Stephen Rowley - Adoption and destiny

[00:00:00] Welcome to Resilience Unravelled. Hi everybody and welcome to Resilience Unravelled,

[00:00:10] a podcast that examines all aspects of personal and organizational resilience. A huge all-encompassing

[00:00:17] subject that covers the ability to thrive in life by harnessing your cognitive, emotional,

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[00:00:28] despite remarkable obstacles, as well as highly successful practitioners and experts across

[00:00:33] a range of topics. And this podcast introduces their amazing stories and expertise, as well

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[00:01:08] get started. Enjoy the show! Hey and welcome back to Resilience Unravelled. And with me this

[00:01:17] week, a subject that needs to be discussed and a subject which is too infrequently discussed

[00:01:23] as subject which for some people mind it a little distressing. So a subject that's incredibly

[00:01:27] topical and a subject which I think all of us at some point in our lives are going to connect

[00:01:32] with. And the subject we're going to talk about is going to be discussed with Dr. Bob Uzlander

[00:01:37] who's joining me today. I think from the States, is that right Dr. Bob? Absolutely. I'm San Diego.

[00:01:42] San Diego? It's Don't tell me it's sunny over there, is it? Well, it's a little overcast

[00:01:49] today but typically by mid-morning the clouds will break and we'll have bright sunny skies.

[00:01:58] I tend not to talk about it too much to folks who aren't here because I don't want to

[00:02:03] make them. If it's sunny constellation, I was chatting to someone from Australia about five hours

[00:02:10] ago and they had a, it was Managed Pocket Night and it was, I think it was something like,

[00:02:14] if I have degrees Fahrenheit so they were, it was, I don't know if they're quite sabbatical.

[00:02:21] So Bob, why don't you tell us a little bit about yourself and what it is that you do?

[00:02:25] Sounds good. So I'm a physician here in San Diego and I am a resident originally from Chicago,

[00:02:31] so I really appreciate the Southern California warmth and weather. But I'm a physician. I've spent

[00:02:39] my first 25 years as an emergency physician. So I was trained in emergency medicine and I spent

[00:02:44] 25 years trying to help save people pretty much if it all costs. And over time, for a few different

[00:02:54] reasons, emergency medicine became a pretty stressful type of career. It's a great career for

[00:03:02] younger doctors. I feel like as you get older the stress and the schedules and become more

[00:03:12] challenging. And for me, I started to really crave a deeper connection with my patients than

[00:03:19] what could be created in that brief experience in the emergency department. And I transitioned,

[00:03:26] really felt a call in a poll towards supporting people who were approaching the end of their life.

[00:03:33] And I transitioned into doing palliative care and hospice care about 10 years ago.

[00:03:38] Right. And after a couple of years working in a traditional insurance-based model for a company

[00:03:46] in San Diego, I found out there was great value in being able to go into people's homes and

[00:03:53] identify what their challenges were, what their needs were, and help find those resources and

[00:03:59] support them. But I became very aware of some huge gaps in our healthcare system that were

[00:04:07] universal and causing people to struggle in a way that was really disturbing to me.

[00:04:15] And the gaps that I discovered were gaps that I felt that I could fill for people who were

[00:04:22] open to engaging with me in a team in a different way. And so I started my own practice

[00:04:30] about seven years ago. So my medical practice is a very holistic, it's a team of people who

[00:04:38] show up to provide support, both medical care, emotional support, spiritual support,

[00:04:45] both for the patients and the families who are going through these challenging circumstances.

[00:04:50] And we basically create a village of support around people

[00:04:55] through their final chapter of life. And the name of my practice is called It's Empowered Endings

[00:04:59] and our goal was to empower people to have the kind of end-of-life experience that we all wanted

[00:05:05] to serve. Yeah, so you've given us lots of go on there. So let's start from the beginning.

[00:05:10] So a couple of basic questions if I may. I mean, I know what goes on with UK but

[00:05:16] are the arrangements for end-of-life care different states in the US?

[00:05:20] Or the arrangements for palliative care?

[00:05:23] Or the life care different states?

[00:05:25] Yeah, I don't know how things go in the UK. I'm assuming that there's the similar to here

[00:05:32] there's hospice care which is available for people who have a terminal illness. Our insurance,

[00:05:38] you know, our insurance structure is such that if somebody is approaching their final,

[00:05:46] you know, the final chapter and let's say that they have cancer and they've been undergoing

[00:05:51] treatment for the cancer. And they were at a point where the treatment is no longer helping or

[00:05:56] they're no longer able to tolerate the treatment. And you know, they're looking

[00:06:01] to have more of a gentle comfort focused approach. They'll refer to hospice care.

[00:06:08] Hospice is covered by my Medicare insurance

[00:06:13] and what you get when you go on hospice care is a nurse who will come to your home and

[00:06:21] do an assessment and help to navigate medications and other types of treatments.

[00:06:28] They will typically communicate with a doctor who never sees the patient.

[00:06:33] Once people go on hospice in this country, the vast majority of them will never see a doctor

[00:06:37] again, which to me is ludicrous. The idea that at this time of life when everything becomes

[00:06:43] extremely challenging and scary and so much is happening, it's very dynamic. The idea that doctors

[00:06:52] are no longer actively engaged in taking care of patients or communicating with families is

[00:06:57] it doesn't make sense. And I think it causes a lot of frustration and a lot of unnecessary struggle.

[00:07:04] There's a lot of confusion about end-of-life care. Generally, even in the medical profession,

[00:07:10] you'll see older people who have end-of-life situations going on where they'll suddenly

[00:07:15] have a doctor arriving who will start to treat them as if they are going to, and it's almost like

[00:07:22] certainly for our world, here is linked up. And I think, I don't know what you think about this,

[00:07:28] is maybe we don't think enough about the subject early enough so we don't maybe write a pathway,

[00:07:33] have a plan, have our wishes explicit, such like I think we have a general reluctance not to talk

[00:07:39] about the end of our own life. What would you say about that? Well, I think that's true. I think

[00:07:45] that people are often reluctant to talk about it. I also know that doctors and people in health

[00:07:51] care are uncomfortable talking about it. They don't receive any training, very little training if

[00:07:57] at all, in how to approach the end of life and how to help navigate people through it. So there's

[00:08:02] a lot of discomfort in having those conversations so they often don't happen. And so planning,

[00:08:07] it doesn't happen. Some people create an advanced health care directive which is a document that

[00:08:12] identifies who they would want to provide care for them and speak for them if they can't.

[00:08:18] And it also indicates what they would want if they were

[00:08:23] imminently dying, if they had a condition that was irreversible and they were

[00:08:31] they were on the brink of death. They wouldn't want aggressive treatment, CPR, things like that.

[00:08:38] There isn't a lot of discussion about the actual, the true path that most people take which is not

[00:08:47] I'm okay now and I'm on the brink of death you know the next day. Most of the time it's

[00:08:54] a series of events, it's a series of hospitalizations, treatments, things where

[00:08:59] where the quality of life starts to erode, the people become more limited, more restricted.

[00:09:08] And they start to think about how much more of this am I willing to endure?

[00:09:15] One of the options if I decide that I no longer want to undergo this kind of treatment or this

[00:09:21] experience, this type of life. And there is so there isn't a lot of discussion about how people can

[00:09:27] choose to allow their life to come to an end. Most people when they get to a point where they feel

[00:09:32] like the quality of life is gone just have to struggle along until something happens and I you

[00:09:39] know we have patients on a regular basis who reach out to us to have conversations because we

[00:09:44] will have those conversations, we will engage in them at any stage along the way.

[00:09:51] And they often tell us I every night I go to sleep and I pray that I don't wake up.

[00:09:56] And then when I wake up I'm just really disappointed and frustrated that I have to keep doing

[00:10:01] this over and over again. And nobody gives them an option. So one of the things that we've

[00:10:08] started that we've been doing for some years now is assisting people through

[00:10:14] illegal end-of-life options. For people who are ready to die for various reasons, their terminal

[00:10:19] ill, they've been living with a severe life-limiting illness and their impain or their

[00:10:26] paralyzed. And life has very little quality for them after careful assessment, psychological

[00:10:34] assessments, engaging to try to do everything we can to improve the quality of life. Sometimes people

[00:10:39] just really truly are ready to die. And if you think about it, when our pets get to that point

[00:10:47] we do the compassionate thing and we take them and let them gently and peacefully go with dignity.

[00:10:54] People are asking for that kind of care for themselves and their family members as well times.

[00:11:00] So we support people through medical aid in dying, which is the death with dignity. It's been

[00:11:04] legal in certain states in this country for a number of years and it's been legal in California

[00:11:09] since 2016 that a person who qualifies meaning that they can make their own decisions

[00:11:16] and that they have a terminal condition with a life expectancy of less than six months

[00:11:20] can go through a process with a position and then a team guiding them to get medication

[00:11:26] that if they choose to take it, they can go to sleep within minutes and die within minutes or hours.

[00:11:31] Very peaceful, very gentle, very dignified, very empowering. Similarly, people who don't

[00:11:38] necessarily qualify or don't live in states that do allow this in our country can go through a

[00:11:43] process called voluntarily stopping eating and drinking, which it will become more and more

[00:11:49] sort of accepted and discussed over time because as the baby boomers age and get ill and

[00:11:56] are approaching death, I think the baby boomers are going to choose differently than their parents

[00:12:02] and the generations before them. And so we've been able to support people who have made the choice

[00:12:08] with appropriate counsel and buy in from their families and their loved ones to stop eating

[00:12:15] and drinking, and with the right support and the team that we can help put in place,

[00:12:19] they can have a gentle end of life experience that unfolds over seven to ten days

[00:12:26] in most cases. So it's often said that the fiercest critics of the process have never actually

[00:12:34] experienced anything themselves. And certainly in this country, in parliament we had

[00:12:38] quite a well known case where one ampie who'd been a famous adversary of assisted dying or

[00:12:45] assisted suicide, everyone to call it as we call it in this country or your more elegant

[00:12:50] term over there became a real advocate for it when he had to watch his own mother where the terminal

[00:12:55] disease go through this process and literally lose their dignity, lose their independence.

[00:13:01] My own mother went through this sort of situation, I had an essay which I think you call ALS over there.

[00:13:08] And no one who's experienced a parent go through that would want that not to happen,

[00:13:12] but there are many many people and it's often religious or spiritual grounds or ethical grounds

[00:13:17] which are used or the fear of the power being abuse which is the reason used to stop it.

[00:13:23] And I know you talk about spiritual aspects to this and psychological aspects to this. I

[00:13:28] wouldn't even just give us a view on the spiritual side of how this might work, especially with people

[00:13:33] with maybe with religious beliefs or families with a different sort of religious beliefs. I'm

[00:13:38] guessing you're trying to mediate a path there between various different action of interests. How does

[00:13:43] that work? Yeah so often we are trying to help navigate there with families. So you know the way

[00:13:49] that I approach that is that we have a very spiritual approach to life. We're not a specific

[00:13:55] religion, not a way. It's a very inclusive belief system and it infuses everything that we do

[00:14:05] in our practice. My wife is my partner in the practice she's a social worker, a spiritual counselor

[00:14:10] and we have doulas who are working closely with us and nurses and everybody has this

[00:14:16] tries to create a spiritual connection with the patients and families that we care for.

[00:14:21] If somebody has a religious, it's strongly religious and that religion does not allow them to

[00:14:32] make decisions that would hasten their end of life then they probably won't go down this path

[00:14:39] and I would never try to convince them that they should. I don't try to convince anybody that

[00:14:44] they should do anything. I try to help allow people to know what's possible and understand all

[00:14:50] of the different options and parameters and then help them make the decisions that are most aligned

[00:14:57] for them. So if a patient has a religious opposition or any other opposition to a certain course

[00:15:04] or a certain path then we honor that and we try to find ways to keep them as comfortable

[00:15:09] and feeling as dignified as possible having the most agency. When we have patients who want to

[00:15:16] utilize medical aid and dying and they have family members who oppose it for whatever reason

[00:15:22] it's our job is to try to help find alignment there to help the family member understand

[00:15:30] how they can be most supported given their different views. Sometimes they come around,

[00:15:36] sometimes they speak to their to their pastor or their rabbi or people in their community

[00:15:43] and find a way to be comfortable. Sometimes they're not and they take a bit and they're less engaged.

[00:15:54] The goal was to try to support the patient in experiencing the most peace and comfort and dignity

[00:16:01] and so we advocate for the patients but recognize that sometimes their loved ones will not

[00:16:08] find a way to be supportive and those are challenging cases because you certainly want everybody

[00:16:14] to be aligned and moving in the same direction on the same page but we do the best that we can

[00:16:21] in those challenging circumstances to make sure that the patient's needs are met. One of the

[00:16:28] big focuses for our practice is helping the families navigate whatever challenges they're facing.

[00:16:36] We realize that in our healthcare system and I would imagine in most healthcare systems

[00:16:40] the patients are the primary focus and the families are often left out. They have

[00:16:45] high huge needs, huge stress that overwhelmed and the system doesn't really have a mechanism to

[00:16:52] take care of them. We do. We focus on taking care of them where we have direct contact. They have

[00:16:59] our cell phone numbers. We're texting and emailing and meeting with and helping family members find

[00:17:05] a way to be at peace as much as possible and we provide therapy and counseling and

[00:17:14] bereavement support because they're the ones who are going to be sticking around. After their loved

[00:17:19] one dies, the experience is going to have an impact on the loved ones for years or decades

[00:17:26] and we believe that we can make a huge impact on the quality of life that those people

[00:17:34] will experience because of the care that they were able to bring to their loved one in those final

[00:17:41] days. That's interesting isn't it? We often have a funeral planning as well after death,

[00:17:48] club planning, something about myself, I have after the planning but very few have

[00:17:53] rebed that planning and actually how you ease your family through the grieving process which is

[00:17:59] complex of itself especially if you've engaged in a long, if you had a long illness it's one of

[00:18:06] the challenges isn't there? Some people who are grieving have this massive sense of relief when

[00:18:10] that loved one dies because actually the end of the pain and suffering and then there's a

[00:18:14] degree of guilt and such like in the grieving having already taken place. And it's that classic

[00:18:19] thing isn't it? The more the subject becomes part of, I was going to say common polons I don't

[00:18:27] mean that but it becomes an acceptable conversation because it's almost like hiding it ways not

[00:18:33] the each it's not the way to deal with this is it? We should be having conversations with family.

[00:18:37] I do have a living well and it's something I would recommend and I have you know what happens

[00:18:42] way after I die and but my care has worked out and that's the way I maintain my dignity and my

[00:18:47] independence because I've made the decisions at the point where I can. Now something might happen

[00:18:52] and who knows but the point is about not being frightened of the process is it?

[00:18:58] Right, well sorry a couple of comments on that and I'm impressed that you've had all this

[00:19:04] all this laid out and these plans made out of every windows. I think that so you can make

[00:19:10] the best the best plans and try to anticipate as much as you can but things often happen in a way

[00:19:19] that challenges that. And so I think the most important thing that you can do to preserve your

[00:19:26] dignity and your agency and have the best chance of having what we refer to as a soft landing

[00:19:33] is to make sure that the people who are going to make decisions for you who are going to speak

[00:19:38] for you when you can't speak for yourself clearly understand what you would want given

[00:19:43] any of the different circumstances that could occur. And that's why we do some pretty extensive

[00:19:51] planning with people. We have conversations and we go through as a long time emergency position

[00:19:56] and then palliative care and hospice doctor I have such a range of experiences that help inform me

[00:20:06] about the things that could happen to people and that they could put them in really challenging

[00:20:11] situations. And so we're able to discuss those and identify what they would want given certain

[00:20:18] scenarios unfolding and then document it or even have those conversations with their loved ones

[00:20:25] so that they really are clear about what they would or would want. And then they need to have

[00:20:30] advocates, they need people who will advocate for them at the time things are happening

[00:20:35] because otherwise the medical system will do what the medical system does which is typically treat,

[00:20:41] treat, admit, diagnose. And then if someone says no we're done with that no more hospital

[00:20:50] stations, no more testing then they basically say okay well there's nothing else to do and they

[00:20:55] kind of push them up onto hospice care where they lose a lot of the things that they had access to

[00:21:02] and there's this huge sort of gap. And that's the gap that we're focused on feeling.

[00:21:09] The other thing I wanted to point out is that we always say that we're a death phobic society

[00:21:14] and no one wants to talk about death and it's such a taboo topic. In my experience people really

[00:21:20] want to talk about it they just don't have a they just don't have a mecca comfortable way to do it

[00:21:27] but I find when I'm out at parties or I'm out and they meet people and they find out what I do

[00:21:34] everybody wants to talk about it. They want to talk about the experience they had when their mom

[00:21:38] died, whether it was because it was either really traumatic and challenging or was really beautiful

[00:21:46] and transformational but in my experience people are dying to talk about this

[00:21:54] because it's freeing in some ways there's something that's kind of it's kept in and it's

[00:22:01] protected and then when you can release it and express these things in a way that feels safe

[00:22:08] I think it's really comforting and satisfying for a lot of people in my experience.

[00:22:15] Yeah that's a very good source actually I'm just making note of that. One of the things

[00:22:21] one of the things you've said which is really struck, made me think about this about the psychology

[00:22:29] of grieving and people building resilience to be good carers, be good voices, be good advocates

[00:22:36] and I like the fact that you're supporting those people because often when you're having to make

[00:22:40] a decision or hurry up with wishes of another person but actually you're sitting there and

[00:22:44] you are psychologically affected by that decision you're making. I know when I had to have

[00:22:49] the conversation about stopping my mother's drugs which meant that she would die. The conversation

[00:22:57] I had with myself was do I do what's right for me which is not to do that or do what's right

[00:23:03] for your parents which is what they want and I think you find a lot of people torn between that

[00:23:08] and actually have and I like the idea of this having a village around the family because sometimes

[00:23:12] it's about reminding people of helping people through that process because again there's quite a

[00:23:16] lot of guilt attached to it. I love that phrase people are dying to talk about it so that's my

[00:23:21] new. I'm going to steal that. You're welcome too. Look how do people find out more about what you do

[00:23:30] maybe connect with you if they're interested to talk more about the situation or even if they want

[00:23:34] to access your services? How do they do that? Well we have a website at empoweredendings.com

[00:23:41] There's a lot of information about myself, my wife, the team that we put together, the work

[00:23:48] that we do. There's an update to the website coming up in a month or two. So we have the medical

[00:23:57] practice here in San Diego. We care for people throughout Southern California and we're also

[00:24:01] looking to help other doctors and do those end-of-life do-lays create practices in their communities.

[00:24:08] So one of the things that we've built is a medical services organization that will support

[00:24:15] practices in being established using our methods. We have an educational institute that is going to

[00:24:26] start training, doing programs and trainings for people in healthcare. We find a lot of people

[00:24:32] nurses and social workers and chaplains who are working within the system would actually like to

[00:24:37] start working outside the system because they could do it in a way that's more aligned for them

[00:24:42] and rewarding. So we're helping to guide people towards finding alternative careers outside of

[00:24:48] the traditional system. And we also have a foundation that is providing financial support

[00:24:55] and bereavement support for people who have gone through certain end-of-life circumstances.

[00:25:02] So there's a lot of information on the websites, Facebook, Instagram, LinkedIn. We're trying to

[00:25:09] really create a tribe, a national or even international tribe of people who want to see end-of-life

[00:25:19] improve and shift the paradigm so that we don't feel like we're taking better care of our pets

[00:25:26] than we are of our people. Yeah, I'm into that. Well look thank you so much for spending time

[00:25:31] today. That's absolutely fascinating. It's such a close to my heart and I remember one

[00:25:35] who did it was popped up on our feed. I was very interested to talk to you and it's been absolutely

[00:25:40] fascinating getting an overall picture of what's going on and also how people can get hold of you.

[00:25:46] It's very topical in this country every now and then when a celebrity has a life of

[00:25:51] threatening condition. We've got some of us called Esther Ransson at the moment who's very well

[00:25:54] known in our country and again wanting to have a sister died and not being allowed to have it

[00:26:00] and we a lot of us have to travel to Switzerland to get that sort of dignity from a company called

[00:26:07] the Great House, right? Which is truly important to have to leave your home and your

[00:26:11] people and your comfort. So hopefully things will improve there and you'll have those options.

[00:26:17] That's how it's all right. Well thank you very much. It's been a joy to have you.

[00:26:23] So it's Dr. Bob, New Zealander, Empowered Endings and find the information in the show notes

[00:26:28] and thank you both for being an absolute joy. Thank you. Take care.

[00:26:35] Hi everybody. I hope you found that episode useful and interesting. Feedback is a

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