Saving Lives and Saving Dignity with Dr. Alan Molk
Saving Lives and Saving Dignity Show Notes
As he was caring for his mother, who was suffering from Alzheimer’s, Dr. Alan Molk had an epiphany. He realized that there were so many people in the world with incurable diseases, no chance at recovery, and no opportunity to talk about their condition. He has been spreading awareness by sharing what he’s learned ever since.
Dr. Molk has been an emergency room physician for 40 years. He’s the author of Saving Lives. Saving Dignity: A Unique End-of-Life Perspective From Two Emergency Physicians, an immigrant to the United States, and someone who has dedicated his life helping others.
In today’s conversation, Dr. Molk and I talk about the unintended consequences of the incredible medical innovations developed over the last several decades. We discuss the growing need for palliative care (and what makes it different from hospice care), and why planning for healthcare emergencies of all kinds is a vital part of any retirement plan.
In this podcast interview, you’ll learn:
- Why the obesity and diabetes epidemics are leading to so many health problems and poor quality of life in Americans.
- How drug manufacturers can benefit from unsustainable and sometimes painful medical treatments.
- Why palliative care is the precursor to hospice care–and how a family can be involved.
- Resources you can use to start tough conversations within your family when you need them.
- Dr. Molk’s views on the COVID-19 crisis–and what he learned from his horrific experiences navigating tragedy
- “Death can come at any time. Having advanced directives is an act of love and kindness to your family, and that’s a really good way to look at it. You are doing something for your loved ones by making a very difficult and tragic situation just a little bit better.” – Dr. Alan Molk
[00:00:08] Dean Barber: Hello, everybody, I’m Dean Barber, Founder and CEO of Modern Wealth Management and your host of The Guided Retirement Show. I got a special guest today, Dr. Alan Molk, a 40-year emergency room physician, author of Saving Lives. Saving Dignity. He’s got a great story to tell from his family history and an immigrant to the United States and what he’s done and what he has seen. Please enjoy my conversation with Dr. Alan Molk.
[00:00:36] Dean Barber: Dr. Alan Molk, welcome to The Guided Retirement Show. Such a pleasure to have you here. You’ve got a great story to tell. So glad to have you. Let’s get started with your background and then we’re going to talk about the book that you wrote called Saving Lives. Saving Dignity. So tell us a little bit about yourself and what brought you to write this book.
[00:00:53] Dr. Alan Molk: Certainly. Thank you for having me on the show, Dean. I appreciate the opportunity to talk about this topic that is of great importance and also very relevant. My background is that of being an emergency medicine physician, ER doctor now for 40 years. I’ve been practicing in the Phoenix, Arizona area for 30 years. Prior to that, I was on the East Coast in New Jersey. And I am one of your fairly typical ER doctors whose lives are all about our careers, and our clinical lives are about saving lives. That’s what we do.
You see that on TV shows. You see how ambulances are rushed into the ED, someone is crashing or about to have a cardiac arrest, and we resuscitate them. And that, as far as what you see on TV and in the movies, a lot of that is, in fact, Hollywood more than reality. In fact, what we’re doing in the emergency room, we save some lives and we do see some critical patients who we have to resuscitate, but many of our patients are not necessarily about to have a cardiac arrest.
Many of them have a multitude of other medical conditions, anything from children with a fever, someone who’s sprained or broken the ankle, someone with abdominal pain who may have appendicitis, someone with chest pain, trouble breathing, or could have pneumonia or COVID. Those are the kind of cases, just to give you a little example. We see everything and we are required to know at least a little bit about every medical specialty and every medical component of the body so we can initially start the treatment and often complete the treatment.
However, over the years, I can tell you that the face of medicine has changed, that what we are now seeing, especially in the last, let’s say, 15 years or so, what I would refer to, Dean, as the unintended consequences of all the amazing treatments, drugs, devices that medical technology and medical science have come up with to cure a lot of diseases and certainly to prolong life in people who previously had a much clearer prognosis. So, what I mean by that is we are seeing more and more people who are complex, who have multiple medical issues. And of course, at this point, I need to add that the obesity and diabetic epidemic that we are seeing has contributed greatly to what we are seeing, because obesity and diabetes creates all kinds of bad issues, heart conditions, kidney disease, strokes, and poor quality of life.
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[00:04:07] Dean Barber: So, hang on a second. I want to ask you a question about that, because I think this is critical. So, as we were– and I don’t want to spend a lot of time on COVID, but as we were going through and are still in this COVID pandemic era, you mentioned to me when we talked prior to us recording the podcast here that you felt like obesity was the number one comorbidity that COVID affected the obese people more than any others. And yet, we heard virtually zero from the mainstream media, from Dr. Fauci, from Dr. Gottlieb about, hey, this is a wake-up call that if we don’t take care of ourselves and our immune system isn’t strong enough, then something’s going to come along and it’s going to knock us off, or what we think is a healthy person.
I’ll never forget, Dr. Molk, I was watching television, and my brother is the CEO of a hospital in Hastings, Nebraska, called Mary Lanning Hospital. And he made the news, and on the news was a guy that was about 45 years old that they wheeled out of Mary Lanning Hospital, saying that an otherwise healthy 45-year-old man spent six weeks in the hospital with COVID and he lost over 100 pounds and he still was at about 350 pounds. And I’m sitting there going, but this guy wasn’t healthy, okay.
Yeah, maybe he hadn’t had a heart attack or maybe some of these things happened. So, I think, can you explain more about obesity and what it does to the organs in your body and why that is a big danger? And then, maybe you can shed some light as to why that’s not talked about openly in our media and in our healthcare industry.
[00:06:04] Dr. Alan Molk: Dean, that’s a great point. The problem with obesity is it is almost now because it is so prevalent, I think the numbers are like 30% of Americans are either obese or morbidly obese. Now, morbidly obese takes you in a whole different category, technically suggesting that you are at least 20% or more over what you consider a reasonable ideal body weight. So, we are not dealing with obesity as being very commonplace, and it has almost become the norm in many people’s eyes. And it isn’t.
Obesity itself is a disease. It’s a condition that is connected directly to diabetes and all its complications, heart disease, back problems, musculoskeletal problems. And it has been overlooked. Part of it has to do, I believe, with political correctness. No one wants to bring it up because there are people out there who claim that they have been discriminated against because of their body size.
And as a result, people who should be talking about it are leery about doing so out of– and I’m talking now about elected officials because they fear a backlash that, oh, well, we’re going to get discriminated against because of our body size. And as a result, it sort of gets swept under the rug. It doesn’t get brought up because it’s a sensitive topic. I would love someone who is in a position of power to look in the camera and tell people, “Hey, America, we need to get healthier. We need to curb this obesity epidemic.”
And it is an epidemic, this diabetic epidemic, because it is costing the healthcare system billions. And people who are experts on the topic of the cost of health care are concerned that we may be going over the fiscal cliff as a result of the diabetes, as a result of obesity, and, of course, as a result of longevity, people living beyond a certain age, which also its health comes with other diseases. So, this is a very difficult topic to talk about, but it needs to be addressed.
[00:08:45] Dean Barber: It does need to be addressed, but I have to ask a really pointed question here. You’ve been an ER doctor for four years. I would say that people would look at you and say, “Okay, this guy knows a little bit about medicine. He knows a little bit about what goes on, not just the medical field, but also in the pharmaceutical field.” And I have to wonder, is there any incentive for the pharmaceutical companies to encourage people to be more healthy? Or is it just the opposite? The incentive is not there because there’s such a financial reward if we have more sick people. That’s in my head and I don’t know if that’s in your head or any other part of the medical communities’ head.
[00:09:27] Dr. Alan Molk: Oh, I think you bring up a very significant point, Dean. I think what you spoke about is real. And we talk about the business of medicine a lot, and that is a whole topic in itself. I can talk, for example, about nephrologists, kidney doctors, or oncologists, people who take care of cancer patients, their bread and butter, their income, their source of making a living is to have people on chemotherapy and have them on different trials. This is a multibillion-dollar industry, which is why oncologists are often reluctant to look at patients to say, “You know what? Maybe it’s time just to look at comfort care, palliative or hospice care,” which is something I talk about with some detail in the book, because the incentive from the pharmaceutical companies who make these chemotherapy drugs is huge. It’s a discussion in itself.
Same thing, example with devices like dialysis machines and keeping patients who are on dialysis, some of whom definitely do quite well on dialysis and can have a good quality of life for a number of years. And then we have a sizable number of people who have every organ system affected and who look poorly and whose quality of life is dreadful, but the nephrologists keep them going on dialysis three times a week because it’s their bread and butter. So, we’re not talking about the concept. Is the medical community of physicians, my colleagues, at least in part, responsible for this dilemma that you and I are discussing? And how do we change the culture? Because it is going to need a culture change, I don’t see what we’re doing as sustainable in the long run.
[00:11:43] Dean Barber: I would agree with you. Alright. So, we kind of got off on a little bit of a bunny trail there because I started it, but let’s go back. I want you to tell your story about coming to the United States, about going to medical school, about your mother, about your father, because I think it’s important that people that are watching us on YouTube and the people who are listening to us on a podcast that they know what your story is because that sets the stage for your passion and the writing of your book called Saving Lives. Saving Dignity. So, please begin.
[00:12:22] Dr. Alan Molk: Oh, sure. Thank you. Well, I am an immigrant to America in 1977 and I did my internship and residency on the East Coast. At the time, I wasn’t certain what I ultimately wanted to specialize in, but ultimately, I started to do some part-time work in some small emergency departments and I realized that I found my niche. And so, that became my career. And I absolutely loved being an ER doctor all these years. The whole concept of being able to help people, being able to be available to help people 24/7. And at the same time, it afforded me a reasonably good quality of life working as an ER doctor. So, you’re on, the pressure is on, but when you’re off, you’re actually off. You don’t necessarily have to carry a pager.
And then, working in the ER, also, over the years, I was mentioning earlier, but with the face of medicine changing that I came across and we all have come across so many patients who are suffering. We’re just keeping them alive. We are doing what I call disease management rather than health care. We are treating their congestive heart failure. We’re treating their diabetes. We give them physical therapy because they’ve had a stroke. We’re treating their cancer. We’re treating their emphysema or COPD, but they’re not necessarily doing well.
And I began to realize that this needs to be addressed better. Now that, in combination with my own personal journey with my mother, you did mention my father earlier as well, I’m incredibly grateful to my father who has been deceased a number of years. He was the one who pushed me to go to medical school. He was the one who said, “You need to find a career, you need to do better than me.” And he always pushed me. And I’m forever grateful to him for that. He’s also the one who encouraged me to come to America. And I’m one of these people who is such a proud American and I am so blessed to be a US citizen. I was naturalized in 1985.
I always tell Americans who complain, you don’t know how good you got it. I’m a foreigner. I come from a foreign country. We are so blessed to be here in America. And I could talk for hours about the joy and pride I have in being a US citizen. I could also talk for hours about those who immigrated and complain. I have one message to them, go back from where you came that you cannot see how blessed and privileged you are to be here. You missed the boat.
Anyway, to go back to my mother, my mother was just a delightful, sprightly adorable, fun individual. And then, at age 75, we realized something wasn’t right. We realized her memory was going down the hill. She was getting confused. She would get lost driving a car, all the telltale typical signs you’d expect of someone of early dementia. Unfortunately, it was a downhill journey from there for six years. It was painful to watch, needless to say. And I’m sure many people who are watching this have some– Alzheimer’s is very common. Dementia is very common. I’ve seen this in a parent or maybe a grandparent or another loved one. And I got to realize that mom has an incurable disease. We know there’s no cure. We know it’s a downhill course. And how can we make the journey better?
And I realized during her journey, one of the things that she lost, Dean, that was so painful to watch was losing her dignity, and saving dignity. Towards the end, she was incontinent, she was staring into space, she didn’t recognize me, she couldn’t feed herself. And it was so painful for me to visit her three or four times a week in the Memory Alzheimer’s Unit she was in towards the end of her life.
And then, one day, Dean, I had an absolute epiphany and I talk about it in the book, I call it the crystal ball epiphany, I kind of made that up. I sat down next to it. I thought to myself, what if six years ago, I actually had a crystal ball in my hand when my mother was still sharp as a tack? And I said, “Mom, I want to show you something, and I don’t think you’re going to like it, but I want you to look in the crystal ball. This is what you’re going to look like six years from now.”
And the thought in my mind, how would she have reacted, how would she have responded? What would she have said? And I know exactly what she would have said, she would have said, “Oh, no, no, no, no, I would never want that. If I’m ever that way, just push me off a cliff.”
So that was a very powerful aha moment for me, so to speak, Dean, and I just realized at that point that there are so many people out there who have incurable diseases, be it Lou Gehrig’s disease, be it advanced Parkinson’s, be it congestive heart failure. There’s a list of them who are truly suffering, who have no realistic hope of getting better or improving, who have never been given the opportunity to talk about where they’re at and their stage of a particular illness. And this is something we need to do better with.
[00:18:28] Dean Barber: And so, that’s where in your book, you discuss palliative care. And I think that you also talk about how few palliative care doctors there are and what a need there is there. So, I think that for many people, they may not have ever heard that term. They may not know what that means. Everybody knows what hospice means, but I want you to explain the difference between palliative care and hospice care.
[00:18:57] Dr. Alan Molk: Certainly. Briefly, hospice care is actually a Medicare benefit that is available to anyone who has Medicare, who qualifies for it, and usually, or not just usually, but it does specifically imply that this is someone who has an advanced disease or condition with a prognosis of six months or less. Now, I will tell you, you will certainly appreciate this. Prognosticating is fairly accurate, but it’s not that accurate either. We will sometimes think that someone has a six-month prognosis, and they did in six weeks.
Or we may think we have a six-month prognosis and they can continue for two or three years, but it’s a good estimate of, say, six months. So, someone who’s eligible for hospice, they get comfort care. And hospice is a beautiful concept. It’s been around for decades, for many years started in the UK. And it is something people do either from home or in a hospital setting.
Now, palliative care is kind of a first cousin to hospice, and it is sometimes what I call the precursor hospice and that it is given to people who have a serious life-limiting condition that may have a prognosis of way beyond six months, but these patients are often getting active treatment either for chemotherapy, for congestive heart failure, for emphysema, for diabetic complications who are suffering, but they are now eligible. They can become eligible for palliative care, which is similar to hospice care, but it is a team approach. And when I say it’s a team approach, it’s a physician, there’s a pastor, there’s a social worker, there is a pharmacist to talk to the patient and family about, saying, “Okay, where are we at? What are your goals of care?” And this is a key phrase we use. “What do you want?”
We know that you have a bad condition, but let’s talk about what if things don’t go well, let’s talk about how we can support you, how we can help you, how we can help your symptoms. Let’s talk about if you’re having pain, let’s help you with that. If you’re constantly nauseated, let’s say from the chemo, we can help you with that. If you’re feeling anxiety, we can help you with that.
And as a team approach to symptom management, which is a beautiful concept, because very often, the people who treat the condition like the oncologists or the cardiologists are so focused on the heart or the cancer cells that they forget about this is also a person who has feelings, who has other complaints that need to be addressed to not just to make them more comfortable, but to make them feel more dignified and improve their quality of life.
[00:22:18] Dean Barber: And so, this palliative care, where does the family conversation come in here, Dr. Molk? Because I think this is a big thing and people might be wondering, okay, Dean, this is The Guided Retirement Show. Why in the world are we talking about saving lives and saving dignity? And I want to set the stage for you here for just a minute because so many people don’t have the conversation with their loved ones. They don’t have their advanced directives, their wills, or their trust in place. They haven’t done end-of-life planning. And I love in your book, you say, “Look, death isn’t a matter of if, it’s a matter of when and how.”
And so, we know that none of us are going to live forever. So, I don’t know why it’s so hard for people to have those conversations. I know they don’t. I know that some people say they want to and yet, they don’t do it. And so, when do those conversations need to start happening? When do people need to get these advanced directives and get their estate plan in order?
And some people think, well, the trust is only for a rich person, but that’s not true. It’s to dictate how you’re cared for when you’re alive, what goes on with your financial affairs when your alive, your healthcare directives, etc. So, I’m interested in your take as an ER doctor on that aspect, because, to me, that’s part of a good retirement plan. You’ve got to have all those things in place, and those conversations need to take place with your loved ones.
[00:23:47] Dr. Alan Molk: Absolutely. You hit the nail on the head on that one, Dean. Let me start off by giving you a real-life example of why it’s so important to have a conversation. The example I’m going to give you has happened to me countless number of times and to other ER doctors as well across the country. Okay, you’ve got grandma being wheeled in from home. She’s 94 years old and cared for by her two daughters by ambulance because she’s not feeling well and she looks like she’s deteriorating very quickly.
She’s not conscious. And she has advanced Alzheimer’s or some form of dementia. She’s been bedridden and 94 years old. The ambulance wheels her in, and her two daughters follow her. I’m there to talk to the daughters and take a look at her. You do not need a medical degree to see that she’s close to death. And I get the information from her daughters. I’ve never seen this lady before and the daughters say, “Yeah, this is mom. We’re concerned she has pneumonia because she’s been coughing and we notice she’s hot to the touch,” and was medically, technically, an end-of-life event. It just is.
In the old days, we used to call pneumonia the old man’s friend. So, I talk to the daughters. One of them looks extremely distraught and the other one anxious, but not that distraught. And I say, “Okay, mom’s not looking well and she’s not breathing well. Her oxygen levels are low. If we’re going to treat her aggressively, she needs to go on a ventilator. She needs to go on a respirator. And I need to know what her wishes are. Does she have advanced directives?” And the two daughters both shrug their shoulders.
No, she doesn’t have advanced directives. I cannot talk to the patient because she’s semi-comatose. And I say to the two daughters, you know what her wishes are? And one daughter says, “Do everything. Do what you have to do. I don’t want to lose my mother. Please do it, put her on a respirator if you have to.” And then the other daughter says, “You know what? She and I once spoke, and she told me that she’d never want to be on a ventilator.”
And I realize that you have these two daughters with completely opposite perspectives of mom, who is clearly at the end of life. And now, I’m in a situation. I got to make some kind of on-the-spot decision. What are we going to do? It puts me, the physician, in a very awkward spot because they know advanced directives. The topic was never discussed. It clearly was taboo to discuss it as I would think, which is very common, by the way. People don’t want to talk about end of life because it’s a difficult, taboo topic.
Fortunately, in this case, I was able to find out that the daughter who said she really didn’t want to be on a ventilator was in fact her power of attorney, she technically was. And I was able to tell the other daughter, if these are her wishes, putting on a ventilator, unfortunately, is not going to save her. She is close to the end.
I think we just need to make her comfortable. But it was a scenario that became high stress, high anxiety that could have been avoided if the family and the patient ahead of time talked about having advanced directives, talking about what their goals of care and wishes are. And when I hear that patients do have advanced directives and I know what they wish, it makes my job so much better, so much easier. And of course, the outcome from the patient family is so much better and so much more serene and peaceful.
[00:27:47] Dean Barber: You know what’s interesting about that, Dr. Molk? And I’m sure that you’ve seen that same scenario. Different people play out many, many times throughout your 40-year career. And we have attorneys here that do estate planning for people. We do the tax plan for people, we do the investment. And it’s all part of a well-crafted retirement plan. And yet, so many times, we’ll get a phone call, and that phone call will be, Dean, my mom and my dad– my mom passed away last year. My dad’s not doing so good. He doesn’t have a will. Can we get one of your attorneys to come over to the hospital and we can get a will put together real quick?
And I think to myself, I mean, okay, I’m 55 years old, I don’t think I’m going anywhere anytime soon. My wife is 52 years old, I don’t think she’s going anywhere anytime soon, but you know what? We don’t know. We don’t know how much time we’re going to be afforded, right? And so, I have gone to the point where I’ve had my estate plan in place for a number of years. My children are all adults now. We have conversations. Here’s where things are. Here’s what mom and my wishes are. God forbid something would happen, but if it does, here’s where everything is, and here’s what we want.
And here’s our healthcare directives. Here’s the financial powers of attorney, the healthcare powers of attorney, everything else. I don’t know why it’s so difficult for people to think about that and get it done. They think, well, I don’t want to spend $3,000 on a trust or $4,000 on a trust, depending upon the part of the country that you live in. That cost is pennies in comparison to the pain and suffering that you put the entire family through, and then you wind up going through probate, and the probate courts take the money anyway.
[00:29:30] Dr. Alan Molk: Dean, again, you hit the nail on the head. I can tell you, and there are studies that have shown that in situations where family choose, where families do have a conversation and they do choose palliative care, that the rate of PTSD is low as compared to people where there’s chaos, I call it chaos because it is chaos, where there was no conversation held because it was– I use the word taboo because I just like phrasing it that way, because we don’t want to talk about that, it’s too painful, even though it absolutely needs to be talked about because it is an eventuality as you just described.
And Dean, there are two kinds of death that we see, this expected and unexpected. And I’ve seen many cases of both in my career in the ER. The unexpected is a tragic case, a shooting, a car accident, someone falling off a building, someone who has an unexpected, massive heart attack, someone who has a ruptured aneurysm of the brain. And then, you got the expected death, where death is really unexpected. The 94-year-old lady I spoke about. Sooner or later, she was going to get pneumonia. And it’s going to be a terminal event.
There’s so much we can do to decrease the trauma to the family by having the conversation. I see what I call a good death where the family, for example, I had a gentleman not long ago, came in with a massive aneurysm. He wasn’t going to make it, and he had advanced directives. And of course, the family was devastated, but they knew that the outcome was going to be bad and they said, “You know what, he would not want to be on a ventilator if we know he’s got such a massive brain hemorrhage, there’s going to be no recovery.”
And the decision making for everyone was easier. The death was much more peaceful. We were able to wean him off the ventilator. The family was able to be there. It was what I call a good death, a beautiful death, as opposed to the chaos, which occurs when there’s a family in disarray and no one knows what the wishes were. And then we have to get legal involved or we have to get ethics involved. And it becomes a ball of confusion, which is what I would consider, most people consider to be a very bad death.
So, we need to be reminded, as you just said, death can come at any time, and having your advanced directives is an act of love and kindness to your family. And that’s really a good way to look at it. You are doing something for your loved ones and your children, your spouse, by making a very difficult and sometimes tragic situation just a little bit better.
[00:32:49] Dean Barber: Right. Yeah, you never want to think about that. You never want to think about that, but it’s inevitable. And so, make it as good as you can. I got to ask, with so many families today that are mixed families, second marriages, third marriages, you’ve got a new wife, you’ve got a new husband, then you’ve got the other kids over here and the kids want to have the say and the new spouse wants to have the say. And that has to be the biggest mess that I’ve ever witnessed when that couple doesn’t have the advanced directives and they don’t have the trust in place or the will in place that said, here’s where things go. Here’s how everything is going to work out. And they haven’t had those conversations prior to the end of life.
And so, do you have any scenarios or any stories that you had where you have that second or third marriage or whatever, and the children really, they want to be there and they want to make the decision and yet, here’s the new spouse and they’re saying, no, I’m going to make the decision? That’s gotta be one of the worst types of scenarios out there.
[00:33:57] Dr. Alan Molk: I have to tell you in the ER, where we are already busy, and ambulances are coming through the door, and the waiting room is full, having to face a situation like you just described or the one I described a little bit earlier, it makes the whole setting so, not just unpleasant, but so, it’s like a Tower of Babylon in the Bible. It’s like everyone’s talking a different language and the decision because we, as physicians, have to make decisions, are we going to put the patient on a respirator or not? Are we going to take the patient to the operating room to try miraculous surgery? Or are we going to do a craniotomy for someone who’s got a brain hemorrhage?
These decisions, spur of the moment kind of decisions are difficult enough as it is, but when faced with the type of complexity that you described and yes, we see that all the time as well, it becomes so unnecessarily difficult. And I keep using the word chaotic because that’s the best way to describe it, then it really needs to be. So, I can tell you that my wife and I, we’ve had our advanced directives years ago. Our kids know exactly what we want. And I see that as, again, an act of love, an act of caring.
And people can understand that it is that I think people may catch a little bit better. I will tell you that physicians also do not do a very good job as a general rule, that’s a topic in itself, about talking to their patients, about having a conversation, even though Medicare does actually pay for it. It does pay for an hour session. And I always encourage patients who are in a difficult situation like this. Talk to your doctor, talk to your pastor, if you’re having trouble. Talk to your lawyer or attorney, talk to various people, and it’ll make it much easier for you to come to a decision that this is a good thing to do.
And I will tell you this, and I think you probably realize this, Dean, that even though having the conversation can be awkward or uncomfortable or taboo or you want to avoid it or sweep it under the rug, once you’ve had it, I don’t know anyone who’s regretted it. You always feel a sense of peace, a sense of, wow, I actually did this and I’m glad I did, even if it was a little bit painful for me to do. I got a checkmark behind it. And to me, that’s the way it should be. It’s pretty obvious.
[00:36:57] Dean Barber: I agree with you. And I think if you think about what you’re doing for the children or the surviving spouse, there’s enough pressure, there’s enough grieving, there’s enough sense of loss that the last thing that needs to be there is any confusion as to what your wishes are so you can take some pressure away from them. When you think that talking about it is putting it in a difficult situation and you’re making that person uncomfortable talking about it, let me tell you what’s going to make you uncomfortable is if they don’t have any idea what you want or how you want to be cared for and you’re left to make that decision.
[00:37:35] Dr. Alan Molk: Yeah, and my message when I’m talking to people about this is to have the conversation. And there are many websites, I talk about it in my book as well. There are many wonderful websites about how to just get started. And there’s one that I like a lot in space out of Boston. It’s called The Conversation Project. It’s a website that anyone can access. For example, just to get people going and just by starting to have a conversation, if you haven’t, is a blessing. And you won’t read it.
People resisted initially, but I’ve found that, and I have a conversation with patients all the time. I hit and missed. Sometimes the patient will say thank you for having that conversation. You know what? Can we call hospice? I think mom is ready to go to hospice. And then I call hospice care. Over there, everyone’s grateful and everyone’s hugging each other and thankful. Then, there are some people who say, I don’t want it, I don’t want to hear it. And a week later, they come back and say, I’m ready to have a conversation.
So, even planting the seeds of having the conversation is helpful and important. I love actually planting the seed because once you bring it up, it usually does resonate a little bit, even in people who avoid the conversation like the plague.
[00:39:09] Dean Barber: So, what we’re talking about now, you mentioned some statistics in your book about most people, I think it was 70% of people say that they would prefer to die at home and in peace, and yet, they don’t. So, let’s talk a little bit about it. I mean, I think what we’re talking about here is the root cause of why they don’t.
[00:39:35] Dr. Alan Molk: Great point, Dean. In fact, studies have shown that this is physicians. By the way, that 80% of physicians, they did a survey of about 12,000 physicians about and they were asked the question very bluntly, where would you want to be at the end of life? And 80% of the physicians who were asked that question said, at home, surrounded by my loved ones. That was the response. So, like a beautiful, understandable, logical response, but yet, as physicians, and I bring this up a lot, we have a double standard.
We see death as the ultimate enemy, as physicians, and particularly those who take care of your patients who have critical life-limiting illnesses, that death is the ultimate enemy. We don’t want this patient to die, we have do whatever we can to keep them going, even at the cost of loss of dignity. And that is where the culture needs to change. And it is changing because that double standard to me is unacceptable. It’s just wrong. We are supposed to treat patients like family.
Every time I go in and see a patient, Dean, you came into my ER as a patient, I would say, I’m going to treat Dean like he’s my brother or my cousin. That’s how we’re supposed to practice medicine, but yet, in this situation, we keep patients in the hospital, we keep them in the ICU. And very often, we need to take a step back and say, are we really doing the right thing? This aggressive treatment is probably futile. Maybe we should talk to the family about more dignified comfort care. And there is more of a wave of education now in the medical world, including medical school, about talking more about end-of-life care, which is something I’m delighted is happening.
[00:41:37] Dean Barber: I am, too. And I’m glad to hear that that’s happening because I really do think it’s important. So, as we kind of wrap up our conversation here, I really want to make sure that everybody has an opportunity to get and read a copy of your number one best-seller book called Saving Lives. Saving Dignity. It’s a great book. It’s an easy read. And it’s easy to understand why you wrote the book after reading the book, and especially after having a conversation with you, Dr. Molk. And I think the message that you’re bringing to the American public is critical.
And it really hit home with me in the fact that when I do financial planning and retirement planning for people and I bring in our team of CPAs, I bring in our team of estate planning attorneys, I bring in our risk management specialists, we have these conversations with people. We talk not only about what do you want the great things to be, but what happens if the unexpected happens, and what do you want to happen? And then, once we get that lined up for people, okay, let’s bring the kids in. Let’s have a conversation with the kids. We want to facilitate that for you and make sure that everybody is on the same page. We want to make sure that the kids know who to call and what to do.
And I got to tell you, one of the best things of all the planning that we’ve done was– a dear client of mine who now is 84, 85 years old. She and her husband were here several years ago. He had just turned 70 and he walked in and he said, “Dean, you won’t believe this.” He said, “We got to adjust the plan because the doctor in my checkup last week said I’m going to live another 20 years. So, we’ve got to make sure that we’ve got enough money to live the next 20 years the way that I want to live it.” I’m like, “Great, let’s talk about it.” We put everything together.
It was a week later, I got a phone call from his wife, and he had died of a massive stroke in his recliner in the middle of the night. And I saw her a week later and she said, “Dean, I have to thank you.” She said, “I know everything is exactly the way that he wanted it. I’m at peace with how he passed and all of our things were in order. So, I now have time to grieve and do the things that I want to do because I don’t have to worry about anything else.” That’s what you want and that’s really what you’re talking about in your book. And people, if they could experience that or see that like you have and like I have, they would understand what kind of an impact that’s going to have for the surviving spouse or the surviving children.
[00:44:16] Dr. Alan Molk: Absolutely, being here, that’s not only the loving thing to do, but it’s also the responsible thing to do. And what you’re describing is someone who took ownership and responsibility for the end of life, an unexpected end of life, and in retrospect, was so happy they did that. And that’s exactly the point we’re making here. So, I hear you are doing God’s work and I see it that way because so many people just sweep this under the rug. And I always encourage people don’t sweep this under the carpet.
Have the conversation, speak to who you need to speak to, which, as I said earlier, can be, and should include your physician, your doctor, your spiritual leader and your attorney and financial advisor, and your family. And you will be glad you did. I think if we can bring that, that’s a message I think is so important to bring across and get that message across, I think, end of life will be dealt with in a far better way than we currently are doing. We can do a whole lot better.
[00:45:32] Dean Barber: I agree with you. Okay, before we wrap up, I want to get your take as a 40-year emergency room physician, what I would consider to be someone who, I’d even call you an expert in the field of medicine because you’ve been practicing for so long and you’ve seen so much. What’s your take on COVID-19? And I know that’s a sensitive subject. I know there’s a lot of different people that are saying different things about COVID-19, but I want your take on it as a medical professional.
[00:46:03] Dr. Alan Molk: I’m glad you brought it up, Dean, because I can tell you that I can summarize it as follows: Number 1, it took us by surprise. We were caught for a lack of a better term with our pants down. The impact on, not just the medical world, but the entire world was so unforeseen, unexpected, and devastating. And from the perspective of how it affected the ER, I’m considered what’s called a frontline worker because that’s where all the patients show up, which is why I was one of the first persons fortunate enough to get the vaccine, but what I saw was, to say it was horrific doesn’t even begin to describe it.
I also spent time in the Intensive Care Unit, in the ICU of one of the two hospitals I work at. Helping families, helping the palliative care team to talk about putting off a ventilator, and so many of these people had no advance directives. I was shocked. Actually, I wasn’t that shocked, but it was shocking to see how they ended up with no advanced directives. Several of them were extremely unhealthy people 300,000, 400,000 people on a ventilator, who already had other medical conditions who we knew had a horrible prognosis. Yet, there were families who wanted to keep you on a ventilator.
And that impact, realizing, number 1, that death can strike suddenly. So many people in 2020 had no idea that this was going to be their last year on Earth because of COVID. You think how many hundreds of thousands of people died having no idea that, my goodness, this is going to be the final year of my life. And looking at advanced directives in that way, saying this could be the final year of your life, it may not be COVID, but it could be a car crash, it could be a massive stroke is, again, another way of relaying the message. COVID just reinforced that big time.
We have so many conversations with family members by Zoom because there were restrictions. Families couldn’t even, because of COVID, be with their families at the end. Eventually, that restriction was lifted. And I have to spend a lot of time with many families convincing them that being on a ventilator is not going to change the outcome, and a peaceful ending would be better off the ventilator. And if the conversation had been held ahead of time, things could have gone much smoother.
So, it was just getting a reminder. I wish people had the conversation more often and had advanced directives more often because tragedy and disaster can strike at any time. And COVID-19 was about as massive an example of this as we can think of.
[00:49:26] Dean Barber: Were you happy with the speed at which the treatments came out? And then, eventually, the vaccine was that? There were a lot of people– I was happy with it, I witnessed it and I thought it was tremendous the way that the government worked alongside the medical community to help get everything as good as it could be, as fast as it could get there, and everybody working together around the globe on vaccines. Were you happy with that or do you think it could have been done faster?
[00:50:00] Dr. Alan Molk: I think we moved at lightning speed, I call it the Warp Speed Project, and even the Trump haters had to reluctantly give him credit for speeding up the process as well as he did. And so, I was happy with the way things moved. And the next concern is, are there going to be more mutations in the virus down the line that may create a problem? It’s too early to tell. Hopefully, not, but yes, things could have been worse. And here in America, we’re lucky to have Pfizer and Moderna and J&J speed up the vaccine and speed up the production. So I think that was well handled considering what a nightmare scenario we’re in.
[00:50:53] Dean Barber: Alright. One last question for you, and then I’m going to let you get on with your day-off. Your 40 years as an ER physician, how much longer will you be working as an ER physician? In case somebody in the Phoenix area needs you, how much longer will they have access to you?
[00:51:10] Dr. Alan Molk: Well, funny you should ask. I plan on retiring this year. I’m going to be 70 at the end of the year in December, but I’m still going to be doing some part-time work. I’m still going to be teaching at the medical school, the UofA Medical School here, which I enjoy doing, giving back. And I’m going to be doing some other medical projects. I’m going to be doing some other part-time work with a company that gives advice to things like emergencies on various international and local airlines. It’s a company based here in Phoenix called MedLink, and I enjoy doing that.
And I’m also in the process of writing the second book about– it’s a bit autobiographical. I’m calling it On the Right Side of the Bed. And it’s a book about attitude and gratitude. It talks about how grateful I am for my life and my career and how I have been. The good Lord has given me so many blessings, many of which I probably don’t deserve. And so, I’m going to be busy in retirement, that 40 years in emergency medicine has been a lengthy career and I’m incredibly grateful for that, but this is the year that I’m going to be, as I call it, hanging up the stethoscope.
[00:52:23] Dean Barber: I think now, after having this conversation, people that have watched us on YouTube or people who have listened to the podcast know that the real man to thank for you being the amazing physician that you are for the last 40 years, is your father by pushing you and getting you to the United States. So, thank you to you and your late father as well. I really appreciate the interview, Dr. Molk. I look forward to reading your new book.
[00:52:50] Dr. Alan Molk: Dean, thank you very much again for having me. I’ve enjoyed conversing with you. And hopefully, our conversation on some of the pointers we’ve made will be helpful to whoever watches. Thank you very much. Appreciate the time and appreciate the opportunity to be on your program, on the podcast.
[00:53:07] Dean Barber: Well, when you finish up your new book, I’d love to have you back.
[00:53:10] Dr. Alan Molk: Okay, I’ll send you a copy. It would be my pleasure.
[00:53:13] Dean Barber: That sounds good. Take care.
[00:53:14] Dean Barber: Well, I hope you all enjoyed that conversation as much as I did. I think that was fascinating. I think it’s a conversation that needs to be shared. So, please, in the show notes, find a link for Dr. Alan Molk’s book. Also, find a link if you’d like to have a complimentary consultation with one of our certified financial planners, estate planning attorneys, or CPAs, all in the show notes. And be sure to share this podcast with your friends and with your relatives. The conversation needs to happen. Please subscribe.
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