Are you afraid of dying? Is it something you even think about? What if there’s an emergency, and you don’t have a choice…do you want to be on ventilators, tubed up and kept alive no matter what? And what about your parents, family, etc…do you talk about death, or is it hidden away? Yes, these are hard questions, but they are critical ones!

Thankfully, in today’s episode, Dr Gary Shlifer, our first ever return guest, is back for a practical, inspiring conversation about the inevitable end facing us all. So, if you’re ready to feel empowered and informed about your choices and response-ability when it comes to death and dying, this episode is for you!

Welcome to We Are Already Free, the podcast empowering down-to-earth seekers to embody authenticity and be the change. I’m Nathan Maingard, empowering wordsmith and transformational guide. If you are done with being trapped in the drama loop of doomscrolling and hopelessness; if you’re ready to live a meaningful life with people who celebrate your sovereignty, then join us as we release limiting beliefs to embrace the freedom within.

Dr. Gary Shlifer is the founder of Evolve Healthcare, a private medical practice in Los Angeles that focuses on disease prevention and lifestyle optimisation. He specializes in preventative care, nutrition/metabolism, and anti-aging medicine. Dr. Shlifer is also a co-founder of SAPIEN, an organization focused on promoting health education and advancing health information technology. His professional affiliations include Regal Medical Group, InMode Medical Aesthetics, and the American College of Physicians. Dr. Shlifer is passionate about promoting healthy living, eating, and lifestyle practices, and he has experience with hospital inpatient medicine to help prevent and cure disease for his patients. He also has deep personal experience with hospice care, and is actively supporting initiatives to empower people to be more empowered in navigating these challenging life experiences.

In this episode, Dr Gary Shlifer shares:

  • Why having the awareness and experience of death is the great equaliser and can bring us all together
  • How to develop the skills and maturity required to process death and live life fully
  • Why death should be a part of everyone’s life
  • How to make empowered decisions about end of life care
  • Why so many people in healthcare choose the DNR (do not resuscitate) option for themselves in an emergency
  • Why Dr Gary thinks assisted suicide should be an option, and the practicalities around that
  • Near the end, Gary shares a deeply moving story about the power of having, or giving up, responsibility for our lives… (this is a super important one for any people pleasers out there)
  • …heaps more…

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[00:00:37] Nathan Maingard: Are you afraid of dying? Is it something you even think about? What if there's an emergency and you don't have a choice? Do you want to be on ventilators, tubed up, and kept alive no matter what? And what about your parents, your family, et cetera? Do you talk about death, or is it hidden away? Yes, these are hard questions, but they are critical ones!

[00:01:00] Nathan Maingard: Thankfully in today's episode, Dr. Gary Shlifer, our first ever return guest, is back for a practical, inspiring conversation about the inevitable end facing us all. Thank you so much to all of you listeners who reached out and said you'd like to hear this conversation happen with Gary. It's happening because of you.

[00:01:19] Nathan Maingard: So if you are ready to feel empowered and informed about your choices and responsibility when it comes to death and dying, this episode is for you. I'm so excited that Gary is returning and has returned for this episode. Thank you so much, brother. I really appreciate your presence. Although this conversation is about death, I really encourage you to view it from a place of curiosity, a place of excitement.

[00:01:42] Nathan Maingard: it's not heavy in the way of depressing. It's heavy in the way of enlivening, enlightening, returning to life. Through the awareness of death. So I really invite you to sink into this. It's a very practical, very rooted, very grounded and important conversation about death and dying and the gifts that it brings to us.

[00:02:01] Nathan Maingard: Welcome back to We Are Already Free, the podcast empowering down to earth seekers to embody authenticity and be the change. I'm Nathan Maingard, empowering wordsmith, and transformational guide. If you are done with being trapped in the drama loop of doom, scrolling and hopelessness; if you're ready to live a meaningful life with people who celebrate your sovereignty, then join us as we release limiting beliefs to embrace the freedom within.

[00:02:30] Nathan Maingard: Dr. Gary Shlifer is the founder of Evolve Healthcare, a private medical practice in Los Angeles that focuses on disease prevention and lifestyle optimization. He specializes in preventative care and nutrition, metabolism, and anti-aging medicine. Dr. Shlifer is also a co-founder of Sapien, an organization focused on promoting health education and advancing health information technology.

[00:02:55] Nathan Maingard: His professional affiliations include Regal Medical Group, inmode Medical Aesthetics, and the American College of Physicians. Dr. Shlifer is passionate about promoting healthy living, eating and lifestyle practices, and he has experience with hospital inpatient medicine to help prevent and cure disease for his patients.

[00:03:13] Nathan Maingard: He also has personal experience, a lot of personal experience with hospice care, and is actively supporting initiatives to empower people to be able to navigate these challenging life experiences, which is why I've got him on the podcast today.

[00:03:28] Nathan Maingard: In this episode, Dr. Shlifer shares why having the awareness and experience of death is the great equalizer and how it can bring us all together.

[00:03:37] Nathan Maingard: How to develop the skills and maturity required to process death and live life fully. Why death should be a part of everyone's life. How to make empowered decisions about end of life care. Why so many people in healthcare choose the dnr, which is the do not resuscitate option for themselves in the case of an emergency.

[00:04:01] Nathan Maingard: Why Dr. Gary thinks assisted suicide should be an option and the practicalities around that. Near the end of this conversation, Gary shares a deeply moving story about the power of having, or giving up, responsibility for our lives and the end of our lives. This is a super, super important one for any people pleasers out there, gives you an indication of the direction it can head, and as always, we talk about loads more, which I'm not gonna fit in here, you can just hear it.

[00:04:29] Nathan Maingard: You can find links to Gary plus many of the things we talk about at That's 36.

[00:04:37] Nathan Maingard: A huge thank you to my sponsor for this episode, Zencaster, the ultimate web-based podcasting solution. I've saved countless hours since I moved over to their platform. If you're thinking about starting a podcast or already have a podcast, but maybe struggle with the time and the technicalities of getting good recordings, I personally recommend Zencaster. Zencastr's Modern podcasting stack allows you to do everything you need for your podcast from record to publish in one place.

[00:05:06] Nathan Maingard: I particularly love how it allows me to record in the best quality, even though the internet connection in my off-grid solar powered studio is not the most stable. It records tracks locally and then it uploads them for maximum backup and safety. If you've ever lost a recording, you know how much it sucks when that happens.

[00:05:25] Nathan Maingard: So thank you Zencaster for solving that problem for me. Their automatic post-production save me hours of work and makes me and the guests sound amazing. Go to That's And use my code, WEAREALREADYFREE and you'll get 30% off your first three months of Zencaster Professional.

[00:05:48] Nathan Maingard: I want you to have the same easy experiences I do for all my podcasting and content needs. It's time to share your story.

[00:05:55] Nathan Maingard: And now please enjoy this heartfelt, sincere, and deeply supportive conversation with Dr. Gary Shlifer.

[00:06:04] Nathan Maingard: That's actually prompted a thought cuz cuz you know, just seeing your wife bringing you a cup of something delicious. And this is one of the things that Carly and I, well I think about a lot and I, and I do speak with Kylie about it, is like, you know, I intend her to be my partner for the rest of my life or, you know, whoever goes first.

[00:06:19] Nathan Maingard: But, and I know technically we're still very young, like it should be a long time away. But I think about it like that there's gonna come a time where one of us is gonna have to say goodbye to the other. And then stay behind for a while. And I even, I just feel sad even talking about it, but it's like such an important thing, I think because I don't know, I, I wanna honor so much this life we're sharing and it's, in a way, it's the most beautiful thought that we're gonna end up in sometime old and one of us saying goodbye with that like massive pain of farewell.

[00:06:53] Nathan Maingard: And based on our last conversation, I feel like acknowledgement of that depth of that authenticity is missing in the way that most of society is currently, or at least Western society, is navigating death and dying. And I would just love to hear you speak to that and then to moving from there into, you know, what, what are our choices around how we can consciously meet the fact that we are all gonna die sometime?

[00:07:18] Nathan Maingard: And that we could do that consciously if we chose, if we get the choice, obviously.

[00:07:22] Dr Gary Shlifer: I think about that a lot too, Nathan. I've been married for four years and I, this is my partner for life and, what does it look like when we get old? or if we're lucky enough to get old together, you know, anything can happen, I've been a hospice doctor now for about seven years, and for me having a relationship with death, having the experience of seeing death on a regular basis, and having this realization that everyone dies and everyone, no matter their ethnicity, their financial status, their background.

[00:07:53] Dr Gary Shlifer: The dying experience is something that is shared by everyone. It's very, very similar, the process. People go through the same battles, the same thoughts, the same struggles. You know, like you were, you were saying, your feeling of heaviness and sadness, even at the prospect of it. Right? It's appropriate.

[00:08:12] Dr Gary Shlifer: You're supposed to feel that way. You're supposed to, and, and you're not supposed to run from that feeling. You're supposed to embrace that feeling because it's that feeling, that this is a finite experience, that it's finite for every single person. It should bond us. It should unify us as like human beings, as as people together, because that is on some level, this great equalizer. You know?

[00:08:35] Dr Gary Shlifer: Everyone always tells me, oh, it's so he heavy. You're dealing with death, all the time. It is, but it's actually a tool that makes me so grateful for every second and makes me really appreciate moments that I may not appreciate. And, and look, it's like anyone else.

[00:08:52] Dr Gary Shlifer: You get caught up in life and you forget and you take things for granted. But when you are faced with death every day, it re, it's a constant reminder. And I think that's something that is terribly missing in our society. It used to be a hundred years ago and before that for all of human history, that people died in their homes or they died in front of each other.

[00:09:16] Dr Gary Shlifer: Now people die in hospitals, more and more in hospitals and nursing homes and in these sort of sequestered environments. Death has been separated from our daily lives, and I think that, that's unfortunate because it, it's such an important part of life. It gives so much perspective.

[00:09:32] Dr Gary Shlifer: It's the heaviness, the sadness, the fear is the counterpoint to the day-to-day life so that you can enjoy the freedom, sun, the hugs, everything. Right. Without that yin and yang, you're left just consuming, consuming, pursuing, good things and pleasure and avoiding discomfort, and you're left feeling hollow.

[00:09:54] Dr Gary Shlifer: So this, you know, we've had this conversation about stressors and creating acute stressors. I don't know, never thought about it before, but maybe that's an emotional stressor, thinking about death and processing death. And embracing death. It is, it's an emotional stressor. That's a fun way to think of it.

[00:10:11] Dr Gary Shlifer: And the more you can present that acute emotional stress to you, the more resilient you'll become. Uh, when you're actually faced with, you know, a loved one, a family member, someone close to your, or someone you care about, passing, and you have skills and tools and experience to process that in a mature way and a healthy way.

[00:10:33] Dr Gary Shlifer: Um, don't know if I answered your question, but I think that's like. This critical message, uh, that I think we connected with on the podcast is that I think is that death should be a part of our education to children. It should be a part of everyone's life and not in this way. If someone got shot on tv, you know, there's this also this Sort of graphic glorification of violence that we experience on tv and it's mirrored in movies and shows and things, and it's death without the experience of dying, right?

[00:11:04] Dr Gary Shlifer: It's the bang, bang, it's quick shot to the funeral. Everyone inquires for 20 seconds and it we move on, right? It's not the reality of death for most people, which is most often a longer drawn out process, body becomes incapacitated, limited functional status, more and more help with activities of daily living, brushing your teeth, eating, pooping, all that stuff.

[00:11:31] Dr Gary Shlifer: And that process is really what dying looks like for Mo the majority of people in in America, in the Western world. And, there's no connection to that. Like, so when I talk to people, when, you know, a loved one is coming on hospice service, or I have a patient that's discussing, it's like talking to a blank slate.

[00:11:49] Dr Gary Shlifer: I mean, I'm talking often to, you know, the children of these folks which are in their forties and fifties and they've, they have no idea about any of that. So you spent 40 or 50 years on this planet with zero experience with death for the most part, right? That's not really preparing for life, right? That's not preparing for reality.

[00:12:10] Dr Gary Shlifer: And these rami, this disconnect, the ramifications go on and on because hundreds and hundreds of thousands of people die from cardiovascular disease every year. We don't worry about those. A virus happens and some people start dying. It's scary. I'm not talking about covid, I'm talking about like, you know, whatever is going on acutely.

[00:12:29] Dr Gary Shlifer: The flu season is bad and everyone freaks out, right? but hundreds of thousands of people are dying from cardiovascular disease. We've accepted it. We've integrated cuz we don't see those people. Those are people dying in the hospitals, in the ICUs after cardiac procedures, after heart attacks, we are disconnected from it.

[00:12:47] Dr Gary Shlifer: And that is, Contributing to this sort of disconnect from what to be a hu healthy human being because we don't see the end point of obesity and diabetes and heart disease. That happens in the hospital. And often even the family members aren't present, they're not involved in that process. So that's why I think it's very important we talk about, death in a healthy way and, and it is sad and embracing the sadness, but there's also a beauty to it because of the way it can connect all of us.

[00:13:19] Nathan Maingard: Thank you so much for what I think is a, is a very beautiful entry into this place. It's one of the things I noticed in our conversation initially, Uh, and you even said that, you were very clear. You're like, I don't think anyone is gonna want to hear a conversation about death.

[00:13:33] Nathan Maingard: And I was like, I'm sure that people will, like this has gotta be, and I had, because we mentioned it in the episode, I had a good few people reach out and be like, I want to hear the conversation about death. So, I, I really understand what you're saying. I hadn't thought of it that way before. Around movies, you know, where we see the, we see death as like entertainment where it's like, oh, the bad guys died, or, or the good guys ally died.

[00:13:55] Nathan Maingard: But it's like so quick and it just, it flies by. And my only experience of very, very close death, that was like in my daily life, I've lost, you know, family members here and there and, but all at a distance. Whereas my dog, Sassa, I think I mentioned, but she ran away. And so I ne we never found her. So like that experience as well was just heart-wrenching because of the lack of closure.

[00:14:18] Nathan Maingard: And in a way, I imagine that that's kind of what many people in society are experiencing subconsciously because the person who's sick goes off somewhere and then just never comes back. And, and then there's a funeral and it's like, I don't know. Is, is that something that you, you, you feel, or you, you witness?

[00:14:36] Dr Gary Shlifer: No. Absolutely. I think that's the whole point of hospice care. So something listeners should know, is maybe, a good frame of reference, right? Is why is hospice growing? What is hospice maybe, and why am I interested in as this alternative thinking doctor that does lifestyle medicine?

[00:14:53] Dr Gary Shlifer: Well, in my eyes, hospice is lifestyle medicine. In the beginning of life or as you're trying to get, go through life, you want to stay healthy, healthy, staying healthy, doing things to be healthy is a lifestyle medicine, right? The idea that we're not, we don't need pharmaceuticals. You could use them from time to time, it's fine, but you don't need pharmaceuticals.

[00:15:13] Dr Gary Shlifer: You need to live a healthy lifestyle. Behaviors, food, all the stuff we again talked about in the last podcast.

[00:15:19] Dr Gary Shlifer: Then there's the middle of life where we start worrying about disease more and more and more. Fifties, sixties. Right. And that, that's, you know, that's that main part of western medicine care that, we all think about.

[00:15:31] Dr Gary Shlifer: And then it's the end of life, right? Where disease processes have see, run their course. The body is frail. The mind is frail, and the. General approach of Western medicine over the, the decades, uh, since really before the nineties is, basically continue aggressive care. And this idea that hey, if we can, we should, if we can put a tube in and put 'em on a ventilator, we can.

[00:15:57] Dr Gary Shlifer: And, and so, US would spend more and more and more and more money, at the last six months of life without any improved outcomes. In the nineties, the Institute of Medicine released sort of a study, with recommendations to start promoting hospice care because people were suffering, money was wasted at the cost of people.

[00:16:19] Dr Gary Shlifer: So we were not just spending all the money, we were also causing suffering and not helping anyone. Symptoms reportedly controlled... a huge mess, and this was like 97, 96. Hospice came to be as a result, they started paying insurance companies, Medicare, all of this. in 2014, they released another study, Dying in America.

[00:16:39] Dr Gary Shlifer: it's a great quick read. you could, guys could look up the summary and it sort of just talks about all the issues with end of life care, how hospice and palliative care have been transformational in keeping people at home, giving people a chance to have their symptoms controlled. Not go to the hospital, not go to nursing homes, supporting families, not just with medical care, with spiritual counseling, with support from physicians and nurses and chaplains and a whole multidisciplinary team. Creating that access to be more quick, more responsible.

[00:17:15] Dr Gary Shlifer: And so, over the last few decades, you've seen, an increase in hospice and palliative care as a result of these initiatives, as a result of this evidence-based me, uh, medicine approach. and I joined, sort of this a concept. I was in residency in 2016. I, I understood end of life care, palliative care.

[00:17:35] Dr Gary Shlifer: It really struck me as an underserved opportunity to help people. I was like, look, there's a bunch of you guys. You wanna do all your heart stents and GI procedures and figure out all these, cancer treatments. And I'm like, great. That's for you guys. I get it. I'm not really interested. I really love my clinic and I really love helping families and patients go through the transition process because no one seemed to be doing a good job of that.

[00:17:59] Dr Gary Shlifer: When I was in the hospital and I was in training and I was watching these doctors and residents talking to families, and I was sitting there with my jaw on the floor like, how can you talk to people like this? For one half of the stuff you said is a lie. Those are not true about the prognosis. You know that as well as I do and the family and you're just trying to make 'em feel better.

[00:18:18] Dr Gary Shlifer: I don't like that you don't lie to families to make them feel better. There is something very powerful about being a physician and being in a position where you can prognosticate. The reality with end of life it's very hard to prognosticate end of life. It's just very, very difficult. But with an experienced physician, you can say when things are looking, that you should start focusing on comfort, and you should feel comfortable making that recommendation.

[00:18:45] Dr Gary Shlifer: In an attempt to protect your patient from suffering, from terrible procedures, from hospitalizations that lead to infections and, and, and, uh, skin tears and, and just the plethora of, of trauma to the patient. And it, and I felt like, man, not enough people are understanding that just because we can, we should also know when to be honest and say, this is not a good idea.

[00:19:09] Dr Gary Shlifer: We need to transition from a goal of extending life at any cost, doing everything possible to a comfort care approach and a comfort care approach is something that a lot of people misunderstand. So a lot of people think that if someone joins a hospice service, that we're stopping all the medicines, we're not treating anything, and we're gonna make the patient die very quickly.

[00:19:32] Dr Gary Shlifer: That couldn't be more far from the truth. If you gave it even a second of thought, you would understand that that's like bizarre and illegal and weird. And maybe you've heard some terrible companies doing that, but it's obviously not what the Institute of Medicine is talking about and what all Medicare is supporting financially and what all of these organizations are trying to do.

[00:19:52] Dr Gary Shlifer: Right. Or it's not, uh, some big giant hustle to kill people. That's fun. That's weird. It's weird to think that it, it's illogical. What it is, is a system that helps people avoid suffering induced by aggressive medicine interventions that have very little to zero benefit potential. It's a giving families and patients a choice to step out of the western medicine process and enter still within western medicine, but enter a treatment plan that is more focused on symptom management, fast re response, because symptoms in these situations are difficult to manage.

[00:20:33] Dr Gary Shlifer: And a comfort care focus, avoiding hospitalization, avoiding interventions, and essentially having the opportunity to comfortably die at home with your family at bedside, with your loved ones around in your environment. That makes you feel comfortable because that I, I think that's the most dignifying and sort of respectable thing I can do for someone.

[00:20:55] Dr Gary Shlifer: When, when an older person who is nearing the end of life is like, I don't want to go to the hospital. Do not put any more catheters and tubes in me. Just keep me comfortable and I want to stay home. I feel like once you ask for that, we should be able to deliver that within our means. Obviously there's situations where you can't, but if I can, I think I'm doing a very special thing for someone at the end of their life.

[00:21:18] Dr Gary Shlifer: And I don't think that being a doctor or being a healthcare professional is all about extending life. It's about helping a person accomplish their goals. And look, that question really opens the doorstep. Some intense stuff like, physicians assisted suicide, which we can talk about separately.

[00:21:34] Dr Gary Shlifer: But look, my goal, my, my perspective really is that a person gets to pick how they, how their life looks. They get to pick how the end of their life looks. We don't tell them what that looks like. And so, yeah, I think it's really important. I'll just summarize it and, you know, hospice care is about comfort care focus, and it is about following a patient's wishes and providing them the kind of care that at home that is consistent with what they want.

[00:22:01] Nathan Maingard: Yeah. Well that's, so this is, leads me onto a question around, cuz for many people listening to this, this might be a kind of new thing and wanting to support people in, in being able to move forward wherever they are in the world, however that looks, but, Could you maybe share some of the ways that patient, uh, uh, not patients, but that people who are nearing the end of their life and their families, some of the ways that they can make empowered decisions when it comes to that end of life care.

[00:22:26] Nathan Maingard: Like, what are some of the, the first things someone could do after this conversation?

[00:22:29] Dr Gary Shlifer: Most people haven't heard the term, but an advanced directive. An advanced directive is a document that basically states what it is you want done in an emergency situation. Now, an advanced directive can also be part of other legal paperwork, like, um, there's trust documents. People will create a trust.

[00:22:46] Dr Gary Shlifer: And that will incorporate an advanced directive. Certain medical organizations will create paperwork. So the advanced directive tells you what it is you want done, and there's a second form that is a pulsed form, which is literally saying in an acute situation, I want to be defibrillated. I want to be put on life support, like a breathing tube.

[00:23:06] Dr Gary Shlifer: I want feeding tubes. Or I don't want any of those things. Or I just want A, B, and not C. You can pick. So those are documents that you can create and I, I actually suggest anyone at any point in their life do it one time just to kind of go through this thought process and emotional process. What would you put here?

[00:23:27] Dr Gary Shlifer: because eventually you're gonna, it, it makes obvious sense, if you're like in your sixties and seventies, of course you should be doing that. If you have a parent or someone in your family that's clearly declining or clearly is getting closer, they don't, doesn't mean they have to die tomorrow, but in the next whatever, 10 years, having those documents.

[00:23:47] Dr Gary Shlifer: Makes, allows that person to ex express their wishes, to family, to the healthcare system, to the courts, even, very clearly if they're not able to make those decisions. So that's really important if you have someone who's losing their memory, because when someone has advanced dementia, they can't fill out that paperwork.

[00:24:06] Dr Gary Shlifer: So it's early in, in the forgetfulness process that a fam that I encourage families to start talking about this. So when we talk, when any, healthcare professional speaks with a family or a patient about what happens at, at the end of life, uh, that's called advanced care planning. So advanced care planning is now reimbursed by insurance companies, by Medicare because it was identified as such an important and powerful component of healthcare.

[00:24:35] Dr Gary Shlifer: Those conversations are essentially about the questions in those forms. So what would you want done an emergency? Who do you want to assign? You know, there's like a power of attorney who, someone who is in charge of your legal matters. There's a power of medical authority. So someone who's in charge of medical decisions, sometimes that's different people.

[00:24:55] Dr Gary Shlifer: Right. Sometimes that could be the same person. I guess again, to try to bring some levity to the situation for providers and people that deal with healthcare all the time and see what Western medicine can do to people. So many of us are like, look, I'm dnr. DNR means do not resuscitate.

[00:25:10] Dr Gary Shlifer: Do not intubate. Because we know that once you get put on a ventilator and all this crazy stuff happens to you in an emergency, the chances of coming back are like with any kind of quality of life are very small. I'm not saying it doesn't happen. I'm just saying there's almost, once you get exposed to the system, day in, day out, day in, day out, you can ask your friends that work in the hospital, nurses and stuff, there's this joke like, Hey, I'm dnr.

[00:25:32] Dr Gary Shlifer: Leave me alone. Don't do that stuff to me. Right. it's funny because then if you ask a layperson who's never thought about death, who's never watch, Someone become critically injured and goes through the ICU process and goes through all of those interventions. If you ask them, well, what would you put on that form?

[00:25:47] Dr Gary Shlifer: They're like, what do you mean full code? Uh, save me by every measure possible. I, I wanna live. I wanna live. It's not really a question of whether you wanna live or die when you get down to it, it's a question of what do you want to happen in an emergency situation? And that becomes a little bit of a deeper.

[00:26:06] Dr Gary Shlifer: Next essential question, what would you be okay with if something bad happened? Would you be okay living on a ventilator for the rest of your life? Would you okay being, being on a feeding tube and being fully dependent on some caretakers to take care? These are questions. Most people, they, it doesn't even crop...

[00:26:24] Dr Gary Shlifer: I'm sure it's the first time you've thought about it. But this is something that healthcare providers, nurses, caretakers are, are dealing with every day in nursing homes and boarding cares and convalescent homes around the country. And that's what I'm saying is th that experience is very separated from families.

[00:26:41] Dr Gary Shlifer: Often families shows up, they see their family member, they spend an hour or two with them and they're out of there. Right. Or they take their family member on a trip, outside of the nursing home and they try to like remind them what the real, you know, what life was like before, but that merging of what true end of life process is, what it really looks like in a modern world today and, and what people should expect and, and should think about it, that that's very rare.

[00:27:09] Dr Gary Shlifer: And so it's really fun when I meet families that have thought about it a lot because we can get into some spiritual conversations, some more Theoretical stuff. As of someone who, who sees a lot of death and what I, you know, guidance I could provide them spiritually, essentially, as opposed to the vast majority of the guidance I'm providing is actually education.

[00:27:29] Dr Gary Shlifer: I'm educating families of what it looks like for a patient to go through dementia, advanced dementia, and the problems that occur, or someone who's got advanced C O P D and their lungs are failing, and what that looks like, someone who's got heart failure and their heart's slowly failing, and that's a very bizarre, strange process to watch.

[00:27:49] Dr Gary Shlifer: Liver disease is a very scary process. So all of these things are something that I'm familiar with. I know what it looks like and I'm educating families. if people spend more time to think about it, then we can think about, then we get to talk about the spiritual, what it means. You know what, and that's, I think, also very important cuz that's how you find peace.

[00:28:09] Nathan Maingard: Well, can I, I wanna jump in here and just, there's a question that, that's coming up about this is that, cuz you've seen this so many times and you've been through this I love hearing like how mu how, how wonderful or how much better or, not pleasurable, but how, I guess more authentic.

[00:28:24] Nathan Maingard: You, you get to explore a different state of being when, when a family has prepared and you get to have a different kind of conversation. And so, If you could lay it out and maybe there isn't a single one, I know it'll be different for different people, but if you could map out the kind of ideal end of life process for a person who is passing, who is, who everyone knows is going to be passing sometime with quite soon, and for their family and loved ones.

[00:28:47] Nathan Maingard: Do you have a sense of w how you might like map that out if you had the the choice to be the one mapping that out?

[00:28:52] Dr Gary Shlifer: that's a great question and I try to encourage that all the time. And basically what I, the dream situation is if you have a loved one, I'm gonna again use an elderly person, not someone who's young with cancer. Those are different situations. Young traumas, the vast majority of of people are elderly, right?

[00:29:09] Dr Gary Shlifer: We have a huge elderly population. And what are they dying for? Brain disease. Heart disease, lung disease. Slowly, slowly. It's not like they're just come going down. It's, it's this process. So the, my, my dream situation is when a family has a relationship with a physician and that physician sees the decline before we go to a hospital and do 10 procedures that will never be of benefit before we put on 20 drugs, that will never be of benefit.

[00:29:40] Dr Gary Shlifer: Before we have a tragic fall where a hip is broken and you're stuck in a nursing home cuz you've lost all capacity to function, um, to identify that moment again, dream situation, better said than possible, right? Is identify that moment. And say, okay, I am ready to avoid that and I want to be at home. And usually, you know, that's again, family member and, and the patient.

[00:30:05] Dr Gary Shlifer: And um, and then they would reach out or their physician would reach out to a hospice, a home hospice company. That company would, send a nurse and a physician, do a full assessment, create a treatment plan at home. That company will provide everything from the medications to durable medical goods. Things like wheelchairs and hospital beds, urinals, whatever is needed.

[00:30:29] Dr Gary Shlifer: Uh, supplies, things for wound care, right? Things for incontinence, all of those things. the physician will supervise, sometimes visit through the televi, me visit sometimes in person. Coordinating care, always coordinating care with the nurse because it's the nurse and the caregivers that are the front line.

[00:30:50] Dr Gary Shlifer: The physician should be the supervisor, the, the big picture person, the, the guide. But look, that's, it's the nurse that's on the boots, on the ground caring for these people. So that's a critical relationship there. and through that process of we're building a relationship with the nurse, having a supervising physician, that hospice will provide a chaplain or some kind of spiritual guide, um, that's a part of hospice.

[00:31:14] Dr Gary Shlifer: there's always a 24 7 emergency line that the family can call so that they don't have to call 9 1 1 so that they can have support, as symptoms get worse, whether it's behavioral issues, whether it's pain or constipation. The physician is able to rapidly order and modify the treatment plan to control symptoms.

[00:31:34] Dr Gary Shlifer: if there's wounds we can help with wound care services. If a robust multidisciplinary team providing symptom control and comfort care treatment. The family is watching the process, feeling supported spiritually, medically, you know, all they're comforted so that the end is a process of, the patient being in their comfort zone, patient being with caregivers that care about them, patient being with family that can be there and not in weird situations in the hospital or a nursing home with, with rules that, you know, you can't do this or you can't visit at these hours.

[00:32:14] Dr Gary Shlifer: And the patient passes peacefully with the nurse at the bedside and family at bedside. That's the dream situation. I gotta say it happens often now, uh, with my services, uh, with hospice services around the country. It does happen. there's huge barriers, you know, this educational component, but that, that's the dream.

[00:32:33] Nathan Maingard: it's in a way, you know, this podcast, we are already free. That's a dream. But unless we have a dream that's big enough that's worth living for, then what's the fucking point? So I really appreciate having something around that. I mean, I, oh, there's so many things I wanna, I want to connect into here.

[00:32:49] Nathan Maingard: the one that's come up a few times as well while you were speaking is around finances, so I don't really have any idea. But when I'm hearing you say all these things, 24 hour care nurses, I'm like, that sounds expensive. And so I'm just wondering if you have advice for people who are maybe in a lower financial bracket or Yeah, just, just support for those at various levels of, of, of, yeah.

[00:33:11] Nathan Maingard: You know what I'm saying?

[00:33:12] Dr Gary Shlifer: It's a very important question because it connects to why, so it, it's two, two pronged. So you're asking like from a family's perspective what, what they're responsible for financially. And I wanna connect it to the beginning of the conversation where, You have the Institute of Medicine saying, oh my God, we're wasting so much money inducing suffering.

[00:33:30] Dr Gary Shlifer: We need to pay for hospice and we need to change the system. So that's all connected. I wish I had the figures. You guys can look it up, but we used to, we still do. We spend the vast majority of our healthcare dollars in the six month, last six months of life. And that's not for hospice, that's for ventilators.

[00:33:48] Dr Gary Shlifer: days in the hospital, antibiotics, aggressive procedures, surgeries, everything. Do everything until right, until there's just, like, literally we've done everything. And that's really, really common. So the research completed by the Institute of Medicine basically indicated that if we provide these hospice services, pay for them.

[00:34:10] Dr Gary Shlifer: So Medicare, and state governments like Medi-Cal combine and private insurances, pay for this insurance pays 100% for Medicare, uh, for hospice, for hospice services. This was part of that research because if you can provide families and patients that level of care, which I just described, right, all of those services, and you, and you make it so that it's a financially viable model for companies, right?

[00:34:35] Dr Gary Shlifer: Because it's, it's still a business after all. then. Those crazy expenditures in the last six months of life go away because you're not doing all that stuff. Now, hospice is a choice and some people do hospice for six months and then the, they freak out when they get to the end and they go to the hospital.

[00:34:54] Dr Gary Shlifer: It happens. You can't control every factor, right? But by creating the opportunity for hospice, you've actually de-burdened the healthcare system from futile care efforts that are extremely expensive, far more expensive than the care I just described for a hospice service. Patients should know that a Medicare patient, even someone with like Kaiser and hmo, all the insurance companies participate in hospice.

[00:35:23] Dr Gary Shlifer: They know that they have to, they have to for a number of reasons, but also insurance companies are in the business of saving money too, right? Everything's a business. So that service that I described that sounds costly and, and is very laborous with multiple specialists. Is nothing compared to what is done to someone trying to give them every second of life full code.

[00:35:49] Dr Gary Shlifer: You know, doing every surgery, going after every finding on every imaging, treating every infection with IV antibiotics, and doing everything. That is so much more money, so much more resources and so futile that, that's the transition I was describing that happened over the last few decades. Uh, once you look at the numbers, you know, and, and most importantly is that spending that we were doing at the last six months of life, it's not consistent with, with the rest of the world.

[00:36:22] Dr Gary Shlifer: So we're the only ones who do that. The rest of the world does a much better job at, having this kind of end of life process. Cultural reasons. This is, that's a very complicated thing, but, so I'm really talking about America specifically. Right? and so that spending is in, unsustainable, We can't do it. So that's why they made these changes.

[00:36:43] Dr Gary Shlifer: It, it, it was so much that unless they did something, we would just, we, we would run outta money. It, it's impossible to spend that much money. So that's why you'll continue to see hospice and palliative care services grow. I think with education, people will realize that in fact, their goals of care,

[00:36:59] Dr Gary Shlifer: like me personally, I would want a comfort care focus. If I was in a critical situation. I wouldn't want to be hospitalized and saved for every last second. I wanna live quality of life and if God forbid, something happens, or when I reach that point in my life, I want to be at home with my family if I can.

[00:37:16] Dr Gary Shlifer: I'm a hundred percent certain of that, and I think as time goes, people will connect with that. And I think that is, Again, coming back to it, that is lifestyle choice. I choose to live a healthy lifestyle now and when things change in my life and, and hopefully that's when I'm like 90 or a hundred, right?

[00:37:34] Dr Gary Shlifer: But I don't know. cuz you could do all the healthy lifestyle choices and anything can happen. then my choice at the end of my life will be a comfort care life. That's what I want. I don't wanna die in a hospital on tubes. That's my choice. So now I get to make that choice.

[00:37:48] Nathan Maingard: So there's something, well, first of all, I, I read a book some time ago called Civilized to Death by Christopher Christopher Ryan.

[00:37:56] Nathan Maingard: Uh,

[00:37:57] Dr Gary Shlifer: Ryan, he wrote Sex at Dawn, the best, the

[00:37:59] Nathan Maingard: Totally. I'm actually just listening to that audio book now. but I, I, I hope I get him on the podcast someday. I, I really appreciate and admire the way that he writes and, and his, his sort of, his sense of humor, even in like really intense stuff.

[00:38:10] Nathan Maingard: but in that, he talked about death, it's something I've thought about a lot since reading it. But he, he mentioned around how in, in cultures that. You know, for a nomadic culture, when a, when an old person would get to a point where they literally couldn't be supported by the resources of the tribe anymore, there would come a point where they'd give them what they could and leave them in a little, in a little Reed shack and be like, I love you, grandma.

[00:38:31] Nathan Maingard: You know, bye. And, and, and leave them. Or there were more extreme ones where they'd actually hit them over the back of their head, you know, at the end of their lives. So, so there's something in this around facing and confronting that at some point life isn't worth it anymore. that the physical body is just done.

[00:38:48] Nathan Maingard: And then we have such an opportunity now in our society to make that process so much easier. Cuz what we've talked about so far is just making it as comfortable as possible to like fade out at whatever pace you're going. But you mentioned something earlier around assisted suicide and, and I kind of want to get into that.

[00:39:04] Nathan Maingard: I also want to get into the idea of psychedelics and end of life. So, um, let's start with the assisted suicide. Because I think that this is something I think about a lot. I know for myself in this moment where I am right now, that I would like to have the choice that if I reach a point in my life where I'm just done, like really done, not that I just think I am, but like, yes, the doctors have everyone's agreed like, yeah, you're heading out,

[00:39:27] Nathan Maingard: it's gonna be weeks or months and it's gonna be pretty damn uncomfortable. I would like to be able to make a choice and say, Family. I'm out, let's say our farewells and, and put me down, man. Like, so what do you think about that?

[00:39:42] Dr Gary Shlifer: Uh, really, really, uh, personal, ethical, moral. It's very tricky. Um, I, I will tell you what I think I can tell you. What the rules are in California, that's where I practice medicine. And I could tell you, uh, my very, uh, intense experience with it. I've had a few but one in particular, and, and I'll leave it at that.

[00:40:08] Dr Gary Shlifer: I'm not going to tell, uh, make a recommendation on how we should deal with it. I think it's. A very, very deep, uh, dark, uh, but also critical choice, uh, and, and thing that we need to solve. Uh, but as it stands, uh, there's certain countries where you can have physician assisted suicide. It used to be in America, you couldn't do it.

[00:40:28] Dr Gary Shlifer: People remember, you know, there was all these issues about doctors that would do it for people. Look, my my opinion, to be honest with you is I think, and, and I guess speaking to, your podcast name, People should be free to do what they want. I mean, yes, we should put limitations and, and, but especially with your own safety.

[00:40:47] Dr Gary Shlifer: If you're of sound mind and body, you should be able to do what you want and, and is suicide terrible and sad? And there's all these Yeah, yeah. But like, you get to choose One message I think people hear from me is you get to choose how you live your life. You get to decide what food you want. Get to decide what you do.

[00:41:02] Dr Gary Shlifer: You get to decide if you live. I, I, I think that's part of it. I don't think society can tell you, you are forced to live. So on a, on a. Theoretical personal level, I think people should be able to participate in suicide if they want to. That sounds weird, but that's what I think. So more importantly, I think it's important and I think the system has recognized that especially patients in very, very critical situations should have the right opportunity to go through a physician's assisted suicide program.

[00:41:32] Dr Gary Shlifer: That program I can speak to in California. So that requires, there's a number of physicians, so if you have a diagnosis that's accepted in the physician's assisted suicide world, With the recommendation of one doctor and the recommendation of a certified doctor and physician's assisted suicide, you can initiate a process.

[00:41:53] Dr Gary Shlifer: It takes I, I think, like a few weeks, to get to do this legally. That process requires you to be able to, do a video testimonial, the physician's evidence. There's multiple interviews and multiple evaluations by multiple physicians. It's a costly procedure as a result because there's only a few physicians allowed to be that main person.

[00:42:18] Dr Gary Shlifer: And after going through a series and I, and I think this is how it should be done for the record, when I said, you should be able to choose Yeah, but, but like regulated like this, so, so we can make sure you're not, you're not just having a moment. It's, it's a whole process and I love that it's an important process.

[00:42:32] Dr Gary Shlifer: My problem with that is it's very expensive and I think that's the cost-prohibitive nature is kind of weird to me. I think it should be. more available to people. and so once you go through all these steps and you're cleared, you were then provided a cup full of pills, or is it powder? Anyhow, you have to grab it with your hand and drink it, and that's how you pass.

[00:42:55] Dr Gary Shlifer: All of those things that I said must be completed until the very end where you have to grab the cup with your hand and drink it. You cannot have, someone cannot administer it to you. I like it. I, it's, they're all good rules. My only problem here in California is it's so cost prohibitive.

[00:43:09] Dr Gary Shlifer: It's all, it should be time prohibitive, right? It shouldn't be something you can do quickly. It should be something that, that's a process, but it shouldn't be like, you know, tens of thousands of dollars that, that's my issue with it. and I'll just, it's a quick story. it just outlines all this stuff.

[00:43:23] Dr Gary Shlifer: Like, I had a patient who was 46. He had been doing anabolic steroids when I met him. He was worried that he had some neurological symptoms. We did a scan and it showed cancer throughout his body, brain, everywhere. I found a scan from about three or four years ago that already showed those spots and his doctor had told him, and he just ignored it.

[00:43:44] Dr Gary Shlifer: So that was his choice. He got to ignore it. He got to keep doing steroids, and that's what happened. Right. So cut to like six months later. He didn't, he didn't even pursue treatment after I told him. Right. He started becoming incapacitated. I put him on hospice. He asked to be at home. He didn't want to pursue a new treatment.

[00:44:02] Dr Gary Shlifer: He actually initiated the process of doing physicians assisted suicide, and he went through the interviews. He, he was well off. He paid the money. He was at the, second to last interview. his family asked him to go to the neurologist to get an assessment, and this neurosurgeon said, look, I can cut out the cancer in your brain.

[00:44:22] Dr Gary Shlifer: I don't know that it will be successful. it will certainly not cure you, but I can cut it out. So they asked me what to do and I said, absolutely do not do that. I mean, I What? So they can cut it out. Oh. And what, and what does, what have you accomplished? I mean, you have cancer everywhere. He completed the interview.

[00:44:40] Dr Gary Shlifer: He had the medicine in his home. He was, he had a planned time to do it. His family freaked out and urged him to get the surgery. So he did, because it was his dad and his mom and his sister and all this. The surgery was completed. He was left, quadriplegic, because the part of the brain that was, uh, when they cut it out, they hit part of the brain where he could no longer, move his body.

[00:45:07] Dr Gary Shlifer: I know that that's the last thing he ever wanted. As a result, he was not able to grab that cup and drink the medicine. As a result, he spent the next two and a half months withering away from a vital 47 year old. I mean, he had already lost quite a bit of weight, but he proceeded to wither away to nothing, miserable.

[00:45:29] Dr Gary Shlifer: I couldn't expedite his death. I could just keep him comfortable, give him comfort care medications. They tried to feed him. He didn't want to eat cuz he didn't want to be in that situation. But at that point, he lost his choice and he passed a few months later. I'll never forget it. Because it's sometimes it's, it's an example of someone who's made their wishes very clear who, whose choice was taken from them, but he was doing it to pacify his family who loved him.

[00:45:59] Dr Gary Shlifer: No one is wrong. No one is right here. There's no winners or losers or... this is a story about reality, about how hard life, the end of life process is. How unpredictable it is, how difficult it is to make decisions about this stuff. That one stuck with me cuz I was close to the guy and I knew his daughter, he left behind like a 17 year old daughter. It was pretty intense.

[00:46:30] Nathan Maingard: Ah, wow.

[00:46:32] Dr Gary Shlifer: Heavy story. I know. That shit was so heavy. my god.

[00:46:35] Nathan Maingard: it's beautiful though, man. Like, I mean, I honor, I honor that, you know, it is heavy and it is, it is heavy. There's just no getting away from it. And I think that's what you've been talking about is that the heaviness is not something to get away from. It's like, can I, this heaviness I'm feeling now, it's like I honor this heaviness because this is what is real and why would I want to like run away from this?

[00:46:56] Nathan Maingard: And so I just really appreciate and I, yeah, I just think of his family and I think of what he went through and. God, I think of the, the things that I thought I wanted to do but didn't do because someone else thought it was a bad like, it's just I connected to all of this being, human. You know? It's fucking being human.

[00:47:14] Dr Gary Shlifer: And being free. I think you, you just said it. It's this idea of. Don't do, like, this is my opinion too, like don't do stuff for other people. Do stuff for yourself. It's why I believe in, in Ayn Rand's concept of objectivism, it's very, very important to me and and how I live my life. When I go to my clinic and I spend every bit of my energy talking to patients and counseling them, I don't do that for them.

[00:47:37] Dr Gary Shlifer: I do that for me. It makes me feel good. When I go to bed at night, I'm super proud of what I do. I'm super satisfied. Now, I freak out sometimes I'm like, oh my God, did I say something right? Because I care, right? But I'm not doing that for my patients. I'm not doing that for anyone else but me. And I think it's really a way I live my life.

[00:47:55] Dr Gary Shlifer: And this whole idea of choice at end of life and choice with what you put in your mouth bef at the beginning of life, right? and your whole concept of we are free. You're free, and you are, and, and you're only limited by the limitations you accept. If you let people tell you what to do and you don't follow your gut, you've lost your freedom.

[00:48:14] Dr Gary Shlifer: That story just resonated so much with me and I tell it to other patients because it's just this reminder of like, it's your choice. You can try to pacify your family and all that. In the end of the day, you are in bed, you are receiving or not receiving treatments.

[00:48:31] Dr Gary Shlifer: It's you. So you should make that decision for you, not for them. At least that's what I think.

[00:48:38] Dr Gary Shlifer: And going back to the advanced directive thing, if you wanna do something today, let your choice be known to your family, to your attorney, to your estate, what, however it is through some paperwork and, and if you change your mind in six months, you get to change that paperwork and then you get to change it again.

[00:48:57] Dr Gary Shlifer: But at least you have what you want to happen. Instead of, God forbid something happened, you get in an accident and it, at least in California, it goes to the next, it goes to the closest living family member. And if there's multiple that are like first line, then they have to battle amongst each other, if you hadn't identified one person to make choices, it's different by state. So, you know, it's quite dif those rules can change, but I'm just, Uh, maybe, maybe in a good next step is look up the rules for end of life in your state. Reach out to a hospice company and be like, Hey, who, who makes a decision if something happens to me?

[00:49:33] Dr Gary Shlifer: And is it like California or is it different? I mean, or ask your doctor. I'm sure the physicians locally know too, but learn about it. Think about it.

[00:49:41] Nathan Maingard: Yeah, bring it in. embrace the heaviness as a, as a part of the responsibility of being alive and being, being responsible, being human. I mean, I'm definitely feeling inspired about this, just thinking about what are the next steps that I can take. I really would like to just, just touch on, we don't have to spend much time on it, but.

[00:49:58] Nathan Maingard: I keep thinking about the, the research that's being done around end of life, especially when people are experiencing massive anxiety and they have terminal illnesses, and then there, there's these, you know, huge positive outcomes from people in those situations who are then, sitting with something like psilocybin or, or various other, psychedelics.

[00:50:17] Nathan Maingard: And I'm curious to know, what are your thoughts on that actually, for both the patient themselves and for the, for the family that's going through it.

[00:50:24] Dr Gary Shlifer: It's just another, you know, reflection of our poor mental healthcare system. We have all these amazing tools and we made half of them illegal, so I think that the sil, the psilocybin is important in mental health care, period, throughout the world.

[00:50:42] Dr Gary Shlifer: I hope that we can, these rules will change and we can start incorporating. For those listening that Nathan is referring to, there was a study, it was overwhelming. People at the end of life obviously have a fear of death, and it's crazy scary. I am only allowed to use western medicine medications, so I It's mostly sedatives, right?

[00:51:02] Dr Gary Shlifer: Anxi, anxiolytics, antipsychotics. Sometimes it, it's all you can use. And if someone's freaking out, you know, you, you send the chaplain, you counsel them. But it, it's hard. This amazing study where they gave, patients with this fear of death at the end of their life, psilocybin. And I think it was, it was in profound, like 80% of them said that, their fear of death had reduced by a dramatic figure, and it helps them with the dying process.

[00:51:31] Dr Gary Shlifer: It is my dream to be able to provide that product. to my patients if they want. I just want it as a tool. It's not a magic bullet, it's just another tool. I think that, especially at the end of life, they should liberalize the use of that. If the patient wants to try it, it's profoundly safe and frankly, it doesn't matter.

[00:51:51] Dr Gary Shlifer: These are end of life patients. They get to choose what they want to do at the end of their life. and then you asked about patients. Yeah, I think like psilocybin, its role in psychedelics is connecting us with nature. I've done some podcasts about psychedelic medicine, and, and I have this, I won't get into the whole thing, but I, I think of the four, these four commonly thought about drugs, these four commonly thought about psychedelics.

[00:52:16] Dr Gary Shlifer: It's MDMA, psilocybin, LSD, and ketamine. So I present them to kind of grasp your mind around them as, uh, M D M A is love, psilocybin is nature. L s D is questions and ketamine is answers. We can talk about that maybe on another podcast cuz that's big picture concepts of how to think about these drugs.

[00:52:39] Dr Gary Shlifer: But why is psilocybin so important at the end of life is because that is a natural process. It is nature stepping in. And going through this transition where you reincorporate into the world through the dying process. It is this process of watching your loved ones go through this transition. It is very, very natural to die.

[00:53:02] Dr Gary Shlifer: And when we're disconnected from nature, psilocybin's great power is to reconnect this with nature. Everything from appreciating that a plant or a tree is a live and breathing organism, that you can feel to understanding the transition process and accepting that that is part of life. So I think that's why psilocybin is so important, period, in our world as we get further away from a natural reality, that it reconnects us and anchors us to what is actual life and nature and, and how it all connects.

[00:53:40] Nathan Maingard: I really want to touch on your, your business, because anyone listening to this right now, especially if they're in California, it's like my recommendation if you, if you're interested, if you need support in moving forward with this, like you've, this is the dude, right? So, um, you said you've expanded your hospice care business since we last spoke, and I would just love you to, to just give us more information about what's happening there.

[00:53:59] Dr Gary Shlifer: Just so we're clear, I do not own a hospice business. Uh, I do not own a hospice service, a hospice service, so I'm gonna be real clear. Calif in California, physicians can't own a hospice. I didn't go that route. I think it's a little bit compromised what I'm actually trying to do, so I work with, uh, dozens of hospices in, in California, and what I've started to do is I provide physician services.

[00:54:25] Dr Gary Shlifer: So hospice agencies are private companies. They're local companies. Cuz think about the care that we're providing. It's very localized, right? You can't just be, the bigger the hospice gets, the more giant it gets, the more diluted everything gets and, and, and it doesn't work. So at least the model at this time is not massive corporations. It's small, often family owned, businesses providing local, regional care. Probably a model for the food system. For many of our systems that, that are broken in this world is make small, local, regional, so that you can serve your population. As I started hospice, I started providing care to various hospice agencies and I realized, That this is such an early stage in that industry that a lot of the problems have not been solved and physician services has never, I have still seen like only maybe one or two companies that literally are providing physician services for hospices.

[00:55:17] Dr Gary Shlifer: Every hospice has to randomly find physicians. There's a huge limitation of, experience and trained physicians, so, I have been bringing doctors on board. I have a, a team that I've built, we call ourselves Evolved physicians network. We provide, the full scope of physician services for a hospice.

[00:55:35] Dr Gary Shlifer: Everything from the medical directorship to the cross coverage where it's called a designee position, even physician on call that if there's an emergency or there's a new admission, we can evaluate the patient. I have a coordinator to do all this, to help the doctors coordinate with the hospices because it's essentially a b2b, it's a business to business service, right?

[00:55:56] Dr Gary Shlifer: And these are businesses that are trying to provide robust care, and they struggle to get physician support. And then the physicians struggle to meet these companies because they don't know, they don't know that there's a, a hospice service in this part of the valley and, and they're doing great work and they're looking for a doctor, like where, where, how do you know?

[00:56:13] Dr Gary Shlifer: Right. There's no like website for this stuff. And if there is, I don't even know about it. So it's not, it's not super effective. I'm trying to connect the doctors that are interested and experienced in hospice, the hospice companies. And I'm providing this physician service. and we're trying to do it in a very, very sophisticated way so that it's quick because again, with hospice, things end of life, things change quickly and things need to act very, very quickly.

[00:56:40] Dr Gary Shlifer: That's part of the deal. It's really, really important and what I do is I look at the guidelines set forth by the Institute of Medicine, the various governing bodies here in California, my goal is to follow them because here's my theory. They wanna do a good job. These governing bodies, the, the department of health, insurance companies. They're all motivated to do a good job with hospice because it's the right thing to do. So my interest is, let's do it. So as they create guidelines, as they change rules, I love it. I'm following it and I'm doing those things because they, to that, to me, it all makes sense.

[00:57:15] Dr Gary Shlifer: We wanna make it as streamlined, as clean and effective a service as possible. And I think, since our last podcast, that's what I realized is I want to contribute to that because so many people push back on change and I'm like, no, no, no. We need to keep changing until we can do this on scale and really make the access to this service much higher.

[00:57:37] Dr Gary Shlifer: If someone is listening and they're really interested in it, they could just reach out to my company, evolve Healthcare. That's just my primary care clinic. We can at least guide you to the appropriate person for whatever it is you're looking for.

[00:57:49] Nathan Maingard: Thank you again. I, I really appreciate that. So we are one more question just to kind of bring this to a close and, and as always, I'm open to the heaviness within the positivity. I'm not trying to like, make this all sunshine and roses. Uh, and then we'll get to, I w I actually wanna ask you a question, but we'll keep this for the patron-only bonus, which is around like, how do nutrition and lifestyle play into improving the quality of life for patients in hospice care and end of life care?

[00:58:13] Nathan Maingard: But we'll get to that in a moment. What I wanna ask you now is, is. obviously respecting privacy and, and everything, but could you share an example of, of a, of a positive experience that you've had with a patient and a family who've gone, who've chosen hospice care and chosen the end of life, the kind of end of life experience that you're talking about.

[00:58:31] Nathan Maingard: Just if there's a story that, that comes into your memory around something that really has touched you and moved you and being like, wow, this is, this is what an honor to be a part of this, and I'm sure there's probably many of but anyway.

[00:58:41] Dr Gary Shlifer: Yeah, there's so many. it's almost every case. that's why I love it. It's almost every case. One that comes to mind is just, and it's just going to be common. It's co Maybe it's interesting to you guys, but it's so common for me, just the family that a, a, a gentleman who was my patient and his wife had dementia.

[00:59:01] Dr Gary Shlifer: He was really struggling with it. The family was sort of in denial. He asked me to come and do a home visit cuz she didn't really have a doctor following I came and I saw a situation that was terribly unsafe and the family, in denial. She was oriented barely to herself. She was, you know, acting wild and unsafe.

[00:59:18] Dr Gary Shlifer: And the family was like, oh, that's just her being her. Oh, that's normal. And I'm like, no, it's not you guys. Like, I know it's not, this is not normal. And this has not been like this for that long. I can see that this changed recently and I just called him out on it because, you know, part of it was I had a relationship with the husband and I knew I was trying to protect him.

[00:59:36] Dr Gary Shlifer: The family didn't want to, but the husband did. It was his choice. I ordered the service. They came. And I was then able to titrate some medications to calm the patient down. We were able to provide some equipment to really help the son, I mean the husband, sorry. And within like two, three weeks, instead of all the craziness that I saw in the home, we had a very calm person who was still eating, who had a safety measures in place, and the family was so grateful to me. Even though I did it, sort of knowing, they were like not on board cuz they thought hospice was all this bad stuff. Um, patient ended up dying, maybe it was like nine months on service total. It was just, expected decline of advanced dementia and it was all beautiful. Patient died, at home surrounded by the family and comfortable.

[01:00:30] Dr Gary Shlifer: It was all love and I got all these thank yous and hugs, they let later came to my office. You know, that's beautiful. Like, if I could do that for someone, if I, if my wisdom and my experience can guide someone to have that kind of experience, uh, at the end of their life and their families to, to get the kind of support they didn't even know they could get, that's pretty powerful stuff. That's why I do it.

[01:00:51] Nathan Maingard: Thank you for sharing that story to me, that there's, there are many layers there that I am resonating with and I think one of the ones that's coming out is, is having leaders, you know, someone like yourself who is so experienced at what you do, who are willing to stand up and say, I see this and it's not right and we can do better than this.

[01:01:08] Nathan Maingard: And then taking action on that and seeing the result, being willing to stand in that fire of discomfort where you're getting this flack of like, we don't wanna do this, is there, and you're like, come on guys, this is literally, this is my thing. I am, this is what I do. Let's, we can, we can do better. And so thank you for, for that.

[01:01:24] Nathan Maingard: And thank you on all levels for being willing to step into this conversation. And as I said at the beginning, you are my first ever return guest on this podcast. And I, and I think it, I feel good about it because I think death is so important. That heaviness, that intensity is so fucking important. I think it is what is gonna bring all of us back to life, who are living out here in this society that has, has hidden us away from the, the intensity of what life really is.

[01:01:50] Nathan Maingard: And so, so thank you for being my first return guest. And I've asked you this question before, and obviously you'll be the first one to get it asked twice. Maybe your answer will be the same, but when you hear we are already free, what comes up for you?

[01:02:02] Dr Gary Shlifer: Uh, I don't even remember what I said last time. I'll connect it to what we talked about earlier. To, to me, real freedom was when I connect, when I read Anne Rand's books, and a lot of people interpret 'em differently, but for me it's this idea of you get to live your life selfishly, making choices that are best for you. And it is through that process that will you, will be of greatest service to mankind.

[01:02:25] Dr Gary Shlifer: Because when you are doing things for yourself that you are passionate about and you believe in, then you will do them at a very high level and you will do them for the right reasons. And so you are free to be selfish and do whatever it is that makes you tick. And I believe at least that that's how you're gonna serve the world, at your best.

[01:02:47] Nathan Maingard: thank you again, Dr. Gary Shlifer. It's such an honor to have you back and I, and I'm excited to, to continue this, friendship and this companionship, and just to spread more information around what it really means to be human and to die well, to have that choice, to make those responsible choices.

[01:03:02] Nathan Maingard: So thank you again.

[01:03:04] Dr Gary Shlifer: Thank you, Nathan.

[01:03:05] Nathan Maingard: Thank you again to Dr. Gary Shlifer for your presence on the We Are Already Free podcast. It's an absolute honor to know you and to have these conversations. Thank you, brother. You can find links to Gary plus many of the things we talk about at That's 36.

[01:03:22] Nathan Maingard: And if you want to hear Gary's important and surprising answer to the question of how diet and lifestyle impact end of life care, be sure to catch the exclusive bonus video on the Patreon. That's also linked in the show notes.

[01:03:36] Nathan Maingard: Facing the end of things. The ending of things, the loss that comes with all change is hard. Especially without support. If you want to connect, please reach out. Chat with me directly by visiting the show notes. Death reminds us of the beauty of life, of this moment. I'm excited to share it with you. Connect with me at

[01:03:59] Nathan Maingard: Thank you for being here with me. Dear listener. I love being me with you. See you next week, and please remember that we are already free.


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