Welcome!

In this episode we dig deep into several topics, so many I had to create a Part 2!

Yes the first line is real regarding my dogs fighting right before I hit record, it's reality so I kept it. Anyway here is a sampling of topics:

• Background story for Rene
• Aging parents who are divorced and living very different lives
• Her late grandmothers fear of dying
• Professional women and caregiving

Caveats:

• This is a judgement free zone
• There are no "shoulds" allowed, we live in curiosity
• Take what works well for you, leave the rest!

If you are finding value in this podcast, please share and leave a review so others can find it too!

If you would like to dig deeper - check out my upcoming course and join the waitlist.

Rebecca

Disclaimer: The information presented on this podcast is solely for information purposes. We do not provide medical, legal, financial, or other professional advice through this podcast and we are not responsible for any errors or omissions. It is your responsibility to seek advice from a licensed professional. Any actions you take are done at your own risk.

All right, then we'll be growling at each other.

I'll growl back.

Uh, welcome everybody.

So I have a very, very close friend of mine here.

Um, Renee has been really nice to come and share some of her stories.

Uh, we've been known each other.

How long?

7, 17, 18 years now.

Wow.

Has it been that long?

Yeah, I, it's, it's been a minute and, um, we've spent a lot of time together at, you

know, eating lunch or having dinner on the weekends or just sitting around the pool.

And I've thought so many times to myself talking to you that there

must be 10,000 other women having the exact same conversation somewhere.

And one of the things I'm really motivated by in starting a

podcast like this is I think these conversations need to be out there.

Um, I think as we've developed as professional women, as we've developed

to have our own voice as we've developed to understand our unique

challenges, it's been important to make this part of who we are and

allow these conversations to come out.

Um, you know, my inspiration is is, you know, being in, uh, a profession

where people are fairly type A and have a certain persona at work, and then

knowing a different dimension of them.

And the dimension I'm most focused on is the dimension of how they're

grappling with their professional lives, um, their children and their

aging parents at the same time.

So could you just give us a quick, you know, sketch of your life,

where you're from, kind of what your upbringing was, your experience

with your parents, um, like what kind of brought you to this point?

Sure.

So I, um, Was from the Midwest.

Um, my father was a corporate executive and he, we traveled

a lot when I was younger.

So that means that, um, you get transferred almost every two years when

you're a corporate executive on the rise.

So we lived overseas for a while and then we came back into

the Bay area of California and then settled in the Midwest.

Uh, I went to almost, I went to six different grade schools growing

up until we finally moved back to Michigan, which is where I'm from,

and stayed there through high school.

So I, when people ask me where I'm from, that's where I consider myself

to be from air quotes, because that's where I went to high school.

And I was raised in a very, um, conservative Catholic family.

I had two parents.

Um, my parents divorced when I was partway through college.

Um, But I would consider us to be a very traditional family.

My mom stayed home until I was partway through high school, and then as my

parents separated, she went back to work.

What kind of work did she do?

So she originally, um, had a psychology degree.

She gave up, uh, her dreams of becoming a nurse because she wanted to marry my dad.

And they got married relatively young.

I think they were 22.

So she tell, she told me that she got the fastest degree that she could, meaning

whatever her credits would count for.

And that was psychology, even though she didn't have any aspirations to

go on and actually be a psychologist.

So for a while she worked, um, as a bank teller when they were young and

my dad was getting his graduate degree.

Um, and then when we were young, she stayed home and

then she went back to work.

Um, took some accounting classes and worked for h and r Block

for a while, um, as I was older.

And then eventually, Worked for a paper company, um, as their office manager.

Interesting.

So one of the things I always wonder, and I know this is fast forwarding quite

a bit, there must have been a point in your life where all of your colleagues

were talking about, you know, raising kids and diapers and, um, preschool

stuff, and then there's a day where your colleagues are starting to talk about

issues with their parents, or assisted livings or, you know, other things.

Can, can you kind of just talk about where you thought that

transition might have happened?

Did you always, um, you know, worry about how your mom would be taken care of?

I mean, maybe we could start back and say, you know, I understand she's in an

assisted living now in Florida, or can you gimme a little more information on that?

Sure.

She actually lives, um, independently, she's in an apartment and I, um, I'm

very lucky in the sense that both of my parents are financially independent.

Um, they both remarried and they, uh, felt that it was their responsibility

financially to provide for themselves whether that meant living and aging in

place in a home, or whether it meant, um, moving into an apartment like facility.

So my mom actually lives in a two bedroom apartment in a facility in Florida that

has multi-step care, meaning that there is also an assisted living facility.

There's a rehab facility there, and then there's also a nursing home type facility.

Can you talk a little bit about, um, her second husband,

uh, and what he went through?

He had a degenerative condition, right?

And they were originally living independently together and then arrest.

They were.

And he was about 12 years older than she was.

And he, they originally had a house on a golf course and he played a lot of golf

and he developed Parkinson's and so he could no longer play golf at that point.

And he was finally willing to move into, um, a place with

my mother, um, in Florida.

And Florida's kind of known for having these levels of stepped care

that you can buy into, but you don't actually own the apartment, but you

sort of buy into the plan and can move through the different levels of care.

And that was very important because he ended up, um, becoming, he was

falling a lot with his Parkinson's.

Um, and she ended up providing care for him in their apartment.

Um, there were meals provided, there was a nurse on staff and sometimes when he

fell, uh, they were able to get someone to come up and, and, And help get him, get

off the floor, which wasn't a big issue.

And then when his needs increased, what happened in that sort of a setting?

Well, as his needs started to increase, he was able to transfer to a different

level of care for a period of time.

Um, and by that you mean more care, right?

Yes.

He was requiring a lot of help with toileting, which is really

kind of what breaks people.

Um, we know that people that require help with their bowels and bladders,

that sometimes family members are just uncomfortable doing that.

Um, or they're uncomfortable with the amount of diapers that they have

to change or with the embarrassment of having to care for someone who's

either a parent or a loved one, um, in more, more of an infant like stage.

So, He was able to go into, uh, kind of a step down unit where he was able

to get more help because he had a fall and I think he had either a pelvic

or a spinal, um, fracture that didn't require surgery, but yet he wasn't very

ambulatory and he was in a lot of pain.

Right.

And so he was able to spend a couple of weeks in that facility and until

he was able to walk a little bit better and then, um, he returned

to their apartment after that.

Now, you and I have actually never talked about this part, but I'm wondering how

did this issue come up with your mom?

Does she email you one day and said, Hey, we've found this great stepped

assisted living type situation.

Did she ask for your opinion on it?

Did she, how did she find it?

Like, so what was it?

Was there a discussion?

Because from my understand kind of culturally, Your family's not

really into like open discussions with difficult conversations.

Right, that's true.

And partly the foundation for that had been laid down by her mother.

So her mother and father had moved to a retirement community

called Sun City in Arizona.

And they had originally lived in Southern California.

So they had a very small house with a pool.

And then as they became older, they decided to move into a facility that

had different levels of care, which ended up So this was your grandparents?

This was my grandparents.

So they modeled this sort of Yes.

Midwestern style.

All due for myself and Correct.

Okay.

Yes.

And, and make sure that I have enough money to take

care of myself and my spouse.

And so that ended up being really important because my grandmother

had a stroke and ended up in assisted living for almost a decade.

And so she had access to it and also access to a private room

because she had like a prepaid plan.

And so my mom witnessed all of the preparation and planning that it took

and the resources and decided that she was going to follow a similar path.

So was this a stressful time for your mom?

Like when was this, did this happen when you were a child or in high

school or, no, I was actually part, part of the reason why I went into

my chosen medical specialty was that my grandmother had a stroke when?

When I was in medical school.

In medical school.

Oh, okay.

So yes.

You saw her go through this?

I saw her through dealing with her own aging parents.

Okay.

I think I was maybe a second year medical student and my mom had

gone my, my grandfather had died on Christmas day, and then my

mother had gone with my grandmother on a cruise the next Christmas.

And on Christmas day, my grandmother had a stroke.

Oh my goodness.

On the anniversary of my grandfather's passing.

Wow.

So, yeah.

Um, and she lived, she, they were in the Caribbean and she was, I think

treated in Puerto Rico and then went to a hospital in rehab facility in Houston,

and then eventually stabilized and was able to live in an assisted living

for, I think, uh, almost a decade.

She survived after her stroke.

So there was not really a modeling or an expectation in your family that,

that you were going to inherit the care for your, your aging parent.

And it sounds like a lot of that was related to, you know, sort of their

resource management during life, which was gonna be that they prioritized or

they had in their value system, that they would have enough resources, um, and

make those decisions to be in situations where, um, an institution or healthcare

setting would take care of them versus.

Coming to live with family, which is very different, you know,

in different cultural settings.

Yes.

Um, so that's what was modeled on your mom's side?

Yes.

And so, yes, my mom felt it was very important that she had enough

resources to take care of herself in the manner that she chose.

So whether that was aging in place in a home, you know, for my mom, a lot of it

was, um, she didn't want to take care of a house anymore and she didn't want to cook.

And so when you move into a independent living facility, a

lot of times everyone eats dinner together in a dining room area.

And so, and even lunch if you choose.

So a lot of it was giving up the, giving up the cooking and the socialization

for her was, was very important.

And what age would you say she was when she went into this?

Independent living setting, do you know?

Yeah.

Um, she's 80 now and I think she was, um,

maybe 75 because her, her husband was, was significantly older.

Do you have any idea how much it costs?

Has she ever discussed that with you?

She did.

It was actually quite expensive to buy in, so I think it was about $250,000.

And then, um, there's still a monthly cost that's associated

with living in the apartment.

And so it's almost like buying an insurance policy, kind of, sort of

like you're gonna, they're they'll take care of you through almost every stage.

Correct.

Do they have a hospice unit there?

I don't know.

And I think they're building a memory care unit because they didn't have that before.

Okay.

Okay.

So it's almost like you're buying into the club.

So there's a large six figure investment up front.

Mm-hmm.

And then there's some maybe on so many people that they're sort

of on fixed income after that.

Yes.

And there's no Medicare or Medicaid coverage for that.

This isn't something that's functioning as, as a, as sort of

a traditional health insurance.

Right.

This is Well, if you get sick, so interesting that you bring that up because

my mom and her husband, um, both got Covid and Medicare did pay, they actually had

an acute care setting, uh, where they could admit them to a different part of

the building and they could get care for Covid, which was really important because

at the time, the emergency rooms, um, and the regular hospitals were jammed.

Okay.

And, um, I was involved in part of that decision making because the CNA called

me from her retirement facility and said, I'm really concerned about your mom.

She's got Covid and she's not doing very well.

Mm-hmm.

And so I told her, we'll go up to her apartment and I'll call you

up there, but bring a stethoscope and a pulse oximeter and we can.

Get some objective information of how she's doing.

And it was very interesting because her husband was already in the

acute care unit, um, with Covid.

And then when I was talking to my mom, her oxygenation was not where it needed to be.

And I asked her, you know, why won't you go to the hospital like your husband?

And she said, because I don't want to have to pay for it.

And the CNA said, well, you'll, Medicare will pay for this because

you have Covid as a diagnosis.

And so, and she really needed to be there cuz she needed to be on oxygen

and she needed to have some monitoring.

So once that barrier was removed, she said, okay, I'll pack up my

things and I'll, and I'll go.

So she was actually on the acute side for probably two weeks or

so and her husband ended up, um, dying from Covid during that stay.

Wow.

And so that the, the husband with Parkinson's, right?

Correct.

Right.

Yes.

Interesting.

So, um, let's go to your dad's side.

So how is, how are aging parents handling that side?

Now your dad is sort of a jet setter, right?

And he's Yes.

Also 80.

Um, so that's very interesting because my grandmother, who's his mother, just

never talked about things like that.

And she actually told me, I'm never gonna die.

I remember how did, how did that work out for her?

Right?

Well, we know how that worked out, but it was a very strange conversation

that I was having with her cuz she was getting a carotid artery fixed.

And I said, you know, Nana, do you have a will?

And she said, oh, I'm never gonna have those discussions with you granddaughter,

even if, even though you're a doctor.

She said, because I'm gonna live forever.

Your kids off for the night.

Your brain needs a break.

Get ready for bed, you can do this.

I have a, uh, announcement that goes eight 10 every night

that tells him to go to bed.

That is hilarious.

Oh, okay.

So, so my grandmother didn't really plan.

And so I remember telling my dad, okay, this is how this is gonna go down.

Like this is what I see happen is that she's gonna trip and fall and she's

gonna get a non-surgical pelvic fracture.

And then she'll be in a skilled nursing facility, and then her she'll use up

her 30 days, and then where will she go?

And, and what ended up happening, that's exactly what happened.

Oh my gosh.

And so it turns out she had bought another apartment and it, it was not

an assisted living, and they were, they wanted her to walk to get her meals.

And my father called me and said, you know, she, she won't

get up and walk to her meals.

And I said, well, put her on, I wanna talk to her.

Well, she, she was so short of breath sitting in the bed, she couldn't walk

to the meals and as it turns out, she had end stage pulmonary fibrosis.

Oh my gosh.

And nobody really understood that this was a terminal diagnosis for her until

I basically explained cuz he said, well, you know, they're not putting

her on oxygen, they're not doing this.

And I said, dad, it sounds like you know, grandma's at the end.

And he said, well, no one told me that.

I actually said, grandma's circling the drain.

And he said, did you just tell me my mother's circling the drain?

And I said, well, yeah, that's kind of how we refer to it.

But, you know, and she died about a week later.

So there's the other piece of that side of the family, which

is in complete and utter denial.

And so, you know, my dad insists I'm never going to live in

a facility assisted living.

I, I'm never going to do those things.

But there's, there's sort of this unclear plan of.

Of who's going to facilitate that.

And in most cases, when you're a man, it's your wife because Right.

Sort of assume that you're going to live a shorter lifespan and that

your wife will take care of you.

So let's talk about that.

So I want to talk about your perception of gender roles and caring for aging parents.

So you have two brothers, yes.

And no sisters.

Now, maybe it's a little unfair because you're also a medical

professional and your brothers are not.

But, um, how, what, how involved are you kind of in these discussions with

your parents or involved in their medical, you know, whatever comes

up for them versus your brothers?

Or do you feel like there are expectations of you that they don't have of the, the

brothers in relation to their healthcare or their, their future arrangements?

I think that's a very interesting question because I think I am everybody's power of

aj uh, power, medical power of attorney.

And I think part of that is I'm not the executor of the will, but I'm, I'm

the power medical power pat fraternity because I think that my parents know

that I can understand the system and I can explain what's happening to them.

And I'm also very committed to carry out their wish wishes.

And we've also discussed as a family, like before my mom, before my mom's

husband died, I actually talked to him and I knew that my mom's, my mom is

still living, but her wishes are very clear about, um, not prolonging her

life and not having a feeding tube.

And, and I asked all of those things.

I think when you agree to be someone's medical power of attorney,

that you need to be very clear with them, um, what they want you to do.

And so I would run through a bunch of different scenarios with my mom.

And asked her how she felt about different things.

Cuz my grandmother, when she had her stroke, actually refused to have a feeding

tube even for a short period of time.

And I said, you know, mom, that would be a little unusual to do that.

Um, because most of the time when you've had a stroke, you may, you

don't need a feeding tube for that long and you can start eating.

And so grandma was willing to not have nutrition provided and maybe die in a week

or two, you know, rather than have a tube.

And I said, I need to know if you feel the same way.

And she said, yeah, that's, that's the way I feel.

And I said, okay, then I can have that conversation with the

physician and the intensive care unit if that's what you want.

But your husband, if while he's living also needs to be on board with that.

So who was the medical power attorney for her second husband?

Um, she was.

She was?

Mm-hmm.

Interesting.

So, if you're in a family that isn't necessarily super open about having

these conversations, I know you have this gift of being very direct and, and

being very good at crucial conversations.

How did you approach your mom to talk about this?

I mean, I can't imagine she called you up and was like,

let's talk about feeding tubes.

I'm sorry.

I can't imagine She called you up and said, Hey, let's talk about feeding tubes.

Like where, how did this happen?

So my mom sent us all a copy of her will just out of nowhere.

Like, did you know this was happening?

Yeah.

Well, she probably warned me on the phone and said, Hey, this is coming.

And so this very fairly bland document shows up that doesn't

have a whole lot of information.

And of course I wanna drill down and know exactly because I know my mom and my

mom has very strong opinions about death and dying and feels that she, I mean,

my mom has, you know, read information about the Hemlock Society and she feels.

She doesn't at all feel like she wants her life prolonged.

And so I needed to know, wait, what's the Hemlock Society?

The, the Hemlock Society, we maybe shouldn't be talking about,

but it's actually a society that believes in assisted suicide.

Oh, interesting.

And so they, they put different recipes online, um, in, I don't know

if it was Socrates, someone used Hemlock to, to poison themselves.

Oh, it's right.

So that's like a substance?

Yes.

Oh, okay.

And so it, yeah.

And so she would read about these things and she just felt very strongly

that I think she wanted some agency about her own life and the manner

in which she was going to die.

So when you say you got a will, cuz I'm thinking of two different documents.

I'm thinking of a will and testament of like, what's gonna

happen to the estate and your, your belongings, and then there's a

living will or an advanced directive.

That is saying if I'm in the hospital and there's whatever

percent chance of recovery do this.

So she sent you what, when you got this email, what was in it?

Was it the both of those documents?

Both of them?

Mm-hmm.

So this was a one fail like Yes, here it is.

Two together.

Here it is.

And it's like to all my children.

And how old was she when she wrote this?

Um, I think she was probably, I know for a long time that she had had a

will cuz she was very open about that.

And when she remarried, she said to me, you know, it's possible

with lack of foresight in planning that the children from an original

marriage can both be disinherited.

Interesting.

And it's possible because if both of the spouses die before, um, their new

spouses and they leave everything to their new spouses, um, it's possible

that the children from the original marriage can be completely disinherited.

And she said, I don't, I don't want that to happen to you.

And also she and her husband married, um, much later in life

when they were established and, and her husband had no children.

And so I mean, I, I was very happy that she felt like she could discuss

that with us and talk about her arrangements and, and what she wanted.

And she was very specific about she wanted to be cremated and she, you know,

where her, you know, cremains should be placed and they were all very reasonable

su suggestions that we could execute.

But when the living will document arrived, I had very specific

questions about it, because, so it didn't cover every scenario, right?

No, these don't typically, I mean, they have some basics in there, but you're

a physician have seen every, every instance of healthcare, you know, um,

uh, how would you say, like different, you know, progression of diseases and.

We have seen people that have what you and I would call

faith's worth worse than death.

Yes.

Right.

That there are people that can survive things that maybe living conditions

that you and I would think, you know, maybe quality of life would be

so low, but how, um, so was it your medical background that spurred you

to, I guess it's hard to say right?

But to go and ask more questions and how open was she to this

kind of nitty gritty discussion?

Because I think there are people listening right now that are cringing thinking, I

could never talk to my mother about where we're gonna spread her cremas Cremas.

So what is it about you or your family or your mom or that relationship, or

is it like, can you, can you gimme an idea, sort of where this comes from?

Because I, again, I, I think there's so many people out there that think there is

no way that that conversation's ever gonna happen between me and, and my parent.

But that understandably, you know, you're saving yourself so much heartache.

You're trying to be right by her.

Yes.

Right.

You're trying to serve her at a time when she might not be able to serve

herself, which I think is a very.

Honorable thing to do, but it does take some extra, um,

challenging conversations Yes.

Ahead of time.

So talk more about that.

So what that does, I think when someone asks you to be their medical

power of attorney is you ask them, well, what does that mean for you?

And there are many, um, conversations that can come out of that discussion.

Um, and, and part of that I think if their spouse is still alive, is to,

to be clear that you don't want to get into a fight with their spouse.

Um, if I, I mean, I was very clear that whatever decision that her husband made,

if she was in a terminal condition, that I would respect, um, and that I would not

oppose if he wanted to take her off life support because I knew, because we'd had

this conversation before and I knew that was important to her, and I knew that

he understood it and would respect it.

And that I would also do that and I would deal with my brothers

if they didn't agree with it.

So I felt like it was an enormous amount of trust and that in order for me to

be worthy and to honor that trust, I had to ask much deeper questions, um,

and talk about different scenarios.

And also, since she had been at the bedside and had witnessed her

mother, she knows cuz she was there.

What that means, you know, when you have a stroke and you decide

I'm not gonna have a feeding tube.

And so I could ask, I could actually say to her, you know, if the same

thing happens to you that happened to grandma, do you not want a feeding tube?

And she said no.

So it was very clear then I could execute that.

If I went, if I have to go to the hospital at some point, I could say that,

you know, I think what's hardest for families is when there's an intensive

care physician looking at them saying, you know, what do you want me to do?

And they have absolutely no idea.

Absolutely.

And I'm so glad you said that because one of the reasons I want these stories

to get out there and, and the voices, particularly of physicians who have

lived through this going wrong and seen thousands and thousands of families

go through that exact situation.

And how much of it might be, um, if you think about honoring that person

in that moment who's grieving, right?

Yeah.

Even if the person is obviously fighting for their life and maybe has

a good chance of surviving, you're grieving the life you had five minutes

before you found this information out.

And to ask that person and the, and their state and their cognitive state, you

know, should we put a breathing tube?

That to me, that that's a very, a, a very challenging question.

Um, and having, and, and I'm trying to give some voice and some, um, structure

to the courage that it might take to have these conversations ahead of time.

Um, as scary as they might sound or as superstitious as you might

be, that you can't talk about that, cuz then it will happen.

I, I think it's almost the opposite.

It's like, you know, like when you pack for your kids, you're like,

well, if I don't pack it, then if I don't pack the extra diaper, then you

know, we're gonna have the, the issue.

And so I'll pack for this.

And so thinking this way of our responsibility as professional women

who are trying to balance our families and our careers and, and our parents, I

think it's almost an ounce of difficult conversations is worth a pound of

absolute terror and, and confusion.

And you're not in the right state when you're standing across from an intensivist

in the ICU to make those decisions.

So it's, so I ironically, doesn't it, it sounds like it's, it's a

difficult conversation to have.

I mean, did you have stress in talking about it?

Now I know you, I have to be fair and remind my listeners

that you're a very strong person.

You're very gifted at direct conversations.

But was there a part of you that felt like this was icky or gross or, Like,

almost like, you know, some people might say, I, I use the word superstition,

like we speak it into the universe and just like it was with your grandmother,

like that's exactly what will happen.

And then yeah, you don't be in the situation.

Or did you find it more matter of fact?

Or like how did you get to a place where that conversation could happen?

Well, back to my other grandmother who didn't want to face death, that that

was actually one of her fam, her famous lines, she would always say, trace,

don't put that out in the universe.

She used to always say that to me.

Like, if you, if you speak it, if you think it, it will happen.

And I'm sort of the opposite.

I'm like, how can I represent you if I don't know what your thoughts and feelings

are about this particular situation?

And what people don't understand is that the default in medicine is

always a full court press, right?

And so if you don't want that, if you don't truly understand what that means,

you know, a prolonged intensive care stay.

Lots of medications being up all night.

If you don't truly understand what that means, well ask because

I can tell you what that's like.

Um, and perhaps that's not what you want.

And if I'm an advocate for someone, then I have to know

what you want me to advocate for.

How has this informed, like, so your children are how old right now?

They are 20 and 16.

So, um, how do you feel like ha, has any part of you thought, I

wanna model for them, like, taking these actions with my parents.

Like I want them to, I wanna normalize that so that when they,

it comes time for them to maybe be my power of attorney or something.

Has that even crossed your mind yet?

Or they're too young for you to think like that?

I think that as long as they're dependent on me, they can't.

Can't think through things in that way because they can't see

me as a separate person and Right.

Um, I, I don't think that they see me as, even though I'm an older parent,

um, I don't think they see me as someone who's necessary old, who's, who's

really facing those life decisions.

Um, but funny story, when I was having my first child, I actually wrote a

document that I gave to one of my practice partners before I gave birth.

And I told her that I wanted her to show up and make decisions for me.

Um, because I had already decided if I had some sort of catastrophic complication

from an epidural and I was, you know, permanently comat or brain dead, that

I was very clear with her how, how I wanted, you know, things to proceed.

And I did not want, um, you know, my husband to have to make that decision.

Um, and that I was not going to live in that state.

You know, I thought that through already.

And she was a brain injury specialist in the practice.

And I said, oh, interesting.

I, I know that you're gonna understand this.

Yes.

And that I'm being clear with what my wishes are.

And even if you can't execute it, if you don't have legal power, even though

I've given you this letter, you can say, I have had this conversation with

her, and I would, I know what she wants.

So you were how old when you had?

34.

34.

So you're a 34 year old healthy former college athlete.

Yes.

Right.

Who had no known, you know, reason to necessarily be concerned about this

childbirth and your thinking ahead of Yes.

Of a potential future self.

And I, and I'd love to talk about this type of thinking as exercising self-care.

Can you talk about that?

What do you think about that?

Like, so I never, I never thought about it as self-care.

I thought I was being a little catastrophic at the time, but it was a

situation in my residency that actually occurred and we, we did actually take

care of a young woman who'd had a catastrophic, um, complication from an

epidural and dropped her blood pressure so low that she had a brain injury.

And so I had actually witnessed that, um, during my training and I was like, okay,

I, I know what I'll do in that situation.

You know, I wanna talk about that a little bit because I think, um, I know

not all of our listeners are physicians, but one of the unique experiences of

being a physician is being, especially in the type of, uh, medicine that we

do, um, being exposed to extraordinary, extraordinarily rare outcomes.

And it kind of biases you towards thinking of the worst.

And I remember I was a medical student rotating.

Um, up in Dallas and trying, you know, when you're a medical student doing

an away rotation, you're trying to impress everybody and be, you know, the

model medical student, future doctor.

And, um, I had this wonderful attending and this wonderful

resident I was working with.

And I had just started our rehab rotation and we walked in, we saw our first patient

and it was a young mother who had gone and gotten a breast augmentation, um,

and had had a stroke intraoperatively.

And she was in her early thirties and woke up in the room and was

coming to terms that the left side of her body did not work.

Yes.

And it was, she was in a mental state such that it was almost like Groundhog day.

And so she would sort of understand it was there and then she was

kind of go out of it for a while.

Again, this was a large stroke and then sort of reimagine this and

this, this terror of waking up.

I'm probably scaring everybody we're talking to, but, but I think this

is important and, and I remember, I don't know, doing an about left

running to the bathroom and vomiting.

Yeah.

And I thought if anybody saw me in this bathroom vomiting, they'd think I could

never be, um, a brain injury physician.

I could just certainly never be a doctor.

And I remember thinking, you know, there's gotta be some grace for sort of

adjusting to horrific life outcomes and how it sort of rotates or, or shades, how

people in medicine understand advanced directives, how they understand outcomes,

not in a sort of like, um, how would you say, like a histrionic way or, I

don't, I don't even know if I like that word, but this melodramatic like, you

know, the worst thing that can happen.

It's almost like this is an outcome.

This is a pos, this is a non-zero possible outcome, and the

way I care for myself is by.

Being prepared for this, preparing my family for this.

And, and I'm not sure people think that, but I, I think, um, and just as

we're talking and we talk about, you know, the, the, the big focus now on

wellness and the sort of resilience and mindset, and we really need to

broaden the definition of what that looks like for professional women.

Because you can get really lost in sort of the yoga and the, you know,

meditation, which I'm not saying those, those are excellent tools for this, but

it's so much bigger than that, right?

And it's like, how are you advocating for yourself?

So I think of this 34 year old, you, you know, writing this paper,

going to a colleague, having this discussion and how out of body it

might have felt, cuz you're probably, what, eight or nine months pregnant

at this time and you're doing this.

And I think of this like, what if we had a larger definition of self-care

and what that looked like for us?

And that's not only doing that.

For ourselves, but then allowing some space for the people that we love,

whether it's an aging parent or maybe it's a disabled sibling that you take

care of and, and giving, um, credence to having these conversations ahead

of time in a, in a col, you know, calm setting, in a setting that

they can be themselves too, right?

That they can make decisions that are sound.

Um, because we work with so many people with what we do every day

that are not making sound decisions, that are not, you know, advocating

for themselves in ways that they normally would have because of a brain

injury or a stroke or something else.

Um, and so we see just how quickly that you can lose agency.

And I love that word that you use because that's really what you're doing

is you're protecting your own agency in a moment where you can't exercise it.

Yes.

Um, and to me being entrusted with being somebody's medical power of

attorney, um, that's part of it.

Um, but I, I can't tell you just in my own experience in medicine, How many times

somebody seems to have nominated a medical power of attorney and not told them.

Yeah.

And so we're producing, you know, a document for a sister that lives

in, you know, 10 states away and you called them and they're like, who,

what, what are you talking about?

Right.

And so it's almost this, you know, um, this, this practice of like, we need to

maybe, you know, empower that document.

It's more than just a document.

It's, it's the beginning of a conversation is what, what comes to me about that.

I, I think that a lot of people who are not in medicine live in the

world of this couldn't happen to me.

And once you become a physician and you're on the frontline and you see things that

happen to people very randomly, sometimes not so randomly, and you realize at any

time that it could actually happen to me, I think there's also, um, this is, is

this kind of maybe getting more into, um, theory, but I think there's this idea.

I I would say that the people I, that my colleagues in medicine probably have

the most strict or restrictive advanced directives, you would see, it'd be

the opposite of what you would think.

So you think a physician would be like, oh no, you're gonna pump this

medication into me and you're gonna cut this open, and then you're gonna,

you know, pump my chest for this long and et cetera, et cetera, et cetera.

And I think when you get the privilege that it is to live next

to death, um, you become, it, it becomes a different entity to you.

I don't know if that makes sense, but this idea that, you know, it's

the most inevitable thing that there is and there's a good way to die.

Um, yes, and I know that sounds dramatic and probably jarring for

some people, but I, I think of that, um, and I know this is, sounds really

morbid to a lot of people, but.

I think of that for my parents too.

Um, we were gonna go hot air ballooning in Mexico last year, and a friend of

mine, a good friend of mine, said, oh my God, wouldn't that be terrible

if he died in a hot air balloon over the pyramids in Mexico City?

And I was like, I don't, that sounds like a pretty badass way to go, actually.

I mean, I don't know.

I mean, the sunset over the pyramids, I dunno.

Right?

What's the alternative?

Right?

So, oh, I wanna be covid on a ventilator in an intensive care unit.

No, I don't know, but not so much.

But I think of this like, I think we are such, our culture is so focused on

prevention of death at all costs, and we see these extreme measures taken to

extend the ounce of life that's left.

And that's almost, you know, a, a highly celebrated thing.

And, and it's part of a physician burnout too, which is we're Yes.

You know, kind of incrementally extending, you know, fighting

these natural processes in life.

I mean, the one thing that is inherently inevitable in all people, Which is to die.

It's like you and I are in a profession that's like meant to prevent this as long

as possible, as long as it makes sense.

So we kinda lose sight of that.

And so, um, you know, as hard as it would be to talk about my parents

passing away, I have this, I have this really morbid thought and I hope my

dad's not listening to this, but my grandfather died working on a bulldozer.

He had a heart attack doing what he loved on a bulldozer.

Somebody found him.

Um, and he had been dead for a couple of hours and that was it.

And it was devastating to us.

But he also had full faculties and function up until that day.

And I think about it as like, okay, there are worse, worse

ways that this can happen.

And you know, I think he was 68, which is maybe just shy of the life

expectancy of a male in America's Rom 72.

Um, for women it's closer to 78.

And so I'm thinking, You know, it's horr.

I, I don't mean to be dismissive of the grief that would come at the loss of a

parent, but I don't wanna lose sight of the importance of advanced directives

and conversations and allowing that to also be another way to serve people.

And I don't wanna make this podcast all about, you know, your parents dying and

that would be a total Debbie downer, but I think that weighs on people.

And you described this, um, we were talking about this a couple

days ago, and you said sometimes there's just this weird fog right.

That sets in, and I don't know exactly what I'm worried about, but my parents

are aging and my kids are, you know, in very crucial developmental points in life.

Mm-hmm.

And I'm also supposed to incidentally be, you know, at the top of my career

at this point, so kind of early fifties.

And that just seems like a lot.

Um, so how do you deal with that?

Because you're sort of in the middle of, you know, advancing in your career.

You have children who still need you, you're a single parent.