Rachael Bedard, MD - Reading and Watching: Finding your style by learning from others: A conversation with Lisa Sanders & Anna Reisman
February 08, 2024Information
2/1/2024
Program for Humanities in Medicine John P. McGovern Lecture
The Anlyan Center Auditorium
Reading and Watching: Finding your style by learning from others: A conversation with Lisa Sanders & Anna Reisman
Rachael Bedard, MD
Physician-writer, New York City Health and Hospitals
ID11283
To CiteDCA Citation Guide
- 00:00Study. I'm Anna Reisman,
- 00:01director of the Program for
- 00:03Humanities and Medicine.
- 00:04Welcome to the 2024 John P
- 00:06McGovern Award Lectureship,
- 00:08supported by the John P McGovern Fund
- 00:11for the Humanities and Medicine Doctor.
- 00:14McGovern was a Texas based medical
- 00:15humanist and an allergist,
- 00:17investor and philanthropist who established
- 00:19several lectures bearing his name
- 00:21at Med schools throughout the country.
- 00:23This award lectureship is given
- 00:25annually to a physician who
- 00:26demonstrates the true healing art,
- 00:29being a scientist and a humanist,
- 00:30and a knowledgeable,
- 00:31humane and caring physician,
- 00:33and this year's recipient is
- 00:36Doctor Rachel Bedard. Dr.
- 00:38Bedard is a writer and internist,
- 00:39geriatrician, and palliative care physician.
- 00:42From 2016 to 2022,
- 00:44she was a doctor with
- 00:46Correctional Health Services,
- 00:47the public agency that provides
- 00:49medical care in New York City jails.
- 00:51While there,
- 00:52she began the system's Geriatrics
- 00:54and Complex Care Service,
- 00:56an interdisciplinary team that
- 00:57oversaw care court advocacy,
- 00:59compassionate release efforts,
- 01:00and discharge planning for the oldest
- 01:02and sickest people in the jail system.
- 01:04In 2020, she helped coordinate efforts
- 01:06to decarcerate the jails during
- 01:08the worst months of the pandemic.
- 01:10Dr.
- 01:10Bidar left Rikers,
- 01:12Etcetera,
- 01:13in 2022 and is now in the second
- 01:15year of a six year term on the
- 01:17New York City Board of Correction.
- 01:19She currently sees patients
- 01:21at Woodhull Hospital,
- 01:22which is a public hospital in Brooklyn.
- 01:24She's also a writer whose essays,
- 01:27criticism, and journalism have
- 01:28appeared in The New Yorker,
- 01:29The New York Times,
- 01:30The New York Review of Books, and elsewhere.
- 01:32She's also co-authored academic
- 01:33work on the intersection between
- 01:35aging and incarceration.
- 01:40She completed her internal medicine
- 01:42residency and chief residency
- 01:43at the Cambridge Health Alliance
- 01:45Fellowship in Geriatric and
- 01:47Palliative Care at Mount Sinai.
- 01:48And she lives in Brooklyn.
- 01:51And I will turn it over to Doctor Bedard
- 01:53and then we will be in conversation.
- 01:56Lisa Sanders, myself and Doctor Bedard.
- 02:04Hi.
- 02:07Hi, everybody. This is my.
- 02:10I've talked a lot today.
- 02:12And so thank you for bearing
- 02:14with me and my voice in a minute
- 02:21for this talk,
- 02:23which is going to be quite brief.
- 02:26I wanted to talk about developing
- 02:29one's style by paying close
- 02:31attention to other people's styles.
- 02:33And I mean that both in my role.
- 02:36I I I think that is something that
- 02:37I have done both in my role as a
- 02:39doctor and in my role as a writer.
- 02:41So when you're training in medicine,
- 02:44the way you learn to doctor is
- 02:47by watching other people doctor.
- 02:49You go into the room with someone
- 02:51and with an attending when you're
- 02:53a medical student and you shadow
- 02:55them and when you shadow them,
- 02:57some attending sit at the side of
- 02:59the bed and hold the patient's hand,
- 03:01and some attending stand over the patient.
- 03:03And some attendings do a lot of
- 03:07explaining and some do a lot of
- 03:09listening and you hear people
- 03:11use turns of phrase especially
- 03:13if you recurrently round.
- 03:16But the same supervisors you hear
- 03:18people use turns of phrase over and
- 03:20over again And then you you think like
- 03:22I'm going to use that turn of phrase
- 03:24next time when I have to explain something.
- 03:25When I was a third year medical student,
- 03:28I heard someone explain the
- 03:31kidneys to a patient,
- 03:33as kidneys are the washing machine of the
- 03:36body and I've used it now for 20 years.
- 03:41I mean I've been saying it
- 03:42for 20 years to patients.
- 03:43Kidneys are kidneys are the
- 03:45washing machine of the body.
- 03:46And so when you go on dialysis,
- 03:47it means you need to use a
- 03:49different washing machine.
- 03:50And so
- 03:54I think you know,
- 03:56and becoming a doctor's slow,
- 03:57it takes a lot of years, right?
- 04:00And so over time you see a lot of
- 04:05different examples and mostly your my
- 04:10experience of it was that in training
- 04:13in medical school and an internship,
- 04:17I was mostly imitating people.
- 04:21When I was doing doctoring,
- 04:22I was I was doctoring in the way
- 04:24that I had seen other people
- 04:26doctor and I was trying it on.
- 04:29And then at some point towards the
- 04:33end of my second year of residency,
- 04:37I started doctoring as myself.
- 04:39And that was this sort of magical
- 04:41transformation where all of a sudden
- 04:43I had instincts about what I wanted
- 04:45to say and do in a room that we're
- 04:48not remembering what someone else had
- 04:50said and done in the room and how
- 04:52I should then try to imitate that.
- 04:53But I was trying to do it.
- 04:55I I had a natural instinct and my
- 04:59personal identity and my doctor
- 05:01identity felt like they had fused a
- 05:04little bit and I became myself as a doctor.
- 05:07And the same thing happens,
- 05:08I think, when you become a writer,
- 05:12which is that you read a lot,
- 05:15and in reading a lot you read a
- 05:17lot of different prose styles.
- 05:20And whatever I have read last
- 05:22influences the thing that I write next.
- 05:25So when I read Virginia Woolf early in 2023,
- 05:32for a while I was writing like really
- 05:34bad prose in the style of Virginia
- 05:36Woolf that really I wasn't pulling it off.
- 05:39But but I couldn't get the cadence
- 05:42out of my mind.
- 05:43And it's a not dissimilar process
- 05:45of of of sort of being influenced
- 05:48by other people's styles,
- 05:50taking elements of that style for yourself,
- 05:53integrating it and then discarding what
- 05:54doesn't work for you until you figure
- 05:56out sort of what your own voice is like.
- 06:00And as an example of that,
- 06:02I wanted to just read 2 excerpts,
- 06:03not by me, but by other people.
- 06:08These are two short excerpts from 2 essays,
- 06:12a sort of story in an essay,
- 06:16both that appeared in The New
- 06:17Yorker in different years.
- 06:18One is by Grace Paley,
- 06:20the Great American short story
- 06:22writer and essayist and activist,
- 06:24and one is by James Marcus,
- 06:26a great essayist and writer.
- 06:29Both James Marcus and Grace
- 06:31Paley's fathers were physicians,
- 06:33and they both wrote essays.
- 06:36Hers is sort of a story when their father
- 06:40about their father's aging and dying.
- 06:42And I want to just read them both to you,
- 06:45Not the whole things,
- 06:46but excerpts from both to give
- 06:48you a sense of how differently
- 06:51you can tell a story that actually
- 06:56in its outline is quite similar.
- 06:59So I'm going to start by reading James
- 07:01Marcus's, which I have queued up here.
- 07:04OK, this is from a piece called Family
- 07:06Medicine that was published in 2019.
- 07:13We like the heart to behave.
- 07:15No skipped beats, no atrial flutter,
- 07:18just the regular precious plotting cadence.
- 07:21For this we will sacrifice much.
- 07:24The medicine my father began taking
- 07:26for his irregular heartbeat in
- 07:282014 could have turned his skin
- 07:30Gray or caused him to grow breasts,
- 07:32or collected in tiny granular
- 07:34deposits behind his eyes so that
- 07:36everything he looked at would have
- 07:38have would have had a blue Halo.
- 07:40None of this happened to him.
- 07:41Instead, he was cold all the time.
- 07:45Inside my parents house,
- 07:46a century old structure north of New
- 07:49York City whose thin walls testify
- 07:51to the golden age of cheap petroleum,
- 07:53he took to wearing a heavy tweed overcoat.
- 07:57He wore it in.
- 07:58He wore it when he watched
- 07:59television or napped on the sofa,
- 08:02or read through old copies of the Times,
- 08:04which he kept in the basement.
- 08:06He wore it at meals, also,
- 08:08donning gloves and a hat.
- 08:10He peeled off the overcoat overcoat
- 08:12only when he went to sleep under
- 08:14several blankets and a stout covering.
- 08:16My parents called Milty the Quilty.
- 08:20Of course they could have turned up the heat,
- 08:23but old habits of thrift got in the way,
- 08:25as did the psychological complexities
- 08:27of a long marriage.
- 08:28My mother had wanted to move decades ago.
- 08:31My father had run out the clock in his
- 08:33typically charming and infuriating manner,
- 08:35and now remaining in the chilly
- 08:37house was punishment for him,
- 08:39not for her.
- 08:41Finally, in February of 2015,
- 08:44they resolved to move to a two-bedroom
- 08:46apartment in a nearby town.
- 08:48By then, however, it wasn't just
- 08:50the cold that tormented my father.
- 08:52At 89, he was a bundle of maladies.
- 08:55The curvature of his spine made him stoop,
- 08:58His legs were weak and he got around
- 09:00with the aid of A2 wheeled Walker,
- 09:02which he hated.
- 09:03For more than a year.
- 09:05He had pinned his hopes on a chimerical
- 09:07operation that would relieve the
- 09:09pressure on his sciatic nerve and
- 09:11allow him to walk comfortably again.
- 09:13A fast talking young surgeon in New Haven.
- 09:15Maybe one of you in this room
- 09:17gave him the bad news.
- 09:19The procedure couldn't be done.
- 09:20He was too likely to die on the table.
- 09:23I'm going to be a cripple forever,
- 09:24my father told me.
- 09:26He rarely complained,
- 09:27always insisting that he took
- 09:29the macro cosmic view of life,
- 09:31and only a supremely buoyant
- 09:33man expects to live forever,
- 09:34even in a crippled state.
- 09:36But the surgeon in his Immaculate
- 09:39green scrubs had delivered a bad blow.
- 09:41Optimists are the least
- 09:43prepared for the loss of hope.
- 09:46What eventually happened was a subdural
- 09:48hematoma bleeding in the brain.
- 09:50When it happened, we don't know.
- 09:53Possibly he banged his head
- 09:54during one of those falls.
- 09:56The ones that couldn't kill him,
- 09:57possibly a blood vessel in his brain,
- 09:59just gave way.
- 10:01He began to have visionary moments,
- 10:03time travelling,
- 10:04moments when he spoke to his
- 10:06dead best friend Ed Booth,
- 10:07or happily sang selections
- 10:09from the hit parade of 1938,
- 10:10or more sentimental tunes
- 10:12that he directed at my mother.
- 10:14Your father has turned into a songbird,
- 10:16she said.
- 10:17In retrospect, these may have been
- 10:19the early effects of bleeding,
- 10:22or maybe they were just specimens of longing.
- 10:25On March 31st,
- 10:26however,
- 10:26he was too weak to get out of bed,
- 10:29and when my mother brought
- 10:30him breakfast on a tray,
- 10:31he began drinking coffee from an
- 10:34imaginary cup with one finger
- 10:36hooked through the invisible handle.
- 10:38He brought the cup to his lips, took a sip.
- 10:41He was no longer singing.
- 10:43My mother summoned an ambulance
- 10:44and he went to the hospital.
- 10:49That's James Marcus, the opening
- 10:50of his essay about his father.
- 10:55This piece this piece is labeled as fiction,
- 10:59but I would call it Auto Fiction by Grace
- 11:05Paley, and it was published in 2002,
- 11:07and it's called My Father Addresses
- 11:10Me on the Facts of Old Age.
- 11:13My father had decided to teach
- 11:14me how to grow old. I said OK.
- 11:16My children didn't think it
- 11:17was such a great idea.
- 11:19If I knew how they thought I might do it,
- 11:21I might do it too. Or easily.
- 11:22No, no, I said.
- 11:23It's for later years from now.
- 11:25And besides, if I get it right,
- 11:27it might be helpful to you kids
- 11:28in time to come, they said.
- 11:31Really, my father wanted to begin
- 11:33as soon as possible, for God's sake,
- 11:34he said you can talk to the kids later.
- 11:37Now listen to me. Send them out to play.
- 11:39You are so distractible you we should
- 11:42probably begin at the beginning, he said.
- 11:44Change first. There is change,
- 11:46which nobody likes, Even men.
- 11:49You'd be surprised.
- 11:50You can do little things,
- 11:51putting cream on the corners of your mouth.
- 11:53Also the heels of your feet.
- 11:55But here's the main thing.
- 11:56Oh, I wish your mother was alive.
- 11:58Not that she had time,
- 11:59but Pennsylvania, I said.
- 12:01Mama never knew anything about cream.
- 12:04I did not say she was famous
- 12:06for not taking care.
- 12:07Forget it, he said sadly.
- 12:09But I must mention squinting.
- 12:11Don't squint. Wear your glasses.
- 12:14Look at your aunt, So beautiful.
- 12:17Once I know someone has said.
- 12:19I know someone has said.
- 12:20Men don't make passes at
- 12:22girls who wear glasses.
- 12:23But that's an idea for a foolish person.
- 12:25There are many handsome women
- 12:27who are not exactly 2020.
- 12:29Please sit down, he said.
- 12:30Be patient. The main thing is this.
- 12:32When you get up in the morning,
- 12:34you must take your heart and your two hands.
- 12:37You must do this every morning.
- 12:39That's a metaphor, right? Metaphor.
- 12:41No, no. You can do this in the morning.
- 12:44Do a few little exercises for the joints.
- 12:46Not too much. Then put your hands like a cup.
- 12:50Over and under the heart,
- 12:51under the breast, he said tactfully.
- 12:54It's probably easier for a man.
- 12:56Then talk softly.
- 12:58Don't yell. Undo your ribs.
- 13:00Push a little when you wake up.
- 13:02You must do this massage. I mean pat.
- 13:05Stroke a little. Don't be ashamed.
- 13:07Very likely no one will be watching.
- 13:10Then you must talk to your heart.
- 13:12Talk what?
- 13:14Say anything but be respectful.
- 13:16Say maybe say heart, little heart,
- 13:20beat softly but never forget your job,
- 13:22the blood you can whisper.
- 13:24Also remember,
- 13:25remember for instance,
- 13:27I said to it yesterday Heart,
- 13:29heart.
- 13:29Do you remember my brother
- 13:31Grisha how he made,
- 13:33how he made work for you that
- 13:34day when he came to the store
- 13:35and he said your boss's money.
- 13:37Zenya, right now how he put a gun in my face.
- 13:40And I said, Grisha are you crazy?
- 13:42Why don't you ask me at home
- 13:43I would give
- 13:44you We were in, we were in.
- 13:46Sorry we were in this America
- 13:47not more than two years.
- 13:49He was only a kid and he said.
- 13:51He said who needs your workers money
- 13:54for the movement Only from your boss.
- 13:56Oh little heart.
- 13:57You worked like a ******* like a dog,
- 13:59like a crazy slave.
- 14:00Bang, Bang, bang that day. Remember.
- 14:02That's the story I told my heart yesterday.
- 14:04My father said,
- 14:05look at what a racket it made to answer me.
- 14:08I remember. I remember till I
- 14:10was dizzy with the thumping.
- 14:12Why'd you do that?
- 14:13Pennsylvania. I don't get it.
- 14:15Don't you see?
- 14:16This is good for the old
- 14:18heart to get excited,
- 14:19Just as good As for the person some people
- 14:22go running to late in life for the muscles.
- 14:24They say that the heart knows
- 14:26the real purpose.
- 14:27The purpose is the expansion of the arteries.
- 14:29A river of blood.
- 14:30It cleans off the banks,
- 14:32carries junk out of the system.
- 14:34I myself would rather remain the heart.
- 14:36How frightened.
- 14:37Sorry.
- 14:37I myself would rather remind the
- 14:39heart how frightened I was by my
- 14:41brother than go running in a strange
- 14:42neighborhood miles and miles the
- 14:44city so dangerous these days.
- 14:46I said, oh, but then I said, well, thanks.
- 14:52I really love both of those pieces,
- 14:56and I really love both of those voices.
- 15:01And I can't write like
- 15:05either of those people.
- 15:06Although having read both pieces,
- 15:09absolutely influenced.
- 15:10When I wrote a piece about my grandmother
- 15:15dying the way that I wrote about her.
- 15:18Having read the way that someone
- 15:21else handled the task of describing
- 15:23someone that you love very tenderly,
- 15:25but honestly describing what it looks
- 15:28like for someone's body to age and what
- 15:32their experience of that feels like.
- 15:34I had these beautiful examples
- 15:37and they had seeped into my brain.
- 15:40And when I wrote,
- 15:42I tried to write in my own voice
- 15:45in a way that reflected all these
- 15:47other voices that had informed the
- 15:49voice that I had to speak with.
- 15:52I'm going to stop there so that we can talk,
- 15:54right? Yeah.
- 15:55OK.
- 15:55That was kind of all I was going
- 15:57to say to you.
- 15:58And now I'm going to answer some questions.
- 16:18OK.
- 16:21Did you turn these
- 16:22on, Turned off? No,
- 16:23they were not turned on.
- 16:25But no, I have a little light.
- 16:28Well, can I just jump in and ask about?
- 16:32I wanted to ask about your
- 16:33the grandmother essay anyway,
- 16:34as I warned you. And so actually,
- 16:41why don't you say a little bit about
- 16:43the piece and then I'll ask my question.
- 16:45OK. Can you hear me? This is working right.
- 16:50My grandmother, Harriet Sherman
- 16:52died in February of 20/22.
- 16:55She was 91 and she was a real piece of work.
- 17:03She had she, she had been,
- 17:07she had not worked when her three
- 17:10children were growing up and she had
- 17:13been a very frustrated housewife.
- 17:15And then she had.
- 17:18When my mother, her third,
- 17:19left the house gone on,
- 17:22she decided she wanted to breed
- 17:23show dogs and she bought a
- 17:25kennel and started doing that.
- 17:26And she did that for 10 years,
- 17:28which was crazy.
- 17:29And then one day she said forget the dogs,
- 17:33I'm going to become an actress.
- 17:35And she was in her 70s and she moved
- 17:37back to the city and she got an
- 17:39agent and she joined an old an, a,
- 17:43a geriatric acting troupe called Act two.
- 17:46And
- 17:49and she started like hitting the
- 17:51pavement and auditioning and she got
- 17:53parts and she was like in commercials,
- 17:54'cause there's not that many like
- 17:5780 year old ladies, you know,
- 17:58who are like ready to play
- 18:00the grandma in a commercial.
- 18:01You know, like a she, she was in,
- 18:03she was in McDonald's commercial.
- 18:05Real high point for my family and
- 18:10she was just really remarkable.
- 18:12And her She remained cognitively just
- 18:15sharp as a tack up through her death.
- 18:19And there had been many points.
- 18:21When I thought she was dying,
- 18:23I'd overcalled it like a lot of times
- 18:25because she had had several very
- 18:28long hospitalizations in her 80s.
- 18:31She had recurrence C diff, You know,
- 18:34I was really worried about her.
- 18:35And she pulled through each time
- 18:36and she would go home and she
- 18:37lived totally independently.
- 18:38And then at 91,
- 18:41she'd become much more frail
- 18:44after living alone through COVID.
- 18:46And the isolation,
- 18:47I think of COVID had actually been the
- 18:49thing that had diminished her the most.
- 18:51And she got a pneumonia,
- 18:53and she went to the hospital.
- 18:54And then she had sort of a geriatric spiral.
- 18:56And I thought that she was dying.
- 18:58And as the family doctor and
- 19:02geriatrician and palliative care doctor,
- 19:04I was sort of in charge of figuring
- 19:06out what was going to happen.
- 19:08And we made the decision to
- 19:09bring her home with Hospice.
- 19:10And I went home to facilitate the transition
- 19:13and be with her in her last weeks.
- 19:16And as all of that was happening,
- 19:17I was writing an essay about her and about
- 19:21taking care of her as she was dying.
- 19:24And I had the amazing opportunity to
- 19:26read her this essay I'd written about
- 19:29her like a couple days before she died,
- 19:32and that was going to be published in
- 19:35the New in The New Yorker on the website.
- 19:38She was upset. It wasn't in the magazine.
- 19:40And and it was just this really beautiful,
- 19:47very.
- 19:47It was this incredibly ideal Hospice
- 19:49experience in every way, frankly.
- 19:51And so that's, that's the essay.
- 19:56And so in Rachel spoke at grand
- 19:59rounds this morning and she really
- 20:02took, she just took the phrase
- 20:04that we use all the time in
- 20:07medicine bearing witness and really
- 20:09kind of like turned it inside
- 20:11out and upside down and really,
- 20:12really interrogated it.
- 20:13And really just a wonderful and critical
- 20:16way to understand and and bring more
- 20:18meaning to this phrase that has kind
- 20:20of lost its meaning in the process.
- 20:22And so another one of these that I noticed
- 20:25in the piece about Harriet was dying,
- 20:28dying of old age.
- 20:29And I loved what you wrote about that.
- 20:31And I actually,
- 20:34I have it. I took a picture
- 20:35of it so you could read it and
- 20:39then maybe you could say something about it,
- 20:43just this paragraph.
- 20:48OK, so this is from the essay.
- 20:51But Harriet, the essence of geriatric
- 20:55medicine is the anticipation of
- 20:57cascading health problems like
- 20:59the ones that Harriet was facing.
- 21:01Frail is a colloquial term used
- 21:03to describe little old ladies.
- 21:04But frailty is also a clinical syndrome that
- 21:07affects more than just our bones and muscles.
- 21:09With that, with time and stress,
- 21:11our internal organs and biological
- 21:13systems become worn brittle,
- 21:15less resilient to infections and injuries,
- 21:18more susceptible to two toxicities.
- 21:21Sick bodies usually have multiple problems,
- 21:24and over time these problems
- 21:27become intertwined.
- 21:28Heart failure leads to kidney failure,
- 21:30which worsens the heart failure,
- 21:31which makes breathing feel more labored.
- 21:34A mind that's slipping away might
- 21:35mean that a person forgets how to
- 21:37provide their own basic hygiene,
- 21:39gets new infections, takes antibiotics,
- 21:42and becomes more confused from
- 21:44the medication side effects.
- 21:45When people speak of dying of old age,
- 21:48this type of spiral is usually
- 21:50what they mean.
- 21:51Aging alone doesn't kill us.
- 21:54Thank you. I found that really,
- 21:56really interesting and just a great,
- 21:59beautifully written analysis of that phrase.
- 22:02And I just wanted to ask.
- 22:03My question is just if you can say
- 22:07something about the act of writing
- 22:09to LA audience about phrases
- 22:11like these without using jargon,
- 22:13how do you distil these kinds
- 22:14of ideas down to their essence?
- 22:18Like like dying of old days
- 22:20bearing witnesses. Sorry, let me
- 22:24I think.
- 22:28I think when I'm like that is
- 22:30that's actually a good example.
- 22:31Or this morning's talk was a good example
- 22:35where the thing that I was doing was
- 22:38unpacking the phrase for myself like
- 22:40I I especially in palliative care.
- 22:42There are a lot of stock
- 22:45phrases you you learn.
- 22:47The way that you learn to to work
- 22:49with people in moments of great
- 22:52intensity is you get handed all of
- 22:54this language that you can bring into
- 22:56the room so that when you're anxious,
- 22:57which you know it's a very intense situation,
- 23:00you have something in your back
- 23:01pocket that you can reach for.
- 23:03And there are a lot of,
- 23:09and it is called them, stock phrases,
- 23:11I think in medicine that we use to
- 23:15describe biological processes or
- 23:17describe aspects of our work that we
- 23:20don't interrogate very often. And I
- 23:27what happens is, you know,
- 23:29in geriatrics we talked
- 23:30about the Jerry spiral.
- 23:31And I wanted to, I wanted to be able to
- 23:33explain to myself what I meant by that.
- 23:35Like what was happening?
- 23:36What did I think was actually
- 23:38happening to my grandmother?
- 23:39And when I was going to explain
- 23:41to my family why I thought she
- 23:43probably wasn't going to live much
- 23:44longer or why we shouldn't intubate
- 23:46her if she needed to be, you know,
- 23:48if she became short of breath.
- 23:51I wanted to be able to do that in
- 23:52a way that was adequately precise,
- 23:55not just for them but for me,
- 23:56so that I really felt like I had
- 23:59explored the concept to its edge.
- 24:03And writing is such a magical way to do that.
- 24:06It really, I mean it forces you to do that,
- 24:08but it is a tool for doing that. And
- 24:13so this morning's talk was,
- 24:15you know, weeks and weeks of
- 24:18writing around the phrase bearing
- 24:20witness to get at where I ended up
- 24:25in an effort for myself to articulate
- 24:27why do I hate this phrase a little bit,
- 24:30You know, I I don't know.
- 24:31But and I want to understand that better
- 24:38you know
- 24:41maybe maybe it's working.
- 24:43Right. It's working.
- 24:45You wrote this fantastic piece
- 24:48about you talked about it in your
- 24:52grand rounds Ramiro Gonzalez.
- 24:55So moving.
- 24:55You know I would really so moved
- 24:58by this piece about a man on
- 25:02death row who wanted to donate
- 25:05his kidney and then it you
- 25:09talk about why you were there
- 25:18why were you there. You know why did
- 25:22you decide to do that to go to Rikers.
- 25:26Well, so Ramiro was in, Ramiro was in Texas.
- 25:31And I decided I I I wanted to interview
- 25:36Ramiro Gonzalez because I had been thinking
- 25:39about the death penalty and how to.
- 25:42I'd wanted to write about the death penalty
- 25:44for a while and was sort of following
- 25:47cases of people on death row around the
- 25:50country and reading news about them.
- 25:52And I, Ramiro Gonzalez is this guy,
- 25:57he's exactly my age. He's turning.
- 26:00He's about to turn 42 and he when he was 18,
- 26:05he had raped and murdered a woman
- 26:08after a very, very difficult and
- 26:11abusive in alienating childhood.
- 26:14And he had been sentenced
- 26:15to death as an 18 year old,
- 26:17which is not something you can
- 26:21actually do now in most states.
- 26:23And he'd been on death row for over
- 26:2620 years and he had undergone this
- 26:30incredible transformation over that time.
- 26:33And so in 2022,
- 26:38he was scheduled to be executed.
- 26:40And in advance of his execution,
- 26:42he had come to the decision that
- 26:45he wanted to donate a kidney
- 26:47to a stranger before he died.
- 26:49And he had really thought this through.
- 26:51He had really thought through the
- 26:53idea that this was a way that he
- 26:55could not restore the life he took,
- 26:57but he could help prolong and improve
- 26:59someone's life in a meaningful way.
- 27:01And his attorneys had made this
- 27:05request to the state of Texas,
- 27:07and Texas wasn't going to let him
- 27:09do it before they executed him.
- 27:11And he couldn't do it after they
- 27:13he couldn't be a a donor after he
- 27:16died because the poison that they
- 27:19used to kill you poisons the organs.
- 27:23And so in the weeks leading up
- 27:25to his scheduled execution,
- 27:27which was ultimately stayed temporarily
- 27:30not for this reason though there was
- 27:33this news about this thing where this,
- 27:35this sort of effort to try to get this
- 27:37guy the opportunity to donate his kidney.
- 27:39And I was really interested in that. And
- 27:44I got in touch with his attorneys and
- 27:50asked if he would be willing to talk to
- 27:52me and wrote him a letter and he said
- 27:55if I'm not executed next Wednesday,
- 27:57I will talk to her. And he wasn't.
- 28:00And so I got to go to death row
- 28:04in Texas and interview him.
- 28:06And to do that is a is anyone.
- 28:08I've never been to death row
- 28:09in Texas in this room? No.
- 28:14You drive for like 90 minutes out of
- 28:17Houston into like really rural, flat Texas.
- 28:21And it was August and it was really hot.
- 28:24And there's no air conditioning in this
- 28:26prison in the middle of Texas like
- 28:27in the sun, where the temperature was
- 28:30like 100° most days of that summer.
- 28:34And men on death row in in Texas
- 28:37are in their cells 23 hours a day.
- 28:41And he had been in those conditions for
- 28:4420 years. And I had an hour with him.
- 28:47And I could bring only, like,
- 28:50a old school recorder that he could
- 28:53hold on his side that would record
- 28:55his voice but not mine because
- 28:57we were speaking through glass.
- 28:59And it was totally weird because
- 29:03the the guy who's like the media
- 29:06guy for the Texas prison system
- 29:08meets reporters and brings them in.
- 29:11And he was excited that I was from
- 29:14New York because he was going to
- 29:17see Lea Michele and Funny Girl And.
- 29:21And he wanted to know, like,
- 29:23if I would like, he was like,
- 29:24he was like, are you into theater?
- 29:25And I was like,
- 29:26I'm having trouble relating to you
- 29:28in this context in this moment.
- 29:30But it was just really, it was just,
- 29:31you know, it was so incongruous.
- 29:33It was so everything about that
- 29:36experience was so stimulating.
- 29:39And Ramiro came and he sat down and
- 29:43we touched hands through the glass,
- 29:44and I started to ask him,
- 29:47I started from a place of can you tell
- 29:49me about this desire to give your kidney?
- 29:52And over the course of that hour,
- 29:56he told me sort of his whole life story,
- 30:01which was relevant to this kidney
- 30:03question because he had sort of
- 30:05come to this decision through
- 30:07very deep work on himself and I.
- 30:09He was incredible.
- 30:11He's spoken just unbelievably
- 30:14beautiful, full paragraphs.
- 30:20And I It was incredibly moving.
- 30:23And so I felt just like not really answering
- 30:25your question about exactly why I was there.
- 30:27I was there, 'cause I wanted to go.
- 30:29And once I was there,
- 30:31it was incredibly, incredibly moving.
- 30:33And I was like, oh, This is why I'm here.
- 30:34Like, I I'm here to see.
- 30:37I'm here to receive this story from him
- 30:41and to put it into the world in a way that
- 30:44will make him feel seen not just by me,
- 30:48but by others. I guess.
- 30:50I thought when you were talking about,
- 30:53even though you were talking about him,
- 30:55you really talk.
- 30:56I thought you were also talking
- 30:58about your beat, as it were.
- 31:02You know,
- 31:03this thing that you write so much about.
- 31:06And I just wondered, why put yourself there?
- 31:12Like in jail, In jail?
- 31:15Yeah, something that most
- 31:17people work very hard to avoid.
- 31:20So the the first thing I'll say is,
- 31:24you know when I was I,
- 31:25I went into medicine because I
- 31:27wanted to do social justice work
- 31:29and I wanted to do anti racist work.
- 31:31And I initially thought I was going
- 31:35to do like community primary care.
- 31:37And then I really loved palliative
- 31:38care and wanted to do a fellowship
- 31:40and was doing a geriatrics and
- 31:41palliative care fellowship.
- 31:42And then I was like what's the social
- 31:44justice version of palliative care?
- 31:46Like where like where do I in New York City?
- 31:48There really wasn't,
- 31:49it wasn't clear to me sort of
- 31:50what the right place was to take
- 31:52that skill set that would feel as
- 31:54mission driven as I sort of wanted
- 31:57to be in my work every day.
- 31:59And I had gotten sort of separately
- 32:01interested in mass incarceration and
- 32:03the fact that there was this exploding
- 32:05population of elders being incarcerated
- 32:08in this country and was thinking
- 32:11about sort of that question and problem.
- 32:14But the real answer is
- 32:16that it was serendipity.
- 32:17Because what happened the year that
- 32:20I was finishing fellowship was the
- 32:23year that New York City fired the for
- 32:26profit contractor that it had used
- 32:29to provide healthcare in the jail
- 32:31system and instead decided to create
- 32:33a public health agency that would
- 32:35provide that would that would provide
- 32:37all the healthcare on Rikers Island.
- 32:40So I would never would have
- 32:41gone to work for them.
- 32:43I wouldn't have gone to work
- 32:44for the private contractor.
- 32:45I think that the constraints
- 32:47of the dual loyalty of that
- 32:49situation would have been too,
- 32:52wouldn't have worked for me,
- 32:53wouldn't have felt meaningful.
- 32:55But as I was graduating,
- 32:56they were making this new agency and
- 32:59they were recruiting a new kind of
- 33:01doctor to come to Rikers who wanted
- 33:02to come and work from this like
- 33:04human rights driven perspective.
- 33:06And they also had lots of money
- 33:10because they needed people so much.
- 33:12And so they just let you make your own job.
- 33:15So I said, like, you know,
- 33:17can I come and can I do geriatrics?
- 33:19And this is how I want to
- 33:20structure the practice.
- 33:21And they said yes.
- 33:23And so that's how I ended up there.
- 33:25Like I I I don't think there
- 33:28are amazing correctional health
- 33:30doctors throughout the country.
- 33:32I don't think that I personally would
- 33:35have had the fortitude to be by myself,
- 33:39working in a system that
- 33:41wasn't aligned with my values.
- 33:43Rikers happened to be in the
- 33:44midst of a shift at the time
- 33:46that I was ready to start.
- 33:50Thank you.
- 33:52Speaking of Rikers, you have
- 33:56written stuff you've written.
- 33:59You know, I, I should say we we in
- 34:01medicine often witness things
- 34:03that we think that the lay public
- 34:06needs to know about, right?
- 34:09We need to, we consider if we should
- 34:12risk our reputations, our jobs,
- 34:14to be whistleblowers of sorts.
- 34:17And most of us, of course,
- 34:19don't do that very often.
- 34:20But you did that a lot
- 34:24when you were at Rikers.
- 34:24I mean that's like the bulk of your work is,
- 34:27is about the bulk of your essays and and
- 34:30opinion pieces are taking on especially
- 34:33during COVID the the need to decarcerate
- 34:36and and to kind of shed light on these
- 34:39these bad things that were going on.
- 34:40So I wonder if you can talk about
- 34:43that and and just that kind of this
- 34:45the the feeling that you have when
- 34:47you have to make a decision about
- 34:49shedding the light on something that
- 34:50might be difficult for you personally.
- 34:55So this isn't it's so a few things.
- 35:00So I think one thing is that as
- 35:03you if you think you want to do
- 35:05social justice work overtime,
- 35:05you have to in the same way you have
- 35:07to get to know yourself as a doctor
- 35:09and as a writer you have to sort
- 35:11of get to know who you think you
- 35:13are in the social change ecosystem.
- 35:15And there are people who are very
- 35:18strident activists for whom working
- 35:21within the institutions that uphold
- 35:24current structures is never tenable, right?
- 35:27Like there are folks who just,
- 35:29they can't work in a carceral setting.
- 35:33Then there are people who I
- 35:37identify with more,
- 35:39who are institutional reformers but
- 35:42who have a really strong sort of sense
- 35:45of an where their boundaries are with,
- 35:48you know, there.
- 35:49So I would do it under those circumstances
- 35:51we just talked about at Rikers.
- 35:53I wouldn't do it in other circumstances.
- 35:55So I was at Rikers as an institutional
- 35:59reformer and my lens initially was,
- 36:02well,
- 36:02first my lens was like I don't
- 36:04understand this place and I have
- 36:05to get to understand it before
- 36:06I like think that I'm the first
- 36:07person to say that it's violent or.
- 36:09And the second thing was that for
- 36:13a long time I felt very effective
- 36:15in the institutional reformer role
- 36:18in a way where whistle blowing did
- 36:19not feel like the most effective
- 36:21thing I could do.
- 36:22I was really empowered to take care
- 36:26of patients the way that I wanted to.
- 36:27But also I built and ran this team
- 36:30that got a lot of guys out of jail
- 36:33and through this compassionate release
- 36:35work and that felt so tangible and
- 36:37real and meaningful that I didn't
- 36:39want to jeopardize it by like an op.
- 36:41Ed was not worth that,
- 36:42you know.
- 36:43And
- 36:47and then the thing that flipped was COVID,
- 36:50which created this new intense sense
- 36:53of urgency around bringing attention
- 36:56to the jails, bringing attention to
- 36:59the fact that the virus was, you know,
- 37:02really Rikers was the epicenter of
- 37:04the pandemic in the US in March 2020.
- 37:07Like, New York City was the epicenter.
- 37:08And then Rikers was the epicenter
- 37:10within New York. And we were panicked.
- 37:13And it felt like the end of the world.
- 37:15And so it was like, OK, well, like,
- 37:17now I'm going to tweet, You know, like,
- 37:19I'm going to break rank and I'm going
- 37:21to tweet without asking permission.
- 37:22And I didn't do it alone.
- 37:25My colleagues did it as well.
- 37:28And I did write an op-ed then
- 37:30that was in the Washington Post.
- 37:32That was basically like,
- 37:35because in New York the idea that we
- 37:38should let as many people out as quickly
- 37:42as possible became official policy quite
- 37:44quickly and we were really successful.
- 37:46But the idea that that should be the
- 37:50model everywhere in the country in the
- 37:54pandemic felt really important to me.
- 37:55And so writing, writing a piece that
- 37:58would advocate for those ideas that that
- 38:00could be read nationally felt really
- 38:03critical and really felt worth risking
- 38:06getting in trouble for her. Also,
- 38:08I think as I said earlier in some point,
- 38:10like, I didn't really think they were
- 38:12going to fire a doctor in April 2020.
- 38:13And so I was like, it's my,
- 38:16you know, it's my time.
- 38:20And then that sort of continued
- 38:23to be true. So, like Rikers got,
- 38:25there was COVID. And then as COVID
- 38:28died down as a problem, Rikers
- 38:33sort of like devolved into crisis
- 38:34for other reasons because the
- 38:36system just absolutely collapsed.
- 38:38And there was this.
- 38:39In the end of 2020 and all of 2021,
- 38:43corrections officers stopped coming to work,
- 38:46and the place became more violent,
- 38:49more chaotic than it had been in any
- 38:52other moment that I had been there.
- 38:55More desperate, basic functions.
- 38:57People weren't getting fed, you know,
- 39:01like it was really horrific.
- 39:03And I also couldn't function as
- 39:05a doctor in that system anymore.
- 39:07Like that work that I had been doing
- 39:09before didn't work because the system
- 39:10didn't work around me enough to make it
- 39:12possible for me to do what I'd been doing.
- 39:14So then the calculus of well,
- 39:16what what what's worth it?
- 39:18It was like, OK,
- 39:19like whistle blowing now is more impactful
- 39:21than like what I'm doing right now,
- 39:22which is coming to work
- 39:24and feeling frustrated.
- 39:25So then I spent a long then I whistle
- 39:27blew every day for a long time.
- 39:34You want to ask,
- 39:47So how do you connect
- 39:50Doctor Ring and writing?
- 39:52Or is that the connection you make?
- 39:55Or is it work your work and your
- 39:57writing that make the connection?
- 39:59I mean, how are those three things?
- 40:02How do they, how are they
- 40:04organized in your brain?
- 40:06How are they linked together?
- 40:12I think
- 40:16for me that I am the same.
- 40:20Person doing all of those things
- 40:22all the time. So when I am,
- 40:25when we talked earlier about trying
- 40:30to unpack phrases in my writing,
- 40:33I think that's basically the same way that
- 40:35I approach clinical problems like I'm.
- 40:37I really like clarity about
- 40:39what it is I think is going on.
- 40:42And I so I feel just insanely lucky
- 40:47that I became a doctor 'cause it
- 40:50was pretty unlikely actually.
- 40:51I I got into medical school early
- 40:55through this special pathway called the
- 40:57Humanities and Medicine Pathway at Sinai,
- 41:00where you got in as a sophomore
- 41:02in college based on like your
- 41:04high school grades basically.
- 41:06And it meant that you didn't
- 41:08have to be a traditional pre Med.
- 41:11And I think if I'd had to
- 41:12be a traditional pre Med,
- 41:12I might not have hacked it.
- 41:13I might not have made it.
- 41:14So it was this real gift to me
- 41:16that I that I had this alternative
- 41:18pathway to go to Med school.
- 41:20I love the way the doctorate doctors think.
- 41:23I love.
- 41:24I love the thought process of medicine
- 41:29and I love thinking like a doctor.
- 41:30I love doing critical appraisal.
- 41:32I love thinking about how you
- 41:35how we know what we know.
- 41:37I love the ideas of medicine.
- 41:40This piece Harlan's here.
- 41:41I wrote that came out this month about
- 41:46Harlan Kremholtz, who's here in
- 41:48Nikki Kowiwasaki's Yale Listen study,
- 41:50which is a study about looking into patients
- 41:54with long COVID and related conditions.
- 41:57It was so interesting to me for a number
- 42:00of reasons that we're all sort of supra
- 42:04the question of long COVID as a disease.
- 42:07Like I like I'm interested in what's
- 42:08the deal with long COVID, right.
- 42:09But I'm. But I was really interested
- 42:11in how are they going to figure out
- 42:13what the deal is with long COVID.
- 42:14Right. How do you design that project
- 42:17in a way that works?
- 42:19How do you navigate the politics around
- 42:22this quite politicized set of illnesses.
- 42:27And those questions are interesting to
- 42:29me in medicine and they're interesting
- 42:30to me as a writer and they're
- 42:32interesting to me as an advocate and
- 42:35and writing is the through line.
- 42:37I think a little bit in that it's the,
- 42:38it's the way to figure out what
- 42:40I think about about them in
- 42:43all those different domains.
- 42:49So you're open for questions.
- 42:57I
- 43:03have a question. You're such a gifted writer
- 43:07and you use it to communicate
- 43:09in different ways.
- 43:10I mean, sometimes it's around advocacy,
- 43:12sometimes it's just for the
- 43:14purpose of telling a story.
- 43:16But you know, physicians are in
- 43:18general very poor communicators.
- 43:19You know, we have trouble finding
- 43:21the words I I actually found and
- 43:24I'm never was as skilled as either
- 43:26the three of you in doing this.
- 43:27But I would tell a story to patients,
- 43:29you know like what When you're
- 43:31making a choice, you know,
- 43:32it's like you're in a in a forest and
- 43:34you're going down a path and there's
- 43:35several different paths you can take.
- 43:37And you know some of the paths
- 43:38are scarier than others.
- 43:39Some of them have you know
- 43:41dangers that are near,
- 43:43but if you can get through
- 43:44those dangers you go to,
- 43:45you know anyway.
- 43:46I would tell make up stupid stories
- 43:48but but I was trying to grapple
- 43:50with how to communicate complex
- 43:52concepts to people in ways that
- 43:54they could internalize and surface
- 43:56their preferences around what it
- 43:58is that they really would want
- 44:00to do if they were fully informed
- 44:02and free to make those choices.
- 44:05And as I listened to,
- 44:06I just wonder,
- 44:07how can you put to work your ability
- 44:10to tell stories in ways that the
- 44:13that can people can do what you did,
- 44:15which is I I've heard that story
- 44:16and I can put that story to use.
- 44:18I've heard that phrase.
- 44:19I can put that to use in a way that
- 44:22helps people to understand something that,
- 44:24you know,
- 44:25I'm not explaining pathophysiology to them.
- 44:27What I'm really explaining to them
- 44:29are are existential choices that
- 44:33have no right answer and only have to
- 44:36do with what is important to them,
- 44:39where they're deciding where do they
- 44:41want to take their risks and and
- 44:42who do they want to put their confidence in.
- 44:45And they they don't always
- 44:46have logic to them.
- 44:47I mean,
- 44:48it's just sometimes someone says I
- 44:49just want to believe the person in
- 44:51front of me because I'm scared and I
- 44:54honestly can't process the information.
- 44:55They may not have been articulated
- 44:57like that but I can't process any
- 44:59concrete mathematical formulas Now
- 45:01maybe my kids not you tell Me 2%
- 45:03chance of dying and 5% chance of stroke.
- 45:06And or you get through this like
- 45:08those are not ways that people
- 45:11can understand their situation.
- 45:13And yet you,
- 45:14the three of you and and talking to you,
- 45:16Rachel in particular,
- 45:17because it's about you today.
- 45:18You know,
- 45:19when I read your words and I think
- 45:20about how you were expressing yourself today,
- 45:22I thought,
- 45:22you know,
- 45:23there's a whole world of of helping
- 45:26healthcare professionals to not feel
- 45:28like I have to prove my competence
- 45:31by demonstrating my ability to
- 45:33speak in words and language and
- 45:35and and and math that you know
- 45:37to the person in front of me.
- 45:38I don't have to anything to prove to them.
- 45:40What I have to do is be able to position
- 45:43them so they can understand where
- 45:46their story has landed today and
- 45:48what control they have over where
- 45:51that story may unfold going forward,
- 45:53recognizing their substantial
- 45:54uncertainty around the choices
- 45:56that they have in front of them.
- 45:58But we never we we, we aren't trained in.
- 46:01Here are several stock ways
- 46:02that you can do this.
- 46:04Here's here's the way that you can use.
- 46:07You know, good writers can teach us how
- 46:10we can surface some of these complex
- 46:13concepts and ways to understand.
- 46:15And when I look at what Lisa did you
- 46:17know as as an advisor to house or
- 46:19what you do in your weekly column,
- 46:21I mean you make accessible,
- 46:24complex concepts and choices
- 46:25that people make.
- 46:27Of course there's a story and
- 46:28there's an end the story.
- 46:29Someone's not in the middle of that.
- 46:30But you,
- 46:31you help people understand how other
- 46:33people have navigated difficult
- 46:35illness and difficult choices or or
- 46:37or or being in tough situations.
- 46:40And I think it gives people strength.
- 46:41And I think lots of people take
- 46:43those stories that you write and
- 46:45they they they put it on themselves
- 46:47in the situations that they face.
- 46:48Like what? What can they do?
- 46:49But anyway, Rachel,
- 46:50this is just a question for you is,
- 46:51is there a world where academia
- 46:54actually puts you guys on a pedestal
- 46:57and says you guys are the ones
- 46:59who help us to,
- 47:00to translate what we're learning in
- 47:03classrooms about the science of medicine,
- 47:05to be able to help it be
- 47:08understood by people who are,
- 47:09who really need stories as a
- 47:11way to interpret where they are
- 47:13in their lives and what choices
- 47:15they have in front of them?
- 47:19Do I think there's a world where academia
- 47:20puts us on a pedestal for doing that?
- 47:22I don't think so. No, no, I don't.
- 47:26I I mean, well, I think we could but we're,
- 47:29yeah, we're going to work on it. So
- 47:33no. But I think to your point, I.
- 47:42So two things. One thing is I think
- 47:45what you just expressed which is look,
- 47:48the actual core task of the clinician
- 47:51is to help people know and express
- 47:54their own values and match those
- 47:57values with potential treatment plans
- 48:00or intervention plans or whatever in
- 48:03conditions of fundamental uncertainty.
- 48:07That's the core task that that's
- 48:10a that's a very mature way of
- 48:14characterizing the clinical.
- 48:15And I I think it takes a while to get there.
- 48:19You know I think as a learner
- 48:21I don't think I knew that.
- 48:23I think I like I really remember
- 48:28being so impressed that I was on
- 48:31rounds and a chief resident was
- 48:33grilling an intern and the intern
- 48:35knew the half life of amiodarone.
- 48:37And I was like,
- 48:38that kid is an incredible doctor.
- 48:41And now I'm like,
- 48:42that's not a big deal.
- 48:44You know knowing the half of of
- 48:46Amiodarone's not that's not that's
- 48:48not actually the core skill but
- 48:50at the time it seemed amazing and
- 48:51this and and it takes a while I
- 48:55think of to get to the place where
- 49:00you are comfortable enough with
- 49:03uncertain to yourself where you are
- 49:08sophisticated enough about data that
- 49:12you can understand how to communicate
- 49:14about data in in ways that help
- 49:17people in situations of uncertainty.
- 49:20You have to understand the
- 49:21fundamental uncertainty of data right.
- 49:23You have to know how to use it.
- 49:25That takes a while to learn.
- 49:26I I think there are a lot of skills
- 49:28implied in the task that you described.
- 49:32But
- 49:33but like, I'm I guess what I'm saying
- 49:35is in a way that like humanities
- 49:38has understood as an other you know,
- 49:40like this is an extra thing
- 49:41that you guys are doing. Right.
- 49:42Yeah. You don't get promoted.
- 49:43But. But I mean what I say it
- 49:45on rounds was that you know,
- 49:46words are just like drugs.
- 49:48You know they have the power
- 49:50to promote recovery.
- 49:50They have the power to impede recovery.
- 49:52They have the power to provide benefit.
- 49:54They have the power for harm.
- 49:56I mean it's one thing when we talk about art.
- 49:58I mean art is sort of exists for its
- 50:00own sake or in some of this writing.
- 50:02But I also see some pragmatic
- 50:05application of words as powerful
- 50:07and in the way that we use them.
- 50:09And I just feel that that within
- 50:12medical education and within
- 50:13our everyday interactions,
- 50:14we're especially as technology is taking off,
- 50:17we're we're actually going to
- 50:19lose something essential and
- 50:20maybe we've already lost it.
- 50:22We've got to reclaim something essential,
- 50:24which is what you were showing
- 50:26today in grand rounds which
- 50:27is the ability to slow down.
- 50:28You talk about slow medicine.
- 50:29You might want to talk about it,
- 50:30but it's like slow down and and
- 50:32and value those words as as,
- 50:36as as important as anything
- 50:38else we do in medicine.
- 50:40And I just think that,
- 50:42I mean and when I read your words,
- 50:43I even think about it in the studies.
- 50:45You know,
- 50:45I mean you should be helping us think
- 50:47about the words we're using as we can
- 50:49send people for studies because you know,
- 50:51because those words are meaningless words
- 50:53as they're packed in legalistic words
- 50:55that are inaccessible to most people.
- 50:57And you guys are talking about
- 50:59how do we communicate and also
- 51:01reach feeling so people can truly
- 51:03get to a point of understanding.
- 51:05I mean what what would it take to do that?
- 51:11Well, I mean I I don't know
- 51:13exactly what it would take because
- 51:15I I'm not in academia anymore.
- 51:17But I I just, I mean I would say
- 51:20like you have this really wonderful
- 51:22robust humanities and medicine program
- 51:24here and it's it's possible I think
- 51:30to value it is possible to value
- 51:31what you're talking about and it's
- 51:33possible to say this is an essential
- 51:35part of the curriculum for learners.
- 51:37This is something that we do and this,
- 51:38this gets equal weight in grand
- 51:41rounds with next week's talk on
- 51:42the GLP one drugs or whatever.
- 51:44You know.
- 51:45So I I think you can
- 51:47imagine a curriculum that
- 51:51holds this up and honors it
- 51:55in a way that gives it more prominence.
- 51:58And also I I also think I I talked
- 52:03earlier about watching people doctor
- 52:06and that is the thing that I'm the
- 52:09most anxious about in training now is
- 52:12that I'm worried that people don't get
- 52:14to watch other people doctor as much
- 52:17as they used to for various reasons.
- 52:19And it is so powerful and so important
- 52:24to watch other people interview someone,
- 52:28to watch someone else manage a difficult
- 52:32encounter, manage a family meeting,
- 52:34manage a psychotic patient. Right.
- 52:35You can think about all of these
- 52:38scenarios that are really really
- 52:39can send a patient break bad news.
- 52:43You have to see people do that who
- 52:45do it well and you have to see them
- 52:47do it more than once.
- 52:49Not just so that you can borrow from
- 52:50them but you just just to get a sense
- 52:52of what the what does it look like.
- 52:54What's it look like when you're doing
- 52:55it well and and that I my sense is
- 52:58although I don't teach in a medical
- 53:01school right now that there's less
- 53:03of that than there maybe once was
- 53:06for various reasons.
- 53:10And that I think that I think is maybe the
- 53:13way to bring it back into the curriculum.
- 53:16Like I really love bedside rounds.
- 53:18I think everybody should bedside
- 53:20round and I don't think that that's
- 53:24the norm anymore to bedside round.
- 53:25But I I think it's really important
- 53:28to see have somebody role model
- 53:31interacting with a patient day after
- 53:33day over the course of their illness.
- 53:38Yeah.
- 53:46Thank you very much for your talk.
- 53:49I was in clinic during the
- 53:51grand rounds this morning,
- 53:52but look forward to hearing it.
- 53:54I was curious about like,
- 53:56you know, you mentioned that
- 53:57you came into medicine through
- 53:59this medical humanities pathway.
- 54:00And so presumably, you know you
- 54:02always had an interest in writing.
- 54:04And whether whether you experience
- 54:07like tension between the writing,
- 54:09like artistic self and the
- 54:12medical science self,
- 54:13especially in your early career,
- 54:15and how you kind of manage that and
- 54:18found time to cultivate this thing
- 54:20that obviously gives you so much
- 54:23pleasure that you're that you're
- 54:24good at and helps your patients.
- 54:29I don't know that I feel
- 54:32tension between myself exactly.
- 54:34If anything, I feel just, again,
- 54:37just very lucky that I became a doctor,
- 54:39'cause I think there's this,
- 54:40there's this version of my life where
- 54:42I didn't cultivate the parts of
- 54:45myself that engage and love science,
- 54:47and I really do love science.
- 54:51But I would, I said earlier to the
- 54:57writing workshop participants who
- 54:59were asking the same questions I
- 55:00would have asked as a resident,
- 55:01which is basically like,
- 55:03you know, how did you do, how did,
- 55:05how did you do it all, all,
- 55:06all the time. And I didn't.
- 55:08I didn't do it all, all the time.
- 55:10Like, I did not publish anything
- 55:12in medical school or residency.
- 55:15I was writing occasionally on the
- 55:17side and a lot of the time what I
- 55:20was writing was three sentences in
- 55:22an e-mail draft and putting it aside
- 55:25and and that's because I was becoming
- 55:27a doctor and becoming a doctor,
- 55:29said this spiel earlier.
- 55:30But becoming a doctor is so
- 55:31hard and it's so important.
- 55:33And it is a place where your brain needs
- 55:36to be growing and growing and growing
- 55:38all the time for a number of years.
- 55:42And I think it's OK to not try to
- 55:47be managing multiple identities and
- 55:49multiple careers during training.
- 55:51I think it's the right thing to
- 55:53do in residency, is to like,
- 55:55throw yourself into figuring out
- 55:56who you are as a doctor and becoming
- 55:59the best doctor that you can be.
- 56:01And then once I was out of training
- 56:09the IT be, it started to feel very natural
- 56:13to write again because I had more time.
- 56:16My mind was clearer.
- 56:18I was reading much more again.
- 56:20And I and medicine was such
- 56:24fertile material, you know,
- 56:26it was so inspiring all the time.
- 56:28Like I was like, oh,
- 56:28I I'm just like in the trenches
- 56:31with humanity all the time.
- 56:32So interesting. And so
- 56:37it didn't this, that part of my
- 56:39life didn't start until later.
- 56:44I didn't rate the first year at
- 56:46Rikers either. You know, I think,
- 56:47I think you're on like the best version of
- 56:49a life I think is when you are on multiple,
- 56:51you know, you you're always on
- 56:53like a new learning curve.
- 56:55And I've had lots of different learning
- 56:56curves and there was like a learning
- 56:58curve around becoming a doctor.
- 57:00And then there was a learning curve
- 57:01around getting to really understand the
- 57:04criminal justice system and how it worked.
- 57:06And that was hard.
- 57:07Like, I had to like, you know,
- 57:10basically not go to law school,
- 57:11but half go to law school to do my job.
- 57:13Well, I had to learn a lot and that was
- 57:15really intense and took a lot of brain power.
- 57:18And then I've been on a learning curve,
- 57:21I think as a writer for
- 57:22the last couple of years,
- 57:26but very much feel like I'm
- 57:27still on the learning curve.
- 57:34We have 10. We're at 6:00,
- 57:37so we're going to stop now.
- 57:40I'm sure Rachel will be happy to answer
- 57:42a few questions here unofficially.
- 57:45But thank you all for coming and
- 57:47congratulations on the McGovern
- 57:48lectureship and it was a pleasure to
- 57:50spend the day with you and get to know
- 57:52you and hear about your wonderful work,
- 57:56writing, brain, etcetera.
- 57:58So thank you.