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"content": "\u003cp>Dr. Jessica Zitter specializes in critical and palliative care medicine and practices at Highland Hospital in Oakland, where she helps people with serious illness talk about how they want to live, all the way to the end.\u003c/p>\n\u003cp>Zitter says those are conversations we all should be having with our loved ones — even if we’re healthy and young. She is the author of \u003ca href=\"https://protect-us.mimecast.com/s/GEp6CyPmRxsNByzzfZXprl?domain=jessicazitter.com\" target=\"_blank\" rel=\"noopener noreferrer\">Extreme Measures: Finding a Better Path to the End of Life,\u003c/a> and her work has been featured in the documentary \u003ca href=\"https://www.netflix.com/title/80106307\">“Extremis”\u003c/a> on Netflix, as well as the forthcoming film \u003ca href=\"https://protect-us.mimecast.com/s/YsLqCzpn0ysRjmppUXnBtw?domain=caregiveralovestory.com\">“Caregiver: A Love Story.” \u003c/a>\u003c/p>\n\u003cp>Here are three stories about her patients, followed by some concrete tools you can use for planning and talking about the end of your life with loved ones.\u003c/p>\n\u003ch3>Michael Thomas: ‘Enjoying Every Moment’\u003c/h3>\n\u003cp>Michael Thomas is 64 and has COPD, a lung disease that makes it hard to breathe. He has already been in and out of the hospital several times this year and is particularly vulnerable if he were to get sick with COVID-19.\u003c/p>\n\u003cp>When Zitter talked with him over Zoom this spring, she asked him what he wanted most. His answer? To be with his children and grandchildren in Ohio. 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I’m concerned you may not have as much time to live as you think you do. If someone told me, ‘Michael is going to die within the next six months,’ I would not be surprised.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Zitter said she has to steel herself to deliver this kind of news. But she believes her patients deserve to know the truth.\u003c/p>\n\u003cp>“I know you have some serious goals, and they include being with family,” she told Thomas. “I would hate for you to miss that opportunity.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Jessica Zitter, critical and palliative care specialist\"]‘This is really what palliative care is all about. It’s about how people want to live their lives. That informs how people want to die. But it really starts with how they want to live.’[/pullquote]\u003c/p>\n\u003cp>Thomas has since moved to Ohio to be close to his family — a decision sparked by his conversation with Zitter and Highland Hospital’s chaplain, Pastor Betty Clark.\u003c/p>\n\u003cp>“I didn’t want to come home. I didn’t want my family to see me in the condition that I’m in,” Thomas told Zitter over zoom after his move to Ohio. “That’s why I was hesitant to come. But then I know they love me so much. And here I am today, enjoying every moment.”\u003c/p>\n\u003cp>“It just shows that if we can just bring ourselves to just face our mortality and plan for it, we can get what Michael got,” Zitter said. “We can get this precious time with the people that he loved the most or whatever it is that’s most important to you.”\u003c/p>\n\u003cfigure id=\"attachment_11838351\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838351\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg\" alt=\"Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \u003ccite>(Courtesy of Jessica Zitter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Evelyn Jarillo: ‘It Makes You Think About Others’\u003c/h3>\n\u003cp>Evelyn Jarillo is a grocery store worker in Los Angeles who got sick with COVID-19 in March. She recovered, but her husband, who has diabetes, also tested positive and is still suffering from health complications. She’s also worried about her 22-year-old son.\u003c/p>\n\u003cp>“When you’re sick and you’re feeling the way you feel, it makes you think about others,” Jarillo told Zitter when they spoke by Zoom recently. “It made you think about what happens if my son gets sick, what happens if he doesn’t make it? No mother will be able to deal with [talking to] their kids about, ‘Son, if you die tomorrow, what do you want me to do?’ ”\u003c/p>\n\u003cp>“Wait, let me make sure I understand,” Zitter said. “Are you saying you can’t ask your son, ‘What you want me to do if you got COVID and you were in the hospital on a ventilator?’ You don’t feel like you could talk to him about that?”\u003c/p>\n\u003cp>“I can’t,” Jarillo told her.\u003c/p>\n\u003cp>“Evelyn saw something that most of us don’t get a chance to see,” said Zitter. “She saw the potential for death.”\u003c/p>\n\u003cp>Like many of us, when Jarillo thought about members of her family dying, she faced a mental block, Zitter said. It seemed easier for Jarillo to share her thoughts about flower arrangements for her own funeral than to think about tough topics like a do-not-resuscitate order or discussing it with her children.\u003c/p>\n\u003cp>[aside tag=\"end-of-life\" label=\"related coverage\"]\u003c/p>\n\u003cp>Zitter had a similar conversation with her own son on his 18th birthday by playing a game called \u003ca href=\"http://www.gowish.org/\">Go Wish\u003c/a>. The game helps families talk about their preferences around death and the important things they want to hold on to throughout the course of their life.\u003c/p>\n\u003cp>“Like Evelyn, the last thing I want to do is think about my children dying,” said Zitter. “It’s just grim. It’s horrifying. It feels in some ways like not what a mother does, right? A mother is supposed to focus on the positives, the weddings. We’re not supposed to focus on the deathbed moments of a child. But asking open-ended questions is something you can and should do with your family. Just leaving space for more.”\u003c/p>\n\u003cp>Zitter has conducted workshops on death and dying with teenagers. Just like sex education, she says, there should be a place for death education in high schools.\u003c/p>\n\u003ch3>Andrew Rich: ‘This Is Where I Want to Die’\u003c/h3>\n\u003cfigure id=\"attachment_11838192\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838192\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg\" alt=\"\" width=\"800\" height=\"803\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1020x1024.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-160x161.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1530x1536.jpg 1530w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut.jpg 1904w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Rich with his dad, Neville Rich. \u003ccite>(Courtesy of Andrew Rich.)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrew Rich traveled to Sonoma early in the pandemic to celebrate his dad’s 92nd birthday. During the visit, his father got sick. They didn’t realize it was COVID-19, and when his father had great difficulty breathing, the family decided to bring him to an emergency room. He spent two weeks on a ventilator and then died alone in the hospital, because COVID-19 rules meant no one could visit him.\u003c/p>\n\u003cp>Rich said that was not what his dad had planned when he imagined his death.\u003c/p>\n\u003cp>“If we could rewind the clock two weeks to that Sunday morning when he collapsed, if we could have put him back in bed and said, ‘Dad, there’s the high likelihood that you have COVID and you’re 92, what do you want to do?’ He absolutely would have said, ‘Leave me here. This is where I want to be. I want to be in this bedroom looking out in the valley. And if I die, this is where I want to die,’ ” Rich said.\u003c/p>\n\u003cp>“The best-laid plans can get completely upended in the face of fear and illness and symptoms and your family not being there with you,” said Zitter, who recommends that families talk proactively about their wishes. “These conversations have to happen early and frequently. We have to get over the fear of talking about it and make it part of our family’s conversations around the dinner table.”\u003c/p>\n\u003cp>Zitter said that she is “very much committed” to critical care medicine and said that it is “in some ways miraculous.” But Zitter says the medicine that keeps us alive should not distract us from the truth of our mortality.\u003c/p>\n\u003cp>“We’ve watched the rise of the hospital and the intensive care unit to the point that we’ve become enamored of the many interventions and treatments that we consider to be the offerings of our modern medical system,” she said. “We’ve really lost the discriminating power and allowed ourselves to get completely distracted from making the preparations we need to face death, from thinking about our deaths and how we want to live, right to the end.”\u003c/p>\n\u003cp>“This is really what palliative care is all about. It’s about how people want to live their lives,” Zitter said. “That informs how people want to die. But it really starts with how they want to live.”\u003c/p>\n\u003ch3>\u003cstrong>Resources\u003c/strong>\u003c/h3>\n\u003cp>Here are things you can do to prepare, no matter your age or health.\u003c/p>\n\u003cul>\n\u003cli>Play “\u003ca href=\"http://gowish.org/\">Go Wish\u003c/a>” with your loved ones. The game helps people start talking about what is most important to them in terms of health and life.\u003c/li>\n\u003cli>Have a conversation about death at the dinner table. The interactive website \u003ca href=\"https://deathoverdinner.org/\">Death Over Dinner\u003c/a> can help you plan your conversation.\u003c/li>\n\u003cli>Write up an \u003ca href=\"https://www.nhpco.org/patients-and-caregivers/advance-care-planning/advance-directives/downloading-your-states-advance-directive/\">Advance Directive\u003c/a> and give it to your doctors and your loved ones. This document should be reviewed whenever your medical condition changes or you learn new information about an illness or condition.\u003c/li>\n\u003cli>People with advanced illness who are considered to be at risk for a life-threatening clinical event should talk to their doctor about completing a \u003ca href=\"https://polst.org/form-patients\">POLST\u003c/a> form. A POLST form is a medical order that documents a person’s preferences for receiving or not receiving certain types of medical interventions (for example, chest compressions, a feeding tube or a breathing tube).\u003c/li>\n\u003cli>If needed, execute a \u003ca href=\"https://www.nolo.com/legal-encyclopedia/california-financial-power-of-attorney-31871.html\">Durable Financial Power of Attorney\u003c/a>, a simple way to arrange for someone to handle your finances, such a bills or insurance matters, if you are unable to do so yourself.\u003c/li>\n\u003cli>Write your \u003ca href=\"https://money.usnews.com/money/personal-finance/family-finance/articles/steps-to-writing-a-will\">last will and testament\u003c/a> and/or a \u003ca href=\"https://www.nextavenue.org/do-you-need-a-trust-for-your-estate-plan/\">revocable trust \u003c/a>to clarify and determine how your assets are distributed after death.\u003c/li>\n\u003cli>Consider what your preferences are for a memorial ceremony, and discuss it with your loved ones.\u003c/li>\n\u003c/ul>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=TJiY8duVgz0\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Jessica Zitter specializes in critical and palliative care medicine and practices at Highland Hospital in Oakland, where she helps people with serious illness talk about how they want to live, all the way to the end.\u003c/p>\n\u003cp>Zitter says those are conversations we all should be having with our loved ones — even if we’re healthy and young. She is the author of \u003ca href=\"https://protect-us.mimecast.com/s/GEp6CyPmRxsNByzzfZXprl?domain=jessicazitter.com\" target=\"_blank\" rel=\"noopener noreferrer\">Extreme Measures: Finding a Better Path to the End of Life,\u003c/a> and her work has been featured in the documentary \u003ca href=\"https://www.netflix.com/title/80106307\">“Extremis”\u003c/a> on Netflix, as well as the forthcoming film \u003ca href=\"https://protect-us.mimecast.com/s/YsLqCzpn0ysRjmppUXnBtw?domain=caregiveralovestory.com\">“Caregiver: A Love Story.” \u003c/a>\u003c/p>\n\u003cp>Here are three stories about her patients, followed by some concrete tools you can use for planning and talking about the end of your life with loved ones.\u003c/p>\n\u003ch3>Michael Thomas: ‘Enjoying Every Moment’\u003c/h3>\n\u003cp>Michael Thomas is 64 and has COPD, a lung disease that makes it hard to breathe. He has already been in and out of the hospital several times this year and is particularly vulnerable if he were to get sick with COVID-19.\u003c/p>\n\u003cp>When Zitter talked with him over Zoom this spring, she asked him what he wanted most. His answer? To be with his children and grandchildren in Ohio. But he also said he didn’t feel a sense of urgency to visit them, because he believed he had plenty of time left.\u003c/p>\n\u003cfigure id=\"attachment_11838731\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838731\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-800x450.jpg\" alt=\"Michael Thomas' family visits him in an Ohio hospital.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped-1536x864.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44913_Michael-Thomas-with-family_cropped.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Thomas’ family visits him in an Ohio hospital. \u003ccite>(Courtesy of Michael Thomas)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“You are a more confident person than I am about myself!” Zitter told him. “I want to be totally frank with you, because I think you deserve that. I’m concerned you may not have as much time to live as you think you do. If someone told me, ‘Michael is going to die within the next six months,’ I would not be surprised.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Zitter said she has to steel herself to deliver this kind of news. But she believes her patients deserve to know the truth.\u003c/p>\n\u003cp>“I know you have some serious goals, and they include being with family,” she told Thomas. “I would hate for you to miss that opportunity.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘This is really what palliative care is all about. It’s about how people want to live their lives. That informs how people want to die. But it really starts with how they want to live.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Thomas has since moved to Ohio to be close to his family — a decision sparked by his conversation with Zitter and Highland Hospital’s chaplain, Pastor Betty Clark.\u003c/p>\n\u003cp>“I didn’t want to come home. I didn’t want my family to see me in the condition that I’m in,” Thomas told Zitter over zoom after his move to Ohio. “That’s why I was hesitant to come. But then I know they love me so much. And here I am today, enjoying every moment.”\u003c/p>\n\u003cp>“It just shows that if we can just bring ourselves to just face our mortality and plan for it, we can get what Michael got,” Zitter said. “We can get this precious time with the people that he loved the most or whatever it is that’s most important to you.”\u003c/p>\n\u003cfigure id=\"attachment_11838351\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838351\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg\" alt=\"Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44911_Jessica-Zitter-Evan-Rusoja-with-patient-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Jessica Zitter with a patient at Highland Hospital in Oakland. \u003ccite>(Courtesy of Jessica Zitter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Evelyn Jarillo: ‘It Makes You Think About Others’\u003c/h3>\n\u003cp>Evelyn Jarillo is a grocery store worker in Los Angeles who got sick with COVID-19 in March. She recovered, but her husband, who has diabetes, also tested positive and is still suffering from health complications. She’s also worried about her 22-year-old son.\u003c/p>\n\u003cp>“When you’re sick and you’re feeling the way you feel, it makes you think about others,” Jarillo told Zitter when they spoke by Zoom recently. “It made you think about what happens if my son gets sick, what happens if he doesn’t make it? No mother will be able to deal with [talking to] their kids about, ‘Son, if you die tomorrow, what do you want me to do?’ ”\u003c/p>\n\u003cp>“Wait, let me make sure I understand,” Zitter said. “Are you saying you can’t ask your son, ‘What you want me to do if you got COVID and you were in the hospital on a ventilator?’ You don’t feel like you could talk to him about that?”\u003c/p>\n\u003cp>“I can’t,” Jarillo told her.\u003c/p>\n\u003cp>“Evelyn saw something that most of us don’t get a chance to see,” said Zitter. “She saw the potential for death.”\u003c/p>\n\u003cp>Like many of us, when Jarillo thought about members of her family dying, she faced a mental block, Zitter said. It seemed easier for Jarillo to share her thoughts about flower arrangements for her own funeral than to think about tough topics like a do-not-resuscitate order or discussing it with her children.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Zitter had a similar conversation with her own son on his 18th birthday by playing a game called \u003ca href=\"http://www.gowish.org/\">Go Wish\u003c/a>. The game helps families talk about their preferences around death and the important things they want to hold on to throughout the course of their life.\u003c/p>\n\u003cp>“Like Evelyn, the last thing I want to do is think about my children dying,” said Zitter. “It’s just grim. It’s horrifying. It feels in some ways like not what a mother does, right? A mother is supposed to focus on the positives, the weddings. We’re not supposed to focus on the deathbed moments of a child. But asking open-ended questions is something you can and should do with your family. Just leaving space for more.”\u003c/p>\n\u003cp>Zitter has conducted workshops on death and dying with teenagers. Just like sex education, she says, there should be a place for death education in high schools.\u003c/p>\n\u003ch3>Andrew Rich: ‘This Is Where I Want to Die’\u003c/h3>\n\u003cfigure id=\"attachment_11838192\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11838192\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg\" alt=\"\" width=\"800\" height=\"803\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-800x803.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1020x1024.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-160x161.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut-1530x1536.jpg 1530w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/09/RS44908_Andrew-Neville-smiling-qut.jpg 1904w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Rich with his dad, Neville Rich. \u003ccite>(Courtesy of Andrew Rich.)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrew Rich traveled to Sonoma early in the pandemic to celebrate his dad’s 92nd birthday. During the visit, his father got sick. They didn’t realize it was COVID-19, and when his father had great difficulty breathing, the family decided to bring him to an emergency room. He spent two weeks on a ventilator and then died alone in the hospital, because COVID-19 rules meant no one could visit him.\u003c/p>\n\u003cp>Rich said that was not what his dad had planned when he imagined his death.\u003c/p>\n\u003cp>“If we could rewind the clock two weeks to that Sunday morning when he collapsed, if we could have put him back in bed and said, ‘Dad, there’s the high likelihood that you have COVID and you’re 92, what do you want to do?’ He absolutely would have said, ‘Leave me here. This is where I want to be. I want to be in this bedroom looking out in the valley. And if I die, this is where I want to die,’ ” Rich said.\u003c/p>\n\u003cp>“The best-laid plans can get completely upended in the face of fear and illness and symptoms and your family not being there with you,” said Zitter, who recommends that families talk proactively about their wishes. “These conversations have to happen early and frequently. We have to get over the fear of talking about it and make it part of our family’s conversations around the dinner table.”\u003c/p>\n\u003cp>Zitter said that she is “very much committed” to critical care medicine and said that it is “in some ways miraculous.” But Zitter says the medicine that keeps us alive should not distract us from the truth of our mortality.\u003c/p>\n\u003cp>“We’ve watched the rise of the hospital and the intensive care unit to the point that we’ve become enamored of the many interventions and treatments that we consider to be the offerings of our modern medical system,” she said. “We’ve really lost the discriminating power and allowed ourselves to get completely distracted from making the preparations we need to face death, from thinking about our deaths and how we want to live, right to the end.”\u003c/p>\n\u003cp>“This is really what palliative care is all about. It’s about how people want to live their lives,” Zitter said. “That informs how people want to die. But it really starts with how they want to live.”\u003c/p>\n\u003ch3>\u003cstrong>Resources\u003c/strong>\u003c/h3>\n\u003cp>Here are things you can do to prepare, no matter your age or health.\u003c/p>\n\u003cul>\n\u003cli>Play “\u003ca href=\"http://gowish.org/\">Go Wish\u003c/a>” with your loved ones. The game helps people start talking about what is most important to them in terms of health and life.\u003c/li>\n\u003cli>Have a conversation about death at the dinner table. The interactive website \u003ca href=\"https://deathoverdinner.org/\">Death Over Dinner\u003c/a> can help you plan your conversation.\u003c/li>\n\u003cli>Write up an \u003ca href=\"https://www.nhpco.org/patients-and-caregivers/advance-care-planning/advance-directives/downloading-your-states-advance-directive/\">Advance Directive\u003c/a> and give it to your doctors and your loved ones. This document should be reviewed whenever your medical condition changes or you learn new information about an illness or condition.\u003c/li>\n\u003cli>People with advanced illness who are considered to be at risk for a life-threatening clinical event should talk to their doctor about completing a \u003ca href=\"https://polst.org/form-patients\">POLST\u003c/a> form. A POLST form is a medical order that documents a person’s preferences for receiving or not receiving certain types of medical interventions (for example, chest compressions, a feeding tube or a breathing tube).\u003c/li>\n\u003cli>If needed, execute a \u003ca href=\"https://www.nolo.com/legal-encyclopedia/california-financial-power-of-attorney-31871.html\">Durable Financial Power of Attorney\u003c/a>, a simple way to arrange for someone to handle your finances, such a bills or insurance matters, if you are unable to do so yourself.\u003c/li>\n\u003cli>Write your \u003ca href=\"https://money.usnews.com/money/personal-finance/family-finance/articles/steps-to-writing-a-will\">last will and testament\u003c/a> and/or a \u003ca href=\"https://www.nextavenue.org/do-you-need-a-trust-for-your-estate-plan/\">revocable trust \u003c/a>to clarify and determine how your assets are distributed after death.\u003c/li>\n\u003cli>Consider what your preferences are for a memorial ceremony, and discuss it with your loved ones.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Steve Pantilat was in medical school and residency training in San Francisco at the peak of the AIDS crisis.\u003c/p>\n\u003cp>“While that was a different type of pandemic, there are a lot of echoes of that, of an illness we can’t treat, of people dying, a lot. Young people dying,” he said.\u003c/p>\n\u003cp>Back in the 1980s, health workers knew they could contract HIV from accidental needle sticks. The risk of contagion with coronavirus is very different.\u003c/p>\n\u003cp>“In this situation, anybody can get sick like this,” Pantilat said. “I could get sick like this also.”\u003c/p>\n\u003cp>Pantilat became a pioneer in palliative medicine, shepherding patients through serious illness and the dying process. He founded, and now directs the palliative care program at UCSF, where he’s setting the protocols that are guiding how the first generation of COVID-19 patients dies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Compared to AIDS, this is much more personal.\u003c/p>\n\u003cp>“My wife and I are both in our 50s,” Pantilat said. “That is a higher risk group for serious complications, including dying of COVID-19. So in our house at least, we think about this a lot because of the work that I do and my wife does, but it’s much more tangible now.” [pullquote size=\"medium\" align=\"right\" citation=\"Dr. Steve Pantilat, chief of palliative care at UCSF\"]“All the clothes go directly in the washing machine. She goes to the shower first thing. We then wipe down every door knob and surface that she touched on the way in the house. And then, we say hello.”[/pullquote]\u003c/p>\n\u003cp>Pantilat’s wife is also a doctor. She’s been on the front lines in the hospital, caring for COVID-19 patients. The concern with carrying the infection home has led to some elaborate routines.\u003c/p>\n\u003cp>“She undresses in the garage, leaves her shoes there, wipes everything down, including the car, her shoes, her stethoscope,” Pantilat said. “She comes into the house, undressed — all the clothes go directly in the washing machine. She goes to the shower first thing. We then wipe down every door knob and surface that she touched on the way in the house. And then, we say hello.”\u003c/p>\n\u003cp>Pantilat, on the other hand, has been protecting himself and his team by working almost exclusively from home, doing his consults over video. While doctors would normally sit on the side of a patient’s bed and hold their hand when delivering bad news, now, all patients have to hold is an iPad.\u003c/p>\n\u003cp>“In order to limit exposure of our staff and to preserve the personal protection equipment, we’ve decided that we will see patients as much as we can by telemedicine, even for patients in the hospital,” he said. \u003c/p>\n\u003cp>Family and visitors are limited to video and phone calls, too. This is hard for doctors like Pantilat, who have made it their life’s work to honor peoples’ last wishes.\u003c/p>\n\u003cp>“I’ve been in rooms where there are 35 family members, people are playing music and holding a vigil and saying prayers and singing,” he said. “They’re even having weddings in the hospital. Just last month, we had another wedding for someone who was dying.”\u003c/p>\n\u003cp>But in the age of coronavirus, all that is out. There’s too much risk of visitors getting sick and there aren’t enough masks to go around. So the new policy at UCSF is one visitor, and only for patients who are actively dying.\u003c/p>\n\u003cp>“We’ve never really faced this before of trying to make these really kind of gut wrenching decisions about visitation and when and who and how many,” he said. “I think that’s really, really, really distressing for everyone involved.”\u003c/p>\n\u003cp>Many of these kinds of decisions are rushed right now. In some cases, COVID-19 can progress so fast, there’s not enough time for a considered conversation with patients about what kind of care they’re willing to have, what’s important to them, and what they want for the end of their lives. Pantilat says we should all be having these conversations with our loved ones now.\u003c/p>\n\u003cp>“Some of us who might not have thought about these issues and thought, ‘Oh, I’ve got a lot of time before I have to worry about this,’ are suddenly facing the reality that you could get suddenly sick and suddenly very, very sick,” he said. \u003c/p>\n\u003cp>Just in case, we should all be saying our goodbyes.\u003c/p>\n\u003cp>“No harm in saying, I love you and thank you and forgive me and I forgive you to the people you care about at any time,” he says. “It’s a really good time to do that now.” [aside tag=\"coronavirus\" label=\"Related Coverage\"]\u003c/p>\n\u003cp>But not all doctors take their own advice. “Good friends of ours sent us a, this sort of letter about, if both of them die, you know, asking us to be sort of official godparents to their three children,” Pantilat said.\u003c/p>\n\u003cp>Pantilat and his wife have two kids. The oldest is grown, but his younger son is 16 and still at home. They don’t have a plan for him. Neither of them have a will. \u003c/p>\n\u003cp>“We’ve talked about it, we have this sort of informal will. We have life insurance, we’ve gone that far,” he says. “But it’s a little embarrassing, as someone who takes care of people who are seriously ill, to say that we don’t have a will, but we don’t have one yet.”\u003c/p>\n\u003cp>Even now, with the haunting pressure of a fatal pandemic, Pantilat wavers. He sighs. He can’t bring himself to write an official plan for his own end. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“You know, probably like a lot of people, there’s a little bit of denial, too, like, is this really going to happen to both of us at the same time in the next few months?” he said. “It’s very sobering to get just this very small taste of what I imagine my seriously ill patients must be thinking about all the time.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pantilat’s wife is also a doctor. She’s been on the front lines in the hospital, caring for COVID-19 patients. The concern with carrying the infection home has led to some elaborate routines.\u003c/p>\n\u003cp>“She undresses in the garage, leaves her shoes there, wipes everything down, including the car, her shoes, her stethoscope,” Pantilat said. “She comes into the house, undressed — all the clothes go directly in the washing machine. She goes to the shower first thing. We then wipe down every door knob and surface that she touched on the way in the house. And then, we say hello.”\u003c/p>\n\u003cp>Pantilat, on the other hand, has been protecting himself and his team by working almost exclusively from home, doing his consults over video. While doctors would normally sit on the side of a patient’s bed and hold their hand when delivering bad news, now, all patients have to hold is an iPad.\u003c/p>\n\u003cp>“In order to limit exposure of our staff and to preserve the personal protection equipment, we’ve decided that we will see patients as much as we can by telemedicine, even for patients in the hospital,” he said. \u003c/p>\n\u003cp>Family and visitors are limited to video and phone calls, too. This is hard for doctors like Pantilat, who have made it their life’s work to honor peoples’ last wishes.\u003c/p>\n\u003cp>“I’ve been in rooms where there are 35 family members, people are playing music and holding a vigil and saying prayers and singing,” he said. “They’re even having weddings in the hospital. Just last month, we had another wedding for someone who was dying.”\u003c/p>\n\u003cp>But in the age of coronavirus, all that is out. There’s too much risk of visitors getting sick and there aren’t enough masks to go around. So the new policy at UCSF is one visitor, and only for patients who are actively dying.\u003c/p>\n\u003cp>“We’ve never really faced this before of trying to make these really kind of gut wrenching decisions about visitation and when and who and how many,” he said. “I think that’s really, really, really distressing for everyone involved.”\u003c/p>\n\u003cp>Many of these kinds of decisions are rushed right now. In some cases, COVID-19 can progress so fast, there’s not enough time for a considered conversation with patients about what kind of care they’re willing to have, what’s important to them, and what they want for the end of their lives. Pantilat says we should all be having these conversations with our loved ones now.\u003c/p>\n\u003cp>“Some of us who might not have thought about these issues and thought, ‘Oh, I’ve got a lot of time before I have to worry about this,’ are suddenly facing the reality that you could get suddenly sick and suddenly very, very sick,” he said. \u003c/p>\n\u003cp>Just in case, we should all be saying our goodbyes.\u003c/p>\n\u003cp>“No harm in saying, I love you and thank you and forgive me and I forgive you to the people you care about at any time,” he says. “It’s a really good time to do that now.” \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But not all doctors take their own advice. “Good friends of ours sent us a, this sort of letter about, if both of them die, you know, asking us to be sort of official godparents to their three children,” Pantilat said.\u003c/p>\n\u003cp>Pantilat and his wife have two kids. The oldest is grown, but his younger son is 16 and still at home. They don’t have a plan for him. Neither of them have a will. \u003c/p>\n\u003cp>“We’ve talked about it, we have this sort of informal will. We have life insurance, we’ve gone that far,” he says. “But it’s a little embarrassing, as someone who takes care of people who are seriously ill, to say that we don’t have a will, but we don’t have one yet.”\u003c/p>\n\u003cp>Even now, with the haunting pressure of a fatal pandemic, Pantilat wavers. He sighs. He can’t bring himself to write an official plan for his own end. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“You know, probably like a lot of people, there’s a little bit of denial, too, like, is this really going to happen to both of us at the same time in the next few months?” he said. “It’s very sobering to get just this very small taste of what I imagine my seriously ill patients must be thinking about all the time.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When Dr. Steve Pantilat asks his patients what they want most at the end of life, the answer is almost always the same: To be comfortable and surrounded by people they love.\u003c/p>\n\u003cp>“I’ve been in rooms where there are 35 family members, people are playing music and holding a vigil, saying prayers and singing,” said Pantilat, chief of palliative medicine at UCSF and author of \u003ca href=\"https://www.stevepantilat.com/latdbook\">Life After the Diagnosis\u003c/a>. “They’re even having weddings in the hospital. Just last month, we had another wedding for someone who was dying.”\u003c/p>\n\u003cp>But in the age of coronavirus, none of this is happening. There’s too much risk of visitors getting sick or infecting critical frontline staff, and there’s not enough protective equipment to go around. So the new policy at UCSF and hospitals across the country is: One visitor, and only for patients who are actively dying.\u003c/p>\n\u003cp>“I think that’s really, really, really distressing for everyone involved,” Pantilat said. “We’ve never really faced this before, trying to make these really gut wrenching decisions about visitation of when and who and how many. It’s a very sacred time, and yet, for this pandemic, it’s really important to limit spread.”\u003c/p>\n\u003cp>Between 100,000 and 240,000 Americans are expected to die from COVID-19, according to the latest projections from the Trump administration’s pandemic scientists. Palliative care specialists, whose expertise is managing pain and disease symptoms as well as having difficult conversations about the end of life, are already feeling overstretched.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Steve Pantilat, chief of palliative care at UCSF\"]“No harm in saying, I love you and thank you and forgive me and I forgive you to the people you care about at any time. It’s a really good time to do that now.”[/pullquote]\u003c/p>\n\u003cp>Dozens of hospitals in the Bay Area and beyond are racing to move their palliative care services online, using video visits and phone calls to keep patients connected with their families and their doctors. Apple donated 140 iPads to UCSF to use in their telemedicine program, and the Stupski Foundation gave $275,000 to Highland Hospital in Oakland to fast-track the building of their telemedicine program so it can be operational for the pandemic.\u003c/p>\n\u003cp>“Is a remote visit from a palliative care service as effective as an in-person visit where we’re sitting on the side of a bed and holding someone’s hand? I would say no,” said Jessica Zitter, a palliative care doctor at Highland and author of the book \u003ca href=\"https://jessicazitter.com/extreme-measures/\" target=\"_blank\" rel=\"noopener noreferrer\">Extreme Measures\u003c/a>.\u003c/p>\n\u003cp>But the technology will have to do. Her team is small, she said, and if one or two doctors get sick, the whole service would be wiped out.\u003c/p>\n\u003cp>“If we want to stay in the game here and offer our services as I think we’ll need to, I think we’re going to do better if we are working from a remote virtual platform,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11810595\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11810595\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-800x533.jpg\" alt=\"Dr. Jessica Zitter, a palliative care specialist at Highland Hospital in Oakland, is working from home during coronavirus shelter-in-place orders.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Jessica Zitter, a palliative care specialist at Highland Hospital in Oakland, is working from home during coronavirus shelter-in-place orders. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Palliative care doctors have been fighting for permission to use telemedicine for years. Especially in rural areas, they’ve wanted the ease of video visits so patients who are ill and in pain don’t have to go to the trouble of coming in to a doctor’s office. But the federal government has refused to pay doctors for most video visits and insisted on various rules and restrictions, including making patients in rural areas drive to local clinics for a telemedicine appointment rather than doing it from their own home.\u003c/p>\n\u003cp>The coronavirus has forced some changes, and just two weeks ago, the feds abruptly shifted policy. At a White House press briefing on March 17, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the agency was dropping the restrictions, as well as the fines doctors faced for using unapproved technology. She encouraged doctors to go digital.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Doctors can provide telehealth with their own phones,” Verma said. “In an emergency, those on the frontlines shouldn’t have to worry about federal rules and red tape hamstringing them when they need flexibility above all else.”\u003c/p>\n\u003cp>Doctors can now get reimbursed for a video visit at the same rate as an in-person office visit, whether the patient or the doctor is at home.\u003c/p>\n\u003cp>“We’re in a system where the only way physicians’ practices keep the lights on is through what they’re able to bill,” said Chris Acevedo, who runs Acevedo Consulting, a health care billing firm in Delray Beach, Florida. “Without the changes that the government put in place, there would really be zero access to telehealth because the doctors wouldn’t have any remuneration for it.”\u003c/p>\n\u003cp>[aside tag=\"coronavirus\" label=\"Related Coverage\"]\u003c/p>\n\u003cp>The policy changes will encourage the uptake of telemedicine, Acevedo said, and by extension, increase access to palliative care for patients. That includes people who are sick and dying from COVID-19, but also patients who are sick at home with other serious illnesses, some of whom are dying and some who will recover.\u003c/p>\n\u003cp>Rae Anne McLaughlin was one of those patients a few years ago. After she went through 12 rounds of chemotherapy and 35 radiation treatments to treat her stage four head and neck cancer, the last thing she wanted was to drive 70 miles from her home on Long Island to the hospital in the city. She had a palliative care team that would call her up and have normal conversations — not science jargon — about how she was feeling, what she could do about the tingling in her hands and feet and how to manage the opioids she was taking for pain. All of this was over the phone.\u003c/p>\n\u003cp>“It was fabulous,” McLaughlin recalled. “I didn’t have to shower if I didn’t feel like it. Imagine just feeling really, really crummy and then having to get in a car and drive an hour and a half. I didn’t want to do it.”\u003c/p>\n\u003cp>She had private insurance that covered the telephone calls. She’s fully recovered now, three years later, but she can still email her palliative care team. And she did recently to ask whether she was more at risk for becoming ill from coronavirus and to get advice about how to protect herself. They told her to stay home and get her exercise in her house and backyard.\u003c/p>\n\u003cp>Even before the coronavirus pandemic, palliative care specialists — including doctors, nurses and social workers — were in short supply. The subspecialty “didn’t get formal approval until 2007, and we didn’t start training palliative care specialists in any kind of serious numbers until recently,” said Dr. Diane Meier, director of the national Center to Advance Palliative Care and a gerontologist at Mount Sinai Health Systems in New York.\u003c/p>\n\u003cp>Meier knew they wouldn’t have enough palliative care specialists at her hospital to meet the demand of COVID-19 patients needing pain and symptom relief, especially shortness of breath. Her plan was to train frontline emergency department doctors and nurses how to do this themselves, but patients overwhelmed the hospital so fast, they didn’t have time.\u003c/p>\n\u003cp>“They’re getting a new patient in the door of the ED (emergency department) every 30 seconds,” she said. “So we’re creating things like pocket cards and 24/7 hotline numbers that a clinician can call at any hour of the day or night to get very specific advice: ‘What dose do I use? What do I do if it doesn’t work? How long do I wait before I give more?’”\u003c/p>\n\u003cp>But delivering bad news and having tough conversations is a skill they can’t easily delegate. And because COVID-19 can progress so quickly — with patients going from okay to barely able to breathe in an hour — there’s so little time to talk with patients about what kind of care they’re willing to have, what’s important to them and what they want for the end of their lives.\u003c/p>\n\u003cfigure id=\"attachment_11810593\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11810593\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-800x533.jpg\" alt=\"Dr. Steve Pantilat, chief of palliative care at University of California, San Francisco (UCSF) is working to provide care remotely during coronavirus shelter-in-place orders.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Steve Pantilat, chief of palliative care at University of California, San Francisco (UCSF) is working to provide care remotely during coronavirus shelter-in-place orders. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UCSF’s Pantilat says everyone should be having these conversations with their loved ones now. Some older people who have had a few tours of the medical system already may not want to be intubated and sedated on a ventilator, he said. They may not want to be in the hospital at all, especially if it means they will be separated from their families.\u003c/p>\n\u003cp>But younger people are dying, too, he added, and should think about where they stand on advanced directives for medical care and do-not-resuscitate orders. They should be thinking about how to say goodbye.\u003c/p>\n\u003cp>“Some of us who might not have thought about these issues and thought, ‘Oh, I’ve got a lot of time before I have to worry about this,’ are suddenly facing the reality that you could get suddenly sick and suddenly very, very sick,” he said. “No harm in saying, I love you and thank you and forgive me and I forgive you to the people you care about at any time. It’s a really good time to do that now.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Dr. Steve Pantilat asks his patients what they want most at the end of life, the answer is almost always the same: To be comfortable and surrounded by people they love.\u003c/p>\n\u003cp>“I’ve been in rooms where there are 35 family members, people are playing music and holding a vigil, saying prayers and singing,” said Pantilat, chief of palliative medicine at UCSF and author of \u003ca href=\"https://www.stevepantilat.com/latdbook\">Life After the Diagnosis\u003c/a>. “They’re even having weddings in the hospital. Just last month, we had another wedding for someone who was dying.”\u003c/p>\n\u003cp>But in the age of coronavirus, none of this is happening. There’s too much risk of visitors getting sick or infecting critical frontline staff, and there’s not enough protective equipment to go around. So the new policy at UCSF and hospitals across the country is: One visitor, and only for patients who are actively dying.\u003c/p>\n\u003cp>“I think that’s really, really, really distressing for everyone involved,” Pantilat said. “We’ve never really faced this before, trying to make these really gut wrenching decisions about visitation of when and who and how many. It’s a very sacred time, and yet, for this pandemic, it’s really important to limit spread.”\u003c/p>\n\u003cp>Between 100,000 and 240,000 Americans are expected to die from COVID-19, according to the latest projections from the Trump administration’s pandemic scientists. Palliative care specialists, whose expertise is managing pain and disease symptoms as well as having difficult conversations about the end of life, are already feeling overstretched.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dozens of hospitals in the Bay Area and beyond are racing to move their palliative care services online, using video visits and phone calls to keep patients connected with their families and their doctors. Apple donated 140 iPads to UCSF to use in their telemedicine program, and the Stupski Foundation gave $275,000 to Highland Hospital in Oakland to fast-track the building of their telemedicine program so it can be operational for the pandemic.\u003c/p>\n\u003cp>“Is a remote visit from a palliative care service as effective as an in-person visit where we’re sitting on the side of a bed and holding someone’s hand? I would say no,” said Jessica Zitter, a palliative care doctor at Highland and author of the book \u003ca href=\"https://jessicazitter.com/extreme-measures/\" target=\"_blank\" rel=\"noopener noreferrer\">Extreme Measures\u003c/a>.\u003c/p>\n\u003cp>But the technology will have to do. Her team is small, she said, and if one or two doctors get sick, the whole service would be wiped out.\u003c/p>\n\u003cp>“If we want to stay in the game here and offer our services as I think we’ll need to, I think we’re going to do better if we are working from a remote virtual platform,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11810595\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11810595\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-800x533.jpg\" alt=\"Dr. Jessica Zitter, a palliative care specialist at Highland Hospital in Oakland, is working from home during coronavirus shelter-in-place orders.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42538_005_KQED_Oakland_JessicaZitter_04032020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Jessica Zitter, a palliative care specialist at Highland Hospital in Oakland, is working from home during coronavirus shelter-in-place orders. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Palliative care doctors have been fighting for permission to use telemedicine for years. Especially in rural areas, they’ve wanted the ease of video visits so patients who are ill and in pain don’t have to go to the trouble of coming in to a doctor’s office. But the federal government has refused to pay doctors for most video visits and insisted on various rules and restrictions, including making patients in rural areas drive to local clinics for a telemedicine appointment rather than doing it from their own home.\u003c/p>\n\u003cp>The coronavirus has forced some changes, and just two weeks ago, the feds abruptly shifted policy. At a White House press briefing on March 17, Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the agency was dropping the restrictions, as well as the fines doctors faced for using unapproved technology. She encouraged doctors to go digital.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Doctors can provide telehealth with their own phones,” Verma said. “In an emergency, those on the frontlines shouldn’t have to worry about federal rules and red tape hamstringing them when they need flexibility above all else.”\u003c/p>\n\u003cp>Doctors can now get reimbursed for a video visit at the same rate as an in-person office visit, whether the patient or the doctor is at home.\u003c/p>\n\u003cp>“We’re in a system where the only way physicians’ practices keep the lights on is through what they’re able to bill,” said Chris Acevedo, who runs Acevedo Consulting, a health care billing firm in Delray Beach, Florida. “Without the changes that the government put in place, there would really be zero access to telehealth because the doctors wouldn’t have any remuneration for it.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The policy changes will encourage the uptake of telemedicine, Acevedo said, and by extension, increase access to palliative care for patients. That includes people who are sick and dying from COVID-19, but also patients who are sick at home with other serious illnesses, some of whom are dying and some who will recover.\u003c/p>\n\u003cp>Rae Anne McLaughlin was one of those patients a few years ago. After she went through 12 rounds of chemotherapy and 35 radiation treatments to treat her stage four head and neck cancer, the last thing she wanted was to drive 70 miles from her home on Long Island to the hospital in the city. She had a palliative care team that would call her up and have normal conversations — not science jargon — about how she was feeling, what she could do about the tingling in her hands and feet and how to manage the opioids she was taking for pain. All of this was over the phone.\u003c/p>\n\u003cp>“It was fabulous,” McLaughlin recalled. “I didn’t have to shower if I didn’t feel like it. Imagine just feeling really, really crummy and then having to get in a car and drive an hour and a half. I didn’t want to do it.”\u003c/p>\n\u003cp>She had private insurance that covered the telephone calls. She’s fully recovered now, three years later, but she can still email her palliative care team. And she did recently to ask whether she was more at risk for becoming ill from coronavirus and to get advice about how to protect herself. They told her to stay home and get her exercise in her house and backyard.\u003c/p>\n\u003cp>Even before the coronavirus pandemic, palliative care specialists — including doctors, nurses and social workers — were in short supply. The subspecialty “didn’t get formal approval until 2007, and we didn’t start training palliative care specialists in any kind of serious numbers until recently,” said Dr. Diane Meier, director of the national Center to Advance Palliative Care and a gerontologist at Mount Sinai Health Systems in New York.\u003c/p>\n\u003cp>Meier knew they wouldn’t have enough palliative care specialists at her hospital to meet the demand of COVID-19 patients needing pain and symptom relief, especially shortness of breath. Her plan was to train frontline emergency department doctors and nurses how to do this themselves, but patients overwhelmed the hospital so fast, they didn’t have time.\u003c/p>\n\u003cp>“They’re getting a new patient in the door of the ED (emergency department) every 30 seconds,” she said. “So we’re creating things like pocket cards and 24/7 hotline numbers that a clinician can call at any hour of the day or night to get very specific advice: ‘What dose do I use? What do I do if it doesn’t work? How long do I wait before I give more?’”\u003c/p>\n\u003cp>But delivering bad news and having tough conversations is a skill they can’t easily delegate. And because COVID-19 can progress so quickly — with patients going from okay to barely able to breathe in an hour — there’s so little time to talk with patients about what kind of care they’re willing to have, what’s important to them and what they want for the end of their lives.\u003c/p>\n\u003cfigure id=\"attachment_11810593\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11810593\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-800x533.jpg\" alt=\"Dr. Steve Pantilat, chief of palliative care at University of California, San Francisco (UCSF) is working to provide care remotely during coronavirus shelter-in-place orders.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2020/04/RS42522_001_KQED_SanFrancisco_StevePantilatMD_04032020-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Steve Pantilat, chief of palliative care at University of California, San Francisco (UCSF) is working to provide care remotely during coronavirus shelter-in-place orders. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UCSF’s Pantilat says everyone should be having these conversations with their loved ones now. Some older people who have had a few tours of the medical system already may not want to be intubated and sedated on a ventilator, he said. They may not want to be in the hospital at all, especially if it means they will be separated from their families.\u003c/p>\n\u003cp>But younger people are dying, too, he added, and should think about where they stand on advanced directives for medical care and do-not-resuscitate orders. They should be thinking about how to say goodbye.\u003c/p>\n\u003cp>“Some of us who might not have thought about these issues and thought, ‘Oh, I’ve got a lot of time before I have to worry about this,’ are suddenly facing the reality that you could get suddenly sick and suddenly very, very sick,” he said. “No harm in saying, I love you and thank you and forgive me and I forgive you to the people you care about at any time. It’s a really good time to do that now.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>When BJ Miller was a sophomore at Princeton University, he climbed atop a commuter train that had been parked for the night. What began as a lark took a tragic turn when 11,000 volts of electricity suddenly surged through his body.\u003c/p>\n\u003cp>“There was a big explosion, a big flash of light, and I was thrown … quite some distance,” Miller says. “My body was literally smoking.”\u003c/p>\n\u003cp>Miller survived that 1990 accident but lost both legs below the knee and half of one arm. Coming close to death and dealing with pain and disability inspired him to go into medicine and the field of \u003ca href=\"https://www.npr.org/tags/499181710/disability-rights\">disability rights\u003c/a>.\u003c/p>\n\u003cp>As a \u003ca href=\"https://www.npr.org/tags/134950354/palliative-care/archive?date=12-31-2013\">palliative care\u003c/a> physician at UCSF’s Cancer Center, \u003ca href=\"https://www.sfchronicle.com/news/article/BJ-Miller-pain-doctor-at-the-Zen-Hospice-Project-2369267.php\">Miller draws on his own experiences\u003c/a> to help people with their physical, emotional and spiritual pain at the end of their lives. His new book, with co-author Shoshana Berger, is \u003cem>A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death.\u003c/em>\u003c/p>\n\u003cp>Miller says it’s hard for him to regret the accident that changed his life.\u003c/p>\n\u003cp>“So much has flowed from it,” he says. “If I’m honest, there’s a little bit of pride. … [What] I’m a little proud of is the decision to work with this experience over time, to dig into it, to mine it, to find a creative energy in it.”\u003c/p>\n\u003chr>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch3>\u003cstrong>Interview highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>On how growing up with his mother, who had polio, influenced him\u003c/strong>\u003c/p>\n\u003cp>To grow up around disability from a young age, to have that carved into your worldview was, you can imagine, hugely helpful for me as a 19-year-old kid with ostensibly everything going for him. … To know in your bones that you’re on borrowed time with being “able-bodied” — I knew that. I didn’t have to learn that, and that was a huge advantage. …\u003c/p>\n\u003cp>In my early childhood, she used crutches and a brace and was extremely physically capable. And then, over time, from the early ’80s on, it’s just been a very slow decline to the point now where she really requires an electric wheelchair, has a little bit of ability to stand, but not for very long, etc. …\u003c/p>\n\u003cp>People think you’re Jesus because you’ve gone through something special. They treat you like you’ve got special knowledge, or they treat you a little bit like Frankenstein. Of course, those two responses are related. Neither of them is accurate. But that’s the kind of vibe you can get — a lot of us who have disabilities know very well. And I had seen that. I knew how to read that, thanks to my mother.\u003c/p>\n\u003cp>\u003cstrong>On deciding to pursue palliative medicine \u003c/strong>\u003c/p>\n\u003cp>I started doing a little work [in] arts advocacy and disability rights. But basically … thanks to the disability rights movement, I realized that disability is not something to be ashamed of. It’s not something to overcome, to put behind you — it’s something to work with. It doesn’t go away. I can’t overcome this; it’s my daily experience. So instead the compulsion was to work with it — in a professional way that I could make a living. And medicine lit up, theoretically, as a way where I could use these experiences and pay them forward in some way or draw from them — not overcome them and put them behind me.\u003c/p>\n\u003cp>[aside label=\"Related Coverage\" postID=news_11784435,futureofyou_443966,stateofhealth_364223]\u003c/p>\n\u003cp>\u003cstrong>On palliative care and the treatment of suffering \u003c/strong>\u003c/p>\n\u003cp>That’s why I think hospice and palliative medicine is so interesting. You don’t just treat pain. You treat suffering. Suffering is a multiheaded beast. … Basically palliative care is the treatment of suffering, versus the rest of medicine as the treatment of disease. …\u003c/p>\n\u003cp>So what is suffering? Well, suffering, there’s a lot of different ways to define it. \u003ca href=\"https://www.bmj.com/content/suppl/2005/07/18/331.7509.DC1\">Cicely Saunders\u003c/a>, the grandmother of hospice work, she called it “total pain.” That [it has] a physical component, a psychological and emotional component, a spiritual component. It’s a multiheaded entity. One might say it affects how you see yourself. It affects your identity. I’ve come to understand suffering as a wedge — a gap that opens up in you. The gap between the world you have and the world you want. So, it gets at your desire, it gets at your longing, it gets at what you’re lacking.\u003c/p>\n\u003cp>\u003cstrong>On finding the balance between life and death, and joy and sorrow\u003c/strong>\u003c/p>\n\u003cp>Coming out of the back side of the experience of my own injuries, my own brush with death, etc., I came out of there eventually holding life much more loosely. So it didn’t teach me to cling to life with my fingernails, that that was the way through. It taught me some adult trick of simultaneously holding on to opposing emotions. …\u003c/p>\n\u003cp>Grief does this. But anyone who’s dealt with pain — chronic pain — when the clouds part even for a moment and you have the absence of pain, it’s a stunning feeling. I remember feeling that I really wanted to stay close to that interface between joy and sorrow, between pain and pleasure, between life and death. It felt like such a rich, rich place that I had been forced into. I had to hang out there for a while, but I became a little enamored of it, because from there I could just as easily get to sorrow as I could get to joy. And that to me has felt like a kind of a dexterity or an agility, something very good. … So death is close by, pain is close by — so is the rest of life. So is the good stuff. That zone, it helps me imagine what my patients are going through, being close to death.\u003c/p>\n\u003cp>\u003cstrong>On how he helps his patients with both their fear of dying and their fear of being dead \u003c/strong>\u003c/p>\n\u003cp>Fear helps point to the things that you care about, the things you love, the things you’re afraid to lose. Fear is a big important subject and really requires and demands looking at. The sooner we do, the better, because oftentimes it’s not so darn scary. … It’s helpful when patients will confess some fear to me. … People say, “Actually I’m afraid of the pain I imagine is going to happen during the dying process.” So the fear of dying, the fear of the dying process. That’s an important distinction, because any hospice and palliative medicine team can do a lot to quell the pain and the sorrow that happens during the dying process. We have medications. We have ways of being with each other. We have ways of positioning your body. There’s all sorts of things to do, so suffering is not necessarily part of the dying process. And there’s a lot of reassurance. … We understand that process pretty well, and there’s a lot we can do. So that’s an important distinction. That’s pretty concrete. That’s knowable.\u003c/p>\n\u003cp>Now, some of my patients will say, “That’s one thing. But I’m actually afraid of being dead. I’m afraid of being in the ground. I’m afraid of what comes next or whatever else.” Then my response, of course, is, “Well, gosh, I don’t know what that’s like either. But let’s think about it. Let’s talk about it.” And when we push on that one, I think most of us can get to a place where we realize that we’re not just our bodies — and our bodies, once they’re dead, aren’t likely to be feeling anything.\u003c/p>\n\u003cp>But when you push on that one, you can open up [about] what is known as [the] modern acronym of FOMO — fear of missing out. That’s very often at the heart of people’s fear of being dead — like all that they’re going to miss. And this idea that the world is going to continue on without them, all the things they’re not going to get to see, etc. But if you go there, then what has that done? That has pointed us very squarely to all the things we love and care about. And then that becomes a nice compass for our way forward, how we’re going to live until we die. The fear there, the things we are afraid to miss, are the things we really should uptick in terms of our attention now.\u003c/p>\n\u003cp>\u003cem>Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\">Fresh Air\u003c/a>.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=After+A+Freak+Accident%2C+A+Doctor+Finds+Insight+Into+%27Living+Life+And+Facing+Death%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When BJ Miller was a sophomore at Princeton University, he climbed atop a commuter train that had been parked for the night. What began as a lark took a tragic turn when 11,000 volts of electricity suddenly surged through his body.\u003c/p>\n\u003cp>“There was a big explosion, a big flash of light, and I was thrown … quite some distance,” Miller says. “My body was literally smoking.”\u003c/p>\n\u003cp>Miller survived that 1990 accident but lost both legs below the knee and half of one arm. Coming close to death and dealing with pain and disability inspired him to go into medicine and the field of \u003ca href=\"https://www.npr.org/tags/499181710/disability-rights\">disability rights\u003c/a>.\u003c/p>\n\u003cp>As a \u003ca href=\"https://www.npr.org/tags/134950354/palliative-care/archive?date=12-31-2013\">palliative care\u003c/a> physician at UCSF’s Cancer Center, \u003ca href=\"https://www.sfchronicle.com/news/article/BJ-Miller-pain-doctor-at-the-Zen-Hospice-Project-2369267.php\">Miller draws on his own experiences\u003c/a> to help people with their physical, emotional and spiritual pain at the end of their lives. His new book, with co-author Shoshana Berger, is \u003cem>A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death.\u003c/em>\u003c/p>\n\u003cp>Miller says it’s hard for him to regret the accident that changed his life.\u003c/p>\n\u003cp>“So much has flowed from it,” he says. “If I’m honest, there’s a little bit of pride. … [What] I’m a little proud of is the decision to work with this experience over time, to dig into it, to mine it, to find a creative energy in it.”\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch3>\u003cstrong>Interview highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>On how growing up with his mother, who had polio, influenced him\u003c/strong>\u003c/p>\n\u003cp>To grow up around disability from a young age, to have that carved into your worldview was, you can imagine, hugely helpful for me as a 19-year-old kid with ostensibly everything going for him. … To know in your bones that you’re on borrowed time with being “able-bodied” — I knew that. I didn’t have to learn that, and that was a huge advantage. …\u003c/p>\n\u003cp>In my early childhood, she used crutches and a brace and was extremely physically capable. And then, over time, from the early ’80s on, it’s just been a very slow decline to the point now where she really requires an electric wheelchair, has a little bit of ability to stand, but not for very long, etc. …\u003c/p>\n\u003cp>People think you’re Jesus because you’ve gone through something special. They treat you like you’ve got special knowledge, or they treat you a little bit like Frankenstein. Of course, those two responses are related. Neither of them is accurate. But that’s the kind of vibe you can get — a lot of us who have disabilities know very well. And I had seen that. I knew how to read that, thanks to my mother.\u003c/p>\n\u003cp>\u003cstrong>On deciding to pursue palliative medicine \u003c/strong>\u003c/p>\n\u003cp>I started doing a little work [in] arts advocacy and disability rights. But basically … thanks to the disability rights movement, I realized that disability is not something to be ashamed of. It’s not something to overcome, to put behind you — it’s something to work with. It doesn’t go away. I can’t overcome this; it’s my daily experience. So instead the compulsion was to work with it — in a professional way that I could make a living. And medicine lit up, theoretically, as a way where I could use these experiences and pay them forward in some way or draw from them — not overcome them and put them behind me.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>On palliative care and the treatment of suffering \u003c/strong>\u003c/p>\n\u003cp>That’s why I think hospice and palliative medicine is so interesting. You don’t just treat pain. You treat suffering. Suffering is a multiheaded beast. … Basically palliative care is the treatment of suffering, versus the rest of medicine as the treatment of disease. …\u003c/p>\n\u003cp>So what is suffering? Well, suffering, there’s a lot of different ways to define it. \u003ca href=\"https://www.bmj.com/content/suppl/2005/07/18/331.7509.DC1\">Cicely Saunders\u003c/a>, the grandmother of hospice work, she called it “total pain.” That [it has] a physical component, a psychological and emotional component, a spiritual component. It’s a multiheaded entity. One might say it affects how you see yourself. It affects your identity. I’ve come to understand suffering as a wedge — a gap that opens up in you. The gap between the world you have and the world you want. So, it gets at your desire, it gets at your longing, it gets at what you’re lacking.\u003c/p>\n\u003cp>\u003cstrong>On finding the balance between life and death, and joy and sorrow\u003c/strong>\u003c/p>\n\u003cp>Coming out of the back side of the experience of my own injuries, my own brush with death, etc., I came out of there eventually holding life much more loosely. So it didn’t teach me to cling to life with my fingernails, that that was the way through. It taught me some adult trick of simultaneously holding on to opposing emotions. …\u003c/p>\n\u003cp>Grief does this. But anyone who’s dealt with pain — chronic pain — when the clouds part even for a moment and you have the absence of pain, it’s a stunning feeling. I remember feeling that I really wanted to stay close to that interface between joy and sorrow, between pain and pleasure, between life and death. It felt like such a rich, rich place that I had been forced into. I had to hang out there for a while, but I became a little enamored of it, because from there I could just as easily get to sorrow as I could get to joy. And that to me has felt like a kind of a dexterity or an agility, something very good. … So death is close by, pain is close by — so is the rest of life. So is the good stuff. That zone, it helps me imagine what my patients are going through, being close to death.\u003c/p>\n\u003cp>\u003cstrong>On how he helps his patients with both their fear of dying and their fear of being dead \u003c/strong>\u003c/p>\n\u003cp>Fear helps point to the things that you care about, the things you love, the things you’re afraid to lose. Fear is a big important subject and really requires and demands looking at. The sooner we do, the better, because oftentimes it’s not so darn scary. … It’s helpful when patients will confess some fear to me. … People say, “Actually I’m afraid of the pain I imagine is going to happen during the dying process.” So the fear of dying, the fear of the dying process. That’s an important distinction, because any hospice and palliative medicine team can do a lot to quell the pain and the sorrow that happens during the dying process. We have medications. We have ways of being with each other. We have ways of positioning your body. There’s all sorts of things to do, so suffering is not necessarily part of the dying process. And there’s a lot of reassurance. … We understand that process pretty well, and there’s a lot we can do. So that’s an important distinction. That’s pretty concrete. That’s knowable.\u003c/p>\n\u003cp>Now, some of my patients will say, “That’s one thing. But I’m actually afraid of being dead. I’m afraid of being in the ground. I’m afraid of what comes next or whatever else.” Then my response, of course, is, “Well, gosh, I don’t know what that’s like either. But let’s think about it. Let’s talk about it.” And when we push on that one, I think most of us can get to a place where we realize that we’re not just our bodies — and our bodies, once they’re dead, aren’t likely to be feeling anything.\u003c/p>\n\u003cp>But when you push on that one, you can open up [about] what is known as [the] modern acronym of FOMO — fear of missing out. That’s very often at the heart of people’s fear of being dead — like all that they’re going to miss. And this idea that the world is going to continue on without them, all the things they’re not going to get to see, etc. But if you go there, then what has that done? That has pointed us very squarely to all the things we love and care about. And then that becomes a nice compass for our way forward, how we’re going to live until we die. The fear there, the things we are afraid to miss, are the things we really should uptick in terms of our attention now.\u003c/p>\n\u003cp>\u003cem>Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\">Fresh Air\u003c/a>.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=After+A+Freak+Accident%2C+A+Doctor+Finds+Insight+Into+%27Living+Life+And+Facing+Death%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Sandy Gibson remembers that his mother thought about the end of her life a lot.\u003c/p>\n\u003cp>When he was 5, his mother found out she had terminal cancer. She was only 39 years old.\u003c/p>\n\u003cp>\"My mom grew up in a very religious family, and she'd ask, 'Why would God do this to me?'\" said Gibson. \"Why would she have a 5-year-old and an 8-year-old and have a terminal illness?\"\u003c/p>\n\u003cfigure id=\"attachment_11759768\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759768\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Sandy-Gibson-800x533.jpg\" alt=\"Co-founder of Better Place Forests Sandy Gibson lost both his parents in his youth. \" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Co-founder of Better Place Forests Sandy Gibson said his parents' gravesite \"never felt like the right place for them.\" \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One year before his mother passed away — when Gibson was 10 years old — his father died of complications due to a stroke. For most of his life, Gibson never wanted to visit that site where his parents were buried.\u003c/p>\n\u003cp>\"It never felt like the right place for them,\" he said.\u003c/p>\n\u003cp>His personal experience with loss is, in part, what inspired Gibson to co-found \u003ca href=\"https://www.betterplaceforests.com\" target=\"_blank\" rel=\"noopener\">Better Place Forests\u003c/a> — an alternative to cemeteries, where families can claim a redwood tree as a grave marker and scatter their loved one's ashes.\u003c/p>\n\u003cp>The company currently has two locations in California — Point Arena and Santa Cruz — and is hoping to expand to locations in Oregon, Colorado, Arizona and Washington.\u003c/p>\n\u003cp>According to Gibson, scattering remains at Better Place Forests involves two rituals. First, selecting a tree. Families come to the forest together to decide which section of the forest speaks to them.\u003c/p>\n\u003cp>\"Because while it's in a 20-acre forest, you might have 50 different sections that feel very different,\" Gibson explained. \"It might be that the birds live in one section, or the fact that rhododendrons are in another.\"\u003c/p>\n\u003cp>Choosing a tree also involves deciding if you want to be scattered alone, or with your pets and family members. Better Place offers \u003ca href=\"http://learn.betterplaceforests.com/knowledge/what-are-the-different-options-in-the-forestv2\" target=\"_blank\" rel=\"noopener\">five different tree options\u003c/a> with varying scattering rights.\u003c/p>\n\u003cfigure id=\"attachment_11759965\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759965\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Tree-Cremains-Marker-800x533.jpg\" alt=\"Families can choose to add memorial markers with personalized quotes to their tree.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/07/Tree-Cremains-Marker.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/Tree-Cremains-Marker-160x107.jpg 160w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Families can choose to add memorial markers with personalized quotes to their tree. \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Once the tree is selected, the second ritual is the spreading ceremony, where family members gather to scatter the ashes.\u003c/p>\n\u003cp>As part of the experience, Better Place takes the cremains and mixes them with local soil to rebalance the pH.\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='Sandy Gibson, Better Place Forests co-founder']'We perform the ceremony where they watch the ashes be returned to the earth and remixed with that soil and then be re-covered. Then we spread wildflower seeds, and the family participates in watering the area around the tree.'[/pullquote]\u003c/p>\n\u003cp>\"That's very important because it's the bacteria in the soil that's going to break down the bone ash to become nutrients for the forest floor,\" explained Gibson. \"That's what starts the cycle of life with that bacteria. And that can only live and thrive in a properly balanced soil mixture.\"\u003c/p>\n\u003cp>After the ashes are prepared, a member of Better Place Forests walks with the family to their chosen tree to perform the service.\u003c/p>\n\u003cp>\"We perform the ceremony where they watch the ashes be returned to the earth and remixed with that soil and then be re-covered. Then we spread wildflower seeds, and the family participates in watering the area around the tree,\" said Gibson.\u003c/p>\n\u003cfigure id=\"attachment_11759766\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759766\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Point-Arena-Visitor-Center-Day-800x533.jpg\" alt=\"The Better Place Forests visitor's center at Point Arena.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">The Better Place Forests visitors center at Point Arena. \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Scattering ashes in forests or other scenic locations is not a new idea. But California has strict laws on where this can be legally performed.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Sandy Gibson, Better Place Forests co-founder']'It's all about creating a ritual that connects you to a sense of place'[/pullquote]\u003c/p>\n\u003cp>According to the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=7116.\" target=\"_blank\" rel=\"noopener\">Health and Safety Code\u003c/a>, cremated human remains can be scattered only in places where \"no local prohibition exists,\" as long as they're not \"visible to the public.\"\u003c/p>\n\u003cp>Those doing the scattering must also obtain written permission from the property owner — be that a private landowner or governing agency.\u003c/p>\n\u003cp>But the California Cemetery and Funeral Bureau (CFB) warns that scattering cremains on private property doesn't guarantee that a family will always be able to return and visit.\u003c/p>\n\u003cp>\"... as time goes on property status may change. If the consumers' goal is to return to a site to visit their loved ones over the years or decades, they may want to consider a licensed cemetery,\" said the agency in a statement.\u003c/p>\n\u003cfigure id=\"attachment_11759761\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759761\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Point-Arena-Forest-Creekside-Area-800x533.jpg\" alt=\""It's all about creating a ritual that connects you to a sense of place," said Gibson. "It's the opposite of my experience. It's the opposite of trying to think about my mother and thinking of a black tombstone. It's thinking about your husband or your father or your mother and thinking about this beautiful place that's full of life."\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">\"It's all about creating a ritual that connects you to a sense of place,\" Gibson said. \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Gibson says the creation of this new option for burial has helped him deal with some of his personal trauma.\u003c/p>\n\u003cp>\"It's all about creating a ritual that connects you to a sense of place,\" said Gibson. \"It's the opposite of my experience. It's the opposite of trying to think about my mother and thinking of a black tombstone. It's thinking about your husband or your father or your mother and thinking about this beautiful place that's full of life.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sandy Gibson remembers that his mother thought about the end of her life a lot.\u003c/p>\n\u003cp>When he was 5, his mother found out she had terminal cancer. She was only 39 years old.\u003c/p>\n\u003cp>\"My mom grew up in a very religious family, and she'd ask, 'Why would God do this to me?'\" said Gibson. \"Why would she have a 5-year-old and an 8-year-old and have a terminal illness?\"\u003c/p>\n\u003cfigure id=\"attachment_11759768\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759768\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Sandy-Gibson-800x533.jpg\" alt=\"Co-founder of Better Place Forests Sandy Gibson lost both his parents in his youth. \" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Co-founder of Better Place Forests Sandy Gibson said his parents' gravesite \"never felt like the right place for them.\" \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One year before his mother passed away — when Gibson was 10 years old — his father died of complications due to a stroke. For most of his life, Gibson never wanted to visit that site where his parents were buried.\u003c/p>\n\u003cp>\"It never felt like the right place for them,\" he said.\u003c/p>\n\u003cp>His personal experience with loss is, in part, what inspired Gibson to co-found \u003ca href=\"https://www.betterplaceforests.com\" target=\"_blank\" rel=\"noopener\">Better Place Forests\u003c/a> — an alternative to cemeteries, where families can claim a redwood tree as a grave marker and scatter their loved one's ashes.\u003c/p>\n\u003cp>The company currently has two locations in California — Point Arena and Santa Cruz — and is hoping to expand to locations in Oregon, Colorado, Arizona and Washington.\u003c/p>\n\u003cp>According to Gibson, scattering remains at Better Place Forests involves two rituals. First, selecting a tree. Families come to the forest together to decide which section of the forest speaks to them.\u003c/p>\n\u003cp>\"Because while it's in a 20-acre forest, you might have 50 different sections that feel very different,\" Gibson explained. \"It might be that the birds live in one section, or the fact that rhododendrons are in another.\"\u003c/p>\n\u003cp>Choosing a tree also involves deciding if you want to be scattered alone, or with your pets and family members. Better Place offers \u003ca href=\"http://learn.betterplaceforests.com/knowledge/what-are-the-different-options-in-the-forestv2\" target=\"_blank\" rel=\"noopener\">five different tree options\u003c/a> with varying scattering rights.\u003c/p>\n\u003cfigure id=\"attachment_11759965\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759965\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Tree-Cremains-Marker-800x533.jpg\" alt=\"Families can choose to add memorial markers with personalized quotes to their tree.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2019/07/Tree-Cremains-Marker.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2019/07/Tree-Cremains-Marker-160x107.jpg 160w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Families can choose to add memorial markers with personalized quotes to their tree. \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Once the tree is selected, the second ritual is the spreading ceremony, where family members gather to scatter the ashes.\u003c/p>\n\u003cp>As part of the experience, Better Place takes the cremains and mixes them with local soil to rebalance the pH.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"That's very important because it's the bacteria in the soil that's going to break down the bone ash to become nutrients for the forest floor,\" explained Gibson. \"That's what starts the cycle of life with that bacteria. And that can only live and thrive in a properly balanced soil mixture.\"\u003c/p>\n\u003cp>After the ashes are prepared, a member of Better Place Forests walks with the family to their chosen tree to perform the service.\u003c/p>\n\u003cp>\"We perform the ceremony where they watch the ashes be returned to the earth and remixed with that soil and then be re-covered. Then we spread wildflower seeds, and the family participates in watering the area around the tree,\" said Gibson.\u003c/p>\n\u003cfigure id=\"attachment_11759766\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759766\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Point-Arena-Visitor-Center-Day-800x533.jpg\" alt=\"The Better Place Forests visitor's center at Point Arena.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">The Better Place Forests visitors center at Point Arena. \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Scattering ashes in forests or other scenic locations is not a new idea. But California has strict laws on where this can be legally performed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=7116.\" target=\"_blank\" rel=\"noopener\">Health and Safety Code\u003c/a>, cremated human remains can be scattered only in places where \"no local prohibition exists,\" as long as they're not \"visible to the public.\"\u003c/p>\n\u003cp>Those doing the scattering must also obtain written permission from the property owner — be that a private landowner or governing agency.\u003c/p>\n\u003cp>But the California Cemetery and Funeral Bureau (CFB) warns that scattering cremains on private property doesn't guarantee that a family will always be able to return and visit.\u003c/p>\n\u003cp>\"... as time goes on property status may change. If the consumers' goal is to return to a site to visit their loved ones over the years or decades, they may want to consider a licensed cemetery,\" said the agency in a statement.\u003c/p>\n\u003cfigure id=\"attachment_11759761\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-11759761\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/Point-Arena-Forest-Creekside-Area-800x533.jpg\" alt=\""It's all about creating a ritual that connects you to a sense of place," said Gibson. "It's the opposite of my experience. It's the opposite of trying to think about my mother and thinking of a black tombstone. It's thinking about your husband or your father or your mother and thinking about this beautiful place that's full of life."\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">\"It's all about creating a ritual that connects you to a sense of place,\" Gibson said. \u003ccite>(Courtesy of Better Place Forests)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Gibson says the creation of this new option for burial has helped him deal with some of his personal trauma.\u003c/p>\n\u003cp>\"It's all about creating a ritual that connects you to a sense of place,\" said Gibson. \"It's the opposite of my experience. It's the opposite of trying to think about my mother and thinking of a black tombstone. It's thinking about your husband or your father or your mother and thinking about this beautiful place that's full of life.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Beloved San Francisco Zen Hospice Project Confronts Its Own End",
"title": "Beloved San Francisco Zen Hospice Project Confronts Its Own End",
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"content": "\u003cp>It was late May when the body of the last person to die in the guest house of the \u003ca href=\"https://www.zenhospice.org/\" target=\"_blank\" rel=\"noopener\">Zen Hospice Project\u003c/a> was carried down the stairs and through the back garden, then sprinkled with flower petals.\u003c/p>\n\u003cp>The San Francisco institution was founded during the height of the AIDS crisis, a time when sick men were left to die alone in the hallways of county hospitals because staff were afraid to touch them. Buddhist practitioners bought the Victorian on Page Street to create a place where men could get compassionate care and die with dignity.\u003c/p>\n\u003cp>Now, after 30 years of caring for people with all kinds of illnesses, the house is closing its doors. The organization no longer has enough money to keep the program going.\u003c/p>\n\u003cp>“It’s a little chaotic in here,” says George Kellar, the executive director of the last two and a half years, as we walk through the foyer of the house. “It’s in total transition.”\u003c/p>\n\u003cp>All the furniture is gone. The floors are covered with canvas tarps. Blue tape lines the perimeter of the living room. Men in jumpsuits and face masks are painting the fireplace, tearing up the carpet on the stairway and power washing the windows.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the hospice issued its press release last week about this turn in the nonprofit’s fortunes, I noted the careful wording — that the guest house was “suspending” caregiving services, that they hoped they could “offer them again, at some point.” The implication was clear: Maybe a local tech billionaire could step in with a Hail Mary donation.\u003c/p>\n\u003cp>But this is a house that’s being primed for a realtor to stage it and put it up for sale.\u003c/p>\n\u003cp>“Five bedrooms, three bathrooms. It has a boarding house feel to it,” Kellar says as he gives me a tour of the upstairs. “It probably has that kind of history.”\u003c/p>\n\u003cp>Before the beds were cleared out, before all the nurses were laid off, the guest house had room for six residents. They called them “residents” not “patients.” This was their home, not a hospice. And they came here not to die, but to live fully until the end of their lives.\u003c/p>\n\u003cp>A corps of volunteers would sit with patients, sometimes for hours — just holding their hand, telling stories, singing songs. Kitchen staff prepared three meals a day to order for each resident, even when they could no longer eat.\u003c/p>\n\u003cp>“They can smell it, they can see it, if they want to taste that they can,\" Kellar says, adding that it's about letting the residents know \"they’re not discarded and ignored and not important.\"\u003c/p>\n\u003cp>The organization became a pioneer in what it means to die well. It helped shape a national movement away from sterile hospital deaths — hooked up to machines — to a mindful, aesthetic end that emphasized being present with what was happening.\u003c/p>\n\u003cp>Donors loved the mission and they were generous. Until the 2016 election.\u003c/p>\n\u003cp>“We’ve been struggling through 2017,” Kellar says.\u003c/p>\n\u003cp>This year, they’re more than $1 million short on their $2 million annual budget. Donors have been telling Kellar they have to cut back on their gifts to the hospice because they need to support issues that have come under attack during the Trump administration.\u003c/p>\n\u003cp>“Voting rights, or women in politics, or immigration help,” Kellar lists the other causes drawing donations instead of his organization. “And homeless, there’s a lot of interest in helping the homeless situation.”\u003c/p>\n\u003cfigure id=\"attachment_364227\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364227\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/George-Kellar-looks-at-ZHP-art-book-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Kellar flips through a binder of art and embroidery pieces created by residents who died at the Zen Hospice Project's guest house. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nationally, philanthropy experts are waiting to see if this is a broader trend. The economy is strong right now and charitable giving has increased since the 2016 election, says Stacy Palmer, editor of the Chronicle of Philanthropy. But it’s unclear if people are giving more overall or shifting their dollars to issues that are in the news a lot.\u003c/p>\n\u003cp>“People really have to make choices about which charities they care about the most,” Palmer says, and in a time of shifting priorities, it can be harder to get people to open their wallets when it comes to end-of-life issues.\u003c/p>\n\u003cp>“People don’t really like to hear about death, even though what hospices do is really make death so much easier. It’s a tough conversation,” she says. “Sometimes really important causes are the ones that suffer just because they are dealing with difficult subjects.”\u003c/p>\n\u003cp>But some of the blame sits with the Zen Hospice Project itself. It relied too much on loyal donors, and didn’t cultivate enough new ones, Kellar says. And, for all these years, the hospice has declined to get licensed under the government’s Medicare and Medicaid programs, closing the door on a steady stream of reimbursement payments.\u003c/p>\n\u003cp>“We don’t want to compromise our commitment to this compassionate model,” Kellar explains. “And if that commitment is compromised by the reporting requirements or by the regulatory requirements, we don’t want to go there.”\u003c/p>\n\u003cp>But idealism doesn’t pay the bills. And that’s one of the reasons Kellar was brought in four years ago: to bring some business savvy to the nonprofit. He’s a Zen Buddhist, and he’s also a Silicon Valley guy — a software engineer with a background in sales and operations.\u003c/p>\n\u003cp>At first, he became right-hand man to the executive director at the time, BJ Miller, a doctor and a charismatic visionary who put the Zen Hospice Project in the national conscience through a high-profile New York Times \u003ca href=\"https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> and a \u003ca href=\"https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life\">TED talk\u003c/a> that’s been viewed more than 7.5 million times. In it, Miller talks about the importance of “sensuous, aesthetic gratification” at the end of life and how the Zen Hospice Project wants to help people enjoy the last of their time by way of the five senses.\u003c/p>\n\u003cp>“Seriously, with all the heavy-duty stuff happening under our roof, one of the most tried and true interventions we know of is to bake cookies,” he said, the smell providing sustenance on so many levels. “As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.”\u003c/p>\n\u003cfigure id=\"attachment_364225\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364225\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/ZHP-Cookie-Book-close-up-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Zen Hospice Project's cookie recipe book sits with other nostalgic items moved out of the guest house as it is readied for sale. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kellar, on the other hand, talks about marketing and distribution and “scaling” operations.\u003c/p>\n\u003cp>“I am using businesslike terms to talk about it, but I think you have to,” he says.\u003c/p>\n\u003cp>When he took over the executive director position, the budget troubles were officially his responsibility.\u003c/p>\n\u003cp>One strategy he pursued was negotiating a partnership with some private insurance companies to have them reimburse for some of the hospice’s services. It’s an appealing value proposition for insurers: It costs $850 a day to care for each patient at the hospice, compared to the thousands and thousands of dollars in daily costs for someone to die in an ICU.\u003c/p>\n\u003cp>But after 18 months, there was still no agreement.\u003c/p>\n\u003cp>“We could no longer wait,” Kellar says.\u003c/p>\n\u003cp>Kellar presented the numbers to the board of directors, and they agreed they could no longer afford to keep the guest house going.\u003c/p>\n\u003cp>“As difficult and sad as it is, which it is, we’re letting it go,” Kellar says. “And that will create another space for something else to present itself. And maybe that something else is this massive opportunity.”\u003c/p>\n\u003cp>That could be an opportunity presented by the \u003ca href=\"https://www.caregiver.org/caregiver-statistics-demographics\" target=\"_blank\" rel=\"noopener\">43 million\u003c/a> informal caregivers in the U.S. — people taking care of their own ailing parents, spouses, or children — who need help. Kellar says if Zen Hospice Project sells the guest house, the organization can reinvest that money into its other programs: the volunteer program, which sends people to sit with the dying in the hospice floor of Laguna Honda Hospital, and the\u003ca href=\"https://www.zenhospice.org/education-training/mce/\" target=\"_blank\" rel=\"noopener\">Mindful Caregiver Education program\u003c/a>, which emphasizes caregivers taking care of themselves so they can take better care of others.\u003c/p>\n\u003cp>“Our mission is to transform the experience of dying and caregiving,” Kellar says. “And while we started at the bedside and continue at the bedside at Laguna Honda, it is now a time to focus on helping other people at the bedside by training and education.”\u003c/p>\n\u003cp>But selling this iconic San Francisco institution to as a private residence for 5 or 6 million dollars?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s not what I expected,” Kellar says, shifting from business guy to Zen guy. “I guess it’s a lesson in impermanence. And a lesson in ‘things change' and to not get as attached as we are because everybody here is very attached to this.”\u003c/p>\n\n",
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"excerpt": "Since the 2016 election, donors have been shifting their charitable dollars away from the hospice.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was late May when the body of the last person to die in the guest house of the \u003ca href=\"https://www.zenhospice.org/\" target=\"_blank\" rel=\"noopener\">Zen Hospice Project\u003c/a> was carried down the stairs and through the back garden, then sprinkled with flower petals.\u003c/p>\n\u003cp>The San Francisco institution was founded during the height of the AIDS crisis, a time when sick men were left to die alone in the hallways of county hospitals because staff were afraid to touch them. Buddhist practitioners bought the Victorian on Page Street to create a place where men could get compassionate care and die with dignity.\u003c/p>\n\u003cp>Now, after 30 years of caring for people with all kinds of illnesses, the house is closing its doors. The organization no longer has enough money to keep the program going.\u003c/p>\n\u003cp>“It’s a little chaotic in here,” says George Kellar, the executive director of the last two and a half years, as we walk through the foyer of the house. “It’s in total transition.”\u003c/p>\n\u003cp>All the furniture is gone. The floors are covered with canvas tarps. Blue tape lines the perimeter of the living room. Men in jumpsuits and face masks are painting the fireplace, tearing up the carpet on the stairway and power washing the windows.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the hospice issued its press release last week about this turn in the nonprofit’s fortunes, I noted the careful wording — that the guest house was “suspending” caregiving services, that they hoped they could “offer them again, at some point.” The implication was clear: Maybe a local tech billionaire could step in with a Hail Mary donation.\u003c/p>\n\u003cp>But this is a house that’s being primed for a realtor to stage it and put it up for sale.\u003c/p>\n\u003cp>“Five bedrooms, three bathrooms. It has a boarding house feel to it,” Kellar says as he gives me a tour of the upstairs. “It probably has that kind of history.”\u003c/p>\n\u003cp>Before the beds were cleared out, before all the nurses were laid off, the guest house had room for six residents. They called them “residents” not “patients.” This was their home, not a hospice. And they came here not to die, but to live fully until the end of their lives.\u003c/p>\n\u003cp>A corps of volunteers would sit with patients, sometimes for hours — just holding their hand, telling stories, singing songs. Kitchen staff prepared three meals a day to order for each resident, even when they could no longer eat.\u003c/p>\n\u003cp>“They can smell it, they can see it, if they want to taste that they can,\" Kellar says, adding that it's about letting the residents know \"they’re not discarded and ignored and not important.\"\u003c/p>\n\u003cp>The organization became a pioneer in what it means to die well. It helped shape a national movement away from sterile hospital deaths — hooked up to machines — to a mindful, aesthetic end that emphasized being present with what was happening.\u003c/p>\n\u003cp>Donors loved the mission and they were generous. Until the 2016 election.\u003c/p>\n\u003cp>“We’ve been struggling through 2017,” Kellar says.\u003c/p>\n\u003cp>This year, they’re more than $1 million short on their $2 million annual budget. Donors have been telling Kellar they have to cut back on their gifts to the hospice because they need to support issues that have come under attack during the Trump administration.\u003c/p>\n\u003cp>“Voting rights, or women in politics, or immigration help,” Kellar lists the other causes drawing donations instead of his organization. “And homeless, there’s a lot of interest in helping the homeless situation.”\u003c/p>\n\u003cfigure id=\"attachment_364227\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364227\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/George-Kellar-looks-at-ZHP-art-book-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Kellar flips through a binder of art and embroidery pieces created by residents who died at the Zen Hospice Project's guest house. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nationally, philanthropy experts are waiting to see if this is a broader trend. The economy is strong right now and charitable giving has increased since the 2016 election, says Stacy Palmer, editor of the Chronicle of Philanthropy. But it’s unclear if people are giving more overall or shifting their dollars to issues that are in the news a lot.\u003c/p>\n\u003cp>“People really have to make choices about which charities they care about the most,” Palmer says, and in a time of shifting priorities, it can be harder to get people to open their wallets when it comes to end-of-life issues.\u003c/p>\n\u003cp>“People don’t really like to hear about death, even though what hospices do is really make death so much easier. It’s a tough conversation,” she says. “Sometimes really important causes are the ones that suffer just because they are dealing with difficult subjects.”\u003c/p>\n\u003cp>But some of the blame sits with the Zen Hospice Project itself. It relied too much on loyal donors, and didn’t cultivate enough new ones, Kellar says. And, for all these years, the hospice has declined to get licensed under the government’s Medicare and Medicaid programs, closing the door on a steady stream of reimbursement payments.\u003c/p>\n\u003cp>“We don’t want to compromise our commitment to this compassionate model,” Kellar explains. “And if that commitment is compromised by the reporting requirements or by the regulatory requirements, we don’t want to go there.”\u003c/p>\n\u003cp>But idealism doesn’t pay the bills. And that’s one of the reasons Kellar was brought in four years ago: to bring some business savvy to the nonprofit. He’s a Zen Buddhist, and he’s also a Silicon Valley guy — a software engineer with a background in sales and operations.\u003c/p>\n\u003cp>At first, he became right-hand man to the executive director at the time, BJ Miller, a doctor and a charismatic visionary who put the Zen Hospice Project in the national conscience through a high-profile New York Times \u003ca href=\"https://www.nytimes.com/2017/01/03/magazine/one-mans-quest-to-change-the-way-we-die.html\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> and a \u003ca href=\"https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life\">TED talk\u003c/a> that’s been viewed more than 7.5 million times. In it, Miller talks about the importance of “sensuous, aesthetic gratification” at the end of life and how the Zen Hospice Project wants to help people enjoy the last of their time by way of the five senses.\u003c/p>\n\u003cp>“Seriously, with all the heavy-duty stuff happening under our roof, one of the most tried and true interventions we know of is to bake cookies,” he said, the smell providing sustenance on so many levels. “As long as we have our senses — even just one — we have at least the possibility of accessing what makes us feel human, connected.”\u003c/p>\n\u003cfigure id=\"attachment_364225\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-364225\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2018/08/ZHP-Cookie-Book-close-up-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Zen Hospice Project's cookie recipe book sits with other nostalgic items moved out of the guest house as it is readied for sale. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kellar, on the other hand, talks about marketing and distribution and “scaling” operations.\u003c/p>\n\u003cp>“I am using businesslike terms to talk about it, but I think you have to,” he says.\u003c/p>\n\u003cp>When he took over the executive director position, the budget troubles were officially his responsibility.\u003c/p>\n\u003cp>One strategy he pursued was negotiating a partnership with some private insurance companies to have them reimburse for some of the hospice’s services. It’s an appealing value proposition for insurers: It costs $850 a day to care for each patient at the hospice, compared to the thousands and thousands of dollars in daily costs for someone to die in an ICU.\u003c/p>\n\u003cp>But after 18 months, there was still no agreement.\u003c/p>\n\u003cp>“We could no longer wait,” Kellar says.\u003c/p>\n\u003cp>Kellar presented the numbers to the board of directors, and they agreed they could no longer afford to keep the guest house going.\u003c/p>\n\u003cp>“As difficult and sad as it is, which it is, we’re letting it go,” Kellar says. “And that will create another space for something else to present itself. And maybe that something else is this massive opportunity.”\u003c/p>\n\u003cp>That could be an opportunity presented by the \u003ca href=\"https://www.caregiver.org/caregiver-statistics-demographics\" target=\"_blank\" rel=\"noopener\">43 million\u003c/a> informal caregivers in the U.S. — people taking care of their own ailing parents, spouses, or children — who need help. Kellar says if Zen Hospice Project sells the guest house, the organization can reinvest that money into its other programs: the volunteer program, which sends people to sit with the dying in the hospice floor of Laguna Honda Hospital, and the\u003ca href=\"https://www.zenhospice.org/education-training/mce/\" target=\"_blank\" rel=\"noopener\">Mindful Caregiver Education program\u003c/a>, which emphasizes caregivers taking care of themselves so they can take better care of others.\u003c/p>\n\u003cp>“Our mission is to transform the experience of dying and caregiving,” Kellar says. “And while we started at the bedside and continue at the bedside at Laguna Honda, it is now a time to focus on helping other people at the bedside by training and education.”\u003c/p>\n\u003cp>But selling this iconic San Francisco institution to as a private residence for 5 or 6 million dollars?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s not what I expected,” Kellar says, shifting from business guy to Zen guy. “I guess it’s a lesson in impermanence. And a lesson in ‘things change' and to not get as attached as we are because everybody here is very attached to this.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Too Late To Operate? Surgery Near End Of Life Is Common, Costly",
"title": "Too Late To Operate? Surgery Near End Of Life Is Common, Costly",
"headTitle": "The California Report | KQED News",
"content": "\u003cp>At 87, Maxine Stanich cared more about improving the quality of her life than prolonging it.\u003c/p>\n\u003cp>She suffered from a long list of health problems, including heart failure and chronic lung disease that could leave her gasping for breath.\u003c/p>\n\u003cp>When her time came she wanted to die a natural death, Stanich told her daughter, and she signed a \"do not resuscitate\" directive, or DNR, ordering doctors not to revive her should her heart stop.\u003c/p>\n\u003cp>Yet a trip to a San Francisco emergency room for shortness of breath in 2008 led Stanich to get a defibrillator implanted in her chest — a medical device to keep her alive by delivering a powerful shock to her heart if it started beating irregularly.\u003c/p>\n\u003cp>At the time, Stanich didn't fully grasp what she had agreed to, even though she signed a document granting permission for the procedure, said her daughter, Susan Giaquinto.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That clarity came only during a subsequent visit to a different hospital, when a surprised ER doctor saw the defibrillator protruding from Stanich's thin chest. It was the first time a doctor clearly explained what the defibrillator would mean for Stanich, said Giaquinto, who accompanied her mother on both hospital trips.\u003c/p>\n\u003cp>To Stanich's horror, the ER doctor explained that the device wouldn't allow Stanich to slip away painlessly. Instead, the defibrillator would give her a jolt \"so strong that it will knock her across the room,\" Giaquinto said.\u003c/p>\n\u003cp>Surgery like Stanich's defibrillator implantation has become all too common among those near the end of life, experts say. Nearly \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61268-3/fulltext\" target=\"_blank\" rel=\"noopener\">1 in 3 Medicare patients\u003c/a> undergoes an operation in the year before death, even though the evidence shows that many are more likely to be harmed than to benefit from it.\u003c/p>\n\u003cfigure id=\"attachment_11652868\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11652868\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/02/rita-redberg-toned-41-f9f41542571d59b90321a2c978b286c7de516c4d-e1519866638109.jpg\" alt=\"Dr. Rita Redberg, director of women's cardiovascular services at the University of California, San Francisco's cardiology division, tends to her mother, Mae Redberg, in Mae's apartment in New York City.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rita Redberg, director of women's cardiovascular services at the University of California, San Francisco's cardiology division, tends to her mother, Mae Redberg, in Mae's apartment in New York City. \u003ccite>(Yana Paskova/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The practice is driven by financial incentives that reward doctors for doing procedures, as well as a medical culture in which patients and doctors are reluctant to talk about how surgical interventions should be prescribed more judiciously, said \u003ca href=\"http://profiles.ucsf.edu/rita.redberg\" target=\"_blank\" rel=\"noopener\">Dr. Rita Redberg\u003c/a>, a cardiologist who treated Stanich when she sought care at the second hospital a week after her defibrillator was implanted.\u003c/p>\n\u003cp>\"We have a culture that believes in very aggressive care,\" said Redberg, who specializes in heart disease in women at the University of California, San Francisco. \"We are often not considering the chance of benefit and chance of harm, and how that changes when you get older. We also fail to have conversations about what patients value most.\"\u003c/p>\n\u003cp>While surgery can be lifesaving for younger people, operating on frail, older patients rarely helps them live longer or returns the quality of life they once enjoyed, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492901/pdf/nihms647215.pdf\" target=\"_blank\" rel=\"noopener\">a 2016 paper\u003c/a> in \u003cem>Annals of Surgery.\u003c/em>\u003c/p>\n\u003cp>The cost of these surgeries — typically paid for by Medicare, the government health insurance program for people over 65 — involve more than money, said Dr. Amber Barnato, a professor at the Dartmouth Institute for Health Policy and Clinical Practice. Older patients who undergo surgery within a year of death spent 50 percent more time in the hospital than others, and nearly twice as many days in intensive care.\u003c/p>\n\u003cp>And while some robust octogenarians have many years ahead of them, studies show that surgery is also common among those who are far more frail.\u003c/p>\n\u003cp>Eighteen percent of Medicare patients have surgery in their final month of life and 8 percent in their final week, according to a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61268-3/fulltext\" target=\"_blank\" rel=\"noopener\">2011 study \u003c/a>in \u003cem>The Lancet.\u003c/em>\u003c/p>\n\u003cp>More than 12 percent of defibrillators were implanted in people older than 80, \u003ca href=\"https://academic.oup.com/europace/article/17/2/174/569259\" target=\"_blank\" rel=\"noopener\">according to a 2015 study.\u003c/a> Doctors implant about 158,000 of the devices each year, according to the American College of Cardiology. The total \u003ca href=\"https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2015.html\" target=\"_blank\" rel=\"noopener\">cost\u003c/a> of the procedure runs about $60,000.\u003c/p>\n\u003cp>Procedures performed in the elderly range from major operations require lengthy recoveries compared to relatively minor surgery performed in a doctor's office, such as the removal of nonfatal skin cancers that would likely never cause any problems.\u003c/p>\n\u003cp>Research led by Dr. Eleni Linos has shown that people with limited life expectancies \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/jgs.14202/abstract\" target=\"_blank\" rel=\"noopener\">are treated for nonfatal skin cancers as aggressively as younger patients\u003c/a>. Among patients with a nonfatal skin cancer and a limited time to live, 70 percent underwent surgery, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23699934\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> her 2013 study in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>When less is more\u003c/strong>\u003c/p>\n\u003cp>Surgery poses serious risks for older people, who weather anesthesia poorly and whose skin takes longer to heal. Among seniors who undergo urgent or emergency abdominal surgery, 20 percent die within 30 days, \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2599170\" target=\"_blank\" rel=\"noopener\">studies show.\u003c/a>\u003c/p>\n\u003cp>With diminished mental acuity and an old-fashioned respect for the medical profession, some aging patients are vulnerable to unwanted interventions. Stanich agreed to a pacemaker defibrillator simply because her doctor suggested it, Giaquinto said. Many people of Stanich's generation \"thought doctors were God ... They never questioned doctors — ever.\"\u003c/p>\n\u003cp>According to the University of Michigan's National Poll on Healthy Aging, published Wednesday, more than half of adults ages 50 to 80 said doctors often recommend unnecessary tests, medications or procedures. Yet half of those who'd been told they needed an X-ray or other test – but weren't sure they needed it – went on to have the procedure anyway.\u003c/p>\n\u003cp>Dr. Margaret Schwarze, a surgeon and associate professor at the University of Wisconsin School of Medicine and Public Health, said that older patients often don't feel the financial pain of surgery because insurance pays most of the cost.\u003c/p>\n\u003cp>When a surgeon offers to \"fix\" the heart valve in a person with multiple diseases, for example, the patient may assume that surgery will \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25749396\" target=\"_blank\" rel=\"noopener\">fix all of her medical problems,\u003c/a> Schwarze said. \"With older patients with lots of chronic illnesses, we're not really fixing anything.\"\u003c/p>\n\u003cp>Even as a doctor, Redberg said, she struggles to prevent other doctors from performing too many procedures on her 92-year-old mother, Mae, who lives in New York City.\u003c/p>\n\u003cp>Redberg said doctors recently treated her mother for melanoma — the most serious type of skin cancer. After the cancer was removed from her leg, Redberg's mother was urged by a doctor to undergo an additional surgery to cut away more tissue and nearby lymph nodes, which can harbor cancerous cells.\u003c/p>\n\u003cp>\"Every time she went in, the dermatologist wanted to refer her to a surgeon,\" Redberg said. \"Medicare would have been happy to pay for it.\"\u003c/p>\n\u003cp>But her mother often has problems with wound healing, she said, and recovery would likely have taken three months. When Redberg pressed a surgeon about the benefits, he said the procedure could reduce the chances of cancer coming back within three to five years.\u003c/p>\n\u003cp>Redberg said her mother laughed and said, \"I'm not interested in doing something that will help me in three to five years. I doubt I'll be here.\"\u003c/p>\n\u003cp>\u003cstrong>Finding solutions\u003c/strong>\u003c/p>\n\u003cp>The momentum of hospital care can make people feel as if they're on a moving train and can't jump off.\u003c/p>\n\u003cp>The rush of medical decisions \"doesn't allow time to deliberate or consider the patients' overall health or what their goals and values might be,\" said Dr. Jacqueline Kruser, an instructor in pulmonary and critical care medicine and medical social sciences at the Northwestern University Feinberg School of Medicine.\u003c/p>\n\u003cp>Many hospitals and health systems are developing \"decision aids,\" easy-to-understand written \u003ca href=\"http://centerforinnovation.mayo.edu/decision-aids/\" target=\"_blank\" rel=\"noopener\">materials and videos\u003c/a> to help patients make more informed medical choices, giving them time to develop more realistic expectations.\u003c/p>\n\u003cp>After Kaiser Permanente Washington introduced the tools relating to joint replacement, the number of patients choosing to have hip replacement surgery fell 26 percent, while knee replacements declined 38 percent, \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2011.0686\" target=\"_blank\" rel=\"noopener\">according to a 2012 study\u003c/a> in the journal \u003cem>Health Affairs.\u003c/em> (Kaiser Permanente isn't affiliated with Kaiser Health News, which is an editorially independent program of the Kaiser Family Foundation.)\u003c/p>\n\u003cp>In research findings \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2599170\" target=\"_blank\" rel=\"noopener\">published last year\u003c/a> in \u003cem>JAMA Surgery\u003c/em> and the \u003ca href=\"http://www.jpsmjournal.com/article/S0885-3924(16)31228-3/pdf\" target=\"_blank\" rel=\"noopener\">Journal of Pain and Symptom Management,\u003c/a> Schwarze, Kruser and colleagues suggested creating narratives to illustrate surgical risks, rather than relying on statistics.\u003c/p>\n\u003cp>Instead of telling patients that surgery carries a 20 percent risk of stroke, for example, doctors should lay out the best, worst and most likely outcomes.\u003c/p>\n\u003cp>In the best-case scenario, a patient might spend weeks in the hospital after surgery, living the rest of her life in a nursing home. In the worst case, the same patient dies after several weeks in intensive care. In the most likely scenario, the patient survives just two to three months after surgery.\u003c/p>\n\u003cp>\"If someone says they can't tolerate the best-case scenario — which involves them being in a nursing home — then maybe we shouldn't be doing this,\" Schwarze said.\u003c/p>\n\u003cp>Maxine Stanich died in 2010, just after her 90th birthday. Although Redberg had deactivated the defibrillator at Stanich's request, it remained in her chest.\u003c/p>\n\u003chr>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"https://khn.org/about-us\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit news service covering health issues. You can follow Liz Szabo on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/LizSzabo\" target=\"_blank\" rel=\"noopener\">\u003cem>@LizSzabo\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Too+Late+To+Operate%3F+Surgery+Near+End+Of+Life+Is+Common%2C+Costly&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Nearly 1 in 3 Medicare patients undergoes an operation in the final year of life. The benefits are often limited, but the costs and side effects can be substantial.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At 87, Maxine Stanich cared more about improving the quality of her life than prolonging it.\u003c/p>\n\u003cp>She suffered from a long list of health problems, including heart failure and chronic lung disease that could leave her gasping for breath.\u003c/p>\n\u003cp>When her time came she wanted to die a natural death, Stanich told her daughter, and she signed a \"do not resuscitate\" directive, or DNR, ordering doctors not to revive her should her heart stop.\u003c/p>\n\u003cp>Yet a trip to a San Francisco emergency room for shortness of breath in 2008 led Stanich to get a defibrillator implanted in her chest — a medical device to keep her alive by delivering a powerful shock to her heart if it started beating irregularly.\u003c/p>\n\u003cp>At the time, Stanich didn't fully grasp what she had agreed to, even though she signed a document granting permission for the procedure, said her daughter, Susan Giaquinto.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That clarity came only during a subsequent visit to a different hospital, when a surprised ER doctor saw the defibrillator protruding from Stanich's thin chest. It was the first time a doctor clearly explained what the defibrillator would mean for Stanich, said Giaquinto, who accompanied her mother on both hospital trips.\u003c/p>\n\u003cp>To Stanich's horror, the ER doctor explained that the device wouldn't allow Stanich to slip away painlessly. Instead, the defibrillator would give her a jolt \"so strong that it will knock her across the room,\" Giaquinto said.\u003c/p>\n\u003cp>Surgery like Stanich's defibrillator implantation has become all too common among those near the end of life, experts say. Nearly \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61268-3/fulltext\" target=\"_blank\" rel=\"noopener\">1 in 3 Medicare patients\u003c/a> undergoes an operation in the year before death, even though the evidence shows that many are more likely to be harmed than to benefit from it.\u003c/p>\n\u003cfigure id=\"attachment_11652868\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-11652868\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/02/rita-redberg-toned-41-f9f41542571d59b90321a2c978b286c7de516c4d-e1519866638109.jpg\" alt=\"Dr. Rita Redberg, director of women's cardiovascular services at the University of California, San Francisco's cardiology division, tends to her mother, Mae Redberg, in Mae's apartment in New York City.\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rita Redberg, director of women's cardiovascular services at the University of California, San Francisco's cardiology division, tends to her mother, Mae Redberg, in Mae's apartment in New York City. \u003ccite>(Yana Paskova/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The practice is driven by financial incentives that reward doctors for doing procedures, as well as a medical culture in which patients and doctors are reluctant to talk about how surgical interventions should be prescribed more judiciously, said \u003ca href=\"http://profiles.ucsf.edu/rita.redberg\" target=\"_blank\" rel=\"noopener\">Dr. Rita Redberg\u003c/a>, a cardiologist who treated Stanich when she sought care at the second hospital a week after her defibrillator was implanted.\u003c/p>\n\u003cp>\"We have a culture that believes in very aggressive care,\" said Redberg, who specializes in heart disease in women at the University of California, San Francisco. \"We are often not considering the chance of benefit and chance of harm, and how that changes when you get older. We also fail to have conversations about what patients value most.\"\u003c/p>\n\u003cp>While surgery can be lifesaving for younger people, operating on frail, older patients rarely helps them live longer or returns the quality of life they once enjoyed, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492901/pdf/nihms647215.pdf\" target=\"_blank\" rel=\"noopener\">a 2016 paper\u003c/a> in \u003cem>Annals of Surgery.\u003c/em>\u003c/p>\n\u003cp>The cost of these surgeries — typically paid for by Medicare, the government health insurance program for people over 65 — involve more than money, said Dr. Amber Barnato, a professor at the Dartmouth Institute for Health Policy and Clinical Practice. Older patients who undergo surgery within a year of death spent 50 percent more time in the hospital than others, and nearly twice as many days in intensive care.\u003c/p>\n\u003cp>And while some robust octogenarians have many years ahead of them, studies show that surgery is also common among those who are far more frail.\u003c/p>\n\u003cp>Eighteen percent of Medicare patients have surgery in their final month of life and 8 percent in their final week, according to a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61268-3/fulltext\" target=\"_blank\" rel=\"noopener\">2011 study \u003c/a>in \u003cem>The Lancet.\u003c/em>\u003c/p>\n\u003cp>More than 12 percent of defibrillators were implanted in people older than 80, \u003ca href=\"https://academic.oup.com/europace/article/17/2/174/569259\" target=\"_blank\" rel=\"noopener\">according to a 2015 study.\u003c/a> Doctors implant about 158,000 of the devices each year, according to the American College of Cardiology. The total \u003ca href=\"https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2015.html\" target=\"_blank\" rel=\"noopener\">cost\u003c/a> of the procedure runs about $60,000.\u003c/p>\n\u003cp>Procedures performed in the elderly range from major operations require lengthy recoveries compared to relatively minor surgery performed in a doctor's office, such as the removal of nonfatal skin cancers that would likely never cause any problems.\u003c/p>\n\u003cp>Research led by Dr. Eleni Linos has shown that people with limited life expectancies \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/jgs.14202/abstract\" target=\"_blank\" rel=\"noopener\">are treated for nonfatal skin cancers as aggressively as younger patients\u003c/a>. Among patients with a nonfatal skin cancer and a limited time to live, 70 percent underwent surgery, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23699934\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> her 2013 study in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>When less is more\u003c/strong>\u003c/p>\n\u003cp>Surgery poses serious risks for older people, who weather anesthesia poorly and whose skin takes longer to heal. Among seniors who undergo urgent or emergency abdominal surgery, 20 percent die within 30 days, \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2599170\" target=\"_blank\" rel=\"noopener\">studies show.\u003c/a>\u003c/p>\n\u003cp>With diminished mental acuity and an old-fashioned respect for the medical profession, some aging patients are vulnerable to unwanted interventions. Stanich agreed to a pacemaker defibrillator simply because her doctor suggested it, Giaquinto said. Many people of Stanich's generation \"thought doctors were God ... They never questioned doctors — ever.\"\u003c/p>\n\u003cp>According to the University of Michigan's National Poll on Healthy Aging, published Wednesday, more than half of adults ages 50 to 80 said doctors often recommend unnecessary tests, medications or procedures. Yet half of those who'd been told they needed an X-ray or other test – but weren't sure they needed it – went on to have the procedure anyway.\u003c/p>\n\u003cp>Dr. Margaret Schwarze, a surgeon and associate professor at the University of Wisconsin School of Medicine and Public Health, said that older patients often don't feel the financial pain of surgery because insurance pays most of the cost.\u003c/p>\n\u003cp>When a surgeon offers to \"fix\" the heart valve in a person with multiple diseases, for example, the patient may assume that surgery will \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25749396\" target=\"_blank\" rel=\"noopener\">fix all of her medical problems,\u003c/a> Schwarze said. \"With older patients with lots of chronic illnesses, we're not really fixing anything.\"\u003c/p>\n\u003cp>Even as a doctor, Redberg said, she struggles to prevent other doctors from performing too many procedures on her 92-year-old mother, Mae, who lives in New York City.\u003c/p>\n\u003cp>Redberg said doctors recently treated her mother for melanoma — the most serious type of skin cancer. After the cancer was removed from her leg, Redberg's mother was urged by a doctor to undergo an additional surgery to cut away more tissue and nearby lymph nodes, which can harbor cancerous cells.\u003c/p>\n\u003cp>\"Every time she went in, the dermatologist wanted to refer her to a surgeon,\" Redberg said. \"Medicare would have been happy to pay for it.\"\u003c/p>\n\u003cp>But her mother often has problems with wound healing, she said, and recovery would likely have taken three months. When Redberg pressed a surgeon about the benefits, he said the procedure could reduce the chances of cancer coming back within three to five years.\u003c/p>\n\u003cp>Redberg said her mother laughed and said, \"I'm not interested in doing something that will help me in three to five years. I doubt I'll be here.\"\u003c/p>\n\u003cp>\u003cstrong>Finding solutions\u003c/strong>\u003c/p>\n\u003cp>The momentum of hospital care can make people feel as if they're on a moving train and can't jump off.\u003c/p>\n\u003cp>The rush of medical decisions \"doesn't allow time to deliberate or consider the patients' overall health or what their goals and values might be,\" said Dr. Jacqueline Kruser, an instructor in pulmonary and critical care medicine and medical social sciences at the Northwestern University Feinberg School of Medicine.\u003c/p>\n\u003cp>Many hospitals and health systems are developing \"decision aids,\" easy-to-understand written \u003ca href=\"http://centerforinnovation.mayo.edu/decision-aids/\" target=\"_blank\" rel=\"noopener\">materials and videos\u003c/a> to help patients make more informed medical choices, giving them time to develop more realistic expectations.\u003c/p>\n\u003cp>After Kaiser Permanente Washington introduced the tools relating to joint replacement, the number of patients choosing to have hip replacement surgery fell 26 percent, while knee replacements declined 38 percent, \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2011.0686\" target=\"_blank\" rel=\"noopener\">according to a 2012 study\u003c/a> in the journal \u003cem>Health Affairs.\u003c/em> (Kaiser Permanente isn't affiliated with Kaiser Health News, which is an editorially independent program of the Kaiser Family Foundation.)\u003c/p>\n\u003cp>In research findings \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2599170\" target=\"_blank\" rel=\"noopener\">published last year\u003c/a> in \u003cem>JAMA Surgery\u003c/em> and the \u003ca href=\"http://www.jpsmjournal.com/article/S0885-3924(16)31228-3/pdf\" target=\"_blank\" rel=\"noopener\">Journal of Pain and Symptom Management,\u003c/a> Schwarze, Kruser and colleagues suggested creating narratives to illustrate surgical risks, rather than relying on statistics.\u003c/p>\n\u003cp>Instead of telling patients that surgery carries a 20 percent risk of stroke, for example, doctors should lay out the best, worst and most likely outcomes.\u003c/p>\n\u003cp>In the best-case scenario, a patient might spend weeks in the hospital after surgery, living the rest of her life in a nursing home. In the worst case, the same patient dies after several weeks in intensive care. In the most likely scenario, the patient survives just two to three months after surgery.\u003c/p>\n\u003cp>\"If someone says they can't tolerate the best-case scenario — which involves them being in a nursing home — then maybe we shouldn't be doing this,\" Schwarze said.\u003c/p>\n\u003cp>Maxine Stanich died in 2010, just after her 90th birthday. Although Redberg had deactivated the defibrillator at Stanich's request, it remained in her chest.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://khn.org/about-us\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit news service covering health issues. You can follow Liz Szabo on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/LizSzabo\" target=\"_blank\" rel=\"noopener\">\u003cem>@LizSzabo\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Too+Late+To+Operate%3F+Surgery+Near+End+Of+Life+Is+Common%2C+Costly&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Last year, California became the fifth state to allow terminally ill patients to take lethal medication to end their lives. The new law — the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/03/10/californias-physician-assisted-suicide-law-to-take-effect-in-june/\" target=\"_blank\" rel=\"noopener\">End of Life Option Act\u003c/a> — took effect in June, 2016.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Piedmont resident \u003cstrong>Ray Perman\u003c/strong> always knew this is the way he wanted to go. He’s 64, a retired pilot, like his father, and an entrepreneur. He’s dying of cancer. I interviewed him about his decision. The following words, culled from that interview, are his.\u003c/em>\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/301315866″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>My pelvis is fully populated by prostate cancer. I have a one-inch tumor in my tailbone. I have seven tumors in my ribs, like little Christmas tree lights. So about two months ago, my physician called me in and said, ‘Well Ray, we’ve done everything we can.’ I said, ‘Well then I want to be on hospice. And I’d like to have you start with End of Life Options.’ He looked at me and said ‘I’ll write the prescription.’\u003c/p>\n\u003cp>So now I have my medical aid-in-dying drugs up in my bedroom, ready to go. You’re not allowed to go to the pharmacy and go pick them up. They won’t have you inadvertently leave them on the seat of the 57 bus. It has to be delivered like a loaded weapon. So the end-of-life options team came here with three people, the pharmacist with the drugs, my case manager and also another witness. They arrived here with these drugs and they went through the instructions on how to use them, and had me sign all the appropriate documents under witness, which is what they should absolutely do.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Remember that I have to take these prescriptions on my own. No one can assist me. No one can cajole or put the straw in my mouth or squeeze the drugs into my mouth. I have to take them, which means I have to have the ability to swallow. So what the hospice team is learning, they give you about a five-day window when you can do this drug and do the deed. And they’re learning, because they’ve missed a couple of times with other patients. They didn’t call it early enough, and the person could no longer do the drug and they feel very badly.\u003c/p>\n\u003cfigure id=\"attachment_281642\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281642\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-800x1002.jpg\" alt=\"Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands.\" width=\"800\" height=\"1002\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-160x200.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-768x962.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-240x301.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-375x470.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-520x651.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They’ve giving me markers, clues as you get closer to the end. You look for changes in perception of food taste, general weakness, or the need to take a mid-morning nap, which I’m starting to do now. My stairway is a measuring device. People say, ‘Ray, should you get a hospital bed down here?’ I say, no I don’t want to die in my living room. I have a beautiful bedroom with windows on three sides, I want to look at my view. So if I can’t get up the stairway anymore, it means we’re darn close. And we are kind of close.\u003c/p>\n\u003cp>It will be a hard decision. People who go for the aid-in-dying option, I understand only 65 percent actually do it. Of the people who don’t, some basically die of symptoms prior to using the option, some simply change their mind. You know, I’m not a hero. I may chicken out.\u003c/p>\n\u003cp>I attended my daughter’s wedding in September and afterwards my oncologist said, the whole department, we figured you had 50/50 odds of attending. And I had a 70 percent chance of dying last month in December. I mean, who knows how it’ll go. Some days I wake up and I can feel cancer coming. It feels like I’m not going to make it to January 15. I have meetings on January 15 — I’ve got to make those meetings. And my wonderful in-home care provider, she’s pregnant and she’s going to give birth around February 15.\u003c/p>\n\u003cp>Our goal is for me to hold the baby. It’ll be great. Maybe I’ll get there.\u003c/p>\n\u003cfigure id=\"attachment_281644\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281644\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayFlying-800x778.jpg\" alt=\"Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27.\" width=\"800\" height=\"778\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-160x156.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-768x747.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-240x233.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-375x365.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-520x506.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-32x32.jpg 32w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-50x50.jpg 50w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I made sure that the newspapers don’t say ‘Ray lost his battle with cancer.’ There’s no battle. If I were to be battling or struggling I would be preempting my ability to soak in all the wonderful things that are happening to me emotionally.\u003c/p>\n\u003cp>For me the epiphany in all of this is that I shifted from wanting to die quickly to wanting to enjoy this last phase. I think it’s the explorer in me. I want to carry the torch into that last phase and say ‘My gosh, look what I’m discovering. It’s beautiful.’ You shouldn’t miss it. Don’t fear death. It’s wrong.\u003c/p>\n\u003cfigure id=\"attachment_281521\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281521\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/KP-Racing-Team-2016-05-1-800x450.jpg\" alt=\"Ray Perman says he's maintained his "rollicking" sense of humor after being diagnosed with two types of cancer.\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman says he’s maintained his “rollicking” sense of humor after being diagnosed with two types of cancer. \u003ccite>(Courtesy of Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When the hospice team gives me the five day window, I will announce to my relatives: It’s time. I’m going to make it this day, come.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>I will have my closest loved ones around me when I do that. I’ll have an open house in the morning for my friends to give me a hug goodbye and then we’ll probably do the deed in the afternoon. Then my family can have time with my body in the evening, as long as they’d like. And I have a complete description on where to dispose of my ashes. It’ll be in the departure path of a Boeing aircraft that took off with my father, on an outgoing tide.\u003c/p>\n\n",
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"title": "Bay Area Cancer Patient Confronts and Embraces His Right to Die",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Last year, California became the fifth state to allow terminally ill patients to take lethal medication to end their lives. The new law — the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/03/10/californias-physician-assisted-suicide-law-to-take-effect-in-june/\" target=\"_blank\" rel=\"noopener\">End of Life Option Act\u003c/a> — took effect in June, 2016.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Piedmont resident \u003cstrong>Ray Perman\u003c/strong> always knew this is the way he wanted to go. He’s 64, a retired pilot, like his father, and an entrepreneur. He’s dying of cancer. I interviewed him about his decision. The following words, culled from that interview, are his.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/301315866″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/301315866″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>My pelvis is fully populated by prostate cancer. I have a one-inch tumor in my tailbone. I have seven tumors in my ribs, like little Christmas tree lights. So about two months ago, my physician called me in and said, ‘Well Ray, we’ve done everything we can.’ I said, ‘Well then I want to be on hospice. And I’d like to have you start with End of Life Options.’ He looked at me and said ‘I’ll write the prescription.’\u003c/p>\n\u003cp>So now I have my medical aid-in-dying drugs up in my bedroom, ready to go. You’re not allowed to go to the pharmacy and go pick them up. They won’t have you inadvertently leave them on the seat of the 57 bus. It has to be delivered like a loaded weapon. So the end-of-life options team came here with three people, the pharmacist with the drugs, my case manager and also another witness. They arrived here with these drugs and they went through the instructions on how to use them, and had me sign all the appropriate documents under witness, which is what they should absolutely do.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Remember that I have to take these prescriptions on my own. No one can assist me. No one can cajole or put the straw in my mouth or squeeze the drugs into my mouth. I have to take them, which means I have to have the ability to swallow. So what the hospice team is learning, they give you about a five-day window when you can do this drug and do the deed. And they’re learning, because they’ve missed a couple of times with other patients. They didn’t call it early enough, and the person could no longer do the drug and they feel very badly.\u003c/p>\n\u003cfigure id=\"attachment_281642\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281642\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-800x1002.jpg\" alt=\"Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands.\" width=\"800\" height=\"1002\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-160x200.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-768x962.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-240x301.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-375x470.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-520x651.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They’ve giving me markers, clues as you get closer to the end. You look for changes in perception of food taste, general weakness, or the need to take a mid-morning nap, which I’m starting to do now. My stairway is a measuring device. People say, ‘Ray, should you get a hospital bed down here?’ I say, no I don’t want to die in my living room. I have a beautiful bedroom with windows on three sides, I want to look at my view. So if I can’t get up the stairway anymore, it means we’re darn close. And we are kind of close.\u003c/p>\n\u003cp>It will be a hard decision. People who go for the aid-in-dying option, I understand only 65 percent actually do it. Of the people who don’t, some basically die of symptoms prior to using the option, some simply change their mind. You know, I’m not a hero. I may chicken out.\u003c/p>\n\u003cp>I attended my daughter’s wedding in September and afterwards my oncologist said, the whole department, we figured you had 50/50 odds of attending. And I had a 70 percent chance of dying last month in December. I mean, who knows how it’ll go. Some days I wake up and I can feel cancer coming. It feels like I’m not going to make it to January 15. I have meetings on January 15 — I’ve got to make those meetings. And my wonderful in-home care provider, she’s pregnant and she’s going to give birth around February 15.\u003c/p>\n\u003cp>Our goal is for me to hold the baby. It’ll be great. Maybe I’ll get there.\u003c/p>\n\u003cfigure id=\"attachment_281644\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281644\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayFlying-800x778.jpg\" alt=\"Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27.\" width=\"800\" height=\"778\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-160x156.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-768x747.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-240x233.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-375x365.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-520x506.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-32x32.jpg 32w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-50x50.jpg 50w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I made sure that the newspapers don’t say ‘Ray lost his battle with cancer.’ There’s no battle. If I were to be battling or struggling I would be preempting my ability to soak in all the wonderful things that are happening to me emotionally.\u003c/p>\n\u003cp>For me the epiphany in all of this is that I shifted from wanting to die quickly to wanting to enjoy this last phase. I think it’s the explorer in me. I want to carry the torch into that last phase and say ‘My gosh, look what I’m discovering. It’s beautiful.’ You shouldn’t miss it. Don’t fear death. It’s wrong.\u003c/p>\n\u003cfigure id=\"attachment_281521\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281521\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/KP-Racing-Team-2016-05-1-800x450.jpg\" alt=\"Ray Perman says he's maintained his "rollicking" sense of humor after being diagnosed with two types of cancer.\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman says he’s maintained his “rollicking” sense of humor after being diagnosed with two types of cancer. \u003ccite>(Courtesy of Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When the hospice team gives me the five day window, I will announce to my relatives: It’s time. I’m going to make it this day, come.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I will have my closest loved ones around me when I do that. I’ll have an open house in the morning for my friends to give me a hug goodbye and then we’ll probably do the deed in the afternoon. Then my family can have time with my body in the evening, as long as they’d like. And I have a complete description on where to dispose of my ashes. It’ll be in the departure path of a Boeing aircraft that took off with my father, on an outgoing tide.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Governor Signs Physician-Assisted Suicide Bill Into Law",
"title": "California Governor Signs Physician-Assisted Suicide Bill Into Law",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227092538\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iTOdYPi32BS7nDkgWWeO1fNHFQH9Ia8E\"]\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227091620\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/227092538&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/227092538'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/227091620&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/227091620'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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