Palliative Care, Mindfulness, and Elephants w/ Dr. Dana Tarcatu

Episode Information

March 25, 2022

Palliative Care specialist Dr. Dana Tarcatu talks about palliative care, meditation, the interconnectedness of everything, elephants, and more

Topics Include:

• Growing up in Romania under the shadow of Communism
• How presence is often enough and can be better than trying to fill in the space with words. Compassionate and supportive presence for those at the end of life is in itself conducive of healing.
• Why she doesn’t like the word ‘patient’
• Her belief that there is only one life, and that the distinction between work and personal life is artificial. Wherever you go, there you are. Meaning, you bring the same energy into whatever you do
• A little bit about The Seekers Forum, different practices of meditation and self-healing
• How she does the Writing to Awaken process with Mark Matousek and how transformative it is
• How she has worked on herself to become less reactive and mindful and how that impacts her work and relationships with those she cares for
• How she runs her practice by learning from her patients and how her patients in turn learn from her and this enriches the relationship
• How she uses a movement practice called “The Five Tibetans” (or The Five Tibetan Rites). The Tibetan monks use it as a longevity practice. Free divers use it to improve their diving skills.
• How excited she is to work with Doctorpedia because she feels it is going to reshape where people get their medical information and also build trust

Highlights

• “[I grew up] during the communist regime, we had very few options and exposure to things that were happening in the Western world. However something that was really beneficial was this element of grit and resilience, sort of a survivorship attitude. You had to figure out how to do things on your own. There was not a lot of room for questioning and cutting corners – you really had to do the work. There was no way out – the only way out was the way through.”
• “By default, being a patient means that the person is disempowered, that they are in a transactional relationship with somebody who’s offering them a service or somebody who has superior powers to fix them. It takes away that element of engagement and accountability by inspiring people to have a passive attitude and wait to be fixed by somebody.”
• “We’re all facing these ups and downs, and the wheel of life constantly turns. Everything is changing around you. Everything is changing inside of you. Having this ability to remain open and embracing the element of constant impermanence puts us in a position of giving – it gives us an extra dimension of not just surviving, but thriving.”
• “We all have to be aware that we are the instruments of our [own] work. By continuing to tune our instrument, we are able to continue to give our best and constantly recalibrate around the things around all the changes that are happening in our lives inevitably.”
• “If you get lost in the narrative of looking at [palliative care] only through the lens of a medical intervention, then you’re missing the bigger picture, the physical aspect of care is just one dimension. What makes us such complex beings is our multidimensionality. This is exactly what hospice does, trying to tune in to this element, to these other dimensions that play a significant role in everyone’s perception of wellbeing and comfort.”
• “One of the questions I always like to ask my patients is, “What does this pain mean to you?” You have to go beyond asking them simplistically, “What does your pain feel like on a scale from one to ten?” You have to really understand the meaning of each symptom for everybody, because that’s when the stories start unfolding. And it’s in the richness of the stories that we find that opportunity to connect with somebody.”
• “I’m excited about Doctorpedia because it’s a very dynamic space where you can make a contribution in your relevant field through these educational videos and the recent content, coming from a place where there is some element of authority. I’m not a fan of authority. I don’t think anybody should talk about themselves as experts in this and experts in that, because we are constantly learning. We are lifelong students, and this is where I come from. I think it’s a phenomenal opportunity for us to find ways to express things that we’re passionate about and talk and create these videos. The excitement is about the vision that people would have a platform to go to where they can see somebody who’s speaking from lived experience about certain topics and I hope it’s going to have a different impact. We hope that it’s going to reshape the way people are looking for medical information, and hopefully there will be more trust.”

Relevant Links

• Doctorpedia Spotlight Interview

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello and welcome to the Doctorpedia podcast.

Daniel Lobell: (00:23)
I am your host Daniel Lobell and I’m so honored today to be joined on the line by Dr. Dana Tarcatu. How are you, doctor?

Dr. Dana Tarcatu: (00:31)
Hi Daniel. I’m great. Thank you so much for having me. It’s a pleasure to be here with you today.

Daniel Lobell: (00:37)
The pleasure’s all mine, and I’m so excited to speak to you because what you do is so fascinating to me and I haven’t spoken to anyone who works in hospice or palliative medicine before. Usually we start interviewing the doctor about their life and I will get to that. But the first thing that jumps out for me is what made you decide to go into this part of medicine that to my mind could be very depressing. It’s obviously necessary, but what attracted you to it?

Dr. Dana Tarcatu: (01:16)
Hmm, interesting perspective. I hear that a lot about this negative connotation and language like “depressing, it must be very sad, it must be this, it must be that.” For me there was no traumatic story attached to my choice or that drove my choice. It was absolutely natural – an organic evolution of my personal development, of who I am at my core.

Daniel Lobell: (02:05)
So, wait: let me pause you there. Who are you at your core?

Dr. Dana Tarcatu: (02:11)
That’s a great question because I’m still discovering that. I don’t think anybody fully knows who they are at their core unless they continue that process of exploration. But as you start, as you take the first step on that path of self observation and self exploration, you get a better sense and a better understanding of your core values and how those start to influence your choices very early on. For me, the alignment came from this element of wanting to be in a space where I could look at people as a whole in their multidimensionality and to be able to integrate these dimensions into the offerings that I make in caring for them. Looking back, that was the construct of my mental framework that allowed me to see this through that lens. Does that answer your question?

Daniel Lobell: (03:49)
It only raises more questions for me, but it’s still a good answer. I guess this is the perfect lead to get into who you are and into your background, where did you grow up?

Dr. Dana Tarcatu: (04:01)
I grow up in Romania actually during a time where it was a hard life, I have to say.

Daniel Lobell: (04:12)
How so?

Dr. Dana Tarcatu: (04:13)
It was very limited. It was during the communist regime – we had very few options and exposure to things that were happening in the Western world. However something that was really beneficial was this element of grit and resilience, sort of a survivorship attitude. You had to figure out how to do things on your own. There was not a lot of room for questioning and cutting corners, you really had to do the work – there was no way out, the only way out was the way through. [Laughs.] We were raised in this atmosphere of responsibility and that has been instilled in my bone marrow growing up and I am very grateful that I was able to use it later in life and maintain that sense of self sufficiency but also adaptability that has helped me in a lot of situations later on.

Daniel Lobell: (05:59)
Give me some examples, because I’m fascinated, you’re growing up in communist Romania. You mentioned that it was very limiting. What were some of the limitations?Specifically, can you think of any stories to illustrate it?

Dr. Dana Tarcatu: (06:13)
Yes, for instance: basic human needs, from Russian food to Russian electricity. I remember my sister and I were sitting in the kitchen at the kitchen table doing homework using this improvised light source that my father put together using the battery of his car, which lit up through a box. This improvised light was the only source of light for us to see in order to study. This is how we did homework during the winter when the electricity would go off at crucial times when people were coming back home from work and they were supposed to sit together and have dinner and do homework and bond and spend time together. That’s an example, and then of course it was a different time and there were not so many distractions, like there are today in terms of social media and other things, but everything was filtered – all the information that was fed to people was filtered through the framework of the communists.

Daniel Lobell: (08:00)
Not an easy life, the whole idea of light coming only from a car battery. It sounds like it really was a very tough struggle to survive there. I think it’s now painting a clearer picture for me of maybe why you went into hospice care, because you come from this very difficult upbringing. I think it takes that kind of grit to be able to face these situations with patients who are going through a very difficult time and being able to help navigate them through something like that. Do you think that connection makes sense?

Dr. Dana Tarcatu: (08:38)
Yes and no.

Daniel Lobell: (08:41)
[Laughs.] At least I’m halfway.

Dr. Dana Tarcatu: (08:43)
Yes. I’m really thriving right now in this space of continuous evolution of my own being and also of my practice and the interconnectedness of everything.

Daniel Lobell: (09:11)
I love hearing things like that, but I’m always so curious. What does that mean? When you talk about interconnectedness, can you give me an example?

Dr. Dana Tarcatu: (09:19)
Yes. For instance, you hear people talking a lot about work life balance and that you have to put a tremendous amount of effort in to doing this balancing act as if we have two separate lives: This is your work, and this is your life. I see it very differently. It’s all one. How you do everything is how you do anything, basically, and the way you operate at work – the same way, the same qualities, the same quality of energy – you apply in your life outside work, and everything is weaved through. The undercurrent is the quality of the energy that you bring to every situation you encounter. It doesn’t matter if it’s work. It doesn’t matter if it’s outside work. It’s basically how you show up in life that determines the quality of your connections, the therapeutic relationship that you are able to co-create with your patients and those you care for. I’m not a fan of the word “patient”, by the way. [Laughs.]

Daniel Lobell: (10:42)
What do you use? What do you prefer?

Dr. Dana Tarcatu: (10:46)
I feel like it’s almost rigid.

Daniel Lobell: (10:53)
It dehumanizes the person.

Dr. Dana Tarcatu: (10:54)
By default, being a patient means that the person is disempowered, that they are in a transactional relationship with somebody who’s offering them a service or somebody who has superior powers to fix them. It takes away that element of engagement and accountability by inspiring people to have a passive attitude and wait to be fixed by somebody.

Daniel Lobell: (11:31)
I think that makes a lot of sense.

Dr. Dana Tarcatu: (11:32)
Going back to what you said about growing up in that atmosphere, one would think it could make you very rigid in your mindset. It gives you this resilience, but also almost with a nuance of inflexibility, whereas the inner work and everything that I’ve been doing through the opportunities that I got through the practice in palliative care and hospice has been towards infusing more of the element of unknown and discovery and staying fluid and being able to navigate these situations that are basically happening to all of us. You don’t have to have any specific history of trauma or any particular negative experience.

Daniel Lobell: (12:46)
We’re all deteriorating at our own pace, in other words, [chuckles] to put it in a bleak way.

Dr. Dana Tarcatu: (12:55)
No, but we’re all facing these ups and downs, and the wheel of life constantly turns. Everything is changing around you. Everything is changing inside of you. Having this ability to remain open and embracing the element of constant impermanence puts us in a position of giving – it gives us an extra dimension of not just surviving, but thriving.

Daniel Lobell: (13:45)
Playing off of what you just said, you said that you’re in the middle of personal growth as well. To go back a few minutes, you talked about how you show up in life being very interconnected to how you show up at home, in your job. My question to you then as a follow up is how did you used to show up in life versus how are you showing up now with your recent personal growth?

Dr. Dana Tarcatu: (14:18)
Yes. I don’t know if I want to remember that.

Daniel Lobell: (14:29)
Let me give you a perspective on why I find this a good question is because I think it could be inspiring to a listener. I think that we have this idea of doctors that they’re beyond us and that they’re this other thing that can fix us and hearing you speak so vulnerably and openly about fixing yourself is first of all interesting and secondly, inspiring. For me to ask you to go into it a little more, I think would be fascinating for a listener to hear and also possibly motivating.

Dr. Dana Tarcatu: (15:05)
Possibly motivating. I would say one key element that has shifted and is continuing to shift is reactivity. I have been diligently working using a practice that I was so grateful to come across a few years ago – it’s a specific meditation practice that I am very fond of. It took me from a place of being at the mercy of my own reactivity to a place where I constantly work towards keeping my mind in a place of equanimity and balance and non-reactivity, so this has been one of the key things in addition to other practices like expressive writing through self inquiry where you use different prompts and you get to go very deep into certain stories that have lived for very long in your mind and you are able to look at them in a very objective way, detaching yourself from the story and taking it out of your mind and putting it on paper.

Daniel Lobell: (16:54)
It’s almost like therapy without the therapist present.

Dr. Dana Tarcatu: (16:56)
It’s very therapeutic. All these are self-healing practices, by the way. Again, I give a lot of credit to the work itself that has inspired me to get on this path, because (and I think I used this term in the piece I wrote on on the website as well), we all have to be aware that we are the instruments of our work. By continuing to tune our instrument, we are able to continue to give our best and constantly recalibrate around all the changes that are happening in our lives inevitably.

Daniel Lobell: (17:54)
Where do we find those questions that you talked about writing the answers to the prompts?

Dr. Dana Tarcatu: (18:01)
I work with a teacher who generously gives his time. It’s called The Seekers Forum and it’s a platform where you can practice this particular type of self-inquiry that’s called ‘Writing to Awaken’. The name of the teacher is Mark Matousek. He gives us prompts and then you can develop with time, as you continue to do the practice over time, you develop, these things start naturally popping into your head, and then you can you develop your own individual practice and you can dig deeper and deeper. What I find fascinating about it is that this process is never ending, because there are new questions that come up, but also because your inner and outer landscapes change all the time, there is always something new to discover. It’s almost like you’re staying current with your own version – 3.0, and goes into version 5.0 and 6.0. [Laughs]

Daniel Lobell: (19:27)
What I also particularly like about what you’re saying is that you have a written thing at the end of it. I did therapy for many years and I always wish that I had transcripts of my therapy and maybe somebody to edit them and punch ’em up a little make ’em funnier, [chuckles] But I always wish I had all that information written somewhere. I could go back and look at it, but it sounds like with this, you do.

Dr. Dana Tarcatu: (19:51)
Yes, you do. Also, the insights don’t necessarily happen in the moment when you do the actual writing, the insights and the breakthroughs occur in those moments when you go back and read what you wrote, and there is that element of objectivity. You are not the story. You are the narrator of the story. You have that complete detachment from the emotionality of whatever it is and you’re trying to say it as objectively as possible without weaving in these elements of intense emotions. You are telling me as a reporter, you’re reporting on the facts, and then you go back and read them – that’s when the insights happen.

Daniel Lobell: (20:45)
Yeah. I write comic books about my life and I’ve put out four of them now. When I go back and read them – now it’s been about one a year – when I go back and read what I wrote four years ago, or three years ago, I think it’s very interesting to observe how I thought when I wrote and how I see the world versus the way I see it today. I wouldn’t necessarily have written the way I had four years or three years or two years ago, even.

Dr. Dana Tarcatu: (21:18)
Yes. That’s exactly the beauty of it, this ability to just look back and see how you change and everything to change your story changes all the time.

Daniel Lobell: (21:32)
Hopefully we’re evolving and not devolving.

Dr. Dana Tarcatu: (21:36)
I think if you get too attached to that, it also creates more misery and emotional level that you don’t necessarily see the progress, but there are ways of objectively capturing the process in this healing journey. It’s not so much about clinging to, “Oh, I have to see the evolution.” It has to be better. It has to be like the more detached and relaxed you are and you allow things to happen. It’s the practice itself that gives you the therapeutic benefit.

Daniel Lobell: (22:20)
Is this doctor who you’re working with the same person?

Dr. Dana Tarcatu: (22:26)
Yes. He’s a writer, actually.

Daniel Lobell: (22:31)
Is that he the same one who’s teaching you meditation? Or is that something separate?

Dr. Dana Tarcatu: (22:35)
No.

Daniel Lobell: (22:36)
So you said it’s a specific kind of meditation. Can you go into that a little bit?

Dr. Dana Tarcatu: (22:42)
Yes. It’s the practice of the ‘vipassana’, which at its core could be seen as a Buddhist teaching. However, it is in no way affiliated with any kind of religion. It’s nonsectarian, and it’s very universal. This teaching came out of India more than 2,500 years ago, and then it got lost for a while, and then it re-emerged out of Burma and they were able to keep the tradition intact and bring it back to India and then to the Western world. It’s an art of self observation through the experiential observations of impermanence using the framework of your mind and body. It is very experiential learning.

Dr. Dana Tarcatu: (23:55)
It’s very simple. What you do is you are observing in your time the sensations that occur as a result of of the interaction between what you feel at physical level and your mind, and what you’re observing is the impermanence of these sensations and how everything changes. It’s basically a real time observation of impermanence using your own body framework and the exercise going back to this idea of economy is that you are maintaining your mind in a state of manner activity, not engaging with the sensations that are pleasant and not towards those that are not pleasant. It’s a more profound philosophy than what I’m telling you here.

Dr. Dana Tarcatu: (24:52)
I just came out of a 10 day sitting at one of the DMA centers up in Massachusetts. It was my third time sitting a 10 day course and I have to say that every time it’s a new experience and you just get deeper and deeper and deeper.

Daniel Lobell: (25:20)
I feel like the funny line would be like, “I just came out of a 10 day sit and I’ve never felt so impermanent.”

Dr. Dana Tarcatu: (25:28)
Basically, we are a mass of bubbles that constantly vibrate to a certain frequency. The exercise is to observe the impermanence of these sensations that this mass of bubbles generate. Ultimately, if you get there, there is this opportunity to transcend into a non-ordinary state of consciousness where the vibrations generated by your physical mass merge with the universal vibrations of the creative force, that is all around us, that we come from – where we eventually return. It’s very simple, there’s nothing mystical about it. Like I said, what attracted me to it is this element of very practical observation and this exercise of staying in a space of non-reactivity, which you take it from the meditation pillow and you apply it in your real life. It’s completely transformative.

Daniel Lobell: (26:43)
Do they have people who try to test you by making, see if you’ll react to different things?

Dr. Dana Tarcatu: (26:51)
Yes.

Daniel Lobell: (26:53)
Like if someone threw a spitball at you or something.

Dr. Dana Tarcatu: (26:56)
You do react – you don’t turn into this passive machine or something. It’s subtle to some level, but it’s also very evident in the way you communicate with others, the way you take your time to react, filtering things through to actually observing your sensations. Like if somebody makes me angry, the first thing that I do is I learned to observe how my breathing changes, that is the first signal, like immediately, your physical body reacts. Then, whatever sensations come about, you then take a moment and try to strive for a place where you are in a balanced state of mind before you respond. It’s a huge difference between responding and reacting to a stimulus, whatever it is.

Daniel Lobell: (28:03)
Yeah. That reminds me of a story I heard recently about a great rabbi who has since passed away a while ago, but that he had had his hand, his finger jammed in the door. The student of his was driving him somewhere and he put him in the backseat and he closed the door on his finger. The rabbi said, “Oh, do you mind opening the door?” He opened it. He brought his hand in, and he never said anything about the fact that he’d closed his finger in the door. And afterwards somebody was in the backseat with him, and said, “I noticed that he closed your finger in the door. That must have been excruciatingly painful.” He said, “It was”, and he said, “Well, you didn’t mention it at all.” He said, “I worked my whole life to reach this moment, because if I would’ve said something to that student, he never would’ve recovered from knowing that he had closed my finger in the door.” He said, “I worked my whole life to be able to control my reaction to that extent where I don’t need to embarrass him or make him feel bad about it, or even make him aware of it because there’s nothing good that would come of it.” I thought that was pretty profound.

Daniel Lobell: (29:11)
Speaking of profound, there’s a piece that you said in your doctopredia.com interview – which I encourage everybody to read – that I thought was very profound. I wanted to ask you about it. It refers to a time when you were working in cancer care, and you say, during that time, I had the eye opening reintroduction to death in its raw and most authentic form. Seeing people die in hospital rooms, their bodies raped by chemotherapy through their last breath while their minds and spirits were left unattended. In those moments, I couldn’t quite integrate intellectually and emotionally what was going on as everything seemed to fit perfectly into the institution’s mantra of we are fighting the good fight. So now having gone through this, writing that, do you think if you placed yourself back in that time, you would’ve seen things differently? What is your opinion now on the mantra of, “We are fighting the good fight.”

Dr. Dana Tarcatu: (30:18)
Great questions. I would be different by default because it’s been a while since I was in that place, so I would show up with a different material, and also, our bodies regenerate every seven years and our tissues are new, so I would bring a totally different physical persona to that space. But most importantly, from an emotional and mental space, I would have a different perspective in the sense that I wouldn’t focus on the conflict. I wouldn’t focus on the tension between “Oh, this is what’s happening here. This is the agenda, we have to try to focus on the medical aspect of care” and intentionally or unintentionally pay less attention to the human element of care. I would probably be able to hold space with a different intention and do my part. It’s not so much about observing and pointing fingers or “This organization is doing this, this organization is doing that”, whatever you can do on a personal level to be the change you want to see happening around you.

Daniel Lobell: (32:16)
What are the changes that you now think would’ve been great to see there that you could bring to it specifically?

Dr. Dana Tarcatu: (32:40)
I would be able to connect at a deeper level with people who go through that experience and not subscribe to the prescribed narrative. You go in as a palliative care physician and you talk about these things, and you have this standard of sets of assessments that you have to do. I would look at it from more of an exploratory approach rather than an explanatory approach.

Dr. Dana Tarcatu: (33:21)
It’s more about getting really curious, but without authenticity, which is the key element. You can’t fake these things when you are in front of people who are facing their deaths, and that’s why it’s so important to be so diligent and intentional about your own practices and about your own resolution, because people see through you. You can’t fake authenticity, you can’t fake compassion, you can’t fake empathy. You have to be in that energy to be able to show up and create this therapeutic space. Going back to your question, I would approach it more from a place of curiosity, asking more questions and trying to learn as much as possible from their experience rather than seeing the negative aspects of care or focusing on the non-important stuff. I think right now they’re not important. My English goes offline. [Laughs.]

Daniel Lobell: (34:45)
[Laughs.] No, no. You’re doing great.

Dr. Dana Tarcatu: (34:47)
If you want to switch to another language, I’m happy.

Daniel Lobell: (34:51)
We’ll stick with English. It’s the only one I can really speak. My friend who was my neighbor growing up now lives in Florida. He’s a World War II veteran. He’s in his nineties and he has emphysema and he’s been getting treatment for it for a while. He lives in Florida now. They put him recently on hospice care at home. And he and I talk all the time on the phone. And he has just a wonderful energy. He laughs about everything. But he said something to me recently that disturbed me. I’m trying to articulate why to myself and some of what you said kind of answered it for me. He told me that his new hospice nurse is great. And I said, “Oh, how so?” He said, “Well, I told her the other day, “I can’t breathe.””

Daniel Lobell: (35:48)
She goes, “Well, Mr. So-And-So, “Why am I here?”” He said, “You’re here to take care of me.” She goes, “Through what?” He goes, “Through hospice.” She goes, “And why are you on hospice?” He goes, “Because they put me on hospice”. She goes, “They put you on hospice to do what? To die.” She goes, “So I’m not supposed to help you breathe. I’m here to help you die.” And he started cracking up and he said, “You’re good. You’re good.” He said, “She’s right. I keep forgetting. I’m supposed to die.” He’s laughing about it, but it hurt me in my heart. I thought, “This can’t be the right response and is it true? Is he just supposed to die? Is that what her job is to just oversee him dying? That doesn’t seem like what hospice care should be to me.”

Dr. Dana Tarcatu: (36:52)
Absolutely not. No. At its core, the hospice philosophy is about leaving. It’s about celebrating life. It’s about focusing on the quality of your life, whatever is left of it, and empowering people, like I said, to engage in that energy. There is no timeline. You don’t give people an expiration date like I’m here because you’re supposed to die in the next six months. That’s not how it goes. The whole model is designed around supporting people to maintain the best quality of life that is possible for them, looking at all these nuances and all these layers.

Dr. Dana Tarcatu: (37:52)
We talk about social determinants of health. We talk about their own support system. One of the key elements in what makes a supportive care program doesn’t necessarily have to be hospice – rather, it comes from this piece of providing real life, real time support. If an agency or an organization is obviously unable to do that 24/7, you pull in the resources from the community. People who feel supported and who feel engaged and connected have much better outcomes than those who don’t. [Because] loneliness is the number one killer.

Daniel Lobell: (38:42)
We saw what happened to so many seniors during Covid.

Dr. Dana Tarcatu: (38:44)
Exactly.

Daniel Lobell: (38:46)
Early dementia, too, because of lack of stimulation.

Dr. Dana Tarcatu: (38:51)
Exactly. The element of cognitive stimulation and the force of vitality that is within each individual – I think that’s what we’re trying to help people preserve and tap into. This is the key thing. I think I said that in my interview too, it’s almost like we’re like guides, we are guiding people. It’s this philosophy of accompanying somebody on a journey. We’re not there to correct them. We’re not there to fix anything because there is nothing to fix at the end of life, there’s nothing broken. It’s a universal law of nature: We come to life and then we die.

Dr. Dana Tarcatu: (39:56)
It’s this space of accompanying somebody and walking by their side. Basically, you have a friend who’s always there with you, reliably shows up, keeps you company. And a lot of these visits, I have to say for some of the disciplines, it could be the doctor. It could be the nurse practitioner. It could be the nurse. There is a lot of time where there is no expectation to do anything, to say anything. People simply want you to have to be there. This element of being present, but being fully present. That’s why I come back to this. I keep talking about the quality of the energy that you bring into the space, because I think that’s what people connect to.

Daniel Lobell: (40:57)
In a way, maybe you’re making a good argument for this person in hospice, because maybe she knows what to say to cheer him up. Maybe she did a good job in that respect, if there is nothing she could do for him physically, maybe.

Dr. Dana Tarcatu: (41:10)
Yes.

Daniel Lobell: (41:13)
Yeah, maybe that’s exactly what she was doing. I don’t know.

Dr. Dana Tarcatu: (41:16)
But sometimes, you don’t need to say anything. Instead of saying, “Oh, you remember why you don’t have to… , because you’re here to die” – instead of saying that, you can just shut up and not say anything and just be there.

Daniel Lobell: (41:30)
Yeah. I guess she entertained him by saying that, so maybe that was good now that I think about it in that respect. Because she read his sense of humor and what would maybe cheer him up in that moment and maybe there is nothing she could do for him. I’d like to think there’s always something you could do to comfort someone medically, but maybe sometimes there isn’t.

Dr. Dana Tarcatu: (41:53)
No. And again, if you get lost in that narrative of looking at this only through the lens of a medical intervention, then you’re missing the bigger picture, the physical aspect of care is just one dimension. But going back to the interconnectedness of everything, what makes us such complex beings is our multidimensionality. This is exactly what hospice does, trying to tune in to this element, to these other dimensions that play a significant role in everyone’s perception of wellbeing and comfort.

Daniel Lobell: (42:41)
When you’re speaking on this, you’re also speaking from the perspective of someone who’s in pain management.Pain medicine is not just medicine. In other words, it can be social and it can be emotional or spiritual as well.

Dr. Dana Tarcatu: (42:56)
Yes, because one of the questions I always like to ask my patients is, “What does this pain mean to you?” What is the meaning that people attach to a certain physical experience?

Daniel Lobell: (43:12)
What are some answers that you’ve gotten that are interesting?

Dr. Dana Tarcatu: (43:16)
For instance, in the end of life context, sometimes people say, “It means that I’m gonna die” or “This pain means that I can’t go outside and see my friends,” or “It just reminds me that the disease is progressing”. If you just ask them simplistically, “What’s your pain level from a scale of zero to 10, how does it feel?” All these things which are helpful, but not really very productive, you have to go beyond that. You have to really understand the meaning of each symptom for everybody, because that’s when the stories start unfolding. Iit’s in the richness of the stories that we find that opportunity to connect with somebody.

Daniel Lobell: (44:20)
Somebody had told me about something called the Sarno method of pain management. It was a mental way of coping with pain to get rid of it. I don’t know if you’ve heard of it, but I’m not sure of the name. But the concept maybe you’ve heard of, for people who are experiencing pain to be able to mentally get rid of the pain.

Dr. Dana Tarcatu: (44:49)
I don’t know what method that is, but I have to tell you – this is what I mean when I like to speak from lived experience. During this meditation retreat, it gets very intense, it’s kind of like a progressive methodology. It doesn’t matter how many times you do them because there is also the individual daily practice, you sit at home one to two hours a day, but during these 10 day sittings, it’s a 10 or 10 and a half hour day of sitting on your butt with your legs crossed. There are moments when there is physical pain that is so intense. One of the dimensions of this practice is the ability to to cultivate your strong determination, the strength of your mind.

Dr. Dana Tarcatu: (45:55)
To do that, you have to commit to not changing your position for the entire one hour sitting and the self observation of sensations. The fact that the practice is all about observing the impermanence. The pain starts, and then you don’t react to it, then you continue to observe it, and you continue the scanning of your body from top to bottom and, from the top of your head to the tip of your toes and back and forth. Eventually what happens (or what I have experienced) is that I come out of these retreats and I think, “Oh my God, I have a superpower.” You literally transcend your pain – after a while, it no longer feels like pain. There is of course a physiological neurobiological explanation for that through the way the pain information travels from the area where it is generated through the spinal cords, to the brain centers that are responsible for that.

Dr. Dana Tarcatu: (47:11)
There is a physiological explanation for why the pain eventually transforms into a different sensation. But if you think about it, metaphysically, it’s more a process of transcendence. I see it in practice. People who have some practice – it doesn’t have to be this – it could be anything where they use the power of their minds to modulate the physical experience that they have. It could be pain, it could be shortness of breath. It could be nausea, it could be any symptom. They tend to have an easier way to navigate through these complex symptoms that they experience at the end of their lives. Not only at the end of their lives, you’re talking about somebody who’s going through active treatment for cancer, these symptoms are there as well.

Daniel Lobell: (48:11)
The name of the doctor I was referring to is Dr. John Sarno, it’s called the Sarno method.

Dr. Dana Tarcatu: (48:19)
I’m not familiar with that.

Daniel Lobell: (48:22)
It says that America’s most famous back pain doctor said that pain is in your head. Thousands think he’s right.

Dr. Dana Tarcatu: (48:29)
I mean, in the sense that you need your brain for that information to travel and to be interpreted as a painful signal. If we didn’t have a brain, we wouldn’t sense anything, but also we need a spinal cord as the highway for all these signals. For people who have spinal full spinal cord compression, you can amputate their legs and they have no pain because there is no spinal cord to transmit the pain from the area where it’s energy to the centers in the cortex where it’s processed.

Daniel Lobell: (49:18)
This is all very, very interesting stuff. But I do want to shift the conversation over to the online health space. Of course, this interview is being conducted on behalf of Doctorpedia, which it’s very exciting that you are a part of. I want to ask you, first of all, your thoughts on the online health space, what you’re doing with Doctorpedia for people to check out and why you’re excited about working with Doctorpedia?

Dr. Dana Tarcatu: (49:58)
I’m excited. It’s a very dynamic space where you can make a contribution in your relevant field through these educational videos and the recent content, coming from a place where there is some element of authority. I’m not a fan of authority. I don’t think anybody should talk about themselves as experts in this and experts in that, because we are constantly learning. We are lifelong students, and this is where I come from. But I think it’s a phenomenal opportunity for us to find ways to express things that we’re passionate about and talk about and create these videos.

Dr. Dana Tarcatu: (51:13)
I still have to start on that. There is not much content on my website yet, but I’m in the process of putting that together in the next few weeks or so. I think the excitement is about the vision that people would have a platform to go to where they can see somebody who is speaking from lived experience about certain topics and I hope it’s going to have a different impact. We’re talking about impact, how is this gonna impact the public? We hope that it’s going to reshape the way people are looking for medical information, and hopefully there will be more trust.

Dr. Dana Tarcatu: (52:14)
What I personally want to do is around this element of empowering people to show up in their interactions with whoever is caring for them, the doctor, the nurse. “This is what I don’t know that I don’t know” and be very open to that and remove that element of transactionality, like “Oh, I’m here to attack you, to challenge you as the doctor, to ask you these questions that I found on Google” and really show up from a place of, “I want to learn from you.”

Dr. Dana Tarcatu: (53:13)
Going back to semantics, you can say a physician has expertise based on experience and knowledge and theory. But people who have gone through the experience of a certain disease process, they have that other nuance of experience, it’s not necessary expertise. It’s the experience. We have to be equally open to listening to what they share with us instead of having that attitude of, “Oh, I know better than you and I’m going to tell you which direction you should go and what you should be doing.” I think this element of empowering people to be equally engaged in the dialogue and community is essential.

Daniel Lobell: (54:28)
Yeah. It really goes back to what you were saying about why you don’t like the word ‘patient’ earlier. It’s sort of an extension on that. It’s being a doctor to yourself. It’s such an obvious thing when you think about it, but who wouldn’t want to have a doctor working on them – who is them? I always feel like you put more into things that you care about than anyone else does. Why shouldn’t it be the same for your health? If you’re a partner in your own healing, you’re in much better hands than leaving it all to someone else.

Dr. Dana Tarcatu: (55:12)
Correct.

Daniel Lobell: (55:13)
Except maybe if I’m flying a plane. I don’t know if I’d want to be an equal partner in that, because I think I’ll leave that …

Dr. Dana Tarcatu: (55:20)
[Chuckles] To the pilots.

Dr. Dana Tarcatu: (55:22)
I agree. Going back to the interconnectedness, it’s all about, “I’m learning from you, you are learning from me.” I have a certain set of skills that I can offer, but I’m also open to constantly feeding the information I get from those I care for back into my own operating system to enrich it, to elevate it, and if we could all elevate each other I think we would be in a better place.

Daniel Lobell: (56:06)
I agree. This has been a really fascinating interview and I’ve really enjoyed the last hour. I feel like we could go on forever, but we can’t unfortunately right now, but hopefully we’ll get to talk again sometime. I think I would be remiss not to bring up the elephants though. [Dana laughs]. I have to ask about the elephants before we wrap up.

Dr. Dana Tarcatu: (56:27)
The elephant in the room. [Laughs.]

Daniel Lobell: (56:28)
Yes. Opening a hospice for elephants is a dream of yours. Where did you develop this relationship with elephants? How did that start? Yes. I do just think if I say “Elephants, go” it’s gonna be fascinating, no matter what you say. Pease go ahead.

Dr. Dana Tarcatu: (56:51)
First of all, elephants are one of the most emotionally evolved species. There is empathy. They grieve, they show love, they express. They’re very emotionally evolved and sophisticated. I was able to be around elephants for the first time in Nepal. I have visited Nepal a few times now. I got to experience being around elephants for quite some time.

Daniel Lobell: (57:35)
What does that mean? Being around elephants? Because I was in South Africa, a bunch of elephants walked by me and I actually almost got stampeded once by elephants. [Dr. Tarcatu laughs] So I was also around elephants. But when you talk about being around elephants, I imagine [you are talking about something entirely different.]

Dr. Dana Tarcatu: (57:49)
I was in a place in the south of Nepal in Chitwan more specifically where there are these elephants that are not wild and not domesticated, but they’re like a hybrid. People come and guide them to the river and they wash them and they wash them. The process is you scrub the elephant and you really take care of them really nicely. But for that, the elephant has to submit. What they do is they get on their knees in the river and they help you not only clean the parts that you normally do not have access to, but they actually allow you to get on their back and then continue the cleaning and so on.

Dr. Dana Tarcatu: (58:50)
They cooperate because they get water in their trunks and they splash all over. Basically, they help you shower them and clean them. Then, there is this very nice ritual where after the baths, you get to dry them off and you get to take care of their little hairs. You take them out of the river and you let them go free. The elephants don’t live as pets – you don’t put them in a stable and then you take them out in the morning and you take them in – they still come alone for this ritual.

Daniel Lobell: (59:41)
It seems like a great deal for the elephants.

Dr. Dana Tarcatu: (59:44)
[Laughs.] Right. But there are nurseries in Thailand where you can go and spend time and really care for them, for those who are in different stages of their lives, for those who are just being saved from the wilderness who have lost their moms like baby elephants. I think the energy around elephants for me feels like home if you’re surrounded by this. I don’t know how to describe it. It’s very calm. It’s very loving, they’re big animals. And like you said, there’s a danger of you getting injured, but they would never stamp on you unless there is some sort of an accident or something like that. But I hope to be able to do that one day.

Daniel Lobell: (01:00:54)
Yeah. It sounds really interesting. I know we talked about meditation and we talked about the writing, but I’m going to round off the interview by asking you, “Is there anything else that you do to stay healthy that you would recommend to the listeners?”

Dr. Dana Tarcatu: (01:01:11)
I tend to stay away from making recommendations because I think everybody should go through their own process of exploration and see whatever it is that resonates with them. What I do on a physical level is energy work. It’s moving energy to the body. It’s called The Five Tibetan Rites. It’s a practice that sea divers use to improve their lung capacity and also to engage their diaphragmatic breathing way more than just using the lungs in the breathing process. You can go online and look it up. It’s a very simple practice that comes out of Tibet, and Tibetan monks have used it as a longevity tool.

Daniel Lobell: (01:02:17)
What’s it called?

Dr. Dana Tarcatu: (01:02:18)
The Five Tibetan Rites.

Daniel Lobell: (01:02:21)
Okay.

Dr. Dana Tarcatu: (01:02:24)
I run consistently and I go on these running experiences. I was on this amazing running experience, spiritual discovery experience in Oaxaca at the end of October for the celebrations of the Day of the Dead.

Daniel Lobell: (01:02:47)
Oh, wow.

Dr. Dana Tarcatu: (01:02:49)
I tend to move my body a lot. There are different movement practices. There is this practice called Nia that I’ve been practicing for a while. It’s also a movement practice that is rooted in breath and movement and music. The beautiful thing is that what you do always changes. You get to do one thing for a while and then you discover something new and then you get to sample a little bit of that. And then either you stay committed to that for a while. I don’t know anybody who just does one thing for the rest of their lives. That’s also my process. I go through different processes and different things, but I think at the core of it, it is going back to tuning your own instrument. Also it is inner wisdom that comes from knowing that without [these practices towards mindful living], my instrument would be out of tune way more often.

Daniel Lobell: (01:04:11)
Wow. You’ve given us a lot to look into for sure. By the way, it’s not lost on me that you seem almost obsessed with energy and you grew up in a home where the government wouldn’t let you guys have any. [Laughs]

Dr. Dana Tarcatu: (01:04:27)
[Laughs.] Yes. It’s probably one of my unresolved areas of grit. [Laughs.]

Daniel Lobell: (01:04:35)
Always searching for energy.

Dr. Dana Tarcatu: (01:04:37)
It’s always possible, it’s very possible.

Daniel Lobell: (01:04:40)
Possible. Whether it’s a car battery or an elephant, you’re feeling the energy and you’re getting some from it. That’s pretty interesting and cool. Thank you so much for sharing your story and your philosophy. I’m really looking forward to the work that you’ll be doing on your webpage on doctorpedia.com. I’ll be following you and looking for anything I can learn from it because it seems like you are a great wealth of knowledge. Thank you so much, doctor.

Dr. Dana Tarcatu: (01:05:07)
Thank you so much for speaking to me and it was a great conversation.

Daniel Lobell: (01:05:21)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare for any personal or specific needs.