Calculate Your Bucket Age

Calculate Your Bucket Age

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Welcome to The Bucket Podcast — a series of interviews that features an eclectic mix of people who all share one thing in common — they’re all going to die. But does being aware of that change the way they live? That’s the question host and The Bucket founder, David Abend, asks them in a fascinating collection of stories that explore the concept — and value — of mortality-based living.


14. Katy Butler: Trust Your Heart

“People who are willing to contemplate their aging, vulnerability and mortality often live better lives in old age and illness and experience better death than those who don’t.”  Right out of the gate, this podcast with Katy Butler, best-selling author of The Art of Dying Well, explores how acknowledging your mortality can be a catalyst for making choices that can help you live a more fulfilling life. Whether you’re in your 50’s and feeling great, or older and feeling your years, Katy’s advice to “Trust your heart’ is permission to all of us to speak our minds on behalf of our bodies. Recorded during the Coronavirus lockdown, the internet connection leaves something to be desired, but not the message.



David: Welcome to The Bucket Podcast. I’m David Abend, founder of The Bucket, and your host for today’s conversation with bestselling author, Katy Butler. Katy is the author of two notable books on end-of-life, Knocking on Heaven’s Door, which was published in 2014, and, most recently, The Art of Dying Well: A Practical Guide to a Good End of Life. She’s also very active in the slow medicine movement, which we’ll talk more about in a minute. It’s a great pleasure to welcome Katy Butler to this edition of The Bucket Podcast. Hi Katy, thanks for talking with me.

Katy: Hi David. I’m very happy to be here.

David: Glad you are. We were just talking a little bit about Corona and how that’s really changed everything for so many people. For what you’ve been doing, for what The Bucket does, talking about death has always been the elephant in the room, if you will. It’s hard for people to talk about end-of-life at any time and now to have a pandemic and to talk about it. What has your experience been with talking to people about this?

Katy: I think it’s fascinating. My first reaction was that nobody’s going to want to hear from me because we are much more motivated at the moment to try to avoid death and avoid death not only for ourselves but for people we love by social distancing and everything else we need to be doing. But I’ve come to realize that the issues that I’ve been writing about are actually more on the front burner than ever. Given that this pandemic does affect everybody, and young people will end up in intensive care units as a result of the disease. However, 80% of the people over 80 who become critically ill are not going to emerge from ICU alive.

David: Do you think this is a new chapter for your book, or do you see what’s already in your book as a guide for helping people through this?

Katy: Both. Things are moving so rapidly on the ground now that I can’t tell you what new chapter should be added to my book, but one of the things that I’ve tended to read aloud when I give a public reading is a super beautiful bathing and honoring practice, which some nurses created to make death in the hospital more sacred. It involves bathing the bodies of the dead and touching all the basic points of the body with lavender oil, anointing and reciting certain lines like, “I anoint the brow that has thought so many thoughts,” or “I anoint the shoulders that have carried so many burdens through this life.” What I realized is that I’m not sure this practice is going to be able to be done physically with the body, but I’ve noticed when I give a reading and I go through this litany, I see many people in the audience closing their eyes and visualizing and imagining doing it with a family member who perhaps has already died and it wasn’t the most sacred of deaths. They’re having the opportunity to relive it virtually and actually imagine doing this bathing and honoring and anointing practice. Perhaps we’re going to see, with Zoom, people doing an imaginary version of these practices rather than an actual face-to-face physical version. To give you an example, when soldiers were dying on the Civil War battlefields, they very much missed the death vigils that were traditional for the 19th century. They would take out photographs of their loved ones on the battlefield so that they could feel accompanied by their family members as they were dying. Clearly, we’re going to need to be inventive and to design new versions of rituals in order to bring ritual into the experience of dying even in this state of emergency.

David: You did a reading at the Harvard Coop in Cambridge. When I read your book, I had highlighted a paragraph which was really profound to me, and it’s really relevant to The Bucket. The first excerpt you read from your book was that paragraph, and I felt like a kid who had gotten the answers to the test right. I just want to read that for our listeners and then talk about it.

That excerpt is: I’ve learned one thing — people who are willing to contemplate their aging, vulnerability, and mortality, often live better lives in old age and illness, and experience better deaths, than those who don’t. This is what The Bucket is all about. It’s this.

Katy: Thank you. Do you mind if I continue and read another paragraph? I really feel it sets up the whole conversation that we’re having.

David: I’d love you to do that.

Katy: Okay.

They keep shaping lives of comfort, joy, and meaning, even as their bodies decline. They get clear-eyed about the trajectory of their illnesses, so they can plan. They regard their doctors as their consultants, not their bosses, seek out medical allies who help them thrive, even in the face of disappointment and adversity, and they prepare for a good death. They often enroll in hospice earlier and feel and function better, and sometimes even live longer, than those who pursue maximum treatment. They make peace with the coming of death and they seize the time to forgive, to apologize, and to thank those they love. They rethink the meaning of hope. And they often die with less physical suffering and just as much attention to the sacred as our ancestors did.

David: I love that. I love the idea behind that. If you think about mortality, it’s not going to kill you. That’s not what makes you die. And, that by thinking about it, you can have a better life and a better death. Is there research that you learned this from or are these your experiences?

Katy: I learned it from a combination of things. For my book, I interviewed more than 200 people who had accompanied others through the experience of dying, and those experiences had sometimes been very successful and positive and sometimes very negative. I learned a lot from the bottom up from the experience of regular people.

Then I also did research from the top down. For example, there is research that shows that people who have terminal illnesses who receive palliative care and hospice often have much more peaceful deaths, experience less pain, and leave their relatives less traumatized afterwards. There is genuine research that also supports the experience of people from the bottom up. I also talked to a lot of experts in geriatrics, hospice, and oncology, and other specialties that are deeply concerned with these issues.

David: When I read that, for me it wasn’t so much at the end, or later in life, it was relevant to me for anybody who thinks about this at all times and has this perspective and appreciates life more. One of the things I want to do with our audience is, that I think about the people who go to your book readings and listen to your talks, I basically call them the choir. That these are people who are in the choir and they believe in this. They believe in death positivity and they get a lot out of it.

I consider people listening right now, they’re not in the choir. They’re not sure they’re going to keep listening right now. Because you’re talking about death and, and that’s a bad thing. And so what are we going to do? You’re trying to keep people from moving on from this podcast. And so what are the benefits of your approach and your perspective that can benefit anybody at any time and keep the, keep them listening because of the value are they going to get.

Katy: First of all, I don’t call them the choir. I call them the early adopters, and things start with the early adopters. They start with the edge and they start with the fringe and they continue to move from person to person. The more I have contemplated death myself, the less afraid I am and the more appreciation I have for my precious, daily life. One of the phrases of the hospice movement is, “Thank you. I love you. Please forgive me. I forgive you and goodbye.” People often intuitively undergo some kind of exercise around those questions once they know that they’re approaching the end of their lives. But, the beauty of that is, you do not have to wait for thinking that you are going to die someday, because you are going to die someday. It’s made it so much easier for me, when the thought crosses my mind, how appreciative I was for, let’s say that ex-boyfriend where the relationship ended really badly and I got hurt. But when I look back, I see how much beauty there was and how much was given to me. I now go ahead and write a note to that ex-boyfriend and let him know, and it’s a beautiful experience. Similarly, saying, “I’m sorry, please forgive me.” I’ve learned how to do that. I’ve learned to be much more spontaneous and less afraid of how I’m going to look poorly if I apologized when I think I’ve made a mistake. So, there is that possibility of continuing to clean up your life day-by-day, evening-by-evening, that some awareness of our mortality can help us with.

David: I agree completely. I’m finding myself becoming less afraid and also doing things to make sure that, when the time comes that I’ve done the things I wanted to do. Let’s talk about your book, The Art of Dying Well: A Practical Guide to a Good End of Life. You had already written Knocking on Heaven’s Door, which was about end-of-life. Why do you feel you needed to write this book and how is it different?

Katy: The first book I could say is in some ways a complaint. It’s a memoir of caregiving my parents through their declining years and their deaths. I was outraged because my poor dad had a very long decline due to vascular dementia and strokes, and he was given a pacemaker in that process that overly prolonged his very worst years. I could not rest until I understood why that had happened, and really analyze the American medical system and see what was wrong. Why had we over-medicalized death? Why were we so terrified of death? Why were we stripping people’s medical autonomy from them? So, that’s a very good book, but there’s a lot of investigative journalism in it. There’s a lot of love in it, but it’s more a statement about a problem than it is about a solution. Now, I’m in my 70s myself and I wanted to create a guide for my generation and the generations that follow us, so that at least some people are going to suffer less, unnecessarily,  in the process of their decline and their dying.

David: You’ve organized this book into chapters that go through the life stages. There’s resilience, slowing down, adaptation, awareness of mortality, house of cards, preparing for a good death, and active dying. I wanted to ask you about something you wrote in the resilience chapter. For those who haven’t read the book, resilience is around age 60 to 70, would you say?

Katy: It’s 60 to 70 if you’re healthy. You might be 50 to 60 if you have more health problems. Or older if you’re very, very healthy.

David: You talk about the importance of diet and exercise, and you say, “I don’t mean to suggest that food, asceticism, and strenuous exercise will ward off death and decline forever. They won’t really make you younger next year, but they may keep you happier, stronger, and more functional.” So, I’m going to put you on the spot. A previous podcast for us was Chris Crowley of Younger Next Year. So, I have to ask, was that a jab at Chris Crowley?

Katy: I think it’s lovely to think that we’re going to be younger next year and, obviously, his work is fabulous and it’s inspired many people. I think we have to temper it, however, with the reality that, internally, (as we age) our immune systems are weaker and we lose muscle mass more quickly. We can do an immense amount to improve our function and our well-being and our functioning as we age. That’s what this whole first chapter is about. But, there’s also an internal reality taking place. Our bodies do age on a cellular level in more than 5,000 different ways. Some of those we can do a great deal to slow down and others we can’t. So, that’s the point of those sentences.

David: Chapter four is called “The Awareness of Mortality.” Should we have awareness of mortality earlier? With The Bucket, I want people to have that awareness much sooner, and hopefully the awareness will influence their decision-making.

Katy: I think different people come to this at different stages in their life and we can’t force other people to come to it at a certain moment that we think is wise for them. Some people will have a friend die young; some people will be in a car accident that actually gives them that whisper of their mortality; some people will have some kind of a wake-up call health-wise, or lose someone they love really, really deeply. I don’t think we can force people to wake up, but I do think life offers us many, many wake-up calls. It’s interesting that you raise that because I actually debated a lot where to put that chapter, and I even tried putting that chapter first, but then it became too complicated to walk back the dog and make sense of the other chapters, so I ended up putting it, somewhat logically, the way it’s most likely to hit most people.

David: It’s almost like people can have that awareness earlier, and it could do them some good, but this is when it’s forced upon them.

Katy: And a lot of us, frankly, don’t do anything until it is forced upon us. I want to give you a personal example. My estate plan is extremely out-of-date, and suddenly, now that I am on lockdown, it is my number one task because I realized, “Wow, I think I’m really healthy. I think I’m practicing all of these precautions to protect other people.” But, the reality is, I am over 70, if I got this (Corona) virus, I have a much, much higher risk of dying than somebody much younger. I really could kick the bucket in a day or two, or a week from now, so I better make my estate plan.

David: That’s a good point. So, at The Bucket, we have something called a Bucket Age. We calculate a Bucket Age by taking your statistical life expectancy, for which we use figures from the Social Security Administration, and subtract your current age, and that’s your Bucket Age. Me, I use 85, I’m 61, so my bucket age is 24. So, statistically, that’s how many years I have left on this planet. We’re trying to help people put that in perspective. So, what’s your Bucket Age?

Katy: Well, I’m assuming that unless I develop something, I will live to be 92. I think that’s my statistical age. What’s that 92 minus 71?

David: 21.

Katy: Oh, 21! Putting it that way sounds like I get to be young all over again. I’ll get to be 21. I’m praying and hoping for another 15 years that are relatively good years. I feel that, from the research I’ve done and from my own parents’ experience, after 70 it’s all random. It’s all a crap shoot. A lot of people I know when they hit 85 or so, see a major, major turn down in their functionality.  I’m not really that keen on outliving my functionality by a whole lot. So, I’m just praying. I’m very, very happy in my daily life right now. My husband and I get along really, really beautifully. There’s a sense of the preciousness of every day, but there’s also a strong sense that we can’t take for granted that we’re going to have good health from now on.

David: The Bucket has a tagline — Live fully. Die well. The dying well is not your dying well. It’s not the things you talk about in your book. It is really about dying without regrets. That’s the simplest way to put it. You have made choices, by looking at your Bucket Age and saying, “Huh, if I’m going to hike the Grand Canyon, I better get to it. My time is running out.” So, let’s say you were on your death bed tomorrow, are there any regrets that you would have?

Katy: Yes, I have a brother who is estranged from me. He’s been estranged for many, many years now. It’s not my doing. I would really regret leaving this earth with that estrangement in place. And, at the same time, I’ve come to accept that that is his choice and that it may be something that I just have to let go of because it may be what serves his own happiness and ease of mind much better than having some kind of reconciliation with me. So, I would definitely have that regret.

I would regret that I had never returned to Greece. I would regret that I never took that watercolor class that I have been saying I would take. I would have some regrets, but the honest truth is that because I got to do those two books about death and dying, and I do feel I got to contribute to the greater good. I think if I died without having written those two books, I would have died feeling, to some degree, frustrated and that I had not fully expressed my life. But, I do feel extremely grateful that after a very troubled history with men, and a very dysfunctional first marriage, I’ve now been married to someone for, well, we’ve only been briefly married, but we’ve been together for 20 years. I’m in a relationship in which I actually do get to express my love for somebody in an effective way, and to feel deeply loved in return, and the combination of having that sense of being loved and getting to love, that I got to truly contribute to the world, or at least think I did, is very, very meaningful for me.

If I walked out of the house today and picked up the Coronavirus at Whole Foods this afternoon, and died two weeks from now, I’m not saying I’d be happy to leave the earth because I really would not, but I wouldn’t feel cheated.

David: That’s great. Do you think that Corona is helping people get this perspective and making them think about what is most important to them?

Katy: I don’t know. I think the lockdown is helping people. The people I know who can regard it as a spiritual retreat, as a pressing of the pause button, as an opportunity to enjoy the natural world that we have been so bent on destroying, those people are getting a moment. But, we’re in the very early stages of this. A lot of people are in deep panic and strong states of outrage about what should we have done differently. A lot of people are experiencing those classic stages of grief. Some people are bargaining, some people are furious about being let down by leaders, and some people are hoping it’s all going to be over in two weeks, which it is not.

We’re all shuffling through numerous emotions, sometimes very rapidly in one day. It’s going to take some time to shake out, and for people to come back to earth, and for people to accept the tremendous load of grief and loss that most of us are, right now, only contemplating. It hasn’t really hit yet. It’s like waiting for the hurricane to come. So, let’s wait and see.

David Kessler has written a book called The Sixth Stage of Grief. He’s been interviewed at the Harvard business letter. You might want to have him as a guest on your program. He worked with Elisabeth Kubler Ross. He has added one more to those stages of grief and that is finding meaning. That we find ways to contribute to the world out of our sadness and out of our loss. He says, right now, we’re all in anticipatory grief. We know loss is coming. We don’t know the shape it’s going to take exactly. And so we’re agitated.

David: When you used to tour for your book, it must have been a great experience when people told you about how the book has affected them. Can you talk about that and tell us some of those stories, about the people and their experiences?

Katy: Sure! One of the nicest was relatively recently. A woman who I know distantly, sort of a friend of a friend type of a person, called me because she had a large family in a huge degree of agitation as her father was dying. I recommended that she take a look at a book, and especially look at the bathing and honoring practice that I discussed. And, she took this practice and her large, obstreperous family got together at the deathbed and they did this bathing and honoring practice. They washed the body of the father, and touched the various parts of his body, and anointed him with oil. And they all recited, together, these beautiful passages. She said it was very, very transformative to what had been going on in the family. That’s one example.

A lot of people have gotten the permission to normalize saying no to an intensely technological death, to feeling okay about choosing comfort care only, for example, for a demented 92-year-old father, rather than putting him through an extremely painful or harrowing hospital procedure.

What I’ve tried to do and have succeeded in doing, to some extent, is restoring people to their own moral authority, to their own trust in their own intuition. We know how to do this stuff. We know much more than we think we know. If we trust our heart, and we trust our gut, and we don’t get too swept away with expert advice. It’s kind of ironic, in a way. My book is full of advice, but one of the main pieces of advice is trust your own advice. There are stories in the book about people involved in a hospital death who definitely wished that this person was not dying in the hospital, was dying at home. But, they have seized the moment in the hospital to ask for a room, for example, that has light or has privacy. They brought in music. You can transform even the most unpleasant environment, sometimes with a little gumption, and sometimes with a great deal of acceptance and letting go.

David: How does that help the survivors? In the moment of the passing — well, I’m not going to say passing. I’m going to say death because I feel like some of the euphemisms we use are a problem. So I can see how people feel good that they did the right thing. They asked for things they spoke up, but is there a residual for the people that spoke up? Does it change them?

Katy: I think it does. A great deal of the reason that we ought to sign advanced directives, for example, is not just so that we preserve our own autonomy and hopefully die closer to the way we hope to die, but also because it leaves a good emotional legacy. The least amount of conflict, self-doubt, and guilt you leave your relatives with, the better it is for them after you’re gone.

So, explicit instructions in a living will, for example, is extremely helpful to survivors. My dad and mom wrote letters to each other right after he had his first major stroke, so I wrote legacy letters to my dad, thanking him for teaching me to swim, teaching me to read, trying to teach me French, and teaching me algebra. We had a very loving and close relationship when I was a young child, which deteriorated massively when I was a teenager. But, we got a chance to really heal that because I took that opportunity to thank him. I suffered extremely  little complicated grief after his death because so much had been spoken and so much had been addressed. There is a great deal of research that families that undergo an ICU death, witness an ICU death, suffer very high rates of complicated grief, sibling conflict after the death, post-traumatic stress disorder because of the suffering that they see the relative go through. That’s why I think, especially in this time of Coronavirus, if you are older with multiple serious illnesses, it’s clear to you that you don’t want to die that kind of highly technological death, you have to have very explicit conversations with your families now. So then perhaps you will be diverted from one of those units, and your death can be more peaceful, and hopefully at home if that’s where you would like to die.

David: I wanted to talk about Slow Medicine. You have the private Facebook group, Slow Medicine. That’s, obviously, very related to what you were just saying. I’d love to hear you talk about Slow Medicine and explain what it is to people.

Katy: Sure! I want to start by saying, I learned two major new things by writing the second book. The first was the importance of community, asking for help as well as giving help whenever you can. Little ways. Big ways. The second thing I learned was that living well segues fairly nicely into dying well, and you have to know what living well means to you if you want to have any clue as to what a good death might mean to you. If you’re living an unhappy, postponing life now, it’s pretty unlikely you’re going to suddenly shape up on your deathbed and be incredibly accepting, and open, and ready for whatever future may bring.

So, how that feeds into Slow Medicine is that Slow Medicine is a very good segue to a good declining experience and end-of-life experience. Slow Medicine is thoughtful, time-consuming, relationship-based medical care. It’s the medical equivalent of the Slow Food movement. It’s quality over quantity. It’s understanding that doing more is not always the same as doing better.

This comes into play particularly when people are aging, when they have chronic illnesses, when they have anything that Fast Medicine cannot fix well. We all know that Fast Medicine is prime at intensive care use, at the ER, at getting people through trauma, and car accidents, and drug overdoses. It couldn’t be better. But, 80% of what we suffer, is likely to be chronic, incurable, manageable, but not fixable. And, that’s where Slow Medicine comes in.

The movement itself started in Italy with cardiologists who were praying and urging for more time with patients, and more caution, especially with older patients because, as you get older, the risks and the traumas related to extreme medical interventions rises as much as their benefits do. The balance, the weighing of pros and cons, becomes much more complex. It started with them. There was a wonderful geriatrics doctor in New Hampshire, named Dennis McCollough, who really took the bull by the horns and developed Slow Medicine for elders in the U.S. He was the author of a tremendous book called My Mother, Your Mother, and if you are caregiving an ancient parent, there is no better book than his to have on your shelf.

David: I think there’s a misconception that doing nothing is not as good as doing something, and that people won’t live as long. But, people can live longer with Slow Medicine.

Katy: It’s extremely ironic because the default of our basic medical system is that everybody wants to live as long as possible no matter what the cost of that, emotionally or physically. The reality is that, for a lot of people as they age, staying functional and being relatively free from pain and having a sense of wellbeing is actually more important than living the last possible inch. The irony is that there comes a point where Slow Medicine is likely to keep you alive at a higher level of functioning longer than Fast Medicine. There’s a chapter of my book that’s called “The House of Cards.” This is usually a year or two from the end of life. People become quite frail. As a result, even the simplest hospital stay, or maybe even a long 24-hour period in the ER, is likely to promote a stage called hospital delirium, which is a state of intense confusion. It can cause a tremendous cascade downward, and people are more likely to die, and more likely to become so dysfunctional that they can’t care for themselves, simply as a result, possibly, of a three-day hospital stay for observation. So, we have to be really realistic about how stressful and traumatic the modern hospital can be to anybody. Then when you pile on top of that huge fragilities and vulnerabilities within the particular person we’re thinking about, the very thing that could save your life at 25 could be the thing that ends your life at 85. The same intervention, but you’re not the same person.

David: Right. I just went through a sad experience. My brother-in-law died a couple of weeks ago. He was in the ICU for six weeks and he started to get a little better. Then the nurses started talking about the ICU delirium. That house of cards you talk about, it happened, and in three days everything had turned around and not for the better. Unfortunately, he died.

Katy: I am so sorry.

David:  Thank you. I want to go back to the choir, or as you call them, the early adopters. Let’s brainstorm a little on how can we take these early adopters and get them to spread the word and get past that taboo, get past the “what do you want to talk about that for?” We’re trying to do it with The Bucket, but people look at you sideways. What can we do?

Katy: I think there’s a lot we can do. We can think more in terms of sales, where what you want to think about is what are the needs of this other person, not what’s my agenda that I’m trying to get them to shape up and adopt, but what are their needs. I’ve noticed people are much more willing to talk about the music they would like to hear played at their funeral than they are to talk about signing an end-of-life document. You can have a lovely conversation with someone about the kind of music they want played at their funeral. You can have a lovely conversation about the things you have really appreciated that you have offered and given you in your life. And you know they’re not going to live forever, and you’re hoping they have another 10 or 20 years on the planet but, no matter what, you want them to give you the opportunity to tell them what you appreciate. I don’t think we need to drag people kicking and screaming. We can open up the shallow end of the pool.

I’m a huge fan of Five Wishes, which is a wonderful advanced directive. It’s written in very humane, human language. It’s also free. You can get it for free now because of the Coronavirus. So, it’s Five Wishes, and if you go online, you’ll find access to it. It’s usually five bucks, but it’s free right now. The wonderful thing about this is it’s not strictly medical. It includes things like, “If I’m on my deathbed, I would like someone to be massaging my hands with the oil;” “These are the poems that I would like read to me;” “These are the people I would like to see in the room, and these are the people I would like banned from my deathbed.” I love it because it looks at the person as a full human being, not a bundle of diagnoses, not just as someone in their eighties. But, “What is the music you love?” “What’s the poetry you love?” “Are there people you would like to apologize to for things you did that you wish you had done better?” These are the ways of making our final five or 10 or 20 years, or our final six months or whatever it might be, looking at these and being able to bring ourselves as full people to them.

Everybody listening to this, we have climbed mountains, we have endured divorces, we have seen children turn out badly, we’ve gone through all kinds of things in our lives and we’ve coped with amazing things. And if we can feel like we’re bringing our full selves to periods of decline or temporary disability, or permanent disability, we have enormous skills of adaptation and acceptance and response and responsibility and moral caring and empathy for people that we love. We’ve exercised these skills during our entire lives and we can bring them all to this later period of our life, too. It’s only if we start to shrink our sense of who we are and start to think, “Oh, I’m just COPD,” or “I’m just diabetes.” It’s only if we start shrinking ourselves down like that, that we start to feel inadequate.

David: Wow. That was amazing! My last question is if you have any other advice that you haven’t already given? You have given quite a bit, so it’s not like I’m thinking like you’ve missed anything, but, is there anything else you’d like to say to people?

Katy: Trust your own moral authority. Trust your heart. If you feel like something is fundamentally off in the way medical care is proceeding, speak up. Ask your doctors to speak in kitchen table language. I literally know people who have said, “Would you say it again in English?” It’s extremely disempowering, or it can be, to go into a doctor’s office and start hearing what’s essentially medical gobbledygook. The reaction tends to be one of two things. It’s either, “Oh, I’m so stupid, I have no idea what he means.” Or, they start to Google and do a lot of research and try to find out what all these terms mean and then speak the way the doctor is speaking. And both of them make us inauthentic. They make us disempowered. It’s extremely important to bring the doctor down to your level and to speak up about what really, really matters to you. He may be assuming that what you want to do is try to live another two years, or that what you really want is hope, whatever that means, dishonest hope, even lie hope. But, maybe what you’re really concerned about is, “I want to garden. I can’t garden anymore.” Or you may be wanting to say, “I’m extremely concerned that I’m going to die before my daughter’s wedding? Is there anything I can do about this or do we need to move up the wedding date, or have the wedding in the ICU?” You need to stay in touch with what truly matters to you.

It may mean that before you say that to a doctor, you need to write in your journal about it. You need to have at least one buddy out in the world who you just download with and process this with until you can actually create some concise questions or statements for somebody. It’s so important to stay in touch with language that makes sense for you, and that you can express what really matters to you in. And the doctor should come down to your level, you should not try to go up to the doctor’s level.

David: That’s great advice. Thank you so much for your time, Katy. I’ve gotten so much out of this and I’m sure our listeners will as well. Stay safe!

Katy: Stay safe. Stay six feet away from everybody. And thank you very much. That was just lovely. I really appreciate you asked me to do it.

David: Oh, sure. I’m so glad. I don’t know whether Corona gave you some time to do this, but if it did, I’ll thank Corona.

Katy: Thanks to Corona, I learned how to use Zoom. I probably would have said, “I can’t do this! Call me on the phone!” You are a great interviewer, by the way. Fabulous. You’re really good. You have a fabulous combination of reassuring and attentive, but also challenging enough and humorous enough that you’re bringing out the best in me and I just want you to know that. This is a good one. You kind of brought out more fire in me for some reason. Just great.

David: Good, good. All right, well thank you so much.

Katy: Thank you. Bye-bye.

David: Well, I’m glad I could bring that fire out in Katy. She’s bringing it out in so many herself with her books and her Slow Medicine group on Facebook.

Thanks for listening. For those of you who are not yet the early adopters, I hope this podcast is your invitation into what Katy called the shallow end of the pool.

To learn more about Katy Butler’s books, go to, that’s Katy with a Y, K-A-T-Y Butler dot com. And to learn more about how embracing your mortality can help lead to a more fulfilling life, go to our website,, that’s the bucket, all one-word, dot com. If you know of someone you would like to hear on a Bucket podcast, let us know at Again, thanks for listening, and stay safe.