As well get underway. We're also joined by the applicant. Welcome Melissa. Thank you for being here. So if I'll wait for the keep the thumbs up from Meredith, and then I'll kick things off. All right, there it is. Thank you. Welcome everybody to the city of Montpelier Development Review Board. It is Tuesday, September 7. My name is Kate McCarthy and I chair the DRB. What I'd like to do by way of introduction of the other members is call people's names and just have them say hello. So, Rob. Oh, I'm a rocket one member of the DRB. Thanks. Michael. Good evening. Good evening, Michael. Abby. Hey, Abby here. Hello, Abby. Joe. Hello, this is Joe. Hi, Joe. And our newest member, Catherine. Hi everyone, Catherine Burgess. It's my first meeting today. Welcome Catherine. And is Jean here? Is that Jean? Hello, Jean. Hi, which way am I looking? That camera is to say hi to people. But if you look, oh that camera. Okay. It's good to see you from all angles, Jean. Yeah, good to be here. Thanks. And Kevin. Great. So if I'm counting correctly, we have eight members here, including myself. So what we will want to do, I think right now is determine which member will be observing and not voting and I think the kind of default thing to do would be Jean, if you would participate. You're welcome to participate, but perhaps not vote since you're an alternate. If that would suit you. I really, really appreciate your being here. Okay, great. Thank you. Thank you. Thank you for your kind of introductions. I will say, um, very glad to have a new member here and we'll have it take a little time at the end of the meeting to just do a round, the around Robin for folks to say a little bit more about themselves, but that so we can do that later. But that's longer than I usually take.  Catherine. Could you just wait so I could see. Oh. Oh, thanks very much. Thank you for asking for that. Great. Meeting has been called to order so before we go any further, I'm going to turn things over to Meredith to review the remote meeting procedures and process. Okay, so we don't have any members of the public other than our applicant on, but Melissa has not participated in a hearing this way and neither has Catherine. So I'm going to probably go through the whole spiel, especially because we have everybody pretty much on remote except for two members and myself. So I'm going to share my screen. And go into my slide show and the slide show is really more for people watching via orca who might want to participate. So for those viewing this meeting via orca media, if you want to participate, once you once the meeting gets started and you hear something interesting that you want to comment on, you can do so by using this link here. And that will take you right into the zoom meeting platform and let you participate and watch anything that we do on share screen, all of those opportunities. You can also call in this phone number and using this meeting ID, and then you'll at least be able to hear and speak as to what's going on. If anybody is trying to log in and is having problems, please email me I'll be monitoring my email throughout the meeting. So for those attending via zoom and doing this for the first time, turning your video on is optional. And actually, if you're having problems with bandwidth, the first thing I suggest is to turn your video off. And that can often help keep that the meeting run more smoothly other another option is to turn off other applications that you may have open. I can always share meeting materials on my screen so that you don't even have to have Adobe or anything open on yours if that's causing issues. So for those attending, please keep your microphone on mute when you're not speaking this will reduce background noise. We don't have anybody on via phone today but if anybody logs on via phone. So using star six will mute and unmute you the zoom chat function that should only be used for troubleshooting or logistics questions. If you have a question or comment about an actual item on the agenda, please raise your hand, either physically if you've got your video on or by using the raise hand button on your zoom toolbar.  Once the chair is recognized someone to participate, please make sure to provide your full name and address for the record we don't really need to do that for anybody on right now. Because we know who everybody is right now but this is if somebody else logs in as a public participant. All right, in the event the public is unable to access this meeting, it will need to be continued to a time and place certain that's one reason I'm monitoring my email. I'll now hand this back over to the chair. Very good. Thank you Meredith. The next item on the agenda is the approval of the agenda. Is there a motion to approve the agenda as printed. Oh, second. Motion by Kevin. Second. Second. Because we're still in this hybrid format I am going to do the motion. All right, so we have a motion and a second. Kevin. Oh, yes. I'm just gonna say you're, I don't know about anybody else here you're, you're just it's stuttering a bit. So I don't know if you want to try and turn off your video or something else. I'll turn off my video. Let's try that for a bit. Thanks for letting me know I can also switch to phone if that's. This sounds good. I can't regarding call the roll. Kevin. Yes. Okay, thank you. Rob. Yes. Michael. Wasn't at the July meeting. We're just approving the agenda now. Oh the agenda. Okay, I approve that then. Excellent. Easy. Abby. Yes. Catherine. Yes. Joe. Yes. And I vote yes. We've approved the agenda. And that was a good test to see how the sound is working. Can you. For me. All right. Okay. Thanks. Great. So the next item on the agenda is comments for the chair. And as I did last time, I want to thank you all just in advance for, I want to thank all of you for joining me. I appreciate it. I appreciate it. It's a great experience. I really appreciate that we have the ability to continue this thing with in-person and remote options. I thank all of you who are there, especially our technical folks, Meredith. And Rob from Orca. Keeping it all streaming. And people should continue to use option that makes sense for them. And we'll continue to all do our best together. So thank you for that. And thank you so much for joining me. And I'm happy to be here today as a new member. Really grateful that she has stepped forward to serve and work with all of us. And we'll chat a little more at the end and get to know each other a little bit better as best as we can in this environment. So welcome. So move on to item six, which is the minutes. We're going to vote on the minutes of July 6th and of August 16th. We're going to vote on the minutes of July 6th. And we're going to vote on Rob, Abby and Jean, who are eligible to vote on the minutes. And we are all present. So let's, let's go ahead and do that. Is there a motion to approve the minutes of July 6th, 2021? So. Just had one suggestion. Motion by Jean. Hold on a second. I had a, I had a change. Let's get a, let's get a second and then discuss it. Yeah. I second it. Yeah. Okay. Is there any discussion? Yeah. I just want a quick change. It's worth noting in, see what is it? Page. Second page. The second paragraph. Maybe adding. Yeah. After the last sentence or added onto the last sentence that. Was not sworn in as a witness. So she attended his counsel, but I think it'd be good to clarify somewhere in advance that that did not happen. I just raised a point for discussion there. Rob. Legal representation is not. That's what I was looking for. Typically sworn in. You get a pass on that. Well, so what I could do is at the end here. Brook Dingledine was in attendance as counsel for Ms. O'Connor and the Copeland's comma and therefore was not sworn in as a witness. That's what I was looking for. Just for clarity. It's redundant, but. Yeah. No, I understand where you're going with that. It makes sense. Okay. Thank you, Rob. Thanks all for the discussion. Is that. Is. Is that acceptable to the person made the motion? Jean. Yes, absolutely. Yes. Great. All right. Let's go ahead and. Let's go ahead and vote on those minutes. And if there's no further discussion. Okay. I'll call the roll. Kevin. Yes. Yes. Yes. Sorry. Okay. How about Abby? Yes. And I vote. I vote yes. And Jean. Yes. Thank you. We've approved the minutes of July 6th. 2021. And then the meetings of August 16th, 2021. Are there any modifications or corrections to those minutes from those who were there? Make a motion. To approve the minutes of. August 16th. Seconded. Thank you. Motion by Rob. Second by Joe. Great. We'll call the roll. All those in favor of Rob. Yes. Yes. Michael. Yes. Joe. Yes. And I vote yes. Oh, sorry, Joe. Okay. I'm experiencing a bit of delay from my sound. So what I'm going to try and do is log off of the computer sound and call in on my telephone. So if you all wouldn't mind waiting for, for 30 seconds while I do that, I'll be right there. Sorry. All right, everybody. How's that? Sounds good so far. You're coming in. All right. Oh, good. So that's an improvement. Thank you. Thank you for your patience. Okay. So without, without further ado or suspense. Let's move on to our business this evening. We have an application for 11 Ridge street, which is a request for driveway improvements with reduced minimum distance from the adjacent driveway. So I'll, I'll welcome Melissa and let you and other board members know how we usually go about these reviews. So what we do is we swear in anybody who wishes to be heard on the issue, the person applying and anyone who wishes to speak. We get an overview of the project for Meredith. We'll hear from, from you, Melissa, anything that you'd like to add. And then we'll walk through the staff report with, or the board may ask questions after you give your initial initial presentation. With this, we're going to really focus on the driveway spacing question. And then we can go back and answer any forward questions about other criteria that we need to assure our match. All right. That's what we're going to do. I'm going to try my video again. It doesn't work. It doesn't work. All right. Great. So, Melissa, what I'd like to do first is swear you in as a witness. So if you would please raise your right hand. And then we'll administer the oath. Do you solemnly swear to tell the truth, the whole truth and nothing, but the truth under the pains and penalties of perjury. Is he nodding? You can unmute yourself. Sorry. Yes, I do. Thank you. I thought you would thank you. Very good. All right. Now we'll move on and receive an overview of the project from Meredith. Meredith, you are on. Thank you. Thank you. So normally a project that's the small where they're just widening the driveway.  But in this instance, we have an interesting situation where. It's a shared curb cut and was actually at one point, a shared driveway. There's, there's, you can see in the photographs that there's almost like a railroad line. So it's a shared driveway. It's a shared driveway when you get further back from the actual edge of the road. And so really it, it's been counted as a shared driveway under the V trans standards. Because for the Vermont transportation and therefore the department of public works standards to be separate driveways, there has to be at least four feet between them. And so we're going to be able to separate those driveways with a, a planted area in between. That at the road right of way is going to be over four feet wide. So under our, the other, the Vermont transportation and DPW standards, these are now two separate driveways. But these two separate driveways are closer together than I can improve administratively. So we're going to, we're going to go to the, to the board to look at the site specific conditions and decide whether or not you guys are willing to approve this separation distance. That's less than the minimum standard. You know, and that minimum standard doesn't mean it can't be approved. It just means that it needs to go through some extra hurdles. The board needs to look at it. And normally we get, you know, we're going to have to look at it. And as long as we've got this minimum spacing of. Over four feet. Department of public works is okay with this. But the board still has to go through the criteria. And make sure that they're happy with it. Under section 3010. That's what I've got. All right. Thanks, Meredith. I'm going to ask Melissa, if there's anything you'd like to add, please go right ahead. No, I think Meredith explained the whole thing really. I'm just looking to go from one parking space to two parking spaces. And in order to do that, I need to separate from my neighbor. Okay. And the width, the new width of the driveway is what will allow you to go to two spaces instead of one. Right. Okay. Thank you. Thank you. That's a great name. Right. Is it Melissa or Melissa? It's Melissa. Yeah. Okay. Thanks. Sorry. I should have asked that center. Okay. Well, great. Board members, are there any clarifying questions right off, right off the bat before we get into the criteria? Yes. From, from me, Kevin. Or go ahead, Kevin. The question I have. This would be for Melissa. Do you have plans to move the. This would appears to be the small garage or shed. At the end of the drive. No. So that'll stay exactly where it is. It's just the actual. Drive itself that is involved in this application. That's correct. Okay. Thank you. Thanks Kevin. Other other clarifying questions. Okay. Well, let's, let's do this. Let's go right to page six of the staff report. This is section 3010 access and circulation. And this section of our zoning bylaw is about promoting safe, safe movement onto a site within a site for people walking, biking or driving. And so one of the standards within that is that in this case, if we look at the, if we look at the district res three, there needs to be a minimum of 45 feet between residential driveways. And typically we, we look at that across the street. We look at it down the street. And in this case, we're looking at them side by side. So. Meredith, it says that. We are considering this. We're using our discretion as a board and our standard is considering the site and street conditions. Do we grant an exception based on site and street conditions? Do we need to consider or evaluate? That's really what you've got. That's the criteria that the board's authorized to do in, you know, with residential driveways, you know, if this were a commercial driveway, there's more standards, but here it's, it's a residential driveway. So it's really left to your discretion. And that's why we tend to get as much information we can, including from the department of public works as to what, what the criteria are and how they feel about the safety. Okay. All right. So maybe I'll kick it off with one question for Melissa and then others can ask questions to get information that they might need beyond within the application. So could you describe for us, Melissa, how these, I'm interested in the function of the driveways because part of the reason for the standard is a safety function. So you're going from. You're going from two driveways like this to two driveways like this and one of them is wider. Is that accurate? That's accurate. Okay. And can you say anything about whether or how this will have an impact on the way that cars come and go from the site? And if that. How, how, how will the driveways function differently or, or will they function the same with this change? I don't think there'll be much impact on the neighborhood unless I'm not thinking about something, but, um, I think it's going to have more impact, positive impact for us because right now my daughter has to park in the street, which it's a narrow. If anybody knows red street, I'm at the end of it. And it's very, very narrow. So, um, you know, it's hard for, you know, it's hard for bigger trucks to get by if there's a car in the street. And then the winter time when there's a parking van, it's almost impossible to park in the street because there's snow cover. And the, the distance between the, um, snow banks, a parked car only leaves a very small strip. So even the mail carrier can't get by. So, you know, the, the winter parking is really where it's going to benefit us right now. She can park out in the street, but, uh, in the winter, it wouldn't be safe. Okay. Thanks. Um, so it sounds like. This will improve. The flow of traffic. In the neighborhood by virtue of having the car off the street. Um, But what questions do folks have about this? Yes. I don't know who this is a question for, but I'm curious as to why the department of public works. Said that they would have, they're okay with it as long as there's a four foot. At least a four foot. Distance between the two. What's kind of magical about four feet? Um, that is a Vermont transportation standard that is in flows down into the department of public work street standards. Um, for, for the V trans, the state standard to have them be counted as two separate driveways. They have to be at least four feet apart. And then, building on that the maximum width allowed for a residential driveway under the V trans standard is 24 feet. So for, for the new, the moved driveway to be able to be 24 feet wide, it has to be at least four feet separated from the two driveways. Yeah. Okay. Thank you. You're welcome. The matter for you saying it can't be 24 feet wide unless it's also four feet apart. Just from a, on the ground, leaving aside the V trans standards is, is that four foot separation also necessary to align the new width where it needs to be? Or is the four foot purely a, a V trans and V, V sub. Any one standard. Uh, the, the, well. Um, so the four foot. The four foot separation. I don't, I don't have it. It's not purely V trans because DP for, for Melissa to get the construction and access permit she needs from department of public works to widen her driveway to 24 feet. It has to be moved at least four feet from the adjacent driveway. It has to be its own driveway. To be able to be a 24 foot width. Um, I don't, I don't, I feel like I'm talking in circles. I'm sorry. No, you're doing, you're doing all right. I'm thinking in circles. Um, so this is, this is because the town has adopted the V trans standards. So it's not V trans is if we're not indicating V trans. Sorry. Sorry. Sorry, Joe. Um, and, um, it's that the 24 foot wide driveway will only be approved. If it's also uphold the other standard as adopted by the town. Great. And those, those numbers are not in the zoning regulations at all, except that. Section 30, 10. Incorporates the DPW and the V trans standards. Like it has to meet those as part of 30, 10. Okay. I think where I'm going with this is perhaps more a policy question than an interpretation of our bylaws and you know, forgive me for that, but it seems like what we're doing by requiring that four foot strip is creating a little more work for the applicant and creating a much wider curb cuts than there would otherwise be. And usually we don't want wide curb cuts. Um, but here we are. That's true. Um, and, but it's, it's a. Um, it also will create a pervious area in between those two driveways for things like snow melt and other other runoff issues. Um, while also still allowing Melissa to have that increased parking area. That can be has room for, you know, snow storage and snow movement. You know, I can, I can only speculate, but, uh, the, the purpose of the four foot, uh, dimension is, is also, uh, to have a viable separate, a viable, uh, uh, planning area. I mean, less than four feet kind of, you kind of defeat the purpose. It's going to be tough to keep anything viable. Um, in a high saline environment. Uh, this, uh, the four feet just gives us a standard, which is already been worked out by. Uh, the trans and DPW. Okay. Yeah. So for future screening opportunities, if, if, if someone wants to do that. Um, thank you. And I should say my, my questions are like carry-on. The policy on the ground more than concern about the application itself. So, um, thank you for bearing with me. Um, what else would, um, are there other questions from DRB members that would help them consider, consider this request. So if you think of something pipe up, but in the meantime, I will say that, um, it is our job to determine whether or not to grant an exception to the minimum. Um, the staff recommendation is that we do grant that requested exemption, given that it complies with the standards we've discussed. It's substantially similar to what is there now. And meeting those standards is not possible on the site. Um, and as we just described, it's still going to be a continuous curb cut. There's still going to be a continuous curb cut. There's still going to be a continuous curb cut. Um, and as we just described, it's still going to be a continuous curb cut. There's just going to be a little more space between the parking spaces. So that, that's that recommendation. Um, does anyone want to, any concerns about that recommendation or questions about this section of the, of the zoning? Rob, I saw your unmuted. I want to make sure we get you if you have a question. Oh, no questions about that specifically. I just, is my understanding that there's no connection between the work on the retaining wall and the driveway. Um, and this, uh, curb cut and that those are completely separate projects. It's not, it's not a separately permitted project. It's part of this permit. It's just that it's been evaluated already. And I would have disapproved it administratively. So that's, it's in here in the dimensional. I folded that special standards into the, um, the, um, three zero zero two and three zero zero three analysis versus having a whole separate special use standards because it's a wall. So really the only thing that comes into play is the height. Um, And, and it meets those requirements and there's no changing of slopes. So we don't have to worry about that. And it's a very, very low wall. Um, so that will be approved here as well. So I guess, you know, our. The, the motion to grant approval at the end could probably be modified to about the 24 foot wide driveway and the. Max two foot retaining wall could be thrown in there, I guess, in the motion. That was maybe an oversight on my part. Is there more information that folks are interested in having about the wall in order to be assured that the. Dimensional standards. So anything you want to talk about? Okay. Um, what I'd like to just do then is open it up to board members. Are there, are there other sections here where we're going mostly with the general standards. Um, uses, dimensional standards, demolition riparian areas, wetlands, rental pool, steep floats, erosion control, storm water management. Are there, are there any, any questions or information that you'd like to have about any of these criteria? And you can just start speaking if you have something to say, because my video is still luggage. I would say Kate that I'm satisfied with the information as presented. Okay. Thank you, Kevin. Um, with that comment and hearing no other questions, um, is there a motion to approve the request for a driveway with less than minimum spacing and. The retaining wall. Is there a motion? I'll make the, I'll make the motion. Thank you. Um, is there a second? Second. Second from Joe motion from Kevin second from Joe. Is there any further discussion? Right. I will call the roll. Kevin. Yes. Rob. Yes. Michael. Yes. Abby. Yes. Yes. Joe. Yes. And I vote yes as well. The motion passes unanimously. Um, thank you all for your questions and discussion. Um, at this point, um, the Meredith will issue a written decision within 45 days. Um, after which there is an appeal period for 30 days. If you have questions about what that means for making decisions about your project, I recommend chatting with Meredith. Um, after the meeting. Um, but that concludes our review of the, of the application. Really appreciate your participation, Melissa. And good luck with your project. All right. Thanks. Everybody. I appreciate it. You're welcome. Good night. All right. Oh, great. Everybody. Thank you. We have a light agenda today. So, um, what I'd like to do now is move on to item eight other business. The first item there is that our next meeting is September 20th. Um, 2021. Um, another piece of other business that I think you're aware of, but I should say publicly is that this is my near to last meeting. Um, as chair and on the DRB that's hard to say out loud. Um, but that's, that's what we're doing for now. And I appreciate you all being so supportive of, of that decision. I really like the sport. And know that it will carry on just fine. Um, so what I'd like to do is just take, you know, 10 or 12 minutes if you all wouldn't mind. Um, really happy to welcome Catherine and just thought it would be really nice if, if we could take this time to each take a minute or so say hello. Say who we are. Um, you can say one or two things about yourself. Um, those can be personal or professional or your favorite ice cream, whatever you like, whatever you want to share. Um, and if you. If you really feel like making it, turning into a fun ice breaker, you can say what you love about the DRB or something that you've enjoyed learning or find interesting about this, or you can completely skip that question because some people hate ice breakers and that's okay. Okay. Could I just ask just sort of a general foundational question with regards to this discussion. Sure. Should we be, should we be an open session or in deliberative session? I throw that out for the board's consideration. I hadn't thought about it one way or another. Um, Meredith, do you want to advise on that? I mean, if all we're doing is introducing ourselves, I think that can be open. That's open meeting. That's fine. Um, you know, that's, that's the public, if there's any public actually watching this on Orca, who knows, am I entertaining them as well? Yeah. Yeah. I mean, it's just a matter of what, what level of detail we get into. I mean, discussing, uh, chair, uh, succession and that kind of thing. That should definitely be done. Right. Well, or kind of have a chance to get up early. Right. Um, we, um, we won't be discussing, discussing any, um, board personnel. This is, this is just a very casual chance to do introductions. And I, I'm totally supportive of the direction we're going in. Okay. Great. And people, um, I, I won't be labored any further. We'll just get started. Um, I'd be glad to go first and then I'll hand it over to Catherine. Um, and we'll go from there. Okay. So, um, you know, my name, my name is Kate McCarthy. I served on the board since about 2012 when I started as an alternate. Um, I later became a regular member and the vice chair and then chair. Um, I'm a land use planner by training and I've done that work in a variety of ways in Vermont, uh, related to environment and communities. Um, I live in a small house in town where I can walk around and that's one of the things I really enjoy about being in this place. Um, I've been very glad to serve on this board and get to meet a lot of people who are doing really interesting things with, with their property and in their neighborhoods. So something I really appreciate having a window into. That's me. Um, so Catherine, if you'd like. Great to meet everyone and looking forward, I hope to meeting folks in person at some point. I'm Catherine Burgess and this is, as you know, my first meeting with the DRB. I'm a land use planner by background, but I've worked in national policy for the past like 10, 15 years. So I'm really excited to serve on the DRB to both get to know Montpelier better. I just moved in the past year and to, you know, do service for the community and also to, um, you know, get to get nitty gritty with zoning here because right now in a national job, I'm often kind of at the 30,000 foot view. So I work for smart growth America remotely. They're DC based advocacy organization. And I previously worked in urban resilience, the urban land institute. So, you know, always looking at kind of national land policy trends. So something I hope I can bring to the board is knowledge of like best practices and trends in other regions nationally. And yeah, that's that's a little bit about me professionally and personally, you know, being new to Montpelier, I've just, yeah, love getting to know the community. And I've got two kids and live near the rec center. Yeah. Great. Thank you so much. All right. Next, I'm going to turn it over to Kevin. If that's all right with you. Oh, sure. So I'm Kevin O'Connell. And, um, I've been a member of the board for, for a few years.  As a way of kind of paying back the community, which I, which I thoroughly, thoroughly enjoy here. In, uh, in Montpelier. Um, I am recently retired from state service, uh, most recent, uh, position and I was a contracting grants manager for the health department. And I retired right before the sky fell with the COVID, which was really kind of interesting. I don't know if I was glad or not about that. I spent most of my time in state service, though, as a, as a budget and management analyst in the governor's office. And, uh, my, if I go back to quite a few more years, um, my graduate education as a landscape architecture and urban studies. And, uh, I sort of took a turn about 30 years ago, which led me away from that and more into administrative financial types of things. But yeah, I live here in Montpelier, lived here.  And, um, uh, have no plans to do, to move anywhere else. I have plans to do a lot of traveling, however, and sort of sums it up. Um, I mean, I'm really hoping that, uh, we can get clear of this, uh, this persistent virus, which is, which is playing havoc with our, uh, with our lives. So anyway, good to meet you. Thanks, Kevin. You're here. Um, Rob, would you mind going next? Oh, absolutely. Um, yeah, I'm a Rob Goodwin. I've lived in Montpelier for. Oh, five, four, five years now, I think. Um, I don't know the pandemic counts is like five years. So in 10 years, like, I don't know, like what the formula is, but, um, I, um, I'm a background in land surveying. The work is a, um, survey project manager at an engineering firm of offices, actually in Montpelier now, um, called VHP. Um, and most of our work, um, is supporting engineering and transportation, uh, projects and utility work around the state. Um, previously I worked for four or five years doing primarily residential survey works and also divisions and, um, you know, site plan type, uh, type work. And, um, I, uh, yeah, I grew up in the, at Rondack's in upstate New York. Um, and, uh, if you see someone really muddy up, like in a gravel roads, it's could be me, but also it could be a bunch of other great people in this town like do that too. So that's, that's really good for fun. Yeah. Well, thanks, Rob. Um, Michael, would you mind going next? Sure. Uh, my name is Michael. I worked for the town of Stowe Oak Creek department. Actually worked with, uh, one of Rob's colleagues today, Brita on a. No renovation projects I have going on in Stowe. Uh, moved back to Vermont. I think it was in 2018, like Rob said, I think it's been a while. I think it's been a while. Has slow down and sped up with the pandemic. And I think the DRB is, is fun because of, uh, All the quirky neighbors you get to meet and all the things that they like to argue about. So I think for me, it's, it's fun. I've been in a lot of Western towns. And it's a good opportunity being in the Northeast because you can actually be a part of, uh, small town government. Um, Abby, can I turn to you? So hi, Abby white. I'm Montpelier resident and I've lived here for. Uh, I don't. Maybe nine years. I can't really remember. I have to go back to like my children and how old they are. Um, I think eight years. And I have two kids in the schools. I have a, um, I have two kids in the school. Um, I'm a eighth grader and a fifth grader. And, um, For professionally, I'm the vice president for, um, strategic communication at the Vermont land trust. So my professional background has been in. Marketing communications. Um, previously I was with efficiency. And I worked in the energy sector. Um, and I've experienced as a coach in my career in marketing communications roles. Um, Gosh, when would I love about the DRP.  No, Every, every meeting is different. Every, every case that we review is different. and to be involved with the the city in a way that's kind of like pretty nitty gritty but very impactful you know quality of life here. Thanks Abby. Joe would you go next? Sure my name is Joe Kiernan. I've lived here in Montpelio with my wife for about eight years now. We moved up. I grew up in Massachusetts went to school in Pennsylvania and I followed her up here when she got a job up here. She actually now works for the same company Rob works for VHB. Previously it was the Johnson company but they got bought. I work as a civil engineer for VTrans and the roadway design group so I design roads all day. Previously I worked as a environmental consultant for a little while and also as a contractor doing utility installation and road work. A little bit about me it's hard to think about anything else right now. Today my wife is 39 weeks pregnant so things are happening quickly probably but not as quick as she would like. So it's a good chance by the next meeting the family will be three instead of two. Wow. Congratulations. Thanks. Keep us posted if you like. Great. Gene. Hi Catherine. It's nice to meet you and welcome to the DRB. I've been in Vermont over 20 years in Montpelio about everyone forgets about five six years. Yeah and this is right here the DRB's bible. I have a phone before you. I brought it. The best tool. I'm an independent contractor in town and I manage a few properties in town. I'm also an upcycled repurposed artist involved with central Vermont recycling and I'm a local business owner. So yeah this is being involved with the DRB is a great opportunity to meet many in our community and assist and learn and be a part of the applicants challenges and agendas. So welcome. Thank you Gene and last but certainly not least Meredith. Thanks Kate. Hi Catherine. So I will try to keep this relatively short. I grew up in the area. I lived in Montpelio for a short stint when I was in high school and then again after undergrad and then my most recent real background is that I went to Vermont law school actually got my JD there and I'm after studies in environmental law thinking I would go into environmental law and then of course I was a baby lawyer competing with all the experienced lawyers moving up from out of state and so I ended up actually doing corporate law for about six years mostly corporate and after I had kids I needed to change pace and so after taking same time off and reassessing I lucked into this awesome zoning administrator job and now I get to work one-on-one with people or small businesses as well as the larger developers and help people understand the regulations, help you all understand the regulations as well as work out kinks in them to then go back and try and fix the regulations if there's stuff that doesn't work and I get to learn new things every day it's great I get to learn things from all the DRB members as well as applicants and you know my team down at the planning department and so it's you know there are days that get a little repetitive but then you learn something new just about every day there's just like Abby was saying you really never know what application is going to come in the door you know am I am I going to be helping someone's dad figure out how to put a porch on their house or am I going to be helping a developer figure out how to put in a new 80 unit you know apartment complex um or are we going to try and figure out how someone can put steps in down to the river um and not violate our repairing buffer so it's it's pretty cool it's pretty fun and I really enjoy the the back and forth that goes on here at the board and as Kate likes to say you know we really try and make it a conversation a lot of the time with a lot of these applications and I think that's great it's been a really fun board to work with the last three years I just want to do a shout out for for Meredith here we've had we've had some really good zoning administrators but no none of them have been as good as Meredith she's the most knowledgeable and happy to help uh administrator that I've ever experienced and really appreciate that thank you Kevin that means a lot considering how long you've been on the board thank you very nice well thank you all for taking the time to do that particularly since we have not we have not convened in person as this board because as we all know why so I appreciate taking just 15 minutes at the end of the meeting to reconnect a little bit Catherine really happy to have have you on the board and use that as an excuse for us to just have a little bit thank you um thank you all for doing that so um if there's no other business I'll take a motion to adjourn motion to adjourn by Jean second I think that was second by Rob and Kevin okay I'll call the rules that's what we do um Kevin yes Rob yes Michael yes Abby yes Catherine yes so yes and I vote yes all right everybody the meeting is adjourned thank you all very much for your time and uh have a good couple weeks uh till we see you on the 20th yes


Boom, what's up everyone? Welcome to simulation. I'm your host on socket and very excited to be talking about humanizing health care We have an epic guest joining us today. We have dr. Jessica Zitter. Hello. Hello. Thank you for coming on to the show I really appreciate it and I'm super excited you initially met Ron at the JCC doing an event there And then Ron taught me about you and I got really excited about you and then I looked into your work And I got even more excited because this is something that we haven't talked about and that society is not really talking about Maybe more ancient cultures have had a better rooting and feeling for how to deal with death in a very humane way And how but now the health care infrastructure has gone very complex and there's so much to talk about here Jessica Zitter is a ICU and palliative care physician in Oakland at Highland Hospital Last ten years now. She's also the author of extreme measures finding a better path for the end of life She is also has the feature in extremis, which is this is extremis extremis extremis is better to pronounce extremis Which is a 26 minute 24 24 minute short documentary about kind of what you're right about in extreme measures and Yeah, and so this is this is really important pressing stuff that I guess is not being talked about so And that's really important to talk about so why don't we let's start with talking about who you are before we get to the To the these pressing themes of the book. So how did you even get your footing in desire for? Being a physician and being in health care because you did some Stanford and some Harvard some UCSF some Berkeley And that's a lot of awesome schools to go through to get to where you're at Well, but the time I got to that Round of going to those schools. I had already sort of decided I was going to be a doctor I decided I was going to be a doctor when I was kind of a baby. I came I was born into a family. It was a family business really My family was a bunch of immigrants and very quickly once reaching Canada, which is where I was I'm from Montreal The both sides of my family, you know immediately started producing doctors This was like something that was very much a part of our family culture. Maybe a part of our religious culture It was sort of this very venerated Profession and I had all these role models of mostly men Who were very intense? surgeons and running, you know er's and and different kinds of very interventionalist types of doctors who had kind of grown up in this time of Specialization within the health care system, which really started in the 60s. You know, that's when we started specializing medicine. And so I decided that the way that I could be Useful in the world was to follow in their path and to learn how to use A variety of different technologies and machines to really keep people alive and to take care of them that way So I went in to this very intensive training Sequence uh at these schools and kind of in these programs and I came out the other end as a pulmonary and critical care doctor And that's how I ended up in medicine Your family that was so funny. You were describing your family like they're like pumping out like Doctors like that's so interesting that when you have really strong like a family that's Has a really strong like kind of like values and mission that they know what they are doing in the world But then the kids kind of are more easily able to I guess find something that they want to do versus Parenting that is a little bit more kind of like Well, whatever so true It was so much easier for me than a lot of my friends because I just sort of Came out into this path and I I uh actually remember You know after college few years after college just watching some of my friends who'd been in the liberal arts and who were kind of like Trying to figure there and I was just like I got my beeper on my pocket and I'm going and it was it was kind of an easy I I mean, I don't say that proudly. It was kind of an easy Straight ahead and it's brought you lots of meaning in life. And that's really important Well, you know, I think it Brought me meaning Mostly once I started to make it mine. Um, I I initially Went into this With an idea of what I was supposed to do and the health care medical training experience Was very happy to tell me. Um, I thought I was supposed to be this sort of high intensity physician and There's many quick and there's paths to doing that that are very easily taught Protocols and you know learning how to do different kinds of technologies and treatments and catheters and all that stuff So I just got sucked into that whole training path The meaning came once I started to Step back and say, okay, now I'm doing this and how do I want to make this something that feels Better to me because I was starting to experience some moral distress in the way that I was practicing medicine Yes, protocolized approach Yes So you you just laid it out right there So there's this protocolized approach and we've heard we've had doctors talking to us before about Going off protocol and being able to do things in a way that actually helps with either The morals of the patient or the it said there's so many different ways to talk about this But you specifically I see you you actually actually what the statistic in the book is quite I think quite high is it was it 40 percent of deaths Occur in the ICU at the peak in like the 80s and 90s Yeah, the and that number's gone down. I think the most recent data shows that 30 percent of people Die either in an ICU or having recently been discharged from an ICU. Okay. Okay 30 So that's a lot. That's almost a third of people are dying in like in ic in ic user right afterward and that's like Whoa, so what that's and what you've been dealing with in that case And I want you to explain what palliative care is but just that there is a lot of people that are Without their family without people that, you know, love them right there when they're in the icu that they're having some sort of Stress about what do I need to do with the medical system? What options are there? Right? Yes, start telling you so, you know what you're telling me the fact is look I am in no way throwing technology under the bus. I am not throwing icus under the bus. I have And then many of my colleagues we have saved many a life using these technologies and sent people back home to their families And there is nothing sweeter than that. That is one of the beautiful things about the our modern healthcare system The problem is that that There's there's several reasons why We're not only taking people who can benefit from it, but we're sweeping everybody into it And when when you take people who are not really Going to have that kind of benefit of a recovery and going home and you take everybody even, you know The frail the elderly the terminally ill the dying and you still do that same treatment to them I call that the end of life conveyor belt because what it is is this this like churning Protocolized literally conveyor belt that just takes everybody indiscriminately and does the same things to them the same Support of organs as they start to fail As you would with somebody who really could potentially Then recover but you're doing this to people who won't recover and we do it That's what caused me this distress was I realized Subconsciously it wasn't even like I had words in the beginning that we were taking so many people who I knew Weren't going to benefit from this type of treatment and doing these things to them Which really as you alluded to Can cause tremendous suffering because what it means to be attached to machines is several things number one You've got machines going into your mouth.  You may be in pain. We don't necessarily know if you're in pain. So there's a sort of haze of Possibly depends again on who you are and what's going on but of pain and slight mild delirium which is very confusing and and distressing and most importantly as you said The family the whole Structure from which you came is not there. You're in this very foreign Sterile place your family's kind of even if they are in the room They're kind of back.  So it's a very isolating experience And that is I think part of the reason that so many people are dying badly in this country Wow, yeah, and there's this whole idea of a good death and we'll we'll get to that I want I want you started He's really started talking about all of the variables that are going into the equation of like an oven of an of a human experience inside of an ICU in this in this case with family twos The delirium that's coming in potentially sedated this there's so much that that is there and then Look, there's this whole like end of life conveyor belt Okay, tell us about palliative care because yeah, this was quite interesting for me to learn about for me cloaking This is cool. Okay. Well, so I'll give you a little background You know, um, and I talk about this a lot in my book because it feels like you know that movie Um Was it zealot well forest gump and zealot where there's this person who like finds themselves in places That were kind of like turning points in a movement and and that's what I kind of when I was writing my book felt happened to me in 1996 a big study came out and I by the way had just Finished my pulmonary fellowship. The study came out was called the support trial and it looked at How people die in america And it was a shock To the people who are conducting this study. It was a huge study five centers in america and the reason I say it was a zealot moment for me was because The study had been conducted during medical my medical school years And one of the centers that conducted it was case western where I went to medical school And in fact, one of the the head person of that site was uh, dr. Albert Alfred conners who was my icu Attending mentor the person who taught me about icu and I was in medical school So he was conducting this study to understand how are people dying in america with other five other centers in the united states The study wasn't published until several years later in 1996 when I was already finishing up my fellowship in pulmonary and critical care But what the study showed Was an alarming State of how people are dying in america huge percentage of people again dying on machines Who probably wouldn't were not ever going to be helped by those machines a huge percentage of people Whose preferences if they had had them Were not known by their physician the sort of clear lack of communication between physician That was very alarming a lot of pain, etc. The second phase of that trial that's crucial those dying preferences are crucial Crucial I think that I can't remember the statistics right now, but I think 31 uh I'm not going to even talk about them because I'll mess it up, but Very few people who had preferences had this had been information that their physicians knew so, um They did a second part to the trial the first part was observational What's going on? What's the state and as I said the state was not good The second part was okay Let's figure out an intervention where we can come to the physicians We can provide enhance the communication We'll provide information from the patient and family to the physician from the physician back to the patient and family will enhance communication, etc No change no improvement very very disturbing And even though this wasn't the etiology or the reason that the palliative care movement started to rise I'm sure it was a big factor because people started to say wow People are really dying badly in america so the palliative care movement um Started I'd say I mean people will disagree with me But it was the early 2000s that they really started putting money into studying this robert wood johnson foundation Started giving grants to sort of study This new approach, which is palliative care and actually before we go into that. Let me tell you what palliative care is To pal palliative care comes from the word paliare In latin paliare means to cloak And you can sort of imagine this person this sick person this patient there's somebody coming and cloaking them sort of Caring for them that attending to everything that might be frightening them scaring them causing distress Yeah, and so the palliative care approach, which kind of came from the hospice movement, which had been started by in the in in the 80s by dame cecily saunders in england This sort of modern hospice approach to bring this multi disciplinary approach To caring for patients from us thinking about the social variables Thinking about all of the things that a nurse might think about thinking about the things that a chaplain Spiritual suffering, which is something we don't even think about in the hospital. We don't even consider that we keep religion away That's not real medicine So we you know and of course physician the the management of the symptoms Binding with the infinite is actually so Crucial in the process of Of death. Well, let me just give you a quick statistic about that because I just did a talk about The faith issue. I I'm Jewish but and I you know, I'm sort of agnostic in the way many many of us are I don't feel comfortable praying at the bedside with my patients And there are a lot of my patients in a public hospital in oakland, california are our christian african american very communal prayers and so a lot of the praying that might go on in a hospital like mine is very communal and and and and loud and and and active and it's not something that I feel like I know how to do I certainly don't you know feel skilled in it. Um, and I also feel like well, that's not really mine to do and most importantly As a doctor and the way our culture works We sort of feel like that's supposed to be separate like if we get into anything that has that looks like faith It's sort of like it diminishes us is the way we are thinking we are supposed to keep science and faith separate And so I never Thought that I was needed even as I started practicing palliative care more and more when this you know When that was needed. Well, the chaplain has it and I'll go on to the next patient and What I'm learning science and faith. They're kind of merging together more into the future. It's interesting I think it really well because here's the data The data show that 91 of people consider themselves spiritual 74 of people affiliate with an actual faith group And I don't remember the number but a very large percent of people Want their physicians would want their physicians to talk with them and even to pray with them to but to acknowledge their faith And it's almost never happening and I know it ain't one happening with me And so what I've learned is when I Just stay present and I stay with my chaplain. Who's amazing in the room That means so much to my patients that enhances our relationship. This is part of the cloaking that's happening It's just this multi this inter we call trans Inter inter professional cloaking of a patient where we all work together on a team That's so different from what I experienced in the intensive care unit where it's very hierarchical the doctors up here No one's really, you know, the doctor's making all the decisions Whatever else is happening is sort of happening in an ancillary way. Yeah. Yeah, and it's it's not and I'll tell you Remind me to tell you a couple of examples of that I could give you an example after example But how it really hurts not only the patient, but it hurts all the healthcare practitioners And and and takes again the humanity sucks the humanity out of the experience of caring for people But anyway, that's what the palliative care movement was and it was sort of growing in the 80s the 90s And 96 the support trial and then early 2000s Robert late 90s different kinds of groups Um, especially the robert wood johnson foundation started giving money to try to enhance the types of Interventions that palliative care teams do in different environments So there was this grant called enhancing communication in the intensive care unit and it came out from the night It was a call for proposals in 2002 robert wood johnson foundation Four hospitals won that grant One of them My chance happened to be one that I had just started working at in newark, new jersey Two months before and I was a new icu attending newark, new jersey in this hospital And all of a sudden they had won this grant I don't even know about the grant yet, but all of a sudden these people start showing up in the icu Called the family support team because no one knew it No one knows what palliative care is the family support team I was like, well, who are these people and they're talking to my patients there They'd come up to me and say, hey, did I don't think that family understands their prognosis and I was like Who are these people? Yeah, that's fun. Wow. That's a great first comment to say It's like does the family even get what's going on? Well, they were and I but I was annoyed. I was like Who are they? This is my patient. That's funny. You know, I can handle this. I'm a good communicator I'm compassionate And then I had my epiphany moment So I'd been working there about I don't know eight months nine months and this nurse who ran the family support team pat murphy She says to me when I'm one day, I'm putting in this catheter into a dying patient and I know this patient's dying And she's standing in the doorway and I look up and I see her and I'm like down to my gloves And I'm about to put this thing this woman's moaning under the bed sheet And I'm putting this huge catheter in her neck Geez Pat stands at the doorway and she goes like this Call the police. They're torturing a patient in the icu The nurses were there the medical student was there everybody's around and What? Me torturing somebody I'm just trying to do my job Anyway, what an interesting perspective on when a patient is basically dying. They're at their last Moments. There's no there's not that faith that family that those things that the dying preferences are not there It's just like Jamming of more of the conveyor belt of medical devices and things to try and get nanoseconds more And not even asking her You know what you know what permission I got I got permission from her husband who by the way I had sent off to the waiting room So he was away from her for these two hours Which were two out of maybe another 16 hours that she would be on this earth Telling him we're gonna do this because it will do this and it will help in this way And he's like okay. Okay. Thank you. We're gonna help I you know, she died the next day I knew you know really I knew she was coming to the end didn't even tell him that there was a chance This wouldn't do anything there was a big chance it wouldn't do anything And didn't give him really the option because he's a good husband. He wants to help And if the doctor's suggesting this next Yeah, yeah, yeah thing what husband's gonna say no Wow So that was an epiphany and then so that is so interesting that you ended up being Right there when the grant was made crazy And then then you were right there with the palliative care kind of movement crazy forward Early stages because it didn't get become a subspecialty in medicine until 2008. So this was 2003 It was many years beforehand And uh, I feel so lucky. I mean I at first was really Like defensive and you know, wait a minute and and but that moment because I had been feeling this sort of distress building And when that happened it took me a few days I got angry at first and then and then I went up to pat I went I remember I walked into her office and I said, you know what? Teach me to your teacher. You're right. Teach me what to do. Yeah, and that's when I She said, okay, so my mentor people say to me who I want to give you high five. That's who are your biggest mentors a nurse And a chaplain. Yeah chaplain So the fact that you had the moment where you came to your own realization that it It's the humility. It was the humility. I love that. I think it's so so crucial that more of us Realize that hey somebody else that has a different perspective on the situation can actually help make these situations across the world better for us together That's beautiful. And when you can actually like anything like with any humility in life the humility of Learning that you weren't a great parent in this moment, which I learned a lot unfortunately and try to you know humility actually once you can just Let it be and say, okay, you know what? I didn't do a great job. I didn't do a great job there It's such a relief such a relief and it opens you up to something so much more powerful and I've had many many many many many many moments of humility And I think it's one of my biggest teachers.  I have to admit I still feel like I'm supposed to be the most important person in the room Yeah, as the doctor And I'm learning that I'm not the patient is and they're dying The first yeah But a lot of times the chaplain has so much more to offer Than I do and you know what I need to just sit there and witness I'm not used to that. I'm not used to that and I'm learning how important it is and And I feel really grateful for it, but it's so it's a it's a very different You know a different way from how I was trained and and anyway, I feel the world opening up a little bit Your learning experience is becoming our learning experience And it's so fascinating because we get to live through you through your experiences In the sense and and I'm I'm happy that you came to that moment of openness and now Yeah, I'm imagining like the way that the chaplain's interacting with the patient and the patient kind of like Almost drops into their their body in this in the spirit and the infant more than Potentially being like, okay, we're going to give you a couple more hours In this in this way. Um, yeah, wow, there's so much to talk about so okay So then over the last like 10 years has been kind of this developing out of the you know The humility getting more and more doctors to be Working with this more disciplines of of people that can help Actually tend to the patient's needs first the palliative care Whatever it is that the patient needs finding out what the patient needs Finding out where the most suffering is whether I'm the ICU attending or the palliative care attending It's always about the patient and eliciting from them What they need what they need to know what they want to know And how we can help them achieve what's most important to them Yeah, yeah, so then okay, so then through this this 10-year period So did Highland get also did you kind of bring palliative care to Highland? No, I mean how do that? Yeah, tell me about how that period worked before we get to extreme Sure, sure. Well palliative care has been growing now. You know, in fact, uh, there's a I mean the movement has it's fascinating actually Really It's it's it's it's captured in some ways. I think it's captured the imagination of many In in in the non-medical community saying Wow, I I didn't know death could be so bad because it's we're starting to talk about it more even in the lay press And people are starting to say whoa, wait a minute So this is that many grassroots movements are born from the non, you know from from the grassroots So we're hearing a lot of we're having a lot more kind of activity and movement in the out there in the non-medical community Saying wait a minute. I don't want to I don't want this to be my only option and then within the medical community There's so many people like me So many people who just needed a little something to wake them up To say yeah, I don't I don't want to be working like that as an automaton I do care about my patients and want to be connecting in a humanistic way The vast majority of people who go into medicine are really good people And people I work with are fantastic and giving you give them one little Alternate route alternate approach and they want it just like I did and when we're finding at highland Is that it's just been amazing just in the past even the past year We have watched our consult numbers rise rapidly and what's interesting There is that You know, you're seeing this called culture change within the Within the healthcare world for a while people are like, you know what that kind of stuff like I used to think If I just had more time I would do it. I'll get to it I'll get to that conversation with a patient all I am caring. I am compassionate, but I think what people are starting to realize is Number one, I don't have the time so I do need some support from the palliative care division. Number two I need some spiritual support. I need some social support. So let's pull in palliative care And also less from the practical perspective of I need these types of things that the palliative care Community group can do I think there's also just this this incredible sense of Wow, there is so much suffering at the end of life And I don't want to do this alone So what what we you know have to figure out in as a movement in palliative care is is How are we going to How are we going to Leverage our presence we can't have Enough palliative care doctors to attend to all of the suffering that's happening What we can do is we can teach Other doctors like I was taught by pat how to do some of this work themselves how to do some Illicitation of preferences and values from patients, which we never really learned how to do formally how to do some Matching of preferences and values with what we're going to do next in terms of medical decision making How to manage pain because pain is a very big problem people are dying in pain at very large numbers And I mean I didn't I wasn't really taught a huge amount about managing pain for me In the icu the whole goal was keep the blood pressure up And let me tell you some pain and sedation medications lower the blood pressure There were many times I'm embarrassed to tell you where I didn't even think about treating pain in a patient who was dying I thought about keeping their blood pressure up primarily That's not That's not okay And so we're we can spread that information out to other practitioners so that a lot of what they're coming to us for Right now that's causing us to just honestly not be able to keep up with the workload is stuff that we can have them Do what's called primary palliative care palliative care that's delivered by the primary team not by us That were more specialty palliative care interesting Now this seems as though it's been going on Actually in different capacities for like thousands of years And then it's just interesting that now the west kind of in some ways mess some things up. Yes, you put it perfectly Yes, that's exactly right Do you want to know the history of how we messed it up in the west? I would like to know that and I want to also tell you that I think that a lot of people would actually Probably prefer if they were only had like a day or whatnot left I would love to go and die in the middle of mere woods or on stints and beach or something like that like I would Like amongst people with family and whatnot, but me laying there amongst the trees animals and beach and water and not In a hospital, you know, most people agree with you And the problem is you know, we have those data that shows, you know 80 percent of people say they would want to die at home Oh, yeah, yeah, which is not happening I mean at this point the numbers the most recent numbers are 40 percent of people are dying at home But that's even an overestimate because of that 40 percent There's a huge number of what we're calling and a rising number of something that's called burdensome transitions Which means people are getting home But right before they die from the hospital So that 40 percent is an overestimate people are not dying the way they would like to die Now the fact that you would like to die in mere woods is great information That's a dying preference. It's dying preferences. You have to ask people have to no, I don't want to even the the medical world shouldn't be asking you You should be thinking this death consciousness. Yes, exactly. We are so we're pretending we're never going to die So we're gonna think about it like our own dying preferences. No with our own 10 like what we care What we want to do? Yeah, the buddhas say Deaths I'm gonna butcher this but death should always be on your shoulder We have a service that we use called we croak that sends us daily death quotes like five times a day Yeah, it's so good and that way what's what's the quote right now? What does it say? I see he's on his Yes, it's All right currently croak says Whatever you're meant to do do it now The conditions are always impossible There you go Well, the fact is I was just speaking with frank ostacevsky Who's you know the founder of zen hospice an amazing man a buddhist? We're gonna actually be in conversations soon in april. I'm really excited Maybe we should have him on sometime. He's terrific. That'd be great. Very smart guy And he said that you know having an awareness of death Is what lets you live your life better and I I agree with that. It's so true You know we probe agrees. Yeah, but you know Helps you live more. He also said and I totally agree with him that so much of this Movement that's really arisen in the past few years But this interest this grassroots interest in death and making death sort of an amazing experience Is Is complicated because You know It puts too much pressure on that moment You're focusing so much on that moment. So if that moment doesn't quite go the way you want it to That could be seen as a big failure The real focus should be on how is this you're living all those days leading up to that That moment you want to do everything you can to make it It consistent with your goals. It would be great if you could die in mere woods You know, you might not be able to die in mere wood and um You know as I said, um, I've seen many stories of people doing everything perfectly Bringing in hospice at the right time having this incredible supportive family in place having a great community, you know community Faith community that comes and checks on them and plays guitar and all that stuff And the fact is that that doesn't always guarantee a good death either So it cannot just be focused on how do you make that moment of death? So great It has to really be, you know, yes, you want to try to enhance that But like putting all the other stuff in place during your life. That's what it should be about Yeah, and that's where we find a lot of our meaning in life is by putting the right pieces together That we care about that leads us to the most meaning in our lives Okay, now that this this has been super solid. I want to see what we can get to with some of the Oh, I was gonna tell you tell us. I was going to tell you how we screwed it up. Let's tell us the screw up Okay, it's actually fascinating. Okay. Um, I do a talk that's called all that glitters and it's about Excuse me It's about the rise of the intensive care unit With all of its other associated What are they called? Um condiments around it. Oh the condom the condiments There's a multi-thousand dollar add-ons the add-ons, right the siloing of health care The hyper focusing that started to happen in the 1930s Do you remember the well, you're young but you know the heart lung machine the iron lung Did you ever see pictures of that? That sounds somewhat familiar the iron lung machine Saved, I don't know tens or hundreds of I think hundreds of thousands of people From dying from polio in the polio outbreak of the late 20s and early and 30s and 40s Oh, this thing is crazy. Yeah a negative pressure Ventilator also known as iron lung or polio Nearly obsolete mechanical respirator which enables a person to breathe on their own in a normal manner when a muscle control is lost Oh, what? So here's the thing. Oh in the night in the 1920 in 1928 there were two Got two guys. Excuse me I'm sorry about my cough. Okay two two guys from the Harvard School of Public Policy I believe it was or or some kind of school at Harvard and they decided To create a machine. They literally took two engines out of vacuum cleaners And they used them to reverse suck air out of a chamber and That earliest prototype kind of sat in the base at basement at Harvard And then when it came time in the sort of mid 30s late 30s for the polio epidemic to start to kick in They started to put people into these these chambers and the chambers basically would suck air out So it would inflate the lungs of a person rhythmically And tens and I think hundreds of thousands of patients who would have died from polio Which causes a weakening so you cannot you can't you know the muscle strength to breathe Survived my anti-fanny survived and went on to live normal lives And but how do you gain muscle strength though? How does that don't because polio is a virus? And so once the virus kind of got out of your body and you could regain It it was a bridge. Oh, it's a bridge. I see a bridge until the virus gets out of the body Okay, just a bridge kept them alive. You can they had these like so we thought we could iron lung out all of the And we did we had huge success with it. It was unbelievable Then Around world war two and korea during those wars was the first time that physicians learned how to manage shock And they could manage, you know massive hemorrhage and shock infectious shock on the battlefield They had these shacks like mash the movie mash, you know, this is the tea. Yes They would be right near the fighting and they would go and they would drag these people back into these things And they would resuscitate them. What so for the first time ever in warfare Young and healthy soldiers Were resuscitated who would have died and sent home. Yeah through the shock And so that's through is that mostly through the cardio through the well, it was it was using Hemodynamic management, which was again this sort of new This prison principles of physics and really of resuscitation So people are learning how to resuscitate bodies that would have died. This was new in the mid 1900s 1958 The first intensive care unit at johns hopkins was created And you know, you need room. These are these machines. By the way, the iron lung gave way to the modern Mechanical ventilator, which we use now to to inflate lungs. Now. It's not negative pressure. That's sucking open Sorry It's Positive pressure that's pushed into yeah So anyway You need room for these things you need electricity You need tubes that have vacuuming because we need to use a lot of vacuuming to suck away things You needed a space and so the intensive care unit was formed and that was 1958 in the next 10 years Every hospital in america had at least one intensive care unit Oh, thank you Every intensive care unit had at least one now we have now Almost created this ridiculous situation.  So not only do we have intensive care units We have the most intricate subspecialties That you can imagine. Yeah, hepatology You know various eye types of all of these doctors who are now going in and soup subspecializing. Yes When I was doing my residency at the Brigham We had 60 graduates at the end of my residency. How many of those do you think went into primary care out of 60 half Three three and Everyone else specialized now Things have changed since 1995 Many more people go into primary care, but that's pretty That's a pretty important thing to think about. These are these are this is my generation of doctors. Yeah Specialization earns more money and there's More opportunity There's many reasons. Thank you Ron There's many reasons why you could Look you could you could wonder why people subspecialized and here are a few of them People certainly make a ton more money geriatricians family practice doctors and primary care doctors And palliative care doctors make the least amount of money. Yeah. Yeah, okay It is About 260 dollars. I think you get from Medicare to do a biopsy skin biopsy, which takes about six minutes If you want to sit and have a conversation with somebody about end of life Practices and their preferences you get paid. I think it's 78 dollars for half an hour I mean, it's it's really discrepant. Oh, I see what yeah, it's where you get The things that we're valuing in our health care system financially and also in terms of prestige Are doing doing things to people. Yeah, we're we're in just in in a there's like I think it's half of all of the health care expenditures are going towards the orphan related diseases That are affecting such a very very small tiny amount of people versus the Again, if we value staying healthy And and and these These preferences the patient preference is putting the patient before the ego like you're writing about right now Okay, let's let's dive into we have been already touching on a lot of the things and extreme measures But I want you to give a kind of like a big picture overview Tell us about that. So the book is really it's it's it's kind of part memoir It's my transition story through this this this change this change in In in my goals You know, again, you know going from being really disease focused or or an organ focused physician to A whole human focused physician and it tells that story of that moment of epiphany and What you know It talks about a lot of the challenges that exist in our health care system that prevent so many of us from Going through that transition. Why is it so much easier to be An organ focused doctor Why is it so much easier to focus on a procedure than it is to focus on talking to somebody and it really kind of gives that whole story both hopefully for a physician audience to sort of For us all to come together and talk about some of these psychological things that are happening inside of us that keep us from Doing the things we want to do and also for for the lay community because this book was written for both To sort of explain what's going on to give perspective and hopefully to empower People to understand what the end of life conveyor belt is How at risk they are for being swept onto it because we all are And how important it is to empower yourself to start to think about the things that are important to you How you live and how you die and make sure that those things Stay front and center throughout your life And particularly in the health care system Yeah, I liked going on your journey and that you also explained it to us the journey of the of this through from the Early 1900s until now where things have kind of been going and And it it totally seems like we're integrating back to the principles of patient first and using The faith based and and other end of life caring about what their preference are preferences are You also were teaching us about how it's so important to have a sense A really deep sense of empathy with a patient and have a you know, if they are asking you to pray with them Maybe pray, you know pray with them. Yeah. Yeah, that kind of stuff. Um Acknowledge your discomfort acknowledge your fears But I think it's still important to to do that and to seek out Figuring out what they want from us that will be most helpful. Yes And then their decisions to go with certain and the certain The treatments that can sometimes be burdens actually decreases if you get if you build a relationship with them, right? and that's borne out Not only in my own experience But in the palliative care literature that when We do engage in communication and in a relationship and the communication and relationship have to be Established before you start Making decisions about do you want to be full code or not full code or do you want to do this surgery? You have to have a relationship a therapeutic trusting relationship with somebody Before you can really start knowing what the right decisions are and helping them make those decisions but What we know is that when we do engage in creating those kinds of relationships Um patients tend to choose lower levels Of intensity of treatment at the ends of life And they die less commonly in the intensive care unit. They tend to die more often in hospice. They tend to die in less pain It works it works. Yeah Relationships really work. Yeah. Yeah the eye to eye human connection asking them what they care about what their preferences are that that works Yeah Okay, I want to See what is going on with your future? Where are you going moving forward with things? What are you thinking? Well I'm a storyteller And a coffer and a kafa I really I am moved by story For my own personal growth The things that move me are the little moments like just the other day I was in a room in the pulmonary clinic. I was in pulmonary clinic and I was talking to a patient Is kind of dying and I wanted to start to talk to her about her end of life preferences and um We had the translator on the phone because she spoke Cantonese and um It was so it was just such a moment like of We're sitting here. It's very hard to use a translator on the phone to talk about these really profound things But these uncomfortable things and so And this translator I would say something and somehow What he would say would stretch out probably eight times longer than what I would say And and not only was I just like ah, but the family was like ah So it was this bizarre experience and then there was some kind of problem with his phone So every time he'd be talking it would he he'd be it sounded like he would be pressing a button for a sec So he goes beep I mean it was just a funny Moment a poignant moment of like an attempt to have a connection with my patient and just all of these things conspiring against it and um I just thought like okay. That's a moment. I have to write about But so for me writing stories and noticing these moments these little things. That's what that's what that's what fuels my growth and makes me think about ways that we can do things differently hopefully better one day And um, I just will keep telling stories. I'm going to be writing and writing and writing What I also believe is that that stories as I I think we found with the movie extremists Telling these stories and by the way that the two main stories in extremists the movie are also in my book He'll recognize them if you pay attention They go in my book in much deeper detail about those two main stories But um, I really believe in sort of the power of using story in both lay communities and in medical communities to try to get people to To examine themselves and try to grow And so I've been working with a variety of different Teaching teaching experiences that Pull in story and use prompt questions and really try to get people to reflect In their own sort of minds on some of these things that are really hard to talk about and try to open up an honest conversation We did it at ucsf for their department anesthesia And I think that this program could be used in a whole variety of medical training Environments and now we're starting to use it in in in lay communities, but I think using story to Change behavior is is really an area that I I would like to go and and creating new films that also themselves have A Story to them and a lesson to be learned through watching other people's experiences We have two films that are coming out and and and a few more that I would like to work on so Well film and then also writing and then this is all based on self-awareness or awareness increasing about this about this field About the subject Hopefully it'll help people to become more interested and aware instead of just providing them data Hearing a story and saying that's interesting that and being moved by that to start thinking differently about it. Yeah. Yeah That's huge work. Okay. May okay. We'd like to ask a couple questions on the way out of the show I'm interested to hear your thoughts about it What do you think we're alone in the cosmos? How could we possibly be I mean I don't the numbers just don't support that That we'd be alone, right? I mean When I really start to think about it. I go crazy, but I can't imagine that there isn't another form of intelligent Of intelligence out in the universe and when you want to talk about humility I mean I think it's kind of No, maybe this isn't fair, but I kind of think it's arrogant to think that we'd be the only intelligent life in the universe How could we possibly be? So I just I guess in some ways I do I would love to see proof of it, but What do you think? Are you not supposed to tell I'm not oh no, I just it's uh, it's very yeah, it's very complicated and interesting I'm very fascinated by what exists past the three dimensional perception systems that we have. Um Do you think we're in a simulation? Hmm Oh, that's interesting. You mean do you think we are a simulation by some higher power? I think it's possible I have no idea, but I do think it's possible Like an experiment What what what kind of nudges you in that direction of thought? Well, I mean As I said, I I think there must be more intelligent forms of life out in the universe. I just do think that um And given that um They must know about us I would think I wish I could I wish I knew for sure, but yeah I don't know if we're an actual experiment, but I wouldn't be surprised Kind of freaky to say that. Yeah. Yeah, it's fun. It's fun. And it's kind of I don't know if we're passing by the way If our simulation is working. Oh, oh, yeah. I'm afraid we may have failed in some areas here. Yeah Well, not We if it's an experiment They are failing. Oh, that's interesting. I just want to throw that out there, you know, if it's a simulation That's a good point. Okay. Yeah oh Interesting question the experiment side of things very interesting. I'm glad you brought that up. She's the first that Said that I think about an experiment. Yeah, I think so. Yeah, yeah, we we've We frequently enjoy that sort of a the zoo hypothesis is a hypothesis. That's Yeah, that that we are Not being discussed about until we evolve to the capacity at least some sort of an intelligent capacity To unlock communication with them like teleportation or something like that Yeah, we've seen that saturday night live skit with um, kate mckinnon where she's they're talking about how she You haven't you haven't seen oh my gosh. It's hilarious. There's this whole series of ones that they do where like three people got sucked up into a Some kind of machine from outer space. Sure. And it had this like this amazing experience the two of them They talk about how beautiful it was and she's talking about well, I don't know about you but and she's smoking a cigarette It's it's hilarious. You should watch it. What did she say? She's just talking about What are you saying these beings from a higher planet?  I mean irreverent and hilarious. You should watch you would get a kick out One of my favorite kate mckinnon series Very funny. Just the last question. What do you think is the most beautiful thing in the world? There's so many But if I had to reduce it to one It's the human ability to Connect with you know people to connect It's just this sense of like what happens when you Connect with other people whether they're friends or people on the street or your patients or your kids your husband And you sort of get this sort of connection of Like like minds and and not being alone in the universe Yeah Because really if you think about it, I mean that's very human Well, it's not just a human thing my my dog snuggles up with me, but I don't know. There's something just really profound about About Connecting with something else and not just being this sort of little robotic loan thing That would have to be it. Yeah, it's beautifully said Jessica, this has been such a pleasure. Thank you for coming on and teaching us about all this Oh, thanks for listening We're living through your Experiences and and that's been that's been very interesting to us and hopefully so many of you that are tuning in because Who would have thought that that people on the way? to death Are just not having the ideal good death preferences that they so want You need to be willing to talk about these things we do We can make it better. We can make it so much better. Yes. Oh my gosh Yes, there's a lot of low-hanging fruit out there. Yes Thank you, Jessica. Thank you so much for coming on the show. We greatly appreciate it. Thank you Thank you. Thank you. Thanks everyone for tuning in. We greatly appreciate you Give us your thoughts in the comments below many of us Maybe having this these scenarios happening to us in our lives with our families and our near friends So go and share with other people about dying preferences having good deaths, etc Also, thank you to Ron for producing and directing Give us your thoughts again everyone. We love you very much for tuning in. Thank you. Thank you And go and build the future manifest your destiny into the world check out extreme measures links in the bio Also, Jessica's website links in the bio or twitter links in the bio. Go check all that out everyone extremists Links in the bio as well. Okay, everyone much love. We'll see you soon build create Bye


Minister for Youth Development and Sports Honourable Kinsen Kazumi has expressed his commitment to strengthening the relationship between his ministry and to the National Youth Council NYC. The Youth Development and Sports Minister, who met with the executive of the NYC earlier this month, stated that he held youth development very close to his heart. He added that St. Lucia's youth needed to have a greater input in the development of their country. For me, it is very important that the youth gets to sit at the table, the youth gets the opportunity to share their perspective on how we develop this land, simply because the way we develop this land will ultimately affect their generation and the generations after. So I've always been one who's part of the youth movement in my community and so it's something that I treasure and I hold a lot of fond memories from. President of the National Youth Council, Anya Edwin, welcomed the opportunity to meet with the ministry officials. Tree-rehoping that whatever comes out of this meeting will be a very, very beneficial discussion that is going to redown to a lot of action and not just talk for the young people of St. Lucia. Meanwhile, Honourable Kazemi, commented on the importance of the youth being given the same concern and regard as shown to other stakeholders and prominent members of society. He urged the NYC to constantly speak out and to ensure that their voice and the voices of the youth of St. Lucia are always heard.  That is how I see youth development and I don't see youth development coming from the top down, which is why we are meeting here today. I think it has to come bottom up and it has to be symbiotic. It has to be at a level where there is always conversation and consultation and so if anybody heard my false contribution to the Parliament, I championed the call for from St. Cabinet ensuring that if you are going to be dealing with a scourge by COVID-19 that affects young people a lot and we are dealing with a dynamic where we have a variant that seems to be affecting persons within the age range of youth that we must have a young person at the seat of the table. Minister Kazemi plans to meet more regularly with the NYC to ensure that his ministry's goals for the organisation are achieved. Julia Tepita reporting for the Ministry of Youth Development and Sports.