Death Shouldn’t Be Scary, Here’s How to Embrace It | Dr. Jennifer Haythe on Health Theory

guys this episode ended up getting amazing uh roughly we'll we'll put the time code uh but we got onto an absolutely fascinating topic and i'll be heartbroken if you don't at least watch that uh so this episode was rad i promise you you will not regret it you can go into the beginning where we talk hardcore coveted stuff or you can skip right to the time code this is going to be right there we'll put it i don't remember where it was roughly sort of halfway through the episode um we got into end of life and some really really fascinating stuff so be sure to check that out hey everyone this episode is brought to you by our sponsor betterhelp an online counseling company with the mission to make professional counseling accessible affordable and convenient i hope you enjoy dr jennifer hey thank you so much for joining me um super excited to get this chance to talk to you thank you for having me i'm excited too awesome so this is a pretty weird time to be in the medical field uh i see your scrubs hanging behind you are you are you more at columbia university the school are you more at the actual hospital yeah so we have a medical center that's associated with our university uh columbia university medical center and uh that's where i had spent most of my covet days and is it still pretty hardcore is it pretty hardcore covered there still you know it's actually calmed down a bit a lot i would say you know it was pretty intense there for a while i i had never seen anything like it and frankly i didn't think that any of my mentors and older doctors that i you know have worked with for so many years had seen anything like it it was really um it was pretty overwhelming the entire hospital became i would say probably close to 80 percent covered uh lots of floors had to pop up and turn into intensive care units to manage these patients and one day you know i walked around and i suddenly saw that you know every icu bed had two patients to a room every operating room had four patients in a room all on ventilators and it just felt like the whole hospital was on a ventilator and everyone had the same exact disease everyone had covered and it was really it was bizarre it felt almost like what i would think war would feel like a bit you know where you have your teams and you trust your teams and um you really depend on them to sort of get you through and support each other and it was it was it was heavy yeah i'm that that is uh something everybody seemed to be super focused on in the beginning i'd think that that story would have resonated it would have been like front um page news somebody telling a story like that now i'm beginning to worry that either because of summer um or just like the the climate where people have been pent up bad things are happening to the economy obviously what's gone on with the protesting that people are so fed up with so many things that now they're acting like the virus will give them a breather but you're saying that we're not seeing the sort of explosive need of the hospital what do you think is going on is it that it's summer months it's vitamin d it's sunlight it's people being outdoors is it that the lockdown was actually effective is it that the virus is mutating like what what do you if you had to hazard a guess and i know that right now it would be a guess but if you had to hazard a guess like why are we um why are times getting better i think it's probably a couple of different things one i think that there was this latent period where we didn't know the virus was spreading between people and people were getting infected and since we know that most people that get coveted have pretty mild symptoms and you know aren't going to be that they probably thought they had the flu or a bad cold and so they were home spreading and spreading and then we reached this just sort of massive number of people infected and when you get to that many infected people you're going to see a lot of people who need hospitalization and so it reached this sort of climax or pinnacle where suddenly the hospitals just couldn't manage it anymore but what's not gonna happen is it's not gonna just disappear and go away and it's not going away because it's sunny out and it's it's still there you know the concern i think of people like fauci and other infectious disease doctors is that when we start being indoors more in closed spaces on the subways going back to work reopening that the spread is going to go up again whether we'll ever have that moment we had at least here in new york city where it was literally like you had to choose who got a ventilator and who didn't and thousands of people dying every day my hope is that that doesn't happen again but that we will have to deal with kovid for the next year chronically coming into our hospital and trying to minimize spread within the hospital which i think we're doing a really good job and if this becomes something that we see every year like a flu um how gnarly is this gonna be like right now man i treat this [ __ ] like it is panic central i don't let um people in my house i am washing or wiping down on my groceries it is a nightmare like and i know everybody's going through this but like what a pain in the ass to one i don't even want to go to the grocery store right so i'm getting everything delivered which miracle of miracles that we live in a time where that's possible but i don't even want like um to go back to the office even though like we have a cleaner that could come in and like be wiping all the surfaces and stuff but it just seems like man anything that i can avoid i want to which was fine when i thought this was like a month or two months but living with that like elevated level of paranoia i'm actually one not sure humans are capable of that i think we will end up letting our guard down i i'm already i can feel myself getting a little bit lacks at the edges um so what does this look like if it's really ongoing it's just here cyclically every year well i think the the hope is that you know viruses that spread the best and stay the best are generally not going to be viruses that kill you quickly because like ebola if you're going to have a 50 you know death rate or mortality the virus won't even be able to get to the next person but you know to find a new host so things like influenza all other coronaviruses like the common cold those things are mild and so you keep it to me i give it to you every time nobody cares and it just kind of spreads around and people get sick and they get better if this virus wants to stick around it may mutate into a less virulent form which is usually what we see over time the other potential is vaccination now whether vaccination will say you don't get it is unlikely it's probably going to be more like a flu vaccine scenario where you get something and you get a milder version or you don't get quite as sick and then that will also allow people to come out and to us to have you know some kind of hurt immunity to this which is really the goal um but to achieve herd immunity before that would require millions of people to die so we're buying our time letting people get infected i mean people are still getting infected we're still treating them it's just that at least the hospitals can manage the intake i want to reassure people and that really the people who die of covid for the most part we've seen are in a much older age bracket or with a lot of other medical conditions that doesn't mean i haven't seen people in their 30s with no nothing wrong with them so yes you're right to think oh my god what if i get coveted i'm screwed i could die like any of us could die but you could also get h1n1 flu and die so there is like this loss of memory that we forget that like you could die of the flu too as a young healthy person it does happen it's not common i think probably covet is worse than the regular flu but it does happen i got the flu in january and it was so gnarly that by the end of it i was like oh my god like this really can kill people i was like this [ __ ] was real i i've never had something linger that long like i always think of being sick as a seven day commitment and so at day ten to have still been like yo i just cannot get out of bed this is crazy and i had been lulled but the common cold the sort of average flu had lulled me into the sense of you get sick you get better and that it was a foregone conclusion that you get better and then when it just wasn't going away wasn't going away wasn't going away and i was coughing so much i was like man i must be doing damage to my lung tissue like you can't cough like this and not have some scarring or something and that actually brings me back to covid so one of the things that made me so interested in talking to you because you're an expert in the heart is what is happening at the heart level like does the normal flu do damage to the kind of tissues that we see kova doing or is this something totally different so that's a really good question so the flu can actually cause a cardiomyopathy which is an enlarged heart it can cause a myocarditis so it but rare you know these are rare instances but viruses causing damage to different parts of the body is nothing new you know we've seen it what's really interesting about covid or coronavirus stars 2 seems to have a really interesting effect on the vasculature so the blood vessels that are sometimes microscopic in size in your lungs in your brain in your skin in your heart in your kidneys and that's why we're seeing this multi-organ systemic involvement in people often who get really sick so we're seeing strokes uh heart attack picture myocarditis inflammation arrhythmias enlarged hearts we're seeing kidneys that fail and then eventually recover um we're seeing terrible skin rashes we're seeing a kawasaki like syndrome in children which is a vasculature disorder so i keep saying to my friends you know covet is sort of like a contagious vasculitis and a vasculitis is an inflammation of the blood vessels and usually it's more of an autoimmune process but there's something about it that feels like a contagious vasculitis like you can catch it the way you catch a cold yeah that that makes this a lot scarier to me if um if i think about in terms of even people that aren't showing symptoms and and i'd love to know if this is actually true but i heard that even people that don't show symptoms if you were to x-ray the lungs or look at the heart you actually do see tissue damage and that is where this starts to get really scary because you want to think well i i didn't show symptoms i'm young i'm strong whatever and so i'm fine but then you actually look at a tissue level it's like no you're not fine and every insult and this is where you know what a weird balance have to it's like we're walking this razor's edge of protecting people from a health perspective but also not letting the economy just absolutely implode we've already seen sort of how much of a powder keg that can make things um but it's like if somebody else gets me sick and even if i don't show symptoms and in their mind they're being sort of flipping about it well i'm not around anybody who's old or whatever you know with underlying young i'll be fine right but that they're sort of edging me closer to the grave because even if i was able to overcome it now but it just it just chipped away at something you know what i mean that's where um i get super nervous are there one i'd love to know like how profoundly are we talking the average person i get it there's people that sort of at the high end just devastating the opposite i need a heart transplant whatever um and then there's people who it's super super minor but like if you had to sort of pick a median uh 50 fall below 50 fall above roughly where we at i think that i mean okay i'm seeing the worst of the worst and i'm also seeing in my icu the people who make it to the icu and who we're gonna try to really save as opposed to a 90 year old who says i don't want a breathing tube right so i'm i'm self-selected to see a very specific group in the intensive care unit so i'm which are sort of younger and possibly you know the ability to make it through i i while i realize that there may be long-term abnormalities that we're seeing in the tissue of people with more mild or moderate disease i feel hopeful because it seems like the majority of people who recover are okay and that there is a fraction i would say you know maybe it's 10 15 20 who have some kind of ongoing issue whether it's you know they have a little like you said if you get a cat scan their lungs might have scarring that doesn't necessarily mean that they are not okay they may have scar i mean we have people who have long scarring who can go run a marathon you know that's not the end of your life i mean even the people who had foaming and heart failure i've seen recover so it's still a work in progress to understand i think that people who've had it and recovered and feel okay shouldn't be worried but we don't have any long-term data we don't know for sure what happens to people two years after covet and that's the scary part and do you have a hypothesis like do you so if you were going to this is what i always tell people to do in business right so you you have information so you're obviously very informed about the heart so your whatever hypothesis you're going to form is what i call an informed hypothesis then you've also been dealing with covid so more information there obviously all of it is incomplete but you've got enough information i'd say you'd be able to build an informed hypothesis and so what do you think is happening biologically why is this virus weakening the vasculature for instance and then coming out of it um what can people do to improve themselves right well first of all the best thing you can do for yourself is to be as healthy as possible going into any of these things so we know for a fact based on data that people with obesity diabetes hypertension underlying heart problems they're at higher risk so we already know off the bat there so if this if you've been in quarantine for three months and you're gonna be home this is the time to eat healthy get in shape get your risk factors under control i mean it's pretty straightforward you know you want to be a healthy person you can't control your age your age is what your age is but i try to reassure people that are younger that it's you know you're probably gonna be fine it's it's okay but if you get it you have to take it seriously another issue is i think that in many instances there were so many people that got sick at once and their access to care was delayed and if you are not feeling well you know instead of having that mentality like i don't want to go to the hospital everyone there has covered go to the hospital and get treatment you know and i think that that's going to really um help a lot of recovery is earlier access to treatment instead of delayed and waiting and also people didn't know right they didn't really know they had coven what is the treatment now if i were to come in and say man i really think that uh this could be coveted you test me it is um what what's the protocol i don't need a ventilator let's say so we're we're okay so let's say your oxygen's a little low and you're coughing a lot so we would give you oxygen now there's a lot of data on steroids there was a big study that came out about dexamethasone i mean steroids have been around forever and they they basically prevent an overwhelming immune response right so there's there's a cytokine storm is that what you're right so the hope is that we'll decrease inflammation decrease the cytokine storm for whatever reason coronavirus affects the blood vessels walls and the cells and kind of causes them to pull apart and then leak and when they leak like that we call you know capillary leak the fluid extravasates into the space around so you get fluid in your lungs you get compromised tissue in the heart in the kidney and so steroids in some manner may or may not prevent that you know we use steroids to uh fight normal vasculitis or inflammatory disorders autoimmune diseases to suppress your own natural immune system and immune response so that's you know the theory behind that um you know it's going to be supportive care but i think the important thing about supportive care like giving you some steroids possibly or giving you remdesseviere which is an antiviral or giving you oxygen those are supportive treatments right none of those things are curing you from coronavirus so we want to support you as much as we can we and the issue is we don't want to let you languish and let your oxygenation get worse and you spiral into this worsening respiratory status and that can happen if you're just sitting at home i mean my parents asked me like what should we buy and i said the best thing i think you should buy is like a pulse oximeter which are those little things you stick on your finger and they tell you what your oxygen is because you might have an oxygen of saturation of 90 and not even know it uh you might not even feel that short of breath and then by the time you get to the hospital you're at 70 and they're putting you on a breathing tube so early intervention is better so going back to getting your underlying health conditions in order what can people do to improve themselves yeah i mean i think that if you start to look at who's at risk and you can look at something like high blood pressure you know like high blood pressure is a vascular disorder it is a disorder of the blood vessels and the arterials throughout your body and what is it about that abnormality that predisposes you to increase severity or increased risk of getting this virus is it that your risk of getting the virus is the same as everybody else's but that the effect on your blood vessels will be different you know probably um is it that you know the medications you're taking for your high blood pressure have some interaction you know we don't know and what about obesity you know also a disorder where your vasculature may be compromised because you know you have uh low exercise you don't work out your heart is not a you know in great shape i mean there's a million interplays and i don't think it's going to be one simple path i don't think it's going to be this causes this causes this i think you know we see that some people get this overwhelming cytokine response and their lungs are completely filled with fluid i mean white out on the cat scan with covet and i've seen an 80 year old lady come in and barely be sick and go home you know it's like why you know you know that's the million dollar question is why in one is it so different from another and like all viruses though i will say you know there is a tolerance right the reason why you know the spanish flu was so bad was that it was a variant we hadn't seen and nobody had any immunity like once we build up our own immune system's ability to fight this we'll be better off the question is how do you do that in advance as sort of preventative and like i said the best we can offer is you know vitamin d maybe take some zinc although we don't know if that's for sure you know exercise run take good care of yourself eat healthy foods but those are all recommendations we give for people's heart anyway yeah i was gonna say and that's i think part of um what i am really excited to see people actually get the information around because what i hear in terms of what people should do for covid is just what you should do period like if the the overlap between do this for longevity and do this for kovid border on 100 i totally and so that's why i'm trying to like even even when you look at um obesity diabetes heart disease um stroke alzheimer's it's they they all start swirling around diet quite frankly diet exercise certainly to an extent but if you were to press me to say okay you can only influence one diet or exercise i wouldn't go to diet faster i would go to diet like a thousand fold over exercise exercise is rad but at least in bodybuilding i always used to say you can't out you can't outrun a bad diet so no matter how much cardio you're doing at the end of the day you're still doing some level of damage from what you're eating um so that's why like just trying to understand like at a cellular level where the breakdown is what's going on like i'm intrigued by vitamin d that's been the thing through this that i've been obsessive about so i'm very grateful that i live in los angeles right about now but i'm curious like as you look at the research that's coming out are people beginning to understand what's happening at a cellular level or are we still just flying blind i mean i think there is research coming out where they're trying to understand you know what kind of antibodies are made against covaid what we're trying to tell us actually no right so if you look at the plasma of people who have had coronavirus and you look at the kinds of antibodies they have and then you test those antibodies against uh receptors that we know exist on the covid virus we're they're finding that there are certain antibodies that completely eliminate the ability of covid to you know enter other cells so you know you think about a virus a virus comes in it takes over your cell it becomes like a hijacker and it makes that cell produce all this virus particle and then it spews it all out and then more viruses cruise around and invade another uh cell and take over that cell and produce tons of virus particles and then the circulating virus itself then causes damage to all your body parts so if you get a vaccine or that has an antibody or you know antibody therapy for covid you're going to want to give someone antibodies that literally you know block the receptor they spit the cell expresses it sits out on the front of the cell the coronavirus comes along with its receptor and it's blocked can't get in because this antibody won't let it get in so you know this is the kind of things that we are looking at when we uh try to understand how to stop it i want to go back to something you said earlier you talked about the 90 year old patient that shows up and has a do not resuscitate being a physician at your level and your expertise i'm sure puts you in touch with death a lot super curious to know how you think about end of life i feel like i may have some not widely held beliefs about end of life i i think that god this is going to sound weird um i think that people may cling to being alive to a point that doesn't make sense and from the outside when you're watching it at the end and there is no joy to be had um i someone that i cared about i watched them die it was so gnarly and they were sort of in and out of consciousness and they at the at the very end i actually i couldn't understand what they were fighting for and it was one because it was it was a one-way street it was cancer like there was just nothing right it was the end it was the end and um i so respected his mentality like he had this shirt that he wore all the time that said can't stop won't stop and i was like [ __ ] yeah man i respect that like that's rad that is a great way to live but if i'm honest and i were in his situation i there is a point at which you go this is this is a fight i can't win it's not like i can get to the other side of this and there's quality of life so now it's like existing just for the sake of existing whereas i personally would rather um tap out a little earlier yeah in a way that's a lot more peaceful um and i'm curious like how you see different people dealing with that do we deal with it the same here that people deal with it elsewhere um you know what are your thoughts on that death is such an interesting topic i mean i think the way you perceive death changes as you age right and as you grow older and as you experience death in your own life i think that our culture has a very strange relationship to death in the united states compared to some other cultures and how there is this like you just pointed out this sort of relentless like i want everything done i want everything done i can't tell you how many people where i'm like what are you doing like this is actually like almost torture like where we've had to call ethics consults because the doctors feel uncomfortable prolonging life that the family wants prolonged and yeah do we have machines that can do these things and your loved one is alive but they're not alive you know they're on 10 different machines and as soon as you turn one of them off they're dead you know so i mean a lot of places especially you know countries that have socialized medicine they don't spend money like that at the end of life they will or they won't offer things like we don't have the resources to offer dialysis here this is a feudal treatment to offer dialysis um and so i think it's in part the health care um like industry's fault and because we're like we can offer this and we can try this and let's try that and then and then part of it is the mentality like i have i have the right to choose all these things for my loved one and i tell my patients sometimes when i'm doing end of life i say you know you're not deciding whether your loved one lives or dies your loved one is gonna die regardless of what you decide here we're all gonna die and they're gonna die sooner the question is how do you want that death to be do you want it to be calm and peaceful or do you want to continue and i and sometimes it's a process it takes people a few days weeks to kind of come around to understand it but you know there are countries where you know people take their loved ones home and die in the home and it's not scary and it's not you know horrible and they can even keep the body there and have like a night or two with the body i mean people do things totally differently in other cultures and one of my mentors was always like not everyone has to die in the intensive care unit and it's so true like there's a time when it's enough but i mean to your point like the mentality of fighting you know i think it's so hard when i was younger and i was in training and i would see people die i think i would have this very unemotional reaction as a resident because you would like run to these codes and and people would live or die or from you know see so many people die and it felt very like robotic like oh my god now as i got older and i'm like hopefully not gonna die soon but like you start to think about it more and when i feel like now when i see death more in the hospital especially with the with covet i think like wow like that's it like that person is done and like that's a different it feels different to me now like it feels more profound but also like we don't always have to do everything like i feel very much about you know helping families try to get through the dying process in a way that's more manageable and i think we really it's starting to change like there's a whole new workforce of palliative care doctors and hospice trying to make death better but i get you know death's scary because we don't know what happens we don't know if that's this interesting i'm i'm not tripped out at all by not no no no i'm tripped out by death to the point where i want to live forever and i mean that quite literally um even though i think there are huge issues if people were to live forever i think that that might actually be wildly problematic but nonetheless selfishly i'm an [ __ ] i want it for myself uh and you didn't get bored you wouldn't feel like no no there's a book you must read it's called einstein's dreams and it's this whole like short stories around um time and one of them is what if everybody lived forever and the hypothesis of that story which resonated with me so much i think about it all the time is the world would bifurcate into two types of people people that did nothing because there's always time to do it tomorrow and then people who did everything because they could actually get good at everything they ever wanted to get good at and i thought oh my god i fall into that camp i'm so aggressive and this is why death freaks me out it's like i am constantly running this thought experiment of like yo my time is finite i can only spend it in so many different ways and that bothers me to a level i don't know how to articulate the mere fact that the things that i find interesting and fascinating that juice me up i can't do them all and that causes like this deep sense of unease i can't even let myself think about it so it's i always tell people if you want to be successful in life you're like you won't have time like you won't have time to learn spanish like you won't have time to like that kind of stuff 100 so i while i have built my life and my psychology around learning and that's it not knowing not being i get rewarded all the time for being something and i try like not to think about it but i know that like i have to work so hard to want to reinvent myself to want to learn where i'm wrong it's very very hard and so even i worry because i can feel as i get older something is changing i won't say whether it's better or worse i can just feel that i am changing and so you age as i age 100 and part of the reason i think people are obsessed with kids is they're just so doe-eyed like they're optimistic about everything and then over time you get all these weird things that reside on a layer of your subconscious that is hard to access and the my wife has put it perfectly and she has really encouraged me to focus on this because she says you've hardened over time and i used to be very playful and so now i try to like bring that back i try to embody that playfulness i try to really take time to be playful but when i think about that without conscious thought it happened it goes back to what we were saying about the virus it's like the virus just ah the one time you got sick man no big deal you got better but it did sort of take some number of days off your life and you just enough of those enough of those enough of those and it's all sort of accumulating in your subconscious and so you have to fight against that so anyway back to death and end of life which i am i am beyond obsessed with this whole idea this whole notion um so palliative care and where that's going i am really intrigued i would love to know the people that you're seeing work in this space how do we make death better what does that mean so what i've learned from them because they're really the experts is when we go to talk to people they say to that they ask them questions like assuming that the person can still communicate but they'll they ask questions like what is what brings meaning to your life right now what do you enjoy how would you want to die how would you want your family to be around you when you die is there anything that's bringing you meaning to life to your life now while you're in the hospital that makes you want to be alive you know like really trying to understand the patient because i think we project so much of our feelings about death onto the person and we don't allow them to express themselves because like they're the ones dying you know so there's that out aspect of it then there's and then people are caught i mean not everyone's simple some people are in denial some people are very angry you know some people different reactions have you seen i'm super curious i've seen i mean look i think that there are certain patients that are very much like i've lived a good life i'm ready like i'm good and and it's not always that they have accomplished some incredible things i mean sometimes they're just regular people their grandparents they have loving families they have loving kids um sometimes they've been through a lot and they're done so they get to a point where they're like i'm not doing this anymore like it's over meaning their their actual breakdown of their body has been brutal yes like i think that they've been through let's say heart transplant and re-transplant or they've gotten a mechanical pump and they're that pump isn't working or they've been waiting for transplant for lungs for a long time and they're not the lungs aren't coming and you know i think that the the the stages of dying is or are grieving you know kind of applies to all things that sort of you know anger denial acceptance you know there's all those stages and i and i think they're real like you see depression and then recovery you see you see people go through it and i think the family reactions are interesting i find that there's there's some families that are like whatever they want we just want her to be comfortable you know then there's these divided families where you can see that there's a lot of conflict in the family itself and who feels like they should make the decision and who feels like they shouldn't and does that happen when the person is still conscious or is that breakdown only when the person can't really i have seen the person who's dying be very disengaged from the conversation and uh one family member's pushing a lot and um it's not that they fight if they fought back it would be different these are more people who are not speaking much that are very i don't want to use the word catatonic but very withdrawn um don't have you know don't feel like engaging much in discussion because they're maybe depressed or exhausted um and that or they sort of have a relationship dynamic with their spouse or their partner or whoever their child where that person makes their decisions for them and tends to go the craziest you must like thin slice the life out of people they walk in you like oh that person's gonna be a problem no but you know it is funny i feel like there are some people who in the beginning are very angry and they're angry that their loved one has had a lot of complications and sometimes complications happen and and those people are challenged and they don't trust the health care system or they haven't they've had experience with someone else and they don't trust the health care system they think we're trying to kill off their loved one i find it's often more painful when people are younger and it's it's not all bad you know sometimes it's very moving and you see you know families want to do the best for their loved one they we help them through a process like we meet with them on monday and we talk about what may or may not happen and let's regroup in four days and then four days you regroup and you discuss this isn't happening it's not getting better and people come to terms over time but i think the reason it takes so long besides the death is inherently hard to accept that your loved one is dying is that we come from a culture where people think well maybe if i transfer them to another hospital they'll be able to save them and it's like science does medicine doesn't keep you alive forever you know there are some conditions that you just can't treat and sometimes they're complicated and hard to explain and that's hard for people to understand especially when they don't have any science background tell me tell me more about the um taking the body home or taking the person home they pass away at home and then spending time with the body um so i actually read this really interesting article about this where i think that there's a story that this happened in in this country with a man i don't remember if he was in seattle where his wife died she had had a long battle and they kept her body uh in the home in bed for you know family to come for her children to be around and sort of accept the time where you go through and realize that like they're not in that body anymore whatever your religious or spiritual beliefs are a dead person is very different from that personal life i don't know if you've seen a dead person with your own eyes or seen someone you knew die and looked at them and awake but like there is something very different about someone who's dead and that experience of seeing like okay well they're not that it's not like my loved one joe or whoever mary is there but it's like they're gone i had i i've i've been to several funerals where um somebody that i cared about had passed away um most of that that was when i was growing up so my grandparents i was around four or three of them dying um and then i recently had a former employee who i really cared about um pass away and went to his funeral and all of that was heartbreaking um but were it not for another experience what i which i will say in a second i wouldn't understand what you're saying right now but when my dog died who was the first dog that my wife and i had so we don't have kids and i was traveling when he died and but like i was on the flight home literally i was um texting back and forth with my wife she was at the vet and it was just all happening so fast and so when i landed i went straight to um the vet and i needed to see his body it was so weird and yeah literally up until that moment i thought i i always tell people if uh if you can predict something it shouldn't be upsetting so i was like look my parents are gonna die i get it and i really felt detached from it like i've loved them i'm so connected to them now i've i've run the thought experiment so i'm not like putting it off this i'm never going to be like oh my god they're mortal like that's so like 100 and so that way when it happens i will be absolutely crestfallen but i won't be like oh my god i see it coming and why didn't i call more like i won't be there right but when my dog died i realized that's all [ __ ] i will only have an emotional response i will be overwhelmed i'll i'll be beating my chest and wailing it's like such a it was this weird deep-seated need to to see his body to know that he wasn't there anymore it was so weird it it even now i can understand it in that i went through it so i know what it feels like from the inside but it's like hard to recapture that sense when you're sort of emotionally sober and on the outside of it i mean i think that what one thing that i'm taking also from what you're saying is how differently we can feel about things at different times and then think about how we felt at that time but not necessarily be able to feel that same way again like or you think about someone who's very depressed and they have this feeling like you know saying things like what does it matter we're all gonna die anyway and like that sort of very fatalistic feeling that come like they that they sort of can see the truth that we're all missing right i've heard had people describe it to me like that like i can you know you don't understand but you know like there's just no point in living because we're all going to die who cares if you win this award or you probably run that marathon you're just dead in the end anyway and then when you're not depressed all of that goes away and like you don't see the world that way you can't even relate to having that thought because you're preoccupied with training for the race and going to work and doing your job and seeing your kids because it doesn't like enter your brain space and it's the same of i think about grief in some ways it's like it can be so overwhelming and yet somehow you move past it so that you're not in that intense moment forever right and um but we don't talk about death and dying at all we don't talk about it to our kids i mean like did your parents ever have a real discussion with you about dying like what do you think happens when you die where do you go do you think there's anything you know no and that's really interesting i have quite my parents i never got like an official birds and bees talk i never got an official death and dying talk like when my grandparents died um i'm sure like knowing my mom i'm sure she was like hey if you need to express your emotion express it like she would have been super super supportive but there was never like a this is what death means or this is how to process it or anything like that right um and you think that you're you know what your parents want to have done if they were sick have they told you have you had that conversation we my so my sister is the keeper of that information so yes but i think it is my dad definitely does not want to be resuscitated i'm not sure about my mom i mean i think the other thing that's hard for people is like what does that mean like of course you would want to be resuscitated from something that you could survive right so like if you're need cpr because you have a heart attack and if someone does cpr and you are recovered from that you'll be okay then i want cpr but if i'm like have end stage cancer and you try to resuscitate me for what so that i can diet two days later that's a different kind of cpr so that's like another thing that needs to be talked about but it's i don't know i just get i i feel like in in cultures in the in you know the east death can take on a different meaning you know this idea that like we don't spend any time with a dead body i get it kind of like it's dead it's creepy body but also like is that normal like maybe it's normal to be with the dead body and to process the death of your loved one i don't know i don't know what i would want i don't know if i would walk but i probably wouldn't want a dead body in my house for that long because it would be upsetting but that's because i've been raised to think that i'm super freaked out with anyone other than my wife i'd be like i would have my moment 100 i would spend you know 20 30 minutes like like it's you know it's rough and and embodying that sense of loss um was very cathartic with my dog and i i know that people will think that that's sort of weird but for me that was actually a very very meaningful moment um so it was wildly cathartic so i would definitely take that time but with my wife dude is taxidermy out like i am so attached to my wife that it's like to anything like what can i do to hold on to that i worry that i would turn into that psychopath that like you know her withered corpse is like in a chair in another room and you know i just i i can't let it go so uh i i probably need to do some thinking on that to not end up in a weird place but uh yeah well i think coronavirus has made everyone think about death a little bit because their fake they've lost people you know they've lost grandparents they've lost parents um and then there's there was this incredible fear of death you know that i think was so part of the quarantine was this fear of unnatural early death for everybody in in a thing that we couldn't control and didn't understand and i think that that was scary and i think that people are a little traumatized from that and so i think this discussion of death is um not so untimely just because i think it's something you know i think that's been on people's minds yeah i think uh i think talking through it and figuring out what people want for themselves is also going to be really powerful i know a lot of doctors have do not resuscitate where do you fall on the issue what's your what's your guidance i mean i think i would want to be resuscitated like we just discussed like as long as i can go home and spend meaningful time with things that i do that i like if i was in terrible pain that couldn't be changed or i had no meaning in my life anymore because i couldn't actually engage with the people i love then i would probably be fine with dnr but like if i had a catastrophic event and was in the hospital on a breathing tube you know out of it i would want my family to to stop care i would not want them to keep me alive you know in a vegetative state in some nursing home for what's the point of that i mean there's all kinds of extremes i think most people fall in the middle somewhere but they come to the middle in different ways you know and um there's always going to be the really extreme like i refuse to let my person die you know or you know the opposite extreme where people kind of seem like they don't care but uh you almost want them to be more involved in the care of their family member that's less often but i think for the most part people are in the middle i just think it's it's hard you know i think that it's hard and i think that coronavirus has made everybody really afraid and so those things together you know are hard and then when you on top of it you make it so that we can't have their loved ones come in to talk about dying you know and then two weeks after that happens you know there's protests with thousands of people on the street and joe schmoe is saying you know why couldn't i come in and say goodbye to my wife of 70 years but these people are allowed to protest oh my god we get that i would lose my mind right and i i've had really angry families say this is typical hypocrisy like how can you tell us this when other people are allowed to be out and we kind of had to stay on the line and just say i mean i think actually we just are opening up our visitation policy like tomorrow or something but we had for so long we had to stay on the line because we were trying to protect other people in the hospital other people that didn't have covet in the hospital you know prevent transmission i mean you're walking into a place where the whole place has covered you know there was concerns that anybody who came in could get it very easily especially if they're at the bedside yeah i would lose my mind like speaking of um by the way i'm in no way saying that the protest shouldn't happen i just i don't know jesus i hope nobody would confuse that but it is it is blatantly a double standard whether it's a warranted double standard or not is a whole other question but you can imagine like just thinking about losing my wife like when you've shared 70 years with somebody and this is that moment where they go like [ __ ] there is no more like that that is sort of that last yeah they want to hold their hand and then you turn around and walk down the street and there's 10 000 people on the street it feels painful yeah i can see people really losing their mind without in any way shape or form diminishing the power of the protest it's like i would lose my mind yeah right jennifer thank you so much for joining me dude this was so much fun like where can people find you um if they want to connect yeah i'm on twitter at dr jen haith uh j-e-n-n-h-a-y-t-h-e and my instagram is the same dr jen heath amazing well thank you again for joining me this was wonderful i really really enjoyed that conversation it's fantastic that was fun take care okay you got it all right everybody subscribe and until next time my friends 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