Tami Simon: You’re listening to Insights at the Edge. Today my guest is Dr. Gustavo Ferrer. Dr. Ferrer is an experienced pulmonologist, founder of the Cleveland Clinic Florida Cough Clinic and president of Intensive Care Experts. He’s received several prestigious awards, including being named one of the Best Doctors in the US by US News and World Report, and also being named the Most Compassionate Doctor and the Patients’ Choice Award Doctor.
With Sounds True, Dr. Ferrer has written a new book called Graceful Exit: How to Advocate Effectively, Take Care of Yourself, and be Present for the Death of a Loved One, where he offers a much-needed guide through the medical, legal, financial, emotional, and spiritual dimensions of dying and death.
In this episode of Insights at the Edge, Dr. Ferrer and I spoke about death anxiety, and how he feels when he walks into a room with a dying patient and the family is not at peace with the situation; and as a caring end-of-life physician, how he deals with that situation.
We also talked about what people need to know in order to be organized and prepared to die and not be a burden for their loved ones. We also talked about the time Dr. Ferrer spent as a young medical student with the Warao Indians of South America, and how he learned from them how to accept the inevitability of death and how to grief in a group and fully. Finally, we talked about the importance of death conversations and how this can help us become clear about our legacy. Here’s my conversation with the very kind Dr. Gustavo Ferrer:
[Dr. Ferrer,] you’re a pulmonologist who specializes in end-of-life care, and to begin our conversation, I want to talk about how you began your new book, Graceful Exit. The very first sentence of the book, which I thought was pretty startling, you write, “Every day, at least one of my patients die.” Every day at least one of my patients die. So here you connect with patients. You’ve received awards for the Most Compassionate Doctor award, the Patients’ Choice Award; what’s it like for you as a compassionate doctor to hear about the death of one your patients every day or more?
Gustavo Ferrer: Tami, that is an excellent question. I can tell you the patients that have been followed by my team and myself for many, many months and from the outpatient clinics that we see them, and they go to the ICU and we see them going through these final stages of life and they die—is basically losing a family. The doctors, we have such an incredible privilege. We can get to know people in the most intimate things of their life and their families, and we become counsels when we are in the ICU in hearing people’s issues and problems. And it’s just like my own family. So, I feel that pain every single day. Primarily when the patients are really close to myself and to my team, we truly experience the pain of losing a family. And it doesn’t change.
But by the same token, Tami, I see this and I see my career, I love what I do. I have passion for helping people. I love to guide my patients and their family, and that is the part that gives me great satisfaction every single day. My family can tell you that sometimes I get home and it’s like grieving somebody from my own family. You go through those stages that you’re sad. But in myself, my team, we practice breathing exercises, meditation. We talk of our patients lives, and those things help us cope with our daily life and the things that our patients and family go through that regardless, impact our lives.
TS: It seems that part of it is, you would have to view your role as a helper differently than “My job as a medical doctor is to help this person get better.” Here you are, you’re a medical doctor that specializes in end-of-life care. To use my own language, in some ways, you’re more like a midwife for the dying process than a doctor who, in certain situations, is trying to create a cure.
GF: Well, the term “end-of-life care” includes many specialties. It includes palliative care team, includes other specialties [in] hospice that have come about. But my job as an intensive is, I think, has to be part of going beyond just patient care, and just as you said, being more kind of a midwife. We go into those details in helping patients and family navigate these waters because here’s what happens.
In the intensive care unit, when people are truly actively dying, we depend on a lot of information from the families and friends. So, we become right there in the mediator between the patient that is in the bed and the family and friends that [are] giving us information. So we need to gather pieces here and there, and the best way for any intensivist to do their job is to have in mind constantly that is not just about helping the patient go through this process, but it’s more than that. It’s keeping the whole family in the loop and continue to gather information that may benefit in bringing those patients back to recovery or prolonging some of their days or helping them have, as we titled the book, have a graceful exit.
TS: Now, you mentioned interfacing with different families, and one of the things you mention in the book is how so many families carry with them a large amount of what you call “death anxiety.” And that when a family comes in and there’s a lot of death anxiety, you can sense that, and that can also make things more complicated than it needs to be. Tell me, how do you sense death anxiety in the family of someone who’s dying? What does it feel like?
GF: Excellent question, also, Tami. When I walk into a patient’s room and I have read the records before meeting the patient, and I review the history and I see that they have multiple medical problems, and they’ve been coming in and out of the hospital multiple times, when I walk into the room and I face the family, I can perceive that the family understands that they’re facing the end.
And how do I recognize that? I think this is one of the skills that doctors and people that do this kind of job develop by practicing over and over. But usually it’s keeping aware of my surroundings. I have the honor and the privilege of teaching doctors in my fellowship training, and I tell them constantly and all the people that surround us, that it’s important to scan the room and see everybody that is in the room. When you’re walking into a room where we have multiple family members, you can sense who is anxious. You see people moving from point to point. You can see it in their face that there is anxiety, and there is the presumption that something not good is going to happen. Those are the people that need support. Those are the people that need to be informed, and those are the people that need to be engaged.
TS: How do you support them?
GF: I think that the best thing that we can do in medicine overall today that we’re living in this time of history [where] we’re flying, that we’re running and running, is to just pay attention to them, listening. I think that this a skill that we continue to lose overall in medicine and many other areas, but in medicine particularly. Listening to them.
I cannot tell you, Tami, how many times I have learned interesting stories that had to do nothing about the patient’s disease process but about that person. And there’s nothing more beautiful, to get to know those really interesting things that people have done in the past, things that they have done to make this world better. And the families and friends are proud to share that with you. Sometimes we are running and running so fast that we don’t pay attention to these moments that really bring the opportunity for the family and friends—just to verbalize, to open up and tell us their feelings.
TS: What’s it like, Dr. Ferrer, when you walk into a room and there’s a feeling that the family has made peace with the passage? Maybe you could tell me a story of a family like that.
GF: Oh, absolutely. In the book I talk about a family, one of the families actually that taught me a lot about this. I learned it fairly young as a critical care physician at the Cleveland Clinic Intensive Care Unit, and within the first week, I met a family that I still have like a fingerprint engraved in my mind, the picture of seeing the patient’s wife, his two daughters in the room. And he was on a breathing machine, but he was aware of what was going on, and the family was there with a computer, with a laptop, showing pictures, showing videos, laughing. I scanned the room, and in the room, there were multiple cards from friends and family that he had hanged in the walls. When I walked and I greet them, you can see that they were suffering, but they were at peace. No anxiety, no excessive stress.
I introduced myself, and I told them a brief introduction of what we know was going on and what’s going to be my job for the day and the week, and I cannot forget seeing the two daughters and the wife coming along and getting closer to me, and they told me, “You know, we understand what’s going on. My father was a man that planned everything, and he had this moment already planned. And he told us that he does not want us suffering. The best legacy that he wants for himself was the legacy that the family remain together, united, on his passing. And if he ever—” he told them, “If I ever get to the Intensive Care Unit, this is what I want you to do. Bring videos. Show them. Show the doctors, nurses, and the people around us what kind of family, what kind of people we are.”
To me, that impacted me because I had never done that before, and I had never done that with my own family, but right there, I learned that when people have things organized and when they come to understand the mortality of human beings and what is to be at peace with your own death, it is rewarding for the family, something that it cannot be explained. And to me, that changed me.
From there on, I’ve looked for that. I’ve looked for that understanding. And I think that that patient in particular, many other patients taught me what Dr. Nelson Bell said many years ago in the 1930s. I put the quote in the book. He said, “Only those [who] are prepared to die are ready to live.” So, the only those that understand that this physical body should have an end, are truly understanding that the life has limits and that you have to plan and enjoy it and live, because you know that this has an end.
TS: OK, I want to talk a little bit more about those people who might be experiencing death anxiety. I notice when I just think about your profession as a pulmonologist—just when I hear that word “pulmologist,” I feel a certain level of anxiety ’cause that means, “Oh, he is the guy who comes in when your breathing is at risk, and you might stop breathing, and that would be the end.” I just imagine so many people, when you’re talking about their loved one—their spouse, could be an elder parent, but it could be something like a child. Of course, they’re going to feel racked in some way. “The pulmologist is here in the critical care unit.” How do you talk to each of these people? You mention that you listen, but what kinds of statements can you make or questions can you ask to help people in that situation?
GF: I usually, Tami, walk into the patient’s room, and again, my first word in there is the introduction, so the people know my job, my responsibility. And the next question that I ask, Tami, is not telling them what I know, is scanning around the room and seeing who is the person that will answer my question,because usually my first question to the group is this, “Who is helping this gentleman, this lady, make decisions?” And when I identify the person, I go and ask her, “Do you understand what’s going on? What is your understanding of the situation?” And right there and then, I discover if they really understand the whole history, how involved they have been with the doctors, or how the doctors have been able to explain until that point whatever was happening.
And the reason I do that now, Tami, I can tell you that many years ago, when I began this journey of being an intensivist and a pulmonologist back home in Cuba, that wasn’t the way that I faced my patients. I walked into the room and I told them, “This is my name.” And I gave them an introduction of what we knew then about the patient. And I see this, Tami, today over and over everywhere I go in the country. People go quickly—doctors and providers will quickly to tell the families and friends or whoever is responsible, to tell them what they think. And we do not spend time asking what they know. So my first interaction with the family is to let them verbalize what they know.
From there the conversation spins into trying to fill in the gap and trying to identify areas where I have the opportunity to show them my humanity and to show them compassion, to tell them or to show that we are there for them, that our job is to help, our job is to guide and no question should be left unanswered. So we are open to listen whatever they have in their minds.
And that’s the reason I dreamed about writing this book many years ago. Because sometimes, when I open that kind of interaction, my patients came up with questions, “My family is about to die, or is in the dying process. What are the steps that we’re going to do after this? When it goes to a funeral home, where is the body going to go? What are the things that we have to do?” And as I worked and I did this over and over, I realized that it was a gap there in my knowledge, because I was stopping just in medical advice and I’d not been paying attention to the 360-degree picture of that person in that situation.
TS: Let’s talk some about what people need to know to be prepared. And this is a big focus of your book, Graceful Exit. Let’s start with the person who wants to be prepared to die. And it may not be all of our listeners, but let’s talk about our own death. “I want to be prepared to have a peaceful death and not leave a mess for my loved ones and not leave all these gaps for my loved ones to sort through.” What are the most important actions that a person can take?
GF: I would group them in three or four categories. I think there is a category that deserves attention, which is, our personal financials. And I’m going to start there, because this is an area where almost everything that we’re going to be talking is going to be ending up on that.
I think it is important if we are going to plan, when it comes to the financials, two things. We need to keep in mind if you are an adult living today in America, that you are 40 years or older—40 to 60—there is a one in three chance that you’re going to be taking care of somebody else in their 80s or 90s. So, first, financially you need to help your loved one in that.
Second, as we grow in understanding our mortality, I need to plan my own death. Financially, that means I need to spend some time in thinking about my last day. Thinking what kind of funeral that I want. Do I want cremation or not? Those are questions that are really hard. Most people don’t think about them, don’t even entertain the opportunity of planning them, but they’re so crucial. The reason that I began right there, Tami, is because financials tear apart families after the death of any loved one that has not planned that. So, the funeral, what kind of funeral they’re going to have, what kind of burial we’re going to have, all that has tremendous financial implications, and I think it is important that we think about those.
If I move it a little bit back, I will say that it is also important for the people that are in their 60s to think about long-term care insurance. It is becoming extremely popular today. And the reason that I say so is because there is one in six chances that we are going to get into a long-term care facility after the age of 65 in the next 10, 15 years, meaning in their 70s to 80s. And that is not covered by any health insurance today in our country, and is a financial stress that many families face today. That implies when we do this kind of insurance, the thinking is, “What kind of care do I want? Do I want that at home? Or do I want the skilled nursing?” Because all that has a tremendous, tremendous financial implication.
If we move a little bit going back into their financials, I think it’s important that we think about our legacy. What kind of legacy we want to leave behind? The word “legacy” is a word that most people think about people that have done extraordinary things in life and have created things that change human history. But the truth is that we all have a legacy that we’re writing as we speak. We all need to think about that. What kind of legacy I’m going to leave to my loved one? Is it going to be a legacy that is organized and planned? Or is it a legacy they’re going to have a lot of disaster after that? So, thinking about the legacy, organizing our financials, organizing our funeral, are very important steps.
And if we move it a little bit more into the time that when we are facing any health crisis and we end up in the intensive care unit. It is extremely important that we look into what are the wishes, what kind of treatments and what kind of things I’m willing to accept in order to survive or what are the things that I’m not willing to accept? And I’m speaking specifically in the so-called, legally called advance directive, where we need to determine, and is an individual decision whether I want the CPR, the chest compressions to be done to me or not.
This is something that I explain carefully in the book, because in the medical community, Tami, there’s a lot of misconceptions, and the so-called advance directive is not clear. And it’s not universally clear, meaning every single state has a different set of rules. But I tell my patients, “Forget about the rules. Forget about what the document says. Focus more on your wishes. If you know that you are critically ill, that you’re terminally ill and the chances of surviving, regardless of what the medical community can do, are limited or minimal, and any intervention that we’ll do is prolonging suffering, would you like to live like that?” Those are questions that we all need to ask.
TS: You write in the book Graceful Exit, “End-of-life wishes should be as common as sharing what’s on your Christmas wishlist.” And I thought, “Well, I’m sure that is not the way it is for most people.” And this was a plea that you make in the book. “Our end-of-life wishes should be as common as sharing what’s on our Christmas wishlist.”
So when I hear you, Dr. Ferrer, going through all of these preparations, being clear about our advance directives, being clear about our will and the funeral, I think most people have resistance to that. They’re like, “You know, I’m not going to die until I’m 90. I don’t really want to deal when I’m a young person.” One of the things you write in the book, is that even people in their 20s, you think, should make sure to be prepared in this way. What do you think is the source of our collective resistance—I’ll go so far as to say refusal—to be prepared like this?
GF: I believe, and this is something that I’m the process of actually doing some research about it—there is a history behind all this, predominantly in America. Because the phenomenon that we see in America, I would agree with you, there is a refusal to talk about this topic. It’s very much something engraved in the human heart, but in America, there is history that tells us that in the early 1800s, speaking about legacy wishes and the trust, people created those legal documents that still exist. It was part of the dinner table, people spoke about this openly. I was able to review books written in the early 1800s looking into this topic. And it’s fairly well-documented that there was a—the history tells us that it was fairly common to speak about death and planning and burial in the early 1800s. People actually chose the place that they want to die and many times they even wrote the family name before people died.
Somehow, when the industrial revolution came about, and medicine became so advanced in the last 60, 70 years, we—the healthcare providers in America—have engraved in the population that we can do extraordinary miracles. And I put that in the book. I have seen my own share of incredible miracles, even in my own family, but that doesn’t have to take away the understanding that life is limited.
My plea to the people is because, Tami, I see the aftermath many times. I see people coming back to my office months and years after, devastated. Tami, I’m going to tell you, just 15 minutes before I came to my office to have this conversation with you, I saw one of my beloved patients that I have followed her for about six years, and I followed her husband as well. She stopped coming to the office three months ago, and my team called her about a month ago, and she made an appointment. She made an appointment and she showed up today. In three months she has lost 20-plus pounds. She’s in her early 70s, and she came telling us that her husband died three months ago. She was telling us the whole appointment was speaking about the aftermath, the devastation of going through the ICU and not having things planned, the financial stress and all the things that she went through. It was all because they did not plan this process.
And as we—as a nation, our life expectancy increases, the more we’re going to see people with multiple medical problems getting to the 80s and 90s and 70s. And the more the populations grow, car accidents are still there for young people. Natural disasters are going to come and things that are going to happen, accidents—this is life. It can happen not just to the elders, but it can happen to the young people. In my book, I put examples of people that I have seen that they didn’t plan and went to an island to do a research and came back with an infectious process and all of a sudden they’re facing life and death. No plan, nothing organized. Who’s taking care of the things that people really love?
I have patients, Tami, that are in their 30s, critically ill, dying, and they’re worried about their dogs, their pets that they’re going to leave behind. Those are the things that they treasure, and we, whosoever is the family of that patient, should pay attention to that. But we all need to organize that. What’s going to happen with our family? With our friends? I believe that once we do this process, Tami, and have our things planned and organized, life gains a different meaning, and we’re free to explore, free to live. That is my plea.
My call to the population is please, have it organized. Please sit and talk to your family. And I went to the extreme of asking to do it just as your Christmas list is, because the Christmas list, people—or whatever holiday people celebrate and give gifts—a few months after they will totally forget what they got, and the value of that will disappear. But the list of things that we need to put in order before dying, are things that will have an impact for many years to come and will have an impact in the generation that follows.
If we do it right—I have testimonials, videos coming out with my book, of people that compare the family that follow the principles in our book in their own family versus people that did not. And they can see all the devastation and all the issues that there are around that. But they also verbalize in their testimonial that the person that have things organized, taught them an incredible lesson to the younger generation.
So we come up every day with new technologies in medicine, and we need to prepare our people to face the end.
TS: OK, Dr. Ferrer, you have made a very, very compelling case that each one of us should get organized around or inevitable death. To be honest with you, it’s not the first time I’ve heard this case, and I think many people have had the thought, “Yes, I really should do that. I really should figure out my medical power of attorney thing. I should really get my will in shape. I should really write down my wishes. I think I’ll do it over the holidays. I’ll do it next year. I’ll do it when we’re on vacation in six months.” It’s this thing we delay, we procrastinate. Talk to the procrastinator. How can you motivate them? I know you just tried, and you made a compelling case, but people, we procrastinate. That’s what people do.
GF: Yes, I think so too. I think we all procrastinate and we leave everything for tomorrow. But my calling to everybody that is listening and everywhere I go, if you’re listening to our conversation today, if you come across your email, your mailbox and your Twitter account or whatever place, I tell people, “Do it today! Just put down some ideas. Come up with a plan.” And the way we’re putting our Graceful Exit book together is because we want to engage the caregivers. And if you are taking care of anybody 65 and older, it is important to know that there is about 80 percent chances that they’re going to be lingering around the system. Eighty percent. It is an interesting statistic.
We know that most people say, “I want to die like that, in two seconds,” but the reality is that only 10 percent or less than 10 percent die like that. The great majority linger around the system—the hospital, the nursing home, the skilled nursing facility. I would say to the people that are listening, if you’re taking care of anybody, do it now. Help them. And in that process, I’m fairly convinced that you will come to the conclusion that it’s important that you too make a decision.
How to start? I tell my patients that if you and the loved ones, the caregivers, call your siblings or your friends, whoever is going to be your group support and put together a tea or coffee or cookies or dinner [in] your home, and bring your family and talk about this. There’s no easy way to start. Nothing more than saying, “We need to organize this because this will happen—regardless, will happen. The only way to have things less stressful and more economically sound is by sitting and facing this reality.”
In our campaign, Tami, we’re going after all the caregivers, because the caregivers are going to be responsible for the things that we’re not planning. And that’s the reason we’re going to target them. I think that historically, we have been going after everybody, and we all procrastinate, but the people that they’re responsible for taking care of somebody else today, they are in the battle, and they need to face it. So, that’s the reason we’re going after and helping the people engaged as caregivers today.
TS: How would you make a compelling case to a young person? Say someone who’s in their 20s or early 30s, and they’re like, “Gosh, I don’t have very much money. Not a big deal in terms of will. What’s the point? I mean, I’m young.”
GF: That’s fantastic. I had a presentation with a bunch of medical students years ago, and I put up this story of one our med students that I had spoken with this gentleman at the end of the day on a Friday. He was telling me that he was about to start medicine. He was in his undergrad. I met him in the hospital. He was a laboratory technician, something like that, and, he was just accepted into med school. Life was unfolding. He was 22 years old. Had a wife that was pregnant. Life was unfolding beautiful[ly] in front of his eyes.
That day, he left the parking where we were talking and he was heading home Friday night. He told me all the things that he wanted to study and the things that he wanted too, and the things that he was planning for his family. Next day in the morning, I walk into my ICU, intensive care unit, and he was there, brain dead. He was heading home in his motorcycle and he was hit by another car. Brain dead. He had a wife, he had no money, and things were not organized. We went through a week of a lot of stress with the family and friends in trying to organize things. That made me realize that that can happen to anybody. So I did a presentation, and what I did, I put a slide in my PowerPoint presentation with one of those bubble heads without [a] face. I talked about this patient. I put the slide and said, “That could be you.”
My calling for the young people is to, at least have a next-of-kin. Have somebody that will make decisions for you. If you don’t want to think or spend time thinking about your advance directives and the things that you need to plan because financially or whatever reason, its not the time in your life, but at least you should have somebody that will help them decisions. And they need to know.
I’m conducting a research, today, Tami, where we ask healthcare professionals if they have an advance directive. And 60-plus percent of them, they say no. And that is the people that they are talking out there with our patients and family about advance directives … 60-plus percent of them.
TS: Wow!
GF: They don’t have it. So it’s kind of the doctor’s blind spot, as well.
TS: It’s all of our blind spot, I think.
GF: Yes. So I tell them, “At least let’s begin with just having somebody that will help them make decisions.” And they clearly understand what are the things that you stand for and your wishes. Just begin there. I think all of us should have that.
TS: Now, Dr. Ferrer, we started our conversation talking about how you sit at the bedside of so many dying individuals, such that maybe one person dies a day in your care. That’s how much experience you have with people who are in the dying process. And one of the things I’m curious to learn about is, what have you learned from being at the bedside of these individuals?
GF: My number one lesson that I have learned from being at the bedside of my patients is to understand that all of them have an incredible thing to tell you. If not the family or friends or the patient itself., they have done extraordinary things and they are wonderful for humanity. I have learned that because I was once—Tami, I was very much involved in running and running, and just going from one patient to the other. I put that story there in my book, where I took care of a patient and we helped him through an infectious process. He was in his 90s, and I was oblivious to my surroundings. And I just want to do my job as a doctor and period, and I totally neglected an elder lady that was in the room. And that patient lady, when he improved, his wife, the patient’s wife—when the patient improved and he was ready to go out of the intensive care unit, she called me and she made me sit down and talk to her.
The first question that she asked me was, “Do you know my husband?” And I said, “Well, I know his name, his age.” She said, “Do you know my husband as a human being?” I said, “I’m sorry, but it’s been a short time.” She said, “Well, you never asked.” And from there, she went on to tell me that she was a retired critical care nurse of 40-plus years. Her husband was a very well-recognized cardiothoracic surgeon in his town. She went on to tell me all the extraordinary things that they had done in Africa and many other places. And I did not take the time to ask them about them as a human being. So, I have learned that I need to ask questions to my patients and family about them. I have learned that I have to think like them and think about the emotions that they’re going through before I phrase any question or make any comment regarding the condition. I have learned above all, Tami, that I have to sit many times and just listen, because we don’t have the answer, but just listen to them.
TS: Dr. Ferrer, I’m ready to sign you up as my doctor.
GF: [Laughs] Thank you, Tami. Thank you.
TS: One of the things you’ve talked about in Graceful Exit is how across the board, people feel the same type of regrets at the end of their life. And you put these regrets into two categories. One is time wasted away from family and friends, not spending enough time with our family and friends. And then the other category of regrets that you wrote about is not having followed a calling, some type of fear of failure. Beyond these two big categories of regrets, what other regrets do you hear people talking about at the time of their dying process, when they’re in the dying process?
GF: In the dying process, the other category that I hear, Tami, is the category of the caregivers, the families and friends. And it goes and involves around the same thing: “I wasn’t there for the birthday. I wasn’t there for the funeral of friends and family. I wasn’t there with my dad or my mom for this event. I should have made time to be there in their anniversary, honeymoon, wedding,” or whatever. And it goes back to the basics, Tami. It goes back to most regrets are linked to emotions, and emotions are driven by a human interaction; that need that we all have to be close to the people that love us and we love, that is what most people verbalize as regret.
The other goes into the mission that people have when they come to this planet. They don’t fulfill this dream, didn’t go after this. And the third one, which is fairly common, is also in the category of the bucket list. Most people—and there was an interesting study published about three months ago—most people have a bucket list. Most people today have a dream, something that is not related to family, something that is not related to work, and places that they want to go is the number one. Things that they want to do that is number two. Those are things that people have in their own backpack, and they’re carrying these things around. And people would love to do them, would love to plan for them. And I guess, because going back to your prior comment, we procrastinate, we then tend to not do them.
TS: Now Dr. Ferrer, here, knowing these regrets, I imagine that you could be as busy as you want to be in Miami, Florida, with the credentials that you have and the level of acclaim that you’ve received as a doctor. You could be busy 100 hours a week. Have you managed, because I know you have a family, to prioritize time with your family and friends? Or is that hard for you? I know many doctors are really, very, very busy people.
GF: I have now. I can tell you, Tami, I have now. At one point in my life, I was—I’m busy, don’t get me wrong, but I was extremely busy about 10 years ago. Academically, in my career, I was really close to the peak of great momentum in the things that I was doing. And I got home one day, Tami—and we all need this kind of wake-up call. I got home one day, a Saturday morning—I returned from a trip, and when I opened the door, my daughter, she told me, “Daddy, we don’t see you anymore.” And that really, really made me think, and made me plan and put my things in perspective and in order.
I went on, after that, Tami, and I learned that I have to say no to many things, and no to people that I don’t want to. And I was saying way too much yes, and taking a lot of things that I shouldn’t and not realizing that there [are only] 24 hours in a day. We always want to do extraordinary things, but we have to have priorities. I have the most incredible wife because she never complained about those things, but we together made the decision to move on. I resigned from that position that I was working, and reprioritized my life.
Still, today, I have days that I work a lot and days that I work less, but I keep that in my perspective, Tami. I keep my priorities very well thought through and organized. My family, my wife, they know that I can have a very long day, but I will make my very best and I will be there the next day, and I try to make every moment that we spend together an incredible time. And we try to do that. We fight against the things that rob our time together, against the cell phones, the TV. And we try to really, really work together as a family so that we can create really, really good memories.
TS: Beautiful! There’s a chapter of the book Graceful Exit that was very meaningful to me. The chapter is called “Grieving, Letting Go and Acceptance.” And in that chapter, you write about what you learned during a period of time when you were a medical student and you were working with the Warao Indians of South America, and how much you learned from them about letting go and releasing emotions. I wonder if you can share some of that with our listeners.
GF: Well, absolutely. I had this incredible privilege—I spent over a year in the Orinoco River, in the jungles of the Orinoco River, living with those tribes and doing some research with the United Nations University. My team of people had doctors, nurses, and anthropologists, and what I learned from the native Indians in the Orinoco was that they have lived, Tami, in such an incredible simplicity for thousands of years around the river. This is a community, one of the few communities that never evolved into planting anything. They are gatherers, which is the number one thing that people have done through history. So they never evolved into planting and anything like that. The jungle is so rich in fish and animals and vegetables, and they live out of that. And they have lived out of that for a thousand years.
So this people have a great interaction with nature, number one, and number two, a lot of family interaction. And that simplicity—when I saw them grieving somebody that died, it was a family event. It was a community event. It was something that was suffered by everybody. That truly impacted me, because right after that I came to this incredible country and I began to study and I went to redo my internal medicine rotation. My first rotation ever in America was in the critical care [unit]. I think that God planned that for me. And I landed in that intensive care unit, and I saw a lot of people without anybody. I saw the disconnect between us and the caregivers and the doctors and everybody, and that really struck me. I was going back over and over it, and I still do it, Tami. I dream about my days over there. It was an incredibly beautiful interaction between people and the nature, the created nature there.
TS: It sounds like in general, if we were to make a cultural generalization that the Warao didn’t suffer from the same kind of death anxiety that you see Western people suffering from in the face of a loved one dying. Do you think that’s true?
GF: That is absolutely true. I think that’s a great summary, because they don’t have the technologies, the hospitals, the machines. They accept death, and we do not.
TS: And what do you think we could learn from them in terms of that acceptance? What do they know that could help us? Is it because they know how to grieve in a different kind of way?
GF: I think they know that life is terminal. They don’t have any experience with hospital technology that can prolong life, or suffering, or whatever way we want to call it, so they have learned that life is terminal and grieving is part of life. And that they have passed from generations to generations.
I believe that what we can learn is, this is a topic that we don’t have to talk about this every day if we don’t want to, but it’s a topic that should be a common conversation between friends and family. Understanding and grieving is part of life, and death is part of life.
TS: There’s a quote from Graceful Exit; You write, “My belief is that the more we allow ourselves to talk about death and to treat it as part of life, the more naturally we will respond to the inevitability of it.” So here we are in a culture where, in general, we don’t talk about death that much. And if you do, people think you’re morbid, or an overplanner, or something like that. So what I’d be curious about, Dr. Ferrer, is, what’s your vision for a culture that is so comfortable talking about that death that we’re prepared for it? What does that look like?
GF: I think that that would look like—again, it’s not going to be perfect, but I think my dream with beginning this journey, writing this book and planning for some others, is to create a culture that when we talk about death, we also talk about legacy. And when we talk about death and we talk about legacy, then we start thinking about the things that we do. And we’re going to be thinking also about planning better, because the two are going to go together. And when we plan better and we think about death and we think about our legacy, we think about what things we are teaching as we go to the rest of the people around us.
We all have 20, 30 people—most people, there are other people that have thousands and millions of people—that they impact with their actions. But if we go to the simplicity, to the 70 [to] 80 percent of the population that can impact 20 people, if each of us talked to the people that we love the most and we tell them, “This is inevitable. This is something that will happen. These are the financial, the medical, and pain consequences that you can avoid,” I think we’re going to be facing a society that will take more responsibilities of the things that they do. We’re going to have a society that is going to be more comfortable managing health care-related issues. And we’re going to have a society that is going to be using better the resources that were given to us.
Tami, this is something that is really engraved in my heart. I’m coming from a country that [with] one-third of the money that we [in the US] use for a person, we can cover 250,000 in my country as a healthcare. I just can’t imagine how many great things we can do if we used the resources that were given to us better, and how many people we’re going to be able to bless around the planet.
TS: A final question for you, Dr. Ferrer. What’s your thinking, planning around your own legacy?
GF: I want to be a physician. I’m a doctor. I love what I do. I want my friends and my family to remember me as a doctor that focused on people and helping others. My goal in this life is to help as much people as I can. When I die, that’s what I want people to say about me. I don’t want people to say anything about me financially or anything like that. My focus is to help others as much as I can.
TS: I’ve been speaking with Dr. Gustavo Ferrer. What a beautiful doctor and human you are! I feel so lucky to have had this conversation with you. I feel your care and your tenderheartedness. Thank you so much!
Dr. Gustavo Ferrer is the author of the book Graceful Exit: How to Advocate Effectively, Take Care of Yourself, and Be Present for the Death of a Loved One. Thank you so much for being on Insights at the Edge.
GF: Thank you, Tami.
TS: SoundsTrue.com: many voices, one journey. Thanks for listening. And go ahead and get all those documents done. Get them done now. Go ahead, get them all done!
