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Driving a Cultural Shift in the End Of Life Experience: A Podcast with Shoshana Ungerleider


What does it mean to create a cultural shift to the end of life experience?  Is it even possible?  How do you even start something like that?  

On today's podcast, we talk to Shoshana Ungerleider about her experience making that change.  Shoshana is one of those amazing advocates for palliative and end of life care.  She started the Ungerleider Palliative Care Education Fund to support innovative programs that further palliative care education.  She is Executive Producer of the Academy Award-nominated end of life documentaries, Extremis and Netflix’s End Game.  Oh yeah.  She also started End Well back in 2017 which brought together people from all different backgrounds and professions with a goal to talk about end of life care.   

This year she is taking the conference virtual with "Take 10" on December 10th.  Take 10 brings names like Maria Shriver, Taraji P. Henson, Andy Cohen, Justin Baldoni, and Atul Gawande to speak about issues within palliative care, caregiving, geriatric medicine, and end-of-life care, all in light of what we can learn from the COVID crisis.  And best of all it's free.   So take a listen to the podcast and sign up for Take 10 here:


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Eric: Welcome to the GeriPal Podcast, this is Eric Widera.

Alex: This is Alex Smith.

Eric: And, Alex, we got a really special guest today.

Alex: We got a really special guest from our hometown, San Francisco. We have Shoshana Ungerleider, who is a physician and founder of End Well. Welcome to the GeriPal Podcast, Shoshana.

Shoshana: Oh my gosh, thank you so much for having me, it's great to see you, virtually, here.

Eric: Well, I am super excited because Shoshana is one of the true leaders in our field of palliative care. Despite actually not being a specialist in palliative care, I think a lot of us know her for the amazing things that she's done, including the End Well conferences, a new conference that's coming up on December 10th, called Take 10. We'll be talking all about that, but before we do, Shoshana, do you have a song request for Alex?

Shoshana: I do. How about Ride Like the Wind?

Alex: I love the way you make that sound spontaneous. [laughter]

Eric: And, Shoshana, do you have a reason why you chose that song?

Shoshana: I love yacht rock, that genre of music, and when I think about that era, that song always just pops into my mind, it's just so fun. It's also hard to play, so I thought it'd be a fun challenge for you.

Alex: It is. It really is more of a full-band song, although there are some nice acoustic versions on YouTube that I discovered.

Eric: Were you going to choose Come Sail Away? Was that another song on the list? I'm trying to think of all my yacht rock songs that I know. It's a good genre.

Shoshana: Anything by Hall & Oates, Christopher Cross, Michael McDonald, Toto. Such good jams.

Alex: Well, thank you for this one. All right, here's a little bit dropped an octave and with one guitar, not three.

Alex: (singing) It is the night, my body's weak, I'm on the run, no time for sleep. I've got to ride, ride like the wind, to be free again. And I've got such a long way to go, to make it to the border of Mexico, so I'll ride like the wind, ride like the wind.

Eric: Alex, if this whole palliative care geriatric thing doesn't turn out, you can do a yacht rock tribute band. Think about that. [laughter]

Shoshana: Love it.

Alex: I coached my older kid's soccer team for years, and I was somewhat shocked that the last year that I coached, I always brought a speaker, and they could play different songs during warmups, and they requested yacht rock, nine times out of 10. So, yacht rock lives on with the younger generation, who would have thought?

Shoshana: I love that.

Eric: A little Christopher Cross there, Alex?

Shoshana: That's phenomenal.

Eric: So, Shoshana, I'm going to start off with: how did you get interested in the topics of end-of-life care, palliative care? Because you haven't done a fellowship in palliative care, right?

Shoshana: No, I'm a generalist, I'm a general internist, I just consider myself an evangelist for the field, I love it so much.

Eric: One of our biggest evangelists, too, it's quite impressive.

Shoshana: I don't know about that, but I appreciate it. I did not get exposed to the field of palliative care in medical school. I trained from '06 to 2010, and it really wasn't until my first few months of intern year where I was spending my required rotations in the intensive care unit. Looking back, I think I was really struck by the number of frail older adults that I was admitting into our ICU, day after day, who had end-stage whatever and were spending their final days and weeks, moments of life really hidden away from their loved ones and receiving very aggressive invasive treatment, when I knew that many of them weren't going to be helped by it, and we weren't asking them or talking with them and their families about what was going on, day to day, and the expectations about getting better were not aligned, I often found.

Shoshana: I felt, in many circumstances, that we were prolonging suffering for people. That's not to say that I'm not a fan for intensive care; I think, for many people, we save lives every day and I'm so grateful for that, especially in the midst of the pandemic. I realized that our healthcare system just isn't set up to be centered around what patients truly want, and there's many, many reasons for that, but it got me interested in thinking about is there a better way to provide care for people? And I was lucky that I had amazing mentors in palliative care, during my residency.

Shoshana: And so I just sought out mentorship from them and realized that an artful skilled conversation with patients and families and the kind of symptom management that a palliative care team can provide is just as important as coming in as a cardiothoracic surgeon and performing some major surgery, it's just as life-changing for people. And so it really got me on this path to say everybody needs to know what palliative care is, needs to have, as clinicians, some baseline competence in it and, of course, the communication skills training that comes along. So, that's what I've set out to do over the last many years.

Eric: Yeah. Going back, were you around when Andrew Lasher and Linda Blum, was Brad Stewart there, too?

Shoshana: Brad wasn't there, although I know Brad. I know Andrew Lasher and Linda, and Katharine Seelye. Andrew is really the reason why I got interested in palliative care. He was my interim program director, actually, at the end of residency, and when I see him around now, he's now gone to Nashville, but I just say, "Thank you so much." All the work that I'm doing now is really because of him and his leadership and being such a wonderful mentor for me.

Eric: You started locally, right, as far as developing a local palliative care conference? I think I remember because I'm pretty sure I gave one of the talks there. Was that part of it, too?

Shoshana: That was a different thing. At Sutter, at CPMC, what we started was a training program for the residents because, like I said, I just felt like no matter what field of medicine you're going into, you really should have a baseline understanding of what palliative care is and then some communication skills training. There, at CPMC, we started the program for all the residents; from day one of internship, they got this required rotation every year. And so as part of that, we started a community education series where we thought, actually, more clinicians would show up for it, which both of you have spoken at actually over the years, and it turns out not that many clinicians come and it's mostly just interested community members, which has been fascinating to me.

Shoshana: We haven't done it during the pandemic, but we would have hundreds of people show up for these quarterly evening sessions. And so that was my first idea in thinking about how do we engage the general public, really, in conversation around some of these hard subjects? It really got me thinking about how do we shift culture in the many ways that that can happen? And I obviously know that's a really large goal. I had an opportunity, actually, to spend some time with a design firm, locally, IDEO, where we worked on this design challenge, and we asked the question, "How can we reimagine or redesign the end-of-life experience for patients and families?"

Shoshana: And through that really incredible few months, I realized that these are topics that aren't just relegated to the medical realm; serious illness, caregiving, the end of life, grief and loss, these are part of the human journey and we need more humans involved in these conversations to come up with new solutions, to make the experience better for everybody. And so I had gone to a lot of conferences around the country, that first few years after residency, because I was like, "Oh my God, I have all this time on my hands now," and I realized that we do a lot of preaching to the choir about how things need to change and how we can shift healthcare and care for our patients and their families.

Shoshana: But I realized we need to lower the barriers to entry, too; in order to really think globally about this, on a societal level, we need to invite more people into this conversation. And so that's how End Well was born. We actually thought of ourselves as an end-of-life design conference, and that was back in 2017. So, we've come a long way from that. That first year, I called up a bunch of my friends and said, "Hey, will you speak at this conference? It's about end-of-life, but it's not a medical conference," and people gave me really weird looks, and we really weren't sure if anyone was going to show up.

Shoshana: And that first year, we sold out three months in advance, hundreds of people on our waiting list to come, and we've just really grown it from there and have become more of a media platform, where we create content on stage, that's Ted style, as you know, and put it out on social media. We have tens of millions of views of our content every year, and people engage from all over the world in conversations that they maybe otherwise wouldn't be having. So, it's been a really interesting evolution of the event itself.

Alex: So much gratitude to you for taking this mission on and hosting such a conference that has surpassed all expectations. Could you share with our listeners, who are mostly clinicians who are caring for older adults and people who are seriously ill, near the end of life, who is this conference for and what would you say this conference is about?

Shoshana: We've actually transitioned into something different this year. End Well, we realized really early on, probably in April, that we couldn't have an in-person event safely, and now that's even more apparent, given that it's November. So, we transitioned to a virtual experience, called Take 10. This year, it is free, it's on December 10th, and features celebrities and everyday heroes, the idea being that we wanted to bring together community, really, in solidarity with our frontline healthcare workers, caregivers, those experiencing social isolation, people facing grief, and those living with serious illness, to really provide a forum for the end of the year, to connect and to process our collective experience in the midst of COVID-19.

Shoshana: So, this year, it's a four-hour virtual experience that will have solo talks, performances, conversations, and it was really important to us that talking about the fact that these really aren't ordinary times, we all know that, so sharing more about the importance of caregiving, about grief and loss, illness, the end of life, I think are harder in a lot of ways, given COVID, but more urgent than ever before. And so the event itself is free and open to the general public, and we have a number of amazing speakers, confirmed, that I'm super excited about.

Eric: Yeah, that lineup looks absolutely amazing so far, the ones that you've announced. Maria Shriver, is that right? And Atul Gawande. Andy Cohen. How did you select who was going to be part of the lineup?

Shoshana: Well, it's been an interesting process. It's a little bit of who's available and who's interested. But our team spends at least three months out of the year during curation for the event, whether it's an in-person one or a virtual one, we think that content is so, so important and to choose the people, both celebrities, as well as people who are less well-known but doing amazing work in their fields, to choose them really carefully and think about what they're talking about and in what ways. Soledad O’Brien, from HBO and CNN, is our host. Taraji P. Henson is talking about mental health for communities of color and her work, her Henson Foundation, in terms of destigmatizing mental health in Black communities.

Shoshana: Atul Gawande's going to be talking about being mortal, in the setting of COVID-19. Andy Cohen, who I'm a big fan of because I love reality TV, he's going to be talking about men supporting other men through times of grief; we think that that's a really important subject right now. Maria Shriver, who you mentioned, she's done a lot of work with Alzheimer's, but then also, of course, in her own life, has faced so much loss, so she's having a conversation with Claire Bidwell Smith about creating a new language to talk about grief and loss in the midst of COVID-19. People like ... Blair Underwood is a family caregiver, but from afar, he lives in Los Angeles and his mother and father, his mother who just died, live in Virginia, and so the issues around caregiving at a distance.

Shoshana: And then a number of people, like Naheed Dosani, who's Canadian, but does palliative care for homeless populations. Maya Scott, who's a social worker, who lost her own child very, very young, and now is a palliative care social worker, talking about caring for young people who are dying and listening to children and their wishes around the end of life. So, it's going to be just ... I'm super excited about the day and how it's all coming together. It's obviously a very different format, being virtual, but we've built this custom online platform, so it looks and feels a lot like Netflix, so this is not just another Zoom webinar, this is something very different, immersive and holistic in terms of thinking about how we go from topic to topic and speaker to speaker. I encourage everybody to check it out and tune in on December 10th.

Eric: We'll have the link to the End Well Take 10 website, where to register, it's December 10th. Shoshana, let's say everybody in the U.S. listens, what are you hoping will happen on December 11th? What's your hope for this, your goal for this type of event?

Shoshana: That's a great question. This year is a little unique, and the title, Take 10, actually came from the fact that it's December 10th, but also the idea that we're encouraging people to take 10 minutes, so start with just 10 minutes out of your day to, first, reflect on your own life what matters to you, and then think about the end of it and talk with the people that you love about it.

Shoshana: I really think that COVID has shown all of us just how fragile life is, that tomorrow is never a given, no matter how old you are, and so this feeling of our own shared mortality, from my perspective, is more palpable than ever before. And so the importance of, number one, talking about the hard stuff in life ... well, first thinking about it, but then talking about it, and then sharing it with the people that you love is so important and so urgent.

Shoshana: And so my hope is that people feel moved and inspired, and then motivated to, if they haven't already, had a conversation with their loved ones about what matters most to them in their life and chat about it during the holidays. We see the pandemic is raging on here, and whether the end of someone's life is near or far away, we know these conversations are so, so important and really integral to be having throughout life, not just in a moment of crisis. And so that's what I hope, and I really do hope that everybody in America hears about this and tunes in, that was my goal this year.

Alex: Terrific. Some people's work is aimed primarily at clinicians, some at healthcare policymakers, your work is, my understanding is, primarily aimed at everybody, people, we would call them "patients" as clinicians, but they're people. Is that your target audience for this conference, and is that difference from prior years with the in-person End Well conference?

Shoshana: It's always been a focus on a general audience. What I wanted to do was take this out of just being in the healthcare or the medical realm and really use language that wasn't medical. So, we don't, typically, talk about things in terms of geriatrics or palliative care, sometimes we say "serious illness," that's a medical term, but we really, again, wanted to make this content as accessible as possible to anyone and everyone, because you could make the argument that we're all going to be patients at some point in our lives, we'll all be caregivers, we will all face illness, either our own or of someone we love, so this is really about the human journey. That's not to say that healthcare doesn't play a huge role or that policy doesn't dictate many things, but those are just pieces of it. And so this year in particular, we really wanted to make sure that this content was free, was accessible to everybody, and really truly lower those barriers to entry for folks, and that's what End Well will continue to do is really think about how to normalize these topics and these conversations for everyone.

Alex: I wanted to ask, also, about another component of End Well, and I presume Take 10, is that there's this interest in bringing together innovators and people who are in business with people who are more in the healthcare space or providers or who are trying to stimulate conversations around advance-care planning, end of life, so there's that blending of the private foundations, or enterprises, rather, with this public mission. I wonder if you could speak to that a little bit more and why you think End Well is particularly suited to that focus.

Shoshana: That's a great question. I think partially because we're based in San Francisco, so near Silicon Valley. My husband's an entrepreneur, so I always got thinking about how can we encourage smart, thoughtful people who know how to build companies that solve real problems, how do we bring them into this conversation? Not that there hasn't been, over the years, many companies in the space, but how do we encourage more people to get interested, and then more investment dollars to flow into these companies? I always think about the fact that, at the other end of the spectrum of life, when pregnant women are having babies or you have a newborn, the number of products and services and entities that exist on the market in order to support pregnancy, labor, birthing, teething, feeding, bathing, I mean you name it, it's a multi-billion dollar industry.

Shoshana: And if you think about the other end of life, the more advanced aging and end-of-life space, there aren't many products that come to mind. This is not an area of which there has been much interest and investment, and there's so many reasons for that, we could talk all day about why, societally, we don't honor and value the end of life; also, it's hard to figure out who's going to pay for that stuff when people are on a fixed income, I mean all those things are part of it. But I think that we, as a society, should be valuing this period of time, and one piece of that puzzle is just encouraging more thoughtful innovation in the space because I do think that we can make this experience so much better for everybody.

Alex: I wanted to pick up on that thread just a little bit, in that there's been some tension, I would say, within the palliative care community on the extent to which we should focus on care at the end of life, or end-of-life care, or even that the term "End Well," for example, might be criticized from some. And maybe you could just say, "Well, this is an academic issue." To the lay public, palliative care is end-of-life care, let's start with end-of-life care in that we do need to have conversations about the end of life. But there's also this risk, a very reasonable perspective, that if we associate palliative care with just end-of-life care, then we're shortchanging what it is we do as a field. And I recognize that you're not trying to promote palliative care, you're trying to promote these conversations in End Well and trying to put it into clinical terms our audience would understand. But I wonder if you've engaged at all in this debate, or if you had any pushback from people or second thoughts about using the term "End Well" or focusing on end of life, in particular?

Shoshana: Yeah, a great question. This is such an important conversation and a debate I find really interesting. As somebody who's an outsider to the field, I have, of course, heard about this and been involved in a few conversations, and I do think it's important to be careful about language, especially when we are talking about it from an academic perspective, and if we're talking about just within medicine, being clear about what it is that palliative care is and does, what is hospice and what it does.

Shoshana: And so I think that the biggest difference for us is that we aren't a medical conference. I am a doctor, but I'm the only doctor on our entire team, and so we think about this in terms of focusing on what the general public really cares about, and, from my perspective, they just care about the experience and the care that they're getting; what it's called is really up to us, and thinking about if we need to shift how systems, how hospitals and other entities think about referring to palliative care or not, I think that that's a different conversation.

Shoshana: I am always a real stickler with our team and with anything that we're a part of in saying that when we're going to use the words "palliative care," let's be very specific about what palliative care is. It is care for anyone facing serious illness and their families, it can be used at any time during the course of illness, ideally at the time of a serious illness diagnosis. Believe me, I hammer that home every single day with our team, so I think it is incredibly important to be thoughtful when we are using those more clinical terms, to be very specific.

Shoshana: But in terms of thinking about ending well, I think that that's something that everybody wants, for whatever that looks like for them. I'm interested, I'm excited to see where this conversation ends up, in terms of thinking about how do we use the words "palliative care," going forward, because I do think language is very important.

Eric: So, you've been a part of two Academy-nominated documentaries. How did that fit in? I think one of them was Extremis, with Jessica Zitter, who we had on our show, I think a couple years ago. And the other one was, I'm blanking on the name-

Shoshana: It's End Game.

Eric: End Game, that's it, opened up to Steve. How does that fit into the whole picture?

Shoshana: I think, for me, the big idea for me is that I believe that, culturally, we don't value the latter stages of life as we do, say, the beginning of life, as I said. I think that people who are of older age or near the end of their lives are hidden away in institutions; therefore, we aren't thinking about and talking about and planning for illness and the end of life, in America, I'll say. In medicine, of course, everyone knows we're incentivized to do things to people, to provide more aggressive treatment, and we aren't really taught how to, first, ask people what matters to them in their own life, and then say, "How can I optimize the care that I'm going to give you to best deliver that for you?" I think that's slowly changing.

Shoshana: But I also think, and I promise I'm getting to my answer, I think there's an awareness gap. I think that most people who have not worked in healthcare or faced a serious illness in their own lives don't realize that, by default, if you become acutely ill, you'll end up in an ICU unless you opt-out loudly, and you'll get very aggressive invasive treatment, and that our healthcare system really isn't set up to be patient-centered and communicate with you about what you want.

Shoshana: So, that's why I've gotten interested in film, really, and all the other work that I'm doing, in order to shine light in some of these hidden places, like the intensive care unit, like a hospice-type facility, like a hospital, because I think that we need to create more awareness so that people can know that they have to advocate for themselves and how to do that in the moments when it really matters. And so I think part of that is educating the public about what palliative care is, that they need to ask for it, if it has not been readily offered, what hospice is, and, again, this default that unless you really opt-out loudly or have a healthcare proxy speaking for you, you will get very aggressive invasive treatment, potentially, near the end of your life.

Shoshana: And so these film projects really fell in my lap, I have no background in film, it just so happened that I was friends with Jessica and we were chatting one day, and they'd spent months filming in the ICU over at Highland, and I called up the director because I was like, "Hey, what is this film that you've been working on?" And he sent me about a five-minute rough cut, and I remember because I was on-call, I was at the hospital, working the night shift, and I watched it on my phone. I was just totally floored by what he had captured in just four or five minutes of footage, of real families, patients intubated or talking with loved ones about the serious illness that they were facing in the ICU.

Shoshana: And it brought me to tears, and I am not an emotional person, and so I said, "My goodness, there's something here. I think more people need to see this and understand why this is important to watch something like this." So, I called him up the next day and I just said, "Hey, I'd love to help with this project. What does that even mean? What could this look like?" And he said, "Well, we need money. We need to figure out how to get it out to the world." And I said, "Hey, I'm in."

Shoshana: And I really thought that the film would maybe live online with The New York Times or something, and we just got super duper lucky that Netflix got in the business of short documentaries that year, and we were the first one they ever bought. And then we premiered at Tribeca, and then we won Tribeca, and that's when I was like, "Huh, I guess this is a real movie. This is super cool." And then, with the Academy Award nomination, I literally was like, "I don't even ..." It still blows my mind that that happened.

Shoshana: And then, to get involved with End Game, which was a totally different team and a very different story, to have that happen again, I just was like, "What?" It's still completely mind-blowing to me that those projects came together in the way that they did, and the teams that really did the work were just so phenomenal, I really just played a supporting role, but I'm super proud of them. And it shows me that there's a different kind of appetite, I think, out there for telling these stories and to be talking about some of this hard stuff that we do with End Well, and so I'm really encouraged by that.

Eric: Yeah. So, hopefully, a different culture around listening to these stories, too. What you're trying to do is a lot of cultural change about end-of-life care and making it part of a natural discussion. One worry is the healthcare system is perfectly designed to get the results it gets, so even if there's a cultural change, even if people make discussions around it, there's pretty good evidence that it's less about what people's preferences are, it's more about the hospital they get admitted to, where they live in the U.S., what kind of insurance that they have, those factors dictate what end-of-life care looks like. How much do you think a change in culture can actually change what end-of-life care looks like to people?

Shoshana: Yeah, I think these are really important things to think about and talk about. I think from a couple of perspective. I think, number one, we've all just gone through the election; we, hopefully, all voted and made our voices heard. I think about it, getting back to this idea of how policy can shift how decisions are made, and I think, on one level, from a cultural perspective, if people are much more attuned to conversations about caregiving, about hospice, about palliative care, we are more likely to put people in office who also are advocating for these things and talking about these things. Now, that's a many, many, many-year, potentially generations process of thinking about this. But I think that there is a huge cultural element to opening the door to these kinds of conversations because we know that policy drives decision making in a lot of ways.

Shoshana: I think, to your point about conversations around preferences and wishes around the end of life, I'm definitely not an expert and I don't review these data day in and day out, I know there has been some interesting studies that have come out, but I do think that there is something to be said for the importance of consumer demand. So, if you are a person facing serious illness, if you're supporting a family member in that scenario, and your clinician doesn't readily say to you, "Hey, you could really benefit from palliative care, let me make that referral," it's often on you to say, "Hey, I know about this thing called palliative care, could I talk with somebody about this? What is that? Would it be appropriate for me right now?"

Shoshana: So, I do think, and I think you both would, hopefully, agree with me that that's important and that sometimes it does take the family or the patient advocating to receive care that's in line with your goals and your values, alongside curative treatment. And those kinds of things come with the shift in awareness and shift in culture about talking about this stuff.

Eric: You're, right now, talking to the choir, like our listeners are the choir. Is there something, and you are one of the leading advocates right now for improving end-of-life care, changing the culture for palliative care, is there something that you wish that the choir would do more of to help change the culture?

Shoshana: That's a great question.

Alex: Eric, I'm just going to clarify that. So, you mean the clinicians who are listening to this podcast who care for older adults or people living with serious illness, is there something that they could do either in their clinical practice or as public citizens and advocates in a position of power, being physicians or nurses or social workers?

Eric: I just love how you put yourself out there, like you are not, at least it doesn't look like you're scared of putting yourself out there, and that even shows with COVID, I see you all around the news right now.

Shoshana: Well, tell me this, what's there to be scared of? To me, if I can use my spare time to do something that I think helps people and pushes the needle for such a critical set of conversation, I'm going to do it. I'm super lucky in that I have the time and the resources right now to be able to do that. I don't even know that I would ask people who are working day and night, taking care of folks, to do more than they're already doing. My goodness, you guys are slammed, especially right now. So, I think just the one thing I would say is take care of yourself. This is such an insanely, unimaginably hard time right now, I think doing the things to nurture your own soul during this incredibly hard time is really the critical thing so that you can show up at work every day and best take care of folks. I mean those are the things that come to mind for me.

Alex: I want to do a quick lightning round here. You've had a number of terrific speakers over the years at End Well. Can you tell us about one or two of your favorites and why they were your favorites? Something that just really sticks out for you, among all of the amazing experiences that I'm sure stick out for you.

Shoshana: Yeah. Getting to interview Tim McGraw on stage, he's one of my favorite singers, that was pretty great. He was just so real and talked all about the experience of being a caregiver and the importance of palliative care for his own family. That's number one. I think hearing Meghan McCain, last year, talk so candidly, I mean she was just so raw on stage, talking about the death of her father, Senator John McCain, and how messy and hard grief often is. She then, the next day, on The View, mentioned how moved she was by End Well, which was like, whoa, she really was. Esther Perel, last year, talked about relationships and intimacy for people facing serious illness, and that talk completely blew my mind because she brought up things-

Eric: I love her podcast.

Shoshana: Yeah. She has two amazing podcasts. She's just a total genius. She talked about things I had never considered. And, now, she's hosting an entire international workshop, actually this last month, on the importance of talking about the end-of-life experience, which she says End Well opened her eyes to. Before coming to End Well and speaking, she was just too scared, being the child of Holocaust survivors, to think about this stuff and talk about it openly. So, this is what we set out to do, End Well wants to normalize these hard conversations, transform how we think about it, how we talk about it, and then, ultimately, experience these things in life. And so seeing people like these, who are some of the drivers of culture in our society, being shepherds of this is really, really powerful for me. Again, I'm encouraged by where we're headed.

Alex: Okay. Two more lightning-round questions. One is: what's the financial model for End Well and what's the sustainability? How do you keep this going?

Shoshana: Were you a fly on the wall during our meeting today? We're non-profit, so just to be totally transparent, I have never paid myself a penny. I do this work because End Well is my baby and I want to see it grow and flourish. Essentially, in a normal year, we make some revenue off ticket sales, that's why we charge, unfortunately, is because we have to keep the doors open; we're a completely remote team, so I joke, we don't really have doors.

Shoshana: This year, we, largely, are relying on the amazing support of our major donors, so philanthropic institutions, corporate sponsors who wanted to get behind this message, and then individual donors. So, whenever I send out an email, asking, "Can you donate $10? We actually really need it," we try to break even every year and stay solvent, but it's a challenge, and COVID has really made that all the more difficult, given that philanthropy is dried up and the economy is strained, so we just do the best we can.

Alex: Yeah. Okay, last question. You have had some amazing guests and speakers. We would love to have them on GeriPal. Do you have any tips for us on how we get some of these amazing people to be on our podcast?

Eric: Or for our listeners who are also doing this in their own different ways?

Shoshana: Well, have you asked them?

Eric: Ask? No. [laughter]

Shoshana: Who do you want? What's amazing to me is the number of ... I send so many cold emails to celebrities and famous scientists and writers, where they don't know me from anything, and they write back and they say, "Wow, this is so important, I will do it for you, and I'll do it for free." It's incredible to me what can happen when you just put yourself out there and ask. That said, if there's anybody that we've had at End Well that you're interested in, let me know, I'm happy to make introductions. I think this year, different than other years, people are at home, twiddling their thumbs, trying to get by because, hopefully, people aren't traveling and doing things. The entertainment industry is still, largely, shut down, as is music and all those, so it's easier to get to people, but that'll probably change once we get COVID sorted out.

Alex: Great.

Eric: Yeah. We're all spending less time on our yachts. That was the transition for Alex. Or my imaginary yacht, where I listen to Christopher Cross. But this is not Christopher Cross.

Shoshana: It is Christopher Cross.

Eric: It is Christopher Cross?

Shoshana: I think.

Eric: Is it? See, that's my acknowledgment to yacht rock. He did Sailing, right? Sailing takes me away.

Shoshana: Take it away, Eric.

Alex: (singing I was born the son of a lawless man, always spoke my mind with a gun in my hand, lived nine lives, gunned down 10, going to ride like the wind. And I've got such a long way to go, to make it to the border of Mexico, so I ride like the wind, ride like the wind.

Eric: Awesome, Alex.

Alex: I would have preferred you doing Sailing. Next time, you got to take us out.

Eric: Next time, we'll have some Mai Tais, we'll be listening to ... Shoshana, a very big thank-you for joining us. And to all of our listeners, December 10th, please register right now. We'll have the links on our GeriPal website. Shoshana, you want to just throw out the URL that they can go to, too?

Shoshana: Yeah. We hope to see you there.

Eric: Great. And a big thank-you, again, for joining us today, Shoshana.

Shoshana: Thank you so much for having me.

Eric: And to Archstone Foundation for your continued support, and to all of our listeners, thank you for supporting the GeriPal Podcast. If you have a moment, please rate us on iTunes or your favorite app, and throw in a comment, comments are a great way to actually start spreading the news about GeriPal. Good night, everybody.