Dr. Bob: Well, hello and welcome to another episode of A Life and Death Conversation. I'm Dr. Bob Uslander, the founder of Integrated MD Care and the host of this series of podcasts.
I have a very special guest with me today. All of my guests are special in some way or another, but Faye Girsh is a phenomenal woman. She is truly a ... I don't know. Some people I've heard to describe her as a marvel and an inspiration, so I'm thrilled to introduce you to my dear friend and co-conspirator, Faye Girsh.
Faye Girsh: Hello, Bob. If you're looking for a wonder woman, I'm not it, but I'm very happy to expound on our mutually interesting subject.
Dr. Bob: Fantastic. And many people would argue that point and would call you a wonder woman, because you've had a fascinating life, and I know a very interesting career, and the things that you've devoted yourself to and committed yourself to are of great importance to many of the people who are listening, because this is a life and death conversation and to me, you have really lived a very inspiring life, and you never shy away from the conversation about death. And you're somebody who has really devoted herself to helping others have the best possible experience of life and as well the best possible experience of death.
Faye Girsh: Thank you for all that.
Dr. Bob: And thank you for all that you've done, because what I get to do in my career, some of what gives my life and my career a great meaning is a direct result of the work that you've done over the years.
Faye Girsh: It's very encouraging now that there are so many people working on this very important issue for all of us.
Dr. Bob: And the issue that you're referring to it's called by lots of different things. When you're talking to somebody about what it is that you do and what you've devoted so much of your life to, what are the words that you like to use to describe it?
Faye Girsh: I guess choices at the end of life, if I have less than 30 seconds, that people should be able to die the way they want to, in a humane and peaceful way, with their friends and loved ones present, and consistent with their own values and beliefs. That's the 45-second version.
Dr. Bob: Actually, I think it was probably closer to 20 seconds, and it's-
Faye Girsh: 20 seconds, okay.
Dr. Bob: ... very descriptive and appropriate, I think.
Faye Girsh: It sounds very simple too, and it's definitely not simple. In fact, the progress towards it is absolutely glacial because many people don't believe that we should have a choice in how we die, which to me is amazing and also very unjust, unfair.
Dr. Bob: Yeah. I agree. And you can spend a lot of time exploring how we got here, and I'm sure there's some value in that because it helps those of us who really do believe that people deserve to have that choice in how, where and when they die. It helps us to see where the challenges remain, by looking at the barriers and the things that have been blocking that-
Faye Girsh: You know, I'm reading an interesting book now, Bob, called Modern Death. I don't know if you've seen it. By a Pakistani American doctor named Haider Warraich. I don't know how you pronounce his name exactly. But he talks about how the way we die has changed so much in the last 50 years because of technology, insurance, hospital, everything.
It explains a lot to me about how things have changed from when I was a kid, and the doctor would make house calls, and I assume that if we were dying, he would have given us a nice injection and sent us on our way, with the agreement of the family, but it's a long way from that now. It's a little bit back to what you do when you visit people at their homes, which is so unusual these days.
Dr. Bob: That does sound like an interesting book, and I'd like to make sure that the listeners have the resources that our very experienced guests are recommending. So "Modern Death" is the name of that book?
Faye Girsh: Yeah.
Dr. Bob: I'm going to pick up a copy. I appreciate that.
Faye Girsh: Subtitled "How Medicine Changed the End of Life". Very interesting. I haven't finished it yet. I don't think he is necessarily a proponent of medically assisted dying, but he certainly leads up to where it should happen. Because I do think that probably 40 years ago, your GP – there weren't specialties then – your GP would come to your house and if you and your family decided that your suffering was unbearable, something in his black bag would help you through to the other side, just to use all these euphemisms.
But that's changed, and the laws have changed. The laws are changing for the better for sure, as far as giving you more choice at the end of life, but it becomes very legalistic and formalistic. And maybe that's good because now there are safeguards, but when men safeguard, they're another man's obstacles. It has become cumbersome and complicated sometimes for people to have a peaceful death.
Dr. Bob: Well, it seems like it used to be a pact between the doctor and the patient and family. We didn't need all the legislation; people trusted that their physician was going to be there and help them make those difficult decisions knowing it was time.
We also didn't have all the other options available. We didn't have all the intensive care units with all of the life-prolonging technology. We didn't have skilled nursing facilities, where people could be housed for months or years-
Faye Girsh: Well, actually we didn't even live that long. We didn't live long enough to have a prolonged and agonizing death. We didn't die of these degenerative diseases that we have now.
So, yeah. I mean, this book explains a lot of that, but this is something that we've sort of accustomed ourselves to over the years, ways to keep people alive.
Faye: I live in a retirement community. I'm 84, and it's getting close myself, and it's very interesting for me to see people, my friends, get old, get disabled, wind up in the care center, or the memory unit at worst, and die quietly.
We really don't know how the end comes for most people unless they are very close friends. And then we get a little picture frame, and a white rose in the mail room and says we died. No telling how we died, or what we went through before we died. And then a little obituary says he died peacefully in his sleep, which is usually a lie. And then a little tombstone says, "Rest in peace," but before that, sometimes there is no peace, and sometimes these steps to getting dead are very difficult.
Dr. Bob: Yeah, as I'm aware of through my own experience and career. That's an interesting ... it's really fascinating to think about that, living in these communities, many of which are very nice, right? They're beautiful. They're like luxury hotels or cruise ships.
Faye Girsh: They are. Right.
Dr. Bob: And then there are all these folks who come to the dining room, or you see them in the common areas, and at the activities, and then you just don't see them anymore.
Faye Girsh: That does happen. Or you see them on walkers, and then in wheelchairs, and then you don't see them. Or if they're your neighbors, they move to the care center, which we have a very nice arrangement. And then the next thing, sometimes as you know, is their little picture and white rose are up there in the mail room.
It's fine. It's a good way to experience death. We don't talk about it very much here, but I've appreciated knowing that, because in my life I wasn't among people who were dying, but now, that's what happens. And what I hope is that people can die the way they want to.
And I know you spend time here too and you know the people who live here. They accomplished a lot. We say our motto in Hemlock Society is, "Good life, good death," which we actually stole from Christian Bernard, I think, who wrote a book. The heart transplant doctor wrote a book, I think, called Good Life Good Death.
And many of us here have lived a very good life, but we often don't have a good death... I've only been here four years ... but who went out to [inaudible 00:10:00] parking lot and shot himself because he had early dementia. And other people who've struggled with dementia then wind up in the memory unit here for years.
In fact, we're having a situation now with my very good friend, whose wife has been there I think now eight years. And they have treated her without consulting the family, but now the family has put their foot down, absolutely no treatment. So she gets nothing. No vitamins or anything. And she's never been healthier. And finally, the family's decision to withhold food and hydration. And of all the things that have happened, is the caregiver has protested and said she would sue the institution here for murder. So, that's a very interesting development.
Dr. Bob: I wasn't aware that was happening.
Faye Girsh: Well, if I were at lunch now, which I usually would be, I would be talking to this man whose wife it is and trying to enlist one of his children to speak at one of our Hemlock meetings on this subject, which is the refusal of treatment in dementia. A very complicated subject, because a demented person can't speak for herself or himself, but the loved ones can, the person who's been appointed as health care agent can. But often those wishes are violated.
I will have another speaker at our January meeting, whose mother-in-law has been in the institution. Those who know Bonnie, was once a very active, beautiful, intelligent woman, and they had been coerced, shamed I guess is the word, into providing treatment for her twice, because she has to have her hip fixed because she fell. She has to have her ulcer treated. Even though she knows nothing it is has made an advance [inaudible 00:12:18]. She doesn't want treatment.
So these things are very complicated, refusing treatment, medically futile treatment that's given so often. And hospice is not saying that they can fix everything, but really they can. They can fix a lot of the pain even, but alone the existential suffering that people have because they can't do what they are used to doing, they don't want to be doped up at the end to alleviate the pain. They want a peaceful way out, and yet they either don't know what's available to them, or they can't find a doctor who will help them use even our California law, The End of Life Option Act.
So we have a long way to go. We are about to finish our 30th year as Hemlock Society of San Diego, and we're looking for new directions to go in. And for me, dementia is the direction because it seems so hopeless to be a long-time demented patient with no way out.
Dr. Bob: That is just ludicrous, to think about that when there are so many people, there are so many people who, as you say, lived wonderful lives, they raised children, they had careers, they contributed, and if they were able to look at the scenario and to see what's happened to them and what's being done, and you ask them what they would want, we know that they would want to not be there.
Faye Girsh: That right.
Dr. Bob: They would be ready to ask somebody to mercifully end their lives. And I'm a physician, and I know that there are laws that prohibit that, and we can't just take it upon ourselves. And even if people have indicated that they would never want to be alive in those circumstances, our hands are tied. But it's just a crazy, crazy situation-
Faye Girsh: Fortunately, we can look North and see what Canada is doing. And Canada is making much more progress than we are, which is not surprising of course. But the Canadian law that went into effect the same time the California law went into, that is June 2016, permits active euthanasia. That is a patient can ask for a lethal injection. It's so much better than what we have to struggle with, these expensive bad-tasting drugs that you have to be able to swallow, to use. That's not such a good solution.
And also, Canadians have made their laws much more liberal. That is, it doesn't just take a doctor to do it. A nurse practitioner can help you die that way. And in our law in California, you have to have a psychologist or psychiatrist to ascertain that you are mentally competent, and another doctor to determine that you are terminal, in addition to the first doctor. But in Canada, that's not the case. A lot of different people can ascertain that you're mentally competent.
And again, it doesn't have to be a doctor to provide the lethal injection. And the criteria is not a terminal illness as ours is, which to me, it is not even relevant to the question of how much you're suffering, and how long you've been suffering, and how long you have got to suffer.
A terminal illness means you're going to die within six months, which in some cases is a mercy, but some of these neurodegenerative diseases take years of suffering before death occurs.
So, I think we have to look to Canada to change our laws. And we've had the Oregon-type model as our model law now in six jurisdictions, five states in the district of Columbia, but that law has existed now for 20 years. To me, it's inadequate, and it's time to move forward and to look at what other countries are doing.
And then, there's a whole collection of ... No, that's not true. There are some doctors and some organizations, and I'm thinking in particular of Doctor Philip Nitschke, who started in Australia and was the first doctor in the world to give somebody euthanasia at their request, under a law. And that was back in 1996. He's now living in Holland, but he doesn't believe that we should try to change the law at all. He believes that people should be able to do it yourself, get what's necessary, whether it's drugs or mechanical devices or whatever, and do it ourselves because he knows that doctors are resistant to doing this and the law is very slow to change.
That's one point of view. I don't totally agree with it. I think it's very helpful to have somebody there, somebody with an organization like Final Exit Network, to be there with you, and certainly a doctor to be there with you if you can find a cooperative doctor like Doctor Bob Uslander to see you through this, because it's not just a one moment decision, you swallow something and you're dead. It's a decision that should be decided over months with consultation with your loved ones. But that is very difficult and complicated in our country.
Dr. Bob: All of this is complicated for sure, so I appreciate you sharing your passion, and your viewpoints on this.
If it's okay, I want to make one slight correction to one of the things that you indicated, about the process for the End of Life Option Act in California, in that it doesn't actually require a psychiatrist or a mental health specialist to weigh in-
Faye Girsh: No. You're right.
Dr. Bob: Only if the attending physician or the consulting physician feel that there is a mental health issue or a psychiatric issue that is impacting the person's ability to make a decision.
Faye Girsh: You're right. It doesn't happen very often actually-
Dr. Bob: No.
Faye Girsh: That a mental health professional is required to make the decision about competency. I think in Oregon has happened very few times. We have-
Dr. Bob: Yeah, because a physician is-
Faye Girsh: Better data from Oregon than we have from many places else. We have 20 years of data that the government of Oregon has collected. No, you're absolutely right about that, Bob.
Dr. Bob: Again, thank you for sharing. We definitely have strides to make. I think we both are feeling grateful that we have come to a place in California where people do have more choice and more options, but we do still need to continue pushing forward.
There are still some issues and problems with the existing law. It doesn't address the needs of the people with cognitive impairment and dementia, and those are really challenging situations.
Faye Girsh: And doctors are not being educated about what this law entails. I have a new primary care doctor that I talked to the other day at Scripps, and she didn't know anything about it. There's never been even, not only a policy described by Scripps but no education about the law at all. She didn't know what to tell me. She's going to find out and tell me later.
But this is not acceptable. This is a law now, and even though everything is voluntary, so it's completely voluntary on the part of the doctor, the patient, the hospice, the pharmacist. That doesn't mean that people shouldn't be educated about it, and that's what we try to do in Hemlock.
I just gave a speech to bunch of elder law attorneys, and before that to an Episcopal convention. And the more people we can talk to the better, but that's a drop in the bucket compared to the people who don't know what their rights are. And some hospitals have gone all out. Kaiser's very helpful in that respect, but my hospital, Scripps Clinic, they don't seem to know anything.
It requires a massive educational effort, and it requires a little more cooperation and enthusiasm on the part of doctors and institutions, and definitely on the part of hospices. I think it's a disgrace that no hospice that we know of in this county will actually provide a doctor to do this for you. Many of them will refer to you, which is fine, but I think hospices should be able to assure a patient who comes for hospice care that if their suffering becomes too great, or they've had enough, that somebody will help them achieve a gentle death, which is what happens in Canada now, especially in Quebec, which has been the leader in this. The formally very Catholic province now, very progressive. And in Belgium and Holland. Their hospices will also provide peaceful death, voluntary euthanasia, but not ours.
Dr. Bob: Not ours.
Faye Girsh: And ours maintain that they can do everything in make dying fine for you and many of them can. I have no question about that. But for many people, there needs to be another option.
Dr. Bob: And I always think about that when we hear from the palliative care and hospice folks, who are all very well-meaning, and compassionate, and they make it very clear that if the suffering becomes too great, then we can medicate people into unconsciousness. It's called palliative sedation, where you get medication so that you're no longer aware of your surroundings, no longer feeling pain, no longer feeling like you're struggling to breathe. And once you get medicated to that level, you will no longer be able to eat or drink, you won't have any nutrition, and eventually, you'll die of dehydration.
And I understand that that is possible, and we for years have been doing that for or to patients. And my response to it is, if somebody has another option if somebody has the option of actually taking something on their own that will prevent that from being necessary, that they have the control, they get some of their power back, why wouldn't we want to make that available to them?
Faye Girsh: I have debated that with so many hospice directors and doctors and nurses. I can't understand why the answer is not as simple as you make it.
I mean, palliative sedation is very nice. I remember debating one hospice director, I guess she was, and she said, "No. Doctors should never help their patients die, never." But later she said, "When I see a patient in intractable suffering ..." well, she said pain, initially, but she was talking about suffering, " ... then, of course, I will administer something that will relieve them, and they won't wake up." Isn't that what I just said? No. Because the doctor has control over the decision, not the patient.
Dr. Bob: Exactly. And I believe that's-
Faye Girsh: And that's wrong.
Dr. Bob: That's where the big divide is. The medical profession has so much ego, and we are unwilling to give control away. So instead of giving the patient and the family the ability to be empowered to have the option to act on their own, to make this determination, we need to do it for them or to them. We don't believe that people have the intelligence or the ability to make this determination of what's in their best interest.
Faye Girsh: I'm not a great critic of the medical profession because I was married to one and I have given birth to one, and I like doctors very much in general. I've always liked the doctors I've had. It's some kind of paradox. I guess it's like politicians, you like the one you have, but then generally they're no good.
I don't know what they need, education or something, and they need to be assured that they're protected from the law, because even though this law that we have, The End of Life Option Act, is clear that if a doctor does this, he or she is fully protected under the law.
Somehow doctors don't believe it, and – again another generalization about what doctors think or do – they don't like to be bothered. There's a lot of paperwork ... you know this ... involved, there is not just, "Let's see. I write the prescription. Goodbye." You really should attend to your patients; you should find out what's going on with them.
So they should be involved, and they don't want to be involved because that's not their job. I just saw a cartoon recently that said, "I'm a doctor, and I believe in preserving life at any cost." And the cartoons said, "Make sure you don't get that doctor."
I mean, it's very nice. I do like people who are pro-life but up to a point. Up to the point where the patient says, "Okay. Death is not the worst option here. Staying alive under these conditions is worse, and I want to die gently and peacefully. And I don't want it to be a big secret, and I don't want to jeopardize anyone by helping me. Let's do it."
And there's certainly more places in the world that are enlightened about this than we are.
Dr. Bob: And I believe we're moving in the right direction as we both stated before. We have a lot of work to do, but we don't want to discount the fact that we are certainly in a better position than we were a couple years ago here in California.
I try not to be critical of physicians. Many of my very good friends are physicians. I have spent a lot of time with some amazing physicians, and I think in general, doctors really do care a lot about people. They go into the profession because they're caring, and they want to help, and they want to do good. And it's not that they, in general, don't want to be bothered. They don't have the time; they're not allowed to have the kind of time that it takes to do this well.
Many physicians are still very uncomfortable with the whole notion of death. When you go to medical school, and in your training, you would assume that there is no such thing as death because it's really never talked about. The textbooks don't mention anything about death. It's all about what we can do, how we can utilize the technology available to us, how we can do the right screening and prescribe people the-
Faye Girsh: To prevent this from happening.
Dr. Bob: So the training isn't there. A lot of people, I think, have to go through their own personal experience, they have to go through their own personal journey. Maybe have their own epiphany about what their role here is, and how they can best serve their patients.
Faye Girsh: Bob, present company excluded, I don't think doctors need to be the agents of a peaceful death. In fact, when I was head of the National Hemlock Society, I started this program called Caring Friends where we educated our peers, older people like us ... I mean, I'm talking about the members of the Hemlock Society now, not you ... to work with people in their homes and tell them what means they could use to achieve a peaceful death, short of getting the drugs necessary.
And there are many means. And of course one of them is not eating and drinking, but that's not the one we advocate. I'm talking now about the national organization called "Final Exit Network," which I was one of the founders, and that emanated from the Caring Friends program that I started at Hemlock. And we knew that doctors were not going to help, that we're not going to be able to get these drugs, which is the gold standard, but there are other ways.
Now I'm using my Final Exit Network hat here–the guys at Final Exit Network teach people how to die peacefully, not using drugs, but using other means, which essentially lowers the oxygen in the brain, which causes a peaceful death but doesn't require drugs.
And there's an organization, a very loose organization, called Nutech, which has been working on this now for years, maybe 15 years, also started by Derek Humphry who started the Hemlock Society, New Techniques in Self-Deliverance. And I just went to a Nutech meeting in Toronto, where people from all over the world were there. It was a $5,000 reward for people who could come up with the best inventions so that people could do it themselves and die peacefully.
So we're a long way from making an ideal situation, but there are situations that people can use, but that's not enough. I always gave the prototype of an 85-year-old woman. I'm about to be that. But an older person who's alone, who's sick, who may be partially blind, who is not mechanically inclined, a limit to what they can do to do this for themselves.
So we do think that people should be there with them, and that's what they do in Final Exit Network. The Exit guide is present when people use these methods, and coaches them in how to use them. And we think we're covered under the First Amendment, but there's some litigation going on, which has challenged that assumption.
Dr. Bob: Not surprising.
Faye Girsh: No. But there are books, and videotapes, and YouTubes telling you how to end your life peacefully. And that certainly has its drawbacks because we don't believe that ... I mean, I am a psychologist by training, and I've worked with a lot of suicidal people, who with therapy have come to realize that suicide is not the answer to their problems. And it isn't.
And there's a fine line between assisted dying and suicide, but generally, people who want help in dying would much prefer to live, but because of their disease or condition find that dying is preferable to living that way, whereas suicidal people don't want to live. They want to die. That's the difference.
So if you make these methods available, then suicidal people have access to them, and that's arguable too. I mean, maybe it's better that they die peacefully than jump off bridges, as one of my very good friends did, or shoot themselves, as another very good friend did, and they could choose to die peacefully. That's a whole another discussion.
Dr. Bob: Yeah. That's a whole another discussion. And I'm just thinking about, as I'm hearing you speak and discussing these topics that are certainly not part of the mainstream conversation that people are having, I'm just imagining that there are going to be people listening to this, who are squirming and feeling uncomfortable about these topics. And you know what? And that's okay.
Faye Girsh: No doubt.
Dr. Bob: These are things that we all really should explore and try to determine our own comfort level with them, and hopefully become more comfortable engaging in the entire spectrum of conversations about life and death.
Faye Girsh: The Hemlock Society of San Diego, which has existed now for 30 years, is at a juncture of where to go next. We can continue having meetings and having speakers and everything else, but we do have to tackle these very naughty issues. And we are tackling them. Maybe we're the only organization in town if anywhere, that is doing it, but it does make people squirm. But we have a lot of people come to our meetings. They're all free. They're all open to the public, and they all deal with different issues about dying.
To one meeting we had three veterinarians who talked about how they can help animals dying. It's so nice. Everybody was so jealous they wanted to grow two extra legs and a tail and be one of these animals that die in the arms of their loved one, peacefully and gently. A little shot in the paw and that's it.
And then I've been a defender of Jack Kevorkian all these years. I thought, when he showed how his patient Tom Youk died, to 60 million viewers, that was a good thing, that we don't see people actually die and we don't even die on ICUs, or even in hospices. We don't see them junked out with drugs for days on end. We never see how people die except fictional, machine guns and that kind of thing.
To see somebody get a lethal injection, keel over and he's dead, and how simple that was, and how desperately he longed for that relief from his ALS. This was the last patient that Doctor Kevorkian helped. And for that, Doctor Kevorkian spent eight years in prison doing a 10- to 25-year sentence that he got.
For a doctor to come out and say this is what's important for doctors to do ... and the thing about Jack Kevorkian was there was nobody in the world practically, unless you were in the middle of a jungle somewhere, who hadn't heard of him, who didn't have an opinion about him, and who hadn't heard from his own patients why they wanted to die.
And that kind of education thought, at that point, when Jack Kevorkian was I think in his seventh or eighth year of doing this, 75% of Americans believed that people should have assisted dying from a doctor. That's gone down considerably, because people don't hear about this, they don't engage in the dialogue, their doctors don't talk about it certainly, and it's up to us, the Hemlock Society of San Diego, and a few other organizations, to discuss this openly, so people know what the issues are.
Dr. Bob: On that note, I think we're going to kind of wrap it up, but I do want to make sure that anybody who is interested in getting more information about anything that we've spoken about, that you've shared, has direction on how to get that information.
I want to thank you for being a pioneer and for dedicating so much of your time and energy and money to this effort. There are many, many people who are indebted to you and have gratitude for the work that you and your tribe, your peers have done.
Faye Girsh: Thank you very much, Bob.
Dr. Bob: You're welcome.
Faye Girsh: I'm getting to the point where a peaceful death is becoming more of an immediate issue, so I'm working extra hard, but I'm very glad you're around. Very comforting to me and many other people.
Dr. Bob: And seeing you and being around you, you have vital energy, and I don't think it's going to be dissipating anytime soon.
How do people learn more about the work that you're doing?
Faye Girsh: Well, we have a website that's very informative, HemlockSocietySanDiego.org. And that will give you our phone number, which is 619-233-4418. We have, of course, an email address, which is ... I'm not even sure what it is.
Dr. Bob: I'm sure they can get it off of the website, right?
Faye Girsh: The website has all this information. And people are welcome to get on our email list to get a notification of our monthly meetings. And they're welcome to come, no charge.
Although we will be having special meetings, I think now, for Hemlock members that we don't particularly want to share with the public, but that's another issue. Because we want people to be empowered the best way they can about ways to have a peaceful death. And not only for them, but we're having more young people come because their parents are dealing with this issue, or not dealing with it.
Dr. Bob: And I've been to meetings, I've spoken at the meetings, and there's a wealth of information, and really some pretty incredible people there. I find that the level of intelligence and acceptance among the people who are really paying attention to these issues is very high.
Faye Girsh: Yeah. And you've gotten to know some of them.
Dr. Bob: I sure have.
Faye Girsh: The ones that have had a peaceful death with your assistance. Maybe that's not the right word, but I don't know-
Dr. Bob: That's fine.
Faye Girsh: ... one has to be a very good-
Dr. Bob: With my guidance.
Faye Girsh: Guidance is a good word.
Dr. Bob: And I've shared with our listeners some of the experiences that I've had and how powerful they've been.
And the more people that I'm able to support and be with, the more strongly I feel about helping to spread the message and allow more people to understand how they can get this control, how can they be empowered when their life is coming to an end, and they're just like many of the people we've discussed. They're just not okay allowing this natural decline to decimate them further when they have a more peaceful, gentle option available.
Faye Girsh: Thank you for doing this, Bob. And thank you for doing the podcast. I appreciate having an opportunity to talk about this.
Dr. Bob: Yeah. Well, you're so articulate and passionate, and I look forward to our next conversation together.
Faye Girsh: Absolutely.
Dr. Bob: This is Doctor Bob Uslander, A Life and Death Conversation, until next time.