a woman stands speaking on stage
Shoshana Ungerleider speaks at an End Well symposium event.

Q&A: This doctor wants to fix how we die

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Shoshana Ungerleider, 38, is concerned about dying. Not her own death, but that of others. A physician practicing internal medicine at California Pacific Medical Center in San Francisco, she founded and serves as president of the End Well Foundation, a nonprofit that holds a yearly symposium bringing together hundreds of people to discuss how to improve the end-of-life experience. She is expecting 600 attendees at the next symposium on Thursday, Dec. 6 in San Francisco. She has funded two short Netflix documentaries about death, and is co-founder of the Ungerleider Palliative Care Education Fund for medical professionals at CPMC. Ungerleider, 38, was named 2018 Woman of the Year by Women Health Care Executives of Northern California, among other honors. She lives in San Francisco.

J.: What happens at the End Well symposium, which brings together not only health care professionals, but entrepreneurs, spiritual leaders, caregivers and many others, including members of the public?

Shoshana Ungerleider: It’s a TED-style convening of thought leaders. This year, we have everything from burial ritual, to grief and law, to what is the role of [artificial intelligence] in terms of caregiving. It’s such a broad range of topics, viewed through the lens of end of life — from the time of a serious illness or life-limiting diagnosis … to death.

Why did you start End Well?

I went to many events with hospital providers, and everybody talked about how the system is broken, how we need a cultural shift. Ending well is not a medical problem, it’s a human problem. Nobody wants to die, but I think the more that we can live with a respect that one day people will die, we will live better.

You believe that talking about death is crucial to a better outcome for doctors, patients and their families. How so?

Seventy percent of doctors haven’t been trained in how to have difficult conversations with patients. To me that’s a huge problem. But it goes both ways: Patients [facing end of life] and families have to have an understanding of what’s available, and advocate for themselves. I am working on engaging consumers to have a better understanding of what’s out there, what questions to ask, and how to think about these problems.

You are a leader in palliative care, a coordinated, team approach of specialized medical care to improve quality of life, focusing on relief from the symptoms and stress of serious illness. Are there other unmet needs surrounding death?

I see this whole thing as a social movement, a cultural revolution in how we think about living well to the very end. It’s very much about talking with the people you love, about what matters most to you. What’s more real than that?

What have you learned about death?

From my personal experience of what I’ve witnessed, the process of dying isn’t that scary. It can be really kind of beautiful sometimes. I think the enemy is not actually death, the enemy is suffering. If we can figure out a way to reduce suffering, we can go a long way. That’s why I’m such a fan of palliative care.

Does your work get depressing?

It doesn’t bring me down at all. I really consider myself an advocate. I see so many people suffering, I feel like it’s my responsibility to do something. It turns out, the majority of people dying get care that they don’t want or don’t understand. For me, the end of life doesn’t have to be a negative experience. I’ve seen it go right many, many times, and that is a win for me. It is the most beautiful thing you can ever imagine — watching people take their last breath. If there’s something I can do to help people achieve something that they want, then that’s why I’m on the planet, to do that kind of work.

You are also passionate about preventing gun violence. You and your husband organized the local March for Our Lives, which drew an estimated 25,000 people to come out in San Francisco following the Parkland school shootings in February. Yet we recently had another mass shooting, this time in a Pittsburgh synagogue.

From the Jewish lens, I feel so sad and a lot of despair around this issue of not only gun violence, but anti-Semitism. And we have young black people who are being gunned down every day, and that doesn’t make the news often. We have a major epidemic on our hands: This is 100 percent about the health of our schools and our public places. I think the more that we can use these experiences to bring about positive change, the better, especially if it motivates young people. I think it’s about having a dialogue and encouraging people to understand that it’s a public health epidemic, and urge them to vote.

Do Jewish values influence your work?

I grew up identifying very Jewishly. Tikkun olam, repairing the world, was instilled in me. It was role-modeled to me by my parents and grandparents.

End Well symposium. Thursday, Dec. 6 at SFJazz Center.

Liz Harris

Liz Harris is a J. contributor. She was J.'s culture editor from 2012-2018.