Language for an Infinite Distance- Art as Work in Medicine with Anna DeForest MD

Transcript

• 00:00Hi everybody, welcome to the
• 00:05program for Humanities and Medicine.
• 00:10Talk featuring Anna Deforest and
• 00:11what is the name of this session?
• 00:16Where did we land on that?
• 00:20Umm. Does anybody remember
• 00:21the name of the session?
• 00:24It doesn't matter because it's
• 00:25a conversation with Anna Faris,
• 00:27the author of a history of present illness.
• 00:30And I'm just, my name is Anna Reesman.
• 00:32I'm the director of the program.
• 00:34And I'm going to introduce her.
• 00:35And then she will read for about
• 00:3715 minutes and and then I have
• 00:39a bunch of questions for her,
• 00:41and then we'll have time
• 00:42for your questions as well.
• 00:43So Anna Deforest, it grew up in.
• 00:48A small town in Illinois.
• 00:51She received her bachelor's degree from
• 00:53Eugene Lang College in New York City.
• 00:56She was a liberal arts major.
• 00:59Adding as I go.
• 01:00She has an MFA in fiction
• 01:02writing from Brooklyn College.
• 01:05Her MD is from Columbia,
• 01:07and she completed her internal
• 01:10medicine internship here at Yale
• 01:13and a residency in neurology.
• 01:16Following that,
• 01:17she completed a Hospice and palliative
• 01:19care medicine fellowship at Mount
• 01:22Sinai and is currently a fairly
• 01:24brand new instructor at Weill
• 01:26Cornell Medicine and an assistant
• 01:29attending at Memorial Sloan Kettering.
• 01:32She is the recipient of the Banister Award
• 01:35from Yale New Haven Hospital in 2019,
• 01:38and she was recognized as an emerging
• 01:40leader by the AH PM American Academy
• 01:43of Hospice and Palliative Medicine,
• 01:45Neuro Palliative care Special
• 01:47Interest group in 2020.
• 01:49Anna has published a number of
• 01:52outstanding essays in JAMA,
• 01:54the New England Journal,
• 01:55the Paris Review, and elsewhere,
• 01:57and many of these essays explore
• 01:59different aspects of language and medicine,
• 02:01and we'll talk more about that.
• 02:02Today.
• 02:04Her first novel,
• 02:06A history of present illness.
• 02:09Was published this past August
• 02:11and a new novel.
• 02:12Which we will talk also
• 02:14about in a little bit,
• 02:16which will be published in 2024.
• 02:20And I will just say that
• 02:22Anna's writing is lyrical.
• 02:24It's an intense it's often dark
• 02:26blazes with intelligence and wit.
• 02:28In ever present curiosity and questioning,
• 02:31she calls out the hypocrisies of
• 02:33medicine and explores them in a really
• 02:35kind of unique and wonderful and
• 02:37interesting way and really makes us
• 02:39think about what we take for granted in
• 02:42this bizarre field that we we are in.
• 02:45And some of you are thinking of joining so.
• 02:49Welcome.
• 02:51Thank you. Thanks for that intro.
• 02:53Do you know what the Banister award is?
• 02:56Do you want to know fastest door to
• 02:59needle time for TPA administration?
• 03:02Thank you. Yes. Yes. No.
• 03:05It kind of like sits oddly on my otherwise
• 03:08literary CV that I once did of all
• 03:10of the residents perform the fastest
• 03:13ordinal time for TPA administration.
• 03:15Yeah. OK, I'm going to read
• 03:19a little bit from the book.
• 03:21I do want to say I'm so happy
• 03:22to see all of you here and our
• 03:24our zoom audience as well.
• 03:25It means a lot to me to come back to
• 03:28this place where I spent so much time.
• 03:31Thanks for coming.
• 03:38Bedside manner.
• 03:42There's something I want to tell you
• 03:45so that we can agree that it matters.
• 03:48It's about my last patient, the last for now,
• 03:51a younger woman with a slow encephalitis,
• 03:54a spreading inflammation
• 03:56in the tissue of her brain.
• 03:59In an early draft, I had been calling
• 04:01her the woman within cephalic itis,
• 04:04because giving her a name that
• 04:06can't be her own felt so false.
• 04:08But now I'm calling her Aida.
• 04:11And the false name is starting to fill
• 04:13up with her and hurt in another way.
• 04:16I miss her.
• 04:17She'd been fine just fighting fevers
• 04:20once we had the seizures under control,
• 04:23but then she began to forget things
• 04:25like the year or her address,
• 04:28or the last thing she ate,
• 04:29or the last thing she said.
• 04:32Despite all our tests,
• 04:33we still did not know why she
• 04:36was losing her mind.
• 04:38After a while, she was in a coma.
• 04:41And I would sit with her
• 04:42husband after a long day,
• 04:43wishing I were at home.
• 04:46He told me how they met.
• 04:48There was only one chair
• 04:50in the room by her bed,
• 04:51so I sat on a step stool
• 04:54near his feet like a child.
• 04:56While he spoke,
• 04:57he laughed a lot and looked at
• 04:59his wife as though he could
• 05:01see through her into the past.
• 05:03All manner of things I thought,
• 05:06can be well.
• 05:08While she was awake,
• 05:10Ada had a view of the river and
• 05:12kept a set of binoculars by the window.
• 05:15In my downtime,
• 05:16I would sit in a chair and examine
• 05:18the opposite shore.
• 05:20I knew from my walks outside the
• 05:22hospital that men fished on the banks
• 05:24along that river and on the streets
• 05:26between delis and dollar stores.
• 05:28Dominicans played checkers on legless tables,
• 05:30the players balanced on their knees.
• 05:33An old arsenal beside the hospital housed
• 05:36the largest men's shelter in the city.
• 05:39During the day,
• 05:40shelter men would stagger the
• 05:42streets high on synthetic marijuana,
• 05:44just oregano or some plant matter
• 05:47sprayed with chemicals made in a lab,
• 05:49labeled spice or smoking incense and
• 05:52sold behind the counter in the delis.
• 05:56The men who smoked it had resin stained
• 05:58fingers and would freeze in place,
• 06:01dazed and sometimes even stand stock still
• 06:04in the street as if they were dreaming.
• 06:08This was the neighborhood,
• 06:09but not what you saw from aida's window.
• 06:12Her view was a bland line of condos
• 06:15and trees shrouding paths along
• 06:17the opposite side of the river.
• 06:20We were only killing time.
• 06:23Because her arms were black with
• 06:25bruises and she couldn't remember
• 06:26what any of the tests were for,
• 06:28no matter how often we reminded her,
• 06:31she would shout and swear at the staff.
• 06:34When her husband couldn't
• 06:36be there to redirect her,
• 06:38she would often end up tied to
• 06:40the bed for trying to get up
• 06:42or taking a swing at someone.
• 06:45And then, just as fast,
• 06:47like an amnesiac on television,
• 06:49she would come back to us blinking, and ask.
• 06:52Where am I?
• 06:55I don't know what it means to suffer.
• 06:59I tried to feel it out.
• 07:01When someone is dying and then they die,
• 07:05what hits you first is relief.
• 07:07Permissiveness.
• 07:08A broad calm for a moment, world without end.
• 07:15Then some deaths just grab you by the throat,
• 07:18remind you of the balance of the game.
• 07:20Remember looking in the mirror as a child,
• 07:23saying your name, this face,
• 07:25you'd think these hands,
• 07:27this house and yard and mother going to
• 07:30bed without dinner on cabbage night,
• 07:32jumping from the roof of the shed.
• 07:34The bravery of it all.
• 07:36The obvious import.
• 07:38But this is how it ends.
• 07:40Surrounded by strangers,
• 07:41your clothes cut off with shears,
• 07:43cold blue hands and gone then,
• 07:45with your body humiliated
• 07:47and left alone to stiffen.
• 07:50In the trauma Bay,
• 07:51once I watched this a cardiac arrest,
• 07:53the patient gone too long for us
• 07:55to be able to bring him back.
• 07:57A nurse got a shock from an
• 07:59ill timed defibrillator and
• 08:00fell to the floor unattended.
• 08:02I picked up his wallet,
• 08:04not the nurses, the Deadmans,
• 08:06which was worn from the specific
• 08:08ways he had handled it,
• 08:09but was now done forever
• 08:11with being in his hands.
• 08:13When my great loss comes,
• 08:14I hope I scream like his
• 08:16wife and fall to the floor,
• 08:18not keep still and silent as
• 08:20my heart explodes in my chest.
• 08:24The obvious, a poet said,
• 08:27is difficult to prove.
• 08:30The hard part is I want to tell the truth.
• 08:33Meaning what exactly?
• 08:34We're schooled in taking,
• 08:36not giving a history.
• 08:38We're taught to reach first
• 08:40for open-ended questions.
• 08:43How, you ask,
• 08:43can earn an answer closer to the truth.
• 08:46For example,
• 08:47you don't ask someone if she drinks,
• 08:50you say how much do you
• 08:52drink on the average day?
• 08:54You don't ask if someone is
• 08:56compliant with his medications.
• 08:57You ask how often do you miss a dose.
• 09:01We're told to normalize
• 09:02our queries about drugs,
• 09:03sex and death by asking them to everyone.
• 09:06But in practice,
• 09:07you will not ask a healthy young person
• 09:09or a child's parents if they want to
• 09:11be resuscitated when their heart stops.
• 09:13You will not ask a frail old
• 09:15grandmother if she has sex with men,
• 09:16women, or both.
• 09:18And we run tests anyway.
• 09:20For the real truth,
• 09:21try to lie on a serum test for syphilis.
• 09:24People will certainly surprise you.
• 09:28We had a man once who smoked
• 09:30cocaine in his hospital bed while
• 09:32admitted for active tuberculosis.
• 09:34The doctors laughed about this,
• 09:36laughed at him behind doors in other rooms.
• 09:40What are we even doing here?
• 09:41They said, laughing to one another.
• 09:44Meaning this was not someone
• 09:46who was going to get well.
• 09:49On the other hand,
• 09:51who would?
• 09:52Some morbid social scientists ran
• 09:54studies in a lab where volunteers took
• 09:57a test on an unrelated subject while the
• 10:00screen flashed small subliminal messages.
• 10:03Pictures of skulls or graves,
• 10:06I guess, or words like death,
• 10:08some classic, unsubtle memento Mori.
• 10:11Afterward, in a variety of surveys,
• 10:13the subjects who were primed
• 10:15with death reminders showed some
• 10:17dark and predictable tendencies.
• 10:20They were racist, for example,
• 10:22and would behave with overt hostility
• 10:24toward people who appeared to be from
• 10:27different cultural or religious groups.
• 10:28The scientists let the subjects force the
• 10:32outgroup strangers to take shots of siracha,
• 10:35a validated measure of aggression
• 10:37known as hot sauce allocation.
• 10:40They suppose that the provoked bigotry
• 10:42was the subject's way of making meaning,
• 10:45of asserting their belonging to a
• 10:47group that would be here after they die.
• 10:50The social scientists dubbed this terror
• 10:53management our dull means of evading deaths,
• 10:56aggressive senselessness.
• 10:59I brought it up at a dinner party once.
• 11:02I've been invited out with two
• 11:04classmates by a Dean to a club in town.
• 11:06A club for members only.
• 11:09The rooms had tall drapes on tall windows,
• 11:11leather chairs hunched around fireplaces,
• 11:14obscene martinis,
• 11:15each served with a second metal glass.
• 11:18The Dean, of course,
• 11:20was a doctor too,
• 11:21and occasionally wrote poetry.
• 11:22He had selected us personally
• 11:24for a discussion of the arts.
• 11:26I thought a poet Dr.
• 11:28should be his game as anyone
• 11:29for talking about death.
• 11:30But he wouldn't even let me get started.
• 11:33The classmates,
• 11:34both men and poets too,
• 11:37talked the way we were meant to about
• 11:40schools they had attended traveling abroad,
• 11:42minor celebrities they all knew and common.
• 11:45On the tour of the club,
• 11:46we took after cocktails.
• 11:48There was a painting smaller than a breadbox,
• 11:51kept behind a little curtain
• 11:53to protect it from the light.
• 11:55Although the curtain was pulled back for us,
• 11:57I don't recall the painting in the slightest.
• 12:01I wanted to ask the Dean about
• 12:03how our terror might be managed in
• 12:05the hospital where we walk around
• 12:07primed with death all day and care.
• 12:09It has been shown more poorly for the
• 12:11poor and the disabled and people of color,
• 12:14groups from which doctors largely
• 12:16do not come.
• 12:18The Dean and the poets and I were all white.
• 12:19In fact, everyone at the club I
• 12:21could see was white except the
• 12:23man who served the martinis.
• 12:24The dinner was one with courses and
• 12:26all kinds of forks and different
• 12:28wines to match the different meats.
• 12:30I had a drunk underwater feeling
• 12:32by the time it was time to leave.
• 12:34I managed, I think,
• 12:35not to say much of anything.
• 12:39The taxi drivers were on strike that week,
• 12:41so I walked fifty blocks home
• 12:43with one of the poets, he said.
• 12:45He planned to become a brain surgeon.
• 12:47He was from an Orthodox Jewish family,
• 12:50but he wanted me to know he
• 12:52didn't believe in all that.
• 12:53He objected to anything he couldn't prove.
• 12:56All sandpiles have the same slope,
• 12:59I told him, and no one knows why.
• 13:01Is that true? He asked. It might be.
• 13:04If not, there's still gravity.
• 13:07There's still time.
• 13:08Still, the way it sometimes seems to
• 13:10matter that any of us were ever even born.
• 13:13He said he'd nearly died just
• 13:14before he was a teenager. Leukemia.
• 13:17And while his family took his
• 13:19survival as a sign from above,
• 13:21he finished chemotherapy as an atheist.
• 13:24He wanted to know what I believed.
• 13:26These were the conversations I always
• 13:28started after being out drinking,
• 13:30though I never wanted to answer
• 13:32the kinds of questions I asked.
• 13:33He said he hated hobbies,
• 13:36hated leisure, hated music,
• 13:38any diversion without immediate use.
• 13:42His indulgences were cooking
• 13:44and the artful plating of food.
• 13:47And poetry,
• 13:48of course.
• 13:49I later learned that his was terrible,
• 13:51all literal and grim.
• 13:53He did have one about a BBQ that
• 13:55ended in a way I sort of liked.
• 13:57Some days it is hard to believe
• 14:01everyone dies only once.
• 14:04And just try to be a smoker in
• 14:05a place like this.
• 14:07When my classmates found me with a cigarette
• 14:08on the corners where I hid between lectures,
• 14:10they would avert their eyes or
• 14:12actually cross the street in silence.
• 14:14But a few of them,
• 14:15even June and the Texan,
• 14:17always after they've been drinking,
• 14:18with or without me,
• 14:20often sought me out and
• 14:22asked for one as a treat.
• 14:24Once I was on the corner with just the Texan,
• 14:26and one of the shelter men approached us.
• 14:28He must have missed last call,
• 14:30gotten locked out for the night.
• 14:32His speech was slurred,
• 14:33but I gathered he was after a cigarette.
• 14:35He stood too near to us,
• 14:37swayed a little.
• 14:38I worked the lighter for him
• 14:39and he thanked me and left,
• 14:41and the Texan said that was a close one.
• 14:44He helped lead a clinic where the
• 14:46students practice taking histories
• 14:47and doing physicals on the homeless.
• 14:49He said he could stand the
• 14:51shelter men in the clinic,
• 14:52but on the street they
• 14:53made him a little sick.
• 14:55Is that wrong? He wanted to know.
• 14:57But why would I be the one to tell him?
• 15:01The clinic was in a church basement
• 15:03and a blacker part of town.
• 15:04It too was a club for members only.
• 15:07In our year it was run by the Texan
• 15:09and a woman on a military scholarship,
• 15:11one way to afford the six figure tuition.
• 15:15She did not have the teeth
• 15:16of a person raised poor.
• 15:18But why else would you join the military?
• 15:21I had applied for a spot at the clinic, too.
• 15:23You had to write an essay.
• 15:26I did not know yet.
• 15:27You aren't allowed to talk
• 15:29about poverty from inside of it.
• 15:31You could only look back on it.
• 15:33I wrote about never having health insurance,
• 15:35knowing how it feels to be sick and afraid.
• 15:38But the clinic decided, the Texan said,
• 15:40to go in a different direction.
• 15:43I voted for you, he said in earnest.
• 15:45But he had to let me know I had provoked
• 15:47some ill will among my classmates,
• 15:49particularly the woman in the military.
• 15:52She was upset, he said,
• 15:53over something I said in psychiatry class.
• 15:56They let you practice on them as well.
• 15:58The patients with psychiatric illness,
• 16:00they consent because they don't know not to.
• 16:03They had brought in a small middle-aged
• 16:06Ecuadoran man who stood before
• 16:08the class and answered questions
• 16:10about why he had been locked up.
• 16:12He was wearing pajama pants and a
• 16:15hospital gown with another gown
• 16:17over it backwards like a Cape.
• 16:19He had been escorted through the open
• 16:21air from the hospital to the lecture
• 16:23hall by a pair of student volunteers.
• 16:26His condition, his disorder,
• 16:27was that he tended to believe you were
• 16:30in love with him, you being anyone.
• 16:33And he lost his job after making
• 16:35passes at his boss,
• 16:36left his wife,
• 16:37and now had been tossed
• 16:38from his uncle's house,
• 16:40for he had thought even that grizzled
• 16:42old man was in love with him.
• 16:44And he had an enamored and heartsick
• 16:46way of telling all this because
• 16:47at first when he was locked up,
• 16:49he knew his doctor was in love with him.
• 16:52But now on the pills they made him take,
• 16:54he had a shake in his hands and
• 16:57no idea who loved him at all.
• 16:59The doctor leading the class,
• 17:01a man with slick hair and a keen interest
• 17:04in what's called bench research,
• 17:06ask the man if he could have been
• 17:08mistaken about the boss, the uncle,
• 17:10the doctor upstairs. No, he said.
• 17:13They all did love me once.
• 17:18So much of medicine is just
• 17:20learning the words for things.
• 17:21In psychiatry, for example,
• 17:24hallucination is perception without
• 17:26an object, while illusion is true
• 17:29perception interpreted incorrectly,
• 17:31like seeing tree branches as reaching
• 17:33arms or hearing murmured voices
• 17:35in the susurrus of running water.
• 17:38A delusion is a deeply held
• 17:40belief that is either false or at
• 17:43least said the doctor leading the
• 17:45class unshared by your community.
• 17:47This struck me as an odd caveat.
• 17:50I imagined any truth teller,
• 17:52Copernicus or whoever meeting the criteria
• 17:55for delusional disorder is the exception.
• 17:57I asked him in class for religion.
• 18:01Is the delusion of chosen ones,
• 18:03of resurrection,
• 18:03of the reign of an all knowing skyman,
• 18:06somehow less insane if enough
• 18:08of us agree to share it?
• 18:10You don't have to say things like that,
• 18:13the Texan told me later.
• 18:15The woman in the military was
• 18:17evangelical and offended.
• 18:19I've seen her in pictures beaming
• 18:21and fatigues posing with guns
• 18:22of all shapes and sizes,
• 18:24even the large lead pipe ones
• 18:27that shoot rockets or grenades.
• 18:30There's a bit here about a
• 18:31fetus getting an autopsy.
• 18:31I think I'll just skip it.
• 18:35I pray. Only in dreams where I'm dying.
• 18:40And I often die in my dreams, or am dying
• 18:42buried in rubble after an explosion,
• 18:44or in a falling elevator or a crashing plane.
• 18:47But in waking life, I'll still sometimes
• 18:49get an urge to pray on the subway,
• 18:52say in the tunnel parts that wind
• 18:54under rivers or on the bridges,
• 18:56or when there's smoke in a station,
• 18:57or when the lights go out on the train.
• 19:01There is one prayer I know will be answered.
• 19:04Lord, let me suffer a lot
• 19:06and then let me die.
• 19:08But I all know.
• 19:09I also know our father and some psalms.
• 19:11I know faith is the substance of
• 19:13things hope for, and the evil of
• 19:15the day is sufficient thereof.
• 19:16And I'm jealous sometimes of the
• 19:18lives of my peers or patients
• 19:20or families who find comfort in
• 19:22icons or in saying the rosary,
• 19:24who keep from collapsing in the face of
• 19:27tragedy by leaving some book with heavy
• 19:30pages open significantly on the bed.
• 19:32It's too easy to dismiss the
• 19:35comforts you cannot have.
• 19:38After the dinner at the club,
• 19:40the very next day,
• 19:41I got called into the office of that Dean.
• 19:45Because I was afraid,
• 19:47or for whatever reason I didn't go for weeks.
• 19:50When I did go,
• 19:51I found he did not want to see me,
• 19:53but had left for me a copy of a poem
• 19:55written by a woman who had been born
• 19:58and also buried in the city where I was born.
• 20:00It said,
• 20:01among other things,
• 20:03the doctors should fear arrogance
• 20:06more than cardiac arrest.
• 20:08I didn't know and didn't ask
• 20:11if this meant him or me.
• 20:28Thank you so much so.
• 20:32It's fun to hear that read aloud.
• 20:34Having read it a couple of times,
• 20:37I want to ask you just to see if
• 20:39you can just start by kind of giving
• 20:41people the gestalt of your book.
• 20:43And how would you summarize
• 20:45what happens in that book?
• 20:48Someone describes it as a heavy on
• 20:51style and low on plot, which is fair,
• 20:54but it is a basically a depiction of
• 20:57medical school in in no particular order,
• 21:00though it does start with
• 21:02anatomy and end with graduation.
• 21:03The rest of it's a bit scrambled.
• 21:07The the book is essentially about
• 21:09medical school as a as a form of trauma.
• 21:13And how traumatizing it is for
• 21:15the students who undergo it.
• 21:17Just the experience,
• 21:18not only of learning about
• 21:20death from seeing it at scale,
• 21:22but also the way that the hospital
• 21:25is the hospital as a as a mechanism
• 21:28with its own interests, which are not,
• 21:30you know, patient centered.
• 21:35Thank you so when I was starting this book.
• 21:40I guess I want to talk about
• 21:42kind of like this fiction
• 21:43and the doctor writer.
• 21:44And so when I was starting and I was a
• 21:47few pages in, I thought, OK, this is
• 21:49another like typical doctor writer book.
• 21:51I mean that only lasted like 2 pages,
• 21:54as you can hear from from Anna style.
• 21:56It's not like a typical kind of doctor memoir
• 22:00for those of you who are familiar with those.
• 22:03And you know most people who go through the
• 22:07writers workshop here at the medical school,
• 22:09and that's How I Met Anna a couple of years
• 22:12ago and she took part writing nonfiction.
• 22:14And just a few people,
• 22:16maybe 15% or 10% of people over like 19
• 22:20years of this workshop have written.
• 22:22Fiction and I'm just curious
• 22:25about why you think that is.
• 22:28Why do why do residents and not just
• 22:30residents but why do most doctors who.
• 22:32Right.
• 22:33Want to write nonfiction or try
• 22:35to unpack their experiences in
• 22:38more kind of memoir than creating
• 22:40something new with fiction?
• 22:43Yeah. I was at first surprised,
• 22:45but I think in retrospect it
• 22:47makes sense that the proportion
• 22:49of Writers Workshop participants
• 22:50who write nonfiction is so high.
• 22:53I think. It must be.
• 22:55There's a kind of availability to
• 22:57just describing things as they occur.
• 22:59And. As we were discussing earlier,
• 23:02I find it incredibly limiting
• 23:04to imagine that someone could
• 23:06like go through and somehow fact
• 23:08checked the thing that you created.
• 23:10Like is. Is this real?
• 23:12But the real answer to why
• 23:14I write fiction is that.
• 23:16The the third genre is poetry
• 23:18right in the in the Big Three.
• 23:21If you can put playwriting
• 23:22up there I guess it's fine.
• 23:23But I was a poet when I started writing.
• 23:25That's all I wrote when I
• 23:27was young and into my 20s.
• 23:28I wrote poetry and I compromised
• 23:30with myself to write fiction
• 23:33because I know nobody reads poetry.
• 23:36This is this is what I said my
• 23:37poet friends get very upset when I
• 23:39explain things in this in this means.
• 23:40But I think that fiction goes further
• 23:43than poetry and arguing for itself and.
• 23:46Making other people if it if the path
• 23:49is to use sound sense and emotional
• 23:52experience to create like a piece of
• 23:55reality that you can hold in your hand.
• 23:57The way that poetry does
• 23:58it is so impressionistic,
• 23:59and then fiction works harder
• 24:01to put it into a built world.
• 24:03This is about as far as I can go.
• 24:06I don't think that nonfiction
• 24:07is a place beyond that.
• 24:09It's like it's a different
• 24:10animal and it's not an animal.
• 24:12I know it's not even an animal
• 24:15I'm particularly interested in.
• 24:17You've
• 24:17written a couple of really
• 24:19good nonfiction essays.
• 24:22What's the story with those?
• 24:24I mean why when you started like with
• 24:27those particular essays and you wrote
• 24:29about eponyms and in another one you
• 24:31wrote about the language that we used in
• 24:33to describe death or something like that.
• 24:35And so like why, like when you started those,
• 24:37were you thinking this is
• 24:39nonfiction versus fiction or?
• 24:41When does it come to you?
• 24:43There's something there
• 24:44about forming an argument.
• 24:46I think maybe, maybe this is
• 24:48completely off the top of my head,
• 24:50but sometimes when you're writing nonfiction
• 24:52you do think that you have a point, right?
• 24:55A point. I I know,
• 24:57I I know something I'm in possession
• 24:58of a piece of perhaps knowledge,
• 25:00and I could share it in
• 25:02this form of argumentation.
• 25:04If if you call a non fiction argumentation,
• 25:07then it makes it really obvious that
• 25:09fiction is which is not that it is.
• 25:11It is experiential, not argumentative.
• 25:16So that might be it, you know,
• 25:17because a few things.
• 25:17So you're going to talk
• 25:18about the eponyms thing.
• 25:19I just like all of those essays were
• 25:22just basically a written out argument.
• 25:24Directed at a specific person
• 25:26that I was trying to like,
• 25:28explain myself to,
• 25:29but fiction is not a way
• 25:31of explaining yourself.
• 25:36Good good answer.
• 25:39I wonder if it's a different one every time.
• 25:41I know it's fun. So, kind of continuing
• 25:44on this, this train of thought,
• 25:47I'm I'm kind of fascinated by your.
• 25:51We we spoke earlier today about
• 25:53this book and the the book that's
• 25:54coming and I just heard a little
• 25:56bit about that and that's also
• 25:58written in the first person.
• 25:59And I'm so curious about this
• 26:02first person narrator in just this
• 26:04style of of having a first person.
• 26:09And. How it gives the feel you really it
• 26:13creates this real ambiguity for the reader.
• 26:16Like, is this true? I know everybody,
• 26:19everybody in the writers workshop who
• 26:21read or heard some of your book case
• 26:23this memoir disguised as fiction.
• 26:25Is this fiction that's supposed
• 26:27to look like memoir? Like what's?
• 26:29What's going on there?
• 26:32I think that the when you encounter a
• 26:35text the more you can remove anything
• 26:37that points to the artificial,
• 26:39the more engaged the reader is going to be.
• 26:42So what is artificial?
• 26:43We were talking about the the third person,
• 26:46the construct of the third person
• 26:48that's so artificial to my ear,
• 26:50which doesn't mean that I mean I read tons
• 26:51of really amazing third person fiction.
• 26:53I can't write it.
• 26:54What I write is the voice of a person
• 26:57who's speaking to you telling you a
• 26:59story because that's a stories were
• 27:01when we started when most people.
• 27:02Couldn't read or write.
• 27:03We talked to each other in this way.
• 27:06So if you can remove the artifice
• 27:09of anything constructive,
• 27:10sometimes even like plot is gone.
• 27:12But certainly there's no,
• 27:13there's no like omniscient narrator
• 27:14that that doesn't exist at all,
• 27:16that it's just a person who's
• 27:18telling you a story.
• 27:19And the person who tells this
• 27:22story is not me.
• 27:24But is someone very similar to me,
• 27:26is someone very similar to me and someone
• 27:28who's had a lot of my same experiences.
• 27:34Definitely not and and so this
• 27:37this narrator who is definitely not you
• 27:39rights often as as you all heard and kind of.
• 27:43I wouldn't say stream of consciousness,
• 27:44but I would say kind of.
• 27:47I don't know what the right word is.
• 27:48Just kind of like desultory,
• 27:49like jumping from one thing to
• 27:51another and something else comes
• 27:52into her mind and she goes off
• 27:54topic and and that there's this kind
• 27:56of jumpiness feeling to the book,
• 27:58which I think creates this kind of like.
• 28:00Weird. Anxiety. I don't.
• 28:03Or at least in me as I was reading it.
• 28:05And so yeah, I want, I want.
• 28:08I'm curious about how it
• 28:10was that like this book,
• 28:11only in the in your new book is is it
• 28:14more kind of a traditional thread or
• 28:16is this just your style, and if so.
• 28:20Talk about if so, why? Why?
• 28:23Why?
• 28:27Well, this book is about trauma,
• 28:30as I already said.
• 28:31I think that for those of us who have
• 28:34in our real lives experienced trauma,
• 28:36the way that you recollect it is
• 28:39involuntary and peacemeal. Um.
• 28:41When you try to take an experience
• 28:43that you have had and assemble it
• 28:46into something that means something,
• 28:49unless that story is very,
• 28:50very simple, the assembly of
• 28:52that story is going to be a mess.
• 28:55It's it's associative,
• 28:57it's it's collaborative,
• 28:58it's it's a collage.
• 28:59When I was working on this book in this way,
• 29:03what came to mind as I meditated
• 29:06on the problem of each chapter?
• 29:09I arranged it in this way.
• 29:11I think it's because of trauma.
• 29:12So what does trauma do to identity?
• 29:16It destroys it. It dissolves it.
• 29:19Being unable to form a coherent
• 29:21sense of yourself is is a symptom
• 29:23of chronic trauma. It's a.
• 29:25Problem is, the narrator of this book
• 29:27has as they attempt to rid themselves of
• 29:301 identity and give themselves another.
• 29:33They don't know who they are,
• 29:34they don't know where they are.
• 29:36Um, so I think the.
• 29:40The time shifts and the collage
• 29:42assembly is part of the recreation
• 29:44of this almost like adolescent
• 29:46desire to self assemble in the
• 29:49in the setting of post trauma.
• 29:51Um, I think my editor was
• 29:53delighted to see the new book is.
• 29:55Much more linear, I think she was.
• 29:58It's also written in the present tense,
• 29:59the new book.
• 30:00It is a book that lives in the now
• 30:03and moves forward into the future.
• 30:06And and this is this is a history.
• 30:09Yeah, actually,
• 30:10let's, let's talk about the title
• 30:13since you said history and.
• 30:15I have to say that so many
• 30:17times when I was writing,
• 30:19writing up my materials for like,
• 30:20advertising this talk and all the
• 30:22other stuff you've done today,
• 30:24I kept having to go back and
• 30:25look at the actual book because
• 30:26I couldn't remember if it was
• 30:28history of the present illness or
• 30:29the history of a personal illness
• 30:31or history of present illness.
• 30:32And so, you know,
• 30:33obviously, very carefully,
• 30:34you chose a history of present illness.
• 30:37One I've I've been like
• 30:39obsessing on what that means,
• 30:40and I would like to hear what you what you.
• 30:43Why you chose this particular phrasing
• 30:45of a history of present illness.
• 30:47I want to agree that it's
• 30:49like such profundity.
• 30:49I'm not going to do this.
• 30:51When I wrote the book,
• 30:52I called it in the hospital.
• 30:54In the hospital was the name of the book.
• 30:56And it's from a joke.
• 30:57I don't know if you guys seen this.
• 30:58It's a joke on Twitter about
• 30:59like a young Doctor Who calls
• 31:01their mom at night and says,
• 31:02like, mom, I'm in the hospital.
• 31:04And their mom was like, yes,
• 31:05you work in the hospital,
• 31:06you're resident.
• 31:07That's where you are.
• 31:08So the sales people thought there
• 31:09was a Super Bad title and they
• 31:11had some terrible ideas about
• 31:12what it should really be called.
• 31:14Some like sad lady doctor stuff.
• 31:16And this was my this was my counterpoint.
• 31:20It's a it's a tough title because
• 31:22it's a the the book is about a person
• 31:25with an illness that the narrator of
• 31:28the book is suffering from some things,
• 31:30psychiatric doing their best.
• 31:35But I think the illness is systemic.
• 31:40And the history is is just a depiction of
• 31:44the the present as it's encounter. Um.
• 31:47The history, that'd be pretty aggressive.
• 31:50I don't know.
• 31:51I'm kind of a vague person.
• 31:53Yeah,
• 31:53no,
• 31:53I think it's perfectly vague and a
• 31:56history because it also just kind of
• 31:58plays on the whole unreliable narrator.
• 32:00Like it's just one of many possible ways of
• 32:02who's who's history, who's history.
• 32:05No, I think it's. I think it's
• 32:07actually a brilliant title.
• 32:11Some of the stuff that you just read
• 32:12in the Charter wanted to ask you about,
• 32:14so this this patient that you
• 32:17talked about named ADA or who
• 32:19you call ADA with encephalitis,
• 32:21she's one of the few kind of threads
• 32:23throughout the book who keeps popping
• 32:25up amidst all of the kind of jumpiness
• 32:27and stream of consciousness feeling,
• 32:29oh, there she is again.
• 32:31So what, what is the story with her
• 32:33and why her story was so important to
• 32:36kind of provide some linearity to this?
• 32:39There's a really startling
• 32:41aspect of medical training,
• 32:42which is the way that you
• 32:44encounter these difficult things.
• 32:45Systemically difficult.
• 32:45But then just like body difficult,
• 32:47just life difficult.
• 32:49Existentially difficult.
• 32:50And they just you walk in one day and you
• 32:52watch someone die and then you leave,
• 32:53or you take care of someone while they
• 32:55go through surgery and then you leave.
• 32:57You're always like going off service.
• 33:01It's a bit of a tangent,
• 33:02but I had the experience
• 33:03recently of attending a funeral,
• 33:04which I don't normally
• 33:05do a patient's funeral,
• 33:06and I realized that it's something
• 33:09I should do more because it places.
• 33:12The death in the context of a
• 33:14life and it places the death
• 33:16in the context of a community.
• 33:18Whereas if you're just like.
• 33:20In this place, these rooms,
• 33:22this hospital,
• 33:22just like watching these terrible
• 33:24things happen without any context,
• 33:26it's so dismantling.
• 33:30So there are times,
• 33:32and in different specialties you
• 33:34encounter continuity differently.
• 33:37But there are times when you meet
• 33:39someone in one state of health
• 33:41and you follow them to the end.
• 33:43And I did in medical school rarely.
• 33:47But there was a there was a a few cases.
• 33:50I did it with one particularly
• 33:53that I I drew on a lot as I.
• 33:55Wrote this out.
• 33:57Because.
• 33:59If we don't understand that
• 34:01the patients are real,
• 34:03then our work doesn't matter.
• 34:05And to understand that something is real,
• 34:07I think like the duration of time,
• 34:09the experience of suffering through
• 34:11time is a huge part of reality.
• 34:15So I did want to have a case
• 34:18that went on and on.
• 34:20So that there was a thread that
• 34:22wasn't about the narratives,
• 34:23personal history or about the
• 34:24pedagogy of medical school,
• 34:26because the most important thing
• 34:27in our work is the patient and
• 34:30what the patient needs from us,
• 34:32what we can do for them and
• 34:33what's in their best interest.
• 34:35So a threat of that,
• 34:37it was absolutely necessary.
• 34:39And then I found it.
• 34:45Thank you.
• 34:48I want to talk about truth and language.
• 34:54Tell me more about that.
• 34:55So the narrator is cynical
• 34:58about language and its limitations, right?
• 35:00The thing you said about like that,
• 35:02you just read in that sample about?
• 35:05Umm. And we run tests anyway
• 35:07for the real truth, right?
• 35:09Try to lie on a serum test for syphilis.
• 35:11And there's another.
• 35:13Quote that I I may not have exactly right,
• 35:16I think in the next chapter.
• 35:18It matters most because it happened.
• 35:20If you learn to tell it right,
• 35:21you learn to leave things out until
• 35:23truth is what it sounds like.
• 35:26And that to me just sounded
• 35:28like a metaphor for writing.
• 35:30Fiction or nonfiction or something
• 35:32like the way that we just
• 35:34kind of craft our stories by.
• 35:36We take this kind of like mess of
• 35:38experience and then kind of trim it away.
• 35:41This is what we're doing in
• 35:42the writers workshop, right?
• 35:43It's just trying to find the story
• 35:45and a bunch of messy feelings.
• 35:47I'm not sure what I'm asking you,
• 35:49but
• 35:49no, it's great that sure. That's fine.
• 35:51We were talking about the the short
• 35:53fiction writer Amy Hempel earlier today.
• 35:55She said that mentor of mine
• 35:56and a huge inspiration.
• 35:57She wrote a story that's called the Harvest.
• 35:59That's about a woman who gets in a
• 36:03motorcycle accident and the story
• 36:05goes for a certain duration and
• 36:07then it stops and then it says,
• 36:09I think the transitional phrases I leave
• 36:12a lot out when I tell the truth and
• 36:15then it tells the whole story again as.
• 36:18Uh, like a revised version.
• 36:20Like, oh, what I said before wasn't true.
• 36:21And this is the truth.
• 36:23And the whole story is is a work of fiction.
• 36:26And when when I encountered it,
• 36:27for me it it's it's a great lesson in
• 36:30process because the question is like
• 36:32what are the things that we need to
• 36:34leave out of our experience to make it
• 36:37strike others as though it were true?
• 36:40What are those things? When I.
• 36:43When I do it as a writer,
• 36:45I don't think I'm super conscious
• 36:46of what I'm up to.
• 36:48But when I try to teach it
• 36:51to writing students.
• 36:53What I tell them is that you
• 36:55have to establish a case.
• 36:56And the case is like,
• 36:58it's very similar to writing an
• 36:59HP I where you have a sense of
• 37:02where you're going and what you
• 37:04leave out is what doesn't fit.
• 37:06But it's not to make an argument.
• 37:08It has a different set of parameters
• 37:10because it has a different goal.
• 37:12So the parameters become rhetorical.
• 37:15They're about rhetoric.
• 37:16They're about how to shape
• 37:18the piece so that it sounds.
• 37:20The word sounds is in the book too.
• 37:22It is. It's. It's about how it sounds.
• 37:25It's about music.
• 37:26And if you want to talk about truth,
• 37:28it's so interesting to me.
• 37:29I was talking with one of the writers
• 37:31from the workshop about music. What is it?
• 37:34Why do we feel this way about it?
• 37:36And then patterns of speech and rhythms,
• 37:39like why do we find them hypnotic,
• 37:41beautiful, persuasive.
• 37:41I don't know the answer to that question,
• 37:44but those are the senses that
• 37:46I'm attending to when I'm taking
• 37:49my real experience and rendering
• 37:51it into fiction means to.
• 37:53Bend it to accord to an internal
• 37:56standard that's related to 1
• 37:58recurrence of symbols and two sound.
• 38:04Set to abstract.
• 38:08I would like to just ask you to tell
• 38:11us a little bit about your new book.
• 38:14Yes, coming out in 2024 and then
• 38:16maybe we'll open to questions from the
• 38:18zoom audience in the live audience.
• 38:21It was very exciting to write the second
• 38:24book, and I almost just want to take this
• 38:25one and hide it and reach you all from
• 38:27the new one like I did at the dinner.
• 38:29Because I this is, this is this was the past,
• 38:32and I'm excited about the next thing.
• 38:34But one of the things about history
• 38:36is that I wrote it on accident.
• 38:38I wrote it, I collected reflections
• 38:41and I set them aside. And then.
• 38:44A series of events occurred in which
• 38:46I then was like coming back to it,
• 38:49and I put it together three years
• 38:50after I wrote it in the 1st place and
• 38:52I never thought I would write a novel.
• 38:54I can't sustain my attention for that long.
• 38:59I have a short story writer.
• 39:01I really feel that I am.
• 39:03So when it came together it was almost like.
• 39:06Like a strange little miracle,
• 39:08it didn't have that much to do with me.
• 39:10And then when I was a, I was a PG Y-3,
• 39:15no four.
• 39:15I was the PG4 neurology resident here
• 39:18in this hospital in January of 2021,
• 39:21and I had just gotten my first
• 39:24COVID shot and I thought,
• 39:25things are really going to turn around.
• 39:28And then my father died.
• 39:31And I out of nowhere.
• 39:34And it every like every mobicom of
• 39:37ideas about how to be OK in the world,
• 39:40like what it meant to suffer and what
• 39:42loss was and what was going on with
• 39:44all of the people in the world who
• 39:45were losing their loved ones to the
• 39:47pandemic suddenly had this personal,
• 39:49unbearable personal character.
• 39:51It was so painful.
• 39:54It sounds very stupid to say
• 39:55in front of an audience,
• 39:56but what surprised me most about
• 39:58the death of my father was how
• 40:00much it hurt like on a spectrum,
• 40:03on a scale that is so unimaginable.
• 40:06Like I was not able to imagine it,
• 40:08and for various reasons I
• 40:09had tried to prior to.
• 40:11It's happening many times.
• 40:14It was so painful.
• 40:15And then I had to start a
• 40:17fellowship in Hospice and.
• 40:21Which was the plan all along,
• 40:22and it's working, very passionate about,
• 40:24but it was suddenly painted with this new,
• 40:28severe sense of what death does
• 40:31to the living. I just didn't know.
• 40:34It sounds so stupid to say so
• 40:37I had to find a way to do it,
• 40:38to do the work, to keep doing the work,
• 40:40and what I did was I wrote.
• 40:43A book about. Grief.
• 40:48And this was the one when the
• 40:50when the trainees want to know,
• 40:52like, did you have a system?
• 40:54Because I did.
• 40:55On the train home,
• 40:56I wrote most of the book on the subway.
• 40:58I was back in New York,
• 40:59and I every day I had just accumulated
• 41:03all of these particularities around loss,
• 41:06and I had to do something with them
• 41:09because otherwise I couldn't breathe.
• 41:14And so that's why I wrote a book
• 41:16that started where it started.
• 41:17That's the beginning of the
• 41:18book that I read at the dinner,
• 41:19and it just goes straight through.
• 41:21And the point of the book
• 41:23was to cure my fear of death.
• 41:25And it did not work.
• 41:27But I think it's an interesting book.
• 41:30I'm excited to share with everybody.
• 41:34Thank you. Questions from. You all here?
• 41:48Hello. Thank you for being here
• 41:50tonight. I apologize if you had
• 41:51mentioned this before I came in,
• 41:53but you just now talked about
• 41:54kind of your process of writing
• 41:55on the subway or the train.
• 41:57And I'm curious about
• 41:59how like maintaining creativity
• 42:01where I think in school
• 42:03like you're it's requires
• 42:05such a kind of linearity and rigidity in
• 42:08terms of like thinking. Whereas creativity
• 42:10often is very like free flowing and
• 42:12imaginative and kind of off the cuff.
• 42:14So how to kind of Createspace for
• 42:16creativity in the midst of guess
• 42:19more rigid way of thinking and being.
• 42:24I really like that question.
• 42:26Thanks for asking it.
• 42:28I think a lot of people in in my.
• 42:31Profession are really
• 42:32intimidated by creativity.
• 42:34They're scientifically minded people
• 42:35who know how to work really hard.
• 42:37If you tell them exactly what to do,
• 42:39they can do it.
• 42:40And then if you're just like but create
• 42:43something and they get really clammy.
• 42:46For me, what I find,
• 42:47like what I was doing on the subway,
• 42:49is it could be, you know,
• 42:50reflecting on a really
• 42:52grievous moment of the day.
• 42:54But sometimes it was like
• 42:56reflecting on something that
• 42:57was surprisingly delightful.
• 42:59And when you have that picture in your head,
• 43:02you're recalling something,
• 43:03and the challenge is to kind of just
• 43:05like pop some words onto it and
• 43:07you get really interested in sound.
• 43:09And then you're trying to find
• 43:10the right words for what it is.
• 43:11And when you find them,
• 43:13you just kind of like delight.
• 43:16And it's a great way to end the day,
• 43:18especially a day in palliative care training,
• 43:21because it's it can be so sad.
• 43:24And I one thing that I do in my
• 43:26writing workshops is I really teach
• 43:28the students about two things
• 43:30phonetics and and rhetorical
• 43:31forms which does give you like a
• 43:34very rigid structure for how to
• 43:35do the thing I'm talking about
• 43:37which is playing with language.
• 43:39And then once you have that you're
• 43:41just like you're sitting on the
• 43:42bus and you're or the subway.
• 43:44I take it there's an express bus
• 43:46from the Bronx to where I work
• 43:48but it's often take the train to.
• 43:50You it's it's it's like a it's like a puzzle.
• 43:54It's so joyous.
• 43:55And I think if you can show folks how
• 43:58easy it is to do with a certain set
• 44:01of skills and how fun it is to make,
• 44:04then I think that really cracks it open,
• 44:06at least for the medical set.
• 44:07When I was not a doctor and
• 44:09just a writing teacher,
• 44:10a lot of people were like,
• 44:11this person is very strange.
• 44:13What what they're asking me to do is bizarre.
• 44:15It's rigid and it's not fun,
• 44:18but actually the medical crowds
• 44:20will really like it.
• 44:21I don't know what your background is.
• 44:23So it's interesting.
• 44:27Experience and myself.
• 44:28Like visual arts? Oh cool.
• 44:34Oh cool. Yeah, I'm super super like.
• 44:38Years in language I have no
• 44:39I have no spatial sense.
• 44:41I'm I'm a terrible visual artist
• 44:42and I don't depict things well.
• 44:44So I think people who have your
• 44:45skill set do see things differently,
• 44:47and I'd be excited to hear, like,
• 44:49how that creativity comes out differently.
• 44:57Let's do Jonathan.
• 45:01And then we'll take some soon.
• 45:13Thanks again for your great talk.
• 45:16One question that I've thought about
• 45:18and reflect on and I'm a second
• 45:20year internal medicine resident. Is.
• 45:22Like medical training? Very much so.
• 45:26Like, appropriately forces us to
• 45:29develop competency and that competency,
• 45:32especially when we're in
• 45:33high pressure situations,
• 45:35almost kind of forces you to shut off
• 45:37your emotional side and view things very,
• 45:40very objectively.
• 45:41And so one thing I've reflected
• 45:44on throughout residency,
• 45:45I don't know if you can comment on this is,
• 45:48is it like a toggle for you back and forth?
• 45:50Because I notice like when
• 45:51I'm in the patient room,
• 45:53if I need to like assess the situation,
• 45:55I'm approaching the patient certain way.
• 45:58But you know, like,
• 45:59if it's not a critical situation,
• 46:01I'm connecting with them in a different way.
• 46:04Um, and then?
• 46:05Yeah.
• 46:06So I guess that's like one question
• 46:08like balancing like the logical
• 46:11decision making assessment side versus
• 46:14like the compassion and the humanism.
• 46:16And also I don't know if you've
• 46:18reflected upon like getting too
• 46:20close versus too far away because
• 46:22like when I was a medical student,
• 46:23I was always like you got to like connect,
• 46:26you got to bond.
• 46:27But like there's some like
• 46:28really intense patient encounters
• 46:30and residency where it's like,
• 46:32I like that was a little bit too much
• 46:34not only to protect myself but also like.
• 46:37Be a good doctor for the next
• 46:39patient in the next room.
• 46:40So I wonder if those are things you've
• 46:42reflected on and wanted to share.
• 46:44Thanks.
• 46:45Did you ask if it was a a toggle?
• 46:51Is that the word you use?
• 47:06I'll talk a little while he does that.
• 47:22Hmm.
• 47:25I know what you mean.
• 47:32Yeah, I I had a very.
• 47:35Distinctive experience. At the very end
• 47:36of my intern year at this hospital,
• 47:38I was in the ICU at night and some patient
• 47:41was sort of crashing and I knew what to do.
• 47:44And I was in the room and I was
• 47:46doing what needed to be done.
• 47:47And I felt this feeling where when
• 47:49I reflected on it retrospectively,
• 47:51I thought was that indifference.
• 47:55And I talked to everybody about it because
• 47:57I'm an external processor and I was like,
• 47:58guys, I was handling it.
• 48:00I was doing everything right.
• 48:01And I don't think I cared about
• 48:02what was going on.
• 48:03And they were like, Oh no,
• 48:04you're just describing competence.
• 48:06But there was that element to it,
• 48:09that detachment.
• 48:10And there are Times Now.
• 48:12So we do have emergencies in palliative care.
• 48:15A palliative care emergency is
• 48:17a person who's dying in pain
• 48:20when you go into that room.
• 48:23Oh my goodness.
• 48:24Often when I'm functioning in that way,
• 48:26I I do what needs to be done.
• 48:28And even I know that I need to acknowledge
• 48:30the emotional experience of the families.
• 48:32And I sometimes do it in a bit of a rote way.
• 48:34I remember my nurse acronym,
• 48:36I say the things I know I'm supposed to say.
• 48:39It's a little bit of a performance
• 48:41because I'm in crisis mode in my head.
• 48:44After I leave,
• 48:45I'm able to reflect on the fact that I
• 48:48have been in crisis mode in my head.
• 48:51Usually it's on the bus or the train.
• 48:54I begin to go home and the feelings
• 48:56change because the stiff performance of
• 48:59Doctor doesn't need to be maintained.
• 49:02And then I realize how I felt.
• 49:05I'm in this reflective process
• 49:08later when I'm back in the room.
• 49:11I think it's a it's a toggle.
• 49:13I can be who I need to be.
• 49:15I still feel my feelings.
• 49:17I'm aware that they're there,
• 49:18or I know that they're coming for me
• 49:21later and will need to be attended to.
• 49:23There was a second part to your
• 49:24question that was really interesting.
• 49:25What was it?
• 49:28I guess I I noticed this when I
• 49:30work with now that I'm a resident.
• 49:31I work with younger medical students, but.
• 49:35Finding like the right balance for
• 49:37like you know you're not because
• 49:38I'm like I was the Med suit.
• 49:40I would see residents like ohh
• 49:41like somebody's residence in
• 49:42the tennis don't care at all.
• 49:43But now that I'm a resident
• 49:45and I see my students that are
• 49:47like so emotionally invested,
• 49:49which is awesome but I just see it also
• 49:51like really weigh on the very heavily.
• 49:54So finding that right balance between
• 49:56obviously caring for the patient and
• 49:59being compassionate but allowing
• 50:01herself to also you know like.
• 50:03Do your job and not get totally
• 50:06destroyed when you go home every day.
• 50:10Do you worry about the students when you
• 50:12see them like that or you do you just
• 50:14you know that they won't stay that way?
• 50:18I I mean, I don't mean to like project
• 50:21my own experience onto medical students,
• 50:24but I remember like when I was a
• 50:26third year student and like the first
• 50:28time I saw a patient get, you know,
• 50:31horrible news like I just like.
• 50:34Was this crushed?
• 50:35And I see that in 3rd year medical
• 50:38students when they experienced that.
• 50:40I also have like aware of how I've changed,
• 50:43even like the last two or three years,
• 50:45and I could probably see that
• 50:47happening in the future to the
• 50:49medical students as they continue
• 50:50to go through their training.
• 50:53Yeah. I think when we have those
• 50:55early experiences that are so painful,
• 50:57the way that the people around
• 50:59us respond to our pain really
• 51:01changes the way that we develop.
• 51:04So if you have that experience
• 51:05of an I still have to do it.
• 51:07I'm with a student and we see a palliative
• 51:11extubation and we watch a patient die.
• 51:13And they've never seen someone die before.
• 51:17And there's like a like a terror
• 51:18at an aspect of volition involved
• 51:20in the palliative extubation.
• 51:22It's a wild procedure.
• 51:23We do it very carefully.
• 51:25We do it with a lot of information
• 51:27given to the family beforehand.
• 51:28The communication aspect is huge.
• 51:30But when I see the patient,
• 51:31when I see the students see it,
• 51:33I have to remind myself that
• 51:35to the best of my ability,
• 51:37what it feels like to see
• 51:38that for the first time.
• 51:40And give them a space to
• 51:41feel whatever they feel.
• 51:42Sometimes they want to go home and
• 51:44I let them go home and go home.
• 51:46This was a big day for you.
• 51:48Umm.
• 51:51Most of the older trainees and and
• 51:54post training physicians I know err
• 51:56on the side of being too distant.
• 51:58I think that we do that because
• 52:00we feel like we have to,
• 52:02and I'm interested in alternatives to that.
• 52:05Because I don't find proximity,
• 52:08emotional proximity to patients
• 52:10to be necessarily damaging if
• 52:12you're able to have ownership of
• 52:14your own feelings so you can keep
• 52:16your feelings from harming others,
• 52:18and you have a supportive environment
• 52:20in which to sort of unpack
• 52:22and debrief that stuff.
• 52:24So my general advocacy actually
• 52:26is toward allowing yourself
• 52:27more emotional proximity.
• 52:29But it it's it has to be that kind
• 52:31of like caring proximity where
• 52:32you don't take your own views and
• 52:34superimpose them onto the patient.
• 52:36You're still respecting,
• 52:37aligning and elevating the patient's voice,
• 52:39and you care about them a lot.
• 52:43But you're also OK with what happens.
• 52:46Thank you. I'm going to actually
• 52:48discuss we're almost out of time.
• 52:49I want to just give US1 zoom question. OK,
• 52:54so we have a anonymous question.
• 52:57What I admire about this book is how poignant
• 52:59it is without being sentimental.
• 53:01How beautiful.
• 53:02But also an indictment.
• 53:03I'm curious about how you hope
• 53:05doctors would respond to the novel.
• 53:07And if that's lined
• 53:08up with the response you've gotten, what
• 53:09have you heard from readers of this book?
• 53:12That's such a nice question. Anonymous.
• 53:17I was really kind of nervous
• 53:19to publish the book.
• 53:21I thought that something
• 53:22bad would happen to me.
• 53:23It's hard to explain what I meant.
• 53:25And everyone was like on a it's lit fic,
• 53:28like no one's going to read it, you're fine.
• 53:31Well, people have read it and a
• 53:33lot of doctors have read it.
• 53:34A lot of doctors I know have read it.
• 53:36And what they say to me is that it's even,
• 53:40you know, there's a lot of
• 53:41particularity to this book,
• 53:43but the some of the aspects of
• 53:45the medical training experience
• 53:46seem to be quite universal.
• 53:48Which is terrible,
• 53:49but it's it's good to hear.
• 53:55The idea that I'm giving voice to
• 53:57something that other people have
• 53:59experienced is so touching to me,
• 54:02and that's the feedback I've largely
• 54:03gotten from the other doctors,
• 54:04at least the doctors who are talking
• 54:07talking to me about it. I imagine.
• 54:12Medical students or just post Med students.
• 54:15People reading this book
• 54:16and just thinking like, oh,
• 54:18if if I were a person like this,
• 54:19it would be OK that I was in medicine.
• 54:21That's all I really wanted to do was
• 54:23say it's a it's probably even good
• 54:24that people like us are in medicine.
• 54:28Which is surprisingly hard to say.
• 54:37Right.
• 54:43Cortana. Thank you.
• 54:47So I want to go back to the question
• 54:49that Anna asked you earlier about
• 54:51finding the truth in a messy first
• 54:54draft or whatever that might be.
• 54:56And I almost thought that you
• 54:58were going to see something about
• 55:00truthiness in in the response.
• 55:03And what, you know,
• 55:04like Stephen Colbert talked about
• 55:05truthiness or something sounds true,
• 55:07but it really isn't. And and.
• 55:10In an age where we're worried about
• 55:13things like conspiracy theories,
• 55:14you know, one of the.
• 55:16Concerns is that.
• 55:18When you when you actually create
• 55:22something that sort of has an internal
• 55:25logic to it that may sound good
• 55:27because of things like the rhythm
• 55:29and word choice and things like that.
• 55:32May in fact be potentially
• 55:34misleading and harmful,
• 55:36and needs to be distinguished from something
• 55:39that actually has a deeper truth and so,
• 55:43so I'm wondering if.
• 55:45Like,
• 55:45how do you guard between
• 55:48something that sounds beautiful?
• 55:49It's kind of the way you want things to be,
• 55:52but it veers away from.
• 55:55What you're really trying to say,
• 55:56or what you really think to be true?
• 55:59That's a really interesting question.
• 56:00It makes me wonder like what
• 56:02you're working on. Yeah,
• 56:04you're thinking, you know, like
• 56:05even say the same thing in physics,
• 56:07like everything is not going to be
• 56:08reduced to equals MC squared, right?
• 56:10Like, it's like they're like sometimes
• 56:12there's there's this notion that something
• 56:15that is beautiful is compelling,
• 56:17but may not actually be
• 56:19an accurate reflection.
• 56:21Of the world or the universe as it is.
• 56:23So I'm just sort of thinking like you,
• 56:25you if you're how do you
• 56:28root your quest for beauty,
• 56:30which has its own intrinsic value
• 56:33and something that really is what
• 56:35you truly believe to be the case?
• 56:39I don't think I'm going to
• 56:41give you a satisfying answer,
• 56:42but I'm going to tell you that I I
• 56:45don't know what I'm saying and I don't
• 56:47know what I believe to be the case.
• 56:50So that the work is the process
• 56:52of trying to figure that out.
• 56:54I want to know what I think.
• 56:56And I do my work to figure that out.
• 56:58So when you're working and you misstep.
• 57:02Because you're going towards sound
• 57:03instead of toward the other thing.
• 57:05Like whatever the other thing is,
• 57:06whatever we want to call it.
• 57:09You usually know I had a writing
• 57:11teacher who said you always knew
• 57:13you were on the right track if
• 57:15what you were doing scared you.
• 57:17And that's that.
• 57:17I mean that's kind of high stakes,
• 57:19but it's something I think about
• 57:21if you you're at a pause in this in
• 57:24the sentence and you're like what,
• 57:25which way is this going to go or is OK,
• 57:28maybe you want to talk about
• 57:30characters or plot all entertain that.
• 57:32What is the most frightening thing that
• 57:34these people could do together and do that?
• 57:39I don't know why that
• 57:40would be the right move,
• 57:41but it usually is.
• 57:44Thank you. In the interest of sticking
• 57:47to the schedule, I am going to.
• 57:50Thank you all for coming.
• 57:51Those of you who have still
• 57:53have a burning question,
• 57:54I think Anna will stick around
• 57:55for another 5 or 10 minutes.
• 57:57And thank you all for coming.
• 57:59Thank you zoom audience and
• 58:01thank you ASL interpreters.