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Can Dying Well Be a Part of Living Well?

“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

Too often, modern medicine focuses on life-extending interventions for those nearing the end of life at the expense of quality of life. Joining Henry Bair and Tyler Johnson, MD, guest Shoshana Ungerleider argues we urgently need to rethink the emphasis of end-of-life care. She’s the founder of the End Well Foundation, a nonprofit that seeks to improve how doctors and patients approach issues of mortality, as well as an executive producer of the 2018 film “End Game” and a major funder of the 2016 film “Extremis” — two Academy Award-nominated short documentaries on end-of-life care.

As a health communicator, Ungerleider is the host of the TED Health Podcast and has been featured as a medical expert on CNN, CBS, PBS, Fox News, and other news networks. In this episode, she discusses her journey in healthcare and shares her mission to transform the end-of-life experience of patients everywhere and make dying well a part of living well.

Ungerleider is the author of “My Dad’s Terminal Cancer Diagnosis May Have Saved My Life” for Newsweek. You can follow Ungerleider on Twitter @ShoshUMD.

In this episode, we discuss “The Good Place,” an award-winning sitcom series about philosophy and the afterlife, as well as several articles and studies about whether physicians are more likely to choose to die at home than the general public. These articles include “How Doctors Die” by Ken Murray; “Association of Occupation as a Physician With Likelihood of Dying in a Hospital” by Blecker, Johnson, Altekruse, et al.; and “Patients, and Doctors, Aren’t Dying at Home” by Danielle Ofri, MD (our guest on episode 35).

In this episode, you will hear about:

  • 2:23 How Ungerleider found her way to a career in healthcare and how she pushed through imposter syndrome while in medical school

  • 10:18 Ungerleider’s formative experiences working with elderly patients in the ICU, leading her to question the practices of modern medicine when dealing with seriously ill patients

  • 15:30 How the COVID-19 pandemic has shifted public consciousness around death and dying

  • 23:51 The origins of End Well, the conference and organization founded by Ungerleider and her colleagues in 2017

  • 30:31 What it would look like for there to be a shift in the cultural conversation around death and dying

  • 36:54 A reflection on the risks of romanticizing the dying process

  • 43:49 The recent cancer diagnosis in Ungerleider’s family and how this has propelled her to proactively manage her own risks

  • 48:49 Advice for new clinicians on dealing with patient deaths

Following is a partial transcript (note errors are possible):

Bair: Shoshana, thank you so much for being here and welcome to the show.

Ungerleider: Thank you so much for having me.

Bair: So you are one of the leading voices advocating for improving how we treat patients with serious illnesses and those at the end of life. Before we get to all of that, however, can you first tell us what initially drew you to a career in medicine?

Ungerleider: Well first I have to say, I don’t know that I’m a leading voice, I think I am a voice. Maybe I’m loud so it looks like I’m leading, I don’t know. But it’s funny when I think about the early days of thinking about medicine, and actually I wasn’t pre-med in college. I was one of those people that kind of had every single major. I was interested in women’s studies and environmental studies and outdoor education and art. For a while I thought I wanted to be a professional weaver. I got really into like textiles and weaving, so much so that I actually had to drop my chemistry class because I couldn’t do both.

Bair: By the way, this podcast is packed with doctors who did not major in biochemistry. So you are in good company.

Ungerleider: Right? Yeah, it’s a lot more fun that way, I think. But I got really interested actually, in marine biology, marine conservation/biology toward the end of college and thought maybe I would do a PhD in that. I quickly realized spending, I don’t know, 2 or 3 months at the Marine lab on the Oregon coast, where I had gone to undergrad, that I really wanted to work with people and that was super important to me.

I finished college really kind of looking at, “Gosh, where do I go from here?” And I spent a few years actually out in North Carolina at Duke University, where I was an intern at the medical center, and then started doing some research at the VA there and actually had to go back to school and do a bunch of post-[baccalaureate] classes because I decided through that experience that medical school was the path for me. And so, yeah, I took a really kind of long route like, many of us these days. Did a bunch of other things in college, and then found myself back at age — How old was I? — 26, I think I want to go to medical school.

Johnson: So you and Henry can have the debate after the show about whether you qualify as a leading voice or not. But whatever, you’re a, let’s say, prominent voice. But walk us through. So you start medical school, and then how do you get from there to … well, first of all, what do you do now? If you can talk a little bit about your advocacy, and then how did you get from medical school to where you are now?

Ungerleider: I guess what I would say is, first and foremost, I just want to say I had a very hard time in medical school. I actually, in the first months thought about quitting. I was like, this is not for me. It was just really, really hard. And it pushed me to my limits, you know, along every step of the way. Aside from getting to third and fourth year — be with patients, which I felt like I was good at — being in the classroom was really, really hard. So if people listening are in that boat and they feel like it’s really hard, it is. But I would say, you know, keep going.

For the full transcript, visit The Doctor’s Art.

Copyright © The Doctor’s Art Podcast 2022.

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