Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Embracing End-of-Life Planning and Care Strategies
Confronting the inevitable is no easy feat, yet it's a conversation that needs to be had. Join us for a replay of “What You Need To Know About End Of Life Planning” from Season 1.
Speaking of Women's Health Podcast Host Holly Thacker, MD interviews Dr. Silvia Perez-Protto from the Cleveland Clinic for a heartfelt dialogue about end-of-life planning. The episode encourages listeners to engage in conversations about end-of-life plans with loved ones.
As we close our second season, we invite you to continue this journey with us, sharing and supporting our mission to bring thoughtful discussions on these crucial topics.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of National Speaking of Women's Health, and I'm back in the Sunflower House for our very last episode of Season 2. But don't despair, we're looking forward to season three. In the last episode of the first season pretty apropos I interviewed physician Dr Sylvia Perez Prato, who's a staff physician in intensive care and resuscitation department of anesthesia at the Cleveland Clinic and she is the medical director of the End of Life Center in the Office of Safety, quality and Patient Experience and she's quite an innovator and she developed the Advanced Care Program at Cleveland Clinic. And I really thought it was such an important episode to replay in Season 2 because it discusses a much needed and many times avoided tough topic end-of-life planning, of life planning. In this episode, dr Perez-Prado shares resources for you and your family in terms of the planning process as well as how to have that conversation with your loved ones about what is important to them and what they want for end of life care. And in the holiday season, where it's the end of the year and the beginning of the new year and there's so much excitement and a lot of times there's family get-togethers and reunions. It's kind of a good time to talk about this. In addition, end-of-life planning is a key part of financial and estate planning. An end-of-life plan allows you to officially document your wishes for your end of life in the final days Now.
Speaker 1:Sometimes death is unexpected and sudden, so not everyone has the advanced notice that they will in fact be reaching the end of their life here on Earth. So there's lots of important decisions to make, such as the medical care that you want or that you do not want, funeral and burial arrangements you'd prefer, and what you want to happen to your assets and your cherished items. Now I was talking with my husband and I said I'm going to write up an obituary and I wanted him to do the same thing and he just thought that was so morbid and I said but there might be something that's really important to you that, in the stress of the acute grief that one of us would forget, that we might want written about our life. So I think it's a good thing to go through, and a lot of times at the end of the year people look at their finances, they get ready for the new year and taxes, taxes and death, they say, are two things that everyone experiences, and I know from talking with patients and friends and family that many people as they age, even into advanced age, avoid planning at all for their death, because it seems depressing and an overwhelming idea to think about as to what will happen to them and their family when they die. But actually, if you do this planning, it can help alleviate extra stress during an already incredibly stressful time. This is true not only for the individual who's passing on but for their loved ones and, importantly, hopefully it can help alleviate all the extra fighting that sometimes happens amongst the family, since the person is ill if they've already laid out how they want everything handled, and planning for the future can make all the difference in an emergency. It's always good to be prepared, not just for the end of life, but prepared for any kind of emergency. We've seen terrible hurricanes and devastations in the year of 2024. Power outages, weather problems, disruption in supply chains. So being prepared and having all your important documents in a single place can really give you peace of mind and help ensure your wishes are honored and ease the burden on your loved ones. Your wishes are honored and ease the burden on your loved ones.
Speaker 1:My husband is legendary for giving good gifts. He's really a great gift giver. I would say, though, that some of his Christmas gifts weren't always the best received by his sons, in that a lot of it has to do with survival kits for your car, chain links to add to your tires if you're stuck in a snowstorm, blankets and devices and kits needed for being prepared, and one of our sons, stetson, who's, of course, been a guest on this podcast and will be a guest in season three one time he was so busy and he got stranded that he actually broke into the food supply kit that he had gotten for Christmas and eaten one of these really high protein, high calorie bars, and he said it was actually good and it was the only food he had eaten that whole day. So a lot of people say the best day is the day that you find out that you didn't have to use any kind of survival foods. That's for sure, but people do get stranded in cars, and, with the cold weather coming, you really want to make sure your car battery is good, that your phone is charged, that you have an alternative way to charge things that areed and put in boots and extra blankets and coats. My husband got this really nice compact shovel that he carries in his car.
Speaker 1:So planning for the future is just a great idea, and when I was doing research for this episode reprising end of life planning I came across a really helpful checklist on the National Institute of Aging website about getting your affairs in order a checklist documents to prepare for the future. I always like checklists. I write checklists to myself on the weekend of all the things I want to do, like record a podcast, make food and prepare in advance for the week, things that I need to tick off to start the week or the new month or the new year anew. And, depending on your faith, many of us are looking forward to the future, afterlife, and so for some it's not depressing, for others it may be, but regardless, everyone, regardless of their health and their age, if you're an adult, you should plan your estate and finances, which includes a will, your estate and finances, which includes a will, a durable power of attorney for finances and a living trust.
Speaker 1:It's important to plan for your future health care, which includes a living will that tells your doctors and health team how you want to be treated if you cannot make your own decisions about emergency treatment, and this alleviates a lot of stress for family members. It also includes a durable attorney for a health care that would name your health care proxy, for instance, your spouse, a person who could make health care decisions for you if you're not able to communicate this yourself. It's important to put all your important papers and copies of legal documents in one place, preferably something that's fireproof. That's another one of my husband's gifts at Christmas to my sons are containers that are fireproof to put those documents in. You want to let someone that you know and trust, like a lawyer, where to find your important papers or your family members, and you want to talk to your loved ones and a doctor about advanced care planning and discussing this advanced care planning with your physician is actually covered through Medicare. During your annual wellness visit, you want to give permission in advance for a doctor or lawyer to talk with your caregiver as needed, and you want to review your plans regularly In terms of that annual wellness visit with Medicare. The one women's health perspective I would have is Medicare will cover for a pelvic exam, like an annual so-called previously annual gynecologic exam, every two years. So some women will alternate between seeing their primary care physicians like an internist or a family medicine doctor and then with their women's health clinician if they're seeing someone in women's health, and they'll alternate that.
Speaker 1:Now, the NIA, national Institutes of Aging, also suggests making decisions about organ donations and funeral arrangements, or what you want to happen after you die. Some people want to be buried in a certain location or a certain cemetery, others prefer to be cremated and have thoughts about where they want their ashes to go. If you and your long-term partners are not legally married, then you might want to get a domestic partnership agreement, because that could be a very smart idea and this document allows you to declare the responsibilities that you want your partner to take on and rights that you'd like them to have, regarding both end-of-life care and financing, life care and financing and some of these topics like end of life, financial planning, divorce. We've done a podcast with the wonderful attorney, ava Saulnier, in previous episodes. In fact, if you're new to our podcast and hopefully you'll pass on this podcast to friends because it's free you may want to take some time scrolling down all of the podcasts that we've already done, because when I see some of my patients and friends and they'll ask me something, I'll say, oh, did you listen to that podcast that we had an expert on or that I discussed, and they're like no, somehow I missed that. So sometimes, when you're taking stock of everything, that might be a good thing just to do a little screen and make a notation of some of these great podcasts and wonderful guests that we've had that you might want to listen to, that we've had, that you might want to listen to.
Speaker 1:So up next is the End of Life Care podcast from season one, the last episode what you Need to Know About End of Life Planning with Dr Sylvia Perez-Prato, and even if you've heard this before, it's really a wonderful listen to remind you about end-of-life planning being more comfortable for both you and your loved ones, and she shares how planning for your death is really an important part of your life. It is part of the life cycle. So I hope you enjoy listening to this episode either for the first time or the second time, and I certainly listen to these podcasts myself when I'm doing them, but then when I listen to them after they're published, I'll think, wow, that's really a good point. And sometimes when I'm interviewing people, I'm so focused on the flow of the podcast that I may actually miss some important points. So it's always good to reinforce things, and please be sure to join us in the Sunflower House for season three in 2025.
Speaker 1:2025 to 2026 is when we're going to start to celebrate the 250th anniversary of our country. 250th anniversary of our country. So we're just celebrating the upcoming third season and it will kick off January 1st 2025. So, happy new year, wishing you and your family a wonderful, blessed, happy and healthy new year, and please enjoy this episode. And please enjoy this episode.
Speaker 1:Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Director of National Speaking of Women's Health, and I am so excited to be back in the Sunflower House today and joining us for one of the last episodes of season one is a very important and somber topic about end of life, and joining us in the Sunflower House for this special episode is Dr Sylvia Perez-Prato, and Dr Perez-Prato is a staff physician. She's one of my colleagues, but she's in the intensive care and resuscitation department at the Anesthesia Institute at Cleveland Clinic. She's also an associate professor of anesthesiology at the Cleveland Clinic Lerner College of Medicine and she's the medical director of the End of Life Center at the Office of Safety, quality and Patient Experience and she is so interesting and fascinating and talented.
Speaker 1:She has specifically developed advanced care planning program at the Cleveland Clinic, which we're going to talk about in depth, and she has had the goal of goal concordant care. She led the implementation of the pause not anything about menopause, but to honor the person who dies at the hospital and the care provided by that hospital team and she also co-created death over dinner for healthcare. I know that sounds a little bit strange and we're past the Halloween season, but it is so important to plan for a healthy death. And she also is going to talk to us about the pause app that she created, developed to foster caregiving and caregiver resilience related to the end-of-life care. Welcome, dr Sylvia Perez-Prato.
Speaker 2:Well, thank you so much. Thank you for your words. I'm very honored to be here.
Speaker 1:Well, we are so excited to have you as a guest on the Sunflower Women's Health Podcast to talk about advanced care planning and advanced directives, and several years ago you did a wonderful column for us on speakingofwomenshealthcom. But as we start off this very important and somewhat somber discussion, but it's so important for the whole entire circle of life, Tell us more about your role in advanced care planning and why did you decide to go into this field and develop this so fully.
Speaker 2:Well, I'm a critical care physician, as you said, and 20% of the people in the United States die during or after an ICU admission. So, even though you start as an intensivist, to save patients actually you develop.
Speaker 2:Yes, one every five people in the United States has been admitted, during or after an ICU admission die. So it's part of our role as intensivists to understand death and dying, as part of our role to help patients to navigate that time, you know, and their families. So that's why I am in this field and I come from another country. As you see with my accent, I'm from Uruguay, south America, and back home, death and dying is more part of our life cycle. It's something that usually people talk about and I grew up talking about that in my family at the dinner table right and here I was sometimes surprised how people didn't like I was bringing some discussions about prognosis and they were all surprises. And I say people need to talk about this as part of a life cycle, as a natural act, you know.
Speaker 1:Yes, it is a natural part of the life cycle. Certainly, my goal in the Center for Specialized Women's Health is to help improve longevity and quality of life, but no matter how healthy one is and how much everybody does the right thing, eventually we are all going to pass on. You told me a very touching story when I first met you about your dad. Do you want to share that with our listeners?
Speaker 2:Yeah, so my dad was a physician and I remember we were in a very small town so he was an anesthesiologist during the day and then he has his office and then he used to go to see patients at their homes. So sometimes he picks us up. And then we went with him and some patients and families invited us to eat cookies while my father was taking care of them. And one day he said I want to warn you, so-and-so passed, so he died, so he's not going to be there. We are going to only say hi to the wife because she is grieving that her husband died. And so I grew up seeing these things. At that time there were no billing or anything you know. So we went there and saw the family, only to say hi. You know, totally different approach, like today. I think that shaped what I am now. And he always say how important is dignity at the end of life. So these are the concepts I grew up with and this is what I want for my patients.
Speaker 1:Wow, so you really are your father's daughter. That is just so wonderful. And one of our earlier podcasts, when I talked with an attorney about divorce and family law. One of the things that did come up is having papers in order and finances in order, and we touched just a little bit about advanced care planning. But tell our listeners, doctor, what specifically is advanced care planning?
Speaker 2:Yes. So that's a great question. So advanced care planning is a process, right, and changes over time. It's basically understand your goals, how you want to live up to the end. So, first of all, this conversation is about life, how you want to live. So if we say, oh, how we want to die, that's another approach to the same topic, right?
Speaker 2:So a fast care planning includes, first, who is going to make decisions for you if you are not able to and this is something important for anyone, because anyone can have an accident, you know, or a stroke, or any time.
Speaker 2:Even the healthiest person can be diving and have an accident, right? So it's important to know who's going to make decisions for you if you are unable to, and that person could be in the order in Ohio, in the state you are, or could be outside right of that order. So the best is to have a document saying who is the first person and the second and the third, and sometimes, even if you have five kids and you know that one is going to take your wishes up to the end and another is not going to be able to do it, and it's not a manifestation of love to choose one over the other, it's like who is going to be able to do it, and it's not a manifestation of love to choose one over the other. It's like who is going to be the best one for healthcare, and perhaps another kid is best for the finances, right? So the first step is stating who is going to speak for you. I recommend to have a document that is the healthcare power attorney Healthcare power attorney, yes, and be in the chart.
Speaker 2:So you have to bring the document to the hospital. We have many, many ways to do it and I can share a website where all this is explained. So it's in the chart. So when we have a problem, we know exactly who to talk to chart. So when we have a problem, we know exactly who to talk to.
Speaker 2:And then for patients that are seriously ill, with a diagnosis that decreases your expectancy of life, like, says, six months, one year, those patients need goals of care, conversations, and these are conversations that we talk what matters most to you, and that's why it's important to do it often, because your goals change.
Speaker 2:Right, as your disease process progresses, you may change your goals, so that's why it's a process.
Speaker 2:So what matters most to you, what are your fears, your worries? And then we can deliver a cure that is aligned to your wishes. And then, of course, we talk about what are your wishes in an emergency, if you are weak and with a terminal diagnosis, if the heart stops, do we want a natural death or we want to do chest compressions, intubation, go to the machine, even when it's futile and it's not going to help? So, and again, there's patients that say I want everything done and we have to respect those decisions. But again, when doctors in the state of Ohio, we feel that they are futile and it's against the standards and we are not going to help, we are going to damage the body, we, even two physicians, we can say we will not offer CPR or resuscitation maneuvers, we are going to allow a natural death and we can talk about it and explain why we think that this is the best approach. So understanding death as a natural part of our life cycle is crucial.
Speaker 1:Very crucial. So you are listening to the Speaking of Women's Health podcast and I'm your host, dr Holly Thacker, the Executive Director of Speaking and Women's Health, and we are joined by a physician, dr Sylvia Perez-Prato, who specializes in the last stages of life, which can, of course, unfortunately happen at any time. None of us can predict the future. Can you tell us, doctor? You talked about a healthcare power of attorney, which is important to name. I know, as soon as my three sons turned 18, on the day they turned 18, they filled out their paperwork, because once they're 18, they're an illegal adult, doesn't matter that you're their mom, and they signed it. Tell us what the living will is.
Speaker 2:Yes. So the living will is a document that says in the case I am terminally ill by two physicians or permanently unconscious and I don't have capacity to share my wishes, I don't want to be connected with machines, die naturally and please, doctor, place a DNR order, do not resuscitate order. So basically, the living will apply in very small population. You need to have a patient that is terminally ill, there's nothing else to do in order to extend the life, and two physicians should sign that document. It's very important that document in cases, for example, with no surrogate, there's no family, there's no documents. The patient is admitted it's a terminal condition.
Speaker 2:In these cases, if we don't have a living will, we have to keep them on the machines until the body, you know, with time it stops and working. But the problem is that we at the ICU are very good today with all the machines and support we have. So many terminal patients may be alive for a long time with no meaningful recovery, no meaningful life. So the living will assures us not to be kept on machines if we are terminal and we are not able to speak. And that helps families because if we have a document it's helping the family sometimes to make the decision to say, yes, let's allow a natural death, and this is another thing that I like to say to my family is, instead of saying, do not resuscitate, just allow a natural death. This is what it is.
Speaker 1:That sounds so much better. I'm thinking of one situation of a good dear friend who had a terminal diagnosis and had, you know, the advanced directives, health care power of attorney, had the living will, including the natural, you know, wanting a natural death. It got revoked because this person who was dying had air hunger, which of course we know how to treat to make someone comfortable and peaceful. And so he then revoked the do not resuscitate and it was like on off, on off and it just seemed like it was not a good death and just like we want good births for moms who are bringing babies into the world, sometimes it can be a little rocky, it's not always as according to the birth plan. You know it's the same thing with the end of life. People are given the comfort care so they're not so uncomfortable and air hungry that they say oh no, do everything and intubate and put me on the machines.
Speaker 2:Yes, so actually we have many teams working in these cases, right In the ICU we have the training to make sure the patient is comfortable, with no shortness of breath, air, hunger, anxiety. So we have medications to help them and if they survive enough, we can even send them to hospice or to the regular nurse floor with palliative care and or hospice care. And the goal change we want the patient to be as much in peace as possible, connecting with the family if possible, and we invite the families to celebrate life, to tell us stories about the patient, and then we have a lot of people that help us, like spiritual care, healing services, services, music therapy. We can even bring their pets and you know we we tried everything that matters most to this person. Right, and this is the question I love to use what matters most to you and that is a very open-ended question that unpacks a lot and you can find like our goal is to make sure that time is meaningful.
Speaker 1:Very important.
Speaker 2:Yeah, so the goal is not always more treatment, more surgeries, more time. Sometimes patients really want this time of peace, this time, and that's why it's so important for us to be honest with prognosis, so they can prepare for that time realistically, right, and you know, say goodbye, say forgive someone, you know ask for forgiveness. I don't know, life is complicated, right, and it's the time of the patient, it's not our time.
Speaker 1:Now, every time I meet a new patient in the Center for Specialized Women's Health, I always give them a folder with information about the practice and people on the team and who the scheduler to call, and I always include information about health care, power of attorney, living will and advanced directives. And some people are just taken aback because they're not expecting that. But I thought you know we're planning for the rest of your life and we need to plan for the whole entire life cycle. How does one start on completing their advanced directives? I mean, I certainly prompt all my patients, but I know not everyone is necessarily seeing a physician or a healthcare clinician that's having these discussions with them.
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Speaker 2:Yes, and the documents are pretty complex it's 12 pages long and sometimes it's hard to understand. So I think you can find us in the website I will share with you. There are resources for patients that we have guides on. Page one is this, page two is this so you can do it yourself and could be witnessed by two people that are not related to you by blood or by marriage or by adoption, so your neighbor can be a witness and then it's called with two witnesses or a notary, but you don't need a notary, and also the clinic social workers, spiritual care are are trained to help patients to complete the documents. And more than the document, I will say.
Speaker 2:The next step is to have the conversation, and that's another tricky thing, right, because sometimes I know who's the person, right? Uh, chosen by the patient, and then say we never talk about this, I don't know what he or she would have wanted. So, and again I will tell my story my dad passed away years ago. So death he was super young when he died. So death is a pretty difficult topic to bring up sometimes. But I wanted to know what my mom would have wanted if something happens to her. And then one day I went walking in the beach with her and I started asking questions, and even me being a physician, it was kind of difficult. I didn't know exactly what to ask and got a little tricky. And then I changed topics and I found a guide that I always offer to my families and families of my patients and I use it with my mom later, and the name is the Conversation Project conversation project and this is a guide with questions that are validated by research and that are questions to share with people when we are healthy, right and uh, and you know, in my house my husband and my daughter was how you're always talking about this and I one day I wanted to have a conversation and they didn't want to hide so.
Speaker 2:So I wrote everything in one day and sent it out. It was a Tuesday night and I was on call and I wrote everything. I said Mom, are you crazy? You're sending me a Tuesday night. But then COVID hit and my husband we have been married for 30 years he said that it was the time that he never saw me so stressed and so afraid of going to the ICU. So one day we were almost to go to bed and he said what exactly you want if something happens to you. And I said seriously. So I said you know, pablo, let's do death over dinners, let's do it. So what said you know, pablo, let's do death over dinners, let's do it.
Speaker 1:So we actually connected.
Speaker 2:What is?
Speaker 1:death over dinner for health care.
Speaker 2:Yes.
Speaker 1:It's not some new restaurant I take.
Speaker 2:Death over dinner. I know, I know. So. Death over dinner started years ago for friends and families to have this discussion about death and dying and how you want to die and what your legacy would be, and to think about that and share it with your loved ones, right. So we started for families and friends and this is what I invited him to do, and so we did the first online death over dinner, because usually it's in a table of six or eight people breaking bread. That connects to your core right, sharing a dinner, sharing a meal, answering those questions. It's a way to connect with others and open up with others and open up, and that was brought by Michael Hebb.
Speaker 2:That is the creator of Death Over Dinner and he came to the Empathy Summit years ago that the clinic used to offer a host and then we said, oh my God, we need to do it for healthcare teams. So, basically, I wanted to take us from the hospital right without our badges that says I'm the doctor, I'm the nurse, I'm the respiratory therapist, right as people, but in teams, right in multidisciplinary teams, and share our feelings regarding end of life and death and dying, because it's hard for us, you know, sometimes if you have a patient for a long time and that patient starts having issues and then die. You miss your patients, right. Or, for us in the ICU, you meet this family in a very stressful situation for one week and then the patient dies, right. Like even in different situations, means different things to us, but it's hard. No, we have these feelings and sometimes patients remind us of our own families or our previous experiences, our previous experiences. So this is a way where the surgeon, the anesthesiologist, you know, the consultant, the internal medicine, the nurse, we all come together as people, not from our roles, and share.
Speaker 2:And at the beginning of the dinner we bring, we turn on a light like a candle to honor someone that we lost. And it was amazing to me to see a surgeon talk about a patient. The first thing he did was to talk about a patient. So it's like, wow, like most of us, we talk about our parents or our grandparents, or that person brought a patient. So it was eye opening for me because I never saw that part from him, you know. So I think it's a way. And then we have questions. So while we have dinner we answer those questions and then at the end we all do a pause to honor everybody. We honor that night and we honor the teamwork for all these patients that we were talking about at the end. So we close with a pause. And this is what is death over dinner for healthcare.
Speaker 1:Wow. So do you encourage everyone to do this, individually or for primarily healthcare workers or anyone who's interested in this process?
Speaker 2:Yes. So if you put death over dinners, there are many versions. So there are death over dinners, even for Jewish people, for Brazilian people there's one in Brazilian, for Brazilian culture it's a huge movement there there's one for families and friends and then the healthcare one is for healthcare team. So the questions are kind of different and at the beginning you you go and choose things. You can choose a podcast, you can choose a reading, and then at the end brings you questions that you're going to use during the dinner so you can organize your own dinner yeah, that is so important to do.
Speaker 1:Just the other day I just had a wedding anniversary and so my husband had my wedding rings because I had lost, you know, one of my side diamonds doing some heavy work. So he had it fixed and, you know, brought it back to me and I had my granddaughter, artemis, on my lap and I said, oh, one day you'll probably have some of these rings. Which one would you like? So she picked the biggest one and then she said and my little sister, beatrice, can have this one. And I thought, okay, this was a good discussion to start to have.
Speaker 1:And my son said, oh, that's so morbid, you're being so morbid. It's like no, I mean, most likely I'm, I hope to pre-decease my children and grandchildren. Exactly, yes, and I think that some people think that they either don't want to deal with it at all or they only deal with certain aspects, like when I'll ask patients, they'll be. Oh, yes, I have a lawyer. I've dealt with all the financial stuff and certainly the financial things are very important. Having an executor and, you know, do you need a consult to your will and are you having trust? I mean. So certainly all of that's important, but I always say well, we're interested in the health aspects and how you want to be cared for. So it really is a whole, entire, comprehensive process that we all need to face once you're 18.
Speaker 2:Yeah, and also organ donation right. I always think I want to die in a way that I can be a donor. I always say that because from death you give life right. So part of the discussions, and that's why the discussion should be early. Like you know, anyone can have an accident right, and if you have an accident you have high likelihood to be a donor and to be healthy, to save many lives right Up to eight life we can save and many, many more improving quality of life. So why we don't talk about this right? And then I always say cremation, and then to the Atlantic Ocean. But I told them don't go to Uruguay, it's too much. You can go to any part of the Atlantic.
Speaker 1:But it has to be the Atlantic Ocean for you, right, right now the pacific.
Speaker 1:Yes, yeah, I was born in the atlantic you know, but that whole thing about organ donation and giving life is so important and um, on our website, um heather mckessa, who runs life bank, uh, in charge of organ donation, she's done a wonderful column and she was highlighting to me that the group of millennial parents many of them, when they're diagnosed and carrying a baby with a fatal condition, they don't choose to terminate the pregnancy. They carry the pregnancy even though they know that the baby may not have a brain or may have something that will not allow life, but they give life through organ donation, because little babies need organs too.
Speaker 2:Yes, yes, so this was part of my story as an intensivist.
Speaker 2:When I was 24 years old, I was in the ICU and this patient came with a procedure in the brain in the right side and she was fine and she needed the left side and she said I don't want to have it, I want to go home and have Christmas with my daughter at eight and then I will come back next month. And then what happened? In January I received her in brain death because she bled after the second procedure and back home at that time we have a document that was pink, saying that you wanted to be a donor, and she had three documents signed. So I said, oh my God, this is the last thing I can do for her is to make sure she's a donor. And in that time, donation gave meaning to death for me as a 24-year-old intensivist at that time, and since then I've been involved in organ donation as well. So everything dies right and how we want to live, how we want to die and what we want to be after, how we want to do it right.
Speaker 1:Absolutely so. You're listening to the Speaking of Women's Health podcast and we are talking about end-of-life decisions, which are all part of our mission being strong, being healthy and being in charge, because it is the circle of life and we're talking with expert physician and intensivist anesthesiologist, dr Sylvia Perez-Prato, and you, dr Perez-Prato, helped create the PAWS app. Can you talk to us about how this app works and how we might get it?
Speaker 2:Yes. So the pause was invented by Jonathan Bartels in Virginia, in the University of Virginia. He was a nurse in the ED and one day he was involved in the resuscitation of a patient, very young, after a trauma and they couldn't save him. And then one started preparing the body, another started going to the you know talk to the family cleaning up the room and then he said stop, let's pause. Let's honor this person, that we help him. We try to help him. Let's honor he was loved. He was somebody who loved others. Let's honor he was loved. He was somebody who loved others. And let's honor us as a team and the care we provided to him. And he did a pause and then he said thank you, and it was transformational. So since then, when we found out that, because a fellow came to the clinic and did that and was amazing for the nurses, so they came to me and said Sylvia, we need to do this at the clinic. So I connected with him and said, hey, every time I talk about the post I will say that we didn't invent it, it came from you.
Speaker 2:And then we, as a Cleveland Clinic way, we did a pilot. And then we, as a Cleveland Clinic way, we did a pilot, we got feedback and this, and that until we had a script that is very, very plain words, because we don't want any religion, anything there. It's only honor the person, honor the team and stop, as in community, but in silence. So each person lives it as they want, as they feel, but it's in communities, all together. So, uh, and then, of course, when you start doing it, you get used to the words and everything, but at the beginning it's hard. So we wanted to have something that is available. So we created the pause app and you can find it is free and we have the script in many, many languages.
Speaker 2:So, if their family doesn't speak english, yes, so if the family doesn't speak english, we explain to them that we are going to do that and we ask permission and we show the what we say in their own language. So they are sure there's no religion, anything there. And I have only one family who asked me not to do that because they wanted to have their own celebration. So our team went to the nurse's room and then we did it there without the patient. But usually families stay with us, they are with us and they they love it. So, um, and it's a way for us to close. You know that relationship that sometimes it was very short and intense and sometimes was longer.
Speaker 1:Um, but it's a way to do it together and so people can go on like their apple itunes store and just download the pause for free. So it's kind of like a yes, health care focused, team focused, non-denominational closure and certainly that doesn't preclude other people from their own religious or spiritual uh, end life or last rites, which you know many people will get as their last. You know, sacrament, end of life, and certainly cultures, religions, ages, backgrounds, I mean, we respect whatever is how that person and their family want to mark and celebrate their death and their life.
Speaker 2:So one of the things interesting that happened because we did this for the care team right In the ICU, in the floor, in the ED, in the emergency room.
Speaker 2:But one time somebody from IT had a colleague that died and they were very unsettled and this manager brought everybody together, said hey, let's do a pause to honor so-and-so.
Speaker 2:And since then it ended up happening in M&Ms when we discuss cases, some people say, okay, let's do a pause about the patient or in quality events they do the pause and then they end up doing it in the executive team and during the pandemic was quite important because executive team were more about, you know, preparing for the search. But every Monday, when they name everybody that died Friday, saturday, sunday and they name all the persons who died in the enterprise and they do the pause, it was coming to reality that these numbers were people with names. So since then they do it every day in Huddle 6 executive team have all the names of the people who died the day before and they honor everybody with a pause. And the Joint Commission was here and found that as one of the 10 most impactful changes at the clinic. So yes, it's incredible how a little act can have so much reach, you know.
Speaker 1:So tell us a little bit about yourself personally, because you're still full of life and living life very full. You're the mom of two daughters, right?
Speaker 2:Yes, I have a 23-year-old and a 12-year-old. That's quite a span, yes, Well, I had some miscarriages, so some doctors in your field helped me a lot and I decided that I will stop studying and getting bored and I started dancing flamenco again last year so I'm very excited.
Speaker 1:That's great. Yes, you're a dancer and I started dancing flamenco again last year, so I'm very excited. That's great, yes.
Speaker 2:You're a dancer? Yes, so there's a group of Abre Paso is the name, and I'm a board member of this organization, non-for-profit to create community through the art of dancing. You know, to create community through the art of dancing. It's Spanish, dancing is very difficult, so I'm preventing Alzheimer's, that's true, it does help your brain Because you have to think about it a lot.
Speaker 1:Yes, You'll have to send us some video clips. So I think it's my name. Yes, please send me a video clip of your dance, oh okay.
Speaker 1:I'll put it up on our social media on Speaking of Women's Health, because people can follow us, not just the podcast. So if you're listening to this podcast on any place you listen to podcasts, just hit follow or subscribe because it's free. Oh, that's wonderful, but we're on Facebook and LinkedIn and Pinterest and X, which is formerly known as Twitter, so we can put that up. I'm sure our followers would love to see you dancing. That is like so wonderful, and you've also had leadership roles.
Speaker 2:I'm not sure I'm ready. I'm not sure if I'm ready to be in the Just a little clip.
Speaker 1:Just a little clip. I'm sure you're ready. I will see. I will see. You've also been involved in leadership roles for the Women's Professional Staff Affairs as well, so you have the respect of all your colleagues. Oh yes.
Speaker 2:Yeah, so well, this is part of my goal of lifting others while I lead, so I have the honor to represent the women professional staff at the clinic. So, yes, I'm humbled by that and, yes, it's something that is important to me to help others while I'm leading.
Speaker 1:Well, we're so proud of you and this has been so helpful. In wrap-up, Doctor, any final tips that people need to keep in mind, that we all need to keep in mind in terms of planning our end of life.
Speaker 2:Yeah, I would say that if you live your life at fullest, we want to live up to the end at fullest, so we need to live it in our own terms. So it's important to share those wishes, to think about it, reflect and then share that with our loved ones and with our care teams so we can have the best experience at the end the best experience at the end.
Speaker 1:I was recently visiting the grave site of one of my friends who sadly got dementia during the pandemic and it rapidly progressed and she died. And so I was going there and I ran into her husband because it was the first time he was going to visit the headstone. It was beautiful and he was there with his sister whose husband had died. And they gave some really good advice to me and my husband. They said plan your own funeral, get your own headstone, because your children will either spend way too much money that you wouldn't want your money to have been spent on or they'll spend way too little. And I thought okay.
Speaker 1:I've got some penny pinching sons, so that was really good advice because it made you know my husband and I think we need to plan all this out and pay for it and you know. So the whole shebang, of course, the healthcare part, and who's going to speak for you, and what are your own personal goals and what you want done, what you don't want done. That is, like you said, living to the fullest, to the very end. But there are factors afterwards that can make it very difficult on the loved ones, like if your paperwork is not in order and you don't have an executor and you haven't decided where you want things to go. That is so important. So we're going to put information about the pause and how people can reach you and links to your column in our show notes.
Speaker 1:So thank you so much, doctor, for joining us at the end of our first season about end of life, which is so important to being strong and being healthy and being in charge up to the very end, and I'd like to thank all of our listeners for joining us, and if you've enjoyed this podcast, you can give us a five-star rating. Share it with your friends, share it with your family, use this as a point in time to start to talk about this, and it's free to subscribe. And if you want to donate to our nonprofit speakingofwomenshealthcom, we would much appreciate it. And please follow us wherever you listen to your podcast Apple Podcasts, google, spotify, iheartradio and I'll look forward to joining you in the Sunflower House next year in season two.
