in those offices or whatever they're going, getting their blood drawn if they're going to get X-rays. I think it makes so much sense to create an army of people who have the same mindset, the same perspective of trying to protect our most vulnerable people who don't have enough protections in place. DA Stephan: I completely agree. I mean you've really hit it on the nose. It is creating that army of eyes and ears and touchpoints that are natural, where our vulnerable populations may have that kinda rare human touch of someone who actually cares and is there for them, and taking full advantage of that. So that was kind of part of the genesis for me bringing together in San Diego, a regionalized coordinated plan, blueprint, to combat elder abuse and to protect our seniors. And we had a blueprint, if you will, for domestic violence, child abuse. But while we were doing a lot of work on seniors and crimes against seniors, we were working in silos. So the prosecution, law enforcement lane, the aging and independence services, the medical community, all kinda working in separate venues. We weren't seeing the whole coordinated vision for how we can do better. And what drove me into prioritizing and recommitting to this, is that San Diego very very fortunate for this, and really a credit to our whole community that just has a beautiful spirit. We are one of the safest urban counties in America. We are at a 49 crime rate low. However, the one outlier is that crimes against seniors went up by 38% in the last five years. And for me, how our civilization treats our most vulnerable, our children, and our seniors, and our disabled, is really gonna be how we'll be judged, how we will be judged as a civilized society. So that just didn't sit well with me at all. And I am in a full combat mode to bring those numbers down. And we brought together small stakeholder groups to iron out where the gaps are, where the needs are. We then went to a larger stakeholder group. We drew out a blueprint of a coordinated plan so that we don't miss these touchpoints. What is really incredible is that we're seeing so much similarity between seniors not reporting and how under-reported the crimes are as we see in areas of sexual assault and human trafficking, strangely enough. It really is that element of shame. Seniors report to us, when we uncover their abuse, that they felt ashamed to tell someone, they felt it made them seem weaker, they felt stupid for falling for different fraudulent schemes and buying, for example in a case we did recently, fake gems that took out all of their retirement money as an investment. They felt silly for falling for those scams, and they didn't report them. So other seniors became victims as well. So it's really that kinda shame element. And then the element that you brought out so astutely, and that's that a lot of the abuse is really by caretakers who are sometimes family members, often in San Diego, and I know across the country, it's an older son, who is taking care of a widowed mother. That's our number one target for abuse. And that older son is ripping off the mom, they often have mental health issues and drug addictions, and the mom is ... This elder mom is just a victim continuously. Dr. Bob: And there's probably some really blurred borders there, right? The boundaries of that, where does helping your child and abuse begin. So that's probably a really difficult one to go after, but if the numbers show that this is one of the big areas, then obviously we need to figure that part out. DA Stephan: We do. And in San Diego, what we're trying to do is we're trying to offer the seniors an understanding that our goal isn't gonna be just to lock up their son. Our goal is to also provide mental health treatment, drug addiction treatment, offer treatment for the son, so that the mom is not alone. But we also are not gonna permit that abuse. It just can't happen. So really we have a very excellent elder abuse unit with trauma-informed people that care, victim advocates that talk to our seniors about look, if you don't come forward, if you don't go through this, this is only gonna get worse. But if you let us help, we will do everything possible to also help your son find treatment, find resources, so that you're not alone in this. So it's a very balanced approach to the issue. Dr. Bob: That's wonderful. Well, so we've been talking for about 13 minutes now, and I'm totally inspired to try to provide support and throw my hat in the ring in some way. So when we're done with this interview, I do wanna make sure we follow up. Because my practice, my whole model practice it was developed to protect people from the gaps that exist in the healthcare industry and the general care industry, because there are all these places where people, especially older adults, seniors, people with illness, where they're so vulnerable, and the system is not necessarily intentionally abusing them, like some of these other criminals, but the system is creating abuse just by nature of not meeting some of the basic needs of the people who are moving through the system. So there's a lot of alignment. I see our healthcare system just unable to really meet a lot of the complex needs, and so people are just sort of pushed along into what's most convenient, and what's most sort of accepted, and then they find themselves, I call it kinda like down the rabbit hole, looking up and thinking, "How did we get here, how did we find ourselves in this place that is so foreign and so unfriendly." So I think it's just a natural additional kind of commitment to try to help figure out how the medical community can partner better with you and your organizations to further protect these folks. DA Stephan: I agree. And these collaborations, they just really ... I call it the multiplier effect. I think the time for kind of silos and people thinking that they just care for their own lane, it doesn't really work when you're dealing with vulnerable populations. We need kind of to build those intersections in all of the world, to kind of work together. One really unique thing we're doing here in San Diego that I think is something to be copied, is we've developed a website called ChooseWellSanDiego.com or .org, Choose Well San Diego. And what it is, it's sort of like a Yelp for senior homes, to create a way where we track the complaints, complaints of falling, complaints of neglect, different things that may not result in criminal action, but they are sort of an incentive and a motivation for homes for seniors to do better, to provide... level of care. So we have about 100 now rated in our area and are creating ... We can't force them into the Yelp system, but we sort of make sure that we start to get them the majority in there, then if you don't see a particular home that you're trying to place your elder in on that list, then you have to wonder why aren't they participating, and what do they have to hide, so- Dr. Bob: Well, that's great. It's a great thing to promote for sure. DA Stephan: Yeah. So it's things like that. And then the other thing I'm really a believer in is everyone no matter how well-intentioned they are, doctors who care, and community members who care. I think having an easy, handy protocol like with questions to ask, signs to look for, that's what we've done in domestic violence, in sexual abuse, in human trafficking. Those sorts of easy, simple ways to detect harm, to look beyond what is right there in front of you, and look for vulnerabilities and signs of abuse, having something handy. And I'm sure with your experience; we would love to get your input on what would go on a card like this, what kinds of questions should medical professionals be asking. Dr. Bob: I would be happy to. I would love to participate. And then, of course, the next step in that is what do you do with the information, right? Where does it get reported or how does it get followed up on? I know that one of the challenges that physicians and other people who are in the healthcare continuum that they're struggling with, is just time, is not having enough time to deal with the basics of the encounters. And to then add another piece on this of trying to do this additional questionnaire screenings, or if you do identify something that seems concerning or suspicious, to take the time to file a report and do the followup. So all of those processes, of course, need to be streamlined and clear as to what the steps to take are. DA Stephan: Yeah. I mean for sure. I mean in California we have mandated reporting for elder abuse, but it needs to be simpler, more streamlined, more upline, so that people aren't spending more time on those sorts of things as opposed to actually doing the care. And it makes it easier to expand the reporting. So those are all issues that we are grinding away, but this blueprint, this regional blueprint gets us started in the right direction, and with a unified commitment from our community to move forward and make lives better for our seniors, healthier, and let them live in dignity in their later years is really really an important thing. Dr. Bob: Yeah. Well, I just wanted to tell that I'm proud to be a San Diegan, and I've been here for about seven, and I love it, and I don't think I'm ever leaving. I appreciate the work that you're doing; I know that you're ... I can tell how dedicated you are to improving the lot for everybody here. I do wanna make sure that we followup, 'cause I want to contribute to this really important initiative and programs. So thank you for taking the time. DA Stephan: Well, I'd love to meet you in person, and definitely we will be in touch with you. I mean you've been doing this important work and shedding light on these issues with the increase in dementia, and Alzheimer's, and all of the the different areas that make our seniors vulnerable. We all need to give them our voice and our attention. And I really appreciate you too.

  Jami Shapiro helps seniors transition from homes with her company Silver Linings Transitions. Learn why she is so passionate about this work and how she can help you or your loved ones. Contact Silver Linings Transitions 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. Transcript Jami Shapiro: Thanks for having me. Dr. Bob: Yeah. It's great to have you here. Jami Shapiro: This is exciting. I was really looking forward to this conversation, so I'm glad to be here. Dr. Bob: Yeah. Why is that? Jami Shapiro: Well, death and what you do, it has just really become ... I guess I should describe what it is that I do so that it can set the stage for people. Dr. Bob: Sounds good. Jami Shapiro: Okay. I own a company, as you mentioned, called Silver Linings Transitions and we started as a senior move management company, which is actually part of a National Association called The National Association of Senior Move Management, and I have to step it back a little bit because about 13 years ago, I was diagnosed with thyroid cancer, and I was 34 years old, and it was life-changing for me to have to wait on the diagnosis and at the same time, one of my closest friends died of ovarian cancer. When you look at cancer as a 34-year old, you realized, "Oh, this is borrowed time." A friend of mine who had cancer as a freshman college said that getting cancer was like getting a front row seat to life. Dr. Bob: Wow. Jami Shapiro: Right. I started to look at my own life, and I knew that what I was doing wasn't fulfilling for me. I ended up moving to San Diego from Florida with my now ex-husband, when he took a dean position out here, and it was an opportunity for me to explore what it was that I wanted to do and the first job that I had was actually working at a cancer foundation started by a family who had lost their daughter at 39 to gastroesophageal cancer stage four, and no one knew because we weren't talking about it or what the symptoms were. I loved that they took their tragedy and they turned it into something, which was really very close to who I was. Around the time that I needed to put my daughter into private school, a friend of mine approached me about starting a business selling things for seniors on eBay. That was how we were going to start. Then while she was researching that, we found out about The National Association and they were going to be having their conference in San Diego two months later, and went to that conference, and that was that light bulb that everybody hopes to get, and it was like, "This is what I'm meant to do," and the people that do the work that I do, which is helping seniors when they're transitioning from their homes. It can be the home they've been in for 60 years. It can be the condo that they've moved into, but going into a senior community typically or sometimes into a smaller space is actually very ... It's a tough transition. It's medically identified as relocation stress syndrome, and they say that it is the most difficult transition a person will make in their lifetime. I don't know compared to what you're helping them transition through, but it's tough. Dr. Bob: It's significant. Jami Shapiro: It's significant. Dr. Bob: It's significant, and it's probably under-addressed and under-recognized in general. Jami Shapiro: Absolutely. Right. Then, what their staff represents to them. That's what we're doing is we're helping them go through the mementos of their lives, so I started it that way with a partner. Then, things happen the way life does, and my partner ended up going to work with her husband because he had actually started a business as well. Then, I had to look at how am I going to do this business by myself because I planned on having a partner. I've got three children. Anyway, I ended up shortly after that, putting something on Facebook that I was looking for help because I'm actually as great as my company is, and you have to be very organized to do the work that we do, but I'm not organized. I knew I had to find somebody that was. Initially, I was looking for a partner, couldn't find the right partner. Then, I put something on Facebook in a group of women that I, in San Elijo Hills, we have a little women's site. I posted something, and the first person that responded to me was a woman who had been a stay at home mom for 18 years, and she couldn't find anyone that would hire her. That was when the second epiphany happened, and that was women when they're transitioning back into the workforce whether they're going through a divorce or their kids are going to school, it's tough for women to compete with the younger women and then to have the flexibility, so that became my team and that was women transitioning back into the workforce. Then, right after that, I started, my marriage ended. It was like I'm starting a business simultaneously and going through a divorce. Then, I realized that women including me, if we walk away from careers and even though I worked, we didn't find my retirement. We find it his, and even though I'm getting half of his retirement, I'm starting at a lower level than he is. Then, you've got the issue of benefits. My long-term objective is actually to help the seniors and the other clients because we now help divorcing clients. We help when there's a death, and we go into the home, but it's also to provide meaningful work for women, a platform that will give them to get the confidence to get back up into the workforce, but I see this really ... In my vision, it's national. That's where I'm going. Dr. Bob: That's awesome. That's really great. It's like a trifecta. You're helping several populations that clearly have needs. Many of those needs are unmet, and you're doing it from a place not ... It sounds like, not necessarily because you want to be a billionaire, but because you want to have meaningful work. You want your life to mean something, and you were fortunate to have that wake-up call at 34 when you realized that, "Wow. There really is a limit to all of this," and you needed to do something now. That's awesome. Jami Shapiro: Yeah. Dr. Bob: That's pretty wonderful. Jami Shapiro: Well, that's actually why I called the company Silver Linings Transitions because I would never have gotten to that place if I haven't had that experience. Dr. Bob: Yeah. Well, I love that. It really resonates with me because for me, I've been accused of being an eternal optimist and even in the phase of situations where it really seems like it wouldn't be the appropriate response, I just have this sense of optimism that things are going to work out and I always look for the silver linings, and I talked about that because there always is one. Jami Shapiro: You're absolutely right. There's always a lesson to be learned. Dr. Bob: Yeah. No question about it because we can't control what happens in life. Jami Shapiro: Yeah. That's exactly right. Dr. Bob: What we can control is our response to it. Jami Shapiro: I just wrote a blog about that yesterday actually, and it ended exactly that same way. Absolutely. Dr. Bob: Good for you. Jami Shapiro: Yeah. Dr. Bob: I love the fact that ... We talked about this before we started recording that there's definitely some similarities and alignment in our ... Not just our chosen, I guess career path. Jami Shapiro: And who we're serving, right? Dr. Bob: And who we're serving, but I think what we're trying to accomplish. Jami Shapiro: Our why? I think we both talked about the fact that we both feel like this is a calling. Yeah. I'm also an eternal optimist and I'm so grateful actually that I am because I have a lot of family members with depression, and I know that it's really difficult, and I feel like if I can talk about God because that's really helped me with everything that's gone on is to know that He's given me these talents and there's some reason that I have them, and there's something I'm supposed to do with them. Dr. Bob: Yeah. If you didn't, well, then you wouldn't be fulfilling your reason for being here. Jami Shapiro: That's exactly right. That's right. Dr. Bob: Right? It's so cool because there's ... In your work as well and in mine, we come across people who are in really difficult circumstances often, and they're going through challenges, and it's fascinating to see how people respond to those challenges because I can be talking with a person who's in their 80s, 90s or over 100 who's struggling, and looking at uncertain future, but likely challenging, but they don't feel victimized. They still see the positives in life, and they still feel grateful for what they've had and what life has been for them, and even what's coming. Jami Shapiro: That's right. What they can do. Right. We need to identify what it is we still can do. Dr. Bob: There's such an opportunity, I think, we're not a psychologist. We're not a psychiatrist. We're not the therapist, but in everything that we do, I think there's an opportunity to help to share this sense of the possibilities. Jami Shapiro: Absolutely. Yeah. Dr. Bob: Right? That there is a silver lining to everything. Sometimes people don't want to hear that in the moment, but I think representing that, living it by example is very important, and it sounds to me like you're doing that. Jami Shapiro: Right. It's interesting because I do get to work with seniors when they're going through the mementos of their life as I mentioned, and so we actually ... I have a partner, Bryan Devore, he's a realtor, and we worked together now. He does his own Silver Linings Transitions, but most people who are selling a home ... Well, everyone selling a home will have to move, and a lot of the clients that we come across are seniors who will also need to sell their homes, so we offer that as a bundled service, but we ended up working with four clients together last year. Two of them embraced moving into a senior community. One of them had his name tag on when we met him, and he was excited about going, and he was going to have his meals there, and the other woman put herself on a waiting list and brought my company in, so we could get her ready for that transition, and those two are thriving. Then, there were two situations where we were called in, and they were kicking and screaming going there, both had put deposits down, but neither one of them wanted to be there. Both of them pass within a month of moving, and it just shows like you're right. You don't have a choice in a matter. The only choice you have is your response to it. Dr. Bob: Yeah. It's powerful. Jami Shapiro: We started a TV show actually that we're going to start filming in March, and I'm really excited about showing people what senior community really is and following people who are transitioning into those changes. Dr. Bob: The communities that you're helping people transition to, is it any size? It can be a large assisted living or independent living or small residential care homes? Jami Shapiro: Sure. We've even done an 8,500 square foot ranch in Santa Fe home into a smaller three bedroom house. Anytime there's a downsize and we actually ... I don't want to plug the business because that's something the conversation is about. Dr. Bob: Please do. You're plugging something that's needed, and valuable. Jami Shapiro: We're working with a family now, and there's a little bit of health stuff going on and they are needing to move out of their son's school because there are some issues going on and there are some boundary changes, and so my team is going in and getting the home organized and helping them move because people would say, "Well, do you have to be a senior?" I said, "No. We don't discriminate based on age." We really help, and Bryan is selling the home for them, and as I mentioned, if he sells their home, then he provides Silver Linings Transitions free for our clients. We actually have a website called packedforfree.com, and we actually created a little thing that looks like a Reese's because what's the best combination in the world? Chocolate and peanut butter and next is selling your home and moving. Dr. Bob: Right. Helping someone transition. Jami Shapiro: Right? Move services. Exactly. Dr. Bob: Well, I just moved a little over a month ago, and we're pretty good at moving. We moved a number of times. I think we just changed. Jami Shapiro: Me, too. Me, too. Dr. Bob: ...When I was looking at the website, and the idea that really appealed to me is you get up in the morning, you leave your bed unmade, you go out, you enjoy your day, you go back to your new place, and everything's in place. The idea of that was just like incredibly overwhelming to me. Jami Shapiro: Yeah. For us ... Dr. Bob: I wish I would have known about you. Jami Shapiro: You know what? I wish that every time somebody said that, I got a dollar because I'd be a wealthy woman. Dr. Bob: I know. Me too. Yeah. No doubt about it. Jami Shapiro: Yeah, exactly. Dr. Bob: For me, and probably for you too, it really makes me sad when I hear somebody say, "I wish we had known about you when my mom was ill, or a few months ago when we were going through these challenges." Jami Shapiro: Right. I think one of the things that also we are different than a moving company because the women that I'm hiring are so compassionate, and it's funny. Most of them have found Silver Linings Transitions. One of them when I was first starting the business, and I wanted to take credit cards, I had to have my ... My home was where I was going to work out of the company or work, and she came in to look at my home and make sure I was legitimate, and we've got into a conversation and her father had just passed away, and she was helping her mother go through all of his belongings, and she's actually my head manager now. That's how she found me coming into my kitchen, and then I have another woman whose husband was on jury duty, and he happened to hear somebody talking about the company, and she approached me. People are coming because I think they feel that calling too, and I think it's so evident when our clients work with us that we are just really compassionate and ... Dr. Bob: That's what they want. That's what people want. Jami Shapiro: Yes. Dr. Bob: They don't want someone who is just going to come in and handle the transaction. Jami Shapiro: Right. They would be heard. Dr. Bob: At this day, for some people, yes, it's about cost, and they have to be conscientious about that, but I think for more people at that stage of life, it's about trust, knowing that they and their things are in good hands and that it goes smoothly. Similarly, I think there's alignment there as well that there's such a ... The norm is that things don't go smoothly. The typical situation is people struggle. They try to find the resources, and they're searching, and they're getting recommendations and they piecemeal it together. To be able to say that anxiety, time, frustration by having a teen that they can really trust and feel good about working makes all the difference in the world. Jami Shapiro: Right. I noticed that about your team as well, and it's having a comprehensive solution. I know when I had thyroid cancer actually, I was very fortunate that I lived in Jacksonville, Florida and there was a Mayo Clinic, and the leading person who dealt with thyroid cancer endocrinologist happened to be in Jacksonville. Then, it ended up that we couldn't go because the insurance have that goes. Dealing with Mayo where everything was in one place, and as a patient, it was so comforting versus them having to leave that system and then have to exactly piecemeal it together. There's nothing worse than going through something really tough, and then having to manage all the pieces too. Dr. Bob: Right. The situation itself is stressful, and then to add on top of that all the frustration that comes with trying to get the right support. Jami Shapiro: Right. Dr. Bob: The healthcare system is the prime example of that, which is why we exist. I would be very happy if there was no need for us. Jami Shapiro: Oh, no death. I say [crosstalk 00:15:34]. Dr. Bob: Well, I would be wonder ... People were going to die, right? Jami Shapiro: Yes. [crosstalk 00:15:39]. Dr. Bob: We're not going to stop that, but if everybody has the right support and the right guidance. Jami Shapiro: Absolutely. Dr. Bob: Because the medical system acts like death is not going to happen. They don't talk about death. Jami Shapiro: Right. I'm not supposed to talk about it either. I was telling you we go out and we give talks. The talk that I've done lately is, "Do you own your stuff or does your stuff own you?" Because so many people are prisoners to these rooms, they're not even living in because their stuff is there. They're not even enjoying their stuff, and that's a whole conversation that I still want to address, but when I talked about it, and we're talking about downsizing and going through the mementos of their life, I've been told not to talk about death. We want to bury our heads in the sand. I actually went to ... An attorney was giving a talk on advance directives, and he said that only 10% of people even have a discussion with their spouse about what their wishes are. It's just like we just want to bury our head in the sand. Dr. Bob: Yes, we do, but we're trying to do something about that. Right? Jami Shapiro: Yes, absolutely. Dr. Bob: And people like us, which is why we're having this conversation, which is why people like us who, for some reason, somehow had become comfortable with the concept. It's so important for us to be out there leading by example and encouraging the conversations. I think that there's a shift happening. There's a movement underway, the death cap phase, and maybe I have a warped sense of things just because I'm so immersed in that. Jami Shapiro: Yes. Dr. Bob: But I do get the sense that when I'm out speaking with people, and they learn what I do, it opens up this flood sometimes of wanting to talk about the experiences they've had. You and your team find yourselves in situations where you're having intimate conversations, and people are in a vulnerable time, so you're probably experiencing some of this as well. Jami Shapiro: Absolutely. Dr. Bob: I'm amazed how freely people talk about the experiences that they've had in their life around death of a relative or a friend, and I would say it's probably equally divided between people who talk about how difficult and challenging it was and their frustration with the system and fear about what might happen next time, somebody that they love or they become ill, but there's another group of people who want to share what an incredibly transformational experience it was because they somehow found the resources they needed. They had a great hospice team. They have advocates, and so it seems so ... The goal really seems to be to try to get those people who have had those scary, challenging, frustrating, horrific experiences to not have to deal with that but to be able to be in that other camp where it is a beautiful, peaceful transformational experience. Jami Shapiro: Right. You said something that you're noticing, and you think it's because of the work that you're doing, but I also am ... I've sort of become, I would say more spiritual, and sort of realizing a collective soul now. I actually had read back in my 20s the book, "Many Lives, Many Masters," by Brian Weiss, and ended up having a conversation with somebody about Akashic records, which is probably something I can't even interest, but I reread the book now in my 40s, and so, now I see this time on earth, they call it earth school, which ties back into the whole silver linings thing, which is what lessons is my soul supposed to learn? That has given me some peace because I'm actually one of those people whose always been really afraid of death too and it was one of the reasons I wanted to talk to you because it's really addressing something that I myself not wanted to talk about. As I'm starting this business and realizing that for me anyway, and I would say most people, we are going to leave this earth. There's no debate. We both know, and we're on the same side of the coin, that's going to happen, but what's your legacy going to be? What is it that you're going to have done? What's your imprint? I think when you are ... [inaudible 00:20:03] the word "aligned," but it is, when you are aligned, when you are listening to that voice or however comes to you, meditation or the light bulb moment, then you realize you're part of something bigger. Dr. Bob: That has brought you more peace? Jami Shapiro: It has. It has. Now, I'm reading "Journey of Souls," and that one's a little bit more challenging for me. I read the Brian Weiss one in a day, and this one, I've been struggling with, but it talks about our souls and the way that our souls evolve and that some souls don't even come back to earth, and that they are so ... They love where they are, so that gives me peace. Actually, when I was in my 20s, I worked with a couple ... I was in a different line of work, but they lost their adult sons, both of them within a period of two years, and I told them about this book. Then actually, recently, I was in yoga, and I was really getting frustrated because I wanted to get into the class and there was a woman, and she was talking to the woman that was checking everybody in, and, "Come on, come on, come on." Then, the one woman said, "I've been thinking about you. My daughter passed away last week." Then, it was just like ... That changed where I was at completely, and I told her about the book because for me, just thinking that this isn't a final conversation, that this isn't a final place and I remember too like that whole class, I felt called to hug her. I just needed to hug her. That's not something I'm just going to like, "Hey yo." Then, I walked up, and I said, "I just have to. Is it okay?" It just was such a ... That collectiveness that we are this one thing. Dr. Bob: You could sense that there was a bond of some sort or you wanted to bring her some comfort? Jami Shapiro: Right. Right. Yeah. Dr. Bob: It's fascinating, and I love where you're going. I love this path that you're on. Do you bring this into ... Obviously, it influences everything in your life and your work. Do you incorporate this into the relationships with your clients and your team? Jami Shapiro: Yes. That is a great question. Actually, when we have had clients and the tears start to come because they do, and I'll say to them, "I was diagnosed with cancer at 34." The idea of being a senior when you're 34 years old, and you don't know ... At that point, I didn't know that I have thyroid cancer. Actually, they call it "the good cancer," but I had to wait 10 days for my pathology to come back to even know that that's what it was, so I had that opportunity to look at my life and my mortality. I say to my clients, "You're so lucky because whatever life threw at you, you get to be here making these decisions. Let's own it." Kind of embracing going into a senior community like starting a new school or I remember we had a client, and she had a ton of hats. Some of these hats had never been worn. They still have the tags on them, and we're going through her belongings and trying to figure out what's going to fit. I said, "Why don't you take the hat? Somebody known as the crazy hat lady? You can change it." It is just like you said back in the beginning; it's attitude. I think when I can say to them, "I faced it, and you're so lucky to be here." That really turns it around for them. Yeah. Dr. Bob: Yeah. Well, we have a shared experience there as well. Yours was a little bit more intensive, but the day before my 50th birthday, which was a little over five years ago, I got a phone call from a doctor telling me that I have prostate cancer because I've been having issues and MRI was done. A month later, it turned out that we found out that that was not correct, but I spent a month with this belief that I have a fairly aggressive form of cancer, and it changed things for me. I already felt like I had a fairly healthy outlook on life, but at that point, I just saw things differently. I started seeing things through a little bit of a different lens, and I realized it's okay. That was a big piece for me. I realized that no matter what happens, no matter what life threw at me, it was going to be okay. I was prepared. I had pretty much said to those I love and those in my life what I want them to know. I didn't feel like I had any relationships that needed to be fixed, which was wonderful. I think it was a gift, but I would love for people to be able to have that gift without having to have that diagnosis or that fear of the diagnosis. Jami Shapiro: Absolutely, right. Dr. Bob: To be able to have something that allows them to do ... Just to check in to do a big-time check in with where they are, and essentially answer the question, "Are you ready?" If you're not, what do you need to do to be ready? Jami Shapiro: Right. Dr. Bob: Get on it. Jami Shapiro: Right. Absolutely. I also see that too as the brick that was turning your path because you're dealing with people when they're going through this time, and when you're in that space, I think it gives you ... I think you're already an amazingly empathetic and compassionate, but now maybe a little more empathetic because you sat there. Dr. Bob: Then, subsequently in the last few years, both my parents going through terminal lung cancer and dying in my presence and my family's presence has added to that. We don't want everyone to have to go through these personal experiences in order to get the lessons, which is I think partly why we're putting ourselves out there and creating opportunities for other like-minded folks to come in and provide support and guidance. Jami Shapiro: Right. Yeah. Sure. Dr. Bob: Yeah. You've had a number of experiences that have influenced your journey and your path and kind of the attribute. I know that you've also experienced death in your life. Jami Shapiro: Yeah. Yeah. Actually, my grandmother was, I think the person that I was closest to in the entire world, and I'm actually wearing her pin today because I'm going to be starting filming on this show and I wanted to have her a part of her with me, and I will sense her sometimes, not necessarily like feeling her, but finding a letter that she wrote that was exactly what I needed to read in that moment or on my 47th birthday, I was going through a divorce. I just had a breakup with the boyfriend, and I was not expecting much of the day because no one to throw a party for me, and I was an only child. My birthday is a big deal. When you have cancer too, you need to celebrate birthdays, but I ended up totally by fluke, I had my three daughters. It was my birthday, so nobody could say no. I'm going to sit in my bed with me, and we're going to look through this box and mementos. I have had this box and some of the things in it for years, but there was a jewelry pouch that had been my grandmother's, and she had these pins that I knew about, and I knew that her wedding ring was there, but there was a little brown pouch, and it was flat. It was a felt pouch and had I not been a senior move manager, I would have tossed the pouch, but something made me put my finger inside, and I found a diamond earring. Then, I couldn't find the other one, and I was searching the whole box, and then I put my finger back in and found the other earring. I'm wearing them. It was funny too because I had gotten this second holes when I was 16 years old and didn't want to wear them, and I was thinking, "Maybe I should get a small earring." Really, this is so true. Then, I found my grandmother's earrings and have been wearing them every day since because I think she meant for me to find them. Dr. Bob: Yes, absolutely. Jami Shapiro: That's my experience with death. I wasn't there when she passed, but it's interesting because she ended up dying from a pulmonary embolism, and I got a call that she had passed, and my husband at the time was going to drive me to the hospital, and my daughter was two months old at the time, and we got stuck in traffic. I needed to get there, and so I got out of the car, and I ran into her room, and she was still there. That was the only time I've ever been close to anybody who had died, and part of me wishes that I had been there to hear that last breath that I hear so peaceful. I've not experienced that, so it's just me seeing this woman that I loved laying there, and I couldn't touch her. Still, it scared me. Dr. Bob: Did you feel like she was no longer there? Did you feel like her spirit, her soul had left the body at that point? Jami Shapiro: Yeah, I didn't sense her. I will say my mom would feel her presence a lot because my mom was actually there when she was dying, and it was a very traumatic death because she was gasping for air, and it really was with my mom and still is. I'm sure I don't even like to talk about it with her because it brings up that for her, but I didn't. I don't feel her the way people talk about feeling energy or I don't feel her, but I know that she's looking out for me because of these little things that keep happening. There are so many synchronicities in my life that are just ... I have no other way to describe them. Part of this is her, but just also I don't know. God is just leading this path. Dr. Bob: Yeah. I think many people feel that. They feel the synchronicities. They feel the signs, messages, but you need to be looking for them, right? Jami Shapiro: Oh, you absolutely have to be open to it. Dr. Bob: I think if you're not, you can just keep blinders on and if that's the case, I guess you could still be hit over the side of the head with a two by four sign. Jami Shapiro: Or cancer diagnosis. Dr. Bob: Yeah. Exactly. Maybe being aware and receptive and looking for those things, maybe that's a health benefit. Jami Shapiro: Sure. Dr. Bob: If you're getting what you need, maybe you're not going to get the things that you don't want because you're not paying attention. Jami Shapiro: Yeah. That's another interesting thing that you brought up. There's another book. I do a lot of reading a lot, and there was a book by Jen Sincero called, "You Are a Badass," and just very inspired by ... I see on your bookshelf, "Think and Grow Rich," but she has an exercise where she says, "For the next minutes spend, look at everything you can find that's right. Count as many things that you can find that are red." You spend a minute counting red, and then she says, "What do you see that was yellow?" Right? We are going to see what we're looking for. Dr. Bob: What we're paying attention to. Jami Shapiro: Absolutely. Dr. Bob: Right. If you look at my bookshelf, when I moved, I took some of the books from home and brought them here. "Think and Grow Rich" could be next to "Many Lives, Many Masters." I have a whole array. I guess I want people to know how to find ... I want people who are potentially going through these transitions or know people who are going through transitions and looking for support. Tell me who are the people who are your ideal clients who really need you, and what's the best way for them to get a hold of you? Jami Shapiro: I feel like my answer is going to make me sound like a transition queen, but as I mentioned ... Dr. Bob: I think you are becoming the transition queen. Jami Shapiro: As I mentioned, Silver Linings Transitions is my company that we started as a senior move management company, and then going through my own divorce and I don't know if I shared it in the interview, but I was having a consultation because my ex and I ... Really, it was a pretty amicable divorce as these things go, but we got to a point where we didn't agree on the house and the attorney that I consulted with said that if we couldn't come to an agreement, that we were going to go before a judge and the judge was going to make us put our house on the market in 60 days, and I looked at her and I was like a deer caught in headlights and like I said, "You're going through one of the most difficult transitions in your life, and now you have to sell your house?" In the middle of my own consultation, I looked at her, and I said, "Do you think divorcing couples would benefit from the services we're providing for seniors?" We started an offshoot, even though it's still Silver Linings Transitions that goes in, but it's called Divorce Home Solutions because I don't think someone going through a divorce is quite ready to hear Silver Linings. You know what I mean? Then, actually my grandmother passed unexpectedly, and my family and they say weddings and funerals bring out the worst in people, descended on her home, but also had to deal with clearing it out when we were grieving. We were having to deal with the physical part of that while we're planning a funeral and grieving this amazing woman. I tear every time I talk about her. I do. I just love ... Anyway, sorry. I remember the items that I didn't get. You know what I mean? One of the things that we do also is we'll go into a home, and we will do a sentimental auction, and we will help the families rather than fight with each other, you come to an amicable solution and then if Bryan Devore who I worked with sells their home, we'll come and we'll clear the whole thing. We can bring the appraiser in to figure out if there's anything of value. We can help divide the belongings. We ship things to people. We just make that another easy transition, and we started meeting with funeral home directors, and a lot of them will keep our brochure and again, that doesn't say Silver Linings Transitions either, but it's really just us going in, and I'm helping anybody and people say, "Do you have to be a senior?" "No." Moving is one of life's top five stressors. If somebody wanted to find me, they could go to my website, Silver Linings Transitions, not just me because I would not be where I am if I haven't had this amazing team of people who found their calling too, but silverliningstransitions.com, and that would give them an opportunity to reach out. Dr. Bob: Are you looking at ... Thank you. Hopefully, that will bring some peace to folks knowing that this exists. I know that when we have patients who die, this is a very common need that everyone is left with so many things that they have to be worrying about and thinking about, and one of them is, "What do we do with all this stuff? What do we do at the house? What do we do with all these things?" It's really the last thing in the world that they really want to be focusing on. Jami Shapiro: Right, or should be. Dr. Bob: Having a compassionate team of people that come in and support that is phenomenal. Are there other companies that you know of that have the same breath of service that you do? Jami Shapiro: Well, as I mentioned, I am part of the national association, The National Association of Senior Move Managers, and people can find it. It's nasmm.org, and they could find other people who do the work that I do and honestly, anybody who chooses to join an association where we're not regulated is already ... As far as I'm concerned, having to learn how to work with seniors and taking that level of commitment to the work that we do. There are other senior move management companies, but I don't think there are any other Silver Linings Transitions, and again, one of my callings is also to help the women who are transitioning back into the workforce. Yeah. Dr. Bob: Are you looking for additional team members? Jami Shapiro: It's a great question. Yes, I am. We're growing, and we're getting to the point where we don't have enough hands. Dr. Bob: Okay. We'll keep that in mind. Jami Shapiro: Yes. Absolutely. In fact, when I go and talk to divorcing people, especially these women who've been at home and are still getting support, I said, "This is the time to start building your resume in that platform," but of course, my vision is to grow and to not just be in San Diego, and rather than doing franchises where you've got to come up with money to pay for a franchise, I want to build this business where we could go in and train people in different cities and give them the tools that they need to run Silver Linings Transitions out of their cities. That's when I think of the whole "Think and Grow Rich," that's the picture of it that's in my head, and not because I want to grow rich but because I just feel like it has to be done. Dr. Bob: Well, you want to grow, and you want to make sure that your life has meaning, that you want to be the example of creating a legacy and doing something that is clearly going to bring value to people. Like us, the need is huge. The gaps are immense, and we want to try to fill that need in the most, I guess, organic and beautiful way possible. Jami Shapiro: Yeah. I can see, by the way, why you coming into someone's home when they're at this point because there's very calming presence about you, and I love the people I have met in your office and that you have this team that can go in and supports them with massage or acupuncture or ... I saw the aromatherapy, I see have been going right now during the interview. Yeah. If it's going to happen, let's make it as gentle as possible. Dr. Bob: Let's make it beautiful. Right. Jami Shapiro: Exactly. Dr. Bob: Because I think back to your grandmother and that struggle, and I don't know how long that went on for those circumstances, but truly I believe that there is a way aside from a very sudden traumatic type death or an incident that is just unanticipated or unexpected, the vast majority of death's cannon should be peaceful and beautiful, and that's not happening routinely, which means that we're doing something wrong, and we have opportunities to make a huge impact because your mom shouldn't have to live with that, right? Jami Shapiro: Oh, no. No. Dr. Bob: That's my why. People shouldn't have to live with fear when we could be there making sure that every last breath is peaceful. Jami Shapiro: Yeah. I just got chills. Just beautiful work that you're doing. Dr. Bob: Yeah. You as well. Jami Shapiro: Thank you. Dr. Bob: I have a feeling that we're going to be collaborating more and this will not be our last conversation. Jami Shapiro: I have a feeling that might be the case. Dr. Bob: Thank you so much for being here. It's a pleasure. Jami Shapiro: Thank you so much.   Weak adjective: difficult by→for in→at , and , I→; I Repetitive word: home the good Undo GENERAL (DEFAULT) 7386 WORDS 3 CRITICAL ISSUES5 ADVANCED ISSUESSCORE: 99 Style checking has been disabled

  Najah Salaam at one time feared death. Today, she helps those nearing the end of life. Learn how she overcame her fear and why helping others is so important to her. Contact Multi-Dimensional Healing website 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. Transcript Dr. Bob: Welcome to another episode of A Life and Death Conversation. I'm Dr. Bob Uslander. Today, we're here with a special guest of ... a woman who I've come to consider a dear friend, who's been part of the journey since we began Integrated MD Care. I'm going to introduce you and allow you to hear some of the insights and some of the beautiful, passionate words from Najah Salaam, who is the owner of Multi-Dimensional Healing. Najah's an acupuncturist, massage therapist, and truly a beautiful human being who brings light and healing to many of the patients in our practice. Najah, thanks for agreeing to talk with me today. Najah Salaam: Thank you, Dr. Bob, for a really sweet introduction. Dr. Bob: Well, I could go on ... I could actually use almost the full half hour or so that we're going to be talking just to tell people how wonderful you are and how much I've appreciated having you in my life, and being able to have you collaborating with us and caring for our patients. Najah Salaam: Oh, yeah. It's my pleasure. I love the work that we do. I mean, I could go on for half an hour about you, too. Dr. Bob: Well, we're going to shorten our little love fest, and we're going to actually get into a discussion. If you would, I have the honor of knowing more about you and your background, and what you do and how you do it, but would you be willing to share a little bit about ... kind of where you're from, and how you came to be doing the work that you're doing? Najah Salaam: Yeah, sure. I actually moved to San Diego in around like 2009 from the East Coast. I'm originally from New Jersey. At the time when I ... right before I moved here, I was working for a large marketing ... I'm sorry, an outdoor advertising company in New York City where I was the marketing coordinator. I was kind of at a turning point where I was feeling like this big push for me to make some changes in my life. I wasn't really happy with the work that I was doing there, so I wound up finding San Diego through a friend of mine who just insisted that I come and visit. It just grew on me more and more. I started coming out here. I think I was out here like four or five times, and then like the fifth time, that was it. I was like, "I can't go back on this plane anymore." That was it. I had to move. So with that move, I decided to make some major changes, and get out of the field that I was currently working in altogether, and to embark on something totally different. I had an experience with acupuncture back in like 2001 when I lived in New York City that was so profound that it just imprinted on me at that time, but I was so young. It was before I even finished my undergrad. I knew once ... like if I decided to go down the path of an acupuncturist at that age, that that was ... like there's no turning back. I felt as though I still had some unresolved things to do like finishing my undergrad, which I really needed to do for myself, so I decided to put acupuncture on the back burner in 2001. Then I finished my undergrad, and I worked in the city in New York City, and then it came full-circle. Then it became like, "Okay, now what am I doing because this is not fulfilling. This is not nourishing my soul." So that's when I decided to make the move across the country. Pacific College of Oriental Medicine, the school that I had originally had that impactful acupuncture treatment in New York, the school actually started in San Diego. So when I moved here and I was looking up acupuncture schools, it was a no-brainer for me to just go to Pacific College of Oriental Medicine, because that was the school that had resonated with me so strongly those years ago. That's what began my journey. I was at a better place in my life. I felt like I was more mature. I was ready for this next chapter, where if I would've started it back when I was about 20, I wasn't quite there yet. So I needed that time. I needed that time to really discover myself and to find the things that really resonated with me on a really deep level, and that, of course, was helping and healing people and just sharing my knowledge and studying and making sure that I had a lot to offer to all people. So that kind of began my journey here as an acupuncturist onto the four-and-a-half-year journey into studying Chinese medicine and all of its modalities and acupuncture and herbs. I graduated in 2013. So I've been licensed since 2014, and I've been practicing ever since happily. Dr. Bob: Well, it's a wonderful gift that you've found that. I totally understand needing to mature and needing to ... Timing is pretty critical. You found it a little bit sooner in your life than I did. I had my direction. I found medical school. I went into emergency medicine. I certainly was able to serve and support people, but it really took a lot longer to truly find that deep calling and listen to it and move in that direction. I'm glad that you found that pretty relatively early in life. You've got a lot of years left to be providing your unique blend of healing. When I was looking for an acupuncturist, I reached out to a couple of people who I trusted and had been in the acupuncture realm for many, many years at the university. I took them out for breakfast, and I said, "Hey, this is what I'm looking for to add, a phenomenal, heart-driven acupuncturist who wants to be part of this really cool collaborative team. Do you know anybody who might ... who you think might work?" The group that I was with, it was unanimous, "Call Najah," because they had worked with you. They had been part of your training. They had been how you interact with people. I think it was especially important that they saw you working with cancer patients and elderly people. When people think of acupuncture, I think in general, they're thinking of people who are younger and getting through sports injuries or just trying to ... part of a wellness type program. It may not be thought of quite as routinely in caring for people who are extremely ill or approaching end of life. Can you share a little bit about how you kind of moved into, I guess, becoming comfortable and passionate about working with some of the patients that we're caring for? Najah Salaam: It was quite a journey because I think when I first moved to San Diego, I was really scared of death. I had a really weird relationship with death, and with the elderly. I didn't have much experience with working with the elderly in that way when I first moved here. Then through my studying at school and learning about the spirit and learning about the energy, and how the energy that is in us, it just continues to move and go even if ... once the body is no longer there. It's like a never-ending life force that we all have, and really learning that. I became so comfortable with the idea of death and dying as it just being like another part of life. With that, it gave me enough ... I felt like strong enough and confident enough to go and work with a delicate population. So like when we had like the last year of our school, we have like your internships where you were actually going out into the field, and we have externships rather. So the externships, you get to pick where you'd like to go. So there are all different ones. There's like you can work with children. You can work with the homeless. You can work with HIV and AIDS patient. There are all sorts of internships or externships that you can do. The only ones ... I thought about it long and hard, on the groups of people that I felt as though I could feel the most ... like I can help the most, and I can really like give it my all and be really comfortable. I just kept on coming back to the senior center and then the cancer center. It was just something about being at that tail end of life that I found comfort in with just helping soothe and care for people that are maybe uncomfortable at that stage. It just felt like a natural calling to me. Once I've figured it out, once I figured out where I fit, I just kind of immediately went to the senior center and did two semesters at the senior center, and then I did three semesters at the cancer center, and then actually volunteered after I graduated there for another semester. Just, because it was a hard place for me to leave. I didn't want to leave there. Dr. Bob: I understand that. You said you developed a greater degree of comfort with the whole concept of death and dying. Do you feel like that happened as a result of these relationships and the encounters you had with these folks, or do you think that had happened before, and that's partly why you felt so comfortable? How did that come about?Najah Salaam: It's like a mixed bag, honestly, because like when I was young, I was thinking about this before, like my first encounters with death, and when was my first experience. I was like, "I don't know if I've had anyone." And I'm like, "Oh my gosh, yeah." From the time I was about 13, there were people around me that were dying, and not even dying because of old age, or they were sick, dying from just tragedy from a young age. So I was seeing ... death was around me. I was seeing people literally just being plucked away. So they were here one minute and then they were gone. That was kind of my first exposure to death, was when I was about 13. The whole time, up until I was about 27, it just became like this thing where it was like this big unknown. Then along the way, I started reading some books. Like my parents, thankfully, they're like very spiritual people. So they always had really great books at the house. They had one book, Conversations with God by Neale Donald Walsch. I started reading the first book. It was just like, all of the questions that I was having in my mind were being answered like little by little with each chapter that I read, and then reading future books. He wrote so many books, but reading later books as well, all of that started to really explain to me like more about this whole process. Even though I was still more scared about death when I was ... right before I moved out here, it was kind of like I wanted to know. I came here with this question. Like I really wanted to know about death. I had to ... because I didn't feel comfortable with it. Then while I was in my studies at Pacific College, I had a really great teacher who's my massage teacher, actually, Robert Leak. He talked in like energy. He was the one that started to really open up my mind to the whole concept of death and dying and the whole entire span of existence, so to speak. I had one semester with him, and we were always talking about energy. He was always giving us really cool tips and information. I remember one time, in particular, he said, "Let's all go outside and ... share energy with the trees. I'm going to show you how to do this." I was like, "Wait. What? What do you mean share energy with the trees?" He was trying to show us how there's energy within everything. So we all go outside in the backyard, like the back area of our school, and there's a bunch of little trees there that were planted. So he shows us how to do it. There's a certain way that you approach a tree, and you're looking to have the tree like invite you to come and share energy with them. It was like this really, really weird kind of like experience. Because I never thought that I would ever be essentially tree hugging. I never thought that I would be doing that. But in doing that exercise and learning how to just tap into the energy within you and then learning how to share that energy with another living thing on this earth was really powerful. So I just remember it like at that moment, I started to really think about like things in an energetic way that there is this whole chair. Then, I went to a yoga retreat down in Costa Rica. Then, I had a really profound experience there with a tree, believe it or not, this huge banyan tree. Our tour guide took us to see this tree because it was like ... I mean, you could walk through this tree. It was so big. I remember walking up to it and just being in total awe, because the tree, they grow up and then they have these like branches that come out. Then the branches grow down, and they reroot. So the tree just becomes massive. If you let it grow, these trees will just continue to grow. I just remember putting my hands on the tree, and it was like a flash hit me and I heard this voice that said to me, "What is alive in you is alive in me." That was the moment that I understood; I understood this energy that goes through all things. I understood that it's never-ending. Because I realized like it was such a profound experience for me because I had already had all these things about life and death and dying. Then to have this moment with this other being telling me that this is ... we share this in common, it's the same thread that's within you is within me, that's never-ending. Then, it was like boom. It was like a light went off. And from that moment, I was like, I understand. That was the moment that made me really understand that dying isn't really dying. So in my mind, I wanted to be around people that were at that tail end of life as a way to make them comfortable with the fact of this next part that's coming, but in my mind, in my heart. I always know ... I know deeply now that it's just a continuation. Just getting people comfortable enough with that continuation of life to me is a huge, huge gift to share. That's pretty much how I got to be comfortable enough that I would want to be with people at that end stage. Dr. Bob: That is so beautiful. I didn't know that story, so thank you so much for sharing it. That's really beautiful, powerful and it explains a lot. I mean, you have clearly an elevated consciousness, in my mind, as far as I can tell whenever I'm with you, so there's something, I think that tree, I think that connection that you made. When you think about it, the trees have been around ... they've been around longer than any other living organism, in terms of having been through the years, the decades, even the centuries at times, so there is wisdom there. And this energy, if you can connect with it and appreciate that, that's a beautiful thing. I recently was having a conversation with somebody who we're talking about green burials. We really want to try to help provide for better, more meaningful rituals around death. That's one of the things that we're going to be working on with our practice, is to not just sort of end the relationship at the time when a patient dies, but help the family and find the best ways to honor people. But in the conversation, someone told me that they had read about a gentleman who planned to be buried beneath a tree, a specific tree, because it was his desire that as his body decomposes and goes back into the earth as its elements, that it feeds the tree, and it nourishes the tree, which then will provide nourishment and connection with the world around, which I thought was a really cool idea. Najah Salaam: Yes. Yeah, I totally agree. Dr. Bob: There's another interesting connection... "Conversations with God" by Neale Donald Walsch was very profound. It had a huge influence on me as well at a time when I was really searching and looking. I had lots of questions about the meaning of life, the afterlife, how are we all connected. A lot of answers came forward in that book. So I'm not surprised that you had also tapped into that as well. Najah Salaam: Yeah. We both did. Wow. Dr. Bob: Yeah. Now you're working in a few different capacities. You're working with massage. You're doing acupuncture. You've had the gift of working intimately with a number of the patients in our practice as they've been gifted by having you as part of their journey. Can you share a little bit about what it's like to be working with some of these people who are really, as you know, that they're, in some cases, in their last days or weeks of life? What's it like to be in that space with them? Najah Salaam: Before I go to see someone, I'm like debriefed on their case, so you know a little bit about them. So you can't help but kind of paint a picture in your mind a little bit before you go. But then when you get there, every single time, every time that I've gone to a patient's house, no matter how sick they are, I'm always blown away by how much life they have in their eyes and in their spirit. Like, their spirit is really bright even if their body is really not cooperating and it's like pretty much failing them, they still have so much brightness around them. Time and time again, I'm pleasantly surprised, because everyone has that. Even when their body ... there's different signs of the body that clearly are showing me ... like the one patient that we had, John, and he had like lots of ... He had like edema down on the legs. So there are clear signs that his body's failing him, but his eyes were so bright. His spirit was, to me ... he was still joking and laughing ... He had just had so much life in him. It's been an honor to be around patients when they're at that delicate stage, and they're also vulnerable at that moment too. They're letting you in, which is a very ... I mean, that's something that every single time when I leave the patients, I am thanking the universe, I'm thanking God for giving me this opportunity to allow this person to let me into their most vulnerable moments. So, yeah, ... I look forward to every patient. Every time I go to see a patient, it is literally the highlight of my day that I'm invited in to care for someone at this late stage in their physical life. I'm always honored. I'm always honored. It gives my life more meaning and more purpose. It's, yeah, it just for me, all around, it's just a beautiful thing to be a part of. Dr. Bob: I love that. That's so clear in the way that you interact with these folks. That's part of what makes it so special and meaningful all the way around, is you're not just going in there kind of as the expert who's going to treat them and fix the issues. You're going in there as a person who truly appreciates and is so committed to making a connection and understanding what they need at that moment, and then feeling this sense of gratitude and appreciation for having been able to make that connection and receive as much as you give. Najah Salaam: Yeah. Dr. Bob: Which is such a huge ... I mean, I think it's missing. I think we don't have nearly enough of that in people who are providing care in our healthcare system. So finding someone like you is such a rare gift. I have seen the way that people speak after they've been treated by you. It goes so far beyond what might happen physically, the relief that you are able to provide through your massage or through your acupuncture. It's just been truly wonderful, beyond description, to have you as a member of the team caring for some of these patients. When you speak about their spirit that is intact and alive and that you're able to tap into, regardless of what their physical condition is, what's happening with their bodies, that's such a huge thing to be keeping a perspective on and aware of. That's really one of the main tenants and philosophies of our practice, as you know, which is why you're a part of it, is because no matter what's happening with the physical body, that spirit, that essence is still there and we can still help bring more peace and joy to that person's spirit. Najah Salaam: Yeah, absolutely. Dr. Bob: I go in and initially meet with people who it's really hard to find the ... It's really hard to tap into the joy in that spirit because a lot of people are just feeling depressed and dejected and uncared for and frustrated. It's understandable because their bodies are failing, and they're not being given the attention and understanding that they're looking for. People were trying to fix it, and when it doesn't look like we can fix it, then they're kind of giving up on them and putting them into the other mode, which is comfort only mode and essentially waiting for them to die. So recognizing that there is this space between where we can still allow them to feel cared for, to feel loved, to feel hopeful about making a connection with other loving, passionate human beings, that's where the magic happens. Najah Salaam: I totally agree. Yeah. So well said. Dr. Bob: We're teammates, right? Najah Salaam: Yeah. Dr. Bob: We get to go in and meet somebody. They may never have had acupuncture. They may never have had the kind of massage or skincare or attention that we're talking about, but once they come to trust that we are ... we truly are looking out for their best interest, and we're not making promises, we're not going to use acupuncture to fix ... to cure your stage IV cancer, but we are just here to make your journey a little bit easier, a little bit more joyful. Then, there's a real opportunity to make an impact. I love having you be part of that. Yay. Najah Salaam: Thank you. I'm so grateful that we are working together in this way. It's the best thing ever. Dr. Bob: Yeah. Well, I agree. Najah Salaam: Yeah. Dr. Bob: You're here in San Diego. In addition to working with us, with Integrated MD Care, we know you have some other activities you're doing. You have a practice of your own, which is Multi-Dimensional Healing. Najah Salaam: Yes. Dr. Bob: How would somebody find you if they're interested in talking with you about acupuncture or massage or whatever other services that you provide? Can you share a bit? Najah Salaam: Yeah, sure. My website is actually multi–dimensional–healing.com. From there, you can find my office location, which is right now in Mission Hills. You can also email me directly asking me any questions that you might have. On there are ... It's Multi-Dimensional Healing because I'm an acupuncturist, and, of course, I do massage as well. I'm also a yoga instructor and a Feng Shui consultant. So under there, there is information about all the things that are near and dear to me. You can just scroll there. There's information. My yoga teaching schedule's on there, and then all the other lovely things that I love to do, which includes doing events around town called AcuRhythms, which are acupuncture and sound healing events, which I look at as a way to provide a really deep healing using vibrational sound instruments combined with acupuncture to send the healing deep down within the body. We do them in group settings. That's like a passion project of mine. The schedule for those is on there as well. Dr. Bob: I've been to one of those sessions, and it was beautiful. I came away from that feeling infinitely more at ease and peaceful. Najah Salaam: Yeah. Dr. Bob: I'd like to do some more of those. Najah Salaam: I remember that. Yeah, totally. We're having one coming up I think on December 10th. Dr. Bob: Okay. Najah Salaam: Yeah. That's our next one. That one's in Oceanside, actually, Yoga Oceanside. Dr. Bob: I'm sorry. So Yoga Oceanside, and that would be on your website as well, the schedule of that? Najah Salaam: Mm-hmm (affirmative). Dr. Bob: Would people be able to ... like if I wanted to have sort of a private event and bring a group together, is that possible? Can you do that? Najah Salaam: Yes, absolutely. Yeah. I mean we can do groups as small as one person. I mean, I do private ones all the time or as many as 12 to 15 people I could do by myself. And then my business partner, if she comes and helps me, Cheryl Davies, then we can like double that number. Yeah, all sizes of groups, we can do. Dr. Bob: Great. Wonderful. Then, I know that there's one other project that you're working on. You recently got married. Congratulations on that. Najah Salaam: Yes. Thank you. Dr. Bob: I know that's beautiful. You and your husband have another business that you've been helping out with. Najah Salaam: Yeah, we do. Yeah. My husband has a passion for food, so we have a food truck called The Groovy Greek. We are all around San Diego. We do all sorts of events like big festivals to private caterings for birthday parties, weddings, lunches. So we're all over the San Diego metro area serving up delicious Greek food that is really healthy, believe it or not. We focus on using locally-sourced produce and wild-caught seafood, and organic ingredients. So you should look for us around town, The Groovy Greek. Dr. Bob: Yup. You can probably find that on Facebook, right? Najah Salaam: Yeah, totally. Dr. Bob: You can get on there and probably like it, and follow it and know where you're going to be. That's great. I'm going to get on there today because I'm getting hungry. Najah Salaam: Yeah. You can find out where we'll be. Dr. Bob: All right. Well, Najah, it was such a pleasure to have this conversation with you, as always. Najah Salaam: Yeah. Likewise. Likewise. This was very, very special. Dr. Bob: Yeah, I love being able to introduce you to a wider audience of people who can learn a bit about how to look at life through your beautiful very, very conscious eyes. So thank you for the beautiful work that you do. Thank you for being part of my team. Najah Salaam: Absolutely. Thank you. Dr. Bob: All right. We'll see you soon. Najah Salaam: Okay. All right. Bye-bye. Dr. Bob: Thanks for listening, everybody. Najah Salaam: Yes. Dr. Bob: Take care.

  Dr. Karen Wyatt founded the End-of-Life University. Hear how her father's suicide lead her to learn about hospice and a career that focuses on helping educate people about end-of-life care. Contact End of Life University 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. Transcript Dr. Bob: On this episode, I'm speaking with Dr. Karen Wyatt. Dr. Wyatt is a family practice physician who specialized in hospice medicine for many years, and more recently has created the End of Life University, which is an online site that provides education and tools for people to learn about and become more comfortable with approaching end of life and having the most peaceful and dignified end of life possible. She's also an author, has written several books, including What Really Matters, Seven Lessons for Living From the Stories of the Dying. She also wrote a book called the Tao of Death and A Matter of Life and Death. She is a speaker and a great advocate for excellent, compassionate end of life care. During our interview, there were a couple of little connectivity issues, so there's a couple of very brief glitches. I hope it doesn't take away from the valuable content. You'll get some phenomenal insight and inspiration from this interview. Thanks for tuning in. Thank you, Karen, for being on our show today. Dr. Karen Wyatt: Hi, Bob. Thank you so much for having me. Dr. Bob: We had a chance to talk a couple of weeks age when I was interviewed for your podcast, and it was a great conversation. I think we both recognize that we have so much alignment, so many things in common regarding our careers and kind of where our priorities are, where our visions are trying to take us. You probably see this as well. Most of the people who are really passionate about providing great care for people at end of life have a personal experience or a personal story that kind of fuels their drive and their passion for that. I know you have one as well. Can you share a bit about how you became so aware of the importance of providing really phenomenal end of life care and making appropriate preparations? What's your story? Dr. Karen Wyatt: Yes. I'm happy to share that, Bob. It started for me a long time ago, when I was just a young doctor, brand new in medical practice, and I had trained in family medicine, but honestly had no training whatsoever in end of life issues. I hadn't received any ... at all around death and dying, which is shocking really when I look back and think about that. I really didn't have any knowledge or awareness of end of life issues and what was happening in that arena. But at that time I was in my early 30s, and my own father committed suicide, which was a horrific tragedy for me and my entire ... , but particularly devastating to me, because I was a doctor, because I had done extra training in psychiatry, just so that I could treat people with depression, and I had worked with some suicidal patients in my practice. The fact that I couldn't help my own father just completely tore me apart and really caused me to question, "Am I even a good doctor? Should I even be doing medicine?" I floundered for about three years with just overwhelming guilt and grief after my dad's death. One day I got the idea to call hospice, even though at that time I wasn't even really sure what hospice did. I knew so little about it, but this inspiration just popped into my head, "Call hospice." I called and had a chat with them, the hospice in my community, to see if I could volunteer in any way. It turns out their medical director had just resigned 30 minutes before I called, and so she said, "Actually, we have a job for you right now." Knowing almost nothing about hospice, or death and dying, or end of life care, I became a hospice medical director. From that moment on, my training started in really learning about dying. I was trained by the nurses. Our hospice at that time had nurses who had worked there for 10 and 15 years, caring for dying patients. I just followed them everywhere. I sat with them, and I just soaked up all this wisdom, and experience, and knowledge from them, all things that, looking back, I know I should have learned as a doctor. It was embarrassing that, as a doctor, I knew so little, but once I started making home visits to patients in hospice, I realized this is where I'm meant to be. This is the kind of medicine I was meant to do all along. It felt like I was home in a way like I'm doing what I'm supposed to be doing now. It was a huge relief to me professionally to be finally offering the kind of care I wanted to give. I loved the fact that hospice was team-oriented, so I got to work with other people, with nurses, and home health aides, and the social work, and the chaplain, and we would all meet together to provide care as a team. That really fit perfectly with how I thought care should be offered to all patients, not just end of life patients. I spent many years doing hospice full time. I left family practice, did only hospice for a number of years. I just had profound experiences there, and I can say really by just immersing myself in death and dying is the way I found my way through that horrible grief and guilt that I was carrying after my dad's death. Long story, but as it goes, I ended up deciding I wanted to write a book about patients I had cared for. ... It took me many, many years to actually do that, find the time and get the book written, but I finally got that done, and I ended up leaving medicine in order to start writing. That happened eight years ago. Now I haven't been in clinical practice. I've been doing more writing, and speaking, and educating for the past eight years. Dr. Bob: Do you feel like the time you have devoted to A, caring for patients and being a part of that amazing hospice team and the work that you've done as a teacher and a writer, have you eased your conscience? Have you gotten to a place where you're not feeling guilty about what happened at this point? How has that worked? Dr. Karen Wyatt: Yeah. I would say it's much better now ... what I've begun to see over time, and it took a lot of years, is my dad was on his own path. He made his own choice and that really I couldn't have interrupted it. It was his decision, and he was determined to do what he did, and that my life intersected with my dad's life, because I was on my path, and his death is really what shifted me I think to a place I needed to be and a place I needed to go, and that without his death, I probably would never have ended up in hospice, and not that I'm saying that's a justification or the reason why my dad died, but it all fit together in that way and kind of brought me to a place where I needed to be. So, I was able to let go of feeling responsible for my dad, and allow my dad the responsibility for his own choices, and feel like I at least was able to make something beautiful out of the tragedy that happened. Dr. Bob: That experience, it's interesting, because I talk to so many people who go through a death, they go through what's a tragic loss, and ultimately there's something powerful and amazing that comes out of that. I couldn't say that that's ubiquitous, and it happens in every case, but I know a number of people, and myself included, where death has resulted in a transformation of some sort that clearly would not have taken place without the death having occurred. I think about the silver lining of life and death. For myself, the first real, peaceful death that I ever encountered or was part of that experience was my friend, Darren Farwell, who died at 32 back in 2001, and for me that was what planted the seed of wanting to provide this amazing type of care to people, you know, this interdisciplinary, holistic, compassionate type of care, because I got exposed to hospice for the first time. Then additionally, his wife ended up creating a foundation to help ... He died of melanoma, and his wife, Rhonda, created a foundation to help support education about the dangers of the sun and then built a company called UV Skinz that makes UV protective clothing and swimwear, which has grown into a phenomenal company. I see these UV Skinz being worn all over the beaches of San Diego and Hawaii. I talked to so many people over time who have been able to make something remarkable happen as a result of having experienced a death in their life. I'm assuming that you've had similar experiences. Dr. Karen Wyatt: Oh, yes. So many times, through the interviews that I do as well for End of Life University and just people that I've met, in this grief work really, that sometimes as our way of working through grief we take up a project or make a change in our lives. It can be profound, but all of these people, as you're describing, talk the same way, that it was a transformation for them. They really feel like they became the person they were meant to be, who they were meant to be, true path, true calling, once they worked through the grief that they experienced from tragedy. Dr. Bob: Interesting. It's not necessarily the death, the loss, the change that occurs because of that. It's the work that goes into the grief process and sort of the rebuilding of a life after the loss. I'm sure it's all part of it, right? Dr. Karen Wyatt: Yeah. Dr. Bob: But I guess that's probably an important component of it, the work that goes in, and what we learn about ourselves, and the other support that we may get that guides us after that experience. Dr. Karen Wyatt: Yeah. So true. It all fits together, but I think death really awakens us and helps us learn to cherish life and then make the most of it too when it hits us that wait a minute. I won't be here forever. This is limited. I need to make sure that I make the most of every moment that I have. Dr. Bob: I mean, wouldn't it be nice if somebody could have that awareness and gain that awareness without having to go through that experience? I guess maybe that's partly what we're trying to do, right? Dr. Karen Wyatt: Yeah. I've wondered about that, like is it really possible for someone to grasp that? But yes. I think most of the information I disseminate has that purpose behind it, that if only someone hears this, will learn something, will open their eyes a little bit and recognize that natural part of life for everyone, so they need to pay attention to it and be aware of it. Dr. Bob: Yeah. Well, the work that you're doing now, you're very prolific. You're putting out a lot on your website, and you're creating groups. I know you created The Year of Reading Dangerously, a book club to help people get exposed to books that are out there that could give them a new perspective and bring more value. Can you share a little bit about what you've experienced through creating that one program? I know there are others, but I wanted to kind of focus a little bit on that one. Dr. Karen Wyatt: Yes. Well, it's interesting. I got the idea at the end of last year. It would be really cool to do an online reading group or book club, because I had written a blog post about how to start an end of life book club in your community, and I heard back from several people that because of that blog post, they had done a year-long book group, reading books about death and dying. I thought, "But what if I could do it online and have a bigger group [inaudible 00:14:15]?" I had no idea if it would resonate with people if anyone would even be interested and would sign up. I just posted it right around New Year's Day. I posted a little message on Facebook, you know, for my Facebook followers and said, "I'm starting this reading group. You can sign up here if you're interested." That was right before I went to bed one night, and I woke up in the morning, and ... already ... reading group, and within a week I think I had 600 people on the list. That post about the reading group had been shared 57 times, so people were sharing it with other people they knew. Now we have 830 people who signed up for the reading group. We're just reading one book each month during the year of 2018. ... Each month I'm doing a conference call discussion of the book. Most of the authors of the books I've chosen for this year have agreed to come on the call and actually be there for a Q&A session. Dr. Bob: Oh. That's phenomenal. Dr. Karen Wyatt: It's really exciting and really fun. I've been fascinated to see the people who are joining the group. At first, I thought it'll just be all the same people. It'll be all the same people that already do this work who are interested, but I'm getting a lot of people are writing in on the Facebook group, "I know that it's time for me to start looking at death and dying, and I thought this would be a good way to get introduced to it." I'm excited. It was just a fun, little experiment, but it turns out that it does seem to be something people are looking for. Dr. Bob: Well, clearly. I'm part of that group now as well. It seems like there really is a growing sense of desire for people to connect around the topic of death and dying. I started a meetup here in San Diego as well, called Reimagining End of Life Care. The idea is I just want to bring people together from all different walks of life who are interested in talking about, sharing ideas, looking at the issues, trying to bring their own unique perspective and gifts, whether that's a nurse, or a doctor, or a social worker, or an Uber driver, or somebody out in the community. There are 120 people in the first couple of days joined this meetup group, because I think it's just something that's sparking interest. People are getting more comfortable exploring. I think people recognize that if you just allow things to happen by default, there's a good chance that they won't go well. There's more awareness of that. Dr. Karen Wyatt: Yes. Definitely. I think this interest has really grown just in the last three to four years. I don't know if you've experienced that, but it seems like there's momentum now behind it. More and more people are starting to wake up and be at least less afraid of talking about death and dying. They might still be afraid of death itself, but they're less avoidant of the subject now. Dr. Bob: I think that there's growing awareness. There are the death cafes that are popping up. I guess I'm a little bit unsure whether it's just the world that I'm living in, and so I'm much more aware of it, or if it's really happening. I'm going to assume that it's really happening. I'm going to make that decision to choose to believe that it's happening, and we are part of that momentum, and we can help I think, through our experiences and through our desires, try to help to guide people to understand what they can do, what each individual can do to have A, the best possible end of life experience for themselves, to help guide others in their sphere of influence. I think like you clearly believe that the best way to have a good experience or the best chances of having a good experience is to be ready, is to be prepared, is to understand what the potential issues are, what you need to put in place to make sure that you have the best chances of having your end of life go the way that you would want it to go. Dr. Karen Wyatt: Exactly. If you even think about it, would you ever go on a journey to a place you've never been before without preparing for it ahead of time, without reading about it and learning what you need to do in advance before that trip? Getting ready for the end of life, it's really similar. You're just learning as much as you can and preparing yourself, so that you can make choices in the moment when you need to, and that you're ready for whatever might come up on that journey that you're going on. Dr. Bob: You know, I like that analogy. There are people who don't want to plan and are going to take a trip, and they're just going to start driving, right? They may know what their ultimate destination is, or they may not even know what the ultimate destination is, but they're okay with things just kind of happening and rolling with it. There are people who will live their life that way, and not plan, and not prepare, and take their chances. That's okay. That's your choice. The problem though with that is that if that's the way you choose to proceed, somebody may end up taking the flack for that, right? Your loved ones, your family members, somebody's may end up having to make choices that they're not prepared for and have to deal with kind of the fallout, which we see all the time, right? Dr. Karen Wyatt: Yeah. So true. Yes. Exactly. The loved ones might be left with terrible grief, and guilt, and a burden of having to make decisions, and that's something we all need to remember. How do we want our loved ones ...? How do we want to leave them when we do go? Dr. Bob: Sometimes people, they need a little bit more incentive than just doing it for themselves. We all know that it's important to plan and to create advanced healthcare, or we should all know that it's important to have advanced healthcare directed, to have a will, to have these things set up, so that your loved ones won't have to try to figure it out in the heat of things, but I think one way to help to inspire, encourage, incentivize people is make sure that they understand that they'll be gone or they'll be unconscious, but it's the people they care about who are going to potentially carry this burden and potentially carry guilt around with them and regret for the rest of their lives. Do it for them. If you're not going to take care of your documents, and your paperwork, and put things in place for yourself, do it for your children. Do it for your siblings. I think it's a really important message for us to share. Dr. Karen Wyatt: Absolutely. I do know many people who say, "I don't care that much what happens to me, so why should I plan." Your message is perfect, because you do care about what happens to your loved ones, and you want them to have as much peace of mind as possible. Dr. Bob: You've put a lot of things in place, and I really encourage everyone who's listening to go to Karen's website, because there's just a wealth of information, resources, and tools that are out there that can help people move forward with this kind of planning. Can you share a little bit about how that's all kind of come together? Dr. Karen Wyatt: Yes. I started End of Life University actually after I wrote the book, the book I mentioned of stories about hospice patients, and it came out six years ago. I decided I have to do something more than just putting a book out there in the world. That's when I started doing interviews for End of Life University with people who work in all aspects of the end of life arena. I do two interviews every month on End of Life University, and your interview is upcoming in March, the one I did with you. Then I repurpose some of those interviews and have a podcast on iTunes, just like your podcast, that comes out weekly, but I keep getting more and more ideas. I start something good [inaudible 00:23:32] new idea, like, "Oh, wait. That's not enough. I need to do something more." Besides the interviews, I created ... for end of life planning, called The Step-By-Step Roadmap to Planning for the End-of-Life. So, it's just a little course, a self-directed course that walks people through the steps they need to take in order to get their paperwork done, and I'm working on other courses right now, courses to train people to become death educators in their community, to go out and start workshops, to become an educator in their own community for their neighbors and friends. Dr. Bob: So, spreading it out, right? I mean, there's so much need, and there's so much work to be done. Obviously, it's going to take a tribe, a village, and so like me, you're bringing together a tribe of people who want to make sure that the experience at end of life is as dignified and peaceful as possible. It starts so far upstream. When we think about end of life and having a peaceful end of life, you think about those last few days or weeks, but it really is so important to be working with people either before they're diagnosed with a serious illness or at the time of diagnosis. We can't wait until just those last few days of life to put in place the things that are going to allow for a peaceful and dignified transition. Dr. Karen Wyatt: Yes. That's so true. Dr. Bob: We have to have a different conversation about continuing or discontinuing treatments. I'm sure you've experienced this as well. The medical community is so reluctant or unable to dive into those deep conversations with people about the potential impact of some of the treatments or the other options that are available. I hear it all the time from patients, you know, "My doctor would never talk about that. They wouldn't go down that path with me. They only gave me this one option." I just heard from somebody yesterday who was seeing an oncologist for esophageal cancer, and when she told the oncologist that she didn't want to do yet another course of chemotherapy because the tumor was still growing ... She'd had very toxic side effects from it, and she just wanted to try to have the last few months of her life not feeling sick all the time, knowing that at some point the cancer would progress, and she would be very compromised, but she wanted this window of time. Her doctor basically told her not to come back, "There's nothing more that I can do. If you're not going to take my advice and go with my recommendations, then here's a number for hospice," which is so wrong. Dr. Karen Wyatt: Wow. Oh. Absolutely. It's heartbreaking because a patient who's been working with a doctor for sometimes year in treatment and then suddenly the doctor abandons that patient and says, "I don't want to see you again," it's tragic. Now ... doctor, who now is not going to be exposed to the actual end of life process for his patients. He's refusing to even deal with that portion of her life as it plays out, and it's really sad for that doctor, who won't get the advantage of seeing what's possible for a patient. That just breaks my heart. Dr. Bob: It did for mine as well. I hear stories like that not infrequently. In this particular patient, she wanted to access a prescription through medical aid in dying, not that she's ready to end her life, but she knows what the ultimate course of metastatic esophageal cancer is, and it's not pretty, so she wants to be prepared, have that option. She asked her oncologist if he was in support if he could help her or even guide her, and his response was, "I don't do that. Here's a number for hospice," which again, I don't want to label all ... I don't want to generalize, but I do feel that the medical community is doing a disservice to people by not recognizing that this period of time between aggressive treatment and death, it could be so much better supported, and there's so much more that can be done, but they don't understand it. Dr. Karen Wyatt: Yes. I would say one of my goals ultimately is to work with my colleagues in medicine and help [inaudible 00:29:02] and open their eyes to death and dying, but I realize that may not happen until we kind of galvanize their patients. We need to ... . At the grassroots level, we need patients going to their doctors saying, "You have to talk to me about and deal with me about this." I was really thrilled a few weeks ago. I got an email from a woman who had been listening to my podcast, and she and her husband are both in their 70s. She said, "We listened to your podcast about how patients need to bring up the topic with their doctors." She said, "We brought in our  ... will, and we sat with our doctor and said, 'We want to go over this with you.'" She said, "His eyes got huge, and he backed toward the door and was saying, 'No. No. No. We don't need to talk about this.'" They insisted, so he sat down with them. He answered their questions. They went through their living wills together. In the end, he seemed grateful. He thanked them and said, "I'm glad that you brought this up." I was so thrilled. It actually does work. If patients will have the courage to insist that their doctors talk with them, I think the doctors will ultimately say, "Okay. I'll look at this with you." Dr. Bob: We might not get every one of them, but I think that's one certain definite strategy. Like you said, that physician was grateful. That very well may have shifted his practice, right? That one encounter, that one experience he might have recognized, "Wow. This is really meaningful, and this is important stuff, and it's not hard." Right? It's not all that difficult. It just takes a little bit of time. Dr. Karen Wyatt: Yeah. If you haven't been introduced to it or trained to have the conversation, it feels much more intimidating, and it is in your mind, than it really is once you start talking about it. I think that becomes an obstacle to physicians to bring up the subject, but once they've done it, they can realize, oh, it actually feels comfortable, and it actually it's kind of a relief, once we get these issues out in the open and discuss it together. Dr. Bob: Well, Karen, I think you and I have a lot of good work to do, both individually and together. I think, as we've been talking about, there are some great opportunities to bring our tribes together, and continue moving the needle in the right direction, and trying to give as many people as possible the tools that they need, the inspiration they need to put in place what they can to ensure that as their life is coming to a close, as they're dealing with these health challenges, that their values and their wishes are honored. I'm really happy to be in partnership with you on that. Dr. Karen Wyatt: Same here. Same here. It's good to join forces. Dr. Bob: Yeah. You got a lot of, as we mentioned, a lot of great material and resources, so how do people tap into that? What's the best way for people to access what you've put together? Dr. Karen Wyatt: They can go to EOLUniversity.com. That's my website, EOL standing for end of life, but EOLUniversity.com. There they can connect to the podcast and blogs I've written. They can learn about upcoming interviews, find my books and courses, so I need to update that a little bit, but they should be able to find everything at EOLUniversity.com. Dr. Bob: Yeah. Well, you've done a phenomenal job. When you go to her website, don't be overwhelmed. There's a lot of information, but just take it a bit at a time. Dive in. If you're interested in, I guess in just dipping your toes in the water of this, then maybe sign up for the Year of Reading Dangerously Book Club and start with one or two of those books. We will, I'm sure, have more time, opportunities to connect and collaborate. Again, I appreciate you taking the time. I love our conversations because it's just sort of like talking to myself, but with somebody smarter. Dr. Karen Wyatt: Yeah. It's wonderful. It's wonderful for me too, Bob, to be speaking to somebody like-minded, so thanks so much for this opportunity. Dr. Bob: Yeah. Thank you for taking the time. Thank you, listeners, for tuning in. Until next time, have a wonderful day, and give your loved ones a big hug and a kiss. Take care.

Nurse Jen Durrant of Integrated MD Care shares her views on dying and why she believes it should be more accepted in society.     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. Dr. Bob: Welcome to another episode of A Life and Death Conversation. Today, I'm going to introduce you to a very dear friend of mine, and a colleague, member of the Integrated MD Care Team, who I'm very excited to introduce to you and let you get to know her a bit because she is a remarkable human being. She is a remarkable nurse, and she is a true, gentle, compassionate, and healing spirit. I know I built her up quite a bit, and she's embarrassed, but that's too bad. Jen Durrant, please say hello to our listeners. Jen Durrant: Hello, listeners. Thank you for embarrassing me, Dr. Bob. Dr. Bob: That is one of my skills, so Jen is a nurse. She is the Director of Nursing for Integrated MD Care, my comprehensive, in-home practice for people with complex and terminal illnesses, and Jen is someone who I can truly say understands what it takes to truly care for people, and she has a wealth of knowledge, and wisdom, and has just been a joy to work with. Jen joined us in our practice just a few months ago, but I've known her for several years. Jen, do you remember when we first met, because I do, and if you don't, that's okay. Jen Durrant: You remember it better than I do. Dr. Bob: I do remember it better than you do, so I remember a few years ago, I was working as a physician with a hospice company. I was doing palliative care and hospice, and I was called out to see a patient because the family was having a lot of struggle with what was going on. The mom was dying, and the family was having a hard time giving up hope of her getting better, and they wanted her to have more treatment, and it was clear to everybody around that she was not in a position to benefit from treatment, and she really, truly was in her last if not hours, then days of life. I came in to try to just be a support, and help guide the family a bit, but I didn't have to do any of that, because when I came in, I saw Jennifer, who with the hospice admissioners, working with this family, and what I saw was a person who was so gentle in her approach, sensitive to what the family was going through, but firm in her conviction that the patient really needed the support of this hospice team, and should not be subjected to any more aggressive types of treatments. I'm not sure. You may not remember that exact moment, but I'm sure that's a familiar scenario in your work in hospice over the years. Jen Durrant: Yes. Especially being a hospice admissions nurse, I was usually the first contact. Sometimes even the physicians hadn't had that discussion with the family yet, so I was used to stepping into those situations, and supporting the family, and helping them see what was really happening with their loved ones. Dr. Bob: Yeah, and I just remember being really impressed. I had not met her before, and I hadn't actually been involved in hospice all that long, so I was learning as well, and I remember thinking, this gal knows what she's doing, and she's doing it really, really well. At some point in the future, if I ever had my own practice, I'd be looking for someone like her to join me. Fast forward a few years, and I was no longer working with that company, and Jen was no longer working with that company, and I was looking for a nurse to join the practice. I heard through the grapevine that she was in transition, and looking for a new home, and I reached out, and it was ... I wouldn't say it was love at first sight, but it was a match, and it's been a great experience, and I think that we have a lot of great opportunities to work together ahead. I hope you feel the same way. Jen Durrant: I do feel the same way, except for me, it was love at first sight. Dr. Bob: I want to ask a little bit, so we've gotten through that. I've told everyone how wonderful you are, and as you know, I share that pretty freely, because I do think you're wonderful. I want to ask, how did you get to the place of being so comfortable in that position, stepping into situations that are so emotionally charged, and everybody kind of coming at you in many cases, needing answers, needing the solutions. How did you come to be comfortable in that role? Jen Durrant: I think it started when worked in pediatric hospice, as a nurse in pediatric oncology, as a nurse assistant, and many times the patients got better and went home, and we got pictures from their high school dances. Sometimes they didn't, and we were there as the kids were declining, and they were getting sicker, and the family ... They're not usually prepared to lose their child. The parents are supposed to go first, and I just found that I had a knack for holding space for them, and mostly what they needed was someone to listen to them, and you didn't have to solve all their problems. They just wanted to be heard, and from then on, I knew that I wanted to work on end of life, and so after nine years of being a nurse assistant, was finally just take that part out. After nine years of being a nurse assistant, I finally decided to go to nursing school, so I could more fully support people in that phase of their lives. Dr. Bob: When you went to nursing school, did you know at that point you wanted to work at end of life work in hospice? Jen Durrant: I had no idea hospice or palliative care even existed, and so once I learned about that, I knew that was exactly what I wanted to do. Dr. Bob: Yeah. Jen Durrant: Yeah. Dr. Bob: It's a good thing. One of the things that I've noticed about you, and it's commented on by patients and families, is your calm presence. You don't get excited. You don't get worked up. You just, you're a very calming supportive presence, and you do. You listen, you hold that space, and yet you also are firm, and provide the right guidance, so people feel very confident in your presence, so I appreciate that. Jen Durrant: My pleasure. Dr. Bob: Yeah. I could tell. We're going to get that piece out, too. I know I asked you to prepare a few things in preparation for our podcast, and because this is a conversation about life in death, I want to ask you first, what are the things in your life that you treasure most? What is most important to you in life? Jen Durrant: That's easy. That's my family. My son, my spouse, my extended family, my friends I consider family, they're all most important to me. Dr. Bob: Yeah. I get that. What do you think about death? What's your ... Just kind of from a high view, what ... When you think about death, what comes up for you? You're around a lot of death. You see people die. You're in the presence of people dying, and you're not a stranger to death, so what's your feeling about it? Jen Durrant: It's a natural part of life, and just so much as birth is a natural part of life, so is death, and I'm very comfortable residing with people that are dying, with the families that are supporting the people, their loved ones that are dying. I don't feel afraid of death, for the most part, I should say, but I feel it should become more normal, normalized process, and less clinical, not a clinical experience. Dr. Bob: Mm-hmm (affirmative), less of a medical phenomenon, and just more of a normal part of life. Jen Durrant: Right. Dr. Bob: Like it used to be. Jen Durrant: Mm-hmm (affirmative). Dr. Bob: Yeah, and I think we're trying to move the needle more in that direction, and I think part of our goal of our practice is to help people get to the place where when death is inevitable, that they're no longer struggling against it, or fearing it, but it's becoming ... It's just; this is the part of life that we all share, right? We share two things. We're all born, and we all die. There's very little else that we can all say absolutely we will share in this life. I think your comfort with that is a really important part of how you're able to provide comfort to others in that space. Yeah, but we're not always ... I think one of the things that I want to also talk about is the life part, because our practice, while we are really good at helping people die peacefully, we're also really good at helping people feel better, and experience some more, a greater sense of joy, and peace, while they're still living. Can you talk a little bit about how you see your role in that? Jen Durrant: Yes. I think being around people that are passing away and their families is actually really life-affirming for me, and I take that to our patients, and to our families, and I feel I'm able to encourage them to say yes to life and try things they may not have considered before. Dr. Bob: What are some of the things that you have encouraged patients and families to try to enhance the quality of their life, that they may not have been open to, or thought about? What are some of those things that you're really excited about being able to bring to them? Jen Durrant: Working with you has broadened my horizons, and being part of the practice, so really encouraging them to try the alternative therapies that we offer, and the practitioners we team up with. I think a lot of people get stuck on just the medical solution to the problem. They want a pill to take their symptoms away, and so we really explore what does acupuncture look like? What does cannabis therapy look like, or massage, music therapy, being able to talk with a social worker, and pain, for example, going at it from all angles. Yes, we'll medicate to make sure you're comfortable, but let's try some acupuncture. Let's try massage, or maybe it's a spiritual pain or existential pain that they really just need to be heard and have someone to talk to, so I feel we take a more broad approach, and it's really nice to be able to open their minds to alternative therapies, instead of just medication. Dr. Bob: Yup. I completely agree with that, as you know. You've been in the traditional hospice world, and now you're working in this world, which is a private model that doesn't have the same constraints. What's it like to be practicing here? How do you ... I guess from the perspective of a nurse practicing in this realm, and what do you think it's like from the perspective of a patient to have, to be part of our practice versus a traditional hospice model? Jen Durrant: As a nurse, it's really freeing. I felt very constrained by the hospice model. Most of the time I felt I was providing 10% of my time towards patient care, and supporting the family, and the other 90% of the time sitting at my computer charting to Medicare guidelines, and everyone needs to fit into the hospice box. Whereas here, there are no boxes, and we're really thinking outside the box to support the patient and family in ways that weren't possible when I was working with hospice. I've been learning a lot, and learning how to support patients and families in ways that don't just include medications, or offering a visit from a chaplain, but really being able to be with them, become part of the family, and support not just the patient and the family, and the caregivers, and I think from the patient's point of view, they're really just getting a lot of extra support, and love, and involvement that they don't get anywhere else. Dr. Bob: Yeah. That's what I see. One of the things that I recognize with our practice is, there's something unspoken. It's hard when you talk about what it is that we provide that's different, the knowledge that the patients and families have that there's somebody available to talk to at any time of the day or night, and it's not going to be a bother. They're not going to get a runaround. They're going to speak to someone who knows them and cares about them, and who they've developed a trust with. I think that that is ... There's no substitute for that, and it immediately, from the moment they realize they have that, it immediately reduces their stress level, and their anxiety, and I think that allows people to sleep better, to feel better, to eat better, and I didn't quite get how important that was, how vital that was, until enough people had told me that, I just feel so much more relaxed, and know that I can call Jenna for anytime, day or night. Whether it's two in the morning. Jen Durrant: That's right. Dr. Bob: Do you have any particular experiences with dying people, or in death that were really especially impactful or meaningful, that came up? Was that one of the questions that you explored? Jen Durrant: Yes, there are so many. I'll share a couple. One, I was with a patient with his wife in the hospital. I went to do a hospice evaluation, to see if they were appropriate to start service and get them started. When I got there, the patient was already passing away, and I told the family, "We won't have time to get him home. If we try, he may pass away in transport," and they were not comfortable with that, and I could have pushed through with the admission, and made them do a bunch of paperwork, and answer a bunch of questions, but I decided not to, and I just stayed for an hour, and provided support, and guidance, even though they weren't officially under our care. Just to see that peace come over the patient and the family, just because they had a supportive presence there, was really powerful. They felt like they were floundering in the hospital and the system, and just having someone to support brought them peace, and I was there as he passed away. I didn't provide any sort of medical care, because they weren't our patient, but just to be there and watch him transition peacefully really meant a lot to me, and it meant a lot to the family. I've attended a couple more difficult deaths, where the patient's suffering, the family's suffering even more so because it's hard to see their loved one having difficulty, and sometimes I didn't have all the tools I needed to ease symptoms, as far as medications with hospice, and it was really just being able to support the family through that hard transition. I believe as a patient's passing away, even though they may have symptoms, they may have trouble breathing, or make strange sounds when they're breathing, I believe the patient isn't conscious at that point, and perhaps their soul's already floating above their body, and that they're not experiencing that discomfort. I know everyone else may not believe that, but because I believe that they're not really experiencing that, I can help support the family and say, tell them they're not conscious. They're most likely not feeling this pain. They'll be okay. It brings them a lot of comfort just knowing even though they look like they're suffering, there's a calm presence telling them, and supporting them through the process that it'll be okay. I'm here for you. What can I do to help you feel better? It's really an honor to just be there, to guide them, and support them, and ... Dr. Bob: I am sure that it is incredibly impactful, and it changes that experience for them, right, an experience that they could be completely out of control, and terrifying, that they would potentially feel guilty about for the rest of their life, maybe decades. You change that. You couldn't necessarily say the person who was dying, that wasn't the role you were playing, but just to be there, to make sure that they had a better sense of what was happening in a calmness. When they look back at that experience, it will be very different than it would've been otherwise, so I'm sure that ... I know the feeling of the power of knowing that you saved people from having potential years of angst, and regret. That's really phenomenal. Jen Durrant: That's my hope. Dr. Bob: That's our hope. That's what we're doing. Yeah, we're here to support the patients, and comfort them, and guide them, but that's just a piece of it, and those patients will die, and they're gone, living on in the memories of their loved ones, but the memories of their loved ones, and the way that the loved ones then go on in the world, is really part of our work, too. Jen Durrant: Right. Dr. Bob: That's really meaningful, and you get that, which is why you're part of the team, so, and thank you for that. Jen Durrant: Thank you. Dr. Bob: Yeah. What do you think happens after we die? Do you have any direct knowledge of that, or are you ... Can you speak from a factual place, or can you only speak from what you believe? Jen Durrant: Both. Dr. Bob: Really. Jen Durrant: Yes. Dr. Bob: Okay, well, share. Jen Durrant: [inaudible 00:22:47] I've been with a lot of dying patients, and in the process of dying, they will reach out to people only they can see. They will have conversations with people only they can see. I had a really strong experience when I worked in pediatric oncology. There was a patient there. He was 21, and he was only in the pediatric ward because he had relapsed multiple times, and so he came back to the children's hospital to continue treatment. He was about six-four, tall, African American kid, and so he took it upon himself to make friends with all the little ones, or with the new patients, and help them feel supported, and like they had a friend that would understand what they're going through. There was a little boy who was five, and they just bonded. They were both terminal at that point, and that patient would spend hours with this little boy, just talking with him, and telling him not to be afraid. He said, "When you pass," it's making me emotional, "When you pass, I'll be there waiting for you. I'm going to go first, so you don't have to be afraid." The patient passed, let's say, on a Wednesday, and the little boy passed the very next day, at exactly the same time, and before he took his last breath, he looked up, and smiled, and put his hands up in the air. To me, that's a fact, that there is an afterlife, and there are people that are watching out for us. Dr. Bob: And waiting for us. Jen Durrant: Mm-hmm (affirmative). Dr. Bob: That's beautiful. Jen Durrant: It is. Dr. Bob: Thank you for sharing that. I'm sure that ... I think that that will be comfortable for many people, so that's ... Based on that, and other experiences and just your life evolving, you're confident and comfortable with that? I guess confident may be a stretch, but you feel pretty comfortable that when we die, there are people wait ... You'll see your loved ones and people waiting for us? Jen Durrant: I do. I've seen it too many times to be able to say there's anything else different. Dr. Bob: Yeah. I'm in complete and full agreement with that, so have you ever had any messengers, or messages directly that you feel were from loved ones, people who have died? Jen Durrant: I do, more so in my dreams. There was a patient when I was a brand-new hospice nurse. I was really close with her, and her family. She had a young daughter about my age with a son about my age, and the daughter was doing all she could to care for her mom, who was very near death, and so I was highly involved in their care, trying to support the patient, and support the daughter as much as I could, probably doing things out of the scope of my practice, but I was okay with that. The night before my patient passed, I had a dream about her, and in my dream, she was up and walking, but she was trying to take her clothes off, and telling me that her clothes don't fit anymore, and it's time for her to take them off, and find something else. When I woke up, I knew that she would pass away that day, and she did. Dr. Bob: She took off her clothes. Jen Durrant: Yeah. She was ready to go, go out the way she came in. Dr. Bob: Yeah, I've had ... I think I've shared before stories of maybe, not in this form, but my strong connection with dragonflies, who have come to visit me after loved ones have died, and there's just no question in my mind that those are messengers just coming to comfort, and let me know that I'm being watched and loved, and I'm always ... When I'm with people whose loved ones are dying, and we have the honor of being able to talk to people who know they're dying, and will be dying soon, and engage in discussions with them and their loved ones, and so I'm always asking them to have a conversation about how they will communicate, as long as they're open to it. I try not to force, push my belief system on others, but if they're open, then I try to have them make that sort of agreement, and I think that ends up being very comforting for people. Jen Durrant: My wife's grandma was murdered. We don't need to get into the details of that, but when her house was being cleared out, they found jars, and jars, and jars of buttons, and she would save the buttons in case someone needed one for their shirt, or whatever they needed it for. Her sister took some of the buttons and made necklaces for the family, and to this day, we will find buttons in places there should not be buttons. One day we were at the beach, and it was a particularly hard day for my wife because it was the anniversary of her grandma's passing, and on the sand, at the beach, there were about 20 buttons, different shapes, colors, and sizes, and that brought a lot of comfort to my wife, and of course we collected them, and took them home with us. Dr. Bob: Of course you did. Anything else that you ... Any other really important or unimportant thoughts that you'd like to share with folks? Jen Durrant: I think these podcasts are important, and it's important to continue the conversations about death and dying, and living, and getting to a point where we talk about death as comfortably as we do about birth. Dr. Bob: I appreciate that, and I know you're part of that movement, and will continue to be, and will continue to bring immense comfort to many people throughout your life, so thank you for being you, thank you for being part of our tribe, and thank you for joining me on the podcast today. Jen Durrant: You're welcome. Thank you for having me.