EP. 1: FINDING MEANING IN MEDICINE

Mar 8

WITH HENRY BAIR and TYLER JOHNSON, MD

Meet the hosts of the show and hear what drew them to medicine in the first place.

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Episode Summary

Medicine is a challenging and complex, yet ultimately fulfilling vocation that has seen much upheaval in recent years, from technological disruptions to the COVID-19 pandemic. For medical student Henry Bair and oncologist Tyler Johnson, both at Stanford University, this moment calls for a mindful investigation of the factors driving those who work in health care, whether as clinicians, educators, or executives. Probing the humanistic dimensions of patient care, they explore the philosophies and realities underpinning the healthcare profession.

In this episode, you will hear about:
• What first drew co-hosts Henry and Tyler to the medical profession - 03:26
• The moments that epitomized why they pursued healthcare as their life’s calling - 10:08
• The growing pattern of burnout and alienation among medical workers - 21:40
• Previews of subjects that will be covered in future episodes of this podcast - 25:03
Henry Bair: Hi, I'm Henry Bair

Tyler Johnson: And I'm Tyler Johnson,

Henry Bair: And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor-patient connection? What can we learn about the human condition from accompanying our patients in times of suffering,

Tyler Johnson: In seeking answers to these questions we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives, those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.

Henry Bair: Welcome to the first episode of the Doctors Art, the podcast in which we explore meaning in medicine. My name is Henry Bair. I'm one of your co-hosts. I'm a medical student at Stanford University

Tyler Johnson: And I'm Tyler Johnson. I'm a clinical assistant professor of medical oncology at Stanford University and also one of the co-hosts.

Henry Bair: We would like today's episode to be a chance for you to get to know us a little bit better for us to share our paths to medicine. And for us to share our vision for this podcast. And we can expect

Tyler Johnson: Mostly we want to put out a welcome to all of our listeners, to health care professionals. We want to say we certainly see and hear and understand that the last two years have been among the most difficult for health care professionals in the last century. I think a lot of us feel that we have given all we had to give and then given a little bit more. There's been an enormous amount of attrition, and even those who are still among our ranks find themselves exhausted and often feeling worn down to the bone. We hope that for you, this podcast will help you to reconnect to the deeper reasons that brought you into medicine in the first place. We also hope that we can talk to those who are considering going into a health care field. I'm thinking here of university students who might be thinking of a career in medicine or a career in nursing or in any of the affiliated fields. We hope that you will glean from this podcast a window into why we do what we do and what keeps us going, even when things are hard. And to the general public who have no specific affiliation with the medical field, we hope that this will give you a little bit of insight into better understanding what drives people, often at great personal expense and sacrifice to go into this field that is uniquely challenging and yet uniquely fulfilling. We hope it helps you also to understand just why we do what we do.

Henry Bair: One of the things I'm most excited about this podcast is the opportunity to bring on voices from people who work across all of health care, across different specialties, whether as the recipient or provider of care. So we could get started with just sharing a little bit about our own paths to medicine and what we find meaningful in medicine. Tyler, what brought you to medicine?

Tyler Johnson: Yeah, it's an interesting question. If I am able to identify a single moment that brought me to medicine, it would be when I was about 19 years old, just starting in college, I read a book by a religious leader I really respected and admired who had been diagnosed in his seventies with acute lymphoblastic leukemia. And he had received really intensive chemotherapy and had gone into remission and was writing the book in his first remission. And in the introduction to the book, not surprisingly, he thanked his wife, his children, their spouses and friends and other family members. But then right there in the next paragraph, he specifically thanked his oncologist and his oncology nurses. And I knew by that point that I wanted to do something where I could really make a difference, and it really struck me that this person listed, for the most part, people who he had known for decades. And then right there on the same page, he was thinking people who he hadn't met until the last year, but who had been so intimately involved in this very difficult and meaningful part of his life that they became special enough to him, that he would note their place in his life right there and extend his public gratitude to them. And so that kind of started me thinking, Well, if I want to make a difference, maybe medicine is the way that I can do that. And that was that was really the beginning of my journey. What about you, Henry?

Henry Bair: I grew up in Taiwan as a third culture kid, having been really fortunate to receive a mixed Mandarin and English language education. So I got the chance to explore world literature from an early age. And I think that really informed my passion for exploring how different cultures inform individuals perception of the world around them. And I came to the U.S. for college, where I immediately took advantage of its liberal system of education, taking classes in topics as far ranging as renaissance musicology to East Asian cinema to philosophy of medicine and modern French poetry. Eventually, I found myself focused most on medieval period epics, as well as classical, Roman and Greek mythology dramas and poetry. I was very drawn to the larger than life stories of those periods. Plus, there is also something remarkable about. Seeing and hearing and reading how people human throughout the ages have struggled with the universal themes of humanity like love and suffering and loss and pain and existential angst, and seeing how those are still relevant. Later on, after I started medical school, I would look back on this time and recognize that through my humanistic pursuits, I gained the tools to consider how I can bring a wide range of the human experience to bear upon my medical work, not only to treat the disease, but also the patient to not only diagnose a disease, but also distinguish what the diagnosis means to a patient.

Henry Bair: But rewinding back to college before I knew that I wanted to do medicine, I came to a point when I started thinking, You know, I do like the classics, but do I want to enter a profession in the classics? What would that even look like? I wanted to. Be in a position in which through my job, I could. Affect tangible difference in the lives of other people. As luck would have it. I happen to know a medical humanist who knew of my interests, and he said, Hey, you know, you really enjoy listening to stories. Have you ever thought about working in a hospice? And from what he described, a hospice sounded like a perfect fit for me at the time because it was a health care setting. These patients were often in dark places in their lives, and what could make their lives a little bit better was having someone there to elicit their stories and hear them out. And so I started working at the hospice and I found it to be a very impactful, very meaningful and very inspirational experience. I found that medicine could be a way for me to apply my interest in the humanities to make a tangible, positive change in other people's lives. And that's why I decided to come to medical school.

Tyler Johnson: Yeah, you know, it's funny and you're telling that story. I remember when I was a sophomore in college, I took a philosophy of religion class that I found fascinating, and I was an American studies major and I thought really hard about becoming a professor. I really wanted to dove deep into my studies. I loved reading and I loved writing, and I really thought about doing that. And I was at home one day studying for my my philosophy of religion class, and my roommate came home and asked what I was doing, and when I explained it to him, he said, Well, yeah, I mean, that sounds like it's really interesting. But even if you go all the way through and get a PhD and become a professor and you write some really interesting papers and really make your mark on the field at the end of the day, are you really going to have made a difference now? To be clear, this is not meant in any way to denigrate people who are professors of philosophy or American studies or anything else, because as I said, I thought very seriously about doing that and I still do some sort of related writing in a very amateur way. All of which is to say that I have enormous respect and I think that ideas do have their own power, actually, and there's a real cultural importance to that. But at the same time, what my friend said really struck me and stuck with me and has always reminded me that I decided I wanted to do something where I could tell that I was making a more immediate concrete difference in my day to day life, and I wanted to be able to do something where I felt like I was really making a mark on the way that other people were experiencing the human condition. And that was a large part of my motivation for wanting to go into medicine.

Henry Bair: So I'm curious, was there a moment a patient you encountered in your practice? Now this is after you've started practicing? Was there a patient that made you feel like, "yes, this is why I entered medicine. This is exactly like the reason this is my reason on Earth"?

Tyler Johnson: Yeah. So I'll tell you sort of a funny story about that. So I finished college and then enrolled in medical school in two thousand five and the very first day of medical school. The powers that be there showed us the movie Wit. Now I just have to back up for a second and fill in our listeners who may not be familiar with the story. It was a play originally then made into a movie with Emma Thompson, playing a professor of English who specializes in the poetry of John Donne and is then diagnosed with metastatic ovarian cancer. And the play begins with the moment when she is told her diagnosis and then progresses through until her death. And there is a scene just before she dies. She's a pretty austere woman who has kind of made a habit of not cultivating relationships almost at all. She's sort of ensconced in the world of John Donne's poetry and the academy and the ivory tower, and that's really all she all she does, and for the most part, all she is, which is to say that when she becomes ill, there's really no family and no friends to speak of around. It's just her and her illness and then occasionally a doctor or a nurse. And so she's admitted to the hospital. She has a gleaming bald head now glistening with sweat from the complications of her disease, and she's on this lonely cot in a lonely hospital room, and a professor from her time in college happens to be in town on this day and the play and hears that she's in the hospital and stops by to say hello.

Tyler Johnson: And then she sits down and asks the patient if she wants to hear some John Donne poetry, but she says no. And so then she offers instead to read her a children's book. And and she does. And while this is this tender scene is happening, there's this Arvo Pärt melody playing in the background. This very spare piece for called Spiegel im Spiegel for piano and violin. And oh my goodness, the day that I watched this on the first day of medical school, it landed on my chest like a hundred pound weight, and I thought I was just overwhelmed with the idea that there are doctors who take care of patients in a moment that is that vulnerable and that. Ripe with meaning. And this was one of those things that then settled way back deep in my subconscious and has sort of been there, I think, all along. So now fast forward through four years of medical school, three years of internal medicine residency, a year teaching internal medicine residents another three years of oncology fellowship and probably three years of practicing as an oncologist at Stanford. So a patient of mine who as luck would have it was a violin teacher, was had had cancer for a number of years and we had met many, many times as an outpatient. She got admitted to the hospital and I knew she was there and I went to visit her.

Tyler Johnson: One morning she was on the eastern side of the hospital, which is to say that it was early in the morning there was sunlight streaming through the room. I walked in to see her and she was lying on the bed in the hospital sort of curled up in the fetal position, her head completely bald because of the chemotherapy that we had been giving her. And she was luckily at peace and asleep when I walked into the room. But with all the sunlight streaming in through the window, I took two steps into the room and then stopped short and in my mind's ear could hear as clear as day. This piano and violin melody from Spiegel im Spiegel playing. And it was. I almost had to steady myself against the wall because it was so surreal because I felt like, Oh my gosh, here I am, whatever 12 or 13 years later and I am in the movie, I am doing the thing that had that the idea of it had impacted me so much those many years before in medical school. And so that is one, I guess, of a million moments, but it reminded me that here, after all of this sacrifice and all these many years of training, I was actually getting to have the privilege of doing this thing that I had those many years before only been able to dream about. What about you, Henry? Since coming into medical school, have you had a moment where you thought, "Oh, this is why I came?"

Henry Bair: I'd like to share two stories that come to my mind. The first was actually prior to medical school. This was towards the end of my college years. I was on a medical mission trip in India, where I got to work at an eye hospital that was based in Delhi. And every week we went on trips to rural areas in Rajasthan and Uttar Pradesh, different states of India to cater to rural populations. And what we would do was go out and screen all those patients for cataract surgery, then take them back to the hospital, operate on them and then the next day, see how they recover. If they were doing well, then we would have them go home. One patient really stood out to me on the first time I went on one of these trips, the day after we did the surgery, I was in charge of removing the bandages on the patient's eyes. And on one particular patient, I remove his bandage and his face just completely lights up. It was the first time he had seen light seen anything in more than 10 years. It takes them a few moments to understand what he was perceiving after a while, he falls to his knees in front of me and holds my hand and starts gushing. He starts saying, repeating, "You've given me my life back. Thank you so much." And there I am. Trying really hard to tell him that I'm not the doctor, and I was flattered, but it wasn't me.

Henry Bair: But at that moment, his whole family, which was right there at the time, they also come and swarm around me and tell me that, you know, this patient had basically been stuck at home for the last 10 years, unable to contribute to the family's work on the farm ever since he lost his vision. And now that he could see again, he could finally be a part of the family again. And I could tell that this patient perhaps had some measure of guilt that he he had been carrying over not being able to help his family. And so the redemptive joy that he was now expressing is something that will always be in my memory. And it really goes to show that when someone is ill in any way, they are unable to move through life and live life, according to their values and preferences. And so to be able to help in that regard, to be able to support patients as they strive towards their vision for a good life, I think is a tremendous privilege.

The second story I would like to share is about a patient who I met on my internal medicine rotation. This was a patient in his 80s who had end stage kidney disease. The medical team's prognosis was fairly grim. We estimated that he would have maybe months if he continued dialysis and perhaps just weeks or less if he chose to went off from the medical team's perspective.

Henry Bair: There really wasn't much else to do besides wait for him to give us a decision about whether he wanted to go home on hospice or to stay and continue dialysis. Now, as a medical student, one of the luxuries I had was to go back in the afternoons and just talk to patients, and I ended up spending many hours talking to him and listening to his stories. I learned all about what was causing him so much anguish. He had lost his child and his wife in a fatal car accident a few years ago. And so he was really struggling with the idea of his collected life experiences the people, the places, the memories and the emotions in his mind vanishing with his death. Medical training did little to equip me to handle the tough conversations with patients who are struggling with existential angst. There really is no standard guideline. There's no prescription. There's no script. You know, often in these situations, the best we can do is to offer patients a compassionate presence as they find their own meaning in this deeply personal yet universal event. This calls to mind that wonderful maxim in medicine of to cure, sometimes to relieve often and to comfort always. On one particular afternoon, during one of our conversations, he pulls out this photo from his wallet.

Henry Bair: It's a blurry photo out of focus black and white, and he tells me that this is a photo that he took when he was a graduate student at the University of Oxford in the 1950s. This was his most treasured possession. He had been trying to take a photo of the campus when he was suddenly knocked over by somebody on a bicycle, and that is how he met his wife. And so that photo was a reminder of one of the most important days of his life. Several weeks later, the patient decided to go home on hospice, and a few more weeks after that, the social worker in charge of his case came and found me on the wards and she handed me that photograph from this patient. And on the back of the photograph was an inscription saying, Thank you for listening. Remember me? To me, this experience perfectly illustrates one of my favorite quotes of all time by Elie Wiesel, who wrote, We must not see any person as an abstraction. Instead, we must see in every person a universe with its own secrets, with its own treasures, with its own sources of anguish and with some measure of human triumph. In medicine, we get the opportunity to live out this exhortation over and over again, and that's just about one of the most meaningful things I can think of.

Tyler Johnson: Well, and I think those are beautiful reminders of what we hope to be the importance and the impact of this podcast, and I think we should just speak to that for a moment. You know, it's I would say an open secret, but it's not even a secret. It's just, I think, become pretty common knowledge now that there is an epidemic of burnout in medicine. And you can very easily find papers and YouTube videos, and I would imagine it's on TikTok and other places as well. People who have gone into medicine, who are then going to young people and saying, Don't become a doctor, this is not what you think it's going to be because people have become so worn down by many things, right? I mean, the elephant in the room right now, of course, is the pandemic. The pandemic has been incredibly difficult.

Henry Bair: Now to clarify, are these health care professionals who are going out and saying this?

Yeah. So even health care professionals I and I know that I have had, you know, I go back to my alma mater about once a semester to talk to people who are considering going into medicine there because they don't have a medical school. And when I go back to speak with them, they will often say, Oh yeah, I spoke to my friend, who's a doctor, and he said, I shouldn't go into it because medicine isn't what it used to be or some version of that. And I totally get it right, and it comes from all kinds of different places right now. As I said, it comes from the pandemic and the pandemic has been incomparably difficult and that is just a reality. But even before the pandemic, there were a lot of people who were saying, Well, the demands of the electronic medical record have become so great that being a doctor means more about being in front of a computer than it means about being in front of other patients or people feel that the bureaucracy of medicine has become so overwhelming that doctors aren't doctors anymore, they're sort of cogs in a machine or whatever. By the same token, I was really struck to speak a couple of years ago to a woman who we may have on the show later, who is a coach for academic physicians, who told me that she has long been surprised that she will talk with people who are very accomplished physicians, sometimes virtually the tops of their field nationally or internationally or whatever, and yet feel terribly burnout. And when she starts off talking with them, she'll say, Well, tell me, why are you here? Like, what is it that you're about? What's your deeper reason for being here? And many of them, it's as if somewhere along the line they just forgot.

Tyler Johnson: They don't even remember anymore why they're in medicine. And so. I guess that if I can just evangelize for a minute, we are here to say. That all of the very real challenges notwithstanding and all of the things that we very much should improve about medicine, including, to be clear, systematic problems that are beyond the reach of any individual, we nonetheless want to stand here and say that medicine can still be deeply meaningful and that it can still be the most noble profession as it used to be almost universally known. And our hope in this podcast is to be able to talk to. Physicians and other health care workers and to people who are not directly speaking health care workers, but to talk to all different kinds of people to try to help reconnect us and our listeners to the stories that make medicine meaningful, to try to discover what medicine tells us about who we are and the grand scheme of things and what our place is in the universe and what our obligations are to each other, and also to talk to people who try to help physicians to remember those things. We're hoping in our small way to help to reconnect the people who are practicing medicine to their reasons for being there in the first place. Any other thoughts about that, Henry?

Henry Bair: I really like the way you have encapsulated what we're trying to do here. I first got the idea of a podcast because for a while now, since the beginning of my clerkships, I have had the habit of writing about my experiences with patients and sharing them. At first, it was just a therapeutic process for me. I would jot down the thoughts that came to my mind because medicine is emotionally challenging, spiritually challenging, and you don't always know what the right thing to think or to feel is. And I had a wonderful clinical mentor with whom I would share my notes with, and at one point she told me, Hey, you know, these are really interesting reflections that you might want to share with other health care providers, other medical students or even patients. And so I gathered together a few of these notes polish them off, and I started publishing them in medical journals. I didn't really know what to expect, but one of the things that ended up happening was I started receiving messages from patients and doctors and other medical students and even healthcare executives telling me how my stories have changed, the way they viewed their relationship to health care and asking me how I would suggest them to improve the doctor patient relationship. I realized that there is a deep hunger among practitioners of health care to. Discuss these important topics at the same time, I also encountered many health care professionals who helped me get a better sense of how I find meaning in medicine. And I saw that there was a huge store of collected wisdom from all these practitioners that just needed to be disseminated somehow. And that's why I decided that a podcast would be a good platform to do just that.

Tyler Johnson: Yeah, I think that's exactly right, and we hope to talk to a lot of different kinds of people here, right? So we hope to talk to health care executives who can maybe talk to us about what they're doing in their organizations to try to allow medicine to retain or regain its meeting for its meaning for their health care practitioners. We hope to talk to coaches and other sort of counselors who work with doctors who try to help doctors to recapture that meaning. And I think at base, what we most hope is that we can hear stories right? Because at the end of the day, as important and noble as all of those efforts are, those efforts are really about facilitation. And the facilitation is to allow doctors to reconnect with those more deeply meaningful stories, right? I think that there is something to be said that medicine is a profession that derives its lifeblood from stories. It's coming to understand the stories of our patients, and it's coming to understand our own stories as health care professionals. And it's understanding how those stories. We've into and out of each other and how they ultimately can help to change each other. And I think that the hope also is, as you said earlier, Henry, the thing that is so unusual about medicine is with the possible other exception of going into a spiritual profession, becoming a member of the clergy or something like that.

Tyler Johnson: There is probably no other profession where practitioners become as intimately acquainted with the stories of people as we do in medicine. And of course, we will always maintain appropriate confidentiality on the show. But even if we generalize the patient specific details so that of course, people will never know the exact characters that we're talking about. I still think that the themes that come out of those stories matter not just to doctors and nurses and physician's assistants and nurse practitioners, but matter to everybody as humans, because ultimately to be a doctor is to study the human condition. It is to become immersed in the sea of humanity, and it is to walk a path with our patients where we see at very close range and sometimes even experience a little bit together with them, the pain of loss and the elation at regaining sight and the harrowing nature of a life saving surgery and the miracle of welcoming a new birth and the sorrow of mourning the loss of a loved one, right? All of those things, the the warp and woof of what makes us human are what we experience as doctors and as we have both mentioned. To do so is a great privilege. And and we hope that as part of this podcast that we can also help anybody, health care practitioner or not to reconnect with the things that make being human most rewarding.

Henry Bair: Thank you for joining our conversation on this week's episode of The Doctors Art. You can find program notes and transcripts of all episodes at www.theDoctorsArt.com. If you enjoyed that episode, please subscribe rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.

Tyler Johnson: We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.

Henry Bair: I'm Henry Bair.

Tyler Johnson: And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.