At some point, your loved ones are gonna die. And do you wanna sit there a year later, two years later, two days later and say, if only I had had either more compassion, more dedication. No, you want to say I stepped up at the plate.

Welcome to the Up Your Average podcast, where Keith and Doug give no nonsense advice to level up your life. So buckle up and listen closely to Up Your Average.

Good morning, Doug.

Hey, good morning, Keith.

It is such a great day to be alive. It's a great day to start twenty twenty six with a bang. And we have my friend, Doctor. George Helms with us today. I'm so excited.

Good morning.

Yeah. George and I go way back. We did a Bible study in Gimbal's First World headquarters over on 98th And Keystone in the late nineties. That a long time ago, but that was good. And he was affectionately in the day, I don't know if you're known as Doctor.

Rebel anymore, but there was a time.

Yeah. Doctor. Rebel?

Doctor. Rebel. Can see why I like George, right?

How did that come about?

Well, it probably came mostly from administrators who weren't happy with me objecting to the way things were sometimes being run, and I was not afraid to let people know. Yeah. So

I think that- That's a pretty good nickname.

Yeah, it is. Yeah. The event that I remember you telling me about was they, I mean, I don't even know if Caleb would know what it was, but they had time cards that I assume would be like this, right? They're this size. Oh, yeah.

And they wanted George to clock in and out every day is what I remember. And his response to it was just what brought a smile to my face. So basically, when I worked,

I worked, know, I'd get My work didn't start when I went to the office. It started when the last day ended and the next day began. So when I filled out a time card, I filled out a time card, it was twenty four hours

every Yeah.

We had the opportunity to befriend George's mom, and she just bragged and bragged and bragged about George. But I think if you wanted a doctor, George is the guy you would have wanted because she would just tell me, I can't believe that he goes to the funerals, he goes to visitations, and goes and cares so much. I'm like, I'm sure that is a historical kind of idea that probably doesn't happen much anymore.

Well, and I always used to tell patients and patient families that when you know somebody for ten, twenty, thirty years, the relationship becomes more of a friend, almost a relative. But I'm also humbled because I recall that when I would go to viewing or a funeral home, I was always surprised that I would, even though I might've known somebody for thirty years, I always learned something about them, about their lives that I didn't know before. You'd walk in and there'd be all these bowling trophies on the wall, or there'd be a picture of a patient wheelbarrowing his wife down the road, things that you just never would have found out. So humbling.

And that's one of the joys of what we get to do, George, is like that we find, because most, I would say our average client's probably twenty five years right now that we've been working with them, we get to know the family. We go and part of what we go through is kind of the idea of our conversation today, and I titled it I'll share our screen with our friends today. I titled it what to do when the options aren't great. And this idea is a medical idea is where I'm zeroing, and there's a lot of those kind of ideas where you can think that way. But in my own experience, this kicked off for me probably in 2009.

My mom was diabetic, and somehow I caught wind that she did a hit and run at a high school football game. Like, ran into somebody's car and drove home. And my thought was, boy, if only there was something I could do about that. I wish I could help him to sit. I wanna like, who does something about that was what I started wondering.

I'm like, oh, nobody's gonna do anything until somebody does something. And at that point, it seemed clear to me that neither of my siblings were gonna do anything. And so I'm like, here we go. And so as we kinda part a big part of this podcast Up Your Average is you are the average of the four or five people you spend the most time with. And I think clearly what Doug and I want for our friends that watch is that they live their best life.

And and when I was thinking about this, I was just thinking of this quote that's attributed to to Mark Twain, but but I'm not sure if he actually said it. Was most men die at 27. We just bury them at age 72. And that process is people get really anxious towards the end of the story, but they let a lot of time between 27 and 72 where they're not living. And so so we try to get them to live that time.

But kinda today, I wanted to talk about is once we get to that time, I found this chart, and it was saying, and and it was kinda showing what I was trying to find was the evolution of a body. Like, you're you you get strength, strength, strength, and at some point, you lose strength and you tail off. And this chart was showing the difference between 1950 and 2015, where, you know, people live, live, live, and then at 77, it started tailing off pretty dramatically. And in 2015, it showed that at age 87 that it starts to tail off. And I think as a bell curve, this idea people don't like to talk about because when it starts to go off the rails, it seems like it can go really quickly.

So as helping a lot of families, you've known these people for a number of years, then if they do annual physicals, were you able to recognize it between one year and the next? Or how would you even recognize it?

I would say the majority of the time it's because loved ones notice a change. Because men and women, when they get to be that age, are still They have this stubbornness that is buried into them, and they're not going to acknowledge that there's any weakness or failure. And typically a wife or a child would point out to them, Hey, did you know that mom left a car running when she went into the house, or the garage door has been open all night? Those kinds of subtle things. The affected person is probably either not going to recognize that or not going to admit that there's an issue or a problem with their decline.

And so would the children tell the parents to say something to you, or would the children somehow send some kind of smoke signal to you? How would you get wind of the problem?

Typically, would ask us if there was something that we could do, some tests that we could do, or some suggestions about how we could maybe bring that up.

The children would. The children.

Or a spouse.

Yeah, was going say because a lot of times with a HIPAA, that would kind of limit some of that communication.

It certainly does.

Yeah. Yeah. Yeah. And of the things that we highly recommend that you all have health care power of attorneys and you include multiple levels, not just the spouse, but in case the spouse isn't capable, that you include who you want to be that person because that's how you, like as the child, you need access to this to be able to figure out what's going on.

Well, and you used the word healthcare, and that's important because people think that once you've established power of attorney, that that's gonna take care of things, but that's purely a financial decision making process, and you need to extend beyond that.

And with my mom, so I'm going back probably twenty years now. With my mom's, probably hers had dad, and then somehow I must have been on there, I don't know. But I didn't even know what to do with it. Right? Like I didn't I noticed mom would repeat things, right?

And this whole hit and run situation, I went to the next level. I'm like, well, how do you well, she probably shouldn't be driving if she did hit and run. So who takes the takes the car away? Right? Like, and so I thought, well, I'll just go do this.

I'll just go I'll go take one for the team. And so I drove down to Evansville and drove my mom to where I'd had an accident one day, we were sitting there, and I was pointing out that I could have really hurt somebody, and you had to sit and run, and man, she got angry. She was really angry with me. And so I thought, well, I'm just gonna call my siblings, I'll tell them what I did. Like, I'll be the bad guy.

And so I told him, and then the next day, I thought, She isn't going to talk to me forever. And the next day, we talked to him, How's everything going, Keith? I'm like, Oh, we have a bigger problem than driving. And so that's when it became more apparent to me that we had something. So then I called her doctor's office and sent them her healthcare power of attorney and asked them to send me her records of the last decade.

So I could just read through, and they had told her probably five years earlier that she had dementia. And I guess she was too embarrassed to even tell Like we didn't know for sure until I read that document. So I guess that's what happened. I don't know. Is that a normal thing?

That's a normal thing.

So if you tell somebody that, they're not telling anybody?

Right. Well, either they don't want to admit it or they don't want to acknowledge it. You know, the testing must be incorrect or that really doesn't reflect where I am.

I'd want to cheer you all on with your family if you're having those kind of conversations, that you don't do that, that you communicate because the loved ones don't know what's going on. If they don't know and they're trying to figure it out, I mean, if a doctor has told you something, you need to make that known as difficult as as much as you don't wanna do it, to have that conversation is gonna help everybody, I think. I mean, it's sad. I put that chart, that bell curve there, because the slope, once you peak out, drops off like a cliff. And you know, most likely, it's not going to give you plenty of time to have these conversations.

It's probably going to begin to drop pretty dramatically. And once it gets really bad, my experience is the emotions are involved too much that nobody wants to talk about the elephant in the room.

Correct. Ryan, typically I would start the discussion telling people that there are three phases that you go through. You can lose money, and people are gonna recover or get over that pretty easily. You can lose loved ones, and that's gonna have a little bit more of an impact. But as soon as you start taking away independence, that is the thing that these people tend to grab onto and hold tightest, is the independence factor.

And driving is a very big one. You take away car keys, they'll get new car keys. You take away the battery, they'll call AAA, and AAA will be out there in twenty four hours, and put a new battery in the car, and they're off and driving again. Sometimes it takes, just for example, driving, there are institutions with occupational therapists that provide a service that says, Come on for a fee, we'll bring your loved one or your spouse or whoever in, and we'll go through a driving test. And we'll be able to tell them whether or not it's safe for them to drive.

And so that's one of the leverage pieces you might have. You say, Well, if you can pass this, then I feel we're better off knowing that. But if you can't, then you need to be able to give up that part of your life. But you also have to be able to provide some type of alternative means of transportation at that point.

Boy, that one is a That's a hard one. I'd say like if you're the kid or the loved one, a way in their living independently is probably whenever you visit to do a walk around their car and just notice the car to see that that that will give you some foreshadowing what's going because there's gonna be dents next to me. Who knows what's gonna be on there? But I always smile when I think about my grandma, and she drove one of those big old Cadillac I don't know what it would have been. It was it was a ship size one, and and it was gold color back in the probably the seventies kinda one.

That thing had dents everywhere because it was trying to, like, move an aircraft

carrier around town. George, how would you encourage Gen two as they're observing some of these changes in their parents? Or how did you do it? Or how would you want to be treated?

Well, a very challenging question. Thinking back to my own parents, it became pretty obvious, but we went through the same phases where denial was a big part of it. And so we had to establish who was in charge. Then you, because I have five brothers and sisters, and because I was the doctor, I had the My name was on that piece of paper saying, Yes, I had healthcare power of attorney. So then it fell back to me.

And then you had to sit down and, as Keith pointed out, to you get some type of proof that there is an issue. And so I think starting with a dementia screen is probably the best way to do that.

Is, man, I think we're going to have a podcast in the weeks ahead about the Del Carnegie course, and communication skills are probably at the lowest they've been in my lifetime as a culture. We're talking about hardcore communication with this thing because you have emotions, different opinions, different personalities. And as the healthcare power of attorney, I was kind of a steamroller. I didn't necessarily try to get consensus because I didn't know that that was gonna do any, like it was going to probably create more emotions, and I took the attitude with my siblings, the out of sight, out of mind. And for me, that worked.

I was just able to take care of mom independently, just getting other advice on what to do in different situations. Because probably in her she moved in with us in 2010, died in 2014, and so probably 2009 was when I started getting more that's probably when I went and had the conversation with her about her car. And when I think about it, like with five, you said five siblings? Mhmm. Trying to talk through every decision and get consensus would seem like that would create a lot of challenge depending on the personality types.

And it's going to vary from family to family. I suspect though in most families, the response is going to be, I'm so glad somebody else is going to take care of this. I live a time zone away and I don't have the inclination to do it. Here, you handle everything. But it's not that way all the time.

Right. Right.

How would you advise Gen two to cheer on Gen one's independence?

I'm not sure I have a great answer for that. I think, again, you want to be able to some of it's gonna be a financial question. Can you provide some type of financial support that's going to allow them to extend their independence? Because typically, when you talk about independence, it may require someone coming into the home or changing their home location, which again is going to create more angst amongst the person that you're trying to take that independence away from. What do you mean I have to sell my house?

What do you mean I have to go into an assisted living environment. What do you mean I can't take care of my wife at home anymore? So I think that the most important thing is that you you try to find a mechanism by which you can support the right decision. It may not always be the option that they want to choose, but if you're going to say, Well, you need to go to assisted living, but it's up to the rest of the family to figure out how that's gonna happen. Because it may not financially be reasonable thing.

Or you may say, well, we can bring somebody into the home to watch mom for, you know, four hours a day. And you then ask yourself, is that enough? And then you ask, who's going to pay for this?

Well,

are hard conversations. And the one that I honestly had no idea about, I didn't even like cognitive impairment, I didn't even have any idea that it honestly, that it was a thing. Like I conceptually knew it, but like until it hit me in the face and we couldn't really even have generation one, generation two conversations with mom about it because she couldn't understand the conversation. Yeah. Which is just it's like you're speaking a foreign language.

It's really humbling. I would say the grace that God gave me the ability to navigate it because we got into some kind of quasi violent things that we had to navigate through, which I had no idea was even a thing.

But again, I would also say that most families should not be expected to have that ability to have those discussions. That's why you have professionals who are trained, if you trust them, to start that process, because they have the vocabulary to be able to talk to people about this, and hopefully the skillset to get into a room with them face to face and try to explain to them what's going on and why it's going on rather than have a daughter or husband or son say, you know, mom, you've lost it.

Yeah. What what does a physician and his or her staff need to be hearing more from the second generation? How can we support our physicians and their staff?

So I guess tongue in cheek, you're in your office and somebody's son calls and says, Hey, I think mom's got a memory problem. Your first response is, Oh my gosh.

That's you as the doctor.

That's you

as the doctor.

Okay. Yes. Because you realize that this is a, as you mentioned HIPAA, this is a difficult situation that you have been thrust into, but you have to be able to take responsibility for that. So I think that family members need to initiate the conversation, and it's probably best done outside of your loved one's presence, at least at the start. Because if you say, Hey mom, I'm going to the doctor's office with you, and then you both walk into the room and the doctor is there, or the nurse, or the nurse practitioner, you say, She's got a problem.

That is not going to go well.

Not a secret, but a private

matter. Right. I found that that was, for me in that season, a hard thing because of communicating to the doctors was difficult. A lot of times mom would get, this is my bias, like third shift at the assisted living wasn't the high priority employees.

Yep.

And they would just send her to the emergency room if there was any problem. And she didn't really need to go there, but then I'd have to go talk to the doctors there. And I would write on the admission forms in bold letters she has dementia, but they would look at the electronic document, and they would never see that.

Right.

And so like one of the last times, And and almost every single time, nobody knew that she like, the doctors when they came in didn't know she had dementia because it wasn't communicated to them. But my well and and if that happens, you're a low priority, so you're in the emergency room forever is my experience. And so the doctor came busting in, and we've been in there for quite a while. And he goes to mom and he said, Mrs. Tyner, what are we in here for today?

And she was probably late seventies. And she says, I'm six months pregnant. And so I just smiled and I'm like, Okay, what do we got to do here? Yeah. But yeah, that whole communication thing can get squirrelly, I think.

Well, and I think the other thing is that with a slow progression, people with dementia or problems like this learn how to compensate and hide things. Oh, yeah. And it's not always obvious that there is an issue or a problem.

One of our friends I really admire, I've seen how she's been walking through this with her husband. And she told me that it's very hard, but she told me that she is enjoying learning more about who her husband is. And so I think for Gen two, that's an important thing. Or if you're a spouse, that's an important thing just to be able to see what can I be learning right now and picking up on cues of who my loved one is?

Right. Well, and I think you also need to acknowledge that there is an increase in vulnerability in these people to the point where you should accept that challenge and recognize that they're going to need more help. It's kind of like when you take your child or your wife in for a surgical procedure and they're under anesthesia and they're out of it back in the Recovery Room. And you're sitting there thinking, If they need to get up, I need to help them. And so that vulnerability is also present in family members who have started down that path of dementia.

What would you say to the third generation, George, as maybe the kids that are in the house watching mom and dad take care of grandma and grandpa?

Well, think that they need to recognize that everyone has limited time. And if dad can't be at your baseball game because grandma fell and broke her hip or grandpa started wandering again, that you have to be able or willing to accept those kinds of things.

Good. I think, again, mean, you helped coach me through some situations that were out there for me, but to begin thinking differently about the process, one of the ideas Connie helped me take into account is that this is a sacred time. It's going to be very stressful, but we're going to learn stuff through this that will change our life forever. I had to like, because there's a lot of all hours of the day things that would go on, and I had to think through, okay, what am I going to do here in this situation without losing my mind? And so I learned a certain level of patience with it.

I don't know what Caleb might remember from those days, but we did have a lot of interesting things go on. But I think there's just a sacred idea of the elderly, and maybe even passing that to that third generation to let them know how sacred these people are.

Well, you know, and it's interesting because I can recall being in the office at midday and getting a call from my mom saying, Well, the door was unlocked and your dad is out wandering, and I have no idea where he is. And then you think, Okay, I'm sitting here trying to see patients and things like that, and I'm the only sibling around. What are you going to do? But I think the most important thing about that is that at some point your family member, your loved ones are going to die. And do you want to sit there a year later, two years later, two days later and say, If only I had had either more compassion, more dedication.

No, you want to say, I stepped up to the plate.

Yeah. No regrets. No regrets. Yeah. I put down like some wins, when to do things on my notes here, when is an appropriate time to start the conversation about what we're talking about today?

Like is there

Well, and that's a great point, but I think the time to start is before you start to see things happen. You know, it's when your mom or dad or your spouse are 60 years old, and you say, Okay, let's figure out who you want to make those decisions for you, acknowledging that it can change. But you want to at least start that conversation ahead of time so that you're not scrambling. I don't know if there's a firm age or physiologic or psychologic bellwether that you can determine. But again, I think the thing to recognize is you want to do that when everybody has their faculties, not when they're starting to sleep.

Maybe just a catalyst you could use could be that maybe you're having a family dinner and another family is hitting this and maybe talk about, hey, this family is going through, not us, but one day it's gonna I don't think anybody estates it, right?

It's connected. No. That is correct.

Yeah. So when that's the way you guys can choose when to start it, and the next thing would be there's a point at which you have to push the conversation. And when you think about that, when's when's the time? Is it Is there a diagnosis? Or like when would you take it to the next level then?

Well, again, I think if there if you do have the observation that things have changed and you do have the opportunity for a healthcare provider to make the determination that there are some things that are starting to slip, you know, I think that's when you become more firm about it.

And the final step that I was thinking about when is then there's even like when you're more firm about, there's a point at which you just have to be not even negotiated, it's I have to take charge at this point. And that's a really hard stage, I think.

Well, that's true, and one of the trump cards you can use is things like liability. If you are aware that your mom just had three hit and run accidents and you chose not to do anything about it, but you knew about it, then you are responsible and liable. And not just financially, but if something would happen, it should weigh on you that you could have prevented it.

Don't know if I'd say I'm type A personality, but I'm willing to take the bull by the horns. I would encourage people to put teams of professionals around them, not only the physicians, but there's plenty of other consultants that you can bring in. We brought in with mom a dementia specialist that helped us in how to navigate through this because I had to learn communicate differently to mom, couldn't have this kind of conversation because she couldn't understand certain things. Short term memory goes away, and so their ability to even understand the language gets different. So you can get consultants in there, and you can get a team around you, and we're happy to help you just kind of make some connections.

But there are just decisions that need to be made, and you helped me with a difficult one this time last year. And so idea that this shift is not correcting, it's not turning around, and there are, I think, physicians that just think they're not necessarily looking at the long term. They're saying, you know, what's this event and how do we fix this event? Does that make sense? Yes.

So one example of my mom, I was in Washington, D. C, and she had some kind of mini stroke or something, and she wasn't able to communicate anymore. And by the time I got back, I was at the emergency room, and a cardiologist came in and was giving her a sales pitch on having heart surgery. And I asked her if we could go out in the hall and say, We're not doing heart surgery. Like there's yeah, this thing is going downhill, and that's not going to be productive.

And so then last year, my uncle had taken a fall, and there was a number of surgeries people wanted to do. And I was out of town, and was trying to act on his behalf, and didn't know what to do. Like nobody was directing me longer term. They were just saying, Here's decision short term you need to make. And how somebody shift from that short term decision to think, How does this fit in the long term?

Whenever I have these discussions, I use the two Qs, quality of life and quantity of life. Because as you implied, a doctor can look there and say, Well, we need to put a pacemaker in this person, or, We need to do surgery on this person. And you have to reflect on what their recent quality of life was and what the projected quality of life will be, and not just in quantity of days, because doctors can do that all the time. If we put a pacemaker in, that's going to keep the heart going and my job is done. But it doesn't necessarily it's not necessarily the right thing to do.

And should be able to project what things are gonna look like a week, a month, six months down the road. If your mentation is poor, I always use the TV test. If you turn the TV on in the room and they don't know the TV's on, they fail the TV test. And so then you say, okay, if we are aggressive with this person, are we improving their quality of lives if we are able to send them to therapy and keep them around for another three, six months? The answer is probably no.

So it becomes a decision about how you impact their quality. And it's interesting you put up this chart about

I'll show this When

I was in primary care practice, my observation was that eighty five is about the time when people kind of wake up every morning and say, okay, God, what purpose do I have for today? And they have a hard time struggling with that. They'll say, All of my friends are gone. I don't enjoy the day. I don't like where I'm living.

And with those people, then you say, Okay, if something semi catastrophic happens, are we really doing them a favor by making them wake up every day?

That helped when I called you last January. That helped. I think my daughter Casey and I went to visit my uncle, and he had a kind of a living room area, then a bedroom area. And when we came into the entrance and living room, he didn't know we were in there. He was hard of hearing, and we heard him praying out loud, Why am I still here?

Mhmm. We turned around and left because I thought this is kind of an intimate moment of his, but it helped me in the decision grid because I knew just what you were saying. That's what he was asking. Let me show oh, I'm showing this. You also helped me one day.

One day I was making one of those middle of the night runs, and I'm like, I was frustrated when I asked you, I don't even know what to do. Like, I'm gonna be in the emergency room. Don't even know why we're there. And I think I was just whining to you as what I was doing. And I wonder with this chart, if it doesn't say the same thing, but you kinda said to me, to relax with what I heard, but you said, I wonder if medical technology hasn't made people live too long.

And I that's really all I needed to hear. Was like, oh, yeah, this mom is here, but she's not really here. And I can get angry. That doesn't serve any point. But from 1950 to 2015, it shows that peak time, it went from '77 to '87.

And I wonder if a lot of that's just medical technology has kept the bodies ticking, it goes back to that quote that's attributed to Mark Twain is that maybe people aren't really living as much anymore.

Well, and you know, my friends and I have conversations when we see the headlines where a 106 year old was still living at home and passed away. And you know, my first thought, as most of my friends are, I wouldn't want to live to be 106.

That's one of my biblical jokes. I think Methuselah lived to nine sixty nine, and my question is, at what age did he wake up and said, Really? Another day?

Well, it's interesting because if you start reading Genesis from the beginning, you start to notice that people, they kind of subtly hint that something is happening. Because yeah, somebody died at 900. Then all of a sudden, she was 600 when she passed away. And then pretty soon it was 130. So I think there's some intent from God to make that shift.

And this change in the graph is probably not from God, but probably from science.

So George, if you were somewhere between 60 and 100 and six years old, What's the one thing that you could do today to make a difference for yourself,

for your future?

Well, I'm a pretty vigorous exerciser, And if that went away, I think I would probably not be very happy. So the things that I would like to do would be to continue to exercise. I think that I would like to strengthen my faith. I'm always amazed when I go to church, you see, and it's mostly women because that's who's living longer. You think, look at this person who's across the aisle from me who is probably in her early nineties, and she's in here learning every Sunday about things that know, she's been doing this for nine or ten decades now.

And so you have to be excited that there is still a lot you can learn. And that's, I think, to be able to continue to learn, whether it's faith or hobbies or whatever, is the thing that I would look most forward to.

Yeah, that's a great way to encourage independence.

Yeah. I think there's

a lot we could have conversations. Maybe you could join us again one day and talk about maybe a couple other specific areas and maybe some, and help us think through some consultants, but I'm really grateful for your time today.

Okay.

George is, I put him in the top shelf kind of friends, the high quality kind of people. It's just an honor to get time with you and to allow you to share some wisdom with That your

just goes to show Keith ought to do a better job of choosing his friends.

Doug, let's do this again. You guys have a great weekend, and we'll see you real soon.