Dr. Erika Altneu | Photograph by Adam Williams
Overview: Dr. Erika Altneu, geriatrician, talks with Adam Williams about the art and science of geriatric medicine. They talk about how she helps her patients pursue a good life and, when it’s time, a good death. They talk about the community connection and creative problem-solving that accompanies being a physician in a small, rural community versus a large urban area like Denver, which has more resources.
Erika and Adam also talk about normalizing conversations about death as a matter of life in “death cafes,” and the who, what, when, where and how of the medical aid in dying process. Among other things.
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SHOW NOTES, LINKS, CREDITS & TRANSCRIPT
The We Are Chaffee podcast is supported by Chaffee County Public Health.
Along with being distributed on podcast listening platforms (e.g. Spotify, Apple), We Are Chaffee is broadcast weekly at 2 p.m. on Tuesdays, on KHEN 106.9 community radio FM in Salida, Colo.
We Are Chaffee Podcast
Website: wearechaffeepod.com
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CREDITS
We Are Chaffee Host, Producer & Photographer: Adam Williams
We Are Chaffee Engineer: Jon Pray
We Are Chaffee Community Advocacy Coordinator: Lisa Martin
Director of Chaffee County Public Health and Environment: Andrea Carlstrom
TRANSCRIPT
Note: Transcripts are produced using an automated transcription app. Although it is largely accurate, minor errors inevitably exist.
[Intro music, guitar instrumental]
[00:00:11] Adam Williams: Welcome to the We Are Chaffee Podcast where we connect through conversations of community, humanness and well being in Chaffee County, Colorado. I’m Adam Williams.
Today I’m talking with Dr. Erika Altneu. Erika is a geriatrician. So we talk about what that means, what geriatric care is, who she sees, what the distinctions might be between that care and the primary care that those of us who are younger than that population are currently receiving.
We talk about the art and the science of this form of medicine. We also get into the differences in care and practice between, say, the Front Range and here in Chey county, what the possibilities are for connecting and community and problem solving.
We talk about Erika’s role in her patients having a good life and also a good death. This leads us to talking about medical aid in dying, of which Erika is a proponent and someone who assists with that process when it’s called for. So we talk about what that process is, the who, the how and the why of it. We talk about why it’s an increasingly legalized and available tool in America, including right here in Colorado. And we talk about death cafes.
The We Are Chaffee podcast is supported by Chaffee County Public health. Go to wearechaffypod.com for all things related to this podcast, including a transcript of the conversation, links, photos, and there are now more than 90 episodes available in the archive.
Now here we go with Dr. Erika Altneu.
[Transition music, instrumental guitar]
Adam Williams: Erika, you have a particular expertise, and I’m really eager to learn about this from you. So with the time that we have today, I would love to just jump right in and I’m going to start at the beginning and ask you a very basic question. You’re a geriatrician. What does that mean?
[00:02:12] Dr. Erika Altneu: I am a physician that specializes in seniors, so this is a fellowship specialty. So I did my residency in internal medicine, meaning adult medicine, and then did additional training in geriatric medicine.
So we focus on the chronic conditions that come with aging, the aging process, and a lot of what happens to patients and their families as they go through the later stages of life.
[00:02:40] Adam Williams: I want to ask what ages we’re talking about, but I also am thinking, and you’ll correct me if I’m wrong, that we shouldn’t necessarily have to produce a birth certificate to validate being able to see you. Right. It’s probably a little bit of a fuzzy area depending on what the person needs and maybe a ballpark area on age.
[00:02:58] Dr. Erika Altneu: Yeah. So in the office, I see patients 65 and older, and some of that’s artificial that kind of just comes along with the alignment with Medicare because Medicare starts for most people at 65.
But the specialty of geriatrics really focuses on older people who are frail or suffering multiple conditions. Now it’s wonderful that I see a lot of healthy 65 to 75 year old people and get to know them, especially before any calamities hit. And I also take care of very healthy 90 plus year olds, which is always wonderful to see people successfully aging.
[00:03:37] Adam Williams: What’s the difference between what you are doing as a doctor for people in this age group versus whoever their primary doctor might have been for decades leading up to this?
[00:03:46] Dr. Erika Altneu: So it is, it’s primary care for seniors. So for primary care, people have the option to see an internal medicine doctor, a family doctor or a geriatrician.
I think the difference is really the focus on the whole person. So it’s a holistic approach looking at where people are at in their lives and their functioning.
I have a huge focus on trying to help people stay independent and then just a lot of experience with the drugs that we use. A lot of people wind up with polypharmacy or they wind up on lots of medications because they have five different doctors, all of whom are prescribing different things.
And so taking a look at the big picture and trying to piece out what we’re doing that’s right for the patient, what we might be doing that’s wrong for the patient. Healthcare can be tricky for older people. So a lot of times I feel like half my job is advocating for patients just navigating through the healthcare system.
People get told different things by different providers, or they’re having different difficulty accessing providers or tests, or I’m playing go between, in between patients and families. And so the healthcare system can be really hard for people, especially older people, and figuring out what’s going to be best can be hard. And so a lot of what I try to do is translate what could be best for them.
[00:05:15] Adam Williams: When you say that if it’s the healthcare system or at large here, what it sometimes does to patients rather than for. I get certain things in my mind based on my own family’s experiences and where we might feel challenges and frustrations. But what do you mean by that? Maybe more specifically.
[00:05:33] Dr. Erika Altneu: So a lot of times we might be treating the disease instead of the patient. And so an example of that that I could give you is a patient of mine who already had pretty moderate dementia and she wound up in the hospital over the weekend with a heart attack.
And she was at the point with her dementia, where she was already having a lot of difficulty at home, her family was taking care of her, she couldn’t live independently.
And I spoke to the cardiologist. I happened to see that she was in the hospital, and I called the cardiologist and I said, you know, this woman’s got moderate dementia, and I think we should treat her heart attack medically instead of with an intervention.
And the cardiologist said, well, she’s having chest pain, and if I go in and I do this intervention, then the chest pain is going to go away. And so we didn’t even try the medical route. And he went in and did the intervention.
She went on to live another very challenging year and a half. She developed severe paranoia associated with her dementia. She didn’t know who her children were, she would call the police on them.
And she might have passed away sooner if we hadn’t treated this heart attack with an intervention. And so we didn’t treat the patient, we treated the heart attack. And so there’s a lot of times where you have to step back and say, yes, we could do this thing, but that’s where I think we did something to the patient instead of for the patient.
[00:06:58] Adam Williams: As a layman, I’m going to ask you to go even further with that example and maybe help me to understand better how you might have done it differently if you were treating the patient in that situation.
[00:07:10] Dr. Erika Altneu: So we would have given her medicines to make her comfortable, to not have any chest pain, and we also could have given her other medicines to prevent another heart attack. And there’s a lot of data in older people that using medicines instead of procedures, not just in the situation of heart attack, heart attacks, but in other scenarios where that’s the better way to go, that we don’t always have to do a procedure because there’s risks with that, too.
[00:07:34] Adam Williams: So the circumstances of this woman’s life and what maybe the bigger picture would have been, would have provided comfort. And you said she might have died earlier then, which would have meant less suffering, is the perspective, more compassion involved?
[00:07:45] Dr. Erika Altneu: Exactly.
[00:07:46] Adam Williams: Okay. You have described your work as a geriatrician as this is the real art of medicine. And I’m curious what you mean by that and how you see medicine, maybe overall, that then this becomes the real craft of it.
[00:08:01] Dr. Erika Altneu: So I definitely believe in the science of medicine, and I feel like I learned, of course, so much through med school and residency. And then when I did my fellowship training in geriatrics, I felt like it brought it all together. And that’s so much what I’ve used day to day, of course, I’ve got all the science backing me up and I believe in the way that we approach the research in healthcare.
But the art is the nuance and I can also say some of the experience that I have now with treating patients. It’s one thing to read a research study and take away the data, but then the art is applying that to the person.
And especially in seniors, you know, we don’t really have a lot of data on how we treat older people. So many people over 75 are excluded from a lot of our pharmacologic studies, from our procedural studies, surgical studies. And so you are extrapolating from that to try to think what is going to be best for this patient. Because we don’t have the data in an 80 year old and 85 year old, you’re basing it on data that we have in a 65 year old. So that’s part of the art is figuring out, all right, we’ve got this information. Does it apply and should it apply?
[00:09:19] Adam Williams: I’m wondering if you also see patients a lot of times who simply are appreciating your time because it is attention and it’s care on this human level that they might not be getting elsewhere. They might have a lot of time in isolation, separated from family, whatever their circumstances might be. So I wonder about that component of when you are having visits with someone and you know how common that is and how you handle that.
[00:09:46] Dr. Erika Altneu: Yeah, for some seniors, going to the doctor might be their only social outing that they have, which is really unfortunate. And a hug goes a long way. You know, people who don’t have family or friends and are not getting physical contact, just being in a small space with a person and listening and hearing what’s going on. So it’s not always necessarily about their blood pressure or their diabetes. It’s really just about how they’re doing.
I love being a primary care doctor because you get to see people over a long period of time and you get to know them. And I have been with a lot of patients over years where they’ve gone through major life events. Losing a spouse, losing a child, and you see how their life changes after that. And having that longitudinal relationship is really important, I think for any primary care provider.
[00:10:44] Adam Williams: You’ve also practiced on the Front Range, and so now you’re out here in Chaffee county, you’re in this rural area. I wonder if there are dynamics that are different about what your experience was in a more urban environment versus what’s going on now with your practice.
[00:10:58] Dr. Erika Altneu: I feel like here I am eager to access a little bit more rogue ways to support people on the Front Range when people are needing more assistance. Really, you’re looking at these more formal organizations hiring people, and there’s a real lack of that here. And all of the people who are involved in the senior community are very involved in working on this, especially the public health folks.
Figuring out who in this community might be available to help some of our more fragile seniors is really something that I want to do. And what I’m seeing is that we have a lot of retirees, very healthy people who are in their 60s and 70s who moved here to do the biking, the hiking, all of the outdoor stuff, very capable people. And then you’ve got the older people that have been here for generations. And I am kind of trying to slowly tap into these younger seniors and say, hey, you could be a caregiver for an older person. It doesn’t need to be full time, but maybe a couple hours a week. You could step into a role and pay it forward. Right. Because you are going to be that person in another 10, 15 years.
And we just don’t have necessarily younger people in their 20s, 30s, 40s that are going to supply those services. So I really would like to see more networking and I would like to give a shout out to Ark Valley Helping Hands, which is a volunteer organization that people can sign up for. And some commitments are short term, some are longer term, but it’s a really good way for people to make connections in the community. And so that was one of the things moving here that I was really excited about, was to see how the community can come together to support the senior population.
[00:12:51] Adam Williams: We’re talking about creative problem solving, it sounds like to me, and that there’s maybe more opportunity for that in a smaller place like this where we don’t have some of the layers of process. And I don’t know if you want to call it bureaucracy, but there’s not necessarily all those touch points that a larger area might have in place.
[00:13:09] Dr. Erika Altneu: Exactly. Yeah.
[00:13:11] Adam Williams: Do you feel closer to the patients as well because it’s a small town, Just like we at least stereotypically are like, oh, small town, everybody knows each other. Which I think tends to be kind of exaggerated. But still, in your case, do you feel like there is a closeness different than how you might have to handle appointments with whatever slate of clients, patients you have say in Denver?
[00:13:34] Dr. Erika Altneu: Yeah. Well, here there’s less than one degree of separation, it seems, for anyone in terms of who knows who, which is great. And I think that in terms of how I want to practice, I. I really do want to be more involved in home visits. And I’ve been working with Heart of the Rockies as my employer. And so we’re sort of looking at how that might be done.
But also if somebody needs something because it is a small town and they’re here in Salida and I’m riding my bike home, if somebody needs me to stop by on the way home because they can’t get to the office, I can do that. And I love that there are some.
[00:14:12] Adam Williams: TV shows like Little House on the Prairie and movies and things out there in a small town, rural environment where that kind of connection and possibility, at least what used to be it seems so quaint now, like we don’t have that possibility, whether that’s due to liabilities and whatever the healthcare system dictates. Do you have thoughts on how that can happen now in a way that takes all of that into account about the change of times?
[00:14:36] Dr. Erika Altneu: So I think that that was a very valuable service. The whole home care program, the old country doctor with their black bag going.
[00:14:44] Adam Williams: Yeah, that’s what I’m picturing.
[00:14:45] Dr. Erika Altneu: Yeah, exactly. And I think that there’s huge value in. And I will say, if you walk into someone’s home, it answers a lot of questions too. Somebody might come into the office and tell you what they’re doing, but you walk into their home, you see pill bottles everywhere, you see that there’s not food in the cabinets.
It really answers a lot of questions for what might be going on with someone’s health. And so there is value for it for the patient, but also for me as their provider to, to figure out what the missing piece is.
[00:15:18] Adam Williams: I think something from what you’ve already said that might have surprised me a little simply because my mind was not going there, is that you also are working with people who are very healthy at these ages, whereas I probably was picturing more of the people who are in more significant need for you. So this range of work that you’re doing, I’m wondering if we can learn a little bit about that knowledge. If you’re working with, let’s say a healthy 65 year old somebody who is active, they’re out mountain biking, they run, they, you know, a fly fisherman, whatever is going on, they ski.
What might be the approach with somebody like that before they come into, I think calamity was the word you used, you know, differently than how you might be dealing with someone who’s 85. And they’re, they are struggling with dementia and some real challenges at that age.
[00:16:07] Dr. Erika Altneu: It’s all about prevention because aging hits everyone. And certainly there are people who do well into their 90s, but most people confront some difficulty, whether it’s just arthritis, decrease in balance, decrease in speed. And so if people are on the right path, it’s just stressing that they continue on the right path. I say a lot of times a body in motion stays in motion.
So staying active and, and a good diet over and over. It’s these lifestyle things that are so critical to prevent the ravages of aging. And then also talking to people if they’ve got any bad habits too. Like now alcohol is bad. And I say in medicine, just give us 10 years and we’ll say exactly the opposite of what we said 10 years ago. Right.
[00:16:56] Adam Williams: It seems like.
[00:16:56] Dr. Erika Altneu: I know. So before it was, oh, everybody should drink red wine. And that came from, from various things. But now alcohol is bad. It contributes to, from my perspective, it can contribute to brain damage associated with dementia, which nobody wants, but also is associated with cancer. So just talking to people about what’s going on with their lifestyle, but also understanding that there is quality of life and finding the balance. Right. And so if someone’s true pleasure is that glass of wine with going out to dinner, then that’s fine, but maybe not the three glasses of wine every night.
[00:17:37] Adam Williams: I assume your advice, the core piece of it there, would apply to me at almost 50, would apply to somebody at 35, that ultimately, you know, our active, healthy choices are at the heart of this. But we’re not going to be able to stop aging, of course.
[00:17:52] Dr. Erika Altneu: Yes, yes, everyone should be, should be preventing disease through a healthy lifestyle. People who have not had a healthy lifestyle up to their 60s and 70s, those are the people who are already paying for it. So if you are unhealthy in your 30s, 40s, by the time you’re in your 60s, you’ve got some of these chronic conditions. And then I’m treating your chronic conditions already.
But if you’ve been taking care of yourself, then it’s about continuing to take care of yourself. And I am a strong believer that you can teach an old dog new tricks. And, and even if you have not been an active person, it’s a matter of getting outside for a walk. It doesn’t have to be exercise, it just needs to be movement. So not being a couch potato is critical.
[00:18:40] Adam Williams: What is it that you love about working with this population in particular? Because I do think there’s passion here. I think you have chosen this specialization because you really do love it.
[00:18:49] Dr. Erika Altneu: I do love it. Oh, that’s a hard question.
[00:18:53] Adam Williams: Is it?
[00:18:54] Dr. Erika Altneu: Yeah.Well, for one, this is not the question you asked, but for one, as a physician, I can listen to older people complain. So people come in with their complaints. And if you are a young person, I would have a hard time listening if you weren’t taking care of yourself. But if you’re 80, you’ve sort of earned the right.
And I will sit there all day and listen to what you’ve got going on and try to help. But I think that there’s– We live in a society that doesn’t honor our seniors like other societies, and an older person is just a young person who has more years behind them. It’s not like they’re a different person.
And as we get older, it’s really apparent. Right. And you think, you think, oh, when you were in your twenties, you thought you knew everything. You didn’t. And I think that when I’m 70, I’m going to say, oh, when, when you were 40, you thought you knew everything. Right. As you get older, you just have more accumulated wisdom. And I really like to hear people’s stories and how they’ve gotten to where they are.
I don’t know. I don’t know that I have a good answer for you, but I like.
[00:20:06] Adam Williams: The storytelling piece of that. And that takes me back to my thought earlier about the connection and how a lot of times people are willing to share their story. They just need somebody who’s willing to list and to care about it. So when people come and visit you and this is their only social interaction maybe for the day or the week or whatever it might be, to have a chance for your ear as well. And your hug seems like it’s as healing as anything else you might be doing there.
[00:20:30] Dr. Erika Altneu: Yeah, yeah. And that being said, I’m on the clock, so I can’t have everyone’s really long story, but that was my next.
[00:20:38] Adam Williams: Question was because the system tends to be like 15 minutes in and out or whatever it is. Right. Generally, the healthcare process. Right. Is there. It involves some turnover and we don’t get a lot of time to talk with and ask a lot of questions of a doctor. So I am curious how that is similar or different for you.
[00:20:54] Dr. Erika Altneu: Yeah, I mean, I do like to hear some things. I do have to interrupt people and we have to move on so that I make sure that I’m addressing whatever the healthcare need is at that time. But sometimes having that Time like, I’m thinking of a patient of mine from the past who, she had lung disease, but her lung disease wasn’t her problem. It was that she had an alcoholic son who was divorced and was the caregiver for her or was the primary parent for her 11 year old grandson. And her entire life was all stress about her 11 year old grandson who was being taken care of by her alcoholic son who would wind up in rehab or wind up in the hospital. And knowing that piece of her life always helped me understand where she was with her own health.
So you have to know the person to know how to treat the person. Right. Again, you don’t want to treat the disease, you want to treat the person.
[00:21:50] Adam Williams: Is that incidental information that just sort of came out along the way because this person was willing to share, or is that part of your process of let me look at you as a whole person, let’s do this holistically. Tell me what else is going on in your life.
[00:22:04] Dr. Erika Altneu: I think that’s where the art comes in. Because if something’s not making sense, somebody’s telling me something and I’m saying, well, this symptom doesn’t match up with the severity of your disease or what you’re telling me.
It’s really not making sense. So obviously I’m missing a piece and I’ve got to try to figure it out. And I may never get there. Right. There may be something that someone hides from me that I never discover. But, but when you do find out something like that, like there’s the alcoholic son, it’s that sort of, aha. Now things make way more sense.
[00:22:37] Adam Williams: It takes time to be able to develop that relationship. And that means not only the longevity of years of being their primary physician, but it also means having enough time on any given visit. And that’s a challenge. Right. Because again, the system, you know, the insurance companies, the everything is pushing us to be in and out as patients.
[00:22:58] Dr. Erika Altneu: Yeah.
[00:22:58] Adam Williams: And for you as a doctor to have to move people in and out.
[00:23:01] Dr. Erika Altneu: Yes. Yeah. There are certain, certainly limitations and we work within them. And I think that, yeah, we all just, we do our best with those limitations.
[00:23:10] Adam Williams: But there’s a real skill in that, I think it sounds like for you to be able to navigate those conversations, knowing how important it is, the social connection, and then compassionately also be able to focus on, well, this is what we really need to do today. And I also need you to have to move along because somebody else needs this. That’s tough. And it sounds like that is if we Go back to the art. Maybe that’s part of that.
[00:23:32] Dr. Erika Altneu: Yeah, yeah. And that I’m really type A and I try to stay on schedule. It’s part of my personal problem.
[00:23:39] Adam Williams: You’re juggling a number of aspects there.
[00:23:41] Dr. Erika Altneu: Yeah.
[00:23:42] Adam Williams: So we’ve talked about the healthier end of that spectrum, maybe with a 65 year old who still is in great shape and doing all these healthy things. If we go to the other end, where there’s somebody who maybe is regardless of their age, but maybe they’re experiencing a terminal illness, they’re in palliative or hospice care, what is your degree of involvement at that point in their experience? Or is there someone else, maybe a palliative physician who specializes in that way, who comes in and kind of takes over? How does this work?
[00:24:11] Dr. Erika Altneu: So I try to be very involved. My philosophy is that I try to give my patients a good life, but I also try to give them a good death. And if they haven’t had a good death, then hopefully I didn’t fail them.
But I want to help them and their family to the end. And so a lot of what I do really is anticipating where people are at in life. And I have very frank conversations with people about that they may be approaching their end of life. And I have found over the years that people, especially later ages, are really willing to talk about this and are not afraid to talk about it. And so if I have a patient who is declining and they’re in my office and I see a lot of change and they’re with their family, I might say to them, do you feel like you’re getting close to death or that you’re approaching the end of life? And it’s really helpful for their children to hear it too, because sometimes, even if mom is 95, mom is still somehow going to live forever.
So having these open conversations can be really helpful for the family and transitioning toward an end of life experience. And I use hospice regularly, so I want people to have support at home through the dying hospice. And I’m still their physician. I can give up that role, which is different, but I’m still their physician when they’re on hospice. But under hospice care, people receive care in the home primarily. And hospice is a service that comes and checks in on the patient. There’s a nurse, there’s medications that are provided, but it is to allow a patient to die with comfort.
[00:25:46] Adam Williams: Is that what you consider essential to good death or what do you mean by that?
[00:25:51] Dr. Erika Altneu: When people have been asked what they think is a good death? So this has been researched extensively. People want to die at home. It is the very small minority. Like less than 5% of people say they would want to die in a hospital. And there are some people who do want that because they are afraid of dying.
But most people say they want to die at home. And so based on that and expressly patients wishes after talking with them, I want to facilitate that. And using hospice services is a way to do that.
[00:26:20] Adam Williams: You’re also familiar with and I think involved in medical aid in dying. Right. Which some people call assisted suicide. I don’t know if that’s a phrase that you subscribe to, like think is off. You know, maybe just a media phrasing. But that is something else that I’d like to talk about here. Because when I talked to you before we were recording and you mentioned this is legal in 14 states, including Colorado, I had had no idea. I’ve not paid attention to this other than to know the name Jack Kevorkian from decades ago.
And I mean, he’s been gone. I looked him up. He’s been gone for almost 15 years. I didn’t even know it. This is how little I pay attention to this subject. So with this being legal now, and I think you have involvement which I’d like for you to describe to the extent that that is true, I would like to wade into these waters and learn about this as well.
[00:27:11] Dr. Erika Altneu: Certainly. So, yes, medical aid and dying is legal in Colorado and I don’t know how many years now, but it’s been quite a few, I want to say, in the five to ten year range. I was not involved in it previously when I was on the Front Range because I was under the auspices of a Catholic hospital organizations. So that automatically excluded anyone from being involved.
[00:27:34] Adam Williams: That’s a conversation there in my mind.
[00:27:37] Dr. Erika Altneu: Sure. Yeah. So there are. So. Yeah, so I wasn’t involved. And I used hospice extensively and I honestly don’t know looking back how many of my patients might have benefited from medical aid in dying. But there’s certainly ways that people are comfortable dying with hospice.
So what I have discovered now that I have gotten involved in medical aid and dying here in Chaffee County. It’s been interesting to me to see that there is a demand for is a different type of work than hospice because you as the physician. So I’ll just briefly outline the process.
[00:28:14] Adam Williams: Sure.
[00:28:14] Dr. Erika Altneu: Thanks. So if you have a terminal illness, the expectation usually is less than 66 months to live. Then you can legally access the medical aid and dying process, which means that two physicians have to certify that you have a terminal diagnosis and that you qualify, you have to be of sound mind. So someone with dementia would not qualify and is an excluding diagnosis. And we also do want to make sure that there aren’t psychiatric illnesses that are contributing to this.
So from what I have seen so far, no one wants to die. But these are people who have a terminal diagnosis. So they are dying and do not want to suffer. And it is. It’s really sad to see how people are suffering. And this is really a request to relieve their suffering at the end of life. It has been a little emotionally challenging for me to do it just because it’s a little more active role in the dying process.
And at the same time, I do think that I am doing the right thing for these patients to relieve their suffering. And all of the patients that I’ve encountered so far have also had incredibly supportive families that are there with them, and they are there with them for when they ultimately take the medication that allows them to pass quickly and peacefully.
[00:29:34] Adam Williams: Okay, we just touched on a number of things that I am curious about to learn more. So I’m going to try to remember them. But one is that two physicians are involved. Can they be any physicians? Or is there additional, say, certification, training, something? And you have to be a specific physician for this situation.
[00:29:53] Dr. Erika Altneu: Anyone who is willing to participate can participate. Ideally, one of the doctors would be someone who is involved in their care. So if somebody has a terminal cancer diagnosis, ideally it would be their own oncologist or primary care doctor. And then I would be the second physician to go through this process with them.
Sometimes if people have a primary care doctor that doesn’t want to be involved because they’re just not comfortable with the process, then we identify another provider in the community that we know is willing to participate in this process.
[00:30:28] Adam Williams: You brought up family members, and that is a question that I’ve had as well, because I would think whether it’s for religious reasons, I like with the Catholic Church you mentioned, maybe it’s due to individual rights and there’s, you know, whatever the controversial matters are that exist in our society around this also might exist within the family. So I’ve wondered if there’s been sort of backlash from family members who disagree with this, whether that’s toward the patient, maybe it’s toward the physicians who assist.
[00:30:55] Dr. Erika Altneu: I haven’t seen it yet personally, although I can imagine that that absolutely exists. There are going to be people who ask for this that their family members don’t think it’s right because People could view it as a form of suicide. I mean, really, we’re talking about people dying days, weeks, maybe months sooner than they would naturally to avoid suffering.
[00:31:20] Adam Williams: I am curious as well about how anyone you mentioned before that you ask a patient basically where they feel in this process. Do you feel like you are dying? Do you feel like death is near? And I’ve wondered how even someone who’s an expert, like yourself as a physician, can assess that. How do we know when somebody’s life is drawing to a close? And you can give a prediction experience.
[00:31:47] Dr. Erika Altneu: Yeah, I mean, I can definitely see. See when there are telltale signs. I’m not sure that I can speak clearly on them other than it’s like, you know it when you see it.
[00:32:01] Adam Williams: Yeah. Okay.
[00:32:01] Dr. Erika Altneu: It’s that kind of answer. And I also have friend conversations, too, with families. And I say, I think, you know, at this point, your parent has less than a year to live. Just to give a broad idea, this is where we’re at in this phase of life, or based on what I’m seeing, somebody may be getting to the last few months of their life. I really try to be upfront with people when I am seeing a decline so that they can plan. I don’t want anyone to be surprised by a death. I hear that story so many times. That somebody died so quickly or they didn’t see it coming. And it’s like, well, there’s so many ways to see it coming.
[00:32:40] Adam Williams: Hopefully there would be in the planning and conversations with family, whether it’s directives, a will, whatever that says, do I want to be on, you know, machines or not? Well, I’m going to tell my wife that in advance. Right. I assume this sort of medication we’re talking about for medical aid and dying is something that also should be addressed or would be so that that’s not a surprise in the moment either, so that adult children of someone who is making this choice are not caught off guard. Like, hey, tomorrow we got a thing at noon. Are you available? Right. I mean, there’s going to be some prep for this.
[00:33:11] Dr. Erika Altneu: Yes, hopefully. If people are involved with medical aid and dying, there’s been multiple conversations within the family. And for most of the people I’ve been involved with, they are on hospice as well. So they’ve got the hospice team, and the hospice folks are obviously well versed in dying, so they’re coaching the whole family through the process as they go.
So it’s nice when people are involved in hospice because there’s more support there and they can help the people through this, if they’re utilizing medical aid and dying or just utilizing hospice medications for.
[00:33:44] Adam Williams: Comfort, how does it work? Is there some sort of scheduled time the family gathers around the person? I mean, how is it administered? Is this intravenously? Is it a pill? And then how long are we talking about before the person just, you know, kind of slides away into comfort and then is gone?
[00:34:04] Dr. Erika Altneu: So I think most people do decide on a date and a time for when they are going to take the medication, which is usually a liquid elixir. That’s one of the other things, is that a patient has to be able to self administer it. So if someone is quadriplegic, there is not currently a way for them to self administer.
[00:34:27] Adam Williams: Even if they’re of sound mind to make the decision, they are not able to do it.
[00:34:31] Dr. Erika Altneu: Yes, I have heard that in, I think Sweden right now they are working on some sort of like blinking motion activated thing that would allow this machine to then administer medications because they’re very. They’re much further along in the assisted dying process than anything in Ameriaa. But at this point in time, the primary way is that you would drink an elixir of very potent, very, very potent medication.
So usually a person would fall asleep within minutes. The actual dying can take minutes, even to a few hours, depending on what their underlying disease state is.
[00:35:10] Adam Williams: So they’re at peace as they go through these last minutes. Hours, correct.
[00:35:16] Dr. Erika Altneu: Okay, yeah. Which if, and if they do not die immediately, it can actually be a little harder on the family members that are sitting by the bedside waiting.
[00:35:26] Adam Williams: Why do you think this has become more accepted? And I’m judging that it has at least some, because Again, I mentioned Dr. Jack Kevorkian and all of this media hoopla and criminal hoopla with him years ago, but now we have 14 states and that’s an increasing number who have put into law this is legal to use this medical approach.
[00:35:49] Dr. Erika Altneu: I think it has to do with choice and autonomy and saying, I want to have control and I don’t want to suffer. We’ve evolved to this point where we have these tools. And so I think that people are saying, well, if we’ve got these tools, why shouldn’t we be able to access them?
Why should we suffer? And a lot of people have said in, you know, we treat our animals better than we treat humans. I hear that from people, right? Like we put our dogs down when they’re suffering, but we don’t do that to humans. Humans, we. They have to suffer. And again, in the case, some of the cases that I’ve seen with the medical aid in dying, there’s extreme suffering going on. And if that was a dog, in that case, we would have put them down. And so I have not been involved in the medical aid and dying movement to get this legalized. But the people who have worked on this really feel passionate about this being an option. And again, I think that we are doing the right thing for these patients.
[00:36:57] Adam Williams: Talking about aging and death seems like it still is a little bit taboo in terms of just polite company society. We don’t go to a social event, have a drink, and say, hey, let’s talk about death. If we talk about aging, it’s, I’ve got this thing with my knee. I can’t believe this. I must be getting old. It’s almost more of a joke, right?
[00:37:16] Dr. Erika Altneu: Except for all these death cafes now.
[00:37:19] Adam Williams: What is that?
[00:37:20] Dr. Erika Altneu: It’s a place where people go and they talk about death and the dying process and aging. Salida always has some bv also, really, there are multiple death doulas now in our communities. And death doul doulas are people who help plan for death so that if people have a vision for what their death will look like, they can meet with a death doula in advance, and they’ll help them identify what the end of their life should look like. So there actually are more conversations going on than you might realize. And I think that older people, a lot of people are willing to talk about this. And then there’s also a lot of people who. I’ll ask them about their advance directives. So that’s your medical directives.
If they’ve worked on that and people don’t like to talk about it, I’ll give them paperwork to take home and discuss. And a year later, I’ll ask if they’ve filled anything out. And they’ll say, no. I’ll say, all right, well, let’s see if this is the year where you can work on that. Or people will take paperwork home. And I say, I really need you to talk to your son or daughter about what your wishes are. And they’ll come back and say, well, my daughter didn’t want to talk about it.
So a lot of times it’s not seniors, it’s the kids. It’s the younger people who are in denial about death or not comfortable around it. But I think as people get older and you’re confronting this idea that your life has an expiration, that you do get a little more comfortable with these.
[00:38:51] Adam Williams: Concepts, I think there’s value in normalizing death. As part of life, and that it is this sort of holistic cycle of things. Where do you stand in terms of your perspectives about aging for yourself and death as a matter of life?
I would imagine that you have been informed by a lot of these experiences that you have been part of as physician to people who are going through these processes. So you have particular insight that I think a lot of us, especially if we’re in denial about the fact we’re getting older and that death is part. Part of life. I wonder what your thoughts are and your perspective.
[00:39:29] Dr. Erika Altneu: So I do. I always have the understanding that death is at the end of life. And again, just trying to focus on living a good life. And that means being independent, being able to take care of yourself, hopefully having intact cognition until your later years.
These are the things that are really important to me for my own self, but also for my patients and trying to see my patients where they’re at. And I’m not in the business of fixing things, but I really try to be in the business of improving things.
[00:40:17] Adam Williams: I wonder if your perspective has shifted at all from when you were maybe a medical student.
You know, you had no idea this was going to be your specialization. Things ended up unfolding this way, and now here you are with all of this experience and, you know, is there a continuing learning for you too, about this? Because more and more experience. What. What else is informing how you view death and aging?
[00:40:43] Dr. Erika Altneu: Always. We’re always learning. And I think if you meet a physician who says that they’re not, then you probably shouldn’t have them as your doctor.
[00:40:51] Adam Williams: Go to a different doctor.
[00:40:52] Dr. Erika Altneu: Yeah, yeah, I do. I actually worry for myself of where I’m going to peek out. Right. Because medicine moves so quickly and so you’re constantly staying on top of the new discoveries, which is different than what you learned when you were in med school.
I’m going to peak at some point and that might be soon, but I also have experience building underneath me. So I hope that that balances out where I’m balancing my aging out of the current science and just knowing how to take care of my patients.
[00:41:25] Adam Williams: Erika, thank you for all of this information. You have a lot of expertise that this community needs, so thank you.
[00:41:31] Dr. Erika Altneu: Thank you so much.
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[00:41:40] Adam Williams: Thank you for listening to the We Are Chaffee podcast. You can learn more about this episode and others in the show notes@wearechafypod.com and on Instagram at We Are ChaffeePod. I invite you to rate and review the podcast on Apple Podcasts and Spotify. I also welcome your telling others about the We Are Chaffee Podcast. Help us to keep growing community and connection through conversation.
The We Are Chaffee Podcast is supported by Chaffee County Public Health. Thank you to Andrea Carlstrom, Director of Chaffee County Public Health and Environment, and to Lisa Martin, Community Advocacy Coordinator for the larger We Are Chaffee Storytelling initiative. Once again, I’m Adam Williams, host, producer and photographer for the We Are Chaffee Podcast. Till the next episode as we say it, We Are Chaffee, “share stories, make changes.”
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