Rachael Bedard, MD - Reading and Watching: Finding your style by learning from others: A conversation with Lisa Sanders & Anna Reisman

February 08, 2024

Information

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.