Podcast Episode 144

with our guest Edward Creagan

Farewell: End-of-Life Lessons From 40,000 Patients

Edward Creagan [00:00:00] But I’m the high priest, I’m the czar of the healing power of pets.

Brilliant Miller [00:00:29] Today, my guest is Edward T. Creagen, M.D. He’s a cancer specialist, the first Mayo Clinic doctor board certified in hospice and palliative medicine. Dr. Ed has authored over 500 scientific papers. He’s given more than a thousand presentations throughout the world. He’s written two books, How Not to Be My Patient: A Physician’s Secrets for Staying Healthy and Surviving Any Diagnosis and, Farewell: Vital End-of-Life Questions with Candid Answers from a Leading Palliative and Hospice Physician. Having watched my dad pass from many lifestyle, or highly treatable, if not preventable diseases, wanted to see what I could learn and share from Dr. Ed in this interview. We talk about the dying process, how to be a good caregiver, or how to interact with those who are in their last days or months. We talk about how to care for yourself. If you find yourself in the role of caregiver, you can learn more about Dr. Ed and his work by visiting. Askdoctored.com. I hope you enjoy and benefit from this conversation with my new friend, Dr. Ed.

Brilliant Miller [00:01:36] Dr. Ed, welcome to the School for Good Living.

Edward Creagan [00:01:39] Thank you. Thank you.

Brilliant Miller [00:01:40] Will you tell me, please, what’s life about?

Edward Creagan [00:01:44] Life is about making the day a little better for some troubled soul, especially those of us who do have privilege, who do have a position. That’s not enough. It’s not enough to have the big car, the lakeside cabin, the BMW. Somehow, those gifts need to be shared because then it will come back to us, especially today, when covid-19 has stripped bare the screaming inequities of health care, the screaming inequities of opportunities. So we really have a responsibility to somehow open a door for someone that may be a digital door. It may be a physical door, but somehow we have been called to make it better for somebody else. And what’s really cool, you make it better and they don’t know it.

Brilliant Miller [00:02:53] Yeah, I’ve heard it said before that true charity is anonymous and what you’re saying there and it seems. Yes.

Edward Creagan [00:03:01] Yes.

Brilliant Miller [00:03:02] So wonderful. Well, Dr. Ed, part of why I’m really interested to talk with you is that I know you have an incredible life experience and you have been at the bedside of more than forty thousand patients who were on their way out of this world. And I wonder, what have you learned in your time dealing with so many people over so many years?

Edward Creagan [00:03:25] Everybody has a story. Everybody has a drama. And at the bedside, there have been overwhelmingly consistent themes. And the theme is regrets, remorse and missed opportunities. And no one ever talks about their four O3b. Their 529, their 401k, the letter from the CEO acknowledging that they were the leader in sales, but it was regrets and remorse, and those are the same themes that I hear when I play the piano in the lobby of the Mayo Clinic. We have the finest piano in the world called the Bush Indoor for. And I try to play a couple of nights a week for 45 minutes and I hear the same stories, I always as good as Elton John, Billy Joel, but then something happened, and that’s what I hear at the bedside. What I don’t hear is people taking ownership or responsibility for their misadventures. I hear unconnected dots. I hear folders which have not been closed here. Unfinished business. The prodigal son who’s never connected, the daughter who had an unfortunate relationship. And we’ve never picked up the horn to make amends. A consistent theme, regardless of the belief system, regardless of the faith system. But no acknowledgment of the role that we played in the messes that we’ve created.

Brilliant Miller [00:05:17] Yeah, this path is. One that I know you began maybe without knowing at a young age. Yes, of course, this is true for all of us. You know, your parents or caregivers played a big role in that. But you had some some early experiences that I think set you on this course. Will you talk about how did you how did you come to the work you’re now doing?

Edward Creagan [00:05:45] I’m often asked that question. Brilliant, and it began in a poverty stricken hamlet in Ireland. The Republic of Ireland, the south is the republic, the six counties are the north, that’s the Protestants in general. That’s Ulster and my grandmother was the oldest of 11 children. And one night, her parents came to her. Her name was Mary, the name of the town was Mexicana. Still remember it? And they said, Mary. At dawn, there’s going to be a wagon at the end of the lane or horse drawn wagon, and you can get in that way, you’re 11 years old now. You can get in that way and go to Cove Cove is the harbor of Cork on the southern tip of Ireland for which the immigrants left. You can get in that wagon and go to America where the death rate on the ship was 30 percent. This is crossing the Atlantic in April. She never saw the light of day. She lost probably 15 percent of her body weight and she was told by her parents, if you don’t take that trip, you will die in Ireland because of tuberculosis, coal consumption, or you will die because of the issues with with Great Britain. So she made a decision in the middle of the night knowing she would never see her parents again. So think about that, she’s dumped on Ellis Island. Like a sack of potatoes, everything she owned was in a pillowcase, she spoke not a word of English. She spoke Irish. She married my grandfather, who was a prominent jockey. Because of alcoholism. He lost his trade, I live with them because my parents were alcoholics and we moved into a rooming house in Newark, New Jersey. And this is where my story started on the second floor. There was a room facing the street that was rented out to a Polish immigrant that I remember as if it were yesterday. His name was John Grybowski. And he had cancer of the rectum. Cancer of the rectum in the 1950s was a dreadful condition. Treatments were brutal, non-effective, and my job as an eight year old was to come home from school and change the appliance, which collected the waste from his intestines twice a day. Wow. Wow. I knew this was the path I would follow. I can’t make this up. This was kind of the Oprah stuff, but whether this was a guardian angel, whomever that started to be on the path of end of life never looked back. No regrets. It was a gift not to have a distraction, because when you grow up in Newark, New Jersey, everyone wants to play for the Yankees or Lord forbid, the Knicks. But this was the path for which I have been profoundly grateful.

Brilliant Miller [00:09:24] From the time you are eight years old,

Edward Creagan [00:09:26] yes, that’s so undergraduate work had the focus for medicine, internal medicine, oncology, national cancer, there was no deviation whatsoever. I had a GPS of the sole. That needed to be honored and acknowledged.

Brilliant Miller [00:09:48] Now, that’s something that I think many people wish they had or they don’t believe they they don’t believe they do, or they they think even if if it’s in there, you know, maybe the battery’s dead or they don’t know how to turn it on. This whole idea of a GPS for the soul. What do you what do you say to people who maybe haven’t activated theirs yet? How can they do it?

Edward Creagan [00:10:12] I’m smiling because I’ve given a number of commencement addresses and what the audience is expecting to hear. We’ve all been there. Follow your dreams. You know, that’s a recipe for oblivion. Because when you’re 17. You don’t even know what day it is. You don’t know what your dreams are. Yeah, and I’m reminded of the commencement address at Stanford University by Steve Jobs. This is a classic and he talks about connecting the dots, that everyone has an intrinsic curiosity about something. Nurture that curiosity, get real good at it. Don’t be an. Don’t be discouraged. And that will leave you to the promised land. And if you look at every person of prominence, however, you may define them. They had a curiosity about something Yo-Yo Ma, the cellist, had a curiosity about music, Elvis Presley loading trucks in Tupelo, Mississippi, had a curiosity about music. But you need someone to open that door and tell you how good you are, and for Elvis, it was Colonel Tom Parker. So every person of greatness has had a polestar. Directing them down the road, because without that polestar, you ain’t going to go the distance, you’re going to become distracted. And the Boulevard of Broken Dreams is littered by the individuals who became distracted by all sorts of issues that we could talk to hours about.

Brilliant Miller [00:12:20] Yeah, well, I love what you’re saying about this intrinsic curiosity where sometimes passion can feel daunting. What if I have so many or what if I just don’t know what it is? But this idea of luck, you’re curious about something. You know, honor that. I really like that. So awesome, let me ask you let me turn the conversation to a discussion about your book, Farewell: Vital End-of-Life Questions with Candid Answers from a Leading Palliative and Hospice Physician.

Edward Creagan [00:12:50] Yes.

Brilliant Miller [00:12:52] Who did you write this book for and why

Edward Creagan [00:12:54] I wrote this for every patient and every family that needs to be empowered. That transition from life to death. Doesn’t open itself for a second chance. There’s no do over, there’s no dress rehearsal. Most of the books which had been written focused on the emotional and psychiatric community. We all remember Dr. Elizabeth Kubler Ross, a wonderful physician from the University of Chicago in the 1960s. And she started the conversation about end of life, unfortunately, the conversation was corrupted and it was not correct. She talked about the stages of death and dying, denial, anger, bargaining, acceptance, and many others believe that this was an orderly transformation from denial to bargaining to depression. But it’s not. But we now know that this is a journey. This is a process. And if we don’t know what’s going on, we’re going to become bewildered and make some major mistakes. The other dimension of the book that very few people talked about was the importance of prudent financial planning at the end of life, which most of us do not do adequately. And then we leave a existential psychic catastrophe. That’s the grieving widow or widower are saddled with for a lifetime.

Brilliant Miller [00:14:46] Yeah, that that I’ve seen right and you right, that we are a death denying culture. Yes. What do you mean by that?

Edward Creagan [00:14:57] Look at the commercials. Every woman is a size four with straight teeth and a twenty four inch waist. We don’t want to think about dying. The concept of advanced directives is anathema to most individuals and simplistically advanced directives dictates who do we want to speak for us? If we can’t speak for ourselves and what aggressive management do we want, if we can’t speak for ourselves? So every couple of years my wife and I, Peggies, my wife, my best friend, my running partner, we sit down with our attorneys to make it crystal clear that there is no misunderstanding, especially in a time of covid. So we revised our advance directive. If I’m not better and I have covid and we hit 30 days, I do not want any aggressive management. I want my care to be deescalated because I would never put my family through what many of us put our families through at the end of life. No.

Brilliant Miller [00:16:12] Yeah, you know, this this thing about being a death denying culture really resonates with me, where a few months ago, this about a year ago, I suppose I’m as part of a group of entrepreneurs I belong to. We took a retreat and we had discussions planned. And one of them was to write and share our own obituary.

Edward Creagan [00:16:33] Yes, yes, yes.

Brilliant Miller [00:16:34] And I was the one who proposed it. And when it came time to actually do it, I didn’t do it. It’s like I don’t know what it was. I sat down in front of the keyboard, you know, in computer. But I just I like I couldn’t bring myself to do it. So I have experienced this firsthand. And having watched my dad pass, you know, just over a decade ago now, it’s actually been 12 years this month as we’re recording this, I’ve seen, you know, the resistance to really looking at that for myself. I’ve seen the difficulty of going through about the importance of the importance of it. And you talk about this advance directive. You talk about some other documents that are important for us or other things are important for us to do. And maybe this is in the context of life completion or maybe that’s something different. But I want to explore with you these two things. One is, what do you mean by the term life completion? And the other thing is what are some of the most common and what I would almost say mistakes or things that we don’t do that we could or should do to make this easier for ourselves and those we love it.

Edward Creagan [00:17:38] Let’s go back to the second question first, OK? About five years ago, I was called by a woman whom I had known somewhat socially. Her husband had been recently diagnosed with cancer, the pancreas, which has a survival under most circumstances of a short number of months. The patient was an MBA and a CPA went to the Wharton School of Finance in Philadelphia. She was a thoroughbred and was a major leader in the medical community, a power broker. So I visited them because they didn’t live terribly far and 80 percent of what we do. It’s showing up, Woody Allen said that 80 percent is showing up. So I listen to his concerns and as we were winding down, I said so and so. Have you taken care of the financial stuff? Because as your energy fades, the last thing you want to do is dealing with an estate attorney as some CPA someplace. Oh, sure, Ed, no problems. Everything’s done. No problems. He dies. Nothing was done. Wow. Zero. And I would see his wife occasionally at a social function. She would take me aside. And she said, you know, Ed, I have been in a fog for three years, ever since my husband died in a total fog. I couldn’t put two and two together, he did nothing financially to ease the burden, so three to five years later, every month or so, she gets a bill, a receipt, an invoice about something that he did not care for. So there is that dagger in the soul reminding her with some bitterness. He did not do his homework. So when my my wife and I visit with this armada of high priced characters, we left the meeting. I said, OK, I want one phone number one phone number that Peggy calls. Just pick up the phone. Who does she call to start this process of resolution? Because most people don’t have any concept of this wills, trusts, estates, who gets what families by definition. Even in Minnesota or wickedly dysfunctional.

Brilliant Miller [00:20:28] That seems pretty universal,

Edward Creagan [00:20:30] let me rephrase that, we have Lake Wobegon.

Brilliant Miller [00:20:34] Yeah, that’s perfect, right?

Edward Creagan [00:20:35] And you throw in grief, you throw in. Stepchildren who don’t even know each other. You throw in second marriages, you throw in different nontraditional relationships, and then you throw in money and everything changes, especially in a farming community where an acre of land in some states might be ten to twelve thousand dollars. And many of the agricultural patients whom I have met did not do responsible end of life financial planning. So that is the answer to the second question, the first kid, the first question is there is an intrinsic need to finish tasks. There is an end finish, there is an intrinsic desire to connect the dots and close the folders. And if we don’t, there’s a sense of incompleteness. So what I hear from patients at end of life. Is to leave a legacy, something maybe they participated in a clinical trial, maybe they invested in a company which is a legacy to their insights. Many individuals have a legacy of a sporting franchise, a stadium, or they developed a running shoe, but just to remember that they lived in that they died and they did something, they simply are not anonymous.

Brilliant Miller [00:22:24] Yeah, and one thing that comes to mind for me here, you talk a little bit about is organ donation.

Edward Creagan [00:22:33] What a gift, and in my my new wallet, I’m not promoting a product, but this is a this is a Walikale, the ridge.

Brilliant Miller [00:22:43] I have that same wallet. Is that the carbon fiber?

Edward Creagan [00:22:46] Of course.

Brilliant Miller [00:22:47] I love that wallet. Yeah.

Edward Creagan [00:22:49] And I got this for Christmas and I thought, I need this like I need a root canal, especially when you gift that comes with a screwdriver. Yeah. So in here is my wallet. In here is my donor card. So that would be a gift that I can give to someone so that in a sense that that legacy is is continued.

Brilliant Miller [00:23:15] Yeah, yeah. This this to me seems a bit of a paradox where, you know, we do seem and we do seem to have this innate drive, this urge, this need to complete things. Right. To close folders and bring resolution and this kind of thing. And yet we resist sometimes facing these challenging issues of our own mortality or, you know, something like that. And I wonder if if some people think, oh, you know, I’m not super wealthy, it doesn’t apply to me. I don’t need to have these these wills and trusts and advanced health care directives and things like that in place. But I think especially after reading your book, that’s not the case. You don’t have to have high net worth for these things to be important.

Edward Creagan [00:24:05] Absolutely. Let me give you a classic example. Again, I’m just parroting really what I pay people to teach me. Almost everyone has life insurance from a company, from a foundation. So if we die. And if there’s any CPAs out there, it’ll probably send me a hate mail, but if we die, that life insurance in general is a highly taxable event. So let’s suppose the life insurance is one hundred thousand dollars and we’re in a 30 percent tax bracket. I think that means 30 percent. Thirty thousand bucks is taken right out of that piggy bank to Uncle Sam. If that life insurance is part of an estate plan, an irrevocable life insurance trust, the bulk of that life insurance is not taxable. Wow, so you have a piggy bank with another 30000 bucks that you can donate to a school, to a team. To find a Head Start program. That’s cool. Yeah, so regardless of who we are, everyone has an estate plan, some are more complicated than others, and we have an existential responsibility to be wise stewards of those resources and not give them away.

Brilliant Miller [00:25:37] Yeah, and I think about that story you shared just a few minutes ago about, you know, the widow who received these these documents, these invoices and so forth after the fact and received them with the sort of bitterness. Oh, absolutely. Right. Where there’s this sense of if we love, you know, those that that were married to or dependent on us or related to us, perhaps one way we could show that love is to be more thoughtful and deliberate in taking care of these things that might seem mundane or trivial while we’re alive. But there will be people who survive us and there will be an impact.

Edward Creagan [00:26:15] And I’ll give you an example of a negative impact. There was a gentleman, he was about 50 who had lung cancer, serious problem. His survival was in a short number of months. He had been divorced, married, a wonderful woman. And she had three daughters, so he had three stepdaughters, he had three sons from his first marriage. He had inadequate estate planning. He died, traditionally, the sons inherit the farm. His sons inherited nothing. The three stepdaughters and their husbands inherited the family farm. The bitterness, the rancor is still being adjudicated in the courts, in upper Midwestern states. So I think if we’re diagnosed with something serious, will we have a kernel of energy and focus and cognitive bandwidth? That next phone call needs to be the banker, the attorney, somebody that can cook the books. I’m from New Jersey, originally cooked the books, do the right thing so we can focus on relationships and our health.

Brilliant Miller [00:27:35] Now, let me turn the conversation to an exploration of. The dying process is something that we’ll all face suddenly or in a I think, as my dad experienced, a somewhat slow, long, slow decline. Yes, yes. But in your book, you write, let me walk you through the dying process so that there is some understanding of what to expect. Yes. Will you sketch that out for us? What is what should we expect from the dying process

Edward Creagan [00:28:08] when most patients are initially diagnosed with a potentially lethal problem, Lou Gehrig’s disease and stage heart disease? Cancer, typically. The process starts with an overwhelming sense of bewilderment. Forgetfulness, the cognitive purchasing power shrinks, and this focus of the world goes to me as the patient. They become indifferent to the rest of the world, that tsunami’s coming down the mountain. I don’t care. I’m focused on me. Then there is a frenzy, a frenzy seeking out that czar, CZAR, that guru. That special person, someplace that must have the key to the kingdom. That person with the Holy Grail, the Rosetta Stone, that’s going to fix this. He has to be out there someplace. Many patients will spend a lot of money and a lot of time trying to find him, and they might be going to a place like a major medical center, so that part of the journey closes. And then the reality hits home, my health is dwindling, so there becomes a shrinkage of their social circle rather than that entourage, your circle shrinks spouse, partner, a pet crucial during the dying process. We could talk about that later. Then there is a gradual folding down of interests. The biological processes go into slow motion. Less engagement, less focus going to bed initially 10 o’clock, then nine, then eight thirty, and then very little energy for the ban on Monday. Discussions of life, politics, sports, relationships, the economy, more time sleeping. And the final ending is much like folding a tent or folding a parachute. It’s not dramatic. It’s the kind of cataclysmic. It simply is a winding down. And most patients die. With no one at the bedside. Most patients die when the faithful partner goes down the hall for a cup of coffee. Most patients die when the family goes across the street to the motel to get a bite to eat and take a shower. Most patients die at night. Most horses die at night, so it’s almost a way of protecting the family from the reality of that final passage. But there’s also a message for visitors, most visitors overstay their visit. The dying process uses a lot of energy. The only sacred property that the patient has is the bed, don’t come in and sit on the bed. Call ahead, call the nursing station, ask if the patient is up for visitors. Ask if you can bring something. And be mindful. That once what was funny is not funny anymore, and they don’t have to have all the sordid details of your bankruptcy or your second divorce. And be sure to leave before the patient asks you to leave. If the health care team comes into the room while you’re there, respectfully. Disengage because it ain’t about you.

Brilliant Miller [00:32:34] Yeah, thank you for for sketching that out, and I realize, you know, there’s two there’s two aspects to this exploration in your book and in this conversation that are very useful. One is when it’s us who’s received the diagnosis or it’s us who’s going through the process. There’s, you know, again, you know, we’ll all face that end of life, whether it’s because of some specific disease or not. But the other is then when we’re a caregiver or we’re someone who’s related to to the person who’s on his or her way out. And what you’re saying now is. You know, for me, it’s very sobering, right, like there’s something I mean, life doesn’t get more serious then than death. Yes, right. It’s the end. And by the way, on that topic, I, I had I think when my dad passed and my brother died a few years later, unexpectedly, just before he was forty five, that was really I mean, I’d had grandparents die and other people I knew, but no one that was as close to me as that. And one of the things that I was so struck by is how absolute it’s not just, oh, I’ll go ask him a question or, you know, see how they’re doing. It wasn’t and I could find my mind looking for creative ways around something as if they were in a foreign country or, you know, they were otherwise inaccessible for a period. But it was just so like final was really remarkable.

Edward Creagan [00:34:03] You know, I’m smiling because. You’re a very good interviewer and you’ve just articulated. What every family member is, the finality, boom, it’s over. There’s no tomorrow. There’s no mulligan. And every family member has this experience, although it’s never quite so articulated. And I can recall. Spouses who would come to see me and they were embarrassed because they came home from the funeral and they were upset because the garden hose had not been turned off by their spouse. They were upset because the mortgage was not paid and she had to deal with this. They were upset because some legal issues were left unresolved. They were upset because they couldn’t go to him to program their cell phone. Now, one woman said to me she was irate because he knew how to increase the font of her phone. She did. And it’s little things like that that slowly drive us insane. Yeah, but the finality of death can be crushing. And even when we know it’s coming, we are never prepared. Never. Yeah.

Brilliant Miller [00:35:40] Yeah. And that that you’re talking about the irritations of the upsets. I experience a bit of that. Even years after my brother was gone, when, you know, we had a discussion at one time as a family and I and I found myself angry. He wasn’t there to be a part of it. I’m like, I want his voice in this conversation. Years later, you know, but how silly is that to be? I mean, that’s a judgment of myself. But how silly of me to be upset at a deceased brother for not being a part of it. A discussion years later, you know.

Edward Creagan [00:36:14] A consistent theme, not quite so eloquently disertated by most family members.

Brilliant Miller [00:36:25] Yeah, and again, you know something we all we all face, so let me ask you about preferences. You talk a lot in this book about honoring the dying person’s preferences. How important? Yes. Yes. And something that often gets overlooked.

Edward Creagan [00:36:45] My first wake up call to this phenomena occurred in the early 1970s. Vietnam was a scar on our collective consciousness, Tet was in the late 60s, I believe 55000 of our troops were killed during that conflict and many communities of faith brought to the United States, members of the Vietnamese community and faith communities in Minnesota open their doors to these people, especially after Saigon fell in the middle 1970s. And I remember this patient as if it were yesterday. And because of confident then chirality, I won’t mention his name, but it’s funny, you know, forget these people. He was a combat veteran and he had a gaping chest war wound where you could see his heart beating. Wow. A tough gentleman and part of his life before the war, he was a barber. And as he was dying, he had in place a catheter into his bladder. Multiple intravenous lines for fluids, and he was getting, with all sincerity, the finest end of life care in the world at the Mayo Clinic. No apologies. The people providing care for his end of life were superstores. And the family was in a state of a huge agitation. They were pacing the room, they were chanting, they had the equivalent of rosary beads, and I was the attending physician and I had no concept of what was happening. But finally, a Buddhist minister came into the room. I said, Reverend, educate me what’s going on. He told me that in their faith system, the way that patient was when he died is the way he would be for eternity. Therefore, upon death, the catheter would be in place for eternity, the multiple IVs would be in place for eternity, and he was a barber for eternity. He needed a comb, scissors and a mirror. It was Minnesota, a thousand degrees below zero. It was February. He had a hospital gown. The social workers went to JC Penney to bring gloves, galoshes, a hat and a coat. So here he is dying in the intensive care unit with a hat, a coat, galoshes and gloves. I’ve never had so many hugs and kisses from women from Vietnam. Wow, because we acknowledged his wishes at end of life. In some belief systems, the deceased must be buried by sundown. Most of us were not terribly aware of these rituals in certain faith systems, so we make darn sure now that we’re educated about the final chapter. Activities for faith systems about which we’re not well-educated. Help me and there’s always a representative in the family of the clan who will gladly say, OK, in our system, here’s what we need. We need incents, we need sage. And with some creative administrative manipulations, we can get it done.

Brilliant Miller [00:40:29] Oh, yeah, and and one of those other things that you touched on it earlier also was pets, that all animals aren’t normally allowed in a hospital or family. Pets aren’t allowed in. But sometimes at the end of life, it’s one of the most important things and it requires this kind of creative approach. Well, you talk about that

Edward Creagan [00:40:48] of now, not to be self-serving, but I’m the high priest. I’m the czar of the healing power of pets. And I had the privilege of writing a definitive peer review paper on this. And the data are overwhelming. If you hold that horse, if you groom that cat, if you struck that there’s a surge of immunologic and enduring hormones which enhance life sustaining biological processes endorphin and Cephalon, serotonin, oxytocin, prolactin, these are measurable. And my first experience with this took place 25 years ago, so this is the anniversary of that event attending physician, Rochester Methodist Hospital, we admitted a patient who was about 50, disheveled, unkempt. He had the stigmata of a hard life. A broken nose that was that set facial scars, poor dentition, a rock hard. Mass behind his collarbone, fluid in his lungs, a liver that was like a rock filled with cancer. We didn’t think he would make it through the night. Full court press fluids, antibiotics, and by the way, no family member basically dropped off at the Methodist Hospital. We asked him with whom he lived and as his sensorium cleared, he says, I have to get home for Max. Now, this was in the 90s. We had no sense of cultural sensitivity, no sense of partnerships. We naively thought Max was a daughter, son, spouse. He says, give me my wallet. Now I’m getting chest pain. It’s not cool to go through a patient’s wallet, give me my wallet. So he gives me the wallet. It was not one of these wallets leather. So I want to show you a picture. And the picture was a 90 pound German Shepherd cross biggest dog I ever saw in my life. That was Max. Max was the catalyst, the payload to get this gentleman home, to spend his remaining time. Wow. So there’s a healing power of pets. That gives meaning and purpose and engagement to people’s lives, and I’ll be at a wonderful program on February 25th. It’s called Fetch Fitty, S.H., Fetch 360 is one of the largest virtual Vetinari meetings in the world, three day deal rock stars and I have the opportunity not that I’m a rock star, but to talk about covid pets and the miracles that I’ve seen that pets bring to patients and families.

Brilliant Miller [00:44:05] Is is this available to everyone or is it all professionals?

Edward Creagan [00:44:09] Yes. Fetch 360 and Dr Adam Christman. C.H.R.I.S.T.M.A.N. is the digital impresario that somehow has pulled this off and I was going to be on an Instagram feed later today. And the gifts that you bring to me is the digital familiarity with this, frankly, I didn’t know that you can have a live Instagram feed. Yeah, pretty cool. So, yes, very cool. Now, I got an e-mail from there early this morning, nausea, vomiting, sick. So we talked about this. I said, you call me any time, any date doesn’t matter. We’ll get it done. But not not when you’re this sick. So fetch 360. And I’ll be on late one afternoon talking about covid and pets and what this means to each of us to.

Brilliant Miller [00:45:18] That’s great. Something I’m really eager to ask you about is deathbed confessions. In your book, you write, My white coat becomes almost a priestly color, the hospital room, a confessional, and that doctor patient interaction and opportunity to set the record straight. Right.

Edward Creagan [00:45:38] It’s true. This is the the deathbed confessional. And usually it’s not something dramatic. I robbed a bank like D.B. Cooper. I had a lot of money and I jumped out of a plane over Washington State. But it’s the subtle things that no other soul of people. I cheated my partner. He didn’t know that we made a windfall because we sold X, Y or Z. I was at a convention. Too much to drink. A moment of indiscretion, a moment that I’m embarrassed about tells me that a moment of why did I ever do that? What was I thinking of? So these are the kind of things that don’t have a big legal implication. But it’s the kind of thing that they need to make peace with. And there’s a phenomenon called the Zig Norick effect. Zain Verjee and I are like. Zig Norick. And this was described by a Lithuanian board psychologist in the 1920s, and she noticed that among waiters when there were tabs that were still open. The waiters remembered everything. The name of the liquor, the name of the divorce, how big the steak was, they remembered everything. There was an anxiety about a ticket that was not resolved. Once the ticket was resolved and they had the check in the tip, they couldn’t remember what these folks ate, the Zig Norrick effect. So likewise. If we hear a song and we don’t quite know how it goes, we’re going to get on Google and find the name of that song. Mm hmm. We have to close the dots. We have to close the files or it consumes our bandwidth, so at the bedside, when there’s unfinished business, people are not at peace. For example, daughters in prison. Dad holds on with advanced cancer until her parole is up and she comes to the bedside, then the dots are connected and he can pass on. Everyone’s heard these stories.

Brilliant Miller [00:48:21] Yeah, yeah. That’s that’s interesting. Is your experience that when when patients dying patients kind of confess, so to speak, to you, that that’s enough for them to close? Yeah, close that.

Edward Creagan [00:48:34] Yes. And they don’t expect to make an apology to their partner or to that wife. That’s not part of the package. But the fact that they told another somewhat credentialed professional about their misadventure was enough to give them the psychic energy to go to the other side.

Brilliant Miller [00:48:55] Yeah, and I think that’s so interesting. And it goes right along with something else that you talk about, about one of the major themes is I’m sorry,

Edward Creagan [00:49:04] please forgive me. I’m sorry. I forgive you. Crucial to somehow make amends. But if there’s a contentious relationship. Call ahead to make sure that it’s OK for you to visit that patient. Mm hmm. I’ve had circumstances where a gentleman was dying. The former partner shows up. It was a divorce that didn’t go well, it was a divorce that was very public and very humiliating, patients dying, the families at the bedside. And the disenfranchized spouse shows up. Not good. So if there’s a contentious relationship, call ahead, ask the nurse to ask the patient is OK if I stop by, if the nurse says no end of story, don’t just show up. You may not be a good seeing.

Brilliant Miller [00:50:05] You know, I’m just struck by how the people who probably most need to hear that are the ones least likely to actually hear it, you know.

Edward Creagan [00:50:13] Yes. And you can imagine the tension if there were bad behaviors that are visible in public. Not not a good way to go out, same way at a funeral, let’s say a wife dies. There were some issues with her previous relationship. If a gentleman, he needs to somehow get a word to the family, is it OK if I go to the service out of respect?

Brilliant Miller [00:50:41] Yeah. You know, something else that for me goes right along with this. And it also is related to the preferences conversation is you in your book, you write, I’ve also learned the hard way to ask the patient who they would like at the bedside. Sometimes it’s a girlfriend rather than the wife. Sometimes it’s the same sex partner the family had suspected, but it never really come to grips with. I’ll bet you’ve seen some interesting things in that regard.

Edward Creagan [00:51:05] Absolutely. And the real issue arises. Patient does not have full capacity or competency is the term we typically use, but capacity is the legal term. Patient isn’t thinking quite right. In most states, the spouse can speak for the patient. In Minnesota, interestingly, there is not that derivative, but common sense would dictate that the spouse would speak for her patient. But I’ve had circumstances where the same sex partner. Was a more appropriate spokesperson for the patient, the same sex partner that everybody sort of knew about but nobody talked about this was that special French. So these are the issues that somehow need to be resolved up front in the light of day, not under the glare of the ICU monitor or the emergency room light. So if there is the suspicions of those unspoken entanglements, boy, it’s best to talk about those over the kitchen table over a cup of coffee rather than in the cacophony of an intensive care unit.

Brilliant Miller [00:52:24] Yeah, I can I can imagine. And I’m reminded of something, a thinker, you know, a 20th century thinker, Buckminster Fuller, of course, he talked about how our societies tend to only deal with with issues once they become emergencies. And this idea of emergence by emergency, that we develop technology or we change our behavior when it becomes literally a matter of survival and and not until then. Not until the pain is so great. And I think that maybe this is that same tendency showing up in individual lives. Like we won’t have that over a cup of coffee or at the kitchen table. For whatever reason, but when it becomes essential on the death. OK, now we will you know, what can we do that

Edward Creagan [00:53:08] we have to think ahead, We have to plan at the time of death, everyone is physically, existentially and spiritually exhausted. The tank is dry. There’s nothing left. Their brain cells are misfiring. Emotions are raw. Tensions are high. So as the patient proceeds down that existential tunnel, that’s when somebody needs to invite someone over a cup of coffee and say, let’s talk about something. There’s something that I’m concerned about, the statements nonjudgmental, but so that we don’t have a disintegration at the bedside. I need your guidance about X, Y or Z. We can’t leave anybody out.

Brilliant Miller [00:53:56] Yeah, I. I imagine there are people who are listening to this who they find themselves in this very circumstance. And you talk about that in your book that if you’re reading this by the bedside like I’ve seen you, I know you’re right. Like again, we all go through this at some point or we avoid it. But the point I’m trying to make is I suspect that this interview will people will find it at the moment that they’re in this caring for a loved one who’s on his or her way out of this world. And they’re they’re they’re getting this idea of, OK, I want I’m going to initiate these conversations. But they don’t they still don’t know how they maybe they feel they need some support. Maybe it’s a clergy or a coach or a therapist or another a friend, family friend or something like that. What what advice do you give to somebody who wants to to do this, who wants to initiate these conversations but doesn’t quite know how to do it effectively or safely?

Edward Creagan [00:54:56] In an ideal world, which is not let me give you an example, here’s an acquaintance of mine who in the dying process now prominent real estate person, power broker in a community in upper Midwestern states. Went through a bitter divorce years ago, has two adult daughters and one adult son. He has extensive real estate holdings, including a palatial lakefront estate. There was a meeting around the bedside. Between the two daughters, the son and the patient. And the patient said to the son, I want you to have the house, I want you to have the house, the other assets I’m going to divide between the sisters. His son was very happy the other sisters went ballistic, accusing the father of not being fair. So this was a bad scene, a priest was making rounds who knew the patient, and he said, you know, said to the adult children, let’s go outside and let’s kind of talk about this so that there’s no misunderstandings. There was a lot of misunderstandings because a lot of money and property was involved. So the priest had the foresight to act as the mediator in a nonjudgmental format. They went back to the bedside and the priest said to the patient, let’s be fair about this. You’re on your way out. Your energy is going to become diluted. You need all the purchasing power you need to make this a fair situation. So there was an agreement. We’re going to sell the house. We’re going to have one big piggy bank and we’re to divide it in thirds. Everybody went home feeling good about it. So if the individuals can talk about it among themselves, which they typically cannot, cannot, then there needs to be some detached professional who could say what I’m hearing doesn’t feel right. Maybe we can explore this other opportunity. But if it’s not done in the light of day when people are rested and comfortable, this will be a Holocaust. That’ll be it’ll it’ll scissors the soul of that family forever. Yeah.

Brilliant Miller [00:57:34] Yeah, I I’ve seen that and different families, so to it two more questions in the section that that I want to ask. One is when one finds oneself in the role of caregiver.

Edward Creagan [00:57:49] Yes.

Brilliant Miller [00:57:50] Yes. Which also can be very depleting. What what recommendations do you have or what have you seen that works well when it comes to. Nurturing, managing and caring for oneself in this very trying time?

Edward Creagan [00:58:05] Is this ever timely, Brilliant. Over the last two years, for some reason, this has become a hot button topic, caring for the caregivers, and I suspect I’ve given maybe a dozen presentations on this. So I looked at some of the data on this data of which I was not aware. And for the caregivers out there. Your life expectancy will be shortened by 10 years. Wow, your life expectancy will be 10 years shorter because of your caregiving responsibility and the data are out there, 50 percent, five of caregivers will die before the patient dies.

Brilliant Miller [00:59:01] Really, really,

Edward Creagan [00:59:03] Half of the caregiver community will die before the patient dies. Right now, approximately 30 to 40 million million individuals are primarily full time care givers.

Brilliant Miller [00:59:20] Is this 30 to 40 million worldwide or in the USA?

Edward Creagan [00:59:24] Wow, 30 to 40 million are primarily full or partial caregivers, average age, late 40s, primarily caring for elderly parents with Alzheimer’s disease. The other dimension of this, of which I was unaware, is the economic catastrophe. And the the fictional story is a caregiver who had been making about eighty thousand dollars a year, which is a high end salary, if she’s out of the workforce for two years because of caregiving, she will have lost two hundred thousand dollars, almost a quarter of a million that she will never recoup. Wow. Wow. So that talks about some numbers, let’s talk about the health consequences, Dr. Judith Kotoko, you are a beloved colleague, was at the Mayo Clinic for several decades and now is at Mayo Clinic in Florida, a marvelous hospice colleague. She’s almost like a Mother Teresa. She saw, as we all see. The implications of caregiving, what it does. So she did a study measuring immunological markers in the blood of caregivers and their immune system basically is paralyzed and goes south and they are a tremendous risk for colds, for the flu, connective tissue disorders and depression. But let me tell you the rest of it. I would ask all of our listeners to take off their shoes and take out your shoelaces. And if you take out your shoelace, there’s that plastic thing on the end of your shoelace that you put into the eyehole, and it’s genetically these are called telomeres, yellow and aureus telomeres. Your telomere has a certain length. Let’s suppose your telomere is this big with stress of caregiving, whether it’s for the elderly or for children with disabilities. Your telomere shrinks. The shorter the telomere, the shorter your life. So we have objective evidence that caregiving can be deadly. So what do we do about it? Number one, if you don’t take care of yourself, there’s no backup. There’s nobody left to take care of your spouse, your neighbor, your friend or your partner. So this is not an indulgence. This is a prominent. Characteristic that you must do, you must have time away. You must have time away in the state of in our communities, a program called Visiting Angels who are Wonderful. At a minimum. Caregivers need eight to 12 hours away from caregiving or they will not go the distance

Brilliant Miller [01:02:40] and this is eight to 12 hours for every day of caregiving

Edward Creagan [01:02:44] or typically eight to 12 hours a week

Brilliant Miller [01:02:47] or eight to 12 hours a week away, just doing their own.

Edward Creagan [01:02:50] Absolutely. So this might be three 1/2 days a week. That would be 12 hours. Yeah, because caregivers become fatigued, their cognitive power nosedives, their judgment nosedives. They cannot make decisions. Bills don’t get paid. And if they’re not technically savvy to begin with, they lose that ability to stay connected. They cannot not access patient portals. You know, most of us are real familiar with the tablet, the cell phone. But there’s a lot of folks out there that have no idea what they think. It’s a big coaster. Yeah. And if one isn’t used to getting online, making appointments, see what the doctor said, what’s the medication that I had? They become overwhelmed and to stand in a big box store for two hours doesn’t make any sense when they can get on a patient portal and have the medication delivered home. Yeah. So caregiving is a lethal profession. Which has tremendous implications for society and for families right now. There are data from the University of Michigan, someone is diagnosed with Alzheimer’s dementia every 72 seconds while seconds. Rochester, Minnesota, has one of the most robust demographic studies in the world of aging. Because all of the care in Augusta County is given in one of two organizations, Mayo Clinic or the Olmsted Medical Group. So everyone has a unified medical record. So we can follow individuals from birth. Through death. We know everything about them. There’s no study like this in the world. This is a human petri dish. And we know that starting at about age 80 or 85, at least half of the population has some element of cognitive impairment, at least half. So your insights about caregiving is so insightful. This is a tsunami coming down the pike and nobody is ready for it.

Brilliant Miller [01:05:22] Yeah, yeah. It’s unprecedented, right? With our aging population and all the other just what we’re facing in in life right now. There’s so much that that we haven’t been exposed to. So looking ahead, can be so good. Well, thank you for for sharing that one thing. I also want to be sure to talk to you about, because I understand you’re a pioneer in this is palliative care.

Edward Creagan [01:05:46] Yes.

Brilliant Miller [01:05:47] What is in my hope unselfishly is that people will learn about it and go into it and go into this as a career. But will you tell me what is palliative care and how and when and why did you get involved?

Edward Creagan [01:06:03] For every one of our listeners really needs to pay attention right now. OK, turn off the television, turn off the ironing. I don’t look at the news and please pay attention to this. In the middle 1990s. I had been on staff at Mayo Clinic for about 20 winters. That’s how we measure things in Minnesota. I have been an oncologist for 20 years. And I became struck, as did many of my colleagues, about the toxicities of our chemotherapy programs. And every one of our listeners has a litany of experiences of misery from chemotherapy. We’re much better now than the 1990s. This was not a good gig, so to speak. So I became curious, how do I learned about this? Because like most doctors, I thought I knew everything. I thought I did need the Internet. I’m a smart guy, so I started to go to hospice meetings. These were wonderful. They talked about practical interventions to improve the quality of life, morphine, stool softeners, medicines for pain, anxiety, but most importantly, to sit down with the patient in the family eye to eye and talk about where this train is going. And to ask one question, what can I do for you? So in 1996, I had a near-death experience. In March, we were in the middle of a blizzard and I was driving from Rochester, Minnesota, in the southern part of the state. One hundred miles to the equivalent of Siberia to get to Minneapolis, 20 below zero horizontal sleet. The car did a 360. Now I’m a bright guy. I thought, you know, this is not going to have a happy ending. I could go home and not take the exam or I could go forward and take the exam. I made the decision to push on the blizzard stop and I passed the exam, so I had credibility. Then I took the exam a few years later and then a few years after that, so in medicine we live in the land of credentials. So I had the credentials about dealing with death and dying, so for our listeners, they need to understand palliative care. You can think of palliative care. As a big basketball. As a big basketball, and it focuses on quality of life and sense of well-being. Regardless of the diagnosis. Lord forbid you have a heart attack, you have nausea and vomiting and your feet hurt. The last thing the cardiologist wants to do is to hear about your nausea, vomiting in your feet. The palliative care people come in and they focus on your symptoms. I focus on the symptoms, the heart, people focus on the heart. When it comes to cancer. The oncologist or the hematologist focuses on your cancer, leukemia, breast cancer, the palliative care people focus on your nausea, your vomiting. You’re diseases of the soul, so we get pretty good at what we get pretty good at. So the big basketball is palliative care, a sliver of that, a sliver is hospice. By definition, hospice supplies to end of life care during a patient’s last six months of life. Simple question is it likely that Mr. Jones or Mrs. Smith will pass away in six months? If the answer is yes, they are hospice eligible? Now, there’s a few subtleties there, but this is a gift from the feds. Simplistically, that the hospice benefit covers financially expenses related to your end of life, this might be a walker, might be crutches, canes, it might be physical therapy coming into the home, might be nutritionist, might be music therapy. It’s an incredible gift to make those six months better for you, the patient, and for the family. Now, there’s two dimensions, bricks and mortar. All of our listeners know about this hospice of whatever, or there’s a hospice which is home based, which typically means that there’s a capable caregiver in the home. Now, not necessarily. It’s not a deal breaker, but ideally, if I’m a hospice candidate, my wife would be available to help. But every family needs to raise the issue to the primary care people. Let’s run this by the hospice team. Let’s run this by the palliative care team. In general, no one in the world really understands this.

Brilliant Miller [01:11:33] No. Yeah, and I I’ve heard many people talk about how, you know, when they’re patients, they often feel like a diagnosis and that. Oh, right, the doctors are treating the disease, but they’re forgetting them as a person. Right. And this this palliative approach seems to be very team approach is something that I think many people like you’re saying they’re not aware of. But if they were, it would literally transform their experience, their end of life experience and who doesn’t want that for themselves and those they love?

Edward Creagan [01:12:06] I should assure our audiences that we did not rehearse this. But you have eloquently summarized this. Most of our listeners have care under a complex health system, computer epic, epic epilepsy just mentioned those four words to any physician. They will grab their chests and bend over, weeping visibly because it’s complicated and it’s very difficult to find out the patient’s occupation. How can we knock on the door, minister, to someone and not know what they do? Yeah. I also include the name of the patient’s pet. And in a charged and of life environment. And you ask patients, who do you live with, and I said, my wife, my spouse, my partner, anybody else? Oh yes, I live with Jesse. Who’s Jesse? Jesse is a golden retriever. Nobody can talk about Jesse without smiling or without some story about their golden retriever. So the calculus I sound like a Harvard business person. The optics now change completely.

Brilliant Miller [01:13:31] And like you were saying earlier, the issues of faith and belief and preferences that that I think can easily be forgotten when it’s, hey, I’ve got to eliminate, you know, this disease, but I’m not seeing you as a person or that the environment that you that you live in, the space that you occupy spiritually, emotionally, mentally.

Edward Creagan [01:13:52] Let me share with you two stories. Walked into the room and saw a gentleman who was in his early 90s bad clinical situation, far advanced lung cancer. He was alone. He had the stigmata of advanced cancer. And sprinkled throughout the history was the word fwd, but it never explained what he was a part of. And I said, Dr. So-and-so, I see you’re a Ph.D. Can you tell me what you did? And he said, Son, what my son said. He said, Have you ever heard of the Manhattan Project at Los Alamos, the Enola Gay and J. Robert Oppenheimer? I said, sure, that all related to the atom bomb. The Enola Gay was the name of the plane that dropped the atom bomb. This gentleman was the chief physicist for the atom bomb project. No one understood his place in history. All of a sudden, he was not just an old man with lung cancer, he was a man who was a factor in transforming. The gyroscope of the human race for which he was tremendously guilty. Another gentleman was dying with a serious problem, intensive care unit, four daughters at the bedside, daughters were probably early 50s. And I asked the gentleman, what did you do? And he went like this. Oh, and the daughter said, Dr. Creagan, do you eat pizza? And I thought, Oh, here it comes. I said, Sure, how did you cut your pizza? I said, well, one of those circular knives, my dad, the patient invented the circular knife. So those are the the nuggets that bring us back to the bedside during very difficult times. So every time I cut a pizza, you think of this gentleman. Yeah.

Brilliant Miller [01:16:05] Yeah, thank you. Thanks for sharing that. Well, Dr. Ed, with your permission, I want to go ahead and transition us now to the enlightening lightning round.

Edward Creagan [01:16:13] Yes, sure.

Brilliant Miller [01:16:14] OK. And by the way, how are you doing?

Edward Creagan [01:16:17] Oh, I’m very durable. Good, unflappable.

Brilliant Miller [01:16:21] Awesome. All right. So, again, this is a series of questions on a variety of topics. Yes. Yes. My aim is to ask the question and for the most part, to stand aside. You’re welcome to answer as long as you want. But sure. OK, question number one. Yes, please complete the following question. OK. Sorry. Please complete the following sentence with something other than a box of chocolates. Life is like a…

Edward Creagan [01:16:48] Chess game.

Brilliant Miller [01:16:50] OK, number two. Here, I’m borrowing Peter Thiel’s question, what important truth do very few people agree with you on?

Edward Creagan [01:16:58] There’s no free lunch.

Brilliant Miller [01:17:01] OK, number three, if you were required every day for the rest of your life to wear a T-shirt with a slogan on it or phrase or saying or quote or a quip, what would the shirt say?

Edward Creagan [01:17:10] Make me feel important.

Brilliant Miller [01:17:13] All right. Question number four, what book other than one of your own have you gifted or recommended most often?

Edward Creagan [01:17:20] Outliers. Malcolm Gladwell.

Brilliant Miller [01:17:23] OK, and what are you currently reading?

Edward Creagan [01:17:28] I’ve often been accused. I only read what I write. But as a distance runner, I have to talk about Hyperfocus. This book was part of your website. Oh yeah. And it talks about the importance of time management. But I also learned in the midst of finishing with the sports gene. Oh yes. Bottom line, there is no gene for greatness. You got to hustle. You got to get up in the morning. You have to do the work. There is no spin of your DNA that’s going to bring you to the NBA finals or to Carnegie Hall. It’s gut busting work. There’s no free lunch. There’s no easy road to become. Very, very good.

Brilliant Miller [01:18:09] Yeah, you know that. Well said. And that is a thought for me that simultaneously, like, liberating and depressing. You know,

Edward Creagan [01:18:18] I but but I think also it’s a copout. If you say greatness is a genetic trait and I’m not great, that gets you off the hook because I could say I don’t have that spirit of DNA. But if you look behind every great person, there is a family, there is a tribe, there’s a community, there’s a confluence of factors. It didn’t happen just by luck.

Brilliant Miller [01:18:43] Yeah, for sure. All right. Thank you for that. OK, question number five. So you traveled a lot in your lifetime. What is one travel hack, meaning what is something you do or something you take with you when you travel, to make your travel less painful or more enjoyable?

Edward Creagan [01:18:59] You must take a list, a non-negotiable list of the minimal stuff you can take. And on that list you better have it. Passport, baby. You may think you’re famous. Immigration doesn’t care.

Brilliant Miller [01:19:13] Yeah, for sure. OK, question number six. What’s something you’ve started or stopped doing in order to live or age well?

Edward Creagan [01:19:25] Watching the news on a regular basis and pruning, limiting any social media exposure.

Brilliant Miller [01:19:34] You’ve stopped that? You’ve stopped looking at the news?

Edward Creagan [01:19:37] I will spend a minimum of time, about four nanoseconds becoming familiar with what’s going on. But I will not waste my time with the entertainment of cable news. I will not waste my time following someone on the Internet or on social media. It’s corrosive, it’s negative. It’s not good for the spirit. And frankly, an hour later, you’ve burned through 60 Minutes. You have nothing to show for it.

Brilliant Miller [01:20:05] Yeah, absolutely. It’s funny that you bring that up right now as well, because over about the last six days, almost a full week, I just said, I’m going to quit looking at the news on my phone.

Edward Creagan [01:20:16] Yes. Yes.

Brilliant Miller [01:20:17] And my days have been so much better at the end of the day. Yes. I just feel better.

Edward Creagan [01:20:23] Yeah, no rebuttal. Absolutely.

Brilliant Miller [01:20:25] OK, question number seven, what’s one thing you wish every American knew?

Edward Creagan [01:20:32] The limitations of medicine and the importance of self care and ownership and

Brilliant Miller [01:20:38] and by the way, for people to learn more about that in a concise and highly readable way, I invite them to pick up your other book, How Not to Be My Patient: A Physician’s Secrets for Staying Healthy and Surviving Any Diagnosis.

Edward Creagan [01:20:52] Thank you. Much. Like me going to an estate lawyer, a copyright people. I don’t know the vocabulary. I don’t know the landscape. I don’t know the vineyard. And 80 to 90 percent of illnesses of reasons why people seek care are due to lifestyle options and lifestyle choices. Yeah, genetics plays a very, very small role. Let me give you an example. I’m an only child. Someone said, well, don’t you have any brothers or sisters? Well, no. By definition, I told each of my parents really struggle with alcoholism big time. What’s the probability of me as an only son having inherited the gene or the tendency towards alcoholism? Probably 100 percent. So when I was probably 15, 16 years old, a light bulb went on. It’s not worth the risk. No alcohol, no problem. So we are not prisoners of our genetic endowment.

Brilliant Miller [01:21:52] Yeah, that’s that’s powerful. There was something I wanted to add or ask, but maybe I’ll recall that I thank you for thank you for sharing that. OK, keep us moving, question number eight, yes, what’s the most important or useful thing you’ve ever learned about making relationships work?

Edward Creagan [01:22:15] Listen. Listen, as they’re talking, don’t be thinking about what you want to do. As I mentioned earlier, the T-shirt make me feel important, everybody has a sweatband, make me feel important. So when I speak, used to be face to face, but now more virtual, make me feel important, make my day count what most people are doing. They’re thinking ahead to the next question. And don’t try to one up someone. They’re talking about some serious medical problem they have. Don’t say that you have the worst pain in the world. Simply listen. You will have a friend for life.

Brilliant Miller [01:23:00] Thank you. And by the way, I do think that it’s worth acknowledging the the length of your marriage you’ve been together. I heard you say best friend.

Edward Creagan [01:23:11] Oh, I am so blessed. My wife is Peggy Manzo. She is a German dietician. That’s why I look like this. But we’ll celebrate our twenty first anniversary next October. But the point is, without a pollster, without that person’s spouse, partner, relationship, colleague, neighbor, who do you call at four o’clock in the morning? If you’re isolated, if you’re marginal, if you’re on the margins, the track record is not good. Yeah. So I think especially now we’re in a digital world, we have the covid thing. We will have enforced isolation probably for the next year, might be loosened up a bit. But I think those communal gatherings, that quick dinner, that impulsive theater, it’s not going to happen, especially with the evolution of the mutant strains.

Brilliant Miller [01:24:10] Yeah, yeah. A lot of a lot of unknowns still.

Edward Creagan [01:24:13] Yes. Yes.

Brilliant Miller [01:24:15] You know, just going back for a moment, the thing that I when you were sharing about lifestyle choices was this was only a few years ago that I had the insight. I was one of my one of my teachers pointed out that aging doesn’t necessarily mean like breakdown and decrepitude. Now, obviously, we lose faculties and things like this. But I had always just imagined, like illness and disease was a necessary and inescapable part of aging. And what this teacher pointed out was you can just ripen and then expire. And I’ve never known that.

Edward Creagan [01:24:50] I think the classic example is Dr. Anthony Fauci. He’s 80 years old. I just think for a moment, the pressures, the tensions, the conflicts, the visibility, the threats that he and his wife and I think two daughters were under during this unspeakable nightmare, he knew what needed to be done. He had the science, he had the credentials, and he had for complex reasons that we may never really understand. He could not articulate that message. And to me, he has now been liberated and there’s a lightness in him, so he’s an example of an inhabitant of the blue zone. Hmm. For our listeners, the blue zones are those parts of the world where people far live in excess of your typical suburban executive.

Brilliant Miller [01:25:50] Yeah, and it’s as you were saying, it’s not genetic. It’s not just genetic.

Edward Creagan [01:25:55] It’s friends, families, it’s colleagues. It’s challenges. It’s being acknowledged. For your insights and wisdom, our elderly today are warehoused in Azerbaijan, in Loma Linda, in the country of Georgia. In certain parts of South America, in Okinawa, people are acknowledged for their elderly skills in our country. That’s not the case.

Brilliant Miller [01:26:24] Yeah, that is a phrase I mean, it’s very descriptive and it brings something up in me about warehousing the elderly. Yeah, yeah. And then in your book, How Not to Be My Patient, you talk about the only true fountain of youth exercise, right?

Edward Creagan [01:26:38] Oh, I know. We’re being recorded, so I won’t become too profane. But yeah, it’s not at some spa. In some Sunbelt.

Brilliant Miller [01:26:47] Yeah. It’s not infusions of certain places. Right. Right. OK, question number nine. Yes. Aside from compound interest, what’s the most important or useful thing you’ve ever learned about money?

Edward Creagan [01:27:01] Invest the same amount month after month or week after week and don’t look at the Dow, the S&P and the Nasdaq.

Brilliant Miller [01:27:10] Yeah, my dad would have liked that. He would have he might have phrased it don’t be a short timer, a cabinet term view.

Edward Creagan [01:27:17] And there’s a company out there that some of our listeners are aware of. That’s all video games. And this has become the poster child of rolling the dice and has really jeopardized conventional financial wisdom. Member Warren Buffett made the comment, never invest in anything that you cannot describe or explain to a friend or neighbor.

Brilliant Miller [01:27:43] Yeah, yeah. Solid. OK, so the last part of our conversation, I have just a few questions for you about writing in your creative process. But before we before we get to that, I want to be sure to ask. Two things, one is I want to be sure to let you know that as an expression of gratitude to you for sharing so generously of your time in your experience, one of the things I’ve done is I’ve gone on Chebeague micro lending site that helps underserved entrepreneurs around the world. And I’ve made one hundred dollar microloan to a group of women in Senegal who are raising crops and they will sell these to support themselves and improve the quality of life in their communities. So thank you for giving me a reason.

Edward Creagan [01:28:30] Well, thank you. Well, thank you. Thank you.

Brilliant Miller [01:28:34] And the other thing, the other question here is, if people want to learn more from you or they want to connect with you, what would you have them do?

Edward Creagan [01:28:42] Or website is askdoctored.com, askdoctored.com and let me share my email address. And that’s Creagan, (CREAGAN) dot Edward at Gmail.com ([email protected]). Because our listeners are survivors. They’re resilient, they’re durable, or they wouldn’t have the psychic strength to listen to this. Yeah. And they’ve learned wisdom, they’ve learned insights that I would like to hear to pass on to other travelers, because there’s no website, there’s no planet that has the solutions, and sometimes we learn nuggets of survival from the least likely sources. So we just need to pay attention and be alert.

Brilliant Miller [01:29:35] Yeah, for sure. Thank you all. Thank you. OK, and the final part of our conversation here today is, as I mentioned, about writing and creativity.

Edward Creagan [01:29:45] Yes.

Brilliant Miller [01:29:45] And one of the things I’m I’m constantly fascinated by is this idea that many people are good at what they do, but they’re not necessarily good at teaching about what they do. And they’re not necessarily good about communicating or writing.

Edward Creagan [01:30:00] Yes. Yes.

Brilliant Miller [01:30:01] But but I think you are. And I wonder, when did you first know yourself to be a writer or when did you first get the desire to write?

Edward Creagan [01:30:11] This was in medical school, which quite frankly, I went to. I graduated from medical school in 1970. And to be very honest, it was a miserable soul shredding experience and being very honest. This is a medical school in New York City and we’ve all heard these stories and they’re true. First day of medical school. We were in a large auditorium, almost like a warehouse. There was one hundred and twenty of us and the doors opened and about 20 colleagues came in who thought they were entering year two of medical school. Their grades were reevaluated and they had to repeat the first year of medical school. Wow. Merry Christmas. Welcome aboard. So it was it was a bitter experience and the lectures were dreadful. They would have so Nobel laureate droning on incomprehensively about something that made no sense whatsoever, and I would say to myself, gee, I can do better than this, so let let me think about writing. And I learned I would come in from a run because I’ve run all my life. And off the top of my head, I was able to write between one and three thousand words. On any topic, this is like someone in a bar who can sit down and play, take me out to the ball game without any sheet music. So now I have a software gimmick called Fluency Direct. So I would come in from a run like we did this morning, sit down and dictate about 2000 words on the next book. The next blog. The next column. Where this comes from, I don’t know, but it’s a gift for which I am profoundly grateful. And most of the topics come from some mundane observation, some thought that goes through my mind.

Brilliant Miller [01:32:23] And part of what I enjoyed about your writing is that it does include stories and it makes it more enjoyable for me to read. It makes it more relevant. You know, I can relate to I have been through you many of those things, thank goodness. But I find that fascinating and so forth. One thing I’d love to know is. As you have these decades of experience and you’ve collected these stories, how do you organize them? How do you organize a book and then how do you slot in stories?

Edward Creagan [01:32:55] The crucial aspect of writing any book is firstly to ask yourself who’s the audience? Who cares about this particular book? The second most important thing is to have an outline of chapters. Let’s suppose I was writing a book about automobile maintenance, so each chapter might be a book about the car, here’s the steering wheel, here’s the carburetor, here’s the transmission. Here’s the electrical system, something like that. Every chapter must have a story. People do not remember facts and figures, and if you look at the cable news, it’s all based on stories. There might be some facts and figures, some slick graphic charge, but the basics are the human interest stories and look at the stories that we all remember of what happened in the Capitol a couple of weeks ago, the terror, the anxiety, the life altering, potentially lethal implications. So there has to be a story. But equally importantly, you must have an editor. You must have it. Ed, I’ve been blessed to work with one of the finest editors in the world, Sandy Wendle from Omaha, and she has a website right on INC authority. Because we developed myopia, we developed cataracts as we put together a book. And you need someone to say, you know, you’re sitting on the next Harry Potter and you don’t know it. Let me give you an example. One of the most iconic, transcendent cardiac surgeons in the world I’m being serious about this is that Mayo Clinic. Has transplanted more hearts and dealt with more children with lethal heart conditions than any performer in any institution. He’s a sacred personality. He’s also a saxophonist. I’m a pianist. Why anybody would play the horn, I don’t know. But I respect his skills and he’s good. And he had an idea for a book melding the concept of the surgeon and the leader in the operating room and a musician and an orchestra conductor. Frankly, I couldn’t get real excited about this. Now, maybe there are business people that would, but frankly, this was not something high on my list. But I didn’t want to shut the door. I referred him to Sandy, the editor, and maybe she says something here. She can tease out the value of this, but we ourselves don’t have the gift to see beyond ourselves, to see the real value of a potential book.

Brilliant Miller [01:35:45] Yeah, yeah. That’s often the case. Right. Either because we get so attached to something and we over we over value or overestimate how valuable it is. Yes. Or we don’t see. I think this is something that people who were very good at what they do, very smart, very talented. They often because their gifts come so easily to them, they don’t know how special their own gift really is. So it’s to have both ways.

Edward Creagan [01:36:08] I think that really applies to golf. It also applies to pianists. You have three platforms of pianists. You have the composers. You have the performers and you have the teachers, very little overlap. You have the composers, you have the performers and the teachers. Same is true in golf, if you look at the top money were winners on the PGA Tour, none of them are teachers. If you look at this, the swing coaches and the conditioning coaches in golf, none of them have had a prominence on the PGA Tour except this teachers. So it’s it’s a remarkable person that has a gift that they can teach and they could also have visibility and

Brilliant Miller [01:37:03] yeah, for sure, that’s an interesting distinction. I’ve never thought of it that way. So if in music it’s the composers, the performers and the teachers. Yes. What is it In golf? Is it the coaches?

Edward Creagan [01:37:15] Yes. If you look at the top money winners, the PGA Tour, everyone has a private swing coach. This is almost a sports psychologist who clearly has a visibility in golf. I’m thinking of Tom Harmon had been a prominent teacher. I’m thinking of Tiger Woods and his first teacher was his father, Earl. So if you look at the top money winners on the PGA Tour, everyone, without exception on speed dial has a coach, a swing coach who is reimbursed for looking at the player’s style. Perfect example. I spoke at a nice venue in Scottsdale a couple of years ago and there was a tent. And in the tent was one of the most spectacular young golfers I had ever seen in my life. I’m guessing 16 or 18 years of age. She had to swing coaches and each of them had a tablet. Each of them had a tablet. One was taping her from the back. What was taping her from the side then? These were on tripods. Then they sat down in the tent where it was cool. She had water and towels and they went over the video of her swing. So here we had an example of someone who is talented but had the environment and the expertize to bring her to the next level. If she was not a person of prominence and a person of possibilities, she would never achieve greatness.

Brilliant Miller [01:38:55] Yeah. So what’s so we have the performance. Yes, that’s one. We have the teacher. But what’s the equivalent of composer when it comes to something like golf?

Edward Creagan [01:39:05] This was someone who would only write. For example, Irving Berlin couldn’t put two consecutive notes together, but he was a composer par excellence. Hmm. Interesting. If you look at Mozart, tremendous composer. But certainly was not well known as a player, Chopin only had probably. Five or ten concerts, but he was good at what he did. I’ve been with the same piano teacher for almost 70 years. Brilliant teacher points out things to me I wouldn’t see in a year, but is not comfortable performing in public.

Brilliant Miller [01:39:45] Yeah, that’s interesting. Awesome. What advice or encouragement would you give to someone who’s either in the middle of writing their own book project or. It’s something that’s like a dream they’ve harbored for a long time, but they haven’t yet begun. What advice or encouragement do you give to them?

Edward Creagan [01:40:02] Every day, without exception, you get a yellow legal tab or whatever and write down a thousand words. This is non-negotiable. This is not optional. They could be bombing Salt Lake City. Some Third World country is invading Los Angeles. I don’t care. I set my smartphone for one hour, one hour a day, and I either dictate or fine tune. So I would say to that author, don’t let anybody discourage you. We all remember the Harry Potter story, J.K. Rowling. And for the listeners who may not know it, she was a single mom and I believe Glassco, she was raising her daughter by herself. She had no hope. She had no options. But every day she sat down at a booth and wrote Harry Potter. She used the initials J.K. because of the prejudice against women authors at that time in the UK. She didn’t want them to know she was a woman. And I believe 22 authors basically said, who cares about witches and goblins and who cares about Hogwarts? And Harry Potter obviously changed everything. However, as we touched on earlier, there is a price for greatness. And she’s been very public about her depression and some some emotional issues. So what needs to be careful about seeking the key to the kingdom? Because it also may be the key to your demise. Ms. Yeah, very difficult to be young and talented.

Brilliant Miller [01:41:48] Yeah, absolutely, every every gift contains a curse, perhaps, and vice versa.

Edward Creagan [01:41:56] Yes, I’m I’m thinking of the FASTA and bargain. Basically, for our listeners, you make a bargain with the devil, if you give me the magic of whatever, I will give you my soul, but the magic of whatever may be the magic of your demise.

Brilliant Miller [01:42:19] What have you learned about marketing and promoting books?

Edward Creagan [01:42:26] Marketing and promoting books is very much analogous to the music industry. For every great author and every great musician, there are thousands, thousands struggling emotionally and financially. And we don’t know in general all about marketing and promotion. That’s where you need an agent or a publicist or an editor who knows how the industry works. For example, I learned before covid that something like 85 percent of all book purchases are within the first seven feet of the store. Hmm. Ninety percent of all book purchases are impulsive. Ninety five percent of book purchases are fiction. This went against my basic DNA, I would not have imagined that a key to a book, which I can’t quickly put my finger on, is to have the author’s picture on the cover or a picture like this. You have the athlete. Mm hmm. So here’s our book, How Not to Be My Patient. OK, this cover took seven hours of preparation, seven hours, my picture. And it was carefully manicured, no Photoshop. So the warts of the wrinkle show the word not. Is there also my credentials? So people see this, but they also see that there was a forward by Dr. Sanjay Gupta. And he says this book is for everyone who decides to take charge of their own health in their own destiny. Now, I knew nothing about marketing. Same with Farewell that Dr. Deepak Chopra wrote the introduction and also the dust jacket. So these are things I was clueless about, and that’s why we rely on other experts to handle that sort of stuff.

Brilliant Miller [01:44:29] Yeah, yeah. That’s one thing I’ve been struck by repeatedly, is how writing and publishing a book and marketing a book really is a collaborative effort.

Edward Creagan [01:44:40] Yes. Yes.

Brilliant Miller [01:44:41] It’s not a not a solo endeavor. As much as we might think of a writer as a really solitary pro.

Edward Creagan [01:44:47] And I think each of us as writers deemed to have some street smarts, savvy ideas about the book industry and how it works. You know, the days of putting your book in a bookstore are somewhat irrelevant, except for the John Grisham Zenda, Daniel Steeles and those folks most authors would self publish. With the help of my wonderful editor, Sandy Wendle, I’ve learned that that e-books are the way of the future and also podcasts, you know, and the concept of having 15 tons of books in my garage just doesn’t make sense anymore.

Brilliant Miller [01:45:24] Yeah, for sure. Awesome. All right, well, Dr. Ed, I’ve learned so much and I’ve enjoyed our conversation very much. I know we’ve we’ve spoken for nearly two hours and we’ve covered a lot of ground. But as a final maybe as a final thought, what what advice or encouragement would you leave those listening with, whether it’s related to writing or life or end of life or anything?

Edward Creagan [01:45:49] Never let anybody tell you that there’s something you cannot do. Be so good that they can’t ignore you. Because regardless of who you are or where we live, one roadblock after another will be put in your way. And I’ll give you an example, about 20 years ago, I started to write a mom and pop column for the Cedar Rapids Gazette and it also periodically appeared in the Minneapolis Star Tribune. So this was mom and pop stuff. Nothing political. Get a cat, stop whining, get the bed early, exercise, eat like a rabbit because you see no rabbits in hospitals, you know, kind of basic stuff. And it was kind of nice to be recognized. And I became sort of cool, the sort of the Mark Twain of Iowa. And then Sandy went off. The woman who had been with for many years, my editor called me up and I still remember the day I was in a hallway about to see a patient.

Brilliant Miller [01:46:54] And you didn’t know her at all?

Edward Creagan [01:46:55] We never, never heard of her. So she called me up and I said she let me call you back because I’m going to see a patient. And she said, Do you know you’re sitting on a couple of bestsellers? Wow. I said, Give me a break. But I try to be polite and I said, well, let’s tell me about this. She said, Well, I’ve looked at a couple of hundred of your columns. You’ve probably put together a couple of thousand words. I think we could work together, so we put together the first edition of this and being a good corporate soldier, I went through all of our various committees, brand management, communications, public relations administration, et cetera, et cetera. And each of them said, who would care about these stories? Who would care that your parents struggle with alcoholism? Who would care that you spent a lot of time shooting pool, going to the racetrack and playing chess? Who would really care that, you know, you were the president of one of the premier medical institutions in the world? Why don’t you just do your thing? We don’t really have much interest in this. And I was very willing to give them the copyright and all that sort of stuff about which I knew nothing. So these various committees said, OK, you do your book thing. Well, to my amazement, this became one of the top best sellers on Amazon. It was nominated for the Book of the Year award. And then the second version had even more popularity, and it’s been translated into probably five or six different languages, including Spanish and also Italian. So if I had walked off on to the sunset, none of this would have happened. So. When we put farewell together, I sort of had the same reaction. These books are a dime a dozen, but there is no other author that heard 40000 bedside discussions, and our book was even purchased for copyright by the People’s Republic of China. Wow. So my message to the rank and file is that no one will acknowledge that you’re on the road to hitting that home run. Be street smart, be savvy. Be aware, but by all means, bring to the table individuals who know how to play the game, you’re good at one thing, but that expertize may not be transferable, relying on some people to do what they do and you do what you do.

Brilliant Miller [01:49:54] Well, Dr Ed, thank you again for for sharing so generously in this interview. I’m really I’m really glad we connected. I’m looking forward to to staying connected. I’m looking I know you’ve got more books and I could tell, so I’m looking forward to that. And maybe we’ll do this again with the next one.

Brilliant Miller [01:50:16] Hey, thanks so much for listening to this episode of the School for Good Living podcast before you take off. Just want to extend an invitation to you. Despite living in an age where we have more comforts and conveniences than ever before, life still isn’t working for many people, whether it’s here in the developed world where we deal with depression, anxiety of loneliness, addiction, divorce, unfulfilling jobs or relationships that don’t work, or in the developing world where so many people still don’t have access to basic things like clean water or sanitation or health care or education, or they live in conflict zones. There are a lot of people on this planet that life isn’t working very well for it. If you’re one of those people or even if your life is working, but you have the sense that it could work better. Consider signing up for the School for Good Livings Transformational Coaching Program. It’s something I’ve designed to help you navigate the transitions that we all go through, whether you’ve just graduated or you’ve gone through a divorce or you’ve gotten married, headed into retirement, starting a business, been married for a long time, whatever. No matter where you are in life, this nine month program will give you the opportunity to go deep in every area of your life to explore life’s big questions, to create answers for yourself in a community of other growth minded individuals. And it can help you get clarity and be accountable. To realize more of your unrealized potential can also help you find and maintain motivation. In short, is designed to help you live with greater health, happiness and meaning so that you can be, do, have and give more visit good living dotcom to learn more or to sign up today.