A Life and Death Conversation, Dr. Bob Uslander Ep. 1

In this podcast, we talk about life, death and everything in between. We’ll explore how to age more gracefully, have meaningful conversations, and what you can do now to ensure the best possible end-of-life experience for yourself and your loved ones. Let’s become friendlier with death.

Transcript

Dr.Bob Uslander: Just me. I will be having guests and bring a number of fascinating, interested, and dedicated people onto this show to share their wisdom and expertise. I thought I would take this first show as an opportunity to introduce myself and give you a bit more of an understanding of why I feel this topic and this conversation is so vitally important.

Every day in the course of my work, I have life and death conversations. I talk with people about how to make their life better, more comfortable, more supported and, frankly, more enjoyable. I also talk with people about how to make their death better. When people are no longer able to find comfort, or joy, or meaning in their lives because they’re old or they’re sick, the only thing that they really look forward to at that point is their death and it’s amazing to me when somebody is willing to sit with them and talk about that in a comfortable way, in a way that doesn’t make them feel judged or make them feel afraid. They open up. They are so grateful to have that kind of honest conversation and connection.

I’ve been a physician now for close to 30 years and I’ve had so many conversations. Initially, I was very uncomfortable with the whole concept of death.  When I first finished medical school and began my training and then my work as an ER physician,  I had a lot of encounters with death. But, for the beginning of the early part of my career, death was always the enemy. When somebody died, it was a failure and we tried to avoid that at all costs. As I’ve gotten older, hopefully, a little wiser, and I’ve had more experiences, personal experiences, as well as experiences in my career, I’ve come to understand the concept of death and how death fits in a much deeper way. I no longer feel that it’s the enemy. I actually feel a close kinship, a friendship with death. That’s what I want this conversation to do for others, to help you and everybody learn how to feel like death is not your enemy but your friend.

This is delicate stuff. I get that. It’s very important stuff. I believe that as a society we need to become more comfortable with the concept of death. We need to understand how our idea of death influences our life day-to-day because death is as much a part of life as birth. They’re two sides of the same coin.

We have no trouble talking about birth. Will it be a natural birth or will it happen in the hospital? Will it be quick? Will it go on for hours or days? Who will be in the delivery room? It’s a very natural thing for people to excitedly discuss all the details of the birth of a child. We even have parties to celebrate the upcoming birth and that’s great. I think that’s the way it should be, but only a small number of people seem comfortable talking about death whether we’re discussing our own death or the death of someone else. Most people do anything they can to avoid that conversation or they quickly change the subject when in a conversation.

This avoidance of talking about death leads to an amazing, incredible amount of unnecessary struggle. It leads to anxiety. It leads to regret. It leads to guilt that can last a lifetime for a person who experiences the death of a loved one or a friend. I want to repeat that because really that’s the reason I’m having this conversation. Refusing to talk about death leads to an enormous amount of anxiety, struggle, regret, and guilt. Most of that is completely avoidable.

I believe the reason that I’ve been so successful in my new medical practice, which is in large part helping people to have a more dignified and peaceful end of life, is because I’m willing to talk about this. I’m willing to talk about death in a way that most physicians aren’t. Unfortunately, most doctors are as uncomfortable and maybe even more uncomfortable talking about death than their patients. This really compounds the problem. One of my goals is to help you help everyone feel more comfortable talking about death because I’m convinced that’s how we can achieve a better life.

I want you to be more comfortable so that you can figure out how to make sure that you or someone that you care about has the most comfortable and struggle-free death whenever that happens. I want you to have the tools you need so if you’re supporting a loved one through the end of their life or you’re approaching the end of your life, you don’t end up having regret. If you are supporting a loved one, I don’t want you to have regret and guilt about what you did or didn’t do during that time. When you’re right in the middle of that storm, that’s not the time to be preparing. The time to do that is now while you have the opportunity.

Here’s what we need to agree on. It’s going to happen. You’re going to die. I’m going to die. The people you love are going to die. Our pets are going to die. Try as we might, there is nothing that can change that. Every living creature that comes into existence will die someday, from the insect that lives less than 24 hours to the tallest and mightiest redwood tree that lives for centuries. Everything has its time and then it dies and you’re no different. I’m no different. Your parents are no different. Even your children are no different.

The goal should not be to try and ignore or defy that principle, that fact of life. The goal should be to recognize and even to embrace the magnificence of this master plan or the random nature of things, whichever way you believe. But the goal is to live a life of meaning and joy and to feel gratitude for whatever time we have to share in this adventure that we call life.

There are two choices. You have two choices. You can refuse to think about death, refuse to plan for it, even live in fear of it or you can find a way to become friends with death, to embrace it, to prepare for it and to allow the awareness and acceptance of death to inspire you to live with more inspiration and even to comfort you. Again, death isn’t the enemy. What I believe is the enemy is a life without joy, without a sense of control and without hope that things will get better.

I’d like to share how I view or feel about death. I don’t know exactly how I came to this awareness but it’s been helpful for me and comforting for me and perhaps it can be that for you as well. I see death like the same way that I feel about an old friend, a friend who I knew when I was very, very young, maybe four, five years old. I have these friendships from my earliest years that were very dear and I look back at those relationships with a lot of fondness. I feel there was a deep connection that was based on sharing joy. There was very little else.

I know that I haven’t seen this person, this friend, for many, many years and I may not see that friend for many, many more years. But, I believe that someday in the future I will again. We will reunite. When we do, we’ll have this immediate sense of connection, recognition, love, and comfort, and the time that has gone by, the decades that have gone by will be meaningless. We know each other in a way that transcends the knowledge of what happened day-to-day in your life. Those things don’t matter. They’re just the details.

I have this sense that death is like this old friend who’s not thinking about me all the time, not necessarily looking forward to anything in particular. But one day we will meet again and we will know each other deeply. That’s how I feel about death because before I was born, I was in a void and I was in the same space where I will be again after I die. There’s a familiarity. We’ve been there already. We have nothing to fear.

Interestingly, my first exposure to death was pretty traumatic. I look back now and I think about that first real experience with the death of another person and that happened in my third year of medical school. I’ll share that story because I think it’s fairly poignant. Up until that time, the only person I had known who had died was my grandfather and an old aunt. I wasn’t there when they died, and as a child, it impacted me, but I was somewhat removed from it. On the very first day of my third year of medical school, that’s when we start doing our clinical rotations and I was on the internal medicine rotation in that very first day. The first two years we spend mostly in classrooms and auditoriums doing lectures and going into labs and dissecting cadavers and learning about germs and medications. We’d have a little bit of contact with patients just by practicing, taking histories and doing physicals but we really didn’t take care of anybody.

That very first day after a long day of working on the medical ward, I was on call and it was my very first night being in the hospital and I was very excited, a little anxious. I didn’t know what to expect. I was very excited. After dinner, I went to my call room and I cracked open my textbook. Then I got called to do a few things, draw some blood, go and manage a couple of minor things. About midnight, I was ready to turn in and try to get some rest.

All of a sudden, I’ve heard the alarm, the code blue alarm goes off. I heard that there was a code blue in the ICU. My call room was immediately across the hall from the ICU so I jumped up and I ran across the hall and I ran into the ICU and I saw a whole bunch of activity in this one bay. I walked into it and I saw a group of nurses scurrying around frantically and on a gurney on the middle of the room was a man who looked like he was in his 40s. He was a young man. He wasn’t an old man. He was young and they were trying to administer medications and trying to figure out what do. I realized there were no doctors in the room. There was nobody actually giving orders or directing the nurses. They looked at me like I was supposed to be the one doing that and I had no clue. I panicked. They saw that. They realized that.

One of the nurses said, “Why don’t you do chest compressions?” I came over to the side of the bed and I got on a little stool and I started doing chest compressions, CPR. That was what I focused on. I didn’t know what else to do. I was pushing, pouncing, trying to keep the blood circulating by compressing the heart, and this went on for several minutes, and then I realized that somebody else had come into the room who was taking charge. It was a resident and they were letting the nurses know what medications to give and what to do. Eventually, they shocked the heart and they got a heart rhythm back. That had taken several minutes, hard to know time-wise because everything seemed to happen very slowly in those moments. But it was probably about five minutes. During that time I was literally inches away from this man’s face and I was watching and looking for some sign of life and feeling a sense of hopelessness and a sense of dread because this was a man who was in his 40s and he was dying or he was dead.

They got a heart rhythm back and everyone stood back and the resident, the doctor … All the doctors have come in by that time and they put their heads together. Everyone trickled out of the room except one of the nurses and me. I think the doctor went off to find the man’s family and have the conversation with them about what had happened. I had a little conversation with the nurse and I learned that this man’s name was Paul and he was 47 and he’d been in the hospital for pneumonia. He had three young children or teenagers and young children and a wife. I ended up getting his chart and looking through it and learning more about him, and I realized I was right in the middle of it. I was right in the middle of everything. It was intense.

A short while later, his heart stopped again. He coded again and the same routine happened over and over. I went up there and I started doing CPR. By that time, I was feeling cramps in my arms. I was sweating. I felt ribs cracking under my hands as I did chest compressions. I realized— even being just a third-year medical student and not having much experience— I realized that this man was not going to survive but we were trying everything possible to bring him back to life. He’d gone so long without getting oxygen to his brain that, even if his heart was to come back and start beating again and he went on, it was clear that he would have suffered severe brain damage. Yet everyone continued trying to bring him back to life and partially succeeded. He actually regained his heartbeat again and the same process repeated four times over the several hours during that night. Eventually, his heart stopped for the final time and didn’t start again and his wife came in and his teenage daughter came in. I watched as they said goodbye in tears.

The whole episode was so intense, somewhat surreal but it felt like we lost. Death won. We lost. Everybody else lost. At that point, I bought into this whole notion that death is the enemy and we failed. We failed Paul. We failed his family. That was really the beginning of my clinical medical career and I ended up finishing medical school and going into a residency in emergency medicine where death continued to be the enemy and we fought against it.

About 10 years into my medical career, I had an experience that changed everything for me and was really the beginning of a new way of seeing life and death and a new way of practicing medicine. That was in 2001 when my who was 32 died from melanoma. He was an athlete. He was a fun-loving, adventurous human being, creative. He was a photographer. He had three young sons. They were five, three and one, Ethan, Seth, and Caleb, and had a wife named [Ronda 00:20:14] who was also a friend. Darren’s melanoma began to progress and he became sicker and weaker and I became his doctor because he hadn’t had a doctor because he was previously just a healthy young guy. As he declined further and needed more support, we brought in the hospice team in this community. This is in a small town in the Sierra Foothills.

When the hospice team came in, the nurse, the social worker, the aides, I saw something I had never seen before. I saw a way of caring for human beings that were so different. It was focused on love, compassion. It was sensitive to his needs, to the family’s needs. I became part of this very sacred journey. Eventually, Darren died. I was with him, sitting with him in his room in the company of his wife and some very close friends and family. As tragic as it was, it was incredibly peaceful and beautiful. That was September 14, 2001, three days after 9/11. I will never forget that feeling and that experience planted a seed within me that has allowed me to grow as a human being and as a physician. It was really the beginning of an entirely new chapter of my life and it drove me to do the kind of work that I do now which is focused on allowing people to have that kind of experience that Darren had.

I thank you, Darren, for allowing me in and Ronda. I believe that I’ll have Ronda on the show at some point in the future to talk a bit about that experience and to share what came out of that for her because she’s created an amazing life, partially inspired by Darren.  And her children live on;  they’re all young adults now. I share that because it was an incredibly meaningful time for me and it was something that truly impacted my life going forward in every possible way.

I continued practicing emergency medicine for many years after that but I started doing things differently. Eventually, I ended up creating my own medical practice, Integrated MD Care, which is predominantly focused on helping people have the most peaceful, dignified end of life possible. I will be bringing on guests in the future who work with me in this capacity. I will be speaking with people in many walks of life who are involved in some way with improving the quality of life, the fabric of life for others and who are fellow travelers on this journey of helping to get the conversation about life and death raised to a higher level.

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