Michael D Fratkin, MD – Death is a Spiritual Event Not a Medical Event

Dr. Michael Fratkin 0:31
all the Australians.

Claire O’Berry 0:34
Right?

Dr. Michael Fratkin 0:34
So sorry what you’ve gone through.

Claire O’Berry 0:35
Yeah, it’s just really like very, very serious. It’s been great to see how the communities and people come together and help each other and that it’s been uplifting, and I think it will change some policy. So that’s good.

Dr. Michael Fratkin 0:54
That’s actually the right segue. For what we’re going to talk about today. We’re gonna talk about how communities or how people have always taken care of each other, in the face of the entirely predictable death of each of us.

Claire O’Berry 1:11
So before we start, I really want them to know who you are, and why it’s so important to me that my audience is introduced to you, because I met you in October 2018, at a seminar that the International Doula Association was having in New York City. You were one of the keynote speakers there. I was so impressed with not only the information that you were giving but how you were giving it, and how you came from a place that just who you are, is holistic.

You are a Medical Palliative Care Doctor; you have Resolution Care, which is in Northern California. But you also have to set a movement going forward in a new model, which I think you’re going to touch on is an old model of being in the home, being with patients, where they are and using technology to do that. And I’m looking forward to my listeners hearing how you do it in Northern California and everywhere.

Dr. Michael Fratkin 2:17
So yeah, thanks for having me. It’s a real pleasure to talk. I like to talk. I’m a talker.

Claire O’Berry 2:24
So, one of the things that maybe my audience needs to understanding is “What is Palliative Care?”. And I’m just going to let you talk because not only “What is Palliative Care?” but “What is Palliative Care versus Hospice Care?”. And how does that work when you’re still in the curative treatment mode? So, maybe break it down with “What is Palliative Care?” first and kind of roll with it.

Dr. Michael Fratkin 2:52
Well, you know, I’ll assume that your listenership is international. I won’t assume that everybody’s view of hospice, is the same. But I’ll circle back to that. I will provide what I think is a sort of a universal and workable explanation of what Palliative Care is and can be. There’s a very formal and official couple of definitions.

One is from the World Health Organization; one from the Center to Advance Palliative Care – the CAPC, and in New York City. And I’ll tell you a little bit about the CAPC definition because it’s good. But first, I’m going to tell you what it is to me. And I’ll do that. Just by introducing myself, and the idea of Palliative Care and the way that I would. If Claire, you were brought to me as somebody with a serious illness that might benefit from our exchange. So I’ll introduce myself to you that way.

My name is Michael, Michael Fratkin, Dr. Fratkin. I am a father, a husband, a brother, a son, and I got a bunch of friends. But I’m also what’s called a Palliative Care Doctor. And what Palliative Care is, while I’m doing it, and while we’re doing it at resolution care, can really boil down to three simple ideas.

Number one, we don’t take care of any patients. We only take care of people. And we do that with a team of other people. Go figure. We put the person under our care inside of this sort of enveloping circle that includes a physician, a nurse, a social worker, a chaplain, a community health worker, and a care coordinator that tries to weave it all together. And it turns out that each of them brings certain expertise and a certain identity professionally, sometimes the license. But really much of what they bring is their humanity, because they and the people we care for are separated by only one simple concept, the calendar.

The people for which we give care are people in a stage of their life where they need to receive such care. The people who are providing that care are in a stage of life where they need to provide that care. It’s their nature. It’s what they do to make a living. It’s what they’re inspired to do, sometimes early on. And so, the first concept is we don’t take care of any patients, we take care of people, and we do it with other people with a set of skills.

The second thing that we’re really good at is that we help people to manage their symptoms. So pain, breathlessness, nausea, whatever, we’ve got a pretty good bag of tricks, we know how to use it. So number two symptom control. We’re not perfect, we’re not 100% making all the pain and miseries that you feel as a result of being sick go away. We’re better than most, and we work hard to be as good as we can be. So number two symptom control.

The third thing that we do is that we help people and their families to navigate to make their way through what is often a very complicated medical set of circumstances. But what is always, always a really hard human experience, like the people we’re taking care of. They’re not coming to us because they have a runny nose or a scratchy throat, or a rash on their elbow. The people that are coming to us are seriously ill. They’re kind of up against it. And when they’re faced with, at least in the States, an absurdly labyrinthine, siloed, fragmented healthcare delivery system that sees them only as of the disease they are. The problem they have, or sees them as an economic input to an industrially designed machine that provides this for that ransactions.

When they’re struggling with their own existence and impermanence, they really benefit from having guidance, advocacy, people that see them for the person they are to guide them through the system that we’ve all been banging our heads against the wall for many, many, many years professionally.

So number one, people, not patients. Number two, we’re very good at symptom control that elevates the quality of lived experience for people without notice. And number three, we do what makes sense to help them get the value that’s available through modern healthcare. Without some of the hassle and redundancy and spinning out that happens and the complicated healthcare system.

So that’s how I like to talk about what Palliative Care is. What CAPC in New York, the Center to Advance Palliative Care, how they’ve worked out their definition. In collaboration with the definition that was provided by the World Health Organization, and through lots and lots of focus groups and everything else. It is a much more typical kind of World Health Organization/ formal definition.

It basically says that, Palliative Care is a speciality of medicine that provides improvement to the quality of life of people with serious illness and their families. It’s a specially trained interdisciplinary team that functions as an extra layer of support to all the disease-directed care that they may receive. Kind of bring them out. So the things in that are, it’s interdisciplinary. It’s a speciality, meaning more special training, information and knowledge. It’s team based. It’s human centered. It takes into account the caregivers and the family, and everybody that loves a person with a serious illness. And it’s extra to all the other medically centered interventions that are available. It’s an extra layer of support. And I think I left it out. But Palliative care is helpful and useful. At any time. In a person’s life, who may be faced with a serious illness.

Claire O’Berry 10:47
Well, I think that’s really what I wanted the listeners to understand what palliative care was. But it doesn’t necessarily mean hospice means that you’re in a terminal condition where you could get palliative care before you get to a stage of a terminal condition. Is that correct?

Dr. Michael Fratkin 11:10
Yeah, no, 10 minutes ago, I just had the good fortune to tell a fellow good news. He came to us about three or four months ago, with a terribly, terribly weakened heart, minding his own business until a few months ago, when he was hospitalized and found to have a heart that functioned and produced less than 20% of the output than it’s supposed to. And we worked with him.

We helped him and his partner. We address their sexuality, their anxieties, their concerns, their advanced care planning, his symptoms. We helped coordinate with cardiology and everything else. We got him plugged into a new primary care provider. We answered his questions. We held his hand. We got him plugged in.

And three months later, he feels as if the work that he’s done has been incredibly valuable for him and supporting as well being. And we just measured another echocardiogram, which showed that instead of having an ejection fraction, for those that know that 10 to 15%, it’s actually recovered to 60, or 65%, which is in the quasi-normal range, the lower part of the normal range.

And in that time, we’ve watched them be able to begin walking again, walking for exercise. We’ve watched him buy into changes in his diet. We watch him; we supported him in staying away from salt, taking his medicines; he never took any before.

He’s very appreciative, he’s feeling a lot better, he’s functioning more towards normal, not quite as normal, but more towards normal. And when they handed me the piece of paper. I didn’t know what it was going to say. His echo test was worse, better, the same, so I prepared him in telling him about that, for all of the history scenarios, before I unfolded that report, to discover the very best of news for him.

Claire O’Berry 13:23
Right.

Dr. Michael Fratkin 13:26
So, that’s an example. And then and then the disappointing thing was the kind of tearful sense of and we’re gonna have to step away from you. Your life right now, because you’re living your life. They’re sweet for us because we thought we felt for him.

Claire O’Berry 13:41
His resolution care in this, I guess, in a billing scenario is considered a hospice care?

Dr. Michael Fratkin 13:49
No, not at all. So we haven’t; we haven’t talked about hospice yet. Claire, we’ve talked about not hospice, right. Palliative Care is not hospice. Palliative Care is for people at any stage of illness, who are trying to get what they can out of the healthcare system to feel better to improve their quality of life. And thank you very much. If it’s possible, they can live a bit longer. Right? That’s Palliative Care. Right?

Claire O’Berry 14:13
Right. Right. Right. Right.

Dr. Michael Fratkin 14:15
That could be cancer patients who were getting series of cycles of chemotherapy that might not cure them, but that might actually help them feel better, do better control symptoms, and live a bit longer. Right.

Claire O’Berry 14:39
Okay. What I need clarity about if I was a patient is that I understand that Medicare pays for hospice if they think it’s like a six month to death time and I knew it was like, you know, rehab for another six months, they think that but I’m not there yet. And I want to have Palliative Care up until I get there. Do I get that support from the time I’ve got a termnal diagnosis? Immediately, I want to tell my doctor; I want Palliative care while I’m being cared. Is there going to be a time when the Palliative Care Doctor says, “Go away, you’re better now. So, I can’t provide the service.” That’s where I’m confused as a patient, you know?

Dr. Michael Fratkin 15:36
Yeah, no, very good. And we’ll circle back and talk about what is hospice in a bit. But we’re going to talk about what’s not hospice, which is crappy framing, but we’re going to talk about it anyway. So, yes, I want you to ask for Palliative Care if you perceive a personal need while you’re going through serious illness. And we’re going to talk about the ideal state and the real state. Okay, the ideal state is a lot better. Okay. Spoiler alert, the ideal state is better than the real state.

In an ideal world, in the US, the American Society of Clinical Oncology, and the American Academy of Hospice and Palliative Medicine states that Palliative Care, as a concurrent care structure, should be offered to everybody with advanced cancer, including even folks that might get cured from the time of diagnosis. Because our focus is not on the cancer. The focuses on quality of life.

Our focus is coping. Our focus is adapting. Our focus is navigating. Our focus is integrating an experience that has impact well beyond the physical. Right? In every domain of existence, the word Cancer associated with you has got you confronted by mortality, whether you’re likely to die anytime soon or not. Cancer is like that. Other things are more subtle. Cancer is not. I’m sorry, you’ve got cancer, and we can’t make it go away. Then you start to go blank, while they tell you all the things that they want you to do. And all the things that could help you. All you’re thinking about is I’m dying, I’m dying, I’m dying, I’m dying, whether you are or not writing because cancers got that kind of gravitas.

So, the American Society of Clinical Oncology, the American Academy of Hospice and Palliative Medicine, agree that Palliative Care has a role for anybody who’s dealing with that sort of thing.

That what was said is that the American Society of Clinical Oncology, American Academy of Hospice and Palliative Medicine recognize that adding a person-centered intervention focused on quality of life, navigation, coordination, education, empowerment, shared decision making, advanced care, planning, all of these things, adds a lot to the best possible cancer care, which I would want.

If I had cancer, I want the best possible medical, physical cancer care. But I would also want the support required to navigate the human and lived experience of having cancer, right. That’s the ideal state. That would include people who might be curable but are likely to go through the wringer for 3 months, 6 months, 9 months, 12 months with chemo, radiation, and surgery. They’re still confronted by a horrendous insult to their quality of life, and they still benefit from support. My fellow with heart failure was a wreck three months ago, has had a physical recovery. But in parallel to that, he also had the support of a team to navigate and make it makes sense. And I suspect that the quality of his life going forward is going to have more to do with the well-being that he experienced during this drag than actually just the recovery of his heart muscle.

Unknown Speaker 19:44
Right.

Dr. Michael Fratkin 19:44
I’ll get back to you in a few years after I run into him. The ideal state is that. The real state is that Palliative care is not a specified benefit of most health plans. And that Palliative Care provided by this robust team that I described nurses, social workers, chaplains, community health workers, care coordinators, and doctors is not covered or paid for in a sustainable way. And despite that, passionate nurses, doctors, social workers, administrators all over the country are building as much capacity as they can, and squeezing as much needed funding as possible. From across the country, what you see are very light-touch Palliative Care programs. And then programs like ours, which are very wraparound.

Now, the reason we are wrapped around is because the people that were able to enroll are people that happen to have a health plan, that values our model, and pays us on a monthly basis and adequate stream of revenue to provide the necessary care for these people. We focus most of our activity on people who are in the safety net population, people that are depending on public insurance, not Medicare, but Medicaid.

Claire O’Berry 21:07
Okay, okay.

Dr. Michael Fratkin 21:09
That’s what we’ve got to deal with. And, I tell you, for people with Medicaid, who are younger, have more social determinants of health working against them are poor. They also have more mental health issues. They have more housing insecurity. They have more substance abuse issues. They have more mental health issues. And my job as a doctor is kind of less than the social worker, the chaplain, the community health worker, the care coordinator, and the nurse. My job is relatively easy. While I’m trying to kind of herd our circle around that person to do the sensible easy things or necessary things that will improve their quality of life. That’s not rocket surgery, though.

Claire O’Berry 21:58
That’s the reality of you know, the healthcare system right now in the United States. And, you know, to some degree in Australia and other Western countries as well. But as an end of life doula, one of the things I try to do right off the bat is support them to find that Palliative Care. And one of the hardest things is, you know, putting in a zip code and finding a doctor that does provide that or says they provide it. A lot of them do. But that’s not how they advertise themselves. So, it’s really hard to find, to match it, Palliative Care doctor before hospice with a patient locally in their area. And which is one reason why I love your model. You’re like teleconferencing. You’re doing it online, a lot of it.

Dr. Michael Fratkin 22:52
And in some ways, that sort of inspired by the kind of network thinking that Australians are known for, the Flying Doctors. Think about how do they work in rural environments. And I’ve talked to a couple of folks, I’ve talked to a Palliative Care doctor in Byron Bay, who was looking for some guidance and using telemedicine to extend their reach out in Australia. I can’t remember who that was, but I really enjoyed talking to him.

So yes. Well, I mean, if you ask yourself, where is their gas station, you don’t have to go too far to find one of those, right? You’re asking yourself, where can I buy a fast food hamburger? Because one of those are, you know, around every corner, or a drugstore, or a supermarket. And the reason that they’re everywhere in reach to populations in most places with very minimal transport, challenges is because the economics provide the presence and the expansion and access to that, right? Whether you’re in Australia or in America, or wherever you are. It’s all about economics.

If you’re looking for an emergency room, there’s one in reach. If you need a cardiologist, well, you might have to drive a couple of hours to a bigger city. But they’re there. But Palliative Care has yet to realize the benefits of our role in the whole economic world. I mean, what’s unique about Palliative care is not that we care about people or patients. Everybody does. I mean, even the cardiologists and whatever. They care about people. But when you look at the forms that developed in our society and culture, they’re all driven by this sort of economics of it. And Palliative Care has yet to enjoy the kind of economic ‘umph’ that will allow us to create capacity and access everywhere. For everyone, right? And that’s kind of an opportunity for us. Because it turns out when Palliative care is provided to people, let’s say cancer patients with advanced cancer. If it’s done, those people live longer, use the hospital less. And the person’s or entity that pays for their health care, pays about 30 to 40% less in the last six months to two years of their life.

Claire O’Berry 25:27
Right. And it’s one that most patients want is to be at home, they don’t want to be in the hospital.

Dr. Michael Fratkin 25:33
Well, that’s what gets me up in the morning. But that’s not enough, you know. All the doulas in the world, the good hearted doctors, and everybody who cares about whether the people have the best possible experience on their last part of life. That’s about enough to get Palliative Care available everywhere or doulas available everywhere. Right? You’re even more rare than we are?

Claire O’Berry 25:56
Well, and yeah, I mean, it’s an issue because I have been traveling so much that I’ve been doing most of my support for people online. You know when I’ve had to figure my whole model from what I was taught, you know. Well, I can do 75% of what my checklist, what I’ve been trained to do. I can do it online, you know. But still, I would love to be able to connect an end of life doula that’s in Boston, to someone that’s on my list that I know is certified and that is trained, you know, and your model.

Dr. Michael Fratkin 26:37
So, you’re so you’re doing 75% of your doula work at a distance using the technologies that we’re using today?

Claire O’Berry 26:45
Yup.

Dr. Michael Fratkin 26:46
And who would have thought. Because what could be a more hands on thing, than being a psychological spiritual guide to people going through a great transition in life. Whether they’re giving birth to a baby, or whether they’re finishing their own lives?

Claire O’Berry 27:03
Yeah.

Dr. Michael Fratkin 27:03
What an amazing thing. Nobody would get that’s like, “Oh, really, you could actually do that?”. People say that to you all the time, don’t they?

Claire O’Berry 27:10
Well, I mean, it’s just you find out what it is that they need, and you get the resources to them. And you coach them on how to do it. In a way you’re kind of training them to do it themselves, a DIY model, you know. And they’re empowered. Their families were empowered, you know. And they get moving on the things, whether it’s for work or, getting in a strange relationship back together, because that means a lot to them, you know, I mean, they just kind of move on it. And you just sort of help them find what their priorities are, you know.

Dr. Michael Fratkin 27:52
Well, people have been coming up to me for the last like, five years, since we’ve been doing this thing. How can you do that? You can’t do that. That’s not as good. Well, maybe it’s better than nothing. That’s sort of the first phase of people’s reaction to what we’re doing. And when I tell people, it’s actually better than real life. There’s something to be said for the space that we provide each other to be in our own location.

So when you think about what we’re doing, I made reference to the transactions that typically fire the economics in regular old healthcare. You have this problem, you get that solution. You pay this bill, you have that procedure, this lab, whatever. It’s a transactional engagement, like you’re buying a hamburger, or even buying insurance or getting a service from a finance or tax person. You make a deal for a thing. You get that thing and you pay your bill. Right, which is nothing at all. That consumerist model has nothing at all to do with being a human being threatened by that. Nothing at all to do with what happens across all dimensions of a human being when they’re threatened by a serious illness. So what we’ve done in a microcosm, a little piece of the ideal is that we’ve constructed the economics for our care, to provide not transactional support, but relational support.

Claire O’Berry 29:36
Right.

Dr. Michael Fratkin 29:38
So they don’t pay for us to do X, Y and Z at this frequency. They pay for us.

Claire O’Berry 29:47
Yeah, yeah.

Dr. Michael Fratkin 29:48
Their health plan pays for us. They’d pay for us to accompany them, be a part of their understanding, problem solving, navigation and empowerment. And there are not that many health plans yet doing it. The fact that when we provide care that way, we save them truckloads of money.

Claire O’Berry 30:11
Right

Dr. Michael Fratkin 30:11
Right. So we’ve got to translate, not just the touchy feely, wonderfulness of Palliative Care. But we’ve got to translate that economic gain for health plans, into the kind of incentives that will allow for Palliative Care Programs to pop up on every corner, and to be robust enough.

Claire O’Berry 30:36
Whether people are in hospice or not.

Dr. Michael Fratkin 30:40
Okay, let’s talk about hospice, right. So Hospice is a special case of Palliative Care. Hospice also is totally great at symptom control, is provided by a team and assist in navigation in a sense. But actually, it’s its own little ecosystem, where a person when they’re ready to go to hospice doesn’t have to go to the hospital anymore. It doesn’t have to go to their oncologist. Doesn’t have to get labs generally, or x rays, or all that kind of stuff.

Actually, all of the care in a hospice model has been shifted, not just a balance of disease directed care, comfort and quality of life care. But the balance has shifted entirely to where a person is finished with disease directed care. They don’t want to go back to the oncologist, get more chemotherapy, get more scans, and all the rest. They want to go home, stay home and be supported as a human being in the last days of their life.

Now that transition of a person’s consciousness from ‘I want to get the best I can from both worlds’ to ‘I’m done with acute care, physical medicine’ that transition tends to happen quite late in the game,

Claire O’Berry 32:08
Right, too late. Yeah.

Dr. Michael Fratkin 32:10
Well, most often, or at least I think, that when Palliative care is involved upstream from hospice, what we demonstrate is that people have an average length of time in hospice care. That’s actually almost half, almost twice as long.

Claire O’Berry 32:28
Good.

Dr. Michael Fratkin 32:30
Right, so they have more time to know the hospice team to, to settle into what’s most important.

Claire O’Berry 32:37
Yeah, that’s right. What I want to cover is you talked about the bookends of the death and birth experience. And that fascinates me to think of death in the same way that you think of birth, you know. We put all of this energy and showers and you know. Mom comes to visit for a week. I mean, there’s all this love and care that’s put into a birth. And death is sort of been pushed aside, isolated and medicalized. And you know it. This is rhetorical. If it was just like the most profound life experience that we have, and we’re just totally blowing it off, like pushing it away and not valuing that moment. It could be the greatest moment in our lives. I mean, what are your thoughts?

Dr. Michael Fratkin 33:36
I think that’s true, I think. I don’t think there’s any argument that it is one of the two most profound human experiences anywhere. And from my point of view, it’s almost exactly like birth, death is, except for upside down. And it’s the opposite of birth. Right. And that birth is this grab an amazing celebration. And that death is this like, horrifying, terrifying end. I get that. I mean, I have the same relationship to death. It’s not I’m looking particularly forward to my death. I’m in love with my life. But when I think in terms of all I feel entirely, it’s exactly equal.

It is no more amazement to me, that we come into this world. Then, we go out of it. It’s exactly the same. And what opens at those moments are equally profound opportunities to better understand and to deeply experience life, love, connection, spirit, all of that whatever you believe whoever you are. And I’ve watched 1000s of people at their death, and a few dozen after birth, two of which were my own babies.

I don’t see much difference in terms of what the energy moving opportunity for everything else. I get this is a celebration. And this is difficult and somber and more profound. But I also get that reality is doing that all the time. Happy, sad, happy, sad, bad, mad, frustrated, you know. All the experiences of a human being throughout the middle part of the life, which is much more confusing and harder to navigate. The experiences that we considered to be less fun are as important or more important than the moments of joy and happiness.

Our moments of great grief and distress; picking ourselves up after failures; and the injuries and wounds and trauma that we accumulate, are just more of the same kind of thing. It’s like, all of those experience is when you’re awake and alive, experiencing them as performative and transformative. And as you create a sense of meaning for yourself, even in the middle part of your life, these two bookends are just that. But there’s all these books and pages and chapters and everything in between, which are also mostly walked with eyes closed by most people. We sleepwalk through so much of our life.

Claire O’Berry 36:49
I just want to ask you one more question, because I know you have other things on your plate to get to and I ask this of everyone. What is death?

Dr. Michael Fratkin 37:02
Hell, if I know Claire, I have no idea. All I know is that it is a curtain, like an inky black mystery. And because of the nature of me, I want to get into proximity. Even if I don’t. It’s not a puzzle to solve. It’s not a question to answer. It’s not a state that I can report from until I experienced it. But it’s a area of potential mystery, that just crackling with opportunity. And I want to get next to that because I am so in love with the experience of being in awe, and wonder and amazement. That’s why I found myself to come nuzzling up to death. And in order to have the privilege of being there. I went to medical school. I learned a few tricks. I got a degree. Now, all the rest of it. But mostly I’m just drawn to that mysterious, inky black mystery that you can only walk through once.

Claire O’Berry 38:14
Maybe. Oh my goodness

Dr. Michael Fratkin 38:17
Maybe, that good point.

Claire O’Berry 38:21
Anyway, I really am so happy that we got this chance to talk, and people got to know who you are. And I have to tell the people. You have a lot of information on the internet. You have amazing, amazing TED Talks. You’ve been on PBS NewsHour. I mean, Washington Post. I mean, you have credentials and you’re making a difference to the public policy around this. And anything I can ever do to support in the public policy, I am just I’m behind you 100%.

Dr. Michael Fratkin 38:57
Do you want me to tell your listeners the secret to all of that output?

Claire O’Berry 39:01
What?

Dr. Michael Fratkin 39:03
Coffee.

Claire O’Berry 39:06
Bulletproof coffee?

Dr. Michael Fratkin 39:07
Lots of coffee, and a little bit of tequila. No, I would invite everybody. I would invite all the listeners to please check us out at www.resolutioncare.com. There’s a pop down thing for our newsletters. We produce all my high quality stuff that we know is valuable and interesting or funny sometimes. We don’t pummel people with fundraising requests. We do that one time a year. That’s our kind of rule of thumb. But yeah, please sign up for the newsletter. It’s a great website.

Claire O’Berry 39:47
It’s a great website and people get can get a sense of the model that you’re working under. You know, because it is unique, the model you’re using. And I wanted to talk about the model more but maybe they can go on your website and find out about that. Okay, because you’re remote, if I was saying and I wanted to have your services by like, do I have to be in Northern California for your services?

Dr. Michael Fratkin 40:17
You don’t have to be in Northern California. But in order to have our services, you have to be in California. And then if you’re a regular person with a regular set of resources, you have to have one of the contracted health plans, that pays us on a monthly rate to provide our services.

If you happen to be of greater means, and you’re in the state of California. And you would like to engage our team, and are in a position where you can pay on a monthly basis for the services, we’d be honored to take care of you. Just like we would be for the person that’s living under the bridge, in a refrigerator box, but paid for by the Medicaid managed care organization. So, if the resources to support our costs plus a little bit so that we can grow is available to us, anywhere in the state of California, we can provide care.

Claire O’Berry 41:18
Well, cuts a large team to so of professionals that are working with you.

Dr. Michael Fratkin 41:24
You’re amazing, amazing, amazing. Amazing.

Claire O’Berry 41:27
Yeah, I can. Go on the website.

Dr. Michael Fratkin 41:30
Oh, yeah, it really has a gajillion. If anybody in the listenership has a jillion dollars, and they want to see more of this work, access and capacity, palliative care in the home across the country. It’ll take about a half a jillion dollars. Half a jillion dollars, and we’ll do everything that’s needed in the whole country. Maybe even come to Australia.

Claire O’Berry 41:56
Let’s work together to make that happen.

Dr. Michael Fratkin 41:59
Okay, thank you, Claire so much.

Claire O’Berry 42:02
Yeah. We’ll talk again soon I hope.

Dr. Michael Fratkin 42:06
For sure.

Transcribed by https://otter.ai