Welcome to back to Final Approach. I’m Jonathan Knaul, author and former test pilot, and in this episode, I’m joined by the highly accomplished Dr. Golnosh Sharafsaleh—a geriatrician, caregiver, author, and founder of Golden Oak Medicine in Asheville, North Carolina. We dive deep into the realities of caregiving, the urgent shortage of geriatricians, empathetic care models, and planning for aging and end-of-life. Whether you’re a current caregiver, facing the journey ahead, or seeking compassionate approaches to elder care, this episode will offer insight, support, and practical advice.

In this episode, I talk with Dr. Sharafsaleh about her unique holistic approach to elder care, the story behind her book Life, Love, and the In Between, and the complex emotional and logistical landscape of family caregiving. We discuss her personal experiences as both a physician and a parent, confronting loss and transforming hardship into deep empathy for patients and families. Key topics include the American geriatrician shortage, integrating end-of-life care, teaching compassion, handling challenging family dynamics, self-care for caregivers, and essential legal preparations like powers of attorney.

Key Takeaways

• Crisis in Geriatric Care: There are fewer than 7,000 geriatricians in the U.S., with only 13% of people in need able to access a specialist. We must urgently encourage more medical professionals into this essential, though often undervalued, specialty for a rapidly aging population. (08:23)
• Holistic, Relationship-Driven Care: Dr. Sharafsaleh advocates a compassionate, holistic model—seeing patients in their homes, hospital, and offices, and always supporting caregivers as fundamental to patient health. (05:05)
• Empathy & Compassion Can Be Learned: Empathy is not just innate—it can be taught and practiced, especially in medical training. Compassion stems from true understanding of patients’ and caregivers’ emotional worlds. (11:55)
• End-of-Life & Palliative Integration: Bringing palliative and hospice care into the client relationship helps families navigate difficult transitions, supporting emotional acceptance and promoting dignity in the final journey. (15:01)
• Caregiver Self-Care is Essential: Burnout is real. Caregivers must set aside at least an hour a day for themselves, seek community, and focus on gratitude—even in the hardest times. (25:47)
• Family Dynamics & Difficult Histories: When caregiving for someone with whom you have a strained or painful past, try to see them as they are in the present—frail, vulnerable, and possibly changed. Compassion may open space for healing. (34:09)
• Advance Planning is Critical: Start conversations about living wills, powers of attorney, and healthcare directives early. Planning for the future—whether you’ll give or receive care—can prevent crisis and ensure wishes are honored. (47:44)
• Grieving and Transitioning Out of Caregiving: The “long goodbye” in dementia or end-of-life care is emotionally taxing, and finishing the journey as a caregiver leaves a void. Grieving, finding meaningful ways to give back, and re-entering life are all part of the process. (54:54)
• Resources to Empower & Educate: Dr. Golnosh Sharafsaleh offers free, practical advice at Geriacademy.com and shares family and patient stories—and life lessons—in her book and newly released audiobook. (01:02:20)

If you found this episode helpful, please share it with someone who’s on a caregiving path, working in elder care, or concerned about aging and planning. Check out Dr. Golnosh Sharafsaleh’s book, Life, Love, and the In Between, available everywhere books and audiobooks are sold, and visit her free resource blog Geriacademy.com for clear, actionable guidance on aging and caregiving.

If you haven’t already, subscribe to the Final Approach podcast for future episodes on family caregiving, geriatric medicine, end-of-life journeys, and practical ways to navigate this challenging but rewarding stage of life.

Let’s keep this vital conversation going—because together, we do better.

Best in care,

JK

Welcome folks. It's the podcast the Final Approach here with Jonathan Knaul, author of a similar book, Final Approach Test Pilot Story of Caring for Loved Ones. It's the beginning of June 2026. I'm here in California at my home and I'm interviewing all the way from North Carolina. Dr. Golnosh, I'm going to say your last name incorrectly, so I'll just go with Dr. G and then we'll have you introduce yourself.

You have a lovely name, but I fear I'll say it incorrectly. And I'm so privileged to have Dr. G here. Dr. G is a geriatrician. Dr. G is. This is hard for me to say, as I was just saying to Golnosh and I prefer to call, call you by your first name.

Golnosh is, and I really want to put it over to Golnosh to introduce herself. Golnosh is the most accomplished person I've ever met. And I, I'm a test pilot working in a field where I work with astronauts and some, some, a few celebrities to say the least. And, but you are the most accomplished person I have met. And, and as I said to you earlier, it leaves me breathless just looking at your resume, what you've done and what you continue to do. And let's also not forget the fact that you are a wife and you have children. Several. And I'd like to talk more about that.

And you've been through no lack of challenges in your life. You didn't get here by any sense of ease. But Golnash, let's put it over to you. Can you, could you please start by just telling us who you are?

Sure. I'll, I'll pronounce my full name. It's gone as Sheriff Sala. It's totally phonetic. But I, I'm not really the most traditional physicians, so friends call me G. Other my patients call me Dr. G. And, and it works for me because I do practice in a very non traditional way.

And even today one of the pharmacists that was working with me sent me some puppy pictures. A patient brought his brand new puppy in and I was on the floor rolling around with the puppy and then my patient, my dear patient said oh my gosh, she's going to leave us and become a veterinarian now. But so very non traditional holistic approach to care. And I became a geriatrician because somehow I learned about geriatrics at the University of Utah when I was a freshman and my first experience with elders was my grandfather who had dementia and I was helping my mother care for him. She was his main caregiver. And while I was in high school, he would wander. So I would drive home at lunchtime, make sure he was there, make sure he had lunch. And after, because the wandering was getting dangerous and he needed help with more activities of daily living, he moved to nursing facility about.

There it is. He moved to a nursing facility about a block away from our home. My mother did that very strategically and we would visit him every night for dinner. And everyone in a nursing facility, I just noticed, were isolated and alone and, and. But it was such a peaceful, wonderful place. That was my first experience with elders. That was really intimate. And then I.

I always wanted to be a physician. So I realized, you know, if I'm going to be a physician and I really want to help people. And by then I had finished a master's in gerontology. I thought, you need to become a geriatrician. And it is, it's, I think, the most rewarding job because through the most difficult times in my life, all of my patients stories and their experiences have sort of lifted me. And I always think if this person can do this, you can too. If this person got through this, you will too. So it's.

It's sort of selfish to say, but I think my patients have given me more than I have ever given back as a physician. But I own a private practice in Asheville, North Carolina, and the model is different. So I see my patients in the office, I will visit them in the hospital. If they get sick, I will go to their home and see them there. And I take time to speak to their caregivers because if the caregiver is not well, then my patient is not well. And I also take time to educate caregivers because I do believe that the health care system has failed our caregivers. We focus so much on treating disease that we dismiss what our caregivers needs are. And sometimes those needs translate into the health of our patient.

Like, how do we not connect those two things? And kind of shameful and we should be ashamed of ourselves.

Yeah, and I agree with you. There was a statistic that you mentioned. I mean, we spoke, I think first was about two months ago. Correct me if I'm wrong, but I think you said there are in the United States, of course, being Canadian, I'm thinking about the grand North America. But in the United States alone, and the ratios reflect what we see in Canada, you said 7,000 geriatricians, am I right?

That's correct. Right. It's actually right under. That's it. It's right under 7,000 geriatricians and geriatrics. You can get into geriatrics by going through family medicine or internal medicine. And then it is a subspecialty of medicine, just like cardiology or gastroenterology. And the goal really, you learn a lot of pharmacology, pathophysiology.

And as we age, the way we take a medication, the way that medication is distributed, the way it's metabolized, eliminated changes. Because as we age, we also change and we learn that additional step in geriatrics. And we also focus a little bit on that psychosocial dynamic and aspect of caring. We focus on that. We focus on dementia, diagnostics and treatment. What we don't focus on, though, and I think I learned this in graduate school, is the psychosocial aspects of aging, which I think is so important to actually take care of our patients in a safer way, in a better way, in a more compassionate way, because we can really delve into their life and understand what is truly going on rather than just writing a prescription. But so right now we have under 7,000 geriatricians in the country, which is low. And by 20 they're low.

Right? So about 13%. It's so low, you know, 13% of people have access to a geriatrician who need to see a geriatrician. And we need to have about 30,000 by 2029, when the last of the baby boomers turned 65 years old. We are only training about 250 a year now. You have to consider the ones that are also retiring. So we will never reach that. And it will become the responsibility of our primary care physicians to step up. And it will be the responsibility of our medical systems to step up and provide the support that our patients need and also our patients, politicians to really support geriatric care and make it an exciting field, an appealing field for people to go into.

It isn't exactly the most appealing field for most medical students because it is one of the lowest paid fields of medicine and most medical students are graduating with this large, large debt. So they are choosing specialties where they're going to get reimbursed enough so that they do not need to worry about paying back their student loans.

So, you know, there are so many things going through my head right now. So just to mention a few, I mean, gosh, that there are so few geriatricians. One of the best things that we, I say we, my sister and I, Felicia, we did. And it really was Felicia who organized it initially was get a geriatrician for our mother. And I've mentioned his name before, Dr. Barry Goldlist in Toronto, who's still practicing. And he's not a young man himself, but absolutely wonderful geriatrician. We're so thankful.

But then my other thought goes to your book. So it's really important that we say that Gulnas has this amazing book, which I just read. Absolutely loved it. Life Love and the in between, published just this year, 2026, under your own publishing company. Because if you weren't busy enough, you decide to, well, I'll just make my own publishing company. Gosh, seriously, I'm breathless thinking about everything you do and what you also do. So, Barry, I call him Barry. We got to know him very well.

So Barry, absolutely wonderful geriatrician, but he didn't do what you also do, which is end of life care. We had a wonderful palliative care physician, Dr. Jennifer Shapiro, who I will forever be thankful for too. You know, and like geriatrics, it's not a field that folks really want to go into. Of all things, she was passionate about it and all of her patients were at end of life. And you do that as well, which is such a unique, amazing thing. And it again, a lot of things going through my head takes me back to your book where you wrote about how, and I think it was one of your colleagues, again, correct me if I'm wrong, during your residency, I think who said to you geriatricians are bottom feeders, something to that effect. And which when I read it, I was offended for you.

I was like, who is that jackass? I think you were very polite how you referred to that person. Maybe it was the same one who did the rounds with you and only showed up part time because they didn't think it was important. And it's really clear through your cv, through your book, how much you absolutely love what you do, how much you see it as absolutely important, the entire field of geriatrics, which for you, you've expanded beyond just simple geriatrics. Again, you do things like end of life care, palliative care, which is truly another field. And I'm not really sure what else to say. Maybe you could talk a little bit about we mentioned, which really caught me too, was your point about empathy and compassion, how important that is as a caregiver and that it can be both of those things. Well, in particular, you said empathy can be learned, which really caught me.

And really, empathy can be Learned. I think one of the big shifts in medical training now is to teach about empathy and help our medical students understand empathy, to truly feel what someone else is feeling. And really, you know, when we say, put yourself in their shoe, well, we could just say that. But how, how can you really understand what someone else is feeling? And once you sense that and once you feel that and once you work towards that, then you can extend and really help. And then that's where the compassion comes in. But going back to that story, I had a. I was just speaking at a geriatrics conference at App State, and one of the doctors that I refer to in this book, Dr. Stewart, I adore her, but she was a medical resident, and she came up to me and she said, doctor, so and so just said, don't do, don't go into geriatrics because they are bottom feeders.

And then anyways, she did end up going into geriatrics, and she's a wonderful geriatrician.

You said something about karma. That's right. Now I remember. You said, karma comes around, of all things. She went into geriatrics. I was killing myself last week. That's right.

Well, and she was a speaker at this conference. And, you know, she's now pregnant. And I met her partner and it was, it was so beautiful. But I thought, oh, my gosh, here I was her mentor, and now she is my colleague. And we're both speaking at the same conference, and we're both so passionate and happy. And in what we do, this person is not a happy person. They haven't done well since because they're just not focused on what gives them what fills their cup, essentially. But regardless, I think once you pick the career that you pick again in geriatrics, one of the reasons that it has worked so well for me is because I am able to walk with my patients through their entire, entire journey.

And when they first come into my office, we focus on, like, their health span. We focus on what can we do to keep you upright and independent. And I mean, I will fight with their children, their adult children at, you know, they are doing great. Let them have this. Don't, don't, don't, don't force this. Don't do that. Because sometimes children do this role reversal thing. And then, you know, then as my patients start to change, you know, I've had one that we've been discussing exploitation.

This person has lost a lot of money recently and sat down with the patient and the child, the adult child, and we were going to, through the process of how we safeguard this stuff from happening. And, you know, at the same time, I'm managing their high blood pressure and diabetes and all of that stuff too. But this is. This piece is important. And then, you know, towards the very end. So I work with hospice organizations where they also recognize that, oh, Dr. G manages her patients at the end of life. I meet with the hospice nurses, with my patient at their homes.

We talk about the medications, and I can intimately talk to loved ones about what is happening. You know, Jonathan, when I have this belief that somehow we are meant to experience the things that we are meant to experience in life, things have a purpose. But when my son was so sick and we had a sick son, yeah, James was so ill, and I had to put an oxygen on him and just a nasal cannula, like, that's nothing. You could put oxygen on somebody. But that. It felt hard. And when I had to give him morphine and when I had to give him lorazepam and. And then he wouldn't eat.

And this is this little baby that can't communicate with me and. But is grimacing and is breathing rapidly because they're in distress. And I am having to administer these medications that I know will slow his breathing and I know are so just scary things that I had to deal with. But I tell my caregivers this story. I tell them I understand, because people don't think you really understand what's going on. I understand. I have been in this position where I had to administer this medicine and I had to do this for someone that I loved. And.

And that is, I think, the other part of the empathy piece. Once your patients stop seeing you as a physician, but start seeing you as a human being that truly cares and values them. And if they tell you something rather than dismissing it, expanding on that, asking them to explain more, what do you mean by this? What do you mean by that? And then I think all of that helps in the process. That life journey and then that passing journey. That's the completion theory, we call it in gerontology. Like, how do we learn to exit this life? But I walk with them. And that is really special because I didn't need to do that. When I transitioned into primary sort of geriatric care, I knew that the hospice physicians were able to pick up and take that on.

But I really. I love that. And I used to teach end of life care when I was a faculty physician. So as I did that, I really enjoyed that part of my job. But I wanted to continue to do it. And it's been. It has been so special to be with people through that.

You know that that is evident in my conversations with you. It's clearly evident in your book. You write about how I want to make sure you know, I won't get the wording exactly like you did. But you say how some. You start off by talking about how you. You talk with children and that you have to acknowledge, I think you made a reference to animals, too, that certain behaviors and certain things you see, feel, sense, hear, these are forms of communication. They're not necessarily something bad. And it's the same thing even with a dementia patient or any level of whatever the pathology is with the patient, they are communicating to you.

So a behavior with an Alzheimer's patient or a dementia patient, for example, which could be very frustrating or abrasive, they're just communicating. And it's that realization that there is a person inside still who is suffering a condition, an ailment, a disease, and as part of the carrier, have to learn about that, understand that communication. And I. I thought that was huge. Again, as I talk to you, all these things going through in my mind, and I want to say them because again, you leave me breathless in a good way about everything you do. But I think that your ability to be so expanded, so full spectrum in your care is. I'm not saying this right. Evident in all the things that you do like or have done.

You didn't just get an md. You didn't just get a master's in geriatrics, if I said that correct. You got an.

The gerontology.

Gerontology. Thanks. I'm sorry, apologies. You got an MBA as well. And the list goes on and on. And I even think about the fact that you got an MBA would make you even be able better to understand when dealing with caregivers, hey, you're not just dealing with the person. You're probably dealing with all their other needs, which would be a whole long list of administrative needs, financial, et cetera. And those things can be in of themselves, absolutely terribly daunting.

And so I really. Gosh, Galnash, my hat's off to you with all the things that you've done to expand your toolbox and be able to bring that care to people. And you mentioned your son, too, which you. You have. My heart goes out to you for that loss.

Thank you.

And how beautifully you spoke about him in the first chapter of your book and that you still have three other beautiful daughters.

Yes.

And your husband also is a physician, if I'm correct.

Cardiac care, pulmonary critical care. He was just in the, I think, you know, he has his caregiving responsibilities as well. But he was just in the ICU covering for seven days straight, these 12 hour days. And he came off service and he's right now camping with his best friend. So he will be back tomorrow, which will be really nice. As it turns out, when, when he goes away, things, you know, strange things happen. A child, one of my children got hurt in gymnastics and they couldn't stop bleeding. You know, and my gosh, we're so lucky.

I think as a physician, I found myself so lucky. But I was, I reached out to a group of women. We are all mothers, we are all physicians. And I said, I need someone to see her tomorrow and she needs a medical procedure. And like three of them reached out to me and one of the surgeons took care of my little baby today. But you know, I think in caregiving too, finding your, your people, your group is very important. But I do want to go back to talking about the symptoms that someone has. And with James, you know, he was a baby, a tiny baby, my son.

And when my mentor, Dr. Scully came and visited me and I talk about that in the book too, I was, I was so surprised and so touched because in this mom, just vulnerability and depression, you know, he, he showed up at my door and, and we're sitting there and he was holding James and he said, he's very much like one of our patients. And at the same time I realized, oh, you're right. You know, when he's grimacing or when he's breathing rapidly, these are signs of pain, discomfort when you're, when a person with dementia is agitated. And I think it's so important for me to help my caregivers and explain that to them. And that's sometimes a part of my visit. Sometimes I don't even see my patient. My visit is just with the caregiver.

And like something as easy as give them some Tylenol at night because I think they're having arthritic pain. That's the reason they may not be sleeping. Something as easy as, what if they have a urinary tract infection? And they are, and they are in so much pain. Let's look at that. What if they're having breathlessness? We can see those cues. We have to really tune in and listen and pay attention. But sometimes caregivers aren't given those instructions. And just the same as when you said about the mva, I find myself doing things because I feel like I need to understand Them better.

I was angry with the hospital administration for not. I know I'm all over the place, but I was so angry with hospital administration, you know, for not allowing me to practice the way I wanted to practice. And I also thought that their, the way they were running systems was inefficient. I'm like, you can be efficient and you can still be, you know, you can be efficient, you can be a good physician, you can be a good system, take care of people, and still be profitable. Why are you people not seeing this? But then I thought, well, maybe, I don't know, Like, I don't know, I haven't gotten an mba. So I, I came home one day and I told my husband, I'm going to graduate school. I need to understand this. Either I don't know what I'm talking about or they don't.

They're lying to me. And so we both find the time.

I mean, just this, this is, this is the part that maybe you can expand on a little bit too, because I try and get across the caregivers, because you can. And we talked about this just before we started this recording that caregivers get stuck. You are. Your whole life becomes caregiving. And it's really because you. And you think you're losing your own life. And it's very hard to deal with. I managed to, through different ways, and I put it in my book, you know, find ways to keep.

Hold on to my life. And I was able to after my mother passed, regained my career. You do this as a living and you have this very full life. I don't mean full because it's. Your 24 hours is packed like I've never heard anybody before, but because you have, you're a very wealthy person. And I mean, because you have three lovely daughters. I haven't met them, but I can tell they're three lovely daughters. Again, I'm sorry for the loss, but you had a lovely son, you have a lovely husband, you have a practice that does so much for so many people.

And the list goes on. That's that richness. And you managed to do it all. And you are a caregiver. So how do you do it?

Very carefully. And believe me, I do have moments when I completely, I think, want to fall apart. And then I, I take a moment, I take small moments for myself. I do. I spend one. One hour. I try to find one hour for myself a day. Whether that is broken up into different segments or whether that is one full hour where I can be at the gym and I can take some time to.

To reflect and. And just sort of meditate with myself and. And I'm always thinking about what I have and how much worse things could be if something wasn't this way. I'm always like, oh, my gosh, I'm so lucky that I have. Even with James, it was like, oh, I'm so thankful that he was able to live those eight weeks. Like, I am so thankful for that because they said he would maybe have hours, and that's. That was all we would get to know him, you know, I'm so thankful for that. And even, you know, in the worst moments, there are things to be grateful for and thankful for.

But I. I have to constantly remind myself, you know, I'll go home one day. And I had a patient who passed away recently, and I was so sad, but I was able to be there for this patient's partner. And that was what I was reminding myself of, how I was thankful for him. I'm so thankful that I was there for her and she was able to experience what she did in a different way. And she was preparing for his loss. And I went over the following day after my patient had passed away, and I was sitting in my patient's home when we were talking, sharing stories, and I realized he had shared a story with me about his childhood, a very funny story that he never shared with his son or his wife. And I thought, wow, how special.

Again, a moment to be thankful for. How much, you know, we were just. I mean, it was. It was a very funny story. And I was like, I cannot believe he didn't share this with you guys. And they were thankful that I had that. But I think as a caregiver, you can find those opportunities. Even when someone has dementia and you feel like they're lost and you're grieving their loss before they are gone.

You find moments, the long goodbye. Yeah, a very long goodbye. But you find moments where they're right there with you. And that's what. When you capture that moment, you have to remind yourself of, like, oh, my gosh, this is. This is life. And it's amazing. In essence, life is so cool.

And, Jonathan, maybe that's the reason I might have some, like, FOMO about life. I want to feel it all and experience it all and not miss out on any part or piece of it, you know, and maybe that's why I go to these concerts with six teenage girls, and I just find myself like, yes, mom will take. My mom will take us all. And I'm the mom and because I want. I want to see it and experience it all. Because I also have seen how time passes so fast and how precious and sacred this is. So, as a caregiver, even though we think it's, oh, this is. We're in it for a long time and we're exhausted, it's going to pass and some of the special moments that you have with your loved one, those are going to be gone, and then you're going to actually miss it.

You're going to miss those caregiving moments, you know?

Yeah. You know, it made me think. I mean, just before we started the recording, we talked and I, I said, I, I. There was, there was much I loved about caregiving, and I did it with love. I, I would not necessarily want to caregiver again if I didn't have to, but then again, I think I would. The more we start talking, it revives in me many feelings I had. And again, it wouldn't be something I would search out to do myself, but there was so much joy in it and I got so much out of it. And I see even more speaking with you about why it's your passion.

And again, I hearken back to your book and you mentioned it a few times and it was in the final, in the ending, in the final sentence, something to the effect of, now go out and find an elder and basically and learn. And you said it much more eloquently, but soak it up. There's so much you can gain from being with an elder. And it's true. And I can see even more why it's your passion. But I again, go, Nash, I'm so impressed. The world is lucky to have you because you care so much about people. And I really don't say that to too many folks.

You are an unusual gem that we're lucky to have.

That is so kind. And no one has ever said that, but that is so kind. And it's probably too much to, to, to get, but thank you. And you know, I, our. Our whole life I started to listen to the, these sort of gurus, and then I was reading books like Carlos Castaneda when I was in, in, in college. But all of that changed, you know, as I grew older and, and really looking at like. And I mentioned these individuals in my book, like Pima Chodron, Eckhart Cartole, and they just have some very insightful teachings. They give us.

They just give us so much sort of comfort or that's how I have always found their words to be.

Yeah, you put Antoine Sant Exupere in there as well, too. Little Prince Judy put a. What a wonderful book. You know, I grew up with that, but yeah. Anyway, sorry, keep going.

That book is so amazing. Do you know, I mean, just about love. I mean, it was. I read that book several times. I love that book and. But what I found was every interaction I had with an elder, they were speaking these words to me like I was. I was like, wow. They are telling me exactly what I'm saying, Seeking this journey that I'm trying to find.

And how often are younger people trying to find their way and trying to figure out who they are? And all they need to do is sit down with someone that they know. You know, a grandmother, a parent, a friend.

So here's. Here's a tough question comes to mind, and because you will. You will see this more. I certainly saw this when I moved. Hardest thing I did was move my mother into a care facility. And I was still her prime caregiver, Covid. So there was limitations on when I could visit her. And then it got better as Covid sort of waned off.

But anyways, spending time in that care facility, I did see. And of course, I knew that I love my mother dearly. And so I was. And I was her best friend. I was going to be there for her no matter what. It's not the case all the time. You know, there are children who do not love their parents, and they're stuck caregiving for them. They might have terrible emotions towards their parents for different reasons.

It might not just be children towards parents. You know, there's siblings, et cetera. So. And you probably experience this a lot in your profession, dealing with different patients. What do you say to the caregiver who's like, look, I'm stuck caregiving for a person I don't particularly like or love, but I'm their caregiver. What. What do you say to them?

I hear this all the time. This is a very tough situation to be in. But, you know, some of our caregivers may have grown up with parents who may have had addiction issues or abuse issues or neglect issues. And now they're here taking care of this person. And I think that we are only who we are in the moment, that. That we exist. And so if. If I have an adult who was just a horrible human being, maybe, you know, they were abusive, whatever, alcohol, drugs, you name it.

Like, what if all of that in their adulthood. First of all, we have to think what got them to that point. What really brought them to that point was It. Because they were not given the love that they deserved. And then now this is how they were coping. And maybe it was just a coping process. But now, 40 years later, this is someone who is. This is a frail person who has physical needs, emotional needs.

They are no longer that individual. And so if we can. And this is very difficult to do, but if we can separate those two individuals and look at who we have in front of us, it makes the caregiving process a lot easier, because now that's where the empathy, compassion can. Can happen. And also, it might open. It might maybe open up some space for us to realize, like, oh, maybe, maybe they were doing the best that they could. And. And this.

That is all they could do at that moment in time. I think about that a lot with my own parents because, you know, we all do, like, if we're ever angry with something. And I. And I think, wow, they really did the best that they could under the circumstances that they had. And I tried to truly understand my mother and my father's circumstances. And in my book, I talk about this. You know, my father went through the revolution. I mean, this is a man who was an engineer, had this huge company, was a mayor of a city.

Everything was taken away from him. Then we moved to Salt Lake City, Utah, because that is where my mother's family was. And, yeah, there were. There was some definite biases for him to try to find jobs. And here is this man. And over the summers, we would work on these AutoCAD projects. I would create spaceships. And, you know, I want.

I was. I always thought I would be an astronaut. Like, that was what I wanted so bad. And then I thought, well, they don't really go very far.

I can relate to that.

You know, I was like. I was like, maybe they don't. Maybe they don't go as far as I would like. But the human body, like, exploring that and then exploring everything else that I can possibly explore around me on Earth, I was like, I can do that. And. And maybe, maybe in the future, you know, I was a big trekkie, but maybe in the future, my future generations. Were you a big trekkie?

I still am a big trekkie. Oh, and I still. Well, I mean, I work with astronauts. I tried to be an astronaut. The journey's been fun and it still is. So life worked out, but I totally understand where you're coming from.

But he had so many challenges and, you know, so, yes, he had moments when he was, I think, just angry or when he just couldn't emotionally be there for Us. And now, I mean, the man is so content and happy just being a grandfather and being my carpool. But our relationship has changed in a way. He is a completely different person because his circumstances are not as difficult as they were, and he has settled and he's no longer, he no longer holds some of that anger that he did when he was a younger adult because of so many things that he lost, that loss of the sense of self. But it also allowed me to understand, wow, they did the best that they could. So when I falter as a parent, I always remember my kids. I'm doing the best that I can. I actually tell my kids this all the time too.

Mommy is doing the best that she can. And it may not be the best, but I'm sorry, I will, you know, I'm here.

You know, I, I, I think I can relate a little bit to what you're saying about your father, because my father suffered terrible PTSD from the Holocaust, from, you know, after internments in both Auschwitz. Duck. Ellen. Losing his whole family. So I, for me, he was a monster at home. He was very abusive, and that was very hard for me. And then he, he, he got sick and, and didn't last long when I was 15. And I took care of him.

But I, I, it's, I really like what you said. I, even at 15, I knew that I had to separate if those difficulties, let's, let's put it simply that I had with him from who I was dealing with now, and the fact that I had a heartfelt obligation to take care of him in the best way possible and show him compassion. And so I did that. And it was not easy to do. And I don't know how I figured that out at such a young age. But I really like that you said that. To make that difference between caring for who, that, what that person is now, what they, what they have, and try put the past aside is, that's a hard thing to do, but it is.

It really is. But, you know, and the same thing for, you know, giving people second chances. Like what happens when someone serves a prison sentence and they've done the time for whatever crime it was. Do we hold that against them when they've done everything, have gone through the recovery, or do we try to allow that individual to, to, to join us as a collective, as a human being? You know, we, that's who we have to be. That is, you know, our humanity depends on that. You know, the hope for life. It's. We have to be together.

Together. We do better and, and I also think that sometimes one person ends up being the primary caregiver, which can be so difficult. And it's so difficult, you know, I know for you, like, wow, because of COVID like your mother. And you had a totally different circumstance because for a while it was just you, you know, that intimate care caregiving situation that you had. But, you know, other times it's just adult siblings who refuse to step in and assist. Especially had an individual who was, we'll just call them like a monster when they were younger. And now you, you're like, wow, here I am in this. And, and sometimes the, the reward for you needs to be.

I'm. I'm learning to be a better person. I have times to reflect on, on these needs, on who this person is and who this person no longer is. You know, that monster is no longer there. So I need to take care of this frail, vulnerable person that is in front of me.

I think you summed that up incredibly well. I think we should come towards a close. And what I would like to ask is what tips might you have? And. Well, any tips you would have for caregivers, some of your top tips. But I think towards the folks who are. They can see it coming. Hey, I'm not a caregiver right now, but it's coming. If it's my parents, my parents are getting older and you're in a stage where there are certain things you can do to sort of set everybody up.

You. You're the person who's going to be caregift for a better situation. I didn't want to say success, but what are some things you might suggest?

Our health is not forever, our freedoms are not forever. And, and, and I think we need to stop pretending like we are always going to be this version of ourselves, healthy and okay, or this version of ourselves as a, as a parent or as an adult child where our parents are okay. I had a situation. My sister and I both had a situation. She was living in Connecticut and my mother ended up hospitalized. And I knew what her goals were again, as a geriatrician. I asked her her goals and my father's goals. She said, I don't want to be in a nursing home.

And so she was hospitalized. My sister and I surprised them by showing up in Salt Lake City and like, what are you guys doing? You know, they were trying to hush, hush the situation. So my sister and I sat down and we had a conversation about this. And maybe this is the geriatrician in me. And I said, we need to all be in one place because I have three young children and my sister has two young children. I said, we need to be together in a way that we can support each other as our parents are aging. And we did that. Everyone moved to Asheville, North Carolina, so we're all here.

I know it took about two years, but this is like, extreme, right? Had a conversation with my mom. I said, mom, if you have a stroke, which is, you know, our family, we have dementia and we have strokes, and these are. These are the things that we know. If you have a stroke, I will not be able to bring you near me, and I will not be able to provide you the care that you need, and I will not be able to honor your wishes. So we had that conversation, and it was very challenging. It was very difficult. And I was surprised, you know, they did it because they had a huge social circle there. They had family, they had friends, but they did.

They moved. And it was. It took time to adapt. Not everyone needs to do that. But I think that if you're going through the aging process and you think, I may not have a child that's going to be my caregiver, and we don't necessarily need to rely on our children to be our caregivers, or I may not be able to take care of my partner as a caregiver, or I may need to become a caregiver. You need to, I think, think about what your caregiving role might look like when that time occurs and what are the needs that I may need to meet. And if you don't think that you can help physically or emotionally or financially, you need to start preparing for those changes, either thinking about retirement communities or nursing facilities, because these things take time to get into. An assisted living where I live takes about 18 to 24 months.

I'm assuming that's around maybe how it is in California to get into a CCRC retirement community. Where I live is five to 10 years, depending on the facility that you choose. And so when my patients initially come in and I start talking to them about this, which other doctors don't, we talk about their. The future and what their needs are going to be. They're like, well, I'm fine. Why would I need to. I said, oh, no, no. We need to plan now for 10 years from now.

And so I think planning and not just. Just assuming we're going to be okay because our health is something that comes and goes. We don't have our health always, so that is very important. And then if you are all of A sudden thrown into caregiving. Because people are often just thrown into caregiving. You know, we have to try to gain a little perspective around what is happening here and what, what do. Where is my mindset around this caregiving journey that I'm about to. To enter and what type of help am I going to need? So I think that that perspective is important and identifying what obstacles the person has.

Where is your circle of individuals that can step in and help sometimes with people who have dementia who can step in for respite care. I had a patient who recently finally convinced her that let's have someone there three nights a week, just three nights a week so you can sleep through the night. And was very hesitant. But my patient liked to get up and walk around at night and do things. Just what happens. And my caregiver was so happy a few weeks after I was speaking to her and she said, oh my gosh, I feel so much better just having three nights of sleep. I mean you need every night. But just three nights was so meaningful.

And she was still there if there was an emergency, but was able to truly rest. So figuring out the obstacles I thinking about I am going to have overwhelming emotions. So there is so much that goes into that. Having a personalized care plan. Now I am working on this module.

I was going to say powers of attorney.

Powers of attorney, exactly. Yes. Let's go back. So elder law attorneys are very important. I generally go through living wills and health care power of attorney forms with my patients and then I have them take them to their attorney so that they can be notarized. But we talk about it is there's a lot of confusion. And what does this actually mean or what does that actually mean? Again, as I think a social gerontologist who became a geriatrician. I have this other perspective.

So I. I understand these forms in a different way. That's really important. Do not resuscitate forms. Oh my gosh, those are so important. It doesn't mean do not treat. It just means do not pound on my chest if my heart stops beating. And would you understanding that?

Yeah. And what you create. Get this done early while you're still of good state of mind. Because if the person is no longer of sound mind, they can't assign power of attorney. And then, and then the children, for example, actually have no right. It's the state that takes over making decisions on the person's care. Have I got that right? Because the same in Canada.

Yeah, well, pretty much so in North Carolina lost change a little bit throughout the state. But as far as healthcare goes, healthcare proxy goes, it's generally like, okay, first it's the spouse, then it's the adult children. But that's just kind of some healthcare decisions. But as far as financials go, yeah, you know, and one of the things I, you know, when my parents moved here, we had an elder law attorney. We put everything in a trust and my sister and I are the executors because things will go into probate. What happens when you need to pay for a funeral and you can't because you can't access your parents money? And what happens when you need to pay their mortgage but you can't? And so then what happens? The house could go into foreclosure. You know, there are so many things to think about. And I, I always stress, you know, find an elder law attorney.

That is the first step. Make sure you're physically on the bank accounts with your children. Because, you know, if something happens to my parents, like I can go and pull money out of the account now, you know, you need your children. You, if you need to trust them and if you don't have that, you can have, you can designate people through like your attorney and you can make sure you state your wishes and what you want. I have a few patients right now who don't have anyone, but they do have a guardian. And the guardian follows exactly what the patient wanted and had set out and had written out. So when I need something, I reach out to the guardian and I say, hey, this is what's happening. This is where we are.

These are my patient's wishes. And we, and we follow the patient's wishes and we honor their goals. And not talking about end of life care and goals, that, that leaves a big burden to, you know, for the people that are left behind. My husband and I were having this conversation. I think the attorney thought we were, you were nuts. But you know, he ends with saving lives like critically, like ill patients. I help people exit in a much more peaceful way. But we were sitting and he said, I said, just cremate me, I don't care.

And he said, I would like you to compost my body. And you know, I had this whole thing and I looked at him, I'm like, are you kidding me? Are you kidding me right now? Do you know how hard that is? How much work I have to do that? And then I said, well, you better just promise to die after me so that our kids can be left with that responsibility. But I'm young, I'm in my 40s and we had the conversation. So it's also never too early to have those conversations with your children. And my 15 year old knows you do not allow mommy to suffer. You let her go down to what if you have a neurodegenerative disease and your mind is sharp like als, but your body is failing you? Well, for me, you know, it's a terrible disease. But my husband, you know, and I had this conversation. I was shocked at what he wanted.

He said, if I, if as long as I'm aware, I would like to see our children grow. I'm okay being on a ventilator. And I'm like, are you kidding me? Like you of all people know this. And I said, well, I, I know they'll be fine. You pulled, pulled the plug. I can't. That's not quality of life to me. And quality of life to him was just witnessing the children grow up, you know, so it, but we have these conversations too.

But it's so important when someone is an elder or early stages of dementia where you're still very aware and things are scary, but you can start, you can make those decisions still. And you know, then you don't have to have adult protective services get involved and guardians, it can get very, very messy. So those are important things to take care of. And then once you have all of those things taken care of, then I believe really as a caregiver, thinking about your mission statement as a caregiver, like what is your goal and what have you set out to do and creating a personalized self care plan for yourself. And it doesn't mean you have to be absent a lot because guilt plays a big role in caregiving, you know, being gone. But sort of these small moments that can accumulate over the day that you can take just for you and you can have that or maybe changing your sleep routine around. I just had a person who, they just started to sleep when their loved one is sleeping and it might be ruining their day. But now this person is like, we're having the best time when we're awake together.

This is great. You know, while they were trying to like go to this, go to that, all this stuff while their loved one was asleep and then when their loved one is awake, then they're exhausted, so they just change their sleep routine around and then think about what happens to you after you're no longer a caregiver. So if you have completely. I put my hand up because just delved into it. You asked me, we talked about this

before we start recording.

Yes, Go ahead. And so what happens, you know, And Jonathan, I think for you, who was a caregiver to mom, had dementia, and, you know, how did you transition that step?

Yeah, that's a really good question. You know, I'll start with my father, because it was when I was younger, and that was a tough transition because I was a teenager and I was in a boarding school. So, you know, I went back to boarding school after he passed, and it was a very tough transition. But I will say that I had wonderful friends, and even at our young ages, they were very understanding, and the teachers in the school were very understanding, too. So they fostered together an environment that helped me make that transition at a critical time in my life for my mom. As I said, I'm still transitioning out of that, and I'm dealing with that by doing this very thing, this caregiver podcast, there are still things I feel guilty about. Guilt is the enemy to good decision. Guilt is the enemy to caregiver, being the best that they can be, which is important, that they can be the best they can be for the person being cared for.

But, you know, my mom's. It's a few years now, but I still think about her all the time. There's still things I feel guilty about. Part of this, that I'm doing this podcast, so I'm not telling everybody, go out and write a book, do a podcast, but I'm trying to help other people, and that's a bit of my therapy. So that's part of how I do that transition. And I do my best to carefully offer advice to others when they're open to it, and not to go into stories about what happened to me unless they really ask. So I try and be. Let people know that maybe I might have some experience that might be helpful to them if they're going through it.

And I'm here, if I can be helpful without being burdensome to them or overbearing, I guess, is one of the other ways I do it. And sometimes people really do want to talk, and sometimes they don't, but that's how I do my transition. So. So, yeah.

Yeah. A friend of mine, just a few days ago, I reached out to see how they were doing, and my friend said, I just don't feel like talking right now. And I said, that's fine. I'm just checking in. And. And then they said, you know, their sibling was coming to sit with them, and they got, this is good. Like, this is. This is perfect.

And. And I think that's another part if you're supporting a caregiver, just, you know, when I send a message, I'm like, I don't need a reply. I'm just checking in. I am right here. If you need me to come over. If you need me to pick somebody up, I'm available. And that's how I think we can sometimes support our caregivers, too, and offer something not necessarily right and. And just be like, you know, I'm available, but I don't need to.

To tell you all of it. Did you do this yet? Did you do that? Did you talk to this person? Did you talk to that person? And, yeah, I. I didn't share this short time, but my sister just was recently diagnosed with breast cancer for the second time. And so she just had. My sister, you know, it's awful, but had to have a mastectomy, and she just finished chemo. So we were celebrating. We were happy. She starts radiation soon, and, you know, it is.

It's so hard. And she's younger than me, and I, you know, there's this, like, why would this happen to my young sister? Like, how could it happen to my young sister? She's so healthy. And when I would reach out to her and. And I would say, how are you? Are you doing okay? And she said, sometimes I get really tired of people asking me how I'm doing. I said, well, I just am asking met medically any IV fluids or anything, but. But you don't have to. You don't have to respond. And it's okay.

It's okay to not feel okay. It's okay to tell people that you don't want to talk. It's okay to tell people that you're tired of being asked how you're doing, all of that. There's no. It's. Illness is messy, caregiving is messy, and there's no rhyme or reason. But like you said, you know, sort of gauging what a person might want from your interaction is really important because that's another empathy piece, right? Figuring that out, too. Oh, yeah, it's an important piece.

I'll say. Also, the bit about how do you transition out of caregiving when that. Because it's going to come to an end. There's. The other thing is it will come to an end. Honestly, many people are stuck with it for many years, but my mom lived until she was almost 99, and so she lived a long life. But she was very clear to me right up until the end. Do not waste time.

Make the most of your life. And even when I was caregiving for her. She was in her more lucid moments, you know, take care of yourself, do the most for yourself. And so I, I, I'm really all about that, especially these days. Like, and like anybody else, I'm human. So I have those silly moments where I'm sitting around feeling sorry for myself. But I remind myself, like, get up. Stop.

There are things to do, there is fun to be had. And the best thing I can give back to, to the, you know, the, of the folks who need care is to show them that I'm living my life and making the most of it. And not in a greedy way, but making the most of life. I mean, make the most while you have it. Which is maybe that's where we'll bring it to a close. Because Gulnaz, I could talk to you for like another four or five hours. It would go non stop because there was so much to learn from you. But you are, you know, I'll use that as a segue.

You are a person who is living everything fully clearly, despite all the challenges you've had. And we only touched on some of them. You know, I read about them. I've heard from you previously. You are making the most of everything in your life. You are making the most of everything in your family's life lives. You're making the most of everything for all of your patients. And that is so clear.

And I really want to encourage people to. By the. Where can your book Life Love and the in between by Golnas.

I'm going to say your Saleh.

Thank you.

I'll say it. Thank you, Sheriff. Saleh.

Saleh. And, and where can they find your book?

It's sold everywhere. And I recently completed the audiobook. I narrated the audiobook, which was very special. I figured, you know, if something happens to me, my kids have my voice and they know my lessons, my life lessons. So I am now done with that. But they can be found. Amazon Bookshop anywhere. I do want to mention I have

to spell your name. This I can do, even though I was having trouble saying Golnash. G O L N O S H. And your last name, Sheriff Sella. S H A R A F S L H S A L E H. Correct.

Yes.

Okay. Yes. You can find your book everywhere. Please go ahead. You were talking about the audiobook.

Yeah, the audiobook is out as well, you know, wherever you. I just saw it on Spotify. It's on excellent. It's everywhere on Apple Books. But I do, I have a blog. It is completely free. And earlier we were talking about how there is such a shortage of geriatricians. But the blog is called Geriacademy G e r I academy.com and it is completely free.

I don't allow them to advertise on the blog because I want to make sure that there's information for individuals just on aging and that they can take some information back to their doctors so they can advocate for themselves. But there are some caregiving blog posts on there. I'll probably need to update those. There are other age related topics and they're made for normal people to read, not doctors. But there is also a link to my book there, so if anyone wants to find it. But yeah, g e r iacademy.com and it was. It was really started during the pandemic as a way to do some outreach because we couldn't go out into the community. And now people from all over the world are reading the blog, which is exciting.

So I keep writing it.

Or do you have the time? Seriously?

I don't know.

And your practice, Golden Oak.

Yep, it's Golden Oak Medicine. It's in Asheville, North Carolina. And it is a very special practice. We're all women that work. We have a therapy dog, and sometimes our kids need to accompany us to work, you know, if they're sick. And we found a way to sort of support ourselves as mothers, as caregivers, as physicians, nurses, and we want to. We want to do the job that we love, but we also have these other responsibilities. And I think Dr.

Blaney, my partner, and I were able to kind of create a space to do that. It's been very special.

Well, look, Golnasha was. I mean this so sincerely. It was absolutely outstanding to have you here as a guest on this podcast. I think what you're giving the guests or the listeners are only a taste of what you give every moment, every day in your life. And I really encourage people to go out and get your book. I'll say it again. Life, love, and the in between, as you mentioned. Find it everywhere.

You've got your blog, your academy, your practice, Golden Oak. And I really encourage people to reach out to you. You are, as I mentioned, a gem. It's hard to find people like you on this planet. And I'll also finish off by saying I don't talk politics here. But you did mention that we're in a very tough time on the planet right now, and the level of conflict is unusually high. And you so well, put it how we have to. And you even mentioned it here about how we're best when we work together, and I still advocate for that.

So, again, thank you so much for being on this show. And thank you, everybody, for listening. And please reach out and get golden ashes. Get Dr. G's book.

Thank you. It was a pleasure to be on your show. I loved speaking with you about caregiving.

Thanks.