‘Death is hot right now’: An advocate for palliative care scored big with ‘Extremis’

Dr. Shoshana Ungerleider, 36, is just three years into her career as a hospitalist at California Pacific Medical Center in San Francisco, but she is already drawing attention in the palliative care community. Two years ago, Ungerleider turned a family inheritance into a philanthropy aimed at improving palliative care, in which keeping a patient emotionally and physically comfortable takes precedence.

Among her first successes: The Ungerleider Fund (formally known as the Ungerleider Palliative Care Education Fund) backed the short documentary film “Extremis,” which was shortlisted for a 2017 Academy Award nomination, and which tells the story of patients in the ICU at life’s end.

STAT caught up with Ungerleider over coffee at a San Francisco cafe. This conversation has been condensed and lightly edited for clarity.

It feels like death is having a bit of a moment.

Oh yeah. Death is hot right now. That’s what everyone tells me. People outside of medicine hear that I’m interested in end-of-life issues, and they’ll say “Listen. Death is hot.” Fantastic!

Where is this coming from?

It’s a weird fascination, I think — especially for millennials. Friends and colleagues are fascinated by this topic. But it seems like such an important thing for us to be thinking about and planning for.

Might this be a death bubble of sorts, like a passing fascination? Or do you think this will have a meaningful run?

Other bubbles have been the result of market trends. Death isn’t changing. I hope this is just the beginning of a major social movement.

You’re a hospitalist, not a palliative care doctor. When did palliative care become such a focus for you?

It was probably midway through my first year of residency, where I was thrown into many months in the ICU. I was just blown away that I’d walk in at 5 a.m. to do pre-rounds, and I’d say, “Wow, Mr. Smith here is 90 years old and has stage 4 cancer and he’s on a ventilator.” I’d ask the

team, “Gosh, you’re telling me this morning’s vitals and all the labs and stuff, but what are we really doing here? What’s the bigger picture?” I’d often get blank stares. It was like, “We’re in ICU. Who cares about the big picture?” And I was like, “Well, actually, I disagree.”

There aren’t many younger physicians who operate a foundation. How exactly did that happen?

My father (the author and sports psychologist Steven Ungerleider) started the Foundation for Global Sports Development, which focuses on supporting underserved youth. So I was raised in a culture of giving back. I’m now in a position where I’m able to use personal funds to make an impact in an area that doesn’t have a lot of other resources dedicated to it. And often, I’ll do it in partnership with my father’s foundation.

Documentary films have notoriously small audiences, yet you bet big on ‘Extremis,’ and the results have been fantastic. How did that happen?

“Extremis” fell into my lap. I knew nothing about film. I still know nothing. [Filmmaker] Dan Krauss spent months at Highland Hospital in the ICU and had amazing footage and he sent me a five-minute rough cut. I’m not a super emotional person, but I’m watching this and I was just crying. I called him the next day and he said he was going to have to table the project, because he didn’t have the funds to finish. I was like, “No. This film has to happen.”

You also helped fund an initiative at your hospital’s residency program, to put more emphasis on palliative care. Why?

In most residency programs, palliative care is taught as a third-year rotation —like two weeks at the very end when people are out the door.

I felt like we needed to start this from day one, since these interns are on the front lines. So we have a mandatory rotation for all three years, getting at palliative care fundamentals through research, case-based learning, training around end-of-life conversations, goals-of-care conversations, how to break the news to a 45-year-old patient that she has stage 4 breast cancer. And so far it’s going great. This past year, for the first time in the history of our residency, two residents went on to palliative care fellowships. We’ve never had a single trainee go into palliative medicine, so we were thrilled.

So those were the big 2016 projects. What’s coming this year?

I’m creating a national symposium on design and innovation around end-of-life, to bring an interdisciplinary group of stakeholders to look at the topic. And I’m advising a startup around advance care planning. I just got married a few months ago, so I’m trying to take on too many projects. We spent our honeymoon working and we were like, “You know, we’re not really good at relaxing. Let’s just work.”

On your honeymoon?

But I love this work! Every conversation I have, whether it’s with my girlfriends or my dad, we always end up talking about this, so it brings me a lot of joy.