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

February 16, 2023

ID9488

To CiteDCA Citation Guide

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.