Cathy Spatuzzi is a yoga and fitness instructor who works with Integrated MD Care. She shares how she helps patients and her views on why she doesn't fear death and, instead, makes sure she is living in every moment.   Books on End of Life Being Mortal, Atul Gawande Knocking on Heaven's Door, Katy Butler Find more in this blog post, here. Dr. Bob: Hello and welcome to A Life and Death Conversation. I'm here today with a good friend and a really valued member of my Integrated MD Care team Cathy Spatuzzi. I'm very excited to introduce you to Cathy and to hear some of her insights. Cathy and I have known each other for a bit, and we've shared some incredible experiences with our patients. We're going to touch on some of those, let you know what Cathy does and how she does it because I think she's really quite an expert in her field and I know that she loves what she does. So, Cathy, thank you for being here and joining us. Cathy Spatuzzi: Hello, Dr. Bob. Thank you for having me. Dr. Bob: Yeah, my pleasure. It's great to see you. I'll share that trying something new, our podcasts, the ones that I've done previously have all been recorded on the phone. Today Cathy is in the office, and we're doing it together. It's really nice to be able to look at her in the eyes as we do this. Cathy Spatuzzi: Yeah, I agree, face-to-face is very nice. Dr. Bob: Yeah. So Cathy is … her title is yoga and fitness instructor. I know that there's probably a lot of yoga and fitness instructors out there who work in various capacities but that doesn't really begin to explain quite what Cathy does because I've seen her in action and I've seen the results of her work. It's nothing short of magical; I have to say. Cathy goes in and works with some of our sickest and most frail patients. She works with people who have dementia. She works with people of all ages and abilities. They don't even know they're exercising. They actually just think they're playing games and meeting a really cool, fun, person. So Cathy, can you just share a little bit about how that happens, what you do, how you approach your patients and just share a little bit about how that magic happens? Cathy Spatuzzi: Sure. So I got my yoga instructor certificate, and I started teaching seniors. I took an extra class in teaching seniors, and I really loved it. Then I met Dr. Bob, and I've always been a physical exercising person myself, and so I've made up my own little program where I go into a person's home, and we have a whole hour of exercise. So we do physical weights, and whatever that person needs at the time, that's how I meet their needs. So we do dancing, we do marching. I bring some music sometimes. I have little balls that we do exercise with. They're bright and colorful. We play games with the balls. I also have just blown up regular balloons, and we hit the balloon back and forth and play a game that way. A lot of people that used to do tennis or volleyball, they remember that, and their muscles and cells remember that and they really get a lot of fun exercise just hitting the balloon back and forth. They tell me lovely stories. Most of my people are 80 to 90, some are a 100 years old, and they tell me fabulous stories. They all have a very positive attitude in life. Dr. Bob: I've met with people, I've been there after you've been with them and it really is pretty dramatic. A lot of our patients, because a lot of times they don't feel well, they don't have a lot of energy, they're dealing with pain, they're dealing with other challenges, and exercise is not something that they necessarily prioritize or look forward to, but that's not the case with you. They obviously don't feel like they're doing exercise. They don't feel like they're working. There's something else. There's another piece that obviously you're bringing to it, which, to me, it feels like you're just really connecting with them very deeply and appreciating them as human beings, and the exercise just happens as on the side. Cathy Spatuzzi: Yes, I agree. I don't think of it as exercise myself. I go in, and I have fun, yes, and I connect with that person one-on-one, find out what they like, what else do they like, then I bring that in with them. Dr. Bob: We've shared a couple of patients that had had some pretty remarkable experiences, people who were not expected to live more than a month or two who through combined efforts have gone on to live for a couple years, people who were not walking who are now walking half a mile to a mile without difficulty. Can you share maybe a little bit about what that's like for you to be part of that? Cathy Spatuzzi: It's a gift. I love all my clients, but to work one-on-one and to see a person that was maybe almost on their deathbed to come back and is living and they want to have a life. One of my sayings is motion lotion. If you don't move your body, you're going to get stiff, and you're not going to feel like moving so let's just keep moving. Some of my other seniors that are more fit, that's what they say, you have to keep moving, you have to keep moving, you have to keep moving. So I keep them moving. Dr. Bob: You keep on moving, and you keep it fun. Cathy Spatuzzi: Yeah. Well, you have to have fun in life, so why not bring it to your work? Dr. Bob: Yup, I agree 100%. So this is A Life and Death Conversation, and part of what we're trying to do is give people just a look into how we can have an easier time talking about topics that can be difficult: death, illness, debility. So as an example, we are doing that there. We're talking about things that might not come up in normal conversation. I, as you know, go right to the point. I don't mince words. I don't hold back a whole lot. I just want to ask you and get some of your personal perspectives on some of these things, if that's okay. Cathy Spatuzzi: Sure. Dr. Bob: All right. Tell me, do you have … and this is a question I ask all my guests. Are you afraid of dying? Cathy Spatuzzi: No, I'm not afraid of dying. Dr. Bob: You're not afraid of dying. Cathy Spatuzzi: No. Dr. Bob: Well, why? Can you share why you're not afraid of dying? Cathy Spatuzzi: My maternal grandmother always talked to me about death. Dr. Bob: Really? Cathy Spatuzzi: It wasn't morbid. It wasn't like, "Oh, I …" I don't know, she just always talked about it. It wasn't something under the covers. Dr. Bob: Just kept in awareness of it in the home? Cathy Spatuzzi: Yeah, like when somebody died, we'd talk about it, or when- Dr. Bob: Okay, how healthy. Cathy Spatuzzi: Yes, uh-huh (affirmative), and so I think I've just adopted her attitude and calmness about it. For me, thinking about dying, I think about living. So I'm alive. I can walk and talk, and do all these beautiful things, but let's be present doing it. If you're just walking through life in a fog, then you're not living, but when you think about you're going to die, maybe that's a point where you're going to wake up and start being present in your life. Dr. Bob: Do you feel like thinking about dying, talking about dying is responsible for you having a greater awareness of and maybe gratitude for life? Cathy Spatuzzi: Yes. I think I have gratitude every night before I go to bed. Dr. Bob: I guess, not being dead is a part of that, right? Cathy Spatuzzi: Right. Driving around and you see the beautiful clouds. You might see an airplane. Let's take each moment for today because maybe you will die tomorrow. Let's be grateful for what we have today, not think about what if, what if, what if it's going to happen. I pray that I have a beautiful day and then I have a beautiful meal and then I go to sleep and die. Not tomorrow. Dr. Bob: Not tonight, yeah. Cathy Spatuzzi: Not tomorrow. I got- Dr. Bob: Because I know you have some things to do this weekend. I know you have some plans. Cathy Spatuzzi: I know, yeah. I have plenty more years ahead of me, but that's what I've always thought about, nice and peaceful. Dr. Bob: Beautiful. Interesting. We both are spending time now with people who believe that they may not have a lot of time left, some of them because they're elderly and some of them because they have a terminal illness, and in some of those conversations, I hear people talking about how their time is so limited. Occasionally, they get into this pattern of feeling bad about it, and I wouldn't say necessarily feeling sorry for themselves, but focusing on how their life is going to be shortened and they're aware of that. I always accept that. I never try to convince them to think differently. That's their thought, and I would never judge that, but what I'm aware of is that there's no guarantee for any of us. I may have a patient who has a prognosis, a life expectancy of three or four weeks. There's a lot of people who are going to die unexpectedly before that person dies. We may be one of them. We have no guarantees, and so focusing on what we have today like you're talking about like you're suggesting being grateful for the fact that we are alive and that most of what's going on in our life is good, may not be perfect. Jon Kabat-Zinn, the creator of