Bookworm Transcripts

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It's a question of the day, Mike. How's Scrum doing?

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Scrum is not happening. No.

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Well, as we were talking about before we hit the red button,

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basically since we recorded the last episode, which has been a while,

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we've had a couple of issues. Your internet got knocked out. I had to travel.

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I really haven't done anything with my OmniFocus.

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So confession time. I confess this on the latest episode of Free Agents that we recorded as well.

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I feel a little bit like a productivity hypocrite because I find myself in this place where I don't

00:00:36

even think about the things that I have to do and then select the most important thing.

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I don't even know everything that I need to do. All I know is that I need to get this course

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off the ground and I know what the next thing is. And so I do the next thing and then I see two

00:00:52

more things that I need to do. And I'm just in the thick of it right now.

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I told David when we recorded, I'm telling all of you right now that this is not a normal state for

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me. I'm not going to stay here. But over the holidays, I'm going to take some time off and

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we're going to hit the reset button and everything's going to be back the way it's supposed to be.

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My email is going to be back under control. I'm not going to have 700 unread messages anymore.

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Yeah, the wheels have basically fallen off, but it's been good because I have been able to make

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some significant progress. And as we're recording this, I actually launched my personal retreat course

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yesterday. So things are moving in the right direction. Hopefully we can get these things

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kind of moving on their own and I don't have to babysit them so much. And then we can kind of take

00:01:41

a step back breathe and reevaluate the systems. But for now, it's a little bit crazy in Mike's world.

00:01:47

So right scrum and omni focus was not going to happen this time.

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Happens sometimes. Yeah, how about you? Well, it's worth a shot though, right? You know,

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these things happen. You had the same thing. You're going to do a personal scrum setup. Did you

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succeed? Yeah, I've been running it. It's been going pretty well for me. I feel like it's been a

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pretty good balance of getting the planning for the week ahead nailed down and then basically

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having a way of knowing, am I doing like, am I planning to do more than I can handle? Like,

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that's a lot of what the big pieces are there. So I found it extremely helpful. I'm going to keep

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doing it, but I will say that you having the break from it for a little while, like that sometimes

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has to happen when you've got a lot going on one project, because it seems like you can

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just go heads down on the project and it's more work than it's worth to constantly be add things

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and then check them off Adam and check them off. Yep. It seems to get to where it's too much sometimes.

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So yes, I feel like it's sometimes you have to step away from it at times. So I'm not in that spot

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right now, but I'm in the middle of a transition work wise. Like, we did the episode on free agents.

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We're talking about free agents a lot today already, but free agents. We did that episode

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about how I'm leaving free agency to go work for a corporation. Well, that's going to be happening

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next week pending paperwork at the moment. So yeah, there's a lot going on there, which means that

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the whole scrum thing has been very well flexed lately trying to help me keep that under control.

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So yes, I'm still definitely in the thick of it and it's been going pretty well. So I'm happy with it.

00:03:38

Nice. You said something at the beginning of that along the lines of scrum has helped you

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identify how much you could actually do. Yes. And I'm not kidding when I say like, it's been crazy

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busy. I feel like if I would have done that, I would have recognized that I've got twice as much

00:03:58

to do as I can possibly do. And then it's like, well, oh, well, figure out a way to do it.

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On Monday, just as an example, I edited, exported, uploaded and published all 10 videos for the

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personal retreat course. I created half of the workbook pages. So there were like five or six

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designs that I had to get done that day. I talked to you and you helped me spin up a discourse

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forum associated with the site. I decided to host a goal setting workshop. So I signed up for

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webinar platform, integrated it with my email marketing, and then created the landing page

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in the event for all of that. Like, it's been ridiculous. I get done and I journal at the end

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of the day and I like, what did you accomplish? It's like a week's worth of work. But I know it's

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not sustainable. So I know I got to stop revving the engine so hard pretty soon. But right now,

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it's just you do what you got to do. Yeah. Which interestingly, you know, we've talked about

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for agents a lot this episode, David and I made an announcement on the episode that went live

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as we were recording this yesterday that we're pivoting the show and we're going to talk a lot

00:05:09

more about productivity, but from a different perspective and a more authentic perspective,

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I think it's going to be rebranded as focused. And it's going to be a productivity podcast about

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more than cranking widgets. It's going to be talking about intentionality and sharing a lot of

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the struggles and the mistakes that we make, which is something that is missing in the productivity

00:05:30

space a lot of times. You see that the experts quote unquote, you know, Sharon, this, these are

00:05:35

the three things you got to do to reclaim 10 hours a week, whatever. And so my hope is that it's going

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to be refreshing in the productivity podcast space because it's going to be a little bit different

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approach to we're still going to dive deep on some of the topics and share the things that we learn.

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You can apply them to your life and hopefully improve your life that way. Really, the only thing

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that would be required to benefit from the podcast, I think would be the growth mindset.

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And just a little bit, you know, talking about the reason behind that, we recognized after you

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put together the Mac Power users discourse that there are a ton of people who listen to free agents

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who aren't free agents. Yeah. Yeah. And who have no intention of being a free agent. They just like

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the content. They understand the mindsets and the principles and they apply them to their own life,

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which I think is awesome. But also, I think that there's a lot of people who don't even listen to

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the show because of the name who could fall into that category and who could benefit from the

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discussion. Sure. And so we want to make it more open, peel maybe to a broader audience, but really

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not change the show all that much other than it's not going to be called free agents. And we're not

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going to be talking about freelancing quite as much. We're going to be talking about a lot of the

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same principles and ideas and systems and things like that. But it's going to be a little bit more

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general. And also, it's going to open us up to have a few more interesting guests on there.

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Like Chris Bailey is going to be on there actually in January, I believe.

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Nice. So it should be fun. Yeah, it sounds very interesting. It seems definitely you and David.

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Like, I feel like that'll be a really good fit. Definitely for sure. So I'm excited about this one.

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I've known it's coming for a while. So I'm excited about it. Sweet. Yeah. And I also want to say,

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because I know we were chatting before this and theirs, there's people out there who are a little

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bit concerned maybe about the, how should I say this? You know, the one more thing in the productivity

00:07:33

space, I think that if you have an idea that is worth sharing, you don't need to worry about

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whether somebody else is doing it already. And I just want to throw that out there because I know

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that there are people myself, I've been there, you know, where it's like, I don't want to do

00:07:48

something that somebody else is already doing. And a lot of times you may be talking about the

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exact same things even, but you've got a different perspective. You've got different dots that you're

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connecting. And so just go make your thing. That's kind of what I'm learning is I'm going through

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this faith based productivity thing is like, well, I'm super niche on some of this stuff. And it's

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not going to appeal to a lot of different people. But for the people who does it, who it does appeal

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to, like they're raving fans, they absolutely love this thing. There's always going to be an

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audience. The internet is big enough for both of us or all of us, I should say.

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Yeah, I know that there's a quite a few productivity-ish and related podcasts and things that are out

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there. But, you know, there's a lot of those that I don't listen to because I don't really resonate

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with the hosts that much. Whereas I know that I do resonate with you and David. So I'm one that

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will listen to free agents and then focused. And then I'll skip on almost all the other shows.

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Just because I have a relationship with you guys. And I feel like you guys have a lot of the same

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views I do. And I resonate with you, whereas I don't with others. So I say that because I know

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there's a lot of folks who have talked about or want to get into the space, it's like, go for it.

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Because yes, there may be quite a few people out there. But there's always going to be, you know,

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a group who don't really resonate with the people who are already there. And your voice

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is likely the one that they will resonate with. So just go make your thing.

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Just as to proof of that. In the productivity guild, there is a thread on goal planning for 2019.

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And I was tagged in the discussion saying, "What do you do?" And before I could respond,

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somebody else had posted in there, "I do a personal retreat." And here's a link to my PDF guide. And

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my response when I saw that was, "That's awesome. Like, way to go with that. It's actually really

00:09:44

well put together. It's totally not the way I would do it. But that's fine. Whatever works

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for you." And so I shared my stuff in there and my process. But it just shows the point that I

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ended my comment with, "The world needs more personal retreats." It doesn't bother me that

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you put together this thing and it's free. And I put together this course and I'm selling it.

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Because you could have that response. It's like, "Oh, this is a competitor." We're not competitors.

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We're buddies. And since I talked about it, I don't like to sell promotion, but I do want to

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just throw this out there because I mentioned it a couple of times. The personal retreat course

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is available. And I'm doing the same thing for listeners, a bookworm that I did for listeners

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of free agents, which is a 50% discount until the beginning of the year. So it's only $47.

00:10:32

I think it's $23.50 then if you get the discount. And so that will, you just use the coupon code

00:10:37

bookworm when you check out. You can say 50% on that. And then I also mentioned the goal setting

00:10:42

workshop that I was doing. That's going to happen January 5th, which is a Saturday,

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a 12 p.m. Central time. And really what inspired this was I've done a lot of these for Asian

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efficiency in the past. So I was kind of in the back of my mind. I wanted to do one of these one

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sometime. And then I read a statistic that 92% of New Year's resolutions next year are going to fail.

00:11:03

And I got more upset than I probably should have. My newsletter that went out today,

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I mentioned like, I have to do something about this. Yes. So I'm hosting this goal setting workshop.

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And I'm going to walk through actually a lot of the exercises that are in the courses and just

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kind of help people connect to the why behind the goals that they want to set or the resolutions

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if you wanted to frame it a different way. And help this be the year that you actually achieve

00:11:29

your goals. So the workshop is free. I think there is limited space, but I don't know what it is,

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whatever the webinar software software is limited is. But there'll be a link to that in the show

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notes if you want to want to reserve your spot. Nice. All right. Stop talking about my stuff.

00:11:44

Let's get into this book. All right. So takeaways here. Oh, I'm sorry. I got to do one more.

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Because there's listener of the show, Michael Diamond, he's actually kind of like a mentor of mine.

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He bought a bookworm t-shirt when we did the campaign a while back. He's got a website and

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he's putting together this huge list of his favorite books. And this is somebody that I really

00:12:09

respect somebody who reads a lot. And he's actually been in the national news lately. He's a really

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smart guy. And he's got a list of his favorite books. And I remember one of the comments that

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people made was you got to quit talking about the productivity and self help stuff all the time.

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And my response in the bookworm club was, well, that's what I like. But Michael Diamond has a list

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which has all the great categories. So he's got history, he's got biographies, he's got a whole

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bunch of things. He showed me basically the work in progress, the draft version of this.

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And I asked him if I could share it with bookworm. And so I've got the link. We're going to put this

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in the show notes. He's assured me that this is going to be live by the time the episode publishes.

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But when he showed it to me, it was really close. And I think that for people who wish we would cover

00:12:56

a broader selection of books on bookworm, there's going to be some great resources on this list.

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Got it. Because I was clicking the link from the show notes thinking this 404 is Mike. Like this

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doesn't exist. Okay, that makes more sense. It was basically done. And then I told him, hey,

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that looks great, except it would look even better if you had like pictures of the books and like

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the actual physical books. You created more work for me. He's working on it.

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Still seem an harder for him. Okay, good job. Yeah. All right, that said, we're going to step into

00:13:28

a book today that is not in the self help, you know, productivity space at all. Like this is

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very, very different than what we normally do. Today's book is being mortal by a tool go on day

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who we've done one of his previous books, the checklist manifesto, one of my favorites that

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we've done so far. And this, I'll put it this way. Mike and I had our, we normally catch up a little

00:13:53

bit before or after the show. We definitely did it before the show this time because I think we were

00:13:58

both just a little nervous about hitting the record button today. Yeah. Because so the tagline

00:14:03

on this book is medicine and what matters in the end. This is about end of life care, aging and death.

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Very different than what we normally cover, Mike. Yep. So I think this will be an interesting

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conversation. I feel like this was a very eye opening book and has led to a lot of questions,

00:14:24

conversations and such. But this is one I'm glad to have read, but I will say I think this book

00:14:31

probably made me cry more than any book we've read by a long shot. So this is a tough one. Very

00:14:39

large number of tears shed over this one. Yeah, this was difficult to read for sure. And I want

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to preface this at the beginning because I feel like on this topic, we are not qualified to really

00:14:54

talk about sure. The productivity stuff, the self help stuff. I mean, maybe I should feel the

00:15:01

same way about that stuff. But I've been in that world for long enough that I feel like,

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I feel more confident saying and sharing my opinions about different ideas in that arena.

00:15:12

This one, I really, I really don't know what to do because I haven't had to go through

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some of the stuff that they talk about in here. Both of my parents are still living and they're

00:15:24

both pretty healthy. I remember going through it with my grandparents, but I was in high school at

00:15:29

the time and didn't really get it. So it feels like it's been a long time since I've had to go

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through that. And there's some really heavy stuff in here. There really are no right answers. I feel

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like for any of these specific situations, there's so much nuance that goes along with everything

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in here. And I just want to preface this by saying like, we're going to do our best to treat the

00:15:53

subject with care and with sensitivity. But if I say something stupid, please forgive me because

00:15:59

I don't have the perspective that Dr. Gawande has. Agreed. Yeah, for sure. Because I know that

00:16:05

like I run sound at church. And one of the things you don't think about when you say that is that

00:16:11

our church hosts quite a few weddings, but even more so, a lot of funerals. And with that,

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somebody's got to run the sound system. So I find myself at the church, at a lot of funerals,

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and sometimes it's babies. It's grandparents, great grandparents. It's young dads, young moms.

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Like it's hard. Like those are hard conversations. And it's hard being there in the room at one of

00:16:43

these funerals, hearing the stories and understanding what exactly happened. These are people I don't

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know most of the time. These are complete strangers. And yet, it's very emotional even to just be

00:16:58

there with them and try to serve them in some way. I would say that is very different than this,

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you know, if this was my parents that we were talking about who developed a cancer of some kind

00:17:12

and we needed to make decisions about end of life care, that's very different than experiencing it

00:17:18

with strangers, of course. But at the same time, I think that a tool Goanda takes us through this

00:17:26

process in a very emotional and a very detailed way, tells a lot of stories that are very hard

00:17:34

to read sometimes. And I think when you come out of it, you have a sense of not necessarily

00:17:42

closure on what you should do when confronted with an end of life situation, but more along the lines

00:17:51

of how should you think about it? And how do you make decisions once you get to the point of realizing

00:17:57

that you are at an end of life stage? So I think there's a lot of hard questions to ask here.

00:18:03

And again, I think you're right, Mike, that this is going to be kind of tricky to work through.

00:18:08

So it's very possible we may misquote something or say something off base. So feel free to call

00:18:15

us out on it. But at the same time, you know, this is not a simple topic either.

00:18:20

No, I can basically guarantee I'm going to say something stupid.

00:18:23

Sure. I apologize in advance. And it kicks off in the introduction, even.

00:18:29

Yes. So the introduction introduces us to a character named Mr. Lazaroff.

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And the reason that I put this one in here is that he shares a statement which,

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as I read the rest of the book, I found myself coming back to this over and over again,

00:18:48

because it kind of challenges everything else that Dr. Gawande talks about. But he says,

00:18:54

don't you give up on me? You give me every chance I've got. So using that as a

00:19:00

to set the tone for this book, basically, this is an older guy who they're trying to decide,

00:19:08

do you want to go through this surgery or not? What's the best thing that could happen if you

00:19:11

go through it? What's going to happen if you don't go through it? Whatever. And he responds

00:19:14

by saying, basically, give me every chance that I've got. So they do the operation. It's technically

00:19:19

a success, but he ends up dying anyways. And the point that they make at the introduction

00:19:24

of this book is that before they did the operation, they avoided talking honestly about the choice

00:19:29

that was really before him. And you need to have those difficult conversations and you need to let

00:19:34

the patient understand what all of the possibilities are and then let them make their own decision.

00:19:39

It kind of challenges the traditional view of medicine, at least the way Dr. Gawande

00:19:46

proposed it in this book, which was basically just do everything you can to keep the patient alive.

00:19:54

Do no harm sort of a thing. And he's basically saying that maybe that's not the best thing

00:19:58

for the patient in a lot of cases. And again, like, I'm not qualified to say yes or no.

00:20:05

But as I'm thinking about Mr. Lazarov and somebody who, this seems like a fairly common

00:20:11

response to me. And I'm trying to put myself in these shoes. And if my dad is trying to decide

00:20:16

whether he wants to have the surgery or not, and he says to me, don't you give up on me,

00:20:21

you give me every chance that I've got. I mean, I'm going through with it,

00:20:24

regardless of the risks. But Dr. Gawande is saying, well, maybe you shouldn't, basically.

00:20:30

I feel like it's a classic, you know, quantity of life versus quality of life.

00:20:36

Yep.

00:20:36

And we have a tendency to say that quantity of life is always the trump card. If you can extend

00:20:46

my life by two days, it's worth it. But what if those two days are you spent in a hospital bed

00:20:55

and you sacrificed a week with grandkids to get those two days? Like that's, that's the question

00:21:01

he's asking. Yep.

00:21:03

And that if you look at it in a retrospect, yeah, sure, you could probably make that decision,

00:21:09

especially, you know, you and I can make that decision right now, because we're not in the,

00:21:13

we're not there. We're not in a hospital sitting in with three nurses and a doctor trying to make

00:21:18

that decision. We're not there. We can do that right now. That's easy. But put me in the hospital,

00:21:24

and if that's my wife on the, that's, you know, that we're having this conversation about,

00:21:29

it's going to be very hard for me to make that clean decision like that.

00:21:33

Yep. Yeah, exactly. And he shares a vision in this introduction, section two, which,

00:21:40

I mean, this is pretty heavy, but he said that he had this recurring nightmare where the corpses

00:21:45

of the people who had died showed up at his house, holy cow. But really, like the thing that got him

00:21:50

moving in this direction was this, this vision and then encountering these patients he talks about

00:21:55

on four, on page three and being forced to confront the realities of where they are. Like they're

00:22:00

in the middle of decline of mortality. And he said it didn't take long to realize how

00:22:05

unready I was to help them. It just, it's, it really is emotional. Again, I'm not, I know nothing

00:22:13

about this, this world, but he kind of frames it as like the system doesn't teach you what you

00:22:18

need to know to look somebody who's older and dying in the eyes and actually help them not just

00:22:25

prolong their life, but help them live their best life until the point where they die. And,

00:22:32

yeah, like I said, I feel completely unqualified to talk about this.

00:22:36

Sure. Yeah, because we are, you know, and I would almost venture to say there's very few people who

00:22:41

feel qualified to talk about it. Thankfully, Dr. Gawande is one of those. I feel that is very well

00:22:49

respected in the and has the ability to talk about this stuff. But I also know that when you

00:22:57

think about, because I'm reflecting on a number of the doctors that I worked with going through

00:23:04

all of my Lyme disease process, it was very much an informational. Like here's what we know,

00:23:11

but never was it asked, how are you feeling with all this? Like that's not, you know,

00:23:19

the emotional side doesn't seem to be at the forefront of a lot of doctors and nurses'

00:23:25

thoughts. Maybe I'm wrong on that. At least that's been my perception, but it doesn't seem to be

00:23:32

the norm at least. And I kind of wish it was, but I don't know what you do to get to that point.

00:23:38

Yeah. But that's what he's getting at here is you get to a point where you're talking with

00:23:43

somebody who has cancer and they're dealing with or coming to grips with the fact that

00:23:48

this is it. Like the chemo is not working. Now what? And being able to have those conversations

00:23:55

about the reality of the situation versus, well, here's the third type of chemo that you could try

00:24:02

and it does have like a 10% success. Well, that's just information sharing. Like that's not actually

00:24:09

working through what the patient wants in that case. Yeah. That's not a simple thing to approach.

00:24:15

And I understand it from the doctor's stance. Like, I wouldn't want to bring that up.

00:24:18

I wouldn't want to be the one that says, Hey, by the way, you're dying. Like, what? That's

00:24:24

insensitive. Like that's not not a thing I would want to bring up. But he's the one saying that,

00:24:31

you know, maybe we do need to bring it up. Yeah, I agreed. Also,

00:24:35

playing into this conversation to my perspective and my inner turmoil with this topic is my religious

00:24:44

belief system. Because I have seen people close to me who have been healed of cancer and the doctors

00:24:53

don't know how they were healed. And I believe that faith has a big part to do with that.

00:24:59

It really doesn't have any place in the discussion of this book, I feel. But if you have somebody who

00:25:08

has faith that they can and will be healed and like Mr. Lazar off, they say, don't you give up on me,

00:25:15

you give me every chance I've got to feel like there's not a whole lot you do do in that situation.

00:25:20

You pray and you believe God or whatever, you know, and that's that's the other side of this coin.

00:25:29

And I don't have a simple answer for that. I try to disconnect from that as I read through

00:25:35

the rest of this this book because he's approaching it from a medical perspective. And you look at

00:25:43

the facts and you make an informed decision. But that's also, like I said, based on my experience,

00:25:50

I've seen people close to me Rachel's mom was was healed of cancer. And so how do you weigh that

00:25:58

into this conversation? I don't know. Yeah, because he's he's definitely in the science

00:26:04

side of this. Yeah, you know, I feel like you and I could have a whole conversation about,

00:26:09

you know, how does how does God play into this? Into this conversation, but he's left completely

00:26:15

out of this book entirely, which is fine. Again, this is a medical doctor talking about this

00:26:20

from a medical perspective. And I know we get accused of bringing our faith into this podcast

00:26:25

too much. Whoops, literally, like Rachel's mom, we we had communion, we prayed for her and she

00:26:32

went into the doctor and the cancer was gone. Like you can't explain that. And I don't know what

00:26:39

doctor go on. They would say about something like that. But I've seen it happen myself. So like,

00:26:44

it's real. And you can define real based on your own experiences, your own belief systems,

00:26:49

however you want to. But that's what's going through my mind as I read this. I also think there

00:26:55

is very much a valid perspective to everything that he shares here. It really challenged me and

00:27:00

we're going to get into some of this stuff in a little bit, like the specifically the assisted

00:27:03

living and like the poor houses, that sort of thing. Like that's that's crazy. But I just I'm

00:27:09

having a really hard time. And this is a big reason why I was hesitant to record this one, like

00:27:14

reconciling all of this in my head and trying to speak to it in a way that is bringing information

00:27:24

and value to the person who's going to invest their time to listen to this and not just hearing me

00:27:29

from a religious perspective say, Oh, you got to believe God. Like, you got to have wisdom too.

00:27:34

And you got to listen to to wisdom and you got to look at the facts. But also like,

00:27:40

the facts can can tell part of the picture and you can believe that picture. And then

00:27:46

that picture may not be the true reality. Like there's there's so much nuance to this. It's so

00:27:52

difficult for me to talk about this. I feel a lot of weight and a lot of responsibility in trying

00:28:00

to articulate this the right way. I'm trying to be very careful with my words. And I feel even

00:28:05

then like I'm failing miserably. You get over it. We'll be all right. All right, let's do this.

00:28:11

Let's just jump in. So chapter one, the independent self. You got a couple points here,

00:28:16

one of which is activities of daily living. Where are you going with that?

00:28:20

Yeah, well, there were a couple lists in this section, which were interesting to me because I,

00:28:25

for the last several years, I've worked with a family business that creates software,

00:28:29

even before I was working with Asian efficiency, like I've been doing this out of college,

00:28:34

create software for special education. And there's a subset of people in special education with

00:28:39

moderate to severe disabilities, who the classification for the type of instruction that they need

00:28:46

would be something like independent living skills. And so when he's talking about these

00:28:51

activities of daily living, this is a lot of the stuff that our software is designed to help people

00:28:56

with moderate to severe special needs do. He's got the eight activities of daily living, which are

00:29:01

use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair and walk. And then

00:29:06

there's eight independent activities of daily living, which are shop for yourself, prepare your

00:29:10

own food, maintain your housekeeping, do your laundry, manage your medications, make phone calls,

00:29:14

travel on your own, handle your finances. So those are kind of all independent living skills.

00:29:19

And those are the things that we've worked with a lot of people over the years to get them to the

00:29:23

point where they can live as independently as possible. And when he's talking about in this

00:29:27

first chapter, the independent self, the way I read this is kind of like, if you have somebody

00:29:33

who is independent, and then at some point they become dependent, at what point are they,

00:29:40

at what point do they cross that line? Like how many of these things do they have to be able to

00:29:44

check the box in order to make their own decisions still sort of a thing? Because I've mentioned that

00:29:49

the nursing homes and the assisted living and stuff like that, that's one of the things that

00:29:53

really impacted me in this book. And we'll talk about that in a few chapters where it really comes

00:29:57

up again. But as someone with parents who are doing great, but my parents are both about 70 years

00:30:03

old. And so it's going to come to the point not too far in the future, where they're not going to be

00:30:09

able to live completely independently. And what happens at that point? Do we stick them in a nursing

00:30:15

home? And I should say like the nursing home may be the right answer for some people. But it shouldn't

00:30:21

be, I would argue the default answer, which is kind of what it's become. And he even talks about

00:30:26

later on, like this daughter who goes into a nursing home with her father to look at it,

00:30:30

the person who's there is selling it to the daughter. He's not even talking to her dad who's

00:30:35

going to be living there. And he's just kind of resigned to the fact that like my daughter doesn't

00:30:39

want to take care of me sort of a thing. Like he doesn't say that, but that's kind of the picture

00:30:42

that you get. Right. You know, and so I don't know, like again, there's no right answer to this, but

00:30:49

I like the the list here of the activities daily limit. It really got me thinking like,

00:30:54

okay, so these are the things that we kind of accept as like, this is what you need to be able

00:30:58

to do. But then maybe one of these things you can't do anymore. That's a warning sign. A couple of

00:31:05

them, you know, now you really got to start thinking about this. And it shouldn't just be,

00:31:08

okay, now I need to take care of my elderly parents. I've got all this stuff going on. I have to take

00:31:14

my kids all these different places. I have no idea where this came from. I never saw this coming.

00:31:18

Well, if you look at these lists, like you can basically see this coming. And then don't make a

00:31:23

decision, a reactionary decision based off of the needs of the of your current situation.

00:31:28

Because you can't, you can't figure out a way to do that. Like I feel like if you see it coming,

00:31:34

you can make modifications and you can take steps which are going to allow you to take care of

00:31:39

elderly parents and not just put them under somebody else's care. And that's really the second point

00:31:46

where he compares like aging in India versus aging in the US because they're two totally different

00:31:50

things. Yes. And that's, you know, this is a thing that really struck me. Because as I was reading this,

00:31:58

this first chapter, I finished the first chapter and thought, hmm, I feel like I would rather live

00:32:05

in India right now like that. That's my thought because he tells the story of his grandfather

00:32:10

who ran a farm in India. And then he was what late 80s and he had some health issues that struck

00:32:20

at that point. And instead of, you know, if you go back to this list of activities of daily living,

00:32:27

I think it was close to half of those he was incapable of doing.

00:32:30

After, I want to see it was like a stroke or something. I'm blanking on what it was, the health

00:32:36

issue was. But he was incapable of doing close to half of those activities. In the US, that would

00:32:43

immediately put him in a situation where they would, they would highly recommend a nursing home

00:32:50

and look at something along those lines. Whereas in India, it just meant that the sons and daughters

00:32:58

and grandkids got involved with helping grandpa with his day to day life, which kind of dumbfounded

00:33:06

me. It's like, well, yeah, I know of people who do that and take care of their parents and such, but

00:33:10

that's a lot of work, to be honest. And it kind of struck me on a little bit of a different chord

00:33:19

because, you know, in that realm, he ended up living to where he was in his over 100 years old.

00:33:27

So he lived for quite a while after that in that scenario, having never gone into formal, long-term

00:33:33

care of any kind. And it kind of struck me in a couple ways. One, we don't have that expectation

00:33:41

in the US at all. Well, I shouldn't say at all. The majority of people don't expect that. Nursing homes

00:33:48

are kind of the de facto answer there. And two, it was kind of sad to think about how, you know,

00:33:56

families are quite distributed across the US anymore. You know, even my immediate family were

00:34:01

spread out quite a bit. And I'm the one who is the furthest away. So, you know, I think about that,

00:34:08

and it's kind of concerning. But it's interesting how that has led us to a point where it's not really

00:34:16

an option to just move in with your kids when you hit that point. Like, say you're not able to do

00:34:22

half of these activities of daily living. It's not normal to move in with your kids long-term,

00:34:29

anyway. Like, sure, it happens as kind of a halfway point until you can find a nursing home.

00:34:34

But it doesn't seem to be the norm. But is that because families aren't as close as they used to

00:34:40

be? Are they not as reliant on each other as they used to be? You know, I feel like there's a lot of

00:34:45

potential reasons for that. But it was a little bit disheartening to think about that we just

00:34:51

don't help our own families out as much as what we used to. So, it was kind of sad to think that

00:34:56

through. Bottom line is we're all a bunch of selfish jerks. Well, there's that.

00:35:00

Seriously. I mean, he talks about some of the different contributing factors to the situation.

00:35:07

And I think that a couple of things are worth calling out here. Number one is that people are

00:35:14

living longer. And number two, that wisdom and status are no longer being attributed to the elderly.

00:35:22

So, in India, where wisdom and status are attributed to the elderly, the age of the live,

00:35:28

how they want supported by their family. Because that's what you do. Grandpas are in the right to

00:35:33

live how he wants. But in the US, we view it as having to take care of my elderly parents. It's

00:35:38

like a convenience. It's cramping my style. So, I got to figure out how to get my freedom back.

00:35:46

And it really is selfish if you think about it. The question that he poses here, based on those

00:35:53

lists of independent daily living, is if independence is what we live for, what happens when it can

00:36:00

no longer be attained. And I think the respect and the wisdom that you attribute to the elder

00:36:07

generation, that's definitely going to influence the decision that you make. But that's also

00:36:14

not what happens in the US for a lot of people. I mentioned the story about the lady bringing her

00:36:20

dad to look at the nursing home and the salesperson selling the nursing home to her. That just seems

00:36:26

so wrong to me. But I don't know. I mean, that's where we are. So, the big question then is,

00:36:34

where do we go from here? And it's going to be different for every situation. Like I said,

00:36:37

there's so much nuance associated with this. I really can't make a call and be like, this is

00:36:41

what should happen. But I will say that it challenged me. And by the end of this book,

00:36:47

I was like, there's no way my parents are going to a nursing home. I'm doing everything I can.

00:36:51

Yeah, I can't say I made it to that point, Mike, but I'm not far.

00:37:01

I feel like there's a lot here. And it's very, it's an empowering book, I think, in that way,

00:37:07

to your point. My parents are not going to a nursing home. But at the same time,

00:37:11

we are still in a point where we do like our freedom to a pretty large degree. So,

00:37:20

yes, I feel like it's not that simple. Right. It's definitely not that simple.

00:37:26

No, no, not at all. All right. Chapter two, things fall apart, Mike.

00:37:31

Yes, they do. And they fall apart quickly. We don't really need to spend a ton of time in here,

00:37:35

but there is a story about a lady Jean Gavrilles. I think is how you say that.

00:37:39

And she was living on her own and was doing fine. And then things fall apart, hence the chapter

00:37:50

title. So basically in this section, they talk about the three primary risk factors of falling,

00:37:57

because falling is a big thing that causes people to quickly go from being able to live

00:38:07

independently to not being able to live independently, and then very quickly coming to the end of their

00:38:12

life. They actually said that the greatest threat to elderly people was falling because 40% of people

00:38:18

who fall end up in a nursing home and 20% can never walk again. So from there, it's a quick downward

00:38:25

spiral. But the three primary factors, or risk factors for falling are poor balance, taking

00:38:31

more than four medications and muscle weakness. So when she goes in to the doctor because she's got

00:38:38

back pain and this thing with her lung, they get fixated on her on her lack of balance in the

00:38:46

five medications that she's on. And they're like, we really need to make sure that you do not fall,

00:38:53

because if you don't have any of those risk factors, then you have basically a 12% chance of falling.

00:39:00

But if you have all three of them, you're at virtually 100% and Jean had two of them.

00:39:05

So I thought this was an interesting perspective. Like you go in for one thing, and then the wisdom

00:39:11

of the doctor, they recognize that something else is wrong, and then they're able to identify.

00:39:14

This is the thing that we really need to be careful of. This is the thing that could

00:39:18

end your independence quickly. And so this is what we're going to do to fix this and the other

00:39:22

stuff that's minor. I think there's a lot there that you could unpack. I think it's...

00:39:29

I'm just going to say this. This is where my action item came from. I have one.

00:39:36

But this is where it started, I guess, because Jean's story here concerned me quite a bit.

00:39:45

Okay. Between my parents, my in-laws, probably more so my in-laws than my parents, as hard as

00:39:53

that is to say. If something happened and happened quickly, I feel like we would want to be very

00:40:02

involved. But at the same time, it means that we need to have some of these difficult conversations

00:40:09

now versus waiting. Because how many times in the book does he tell a story, and then they have

00:40:18

to ask some hard questions that no one wants to answer, but they should have really asked those

00:40:23

questions six years prior, or a decade prior, or longer. Like, I don't want to be in that position.

00:40:31

I don't want to be in a spot where I need to ask, you know, how do you want us to handle things if

00:40:38

you're incapable to make decisions for yourself? That's not a fun conversation.

00:40:43

Yeah. Don't walk up to your in-laws and say, "How do you want to die?"

00:40:47

Yeah. But at the same time, they may not be able to answer those questions, but it should at least

00:40:54

spark the thought process to work through that. And again, that's not a fun thing to bring up.

00:41:02

You have to be very delicate in how you even approach the topic, but it's still one that I feel

00:41:09

like needs brought up because things can happen quickly. That was my takeaway from this chapter.

00:41:16

I think we got to be delicate in how we approach this topic, and we're still going to lose a

00:41:19

bunch of listings. Well, in Teach Their Own. Yeah. Now, I agree. That action item could probably

00:41:28

come from a lot of these different chapters. That really is the only action item that you could

00:41:33

possibly have from this book. I didn't have an action item, by the way, because I'm not ready to

00:41:38

have those talks yet, but it does make me think about it. Like I mentioned, as I'm reading this

00:41:45

book, and especially in the next couple chapters where they talk about the nursing home,

00:41:48

I'm like, my parents are not going there. But I do recognize that at some point you are going to

00:41:52

have to have those difficult conversations, and you are going to have to figure out how to come

00:41:57

to an agreement with these things. And again, no easy answers to that. Should we talk about

00:42:02

nursing homes? I don't want to, but I feel like we should. All right. So chapter three is called

00:42:09

dependence. And the all my notes, basically, from this section have to do with the Irving

00:42:19

Goffman who compared prisons and nursing homes in his book Asylum. There were four characteristics.

00:42:26

All aspects of life are conducted in the same place and under the same central authority.

00:42:31

Number two, each phase of the member's daily activity is carried on in the immediate

00:42:35

immediate company of a large batch of others. Number three, all phases of the day's activities

00:42:40

are tightly scheduled. Number four, the various and forced activities are brought together into

00:42:44

a single plan, purportedly designed to fulfill the official aims of the institution. And as you

00:42:50

read those four things, I'm not sure what kind of reaction you had, but I'm like, that sounds miserable.

00:42:55

So, not a, not a painting nursing homes in a very positive light, but also in this chapter,

00:43:04

they talk about the history of them. Because in the early 1900s, the elderly that weren't wealthy or

00:43:12

had children to take care of them went to poorhouses, which were sad, disgusting places for elderly

00:43:19

poppers out of like immigrants, young drunks, and the mentally ill. And they typically spring up,

00:43:25

he mentions in the book, in countries that were transitioning from poverty to wealth,

00:43:29

because at that point, you are breaking up the extended families without producing enough

00:43:35

affluence to really take care of these people. So they're kind of falling through the cracks.

00:43:40

And on page 71, he says that nursing homes weren't created to help people facing dependency in old

00:43:47

age. They were created to clear out hospital beds. And when you think about it that way,

00:43:55

I don't know, it just left a very poor taste in my mouth. But I can think back to all the nursing

00:44:01

homes that I have been in. We even have a ministry at our church where once a month we go to the

00:44:07

nursing home that's down the street from our church. And it's got a reputation in town is not a very

00:44:12

nice one. And we just go visit with people who don't have anybody else who is going to come visit them.

00:44:18

And every time you step in there, it just, it doesn't feel great. It feels great talking to the

00:44:26

people and seeing the reactions that they have and how appreciative they are, but just walking into

00:44:30

the place, as he's describing this, I'm like, "Oh, yep, that's that place. We go there once a month."

00:44:36

Like he's hitting the nail on the head. And I know that they're not all that way. And in a couple

00:44:42

chapters, we'll talk about Bill Thomas, who had a different way of doing things. So there are

00:44:48

people who are challenging this, but understanding the history behind it, I don't know. It just helps

00:44:54

me see where we got where we are. And then also it just makes me feel real sad for the current

00:45:00

situation and challenges me like, "What can I do to help this?" Like I said, we've got to

00:45:06

ministry our church where we're going once a month. That's great. That's one small step in the right

00:45:10

direction. But there's a lot of hurting people there. And there's probably a lot more that I could do.

00:45:16

Yeah. I think we're generalizing when we say nursing homes, when we talk about the state of

00:45:22

nursing homes, as he does as well. And he acknowledges that in the book. He's like,

00:45:27

"This is not necessarily... It's not every nursing home because he knows of nursing homes

00:45:34

that do things absolutely right." And again, we'll talk about one of those here in a little bit.

00:45:39

But generally speaking, there are a lot of similarities between nursing homes and prisons,

00:45:47

to your point earlier. And this just struck me so hard. You think about what happens in prison

00:45:56

versus what happens in a nursing home. Well, it's all set schedule. Everyone gets up at the same time.

00:46:00

Meals happen at the same time. All of that happens. Everything's dictated.

00:46:06

You have no control over it. Everything is... When do you take your medications,

00:46:09

when are you going to take a bath? All of that. All has to happen on a schedule that's set by

00:46:15

someone other than yourself. Well, that's the same thing in a prison.

00:46:19

Okay. Exactly. So just taking a step back, you and I are creatures of habit. We do things based

00:46:29

on routines. We have our way of doing things. If someone told me that I now needed to get up at

00:46:37

six o'clock and I was going to have breakfast once, not twice, lunch is going to happen at 11.30.

00:46:45

You know, we'll have game time at 1 p.m. Like, if someone started dictating that to me all the time,

00:46:51

I am pretty sure I would revolt. Yeah, exactly. Which makes it easy to see then why there are so

00:46:58

many people there that are bitter. One of my gap books, I forget which episode it was for,

00:47:03

was 30 Lessons for Living. And it was written by a guy who went to all of these different

00:47:10

nursing homes and he found the bright spots. The people who have the great personality,

00:47:15

they're always smiling, they've got joy, which is not normal for that situation because a lot of

00:47:21

those people are there. It is a prison to them. They're there against their will. They don't want

00:47:25

to be there, but they're not independent enough to do anything about it. You know, the kids stuck

00:47:29

them there and they never come to visit. That sounds very general and negative, but that's the story

00:47:33

of a lot of the people, the one that we go visit. It's really, really sad. So, the 30 Lessons for

00:47:40

Living though, he goes and he interviews thousands of these people who have a different perspective

00:47:44

about what are the things that allowed you to live a good life? Why do you have the attitude that

00:47:52

that you have? And so, there is obviously things that you can do to overcome your circumstances.

00:47:58

It's not just a situation that you happen to be in, but it's easy to see how you can default to

00:48:05

that and you really can't blame anybody who's stuck in that nursing home because their kids don't

00:48:09

want to take care of them. That's convicting to me. I don't want that to happen.

00:48:13

Yeah, and I suppose we need to be careful there too because their kids don't want to take care

00:48:17

of them. That may not necessarily be the case. True. Yeah, again, we're generalizing. I'm going

00:48:21

to say stupid stuff. I apologize. I just caught that one. That's all because I know of,

00:48:28

even personally, I know of situations where it's not a matter of whether or not

00:48:33

son or daughter wants to put mom or dad in a nursing home. It's simply not an option.

00:48:41

Correct, but there are people that we go visit. I'm like, "Hey, how are you doing?"

00:48:47

Okay, and we get to talking to them and like, "Do you have any family?" "Yeah,

00:48:51

do they live nearby?" "Yeah, they live in town." "Oh, did you get to see them?" "No,

00:48:55

they haven't been here in years." "That shouldn't be." Yeah, yeah. It's way too common for the people

00:49:02

that we minister to anyway. Yeah, no, I totally agree with you. I mean, it's overcome, but

00:49:11

just wanted to say it's not necessarily everybody, for sure. Okay. Thank you for clarifying.

00:49:17

So many disclaimers this time around. Yeah, it's sensitive topics. So many. Got a lot of it.

00:49:23

Chapter four, "Assistance." I feel like you have a lot to say on this one, but a lot of it has to do

00:49:28

with kind of a new way that came out after nursing homes because nursing homes and poor houses got

00:49:35

quite a bit of press. I forget the timeframe, the 40s, 20s. I've drawn a blank member to tell you

00:49:43

that she's... We read this book a while ago. It's been a while since we have tried to record it.

00:49:47

Yeah, we had our time getting recording done on this one, but there was kind of this next level

00:49:53

of assisted living as opposed to a nursing home. And with that, I feel like there's a chance for

00:50:03

assisted living could be a good step forward, at least by its original design, but I think it's

00:50:09

become more than that, more than they intended it to be. Maybe not more, less than the intended to

00:50:15

be. I don't know. One of those two. Right. So the thing that I wrote down here, I've got a couple

00:50:20

personal stories to talk about here. One story that stood out to me was "Loo and Ruth," which is an

00:50:29

older couple. And if I remember the story right, Ruth passes away. And typically, at that point,

00:50:35

when you're significant, other passes away and you're elderly, one of two things happens either.

00:50:41

You're so heartbroken that you follow not long after. Or if you've been the one that's taking care

00:50:47

of them, you now find some independence and you find another reason for living. My grandma was

00:50:52

kind of that way. She's taken care of my grandpa. And then when he passed away, it wasn't like she

00:50:57

was biting time until he passed away. She definitely loved him, but she found another purpose.

00:51:02

And she was really involved with her church and did a bunch of stuff. And it was cool to see how

00:51:09

she connected to something else when she needed to. And that's kind of what Lou did. I mentioned

00:51:14

in here that Lou made friends easily. He didn't mind being alone. He played cribbage with friends.

00:51:18

He went to the library, etc. And that totally reminded me of my great grandma Clara, who lived

00:51:23

to be, I believe, 98. And she lived in a town in Minnesota that my mom is from, called Welch.

00:51:30

She's only 60 people, but if you ski, you're probably familiar with Welch Village, which is

00:51:33

like a big ski hill. It's like the only thing in the town. And I remember going to visit my grandma,

00:51:39

who took care of my great grandma, and they retrofitted her house so that she could use the

00:51:44

bathroom and take a shower and all that stuff. My grandma took care of her. And every day,

00:51:51

she would go down to down the hill. In this town, there was like two stores, and one of them was a

00:51:59

tavern. And she would go to the tavern at like 1130 every day, and she would play Uker with a

00:52:04

bunch of other old people. And so as I'm reading this story about Lou, I'm like, that is so my grandma

00:52:10

Clara, because I never met my great grandpa. He passed away long before I was born. But that

00:52:16

was like she had so much fun doing that. And I thought that was kind of cool. But then also

00:52:22

later in this story, as he evolves it, and he talks about the assisted living part. He talks

00:52:27

about Shelley, who was Lou's daughter, I believe. And they're looking at assisted living,

00:52:33

lose in assisted living, because he loses some of his independence. And she goes to visit him

00:52:39

and the assisted living at page 104. It says what bothered Shelley most was a little curiosity

00:52:44

the staff members seem to have about what Lou cared about in his life, and what he had been forced to

00:52:48

forfeit. So basically, they didn't even care that he really got a lot of life out of playing

00:52:53

crib vision going to the library. And they didn't try to replace those things. You know, just you're

00:52:58

here, you're on our terms. They didn't recognize their ignorance in this regard. They might have

00:53:03

called the service they provided assisted living, but no one seemed to think it was their job to

00:53:06

actually assist him with living to figure out how to sustain the connections and the joys that most

00:53:12

mattered to him. Their attitude seemed to result from incomprehension rather than cruelty. But as

00:53:18

Tolstoy would have said, what's the difference in the end? Like, that's a really convicting

00:53:22

paragraph. And I think that accurately describes a lot of assisted living situations again, not all.

00:53:29

Yes. Okay. But I don't know, just one of these instances is enough for me to say like, that's wrong.

00:53:37

And then we need to fix it. And it reminds me also of a story with Rachel's mom,

00:53:43

because really, what is the point of assisted living? Is it health and safety? Or is it like he

00:53:49

talks about in page 104? Is it to assist in actual living? Rachel's mom was working, she was doing

00:53:56

childcare, I think at a church, and she heard her back on the job. They were being kind of dumb

00:54:01

about the workman's comp stuff. She needed to have back surgery, and she was living in a

00:54:06

downstairs apartment at the time. So we were like, this isn't going to work. You just come stay with

00:54:12

us and stay as long as you need. So she had the surgery, we have a ranch house. So she moved into

00:54:18

one of the bedrooms on the main floor. And she not only healed up, but she went back to school,

00:54:24

you know, once the workman's comp stuff got figured out. And she's actually graduating this

00:54:28

Saturday with a communications degree. She's got a job all lined up. Yeah, the Boys and Girls Brigade,

00:54:34

like it's awesome. She kind of reinvented herself. But it's encouraging to me to see that because

00:54:41

not to pat ourselves on the back, but I feel like that's the goal with assisted living. And

00:54:49

depending on how old you are, maybe the end goal is a little bit different. But to help people get

00:54:54

back on their feet, or to help people maintain the connections that are going to produce the

00:54:59

quality of life that they want to have, it's not just to keep them safe.

00:55:03

So he gives the history of assisted living here too. Like where that concept comes from. And

00:55:09

again, I'm going to blank on names here, but the gal who basically dreamed this up,

00:55:17

were started to build it, to build it out had a lot to do with her mom. And her mom going into a

00:55:25

nursing home and deciding, no, we're not going to do this. We're going to do something different.

00:55:31

We're going to find a different way to help people in the end of life stages. And it was designed

00:55:38

to help people maintain their own schedule, set their own, you know, if they want to skip their

00:55:45

meds, that's their call. Yeah, that's, you know, that's the thing. Like, as much as we like to say,

00:55:50

well, that's not that's being unwise, that's not being safe. Like you need to help them make sure they,

00:55:55

well, what if they cause side effects that they don't like? And by taking their ability to make

00:56:04

those decisions away from them, you're taking away their will to live at the same time. Yes.

00:56:09

So there's something to be said for allowing people the like, and I'm saying people there just to

00:56:17

kind of separate myself from it to some degree, but allowing people to make their own decisions

00:56:23

and make the calls in their own day to day life, because that gives them the dignity of having

00:56:28

control over themselves and not having it dictated to them like it would in prison.

00:56:34

Yep. So anyway, yeah. So page 89 to speak to the situation you're just discussing, he says,

00:56:42

home is the one place where your own priorities hold way at home. You decide how you spend your

00:56:47

time, how you share your space, how you manage your possessions away from home. You don't. And so

00:56:51

Wilson, I think was the lady's name, she talks to her mom, but well, what does your ideal place

00:56:56

look like? And actually wrote down the list that's small with a little kitchen in the bathroom.

00:57:00

It's going to have her favorite things in it. There's going to be people to help her with things

00:57:04

that she can't do without assistance, but she'd have control. She could adjust the heat, she could

00:57:07

lock the door, et cetera. Like you were saying, if she doesn't want to take her medication, she doesn't

00:57:11

have to. No one would make her get up, turn off her favorite soaps or ruin her clothes. She'd have

00:57:15

privacy when she wanted. She'd be a person living in an apartment rather than a patient in a bed.

00:57:20

So the history of this is that in 1983, Wilson and her husband created this thing called

00:57:24

Part Place, which was assisted living. And over the years, Dr. G

00:57:43

explains the reason that it got this way is because the focus was no longer on

00:57:50

helping Wilson's mother achieve the quality of life that she wanted, but it was focusing on

00:57:54

that health and safety because it's hard to measure Wilson's vision for assisted living.

00:57:58

It's a lot easier to measure health and safety. So that's where the regulations are, and that's

00:58:03

what gets measured. And the thing that I wrote down in response to that was a quote that he has.

00:58:09

He says, "We want autonomy for ourselves and safety for those we love." And I think that applies to

00:58:14

the middle-aged son or daughter who is looking at nursing homes for their parents. And I put as a

00:58:20

comment, "Don't fall into this trap." So like you said, assisted living, it's not all bad. It

00:58:26

actually started out really good. It was a response to something that they saw in nursing homes that

00:58:30

they wanted to fix. But over the years, because health and safety is the thing that is easy to

00:58:35

measure, it's kind of evolved to that point, generally speaking.

00:58:39

I want to talk about Bill Thomas. Can we talk about Bill Thomas?

00:58:42

Yeah. Chapter 5, Bill Thomas, he's an interesting guy. Let me tell you, this was the bright spot in

00:58:48

the entire book for me. I read this whole story twice. Yeah. Because it made me want to throw a party.

00:58:56

So chapter 5 is actually called a better life. And Bill Thomas was actually, he describes,

00:59:03

a doctor, wanted to describe them in the book as more farmer than doctor. He was a homesteader who

00:59:09

started working at a nursing home because of the regular day hours. And while he was there,

00:59:14

he recognized that this isn't a great place. And so he wanted to inject life into the nursing home.

00:59:20

And the director at the time told him, "You're confusing care and treatment," which

00:59:25

maybe we want to unpack that, maybe we don't. I don't know. But anyways, Bill Thomas believed,

00:59:31

yeah. Bill Thomas believed that a good life was one of maximum independence. And so he sought to

00:59:37

fix what he considered the three plagues of nursing homes, boredom, loneliness, and helplessness.

00:59:44

And in this story, they talk about a couple specific things that he did. He proposed right

00:59:51

away two dogs, four cats, and a hundred birds. And he had trouble selling it initially, but once

00:59:58

they got them, they found that the drug costs for the people who were living there fell 38%, and

01:00:03

the death rate fell 15%. And so this brings up this whole idea of individualism versus loyalty to a

01:00:10

cause bigger than yourself because a lot of these people, the highlight of their day was taking care

01:00:14

of their bird or taking the dog for a walk or whatever, like even just something simple, like

01:00:19

caring for an animal, that was enough to infuse purpose behind their existence in that place,

01:00:25

which when you think about it, if it's really that simple, like, what a crime to let people

01:00:32

stay in that place. And that's, again, there's so much nuance to all these different situations.

01:00:37

Everybody's going to be a little bit different, but reading this story, it kind of makes you think,

01:00:41

like, yeah, there is a way out. There are things that you can do.

01:00:44

I just love this story. Like, let's bring animals into a nursing home, and let's bring in a whole

01:00:56

bunch and let them take care of the birds. That just, it just made me smile and made me happy.

01:01:03

And I was kind of dumbfounded by the number of, like, he shared, Bill Thomas shared quite a few

01:01:09

of the results that they had with that. Even so much as there were people who they had never heard

01:01:16

speak before start to ask questions about whether or not they can walk the dogs, or, you know,

01:01:23

and that sort of thing starts to come out. Like, okay, well, there's more of this that's mental

01:01:29

than what we think. It's in our brains more than it is in the physical, in our biology, if you will.

01:01:37

I was thrilled to see this, and it kind of helped me realize that, you know, because I thought about

01:01:45

a number of the elderly folks that I have close relationships with, all of them have animals,

01:01:52

and some degree. It's like, huh, kind of interesting. I don't know if that's related at all, but

01:01:58

it was at least a point that was kind of interesting to me. But I like Bill Thomas. I think he has a

01:02:04

great idea with how to improve the situation. I would be curious to see how it's still going

01:02:10

today after a long-term process. But I've not done my research there. Call me a failure.

01:02:17

That's okay. No. I think really the big takeaway from here, because you spend so, so much up until

01:02:25

this point, talking about the negative atmosphere of these places, it's just injecting some positivity

01:02:30

and some life into them and making you think that it's not as hopeless as maybe it appears up until

01:02:35

this point. So chapter six, it's time to let go, Mike. This is a tough one. Can we skip this one?

01:02:43

Well, I'd like to. Okay. Let's not. Chapter six, just real briefly, there is something that I

01:02:51

want to call it for me. I actually have a ton of notes on this chapter because maybe I'm just

01:02:57

a naive millennial, but I had no idea what hospice really was. I just knew it was something

01:03:03

that when people said it, you kind of, everybody else got real quiet. Like, it was almost like a

01:03:09

bad word. So this is the first time I really understood it. He explained it here. Hospice,

01:03:16

he said, is only available for patients with a life expectancy that's less than six months,

01:03:20

and the goal of hospice is to help people with fatal illnesses have the fullest lives possible

01:03:25

right now. That seems like a really noble goal to me. And I understand why people don't want to talk

01:03:35

about it because it's almost like we're giving up at this point. And actually later on in this

01:03:41

chapter, he talks about a concurrent care program where policyholders with life expectancy of less

01:03:47

than a year were allowed to get hospice, but also still get the treatment. So when they did that,

01:03:54

hospice use jumped from 26% to 70%, but they found that those people visited the emergency room

01:04:00

half as often. And the use of hospitals and ICUs overall drop by more than two thirds.

01:04:05

And overall costs drop by 25%. That's the not attractive part of this chapter that he talks a

01:04:10

lot about is like a lot of the spending that comes with health care, like 25% of Medicare

01:04:17

spending, he said, is on the 5% of patients who are in their final year of their life.

01:04:21

So the point he's making without really making it is maybe we shouldn't spend so much money on

01:04:28

these people who are at the end, which isn't a fun conversation to have. But also the question

01:04:36

in the back of my mind. And again, not trying to make this a religious discussion. But the big

01:04:41

question here and the reason why a lot of people don't want to talk about hospice is like, why are

01:04:45

we so afraid of death? This is a natural transition. Everybody is going to go through this. And maybe

01:04:52

if we could, especially if we have something like a concurrent care program, maybe we can,

01:04:57

we can take advantage of this and we can work our way out of this, just the fact that we have

01:05:01

this support system, that means that we end up living a lot longer than we would have otherwise.

01:05:06

Another point he makes here is that doctors typically overestimate how long people live.

01:05:13

Out of 50 patients, they said 63% were overestimated, only 17% were underestimated. But the ones that

01:05:20

were overestimated, their average estimate was 530% too high. So I don't know, there's just so

01:05:27

much information and so much facts here that say like the best thing to do here is to provide

01:05:33

the hospice care to have your best life now. But also don't say we're pulling the plug and

01:05:40

continue to offer the care. Like going back to Mr. Lazarov at the beginning, you give me every

01:05:45

chance that I've got. Reading this chapter really struck me that you shouldn't have to,

01:05:52

by saying yes to hospice care, that shouldn't be the concession that we're not going to give

01:05:57

you every chance that you've got. Well, I work on church staff. Well, I'm on my way out of working

01:06:04

on church staff. So that's one of the side effects of me joining our company. But part of those

01:06:11

conversations on our weekly staff meetings have been, there's a time when we pray for

01:06:16

our church body and those who have requested prayer. So we have a whole prayer request process that

01:06:22

that they go through, which can sound kind of cold, but it's really quite endearing and it's

01:06:29

been a big part of our church. So it's common for the church staff to be talking about folks who

01:06:37

just learned the head cancer or they fell and now they're under hospice care or you know,

01:06:44

this person had to move into a nursing home. But I feel like whenever the term hospice is thrown

01:06:52

out, at least my experience firsthand with it is that we're not necessarily afraid to talk about it

01:06:59

as much as we are realizing that that means we need to go see them or go help in some way.

01:07:07

So it hasn't necessarily been a kind of a scary thing. It's more of a call to action of sorts,

01:07:14

which is probably the way it should be. But so I can't say that I can't say that I share that

01:07:22

reaction, Mike, where you hear the term hospice and you're a little bit afraid of it or don't

01:07:26

want to talk about it. I can't say that we'd operate that way. It might just maybe that's just

01:07:31

subcultures of areas and such regional thing. I don't know, but at least that's been my reaction

01:07:38

to it. Yeah, and that's that's completely fair. That probably is the right reaction. And really,

01:07:42

it's the result of normalization of the conversation. Like I said, my grandparents passed away when I

01:07:49

was quite a bit younger. And so I remember hearing the word thrown around, but also I remember

01:07:54

more seeing the reaction on my mom and dad's faces and my aunt and uncle's faces whenever it was,

01:08:01

you know, it's just like something you didn't want to talk about. And so again, I'm probably a naive

01:08:07

millennial when it comes to this stuff. But like when he explained it in this book, it was kind of

01:08:11

like, well, yeah, this is the right approach. This concurrent care program where it's not just

01:08:16

where you have to make the decision between hospice or having the surgery, giving you the person

01:08:22

every chance that they've got be willing to do both. And it sounds on the surface like doing

01:08:29

both. Maybe that's more expensive. But although the research shows that it's actually quite a

01:08:32

bit less expensive from if that really is the concern. And again, like that's making it

01:08:37

cold and based on a money decision instead of a person decision. But right, that's how insurance

01:08:43

companies probably would look at the situation. Again, I'm not qualified to speak to this, but

01:08:47

that's just the reaction that I had. The other thing here is the breakpoint discussions.

01:08:52

So this comes from a story about Susan Block and her dad. And her dad needed to have surgery.

01:09:01

Basically, there was surgery and there was some complications with his spine, I think.

01:09:06

And she had to make a decision about whether to send him back in for surgery. And they had had

01:09:10

this breakpoint discussion, they call it, to sort out when to stop fighting for time and when to

01:09:15

start fighting for something else. That's how Dr. Gawande describes it before they went in for

01:09:20

the surgery. And her dad said, "If I'm able to watch football and eat chocolate ice cream,

01:09:24

keep me alive." Which I love, by the way. I love that that was so clear cut to him.

01:09:30

Yeah. And it sounds maybe too simple or maybe it sounds, I don't know, like,

01:09:36

that's not real. But the story goes that complications in the surgery, Dr. comes out,

01:09:43

she's got to decide, she's got three minutes to decide about going back in for surgery on his spine.

01:09:48

And because they had that conversation, she's able to ask the doctor if it's successful,

01:09:52

"Is he going to be able to watch football and eat chocolate ice cream?" And so, yep, easy

01:09:56

decision. They go back in, they do the surgery, and he ends up living another 10 years and he

01:10:00

writes two more books. So not only was he able to watch football and eat chocolate ice cream,

01:10:05

he was able to write and do basically what he had been doing, what his life was all about,

01:10:10

up until that point. Which is awesome. But just taking the time to think that through,

01:10:15

I think that's a really powerful point. Yes. And at the same time, that particular

01:10:20

conversation is one that Dr. Gawande brings up with his dad. Because it's about this point in the

01:10:30

book where he starts to talk about his own personal experience with his father. And his father's decline

01:10:37

because of some health issues as well. So he posed that question to his dad and he's like,

01:10:45

"Well, that wouldn't be enough for me. Ice cream and football, I have no interest in football.

01:10:50

It's not a thing I'm going to do." But at least sparked the conversation that they needed to have,

01:10:56

which is exactly what the next chapter is about my hard conversations.

01:10:59

True. So there's a couple things from this chapter, but really I want to spend a big part

01:11:07

of this chapter talking about patch atoms. So there's three different types of relationships

01:11:15

between doctor and patient that he talks about in this section. There's paternalistic where the

01:11:20

doctors are the medical authorities aiming to ensure patients receive what they consider best.

01:11:25

The doctor makes all the critical choices. Take the red pill. Then there's informative,

01:11:30

which is the opposite. Doctors share the facts and figures the rest is up to you. So the doctor

01:11:34

is the technical expert, the patient's the consumer. And this is the more common way he says,

01:11:38

"Here's what the red pill does. Here's what the blue pill does. You decide." But he argues that

01:11:42

the ideal one is called interpretive. It's in between where the doctor helps the patient determine

01:11:46

what they want. And only when the doctor knows these answers can they say whether you should have

01:11:50

the red bill or blue pill. It's kind of a shared decision-making process. And as he was going through

01:11:57

this, I texted you because I was thinking about the movie patch atoms, which I hadn't watched in

01:12:05

a really long time. But I remembered the doctor at the beginning of that movie when he checks himself

01:12:11

into the medical or the mental hospital. And he's talking to

01:12:20

him and the doctor's not even listening. He's totally the paternalistic guy. He's like,

01:12:24

"I'm the one who can make the decisions about whether you're cured and you can live independently

01:12:30

or not." And I went back and watched the movie. I asked you if you would do it too, and maybe we

01:12:37

could share some insights from this because I was pretty amazed after I watched it how much of an

01:12:44

emotional impact that movie had on me after reading this book. And again, this is totally Hollywood,

01:12:51

so I'm sure that you could nitpick a bunch of stuff in here. But there's some really profound

01:12:58

things I think that happened here. When he's checking himself into the psych ward and he's

01:13:02

talking, he's narrating through all of the things that are going through in his head,

01:13:07

that felt a lot to me like the description of what people go through before they enter a nursing home.

01:13:14

And then even once he gets in there, they say, "Wake up as at 7am," and they lock the door behind

01:13:18

him. The doctor doesn't listen. He doesn't really care about the patients. It attaches an image

01:13:27

to it. And again, it's Hollywood. It's a movie, but you see it in a way, I don't know. I saw it

01:13:34

different when I read this, after I read this book, it hit me in a more profound way. And obviously,

01:13:40

the character in that movie, Patch Adams, he's able to just walk out of there and completely

01:13:43

change his life because he gets this revelation that I really want to help people. In fact,

01:13:47

he tells the doctor at one point, "I want to help people." He's like, "That's what I do." He's like,

01:13:50

"Yeah, but you suck at them. You don't even look at people when they're talking to you."

01:13:53

So I don't know. What was your response? When you went back and watched the movie?

01:14:01

Well, I didn't get a chance to actually watch it, but it's only been, I think, two years ago,

01:14:06

since I watched it most recently. So I went and watched a bunch of the trailers and stuff just

01:14:12

to refresh my memory on it because I remember watching it and seeing that as something that

01:14:23

I wished happened more. Now, granted, so it's a Robin Williams movie.

01:14:27

Which, that alone, by the way, knowing what we know now about him committing suicide, like,

01:14:32

"Wow, you go through that movie and you see him going, his character is portraying this internal

01:14:39

struggle later on in the movie. He's contemplating suicide." And you're like, "Wow."

01:14:43

Yep. I had no idea when I watched it the first time.

01:14:47

Yeah. It's bone-chilling when you start thinking through all the nuances that come with it. So,

01:14:57

yeah, it's a fascinating movie. I think if you were to read being mortal and then turn around

01:15:04

and watch it in the way that you just did, Mike, I could definitely see how that could really

01:15:10

almost mess with your head. It does. What? Like, this is, yes, that's exactly what I could

01:15:16

definitely see those reactions. Totally personifies what Dr. Gawande is talking about. In fact,

01:15:22

we just got them talking about the three different types of relationship between doctor and patient.

01:15:26

And the dean, when he first gets into medical school, Robin Williams' character,

01:15:32

he says, "First, do no harm." And that made me ask the question after reading this book, like,

01:15:37

"What is harm?" Yeah. Keeping them alive even though they're miserable, is that harm? Or is it not

01:15:44

doing everything that you can to extend the life of the patient? There's so many questions that

01:15:48

he's struggling with that I did not even realize in the nuance of how that movie was filmed.

01:15:54

He says, "In that same speech, the dean, he says, "We're going to train the humanity out of you."

01:16:00

And I was like, "Wow." Like, Dr. Gawande was just talking about this, how we don't address these

01:16:05

things in the medical system, and we need to change this. And I'm like, "Here's this guy in this

01:16:09

movie who's totally living up to the stereotype that Dr. Gawande just painted in this picture."

01:16:14

Yeah, perfectly too. Like, that's to a T. That is the type of doctor you do not want. But,

01:16:20

you know, that's the way the movie goes. But that's also the exact relationship that Dr. Gawande is

01:16:26

almost warning against. And how, I mean, go back to one of the questions I asked at the very beginning,

01:16:32

is taking a week of treatments to prolong your life by two days better than just taking the

01:16:37

week that you had to spend it with grandkids. You know, that's, is it doing harm to do the treatment

01:16:45

to extend your life by those two days? In that particular case, I would say yes. Right now,

01:16:52

not being in the situation and having zero emotional ties to it right now. Like, that's,

01:16:56

that's the decision I feel like I should make. But trying to think that through from a doctor,

01:17:04

from a training aspect, like when doctors are in school, like, how do you teach that? Like,

01:17:11

that's, that's not simple. I don't think like, you're basically teaching people to be subjective.

01:17:17

Yep. Which brings all kinds of potential messiness with it and how our insurance

01:17:23

company is supposed to deal with that. Exactly. And then when something goes wrong,

01:17:27

whose fault is it? Right. If it's subjective and you did something,

01:17:32

I can totally see how that can haunt you. I can totally see how Dr. Gawande deals with that

01:17:37

nightmare that he described at the beginning of where the corpses of the people who died showed

01:17:41

up at his house. And I remember, when I watched the movie, there's a point in there. So spoiler alert

01:17:46

right now, if you've not watched Patch Adams and you don't want to know how this ends,

01:17:49

turn off the podcast right now. Because there is a point in there where Patch Adams convinces

01:17:55

everybody that is around him that the thing to do is to increase the quality of the patient's life.

01:18:00

So they kind of go and they start their own clinic. It's not really a clinic, but it's just a place

01:18:04

where they can go show care to people who, who need something. Maybe they need a band aid or they

01:18:10

need a, you know, this brain and ankle or whatever. They're not professing to be like a medical

01:18:15

alternative, but they're for all of the people who aren't getting the, the human element of the

01:18:21

care that they want when they go to the hospital. Okay, so there's this guy Larry who walks in and

01:18:26

he makes a call later and he says he needs some help. Okay, so Patch Adams, his character,

01:18:32

falls in love with his other medical student, Corinne, she gets the call and she goes to Larry's

01:18:38

house. Larry ends up, they don't show anything. So it's not brutal or anything, but he ends up

01:18:43

killing her and himself. And Patch Adams that rocks him and he's, he's, he basically walks away from

01:18:50

medical school. He's about to graduate. He's just like, everything I know is wrong. And he's talking

01:18:54

to Truman, who's another medical student. He's like, you can't just walk away from this place.

01:18:58

You're the one who did this. You know, Corinne's death doesn't change anything. Like we still need

01:19:02

to help these people and Patch the struggle when she dies. He's like, I taught her the medicine that

01:19:07

killed her. Oh, the ouch. Twist the knife a little deeper. You know, like I can see where as a,

01:19:14

especially as a doctor, like Dr. Goan day, you're gonna constantly be going back to the lives of the

01:19:19

patients that you have, that you have delivered care to and saying like, have I done everything?

01:19:24

Have I done the right thing? Especially if you don't have any formal training in geriatric care

01:19:29

or whatever the case may be. Geriatric care is one small subset of this, but it's also a point

01:19:34

that stood out to me. He said that they really don't teach this. And this is where the need is.

01:19:39

This is where we're completely unqualified as doctor, Dr. Goanda's words to minister to these

01:19:46

people and to care for their real needs. It's so powerful. Now the movie isn't all negative.

01:19:52

And Zana positive. The dean tries to keep him from getting his medical license. He ends up getting

01:19:59

it. And he delivers this really passionate speech at the end in front of the medical board.

01:20:04

And he says a couple things, which really I thought encapsulated the whole idea behind this book is

01:20:09

that a doctor's mission should be not just to prevent death, but also to improve the quality

01:20:13

of life. If you treat the disease, you win or you lose. If you treat the person, you win every time.

01:20:18

And I thought that was a really powerful idea. I may feel like that encompasses a lot of this book.

01:20:23

Yes. Single handedly. Yep. Exactly. I could not believe after I watched it, how many parallels

01:20:30

I found. Because I did go back and I watched the whole thing. And I was trying to take notes as

01:20:36

I was going through. But a lot of times I just got myself, found myself just sucked into the

01:20:40

emotion of the movie in a way that I never had been before. So I don't know if this is an

01:20:45

interesting topic to you. I definitely recommend that movie, especially after listening to this

01:20:48

podcast. Yeah. Yeah. Give it a new light for sure. Yeah. One more chapter. Okay. You ready?

01:20:58

Courage. I have to admit that whenever I saw the title for this, the only thing that came into my

01:21:04

mind was Phil Schiller on the stage at Apple when they pulled the headphone jack out of the iPhone.

01:21:13

Oh my gosh. I didn't even think about that. I'm glad I did. That was the first thing I came

01:21:17

to mind. I didn't. Wow. I'm sorry. There you go. Easter egg of the day. I'm not sure I can even

01:21:21

talk about this now. Yes. Two kinds of courage. I'll cue you up. How about that?

01:21:29

So the two different kinds of courage that are required in aging and sickness that he outlines

01:21:34

in this chapter are the courage to confront the reality of mortality and the courage to act on

01:21:39

the truth that we find. And I think that's a great way to articulate this. He defines courage as

01:21:45

strength in the face of knowledge of what is to be feared or hoped. Like I said at the beginning,

01:21:50

there is a faith element to this for me which maybe overrides some of this stuff, but not all

01:21:58

of it. And again, I'm not in the situation where I can really say like, "Oh, this is what I would do."

01:22:02

It's way more difficult than that. But this is… I hate this chapter. This is the chapter where he

01:22:11

shares the story of how his dad died. And he obviously has a very close relationship with his

01:22:17

dad and he basically is very detailed. And all of the steps along the way to his father leaving.

01:22:25

And I think it's really sad. It's very emotional. It does raise a very powerful and

01:22:34

interesting question. He does call out in this chapter the fact that like… He's been talking

01:22:40

about, "We don't want to just keep people alive, but there's also the other side of this," which

01:22:44

is not necessarily great either. In fact, in the Netherlands, I believe, like one in 35 people

01:22:50

have an assisted suicide. Like, that's not the right answer either. So he kind of ends it as like,

01:22:56

there's these different ends of the spectrum. What we're shooting for is something in the middle,

01:23:01

but we shouldn't just say we want to keep the person alive. We shouldn't just say we want to

01:23:04

make them happy. But we have to consider all of the information when deciding what is best for the

01:23:11

patient. And by the way, this is really emotional for me too. So I don't know, by the end of this

01:23:16

chapter, you're just in tears. Is that fair to say? Yes. He takes you through the whole process of

01:23:24

his father's death. And he's a very good writer. He's very descriptive. And this is a very emotional

01:23:35

story for him. So he spells it out in a lot of detail. Yes, he talks about courage. He talks about

01:23:42

the courage to confront that you are dying and then the courage to act on it. He talks about how

01:23:50

we have this illusion of control. We feel like we have control over everything all the way up to the

01:23:56

end, but you really don't. You just kind of have to navigate your way through what happens.

01:24:05

Through all of that story, the bulk of the chapters about his father's story,

01:24:09

which means that when you're talking about courage here, he's telling you how they went through

01:24:16

theirs. Yep. Well, through their personal scenario and how his mom fought it.

01:24:22

How his siblings fought it to some degree. And what happened afterwards, what did they do

01:24:33

after his father died? And how did that help them bring closure? It's hard to read this. It really is

01:24:42

because you can't help but think, you know, what would I do in that situation? And you can't help but

01:24:49

wonder, like, if that were me, if I was Dr. Gawande's father in this situation, which was a little

01:24:57

confusing to some degree because his father was a doctor as well. So they would refer to him as

01:25:01

Dr. Gawande to. So it got a little confusing here and there. Right. Over that. But they did a lot

01:25:09

of things right. They did a few things wrong. They will tell you that. But that's what he's

01:25:14

getting at. You feel like you have control over the whole situation. But even though they had

01:25:21

everything done right, they were in the middle of hospice care. They felt like they had a good

01:25:25

handle on everything. Some things happened. You know, his dad made a decision. He was a doctor. So he

01:25:33

was always messing with his own medications. He decided to do something different with his

01:25:37

medications and it caused him to go into some form of shock and it scared his mom. So

01:25:45

she called the hot she called 911. Now, you know, that's what she did. Well, that ended up

01:25:52

causing more pain than it should have. Yeah. What she should have done in that case is called hospice

01:25:56

care and they could have worked through it and everything would have been fine, it seems. If it

01:26:00

didn't want to consider hospice because of the stigma attached to it. Yeah, they didn't want to

01:26:05

do all of that. So it was hard to make those decisions. They had had a lot of these difficult

01:26:13

conversations that we've been talking about. You know, if you're able to have X, Y, and Z, is it

01:26:17

worth continuing life or should we pull the plug? Not a fun conversation. Definitely a hard one to

01:26:22

have, but you have to have in this case the courage to have those conversations and act on it.

01:26:28

That's what he's talking about. And again, they didn't do everything right. They will tell you that

01:26:34

through his father's process. But what he's trying to do and I think he does a very good job

01:26:43

in his story is show just how messy it can be and how hard it can be and how much you feel like

01:26:51

you can control the situation and yet you can't. Yep. And that's what he's getting at is you have

01:26:57

to navigate your way through this in the moment and just make sure that you're constantly talking

01:27:04

about it instead of just making assumptions because how many times did they talk about the

01:27:09

conversations that you had to have and the person who was ill shares with the caretaker what they

01:27:17

would want in an end-of-life situation and it's completely different than what the caretaker was

01:27:24

expecting. Yeah. That just blew ice cream and football really. That's it. You don't ever watch

01:27:30

sports. Why does that? You know, that's what happens. And I think that's really important. It's

01:27:36

hard to get your head around it. It's an emotional process, but it's a vital process. Definitely.

01:27:44

And the last point here, the illusion of control. So there's really like two different

01:27:49

selves that he describes in this last chapter, the experiencing self who endures every moment

01:27:54

equally. And the remembering self who gives almost all the weight of judgment afterwards to two

01:28:00

points in time, the worst moment and the last one. So this kind of gets into maybe predictably

01:28:06

irrational territory or the art of thinking clearly where like you can't trust the way that

01:28:11

you're thinking about things. But the main takeaway here and really the thing that kind of struck me

01:28:17

is that no one ever has control, but we're not helpless either. So maybe rephrase that no one

01:28:23

ever has complete control. So there are things that you can do. There's things that you can do

01:28:27

to influence the quality of your life as you come to the end of your life. But it is something that

01:28:32

everybody deals with and there are no easy answers. And you need to ask the tough questions in order

01:28:37

to figure out what the right situation is for each individual. The last chapter we talked about

01:28:43

the old model where the patient comes to the physician and the physician just tries to fix him

01:28:47

or her. And Dr. Gawande proposes a new model where we figure out how to navigate the end of this

01:28:52

life together. Again, not a fun conversation to have, not a very uplifting read, but I'm very

01:28:57

glad that I read it. I really appreciate Dr. Gawande's perspective. And I feel like he's the

01:29:02

perfect person to have written this. Yeah, I don't know how well it would have come across from anyone

01:29:07

else. So I think it was perfectly done by him. So take his word for it, not ours.

01:29:12

There's that. So we've made our way through the book. You feel better now, Mike? I do.

01:29:19

Until this releases. And then people point out all the dumb things that I said.

01:29:24

Okay, action items. I have one here. Do you have anyone you want to add to this? No, no, I'm not

01:29:33

putting that action item on there. It's not happening for a while. I'm going to attempt to

01:29:38

start this conversation. You let me know how it goes. I don't know that I want to.

01:29:46

It's not one that I'm looking forward to at all. And it may not happen soon either.

01:29:52

This may be something that doesn't happen for a year because I'm not sure.

01:29:57

It's not a thing I think needs to happen over the phone. It means it has to happen in person.

01:30:03

And especially with my parents. Yeah, with my parents, I don't think we don't,

01:30:11

we're not able to connect face to face very often because of the distance between us.

01:30:15

My in-laws, we could probably have that conversation very quickly. But it's one that I at least want

01:30:22

to embark on starting. How do you want us to handle things? I know for example, my mother-in-law

01:30:32

has been telling us for years now, don't put me in a nursing home. I'm coming to live with you.

01:30:36

Like she's been telling us that for a while. So, okay, we've been joking about this for years now.

01:30:43

Let's talk about it. Let's be honest and figure it out. So, I want to at least start that.

01:30:49

Sure. Again, I don't know how it's going to go. I don't know how to report back on it

01:30:52

until it happens. And I may not remember to bring it up once it does happen. But I think it's

01:30:58

worthwhile. Yeah. So, I'm going to attempt it. You're a brave man, Joe Buleg. Yeah, we'll see.

01:31:03

All right. Yeah. No action items for me. I'm styling rating. I almost want to skip this part.

01:31:08

How do you rate a book about end of life care?

01:31:13

So, I'll rate it from a bookworm perspective. And that is based off of the entire history of

01:31:20

bookworm and why we started bookworm. Okay. And I will give this four stars because I feel like

01:31:27

the information that's provided here is great information. I find that there really isn't anything

01:31:32

actionable from this other than having that conversation. And even that's not something that's

01:31:37

going to happen in the next couple years for me. And so, when you think about like, why do we

01:31:43

read books and why do we have bookworm in the format that we have it? Why do we do the follow-up

01:31:48

every week stuff like that? Like, this book really doesn't fit. But it's a good book. I would

01:31:53

recommend that people read it. I was really challenged reading it. It was an emotional read.

01:31:57

It inspired me to go back and watch Patch Adams again. I found myself like really emotional in the

01:32:02

description of like the nursing homes and the assisted living and just deciding been in there.

01:32:08

Like, this is not happening for my parents. But I don't know. I mean, like, I don't know what you

01:32:14

can expect from this book other than having your perspective changed a little bit. I even think,

01:32:19

man's search for meaning was more actionable than someone. Which, obviously, that one is one of

01:32:26

my favorite books of all time. Yeah. This was a really difficult read. It was hard for me to get

01:32:31

through it. But I'm really glad that I read it. I'll just leave it at that. Sure. Well, you can

01:32:37

find excuses around it all you want. But I'm going to give it a 5.0. Which I don't think I've done for

01:32:41

a while. I have a lot of reasons for that. I had a hard time finding really any fault with it

01:32:48

from a book stance. Like, I feel like he covered at least every point around this topic that I

01:32:54

feel like I would want covered. And he did it in a very well thought out in a well-designed way.

01:33:00

You know, per conversations we've had in the past, I feel like the length of this was spot-on.

01:33:07

It's kind of long. But I feel like it needed to be long in this case. Which is kind of weird.

01:33:12

We usually say the other thing. Like, this is way too long. This should have been a blog post. Like,

01:33:16

no, this was almost 270 pages and it needed every one of them. I felt like as much as,

01:33:23

you know, I only have the one action item. It's about the only action item I feel like you could

01:33:28

get out of this. Right. From a broad perspective. I'm sure there's a lot of little stuff that you

01:33:34

could pull from it. But I do think that this is one, and I've recommended this already to a lot of

01:33:40

people. Especially in our church. And I continue to tell people to pick it up. I don't know that I

01:33:47

run across many people that I would say shouldn't read it. Just because I feel like it's been so

01:33:53

important as far as understanding. Because everyone's going to approach this topic at some point.

01:33:58

Sure. Whether it's with relatives, friends, yourself, everyone's going to approach this

01:34:04

at some point. So that means I feel you should have at least thought this through

01:34:12

and to some level or at least be aware of it. That's why I put it at the five. Oh, I think it's

01:34:17

well worth that. It's done very well. And I just, I loved reading it as much as it was hard to read.

01:34:24

I've been a long time since I've cried that much reading a book. The number of times I was reading

01:34:29

this and Becky, my wife would look at me and be like, "You're right over there? Yes, I'm fine.

01:34:34

Leave me alone." Just let me do this. So, yes. So there you go.

01:34:42

Well, I think Five-O is definitely, it's definitely you deserved. A tool or Dr. Gawande is a very,

01:34:52

very good writer. There is tons of personal story in here. There's tons of research. It

01:34:56

checks all the boxes for me, other than, "What am I going to do with this?" And if you were to say,

01:35:02

"Give me the five most influential books that you've ever read that I'm just getting into

01:35:06

productivity. Just getting into self-help because that's typically, I'm just going to go and say,

01:35:11

"That's typically where Bookworm resides." The average person who comes to Bookworm,

01:35:16

they're coming here as a productivity podcast for the most part.

01:35:20

So, looking at if that lends, what are the top five books that I should read?

01:35:24

This isn't going to be on the list, but that doesn't mean that it's not a phenomenal book.

01:35:27

It's totally going to be on that list. Well, think about it this way. A lot of the people

01:35:32

that listen to Bookworm do so because they want the cliff notes versions of the books.

01:35:37

If you listen to this podcast and you don't go read this book, you are a fool. You cannot,

01:35:43

like you said, this book is a perfect length. It's kind of long, but it needs every word that he

01:35:47

uses. I totally agree with that. This is not something that you can skip through.

01:35:52

You can't abbreviate this in any way, shape or form. It's just such a heavy topic. But because of

01:35:58

that, I kind of feel like it doesn't really fit, which is my only knock on this. I'm trying this

01:36:03

just to say, I'm putting it at 4.0 for those reasons, but I completely agree with your 5.0 rating.

01:36:10

And if this is the right thing for you at this season of your life, like absolutely, definitely,

01:36:15

this is the thing that you should pick up and read next. You won't be disappointed. Dr. Gawande,

01:36:19

like I said, he's a phenomenal writer. He's so good. Not just like it's interesting to read him,

01:36:25

which is how some of the books that we read, like Chris Bailey is a great writer because he

01:36:30

keeps you interested. Then there's people like Mahali who you can tell, they're just really,

01:36:34

really smart. Dr. Gawande is both. He's phenomenal. I would not hesitate to read another book by him,

01:36:44

even though this is maybe the first repeat. No, second repeat author we've had in Bookworm history.

01:36:48

Yeah. There's a couple we've done. Yeah. Cool, cool. All right. We can put this one on the shelf.

01:36:53

What's next, Mike? Put the tier-stained pages on my shelf. Yep. Go for it.

01:37:00

So the next one is my number one book of all time, I think, when we did the Bookworm draft.

01:37:05

Yes. And that is The One Thing by Gary Keller and Jay Popison. This one does not have any votes

01:37:10

in the Bookworm Club, but my wife read it recently. Sorry, everybody in the club, my wife's

01:37:15

saying I should go back and revisit this one. I totally agree with it.

01:37:19

For the most part, we are going to go off of those readings every once in a while. I'm going to pull

01:37:25

a Trump card though, and I feel like this is one. It's my favorite book of all time. We've got

01:37:29

to cover it for Bookworm. It's unbelievable that we haven't done it yet. All right, listeners.

01:37:33

So you heard it here. Mike's wife trumps you all. I'm sorry. I guess we're going to do the one thing

01:37:40

next then because of Rachel. Yep, you can blame her totally. I've not read it, so this will be good.

01:37:47

I should also say that I picked this one now because of my current situation.

01:37:52

Yeah, I wonder. I feel like this is the right thing at the right time. So selfishly, that's why.

01:37:59

Yeah, but also going back to the Bookworm library and catalog, I'm kind of ashamed that we don't

01:38:05

have one on the one thing. So this is an episode that I want to have in the catalog.

01:38:09

Got it. Well, following the one thing, I have selected Blink by Malcolm Gladwell.

01:38:16

Yes. I feel like Gladwell is one of these authors that people love or hate, it seems.

01:38:26

And I feel like we should at least enter that world to some degree. He's got a few books out.

01:38:33

I selected Blink partially because I already owned it. And partially because I like some of

01:38:40

the taglines and stuff that come with it, the power of thinking without thinking. So, I don't

01:38:45

know. I'm just kind of interested in that one specifically. So we'll dive into Gladwell a little

01:38:49

bit. Cool. Gap books. I've got one and there's a story behind this one, by the way. Oh, stories.

01:38:57

So I had a Skype call with a Bookworm listener who wanted to talk about the faithless productivity

01:39:07

stuff that I've got spinning up. And they recommended to me a book called Do More Better by Tim Chally's,

01:39:15

I believe it's how you say his name. It is a Christian perspective to productivity systems.

01:39:21

It is a short book. I started it. It's pretty interesting. And I am excited to get through the

01:39:27

rest of this. I just am like a chapter in, but it gets into a lot of the systems that Matt Perman

01:39:34

tried to address in what's best next, but it's a really short book. Forget how many pages it is.

01:39:40

Does it say on Amazon? It's little though. You could probably get through this in a couple of

01:39:45

hours if you just crank through it. But there's so much stuff in here that there's going to be a

01:39:50

pretty decent Mind Node file for this. Sure. Sure. Mind Node is now a part of set app, by the way.

01:39:57

I saw that. So go sign up for set app right now and then go sign up for my newsletter so you

01:40:01

can get the Mind Node file. No, those are PDFs. Yeah. A huge fan of set app. I've got a gap book

01:40:09

this time, Mike. I see that. Exciting. A place of my own by Michael Pollan. I'm

01:40:16

show a hand. Who knows Michael Pollan? I don't know if you raised your hand or not. I'm not raising

01:40:21

my hand. He has written, says his fourth, third. He's written three or four books. His other ones

01:40:30

that are more well known as the omnivores dilemma and in defense of food. So he's he's a journalist

01:40:36

of in the diet world, if you will. He's got another one too. I forget what it is. Cooked,

01:40:44

I think is what it is. Yeah. I've read all three of those. Yeah. So call me a Michael Pollan fan.

01:40:49

Anyway, this one came before all of those and it was the tagline on it is the architecture of

01:40:55

daydreams. He built like his own little room out in the woods so that he could do his writing and

01:41:02

reading. That's amazing. That's where he wrote one and a half of his books. So he goes through the

01:41:07

process. He's not a handyman at all. So he goes through the process of how did he learn architecture

01:41:12

and design and go about building this place, which sounded fascinating to me because I feel like I

01:41:16

want to build a place like this at some point. Thankfully, my wife doesn't listen to this podcast.

01:41:21

So she doesn't know that I'm plotting this. So there you go. All right. Cool. So if you want

01:41:29

to recommend a book, I promise I will look at your recommendations and pick one from the club next

01:41:33

time until Rachel Trump. Nope, not true. I'm going on the record right now. I'm going to pick a

01:41:42

listener recommendation for next time. So get your recommendations in. I was recording this,

01:41:46

by the way, I just recorded through the Bookworm Club. I got connected with Patrick from Knowledge

01:41:52

Without College podcast. We recorded that yesterday. So I don't know when that's going to go live,

01:41:56

but that was a fun conversation. And he said he's going to go recommend some books too. So you can

01:42:02

join Patrick, recommend your books at the at the Bookworm Club, which is club.bookworm.fm.

01:42:08

You can also get there via the website bookworm.fm/list. Just click the button to recommend a book.

01:42:14

And you will also see a list of all of the books that we have covered, including Amazon links to

01:42:21

buy them, which are affiliate links. So if you want to support the podcast, that is one of the ways

01:42:24

that you can do that. Another way you can support us is with iTunes reviews. We love reading these

01:42:29

things. They're fun. Yes, we do. I don't care if it's good or bad. I just like reading them. I feel

01:42:35

like I have to call out one by the way. WebGuy9402 gave it four stars is please add chapter bookmarks.

01:42:40

Great podcast, but I'd like to be able to skip all the follow ups and jump straight into the book

01:42:44

discussions, even moving through the book discussions with with chapters will be very helpful. And

01:42:50

since I started editing the podcast a couple of episodes ago, there are actually chapter bookmarks

01:42:56

in the episodes. I'm not sure if people have noticed that. So you can skip the follow up

01:43:01

by clicking the chapter button in your podcast player that supports it. I know not all of them do,

01:43:06

but I wanted to want to address that. So other people know that there are actually chapter bookmarks

01:43:11

in the most recent episodes. Why would you skip our follow up? Anyway, I just just gonna throw that

01:43:19

out there. Maybe there's sick of hearing about you and your meditation practices.

01:43:24

So here's a good thing to call out. We do read these reviews and sometimes we do act on what you

01:43:30

say. Yes, we do. I don't think I said quote unquote at all this episode. I was trying to think of a way

01:43:36

to use it right now. But there's some feedback we'll take and then we'll just do exactly what you

01:43:43

tell us not to do. But if you have good feedback, we would love to hear it or if it's just something

01:43:48

you want us to know. That's a really good way to let us know. Another way to jump into the

01:43:53

conversation around Bookworm is to just join the club club.bookworm.fm. Some fun conversations

01:43:58

around the episodes and stuff that happen out there. And if you want to share maybe your action

01:44:03

items and we can follow up with you, no one would skip that. They just wouldn't click it. So,

01:44:09

you know, you can share your action items on the club as well. If you're looking for some of the

01:44:13

accountability that Mike and I have through the show and if you don't have someone to do that with,

01:44:18

the club is a great place to do that. So club.bookworm.fm. Join the podcast book club.

01:44:24

Submit a review. Help us take down KCRW. And we will talk to you next time when we cover the one

01:44:29

thing by Gary Keller and Jay Popison.