Cathy Spatuzzi is a yoga and fitness instructor who works with Integrated MD Care. She shares how she helps patients and her views on why she doesn't fear death and, instead, makes sure she is living in every moment. Books on End of Life Being Mortal, Atul Gawande Knocking on Heaven's Door, Katy Butler Find more in this blog post, here.
Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text. We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print.
TranscriptDr. Bob: Hello and welcome to A Life and Death Conversation. I'm here today with a good friend and a really valued member of my Integrated MD Care team Cathy Spatuzzi. I'm very excited to introduce you to Cathy and to hear some of her insights. Cathy and I have known each other for a bit, and we've shared some incredible experiences with our patients. We're going to touch on some of those, let you know what Cathy does and how she does it because I think she's really quite an expert in her field and I know that she loves what she does. So, Cathy, thank you for being here and joining us. Cathy Spatuzzi: Hello, Dr. Bob. Thank you for having me. Dr. Bob: Yeah, my pleasure. It's great to see you. I'll share that trying something new, our podcasts, the ones that I've done previously have all been recorded on the phone. Today Cathy is in the office, and we're doing it together. It's really nice to be able to look at her in the eyes as we do this. Cathy Spatuzzi: Yeah, I agree, face-to-face is very nice. Dr. Bob: Yeah. So Cathy is … her title is yoga and fitness instructor. I know that there's probably a lot of yoga and fitness instructors out there who work in various capacities but that doesn't really begin to explain quite what Cathy does because I've seen her in action and I've seen the results of her work. It's nothing short of magical; I have to say. Cathy goes in and works with some of our sickest and most frail patients. She works with people who have dementia. She works with people of all ages and abilities. They don't even know they're exercising. They actually just think they're playing games and meeting a really cool, fun, person. So Cathy, can you just share a little bit about how that happens, what you do, how you approach your patients and just share a little bit about how that magic happens? Cathy Spatuzzi: Sure. So I got my yoga instructor certificate, and I started teaching seniors. I took an extra class in teaching seniors, and I really loved it. Then I met Dr. Bob, and I've always been a physical exercising person myself, and so I've made up my own little program where I go into a person's home, and we have a whole hour of exercise. So we do physical weights, and whatever that person needs at the time, that's how I meet their needs. So we do dancing, we do marching. I bring some music sometimes. I have little balls that we do exercise with. They're bright and colorful. We play games with the balls. I also have just blown up regular balloons, and we hit the balloon back and forth and play a game that way. A lot of people that used to do tennis or volleyball, they remember that, and their muscles and cells remember that and they really get a lot of fun exercise just hitting the balloon back and forth. They tell me lovely stories. Most of my people are 80 to 90, some are a 100 years old, and they tell me fabulous stories. They all have a very positive attitude in life. Dr. Bob: I've met with people, I've been there after you've been with them and it really is pretty dramatic. A lot of our patients, because a lot of times they don't feel well, they don't have a lot of energy, they're dealing with pain, they're dealing with other challenges, and exercise is not something that they necessarily prioritize or look forward to, but that's not the case with you. They obviously don't feel like they're doing exercise. They don't feel like they're working. There's something else. There's another piece that obviously you're bringing to it, which, to me, it feels like you're just really connecting with them very deeply and appreciating them as human beings, and the exercise just happens as on the side. Cathy Spatuzzi: Yes, I agree. I don't think of it as exercise myself. I go in, and I have fun, yes, and I connect with that person one-on-one, find out what they like, what else do they like, then I bring that in with them. Dr. Bob: We've shared a couple of patients that had had some pretty remarkable experiences, people who were not expected to live more than a month or two who through combined efforts have gone on to live for a couple years, people who were not walking who are now walking half a mile to a mile without difficulty. Can you share maybe a little bit about what that's like for you to be part of that? Cathy Spatuzzi: It's a gift. I love all my clients, but to work one-on-one and to see a person that was maybe almost on their deathbed to come back and is living and they want to have a life. One of my sayings is motion lotion. If you don't move your body, you're going to get stiff, and you're not going to feel like moving so let's just keep moving. Some of my other seniors that are more fit, that's what they say, you have to keep moving, you have to keep moving, you have to keep moving. So I keep them moving. Dr. Bob: You keep on moving, and you keep it fun. Cathy Spatuzzi: Yeah. Well, you have to have fun in life, so why not bring it to your work? Dr. Bob: Yup, I agree 100%. So this is A Life and Death Conversation, and part of what we're trying to do is give people just a look into how we can have an easier time talking about topics that can be difficult: death, illness, debility. So as an example, we are doing that there. We're talking about things that might not come up in normal conversation. I, as you know, go right to the point. I don't mince words. I don't hold back a whole lot. I just want to ask you and get some of your personal perspectives on some of these things, if that's okay. Cathy Spatuzzi: Sure. Dr. Bob: All right. Tell me, do you have … and this is a question I ask all my guests. Are you afraid of dying? Cathy Spatuzzi: No, I'm not afraid of dying. Dr. Bob: You're not afraid of dying. Cathy Spatuzzi: No. Dr. Bob: Well, why? Can you share why you're not afraid of dying? Cathy Spatuzzi: My maternal grandmother always talked to me about death. Dr. Bob: Really? Cathy Spatuzzi: It wasn't morbid. It wasn't like, "Oh, I …" I don't know, she just always talked about it. It wasn't something under the covers. Dr. Bob: Just kept in awareness of it in the home? Cathy Spatuzzi: Yeah, like when somebody died, we'd talk about it, or when- Dr. Bob: Okay, how healthy. Cathy Spatuzzi: Yes, uh-huh (affirmative), and so I think I've just adopted her attitude and calmness about it. For me, thinking about dying, I think about living. So I'm alive. I can walk and talk, and do all these beautiful things, but let's be present doing it. If you're just walking through life in a fog, then you're not living, but when you think about you're going to die, maybe that's a point where you're going to wake up and start being present in your life. Dr. Bob: Do you feel like thinking about dying, talking about dying is responsible for you having a greater awareness of and maybe gratitude for life? Cathy Spatuzzi: Yes. I think I have gratitude every night before I go to bed. Dr. Bob: I guess, not being dead is a part of that, right? Cathy Spatuzzi: Right. Driving around and you see the beautiful clouds. You might see an airplane. Let's take each moment for today because maybe you will die tomorrow. Let's be grateful for what we have today, not think about what if, what if, what if it's going to happen. I pray that I have a beautiful day and then I have a beautiful meal and then I go to sleep and die. Not tomorrow. Dr. Bob: Not tonight, yeah. Cathy Spatuzzi: Not tomorrow. I got- Dr. Bob: Because I know you have some things to do this weekend. I know you have some plans. Cathy Spatuzzi: I know, yeah. I have plenty more years ahead of me, but that's what I've always thought about, nice and peaceful. Dr. Bob: Beautiful. Interesting. We both are spending time now with people who believe that they may not have a lot of time left, some of them because they're elderly and some of them because they have a terminal illness, and in some of those conversations, I hear people talking about how their time is so limited. Occasionally, they get into this pattern of feeling bad about it, and I wouldn't say necessarily feeling sorry for themselves, but focusing on how their life is going to be shortened and they're aware of that. I always accept that. I never try to convince them to think differently. That's their thought, and I would never judge that, but what I'm aware of is that there's no guarantee for any of us. I may have a patient who has a prognosis, a life expectancy of three or four weeks. There's a lot of people who are going to die unexpectedly before that person dies. We may be one of them. We have no guarantees, and so focusing on what we have today like you're talking about like you're suggesting being grateful for the fact that we are alive and that most of what's going on in our life is good, may not be perfect. Jon Kabat-Zinn, the creator of the mindfulness-based stress reduction program, had a phrase that I love and I repeated often. It's, "As long as you're breathing, there's more right with you than wrong with you." Cathy Spatuzzi: Yes, I agree. Dr. Bob: Yeah. Cathy Spatuzzi: That's beautiful. Dr. Bob: Sometimes if somebody is lamenting about the pain that they're having, the limitations that they're having, just remembering how many trillions of things are happening simultaneously in our body, the chemical process, the cellular division, the fact that everything is working as it's designed to, except for a few things, which could be significant things, it's still a magical design. Cathy Spatuzzi: Yeah, the body is an amazing piece of work. Dr. Bob: Yeah, and you're doing a great job of keeping it amazing. Cathy Spatuzzi: Thank you. Dr. Bob: Yeah. Cathy Spatuzzi: I love working with the clients, yeah. Dr. Bob: Yeah. Some of our clients die, right? Cathy Spatuzzi: Yes, they do. Dr. Bob: Yeah, they do. How do you deal with that? Cathy Spatuzzi: It's difficult at first. Dr. Bob: Because you spend more time with them even than I do. You're with them sometimes two or three times a week and getting very close, getting very connected with them. Cathy Spatuzzi: Yes. When they die, going into this though, I mean that's part of life, and I knew that but when they die, I go into myself and remember all the good times that we had together, but then that also brings up for me my own experience with my own family and dying. So then it's almost like I grieve all of them: my parents, my grandparents, a friend all over again, which isn't a bad thing. Yes, it's sad and, yes, I cry, but there's another layer of deepening, of healing, of comfort for me. Dr. Bob: So when a patient dies, when somebody who you've been working with a client, it sounds like you're allowing that experience to create another layer of connection with other people who have gone before them, with your family. It allows you to grieve all of death, all of the people who have gone. Cathy Spatuzzi: Yes, I grieve all of the people that have died that I know and then I think about where did they go … all the same, questions come up for me. Where did they go? Where does the spirit go? Where does the soul go? Where does the brain …? I've read a lot of books, and I still don't have any answers. Dr. Bob: Oh, darn it. I was hoping that you were going to give me the answer now. Cathy Spatuzzi: No, I don't have any answers, and that's okay. I'm comfortable with that. Dr. Bob: So you don't know but what do you think? Where do you think … what's your thought about what happens after we die? Cathy Spatuzzi: Well, I believe that the physical body dies. I would like to believe that there is an after realm, rather you call it heaven or reincarnation. Those are the things I don't know, but it would be nice to see some people again that have gone before me. Dr. Bob: So you're not positive. Cathy Spatuzzi: No, I'm not positive. Dr. Bob: What percentage of certainty are you that there's something else? Cathy Spatuzzi: 50/50. Dr. Bob: 50/50. Cathy Spatuzzi: Yeah, and I'm comfortable with that. It's because I've thought about it so much. Dr. Bob: Well, if there is … Oh, that's nice. You're like right on the 50-yard line there. So if there is something else, then that's great, and we'll be hopefully very pleased to find out, and if there isn't, well then we will never know, right? Cathy Spatuzzi: Right. I've asked some of my relatives that were dying. I said, "Now, when you get wherever you're going, wherever that is, give me a sign." Dr. Bob: And? Cathy Spatuzzi: I haven't gotten anything. Dr. Bob: You haven't gotten anything. I have. I think I've shared that, my dragonfly connection. Cathy Spatuzzi: I did have a feeling, but not necessarily like a physical sign, like a picture or something, but I've had feelings of my grandmother touching my hand. I knew it was her. Dr. Bob: Yeah. Cathy Spatuzzi: I knew it was her. Dr. Bob: Okay. So then- Cathy Spatuzzi: So maybe yeah. Dr. Bob: Yeah, I'll go with that. Cathy Spatuzzi: Yeah, yeah, yeah. Yeah. Dr. Bob: Cool. It's interesting because there are … I hear that people are very uncomfortable talking about death. I hear that all the time. People don't want to talk about it. They want to ignore it, pretend it's never going to happen. I don't have that experience with people, and maybe it's just because I draw it out. But in the conversations that I or maybe people who … Maybe those people like walk away when they see me coming; I don't know. But I actually find that people want to talk about it and given the opportunity, they're drawn to the conversation. It's interesting because I find some people want to talk about a bad experience and maybe it's because I'm a physician and I make it safe, but they want to share how traumatic this was and complain … not complain, but just put it out there and it seems like it's little cathartic when they talk about how difficult an experience was. Then there's another group of people who were really transformed by a beautiful experience around death and dying of a friend or a loved one, and they also want … it's cathartic for those people as well. I find it really fascinating how much people want to have this conversation when it's brought up in a way that's safe, and someone clearly wants to hear what they have to say, what their thoughts are. Cathy Spatuzzi: I have found that some people just need somebody else to listen. They haven't found that person, and maybe that's you. Dr. Bob: Yeah, maybe, maybe. I'll tell you that sometimes my wife, Sandy, it gets a little overwhelming for her because she's with me and we'll be either at dinner, we'll be at a party, and I start talking to somebody and she goes away and comes back, and we're deep into this conversation about how their mother passed away or the complexities of certain situations. I just find that that's sort of a natural thing that's happening. Cathy Spatuzzi: You have a gift. Dr. Bob: I don't know it's a gift, but it's an interesting phenomenon, so. Cathy Spatuzzi: Yeah. Dr. Bob: Do you have any experiences that were either challenging or really beautiful that you want to share? Cathy Spatuzzi: My maternal grandmother, Jenny, she was 80 years old. She fell and broke her hip. I was her guardian because my mother had already passed away years ago, which is a whole another story. But I was in the nursing home room right beside my grandmother, and she was dying. I could see her coming in and out of what I call crossing the veil. She wasn't exactly sleeping, but she was testing the veil and then coming back. She'd come back, and she'd say, "Oh, Cathy, you're here," and then we would talk and I was able to tell her how grateful I was for all the time that I got to spend with her closely after my mother died. She said, "Oh, I want to die," and I said, "Okay, I don't want you to suffer. It's okay." She said, "But I don't want to leave you." I said, "Grandma, it's okay. I'm going to be fine." Then the next day she died. So, and I've heard this similar kind of story from several other people and the person that's dying just needs permission. Dr. Bob: But you weren't there when she actually died? Cathy Spatuzzi: No, I wasn't in the room when she died. I was there the day before. Sometimes they don't want to die with you in the room. Dr. Bob: Yup, that happens frequently. Cathy Spatuzzi: Yes, yes. Dr. Bob: Which is hard, which is a challenge because you don't want to leave. A lot of times people don't want to leave. They feel like they're supposed to be there through the very end, to the last breath, and it's hard to know what's happening. So there are times when someone does step away, they go to the bathroom, they run out to get something for somebody, and they slip away, and that's the way it's meant to be. Cathy Spatuzzi: Yes, I agree. Dr. Bob: Yeah. When you describe … what was the word you used? Cathy Spatuzzi: Crossing the veil or testing, testing the veil. Dr. Bob: Crossing the veil. Testing the veil. Can you share a bit more about that? What made you believe that she was testing the veil and not just like napping or falling asleep briefly? Cathy Spatuzzi: I can't describe it any other way, but I could feel her body, her spirit, not really her physical body, but her spirit, her soul, and I didn't … I could see something but it's kind of this feel-see type of a thing, and I knew she wasn't exactly sleeping because I could feel it going out, this energy, and then coming back in. When she would come back in, you would see her body be more alert and then she'd open her eyes and then we'd talk a little bit and then … I could tell if she was sleeping versus doing this testing. Dr. Bob: Fascinating. Cathy Spatuzzi: Yeah. Dr. Bob: Yeah. Cathy Spatuzzi: It was great. Dr. Bob: That's great, yeah. I hear about, read about and I've seen people who I believe are in that place. Testing the veil, I haven't heard that description, but I like it. I truly believe that as people get closer to death, they're in two worlds, right? Cathy Spatuzzi: Yes. Dr. Bob: They cross. They slip back and forth. So if we really believe that, then it certainly gives us a little bit more comfort and assurance that there is something on the other side because that's what they're testing, that's what they're exploring. I've seen people in the last moments or hours of life reaching out, talking about people who they see, loved ones, and I know that a lot of people would write that off as hallucinations, as due to medications. They're not really there. But I completely believe that they are making a connection with the spirit world and those who they are going to be reunited with on the other side. I can't prove it. I know that there are books written about it, a number of good books, and we can put some of those resources on the website to share, but I implore people, I welcome you to read some of these things because it really does provide quite a bit of comfort. If you're uncertain or you're worried about everything just ending or what might happen after death, reading about the experiences of people who fully believe that they were on the other side and came back to be able to tell about it can be very reassuring. Cathy Spatuzzi: Even the people that have been in terrible car accidents and then they've been rushed into the surgical room, and they have a story that they're up on the ceiling watching their body being operated on and then after that, they come back in, and they come and tell their story. Dr. Bob: Yeah. Cathy Spatuzzi: So, yes, it seems like a very pleasant place. Dr. Bob: Yeah. Cathy Spatuzzi: Yeah, but I guess- Dr. Bob: No, I don't think I have ever heard anybody come back and say, "Wow, that was really bad. I mean that was like fire and brimstone, and I don't want to go there." Of course, as a physician, I'm supposed to be very scientifically minded. I know there's a lot of cynics, a lot of skeptics, and everyone is welcome to their own beliefs and opinions. I choose to believe that there is something beautiful waiting for us and you have the ability; we have the ability to access it on this side. I do believe that the walls become more permeable, the closer we get to death. I feel that comforts me and apparently, you've had experiences where you feel the same. Cathy Spatuzzi: Yes. Yes. Dr. Bob: Yeah. So I just want to ask one last question before we wrap it up. What's most important to you in life? Because this is life and death. We talked about death. We've also talked about the way that you enhance people's lives, which is incredible. But for you personally, what is the most important thing for you in life that makes life really beautiful for you? Cathy Spatuzzi: Being present as best I can in the moment and being kind to myself and being kind to others. Dr. Bob: That's a good way to be, and you are doing that incredibly well. Cathy Spatuzzi: Thank you, Dr. Bob. It's a pleasure. Dr. Bob: Yeah. Thank you for being with us. I look forward to having you back on another time if you're willing? Cathy Spatuzzi: Sure, yeah. Thanks for inviting me. Dr. Bob: All right, you have a good day. Thanks, everybody for tuning in. Cathy Spatuzzi: Bye. Dr. Bob: Bye-bye.