Dinner and a book is supported by the Rex and Alice A. Martin Foundation of Elkhart, celebrating the spirit of Alice Martin and her love of good food and good friends.

modern medicine has transformed the dangers of birth, injury and infectious disease from harrowing to manageable.

Through the research and stories of his own patients and family Atul Gawande reveals the suffering produced by medicine's neglect of the wishes people might have beyond survival.

In this book, Being Mortal Medicine and What Matters In the End, my friend and guest Doug Farmwald is here to discuss this powerful book that is this year's selections from the St. Joe County Public Library's One Book One Michiana.

I think we've been doing this about 12 years and and it's been really fun, wonderful books.

And I've been really surprised at books that I would not have picked up otherwise.

And some of them at night circus is one has become one of my favorite books.

You like magical realism?

I guess I do, yes.

Which is not what we have today.

No.

no.

We don't like it.

It's magical.

The story is still magical.

But, you know, we we have studied maybe 20 or 40 years ago a German woman.

What was her name anyway?

She wrote the book on Fear of Dying.

And we went to see her at Goshen College.

And it was more about us, Elizabeth Kubler-Ross.

And it was all about the stages of dying and how we handle and adjust to the stages.

This is more this is almost more controlled by the patient itself.

What are you doing?

And that's the point.

Yes.

Put the patient, the individual back in control and not the medical system.

Right.

Medical science has done amazing things.

You know, we we can expect to live to 80, 85 easily now, whereas even in the forties we could have no, probably not know.

We would have ended our stay in the hospital a little earlier.

But today people are being asked, what do you want to do, particularly in a situation where it's not very hopeful you what's not clear cut?

How long, how long?

Yes.

And you know, if you've probably all gone through this, asking the doctor about a loved one's future here, how long and when will that be?

My doctor said to my doctor, my father's doctor said, well, we don't know.

Three months, maybe you'll have to ask him.

And I thought, that puts my father in a bad spot there.

But today we can actually say how we want to live.

Do we want to have our little poodle in the room with us?

Do we want to have birds in the hall?

Do we want to have music?

Do we want to have dancing?

I mean, you can't actually do that at the very end.

But as you move from, let's say, a condo to assisted living and then maybe on to a hospital nursing care, you could even say what you and I. Yeah, we're trying to de-medicalize the system.

And that's not an argument against medicine by any means.

But one of the things I think I think Americans, maybe more than most or difficult have difficulty with is accepting mortality.

Well, we're not going to live forever.

And if we don't think about it and don't make some decisions ahead of time, the system will make them for us by default.

Yes.

And the system by default pushes survival, whether that's on a respirator, whether that's on third stage chemotherapy after the first to have it worked.

But it's always pushing for survival because that's how doctors are trained.

Yes.

To keep people alive.

And it takes a strong person to know.

They can say, wait, stop, this is it.

I don't want any more of this.

And I think this book kind of brings that to it to a point where your family and you can sit down and talk about this.

My husband and I have talked about I think I mentioned this some point already.

We talked about how we want when do we want to have things cut off and what do we want?

We want to be in the ICU.

Do we want to be in a at home and or do we want to be in a nursing home that's going to be different for every person?

Yes.

Still right answers.

Yes.

I want you to try every possible thing.

I don't care if it's 1000000 to 1 shot.

I want you to try it.

And then there going to be other people said no.

If I if I can't stay at home, if I can't be self-sufficient, that's not a worthy quality of life.

Right?

So there isn't one size fits all.

Well, and we said this, of course, we've been thinking about this for a couple of weeks now.

And my husband and I talked about it and he said, I don't want any heroics, but I do want classical music.

So I was looking at some of them.

He's not ill or anything, but I started thinking, now where are those that he likes?

But things of that nature and which ones?

So today you would think, well, what is this cooking about?

I mean, we're talking on that is as much as I have enjoyed one book, one mission, and it's not always the easiest books to make a menu from.

Right.

Right.

But that's not why they were chosen.

So that's that's okay.

Right.

And that's okay.

We can we can adapt.

Right.

And there was one line in the book that go on they had is what we all want as much as anything is to be able to shape our stories.

Yes.

Whether it's at the beginning in the first chapter or at the last chapter.

And so shaping our stories to me means finding meaning or making meaning.

So what is meaningful And food, I think, really ties into that because there are so many rituals, formal or informal, that families have.

And in most homes the kitchen is central to the family.

Right.

And you are going to tell us what you're going to make to go along with this.

This is, you know, to try to come up with something meaningful.

The recipes actually are quite simple, but this is just a date stuffed with goat cheese and wrapped in bacon to an appetizer.

The reason this is meaningful is we have this at every family gathering.

If our family has come together, this will be the first thing out of the oven.

And usually I get maybe one because everyone else eats.

And before I get done cooking anything else.

But it's something we always have.

And this symbolizes to me everyone coming together.

That's why it's important.

So that that's the meaning.

So that's why he's doing that one.

I am doing a pecan pie.

In this first episode you would say, Well, if you're sick and you might not want pecan pie.

Well, that's true, but this might be before you really are sick.

This this is something my husband loves pecan pie.

So besides the classical music, I will have a pecan pie for him.

And so that's what I'm doing in the second I'm going to do.

Black cows like cows.

Black cows because my brother used to love black cows when he was little.

So we're going to have a Coke, or we could have root beer and some ice cream and we're just going to serve it in a tall glass.

And that's what my side of the family will have.

So that's what we've chosen.

We thought long and hard about that, and you might want to think about that, too.

We have about 4 minutes to go.

You're already started here.

I'm kind of behind.

I'm going to turn this butter on just a little bit.

Then I have a cup of more than a cup of brown sugar in here.

And we're going to add brown sugar and three eggs and some salt Karo sirup, which I never I never had when I was a child.

And the first time I made this was when my mother in law came to visit down at Purdue and she made the perfect pecan pie.

And I did not.

And I. I cooked it too long.

I baked it, and it was like a shellacking of the top of the pie.

And it was hard.

We couldn't even cut into it.

But I didn't cook when I was first married.

So this is a super easy recipe.

Yours is?

Yeah.

Take some.

Did I get you can get pitted dates I get un-pitted ones.

I like the way they open up and stuff a little bit better.

You just slice them, put some goat cheese in, wrap half a slice of bacon around them and then put a toothpick through them to hold them.

Make sure you get wood toothpicks.

Plastic doesn't do well in the oven, and then they go in the oven at 350 for 20 minutes and you just turn them halfway through.

They are delicious.

I've never, ever had any left over anywhere.

So they go over well with just about any occasion.

And it's meaningful for my family, which is why I chose a little vanilla.

So simple ahead.

And stick these in.

Yes, some chopped pecans.

And then when we are going to pour it into the pie crust, I have some that look whole.

And it's not that you have to make a design or anything, but I'll try to do that and then we'll put it in the pie here.

I'm now I'm adding the butter brown sugar and you can use white sugar, but I like brown sugar.

And I put all that and I said, I put it in a little seasoning and we had the but we have the butter in here now.

What else?

It does have to be well-mixed.

And the first time we made it, I thought I was developing a bomb or something.

I mean, I, I was so worried about what happened and what we were going to do about this.

And today I'm just putting it together and then we'll put it in the oven for an hour is how we do it.

You know, recipes that we're comfortable with that we can cook as we're talking.

You know, kids are grandkids will be in the kitchen.

And that's how we like things to be.

Okay.

I've got a minute to get this in the pie crust and in the oven, and I think I might even ask for 30 seconds more and we will get it going.

And I'm going to add these little perfect halves here to try to make a little design, and we'll put it in the oven for 60 minutes and then we'll be ready to go on to the next thing we're doing after we take a little break.

So anything you want to add about your.

Well, the recipes are very simple.

The next segment I'm going to do spaghetti carbonara, which is still simple and what I call basically peasant food, which is what we eat that is delicious.

Well, you always are such a good cook.

You have a good time and you make delicious food.

Okay, This is it.

So this is going to go in here and in the oven.

And I probably should have warmed this up a little bit.

We'll put it in the oven for 60 minutes and then we're going to take a little break.

We come back, we'll do our second round.

We'll talk more about what our doctor has to say about certain activities and certain parts of life.

He is really a serious and kind person.

So here we go.

And in the meantime, we'll just take a little break.

We're going to show you the menu and then we'll be right back we're back.

And we've been doing some cooking in between, waiting for things in the oven to bake.

And so I'm starting my pastel spaghetti.

Yes.

Okay.

You're going to put that in.

You wouldn't mind helping by grating some cheese.

I love it, too.

Wonderful.

All right.

And we want to talk a little bit about, too, when does this all change?

When people didn't stay home.

People didn't stay home to either spend their last days, their last breath.

And we were saying in the book, set it to it.

And it's very clear.

YOUNG people don't come back to their hometowns.

Sometimes they don't.

They go off to the other coast.

I have a daughter in Denver and a son in Washington, D.C.

So, you know, I can't call him and ask him to run and, you know, turn this program on for Bob or something of that nature.

So this is what kind of calls this movement towards the facilities rapid explosion while following the Second World War.

And you know that, too.

Yes.

People it was also pushing back the frontiers of science as medicine got better, able to deal with conditions common to aging.

People could live longer, but they would still be sick at the end and in a hospital.

And hospitals discovered that they're really not optimized to care for people long term like that.

And they needed the beds.

They needed the beds.

And so that's why people move were moved out of the country to nursing homes.

Yes.

So to have a system of care for the aging is improvised.

Yes.

And it's still being experimental is being experimented.

I mean, you don't go right to the nursing home unless you are really you know, you've had a horrible stroke and you really need to.

Some some profound rehabilitation.

Profound.

Yes.

And so, you know, these young people weren't around to take care.

The daughters had jobs.

They didn't stay home to take care of the ailing parents.

So we're all faced with that.

So maybe you've already thought about this and what you're going to do.

You know, when my parents live, you know, my father and stepmother live in a community for older adults, you have to be at least 55 even to live there.

My mom was with my sister.

So, you know, we've got a little bit of each going on.

And my as I say, I wouldn't have any I wouldn't have any place to send my, My husband or myself.

So we have to look at these things and we have to have finances to pay for these.

And they are not like going to a, you know, a campsite.

$35 a night room that's getting nice and brown garlic in here.

Now, recipes will tell you how much I I've never measured garlic.

You like it, don't you?

Put that in until it seems like.

And when I bake, I never measure the vanilla.

I'm going to let you do a little turning here, too.

This is going to be the sauce.

And so our economic system changed and we do want to talk to about this whole idea of who can afford this care.

And do we all have, you know, and insurance for this sort of thing.

And people with money get the best care and they get the best sites and people without often just get warehoused where.

Yes.

And so we as a society need to decide how we want to treat our aging.

You know, it's going to be all of us one day.

You know, I'm at the stage.

I'm not quite senile yet.

No, not quite.

You know, my knee is gone bad.

I can't really run like I used to.

I'm on blood pressure meds now.

I've got more time behind me than in front of it.

And that's not meant to be morbid.

No, I know you're just being practical and you're thinking about it.

So have you decided what you want to do?

Well, I would want it to be as least medicalized as possible, as much as I can be at home.

You know, self-sufficiency is a big deal for me.

Yes.

So why would you want to be home if you are self-sufficient?

And if not, that might be you know, that might be a red line for me.

And you may have to go to either assisted living or the next hospice.

And one thing that really impressed me in this book was that people getting good hospice care often lived longer than people that did not.

The people that stayed and got all the chemotherapy and all the intensive care, it's very unusual how these things are working out.

They have changed so much in the last ten, 15, 20 years, and they're going to continue to change.

And who is running the system?

Who is making the decisions?

It should be the families.

But I do believe it's insurance companies helping them as much as possible should be the individual.

Yes, because that was something that came up in the book.

So two thirds of patients would undertake a chemotherapy or any other sort of therapy that they didn't personally want if their family insisted.

Yes.

And that that really struck me.

And I got to I have to admit, if I were being persuaded, I could probably do the same thing.

You mean you would go for one round?

I can probably be talked into it for my kids sake, for my wife's sake.

You're very practical and very matter of fact.

And that's good.

I think it is.

Because if you talk, if you really explore almost any philosophy, any religion, it comes down to what in Buddhism is called mindfulness, but it applies in everything else.

The Stoics were the same.

They even C.S.

Lewis wrote something that really stuck with me.

We all act as if we're a body that possesses a soul.

But what we say we believe is that we're a soul is temporarily inhabiting a body.

So the way I look at it is this is a rental.

yeah.

So wherever I go next and I have no idea, that's going to be a big surprise.

That's jumping off the high dive.

Yes, I guess you could say you're going to jump off the high dive at some point.

At some point and you're going to make the decision which high dive?

Right now, usually we have some kind of a booze and you could spike this, which we could do.

Yeah, we could.

We could put some rum in here.

We could put anything.

But we're having what my brother wanted when he was.

I've never had one before.

Well, this is it.

And we used to sit on the front porch, you know, when it was raining, and we'd have these.

So I whisk the eggs together with the Parmesan.

And some people wonder about eating raw eggs.

I'm not a doctor, so I'm not giving any medical advice.

But I've eaten this for years.

I fed it to my kids.

We've never gotten sick.

All right.

I would say maybe if you're immuno compromised or pregnant or something, you might want to consider not eating a raw like a fettuccine instead.

yeah.

Make a fettuccine, Alfredo.

But yeah, here we go.

Just about now.

You're making this perfect.

Is.

Is.

So I turn the fire off.

All right, good.

Do you want to plate or how do you want this?

Well, we're going to going to eat it out of the bowl, so I guess we're going to eat a couple of plates.

All right.

All right.

So before we go ahead, in the pasta, now we're either at home or we're in the nursing center, and here it is.

So this is what I would serve if I were serving a person who is not long for this world.

Some color.

It's easy to say this, but when my father died, I could not say a word.

I couldn't talk.

And it was my brother who leaned in in my father's hair and said, You have been a very good father.

And I said, he did it.

He did it.

So we're going to toss out with the bacon and the bacon grease, Little pasta water in there.

But all of it goes into the sauce.

And one of the best ways is take the handle and just isn't that clever?

And I can see how it's forming a sauce.

yes, I do.

It's nice and creamy.

There's no cream in it.

But you have the fat from the bacon and you have the eggs and you get a nice emulsion.

It's actually kind of similar to how if you were making mayonnaise from scratch.

But we've got all the garlic and the parmesan, and then we finish it with some black pepper and there you go.

We have our dessert, we have our pasta, and we're going to take another break set up for our final.

You are all invited at home.

And here your invites.

Yes.

And we'll be right back.

Being Mortal is our book today.

My guest is Doug Farmwald, who is always welcome.

And he's done such a good job over the years.

And I appreciate what you do and I really appreciate this program.

One book One Michiana is a great program and I've really enjoyed being involved with it.

So have I.

And good books have come out of it.

You know.

Many Many ones!

Yeah.

Yes.

So let's just quickly go over what we made you start with your appetizer.

We have dates stuffed with goat cheese wrapped in bacon for entree of spaghetti carbonara.

And then you made dessert.

I did.

I made a pecan pie and black cows Yes.

Not a typical menu, but every recipe we made has meaning for our household.

Yes.

Yes.

So think about that.

When you go home or you're talking with your family tonight, think about this sort of thing and ask ask your kids, Ask your husband what he'd like and even ask him where he'd like to end up sleeping when he's not going to be here very long at home, at a nursing home.

I mean, he'll have to be someplace and well, there's a whole chapter in the book.

Are those hard conversations.

And it is a difficult conversation.

it is.

It sounds so easy here, doesn't it?

Yeah.

And, you know, we can all sort of feel our horizons contract as we get old.

There's things that I, you know, that I would have done in my twenties and thirties that I look at now.

So that's just an insurance deductible.

I'm not doing that now.

So we can kind of feel that we need to own that, to internalize it.

We are in fact mortal.

Yes.

And so be creative and ask your ask your grandchildren.

This might be too much for them and maybe their parents wouldn't want that.

But maybe if they're older, you could talk about it with them.

I think it's all very, very important and they will learn not to worry about it so much.

Not so much.

It's not so much that we're focusing on death and dying, but we're focusing on meaning.

So what would be meaningful if I knew I had a week left?

What would matter?

At some point down the road?

I'm going to be down to a week.

Yes, you will.

So hopefully it's a ways off, but we don't know.

We're getting the wave to take off.

You know, that means the show is coming to an end.

We're so glad you watch us today.

We enjoy having your company.

And remember, good food, good friends, good books, make for a great life.

And thank the library, the Saint Joe County Public Library System for having great books, having One Book One Michiana and we hope you enjoyed this book.

Thank you.

Thank you, Gail See you next time.

This WNIT Local production has been made possible in part by viewers like you.

Thank you.

Dinner and a book is supported by the Rex and Alice A. Martin Foundation of Elkhart, celebrating the spirit of Alice Martin and her love of good food and good friends.