EP. 12: COURAGE AND CURIOSITY

WITH PHIL PIZZO

May 25

WITH PHIL PIZZO, MD

The former Dean of Stanford Medical School discusses what caring for seriously ill children has taught him about courage and resilience.

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Episode Summary

A former dean of Stanford Medical School and past leader at the National Cancer Institute, Dr. Phil Pizzo is as renowned for his groundbreaking research on childhood cancers and immunodeficiency as he is for his promotion of medical education. He is also a tireless scholar who continues pursuing knowledge and purpose deep into what many would consider the retirement years. In this episode, Dr. Pizzo shares what caring for children with some of the most harrowing diseases has taught him about courage, and how his creation of Stanford’s Distinguished Careers Institute epitomizes his vision for longevity and philosophy of lifelong learning.

Dr. Phil Pizzo served as dean of Stanford Medical School from 2001 — 2012, where he was also a professor of pediatrics, microbiology, and immunology. Prior to joining Stanford, he was the physician-in-chief of Boston Children’s Hospital and Chair of the Department of Pediatrics at Harvard Medical School. Dr. Pizzo also spent over 20 years in various leadership positions at the National Cancer Institute, where he is renowned for his groundbreaking research on childhood cancers and immunocompromised children.
In addition to his medical work, Dr. Pizzo is a thought leader on the intersections of human longevity, aging, and education. In 2013, he founded the Distinguished Careers Institute at Stanford , a program that provides an opportunity for individuals in mid- and later life to return to higher education.
How a college music reviewer came to write for The New York Times - 1:41
• How Dr. Pizzo’s love of learning and objection to the Vietnam War led him to a career in medicine 2:00
• Teddy, a “boy in the bubble” whom Dr. Pizzo cared for and who profoundly shaped Dr. Pizzo’s career and life philosophy 5:54
• Leaning into the work of treating severe diseases, despite the realities of the deep suffering involved 14:46
• The guiding principles behind Dr. Pizzo’s time in leadership at the National Institutes of Health, Harvard Medical School, and Stanford Medical School 20:01
• How Dr. Pizzo manages to maintain tranquility of mind and buoyancy of spirit over his long career, and why he created the Distinguished Careers Institute 22:51
• The surprising next step in Dr. Pizzo’s scholarly journey 30:42
• Dr. Pizzo’s advice to young people about the value of a habit of lifelong learning 34:40
Henry Bair: [00:00:01] Hi. I'm Henry Bair.

Tyler Johnson: [00:00:03] And I'm Tyler Johnson.

Henry Bair: [00:00:04] 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: [00:00:27] 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: [00:01:03] We are delighted today to welcome Dr. Phil Pizzo to the episode. From 2001 to 2012, Dr. Pizzo served as Dean of Stanford Medical School, where he was also a professor of pediatrics, microbiology and immunology. Prior to joining Stanford, he was a physician in chief of Boston Children's Hospital and chair of the Department of Pediatrics at Harvard Medical School. Dr. Pizzo has also spent over 20 years in various leadership positions at the National Cancer Institute, where he is renowned for his groundbreaking research on childhood cancers and immunocompromised children. In addition to his medical work, Dr. Pizzo is a thought leader on the intersections of human longevity, aging and education. In 2013, he founded the Distinguished Careers Institute at Stanford University, a program that provides an opportunity for individuals in mid and later life to return to higher education. Dr. Pizzo, thank you very much for being with us here today.

Phil Pizzo: [00:01:58] Thank you for having me.

Henry Bair: [00:02:00] Dr. Pizzo, as our introduction illustrates, you have done so much over the course of your distinguished and diverse career, from clinical work to research to academic leadership. But I want to go all the way back to the start. Can you tell us what first drew you to medicine as a career path?

Phil Pizzo: [00:02:21] Well, you know, like many part of it was intentional and a good part was serendipitous. So I know that my story is similar to many others in that I grew up in an immigrant family first to go to high school, so there were no role models for me. So I found my way to medicine through reading as a youngster. My kind of salvation for a whole variety of reasons was just probing and learning at the local community library, and it was there that I found some of the great discoveries about them and their biographies, and I was very motivated to that, but my interests were pretty broad. So I was doing physics and math and lots of different things along the way. The serendipitous part was that I wound up attending college in New York. I had to go to a school that gave me a scholarship, and I wound up going to a place called Fordham College, which is a Jesuit school, which turned out to be great in some ways, but not so much in others. So it was great in philosophy and ethics. It was horrible in science. I had to continue learning on my own. I mean, they deny the evidence for evolution as a case in point. So and they didn't want to hear about the burgeoning field of molecular biology. So I was on my own and kept reading and learning, doing experiments and carrying on different kinds of activities. And then came the decision about whether to pursue a doctorate in philosophy, which had been my area of concentration or potentially do something else.

Phil Pizzo: [00:04:08] And I have to say that something else was also driven by the fact that I was growing up during the middle of the 1960s, there was a war on to which I strenuously objected, and an alternative service was going to medical school. So that's how medical school came about. In retrospect, I'm very pleased that I had that opportunity. I have not given up on my other interests, but that's where I kind of got started with the pursuit of of medicine. I entered medicine with many students. I'm sure you as well, Henry White eyes thinking that this was going to be an opportunity to have an impact helping people cure people. I remember and you may have had an experience like this in medical school, having my tutor or advisor be a young pediatric hematology oncologist. And this was in the late 1960s before there were advances in the treatment for childhood cancer. And he brought me to the room, the hospital room of a young child. I could still see this youngster sitting in a crib with sky and purple all over his legs, diagnosed with acute leukemia and clearly facing a very serious, life threatening disease. And I looked at this child and looked at him and thought, how could anyone devote their career to an issue, a challenge like this, that has such a high degree of morbidity and mortality, not knowing that that was going to be the course of my own life just a decade later. So the serendipity kind of continues to play out in unexpected ways.

Henry Bair: [00:05:54] Well, thank you for taking us through that. So you mentioned that with this child who you saw you mention thinking how can anyone dedicate their career to to treating a condition like that, treating patients with that high of a morbidity? I was wondering if you could tell us at what point you realize that this was something that you wanted to explore further, this was something you wanted to dedicate your life to. Was there a was there a pivotal moment that made you understand that this was the most meaningful thing that you could do?

Phil Pizzo: [00:06:24] Yeah, there actually is more than one, but I'll kind of link those together, if I can, for you. So I left medical school and was going to Boston to do my training at the Children's Hospital. And when I left, I had very much the aspiration of proceeding to a career that would involve serving underserved children. I was very inspired by my advisor mentor in medical school, who is the chair of pediatrics, and that was the goal until I got to my residency and then I had several things happen simultaneously. One of them was the recognition that my real attraction was to trying to prove and understand serious illness. So even though I was working, as was the case then, 135 hours in the hospital, which was what? You did when you were a resident, if you can believe it. I was doing research at the same time, so I made use of my time off and was already pursuing on my own research work under the guidance of others at that point. And then I began to get very much challenged by the bigger issues in pediatrics. So I decided that pediatrics was right for me. But I came to the recognition that dedicating my life to caring for children who are otherwise well would be less meaningful than taking on the challenge of those who were quite sick. And then among the quite sick were those who experienced at that time serious infectious complications, as well as those who face the challenges of childhood cancer.

Phil Pizzo: [00:08:11] Remember when I was doing that work, residency training in the early 1970s? It was really at the very beginning of the first introductions of chemotherapy for childhood cancer. And so I could see that there was an opportunity to use research to impact the course of the disease, and that became a very meaningful thing to me. And so I made the decision that I was going to train in both areas that I was dedicated to. One was infectious disease and the other was oncology, and my plan was actually to continue my training and do fellowships in Boston at Harvard. And then serendipity prevailed. Unexpected events in June of 1973, exactly one month before I was going to begin my fellowship. It's 630 in the morning. I had a call from the chief of the division that I was going to be involved with, saying, By the way, they need you at the National Cancer Institute. And I said, Excuse me, I think I'm supposed to be starting my training with you next month. Well, it turned out and this was really a pivotal part of my own life journey, that there was a ten year rule to live with an 11 year old youngster who had been diagnosed six months previously with a disease called aplastic anemia, where there is bone marrow failure and the real risk is either bleeding or infection.

Phil Pizzo: [00:09:46] And a decision was made because this was the child of a prominent investigator at the National Cancer Institute that perhaps they might try to buy some time. And so they made the decision to put this youngster into what was then called a protected environment. You may have heard of the boy in the bubble. You know that whole concept. Well, this was the second one, though. His name was Teddy. And he was put into this room, which was the size of a bathroom, and basically spent almost eight years in that room. And because he was put into that room and six months after he was there, he wasn't showing evidence of recovery. They needed a pediatrician to come and care for him. And so they gave a call to Boston and Boston gave a call to me. And I had been in the public health service. So I was could have gone to the NIH. I'd been admitted there, but I was going to opt out to go to stay in Boston. And the chief said to me, well, you have a choice. You can either go to Bethesda in a month or the word is they'll draft you if you don't. So off we went to Bethesda. And that turned out Henry to be to be among the most powerful experiences in my life. I think about it all the time. This was a youngster who is just emerging into his teenage years, who basically was completely removed from the normal environment, isolated in this small space where he was fed sterile food, had to be bathed, and antibiotic solutions take many.

Phil Pizzo: [00:11:32] And about a sterilized gastrointestinal tract, everyone who came into the room had to be garbed as if going into an operating room. And I became to him the one person that he trusted to be his doctor. So I was pretty young and then I was really at the very early stages of my training, but that matured me tremendously, and I wound up caring for him, trying to work on things that might help him. You know, we began many different kinds of experiments in the laboratory and even in clinical trials that might make a difference. And it changed the nature of my career direction. I became very interested in individuals whose immune systems were altered. I. My interest, of course, in childhood cancer. But I was right at the interface between cancer, immune deficiency and infectious complications, and that was pivotal in terms of other work that ensued because in the face of Teddy, I saw a youngster grapple with disease, with extraordinary courage and resilience in ways that really transcended what one would expect from a youngster, someone who kind of rose above confines, and who, with the help of Nasser, we were able to create ways of taking him out. So I accompanied him in a space suit to rock concerts and things like that, but it became transformational.

Phil Pizzo: [00:13:08] Unfortunately, he ultimately died not from infection, not from bleeding, but from something that we didn't anticipate because we just didn't know that it was going to be an issue, which is that all those transfusions, red cell transfusions and platelet transfusions that he received over seven or eight years gave him a huge iron overload so that he wound up with hemo cirrhosis and his organs were damaged by iron and he ultimately developed arrhythmias. And that led to a very difficult decision, which was how far do you go when someone is facing a really serious, life threatening disease? Now, this was not any longer just a patient. I mean, he was like a member of my family, almost like a child to me. I mean, I literally saw him every day and needed to therefore, pursuant to our beginning conversation about being mortal, have those kind of very deep conversations about what you want to do with the rest of your life if you can't live, you know, do you want artificial support? Is we there currently thought of that? And those are the things that in his case were transformational and in my own life transformational. So it made a difference and set the stage both for the research I did for my own witnessing of human courage, even coming from a youngster that has held me very well over the years that followed.

Tyler Johnson: [00:14:46] Dr. Pizzo I'm so struck because the way that you tell that story, you. Centered on the young man's courage, which is certainly understandable. At the same time, though, there's so much of suffering in that story, right? There's a young man who's sort of ripped from his normal life, whether you're talking about just the give and take of living with his family in a home where he can have dinner and and watch cartoons on Saturday mornings and whatever, or being with friends and going to dances and high school and all the rest of it. And then after all of this painstaking work on you and your colleagues part, and after all of his courageous endurance, then up crops, this insidious problem that you didn't even know was there that then eventually takes his life. All of which is to say that it's so striking to me that in the face of that suffering that you shared to the degree that you could with him and sort of walked the path with him so carefully that instead of the response that many people might anticipate, which is to see that suffering and turn away from it or or wish to escape it, that that instead sort of becomes your calling. It becomes the the thing that drives the rest of your career to to some degree. And and I'm sure that since then, you have thousands of other stories of of suffering in many different ways that you've seen on behalf of your patients. And I'm just wondering, how does that work? How does it how does it work that you encounter that suffering and it becomes a calling rather than something that turns you away?

Phil Pizzo: [00:16:24] You know, it's a really important question, and I'm going to reframe it for you in this way, because I have witnessed over the years so many individuals, mostly young people, children, adolescents, young adults who have faced truly life threatening diseases. And what I watched in them was how facing these challenges, they didn't give up. In some ways, it almost made some lives better, if I can say that, and I'll give you an example of that. In the days that followed, Teddy, a new illness emerged, which was HIV AIDS. And I was really at the early days of that, particularly as it related to children. There were no other people who made a commitment to work on pediatric AIDS. And so I had to kind of set the stage for that and lead the way against a lot of challenges and even some adversity. And one of the things that I used to hear a lot was that particularly when HIV, AIDS and kids went from transfusion to vertical transmission from mothers and fathers who had used drugs and gotten infected and infected their kids vertically, was that you'd never be able to care and enroll children like this coming from such challenged environments into clinical trials. And I just didn't buy it, quite honestly. I thought, you know, if you could marshal resources, treat people with dignity, that you could actually enable them to make a difference. And what I observed over and over again were young people and parents who may have had really fractured lives, lives that would have just been so painful to watch rise above that in ways that enable them to either care for their child or for their child to become, if you will, a more wholesome person.

Phil Pizzo: [00:18:32] Now, it was sad in the early days to watch that happen with the consequence of death still being the inevitable end. But in time, as better therapies were found, many of those children went on to live. I still hear from them to this day, and I have to say to your question, I have for myself always been inspired by that. When I get into difficult times and difficult challenges, I think about them in trivial ways. You know, when I'm running a marathon and I'm beginning the process of doing that, I often think about, you know, the kind of marathons that my patients over the years ran or when I'm dealing with or was dealing with difficult challenges in academic medicine or research or other things, I often reframe it in terms of the power of individuals facing adversity. I think to to directly your question, I have been an individual to my surprise, I evidence the early questioning in my mind about whether I could do what that young hematologist was doing and then became kind of a person who embraced that so that I wound up always being attracted to. A more difficult challenge is the more difficult problems rather than the simpler ones. Those have been, for me, kind of the guidepost for my life.

Henry Bair: [00:20:01] Dr. Pizzo, throughout your career, you have taken on many leadership positions from the National Institutes of Health to Harvard Medical School to Stanford Medical School, and even to the Association of American Medical Colleges. What is your guiding principle behind the decisions to assume these roles? How do you think about leadership and what it means?

Phil Pizzo: [00:20:23] These are very important and in some ways difficult questions to to answer. But I'll try to respond as best as I can. I think we're all passengers on this ship of life. You know, we are all playing our role in different ways. And one of the things I've been very adamant about and don't want to do is to put myself kind of above others. You know, we're all part of a dynamic process, and there's nothing more special about me than there is about other people. We're just talking about me. We could be talking about you. And there could be many things in your lives that would be deeply meaningful as well. My thankful quest has been that I have never, for whatever reason, felt that I was going to work or that I had a job. It's not that there weren't times when it was painful because of course that's the case. But I've always approached my work with a kind of bigger sense of vision. What's the mission, what, what? What's the goal that we're trying to accomplish? I've heard from so many people over the years about their aspirations to, quote, climb the academic ladder.

Phil Pizzo: [00:21:40] And thankfully, I've never had that as my own goal. It's just been a series of coincidences. I never aspire to be dean at Stanford that came to me completely out of the blue. And in fact, my initial response to the person who called me was to quote a famous line that I had heard, which is, there's only one letter separating Dean from dead. And by that I mean that I had been then kind of deeply involved in my own work, things that made sense when I went to the NIH. As you heard, I went because a road opened and I, in a sense, had to take it. But once there, you know, I had choices, but I chose to stay with the challenge that I was facing. I had only a two year commitment to the NIH as part of the Public Health Service. I stayed 23 years and I stayed there because I was deeply, deeply committed to Teddy. And then I was deeply committed to continuing the work on childhood cancer and then extraordinarily committed to the challenge of pediatric AIDS.

Tyler Johnson: [00:22:51] Let me ask one related question, and the framing may make your ears burn a little bit, but I hope you'll forgive me. So when I was a chief resident here, I ended up in some meeting with Norm Rizk, who at that time was the chief medical officer at Stanford. And and this was just at the time when you were getting ready to finish your tenure as the dean of the Stanford Medical School. And so they were in the process of putting together the search committee and going through the search process. And in a candid aside to me, one day, Norm Risk looked at me and said something like, Tyler, this is just hopeless. I don't understand this person. Dr. Pizzo gets up at like five in the morning and runs, I don't know how many miles and then comes in to work and then is working all day with this burning moral fervor and a spring in his step and a sparkling his eye. And then he works 12 hours a day after getting up at five in the morning to run. I just he. How do you replace a person like that? How do you even lead that kind of a search? So all of that is to say that in this podcast we're always operating on two levels. There's sort of a philosophical level and then there's a practical level. And by that time that he was telling me that you had probably been in academic medicine for somewhere between three and four decades. And I'm just curious, on a practical level, how does someone who has been doing hard things for that long keep that kind of a spring in his step and that kind of a sparkle in his eye and still be enthusiastic and and passionate about what you were doing.

Phil Pizzo: [00:24:26] Yeah, it's great. Well, I think I'm inspired by challenge. I keep changing the challenges. So I think one of the things that is, I think important and is a lesson is that life courses can go through a period and we see this in medicine as well, burnout, where, you know, you continue to do things. And after a while, if you don't figure out a way of kind of revitalizing yourself, you begin to get less engaged. So for me, it's always been the process of what's the next question, what's the next thing to do? I always felt in my own career that one should engage deliberately, but only for defined periods of time, that it was not the job but the cause that made a difference.

Henry Bair: [00:25:16] Dr. Pizzo, shortly after you concluded your tenure as the dean of Stanford Medical School, you went on to create the DCI or the Distinguished Careers Institute, which is something that you have dedicated the better part of the past decade to leading. So I'd like to ask you next about that work. What exactly is the DCI? Can you tell us more about the genesis behind your vision for the program? And what are your hopes for the students who participate in it?

Phil Pizzo: [00:25:47] Sure. So the name may not be the best one, but it describes a life course for individuals who've already had a career in which over 20 or 30 years they have done some significant things in their lives. So they're ready for change, but they don't know where to go. So just like think about how it is when you're a high school student and you're applying to college, you're beginning a journey and you're not quite sure where you're going to go. But higher education becomes the anchoring space for you. And my basic thesis is that that should be the case for people through the life course. We shouldn't think about higher education as just for young people, but we should think about it as entry points throughout the life journey. After all, the half life of knowledge is pretty short and we all need opportunities to kind of re develop our skills in time. So the DCI has a very significant set of research pillars that underpin it. So it's really built on the three major contributing factors that contribute to positive longevity. One is the importance of renewing purpose. The second is building community as an antidote to loneliness, and the third is wellness. So the DCI built on these three pillars of renewing purpose building community recalibrating wellness brings to campus 30 fellows who applied to the program from around the world who are going to spend a year as a non matriculated graduate student during which they enroll fully in the life of the university.

Phil Pizzo: [00:27:36] They take a full load of courses sitting side by side with undergraduate and graduate students. That, by the way, is hugely important because it's not only beneficial for them, but also leads to an incredible intergenerational experience, just like you've experienced, I hope, Henry, in your own interactions, these are people who have life experience and hopefully some wisdom. They're learning and they're sharing. So during the course of that year, it becomes bi directionally transformational for the fellows as well as for graduate and undergraduate students. We bring the fellows together beyond what they do in their classwork for additional directed learning. We bond them together through the art of storytelling. We work with the design program. We have a course called Designing Your Life, and then we work with guided autobiography and memoir writing and use storytelling for them to share deep experiences that have been transformative in their lives. And what that does is bind this group together. So we have witnessed now, since 2015, now that we have over 300 people in the program, each class or cohort becomes deeply bound to each other and continues doing that over time. And then they can take part in a whole program of wellness from a physical, emotional and spiritual perspective. So it's a really pretty intense experience. Almost everybody who's enrolled in the program says to us that it's really been about the most meaningful one in their lives.

Phil Pizzo: [00:29:20] It's a program that has been expensive, we understand that. But thankfully we've now gotten a lot of contributions from our fellows so we can diversify the program and provide financial assistance to those who can come and also benefit from this kind of experience. So we think of it as transformational, as a prototype transformation for individuals, for universities, and ultimately on a societal level. When I started the latest program, the DCI program, I announced that I was going to do it for up to a decade and not more than that. I always planned that I was going to step down from that role somewhere in 2022, and I was very intentional about that. And people said to me along the way, just as they did it earlier stages of my career, How could you leave? You know, things are going so well. Why don't you stay? And my response was twofold. One is, I need myself to be recharged. I know that about myself. But the second is, I also know that you may think that, you know, you really need someone like me with you now, but a year from now you'll probably start thinking differently. So you do anticipate that because nothing goes on forever. So let's really try to kind of work collaboratively to allow that to happen.

Tyler Johnson: [00:30:42] We understand that one of the things that you will be doing now that you're going to be stepping away from the DCI is to go to rabbinical school. Talk to us a little bit about that. I have to say that that would not have been on my bingo card for you if I could guess the next step in your life.

Phil Pizzo: [00:31:00] Yeah, I know. In fairness, it wasn't on mine either. And I guess this comes right back to the serendipity. Right? I anticipated that I would at this point likely be going back to school. That was my intent. I thought it was going to be history. I mean, I have read so much history, but I went through a period influenced by many factors, including my wife, who is a deeply spiritual person of experiencing after many years, really giving up on religion, to be honest with you. You know, I walked away from organized religion as a teenager because I just couldn't buy it. I mean, I was one of those classic as a scientist, you know, I had all these questions and the kind of clinical involvement that I had over the years just reinforced that. But in the last decade, I began reengaging with some of those imponderable questions that I have always had lingering in the background. And then, for reasons that we're going to surprise to me, I found my way to Judaism. I'd grown up, you know, as a Catholic, left Catholicism didn't really have a religion. So this was a positive affirmation for me to join a community, religious community. And with that, you know, I began thinking about because part of my entry to that was learning about it. So the way I once I decided that I was interested, I read everything I could get my hands on to learn more about it. And then I thought about five or six years ago, Gee, if I could start over again, maybe I'd really like to be a rabbi teacher, someone who continues to learn. And I didn't think it was going to be feasible or possible to do that really because of my age, because I didn't have a long background in the area.

Phil Pizzo: [00:32:55] But the long story short, I had a recommendation to a seminary that I applied to a couple of years ago. It was a pretty rigorous application process and I was accepted, kept that in the background until this year. I'm getting ready to start in August of this year and it's just another calling. It's to me an opportunity to bring new guidance to some of the questions that I have had, maybe to create some more complementarity or completeness. You know, in my own pathway, I'm not doing this, by the way, because I'm becoming a rabbi to follow a traditional career path. I'm really doing it for myself as a way of learning and then will likely with that use scholarship, writing, teaching and maybe some pastoral counseling as the ways of bringing this to fruition. It's a serious commitment. The program is five years in some ways, you might say it's a little bit of a race against death to do that. I mean, I'm 77 as I begin this journey, and most people are long retired by that time, and I'm starting anew. And I need to start anew in a way that recognizes that I'm like a child coming into this. So be people much younger than I who will know much more than I will. And I need to be able to learn from them and from others and maybe share some wisdom. But it's going to be a brand new course. And I think to your question, it will be an opportunity to evolve some new neural networks by having to learn new and different things.

Henry Bair: [00:34:40] Thank you. I think from our conversation today and hearing your path through all the different parts of your career, a common theme is lifelong learning and maintaining a curious and scholarly habit of mind. And you not only talk about it, but you live it through every part, every phase of your career. This is this has been a prominent feature. So I'm wondering. As someone who has also been an academic leader, someone who's taught many students, what advice do you have for medical trainees and for clinicians early in their careers about the value of maintaining lifelong learning?

Phil Pizzo: [00:35:28] Well, you know, I think thank you for that. And when you think about the fact that young people, including you, are going to be surviving, living to 100 or more. I mean, that's the current projection. One really needs to think about how do you pace your life? There's such a rush, you know, and I witnessed it in my own life to kind of get to the next thing as quickly as possible. But you need to kind of look at your life journey over many, many years and decades. So continuing to stay open minded to allow a word that I've used over and over again to allow the unexpected, the serendipity to take place, to move you to paths that you hadn't perhaps thought about, to walk down, paths that are meaningful to you. And if you encounter ones that are not to not get stuck and stay in them. One of the great things about medicine and science is that you have options. You don't need to stay stuck in the same area. You can create different ways of opening up new corridors to your to your life. And there's no right or wrong way to it, although I do think there's an established way that may not be the best, which is I'm going to start out as a trainee and I'm going to go into practice and I'll stay there for my career, which is probably not going to work because it's too long and it's going to get ultimately something that needs to get refreshed or I'm going to go down the academic pathway and ultimately I'm going to climb the ladder of success.

Phil Pizzo: [00:37:04] And I think both of those is kind of planned structures, doesn't allow the flexibility for new opportunities to emerge. I think it's important to learn deeply in the areas that you're involved in. I loved learning in science and medicine, of course, and I still try to keep up, but I'm nowhere near where I was earlier. But keep opening new corridors, keep opening new venues. One of the things that I've thought about in my own career, and I'm going to be very candid with you, is because of where I am on the life journey, I know that the next decade or more is not going to necessarily have the same physical wellness as I've been able to have up till now. So one of the reasons why I've chosen to work on the life of the mind, if you will, over this next period, and to be more contained within myself than running something that involves other people is because I'm more likely to be able to do that. So I think that's one of the things one needs to think fully through how you pace yourself through your career and how you wake up every day feeling good about it. It's not that you're even if you're happy overall, that every day is going to be a great day. But if day after day is not, then you're probably doing the wrong thing and it's time to kind of look elsewhere.

Henry Bair: [00:38:28] Thank you very much. On that inspiring note, we want to thank you again for your time and for sharing your insights with us.

Tyler Johnson: [00:38:36] I will say, Dr. Pizzo, having spoken with a lot of people, even just in the early run of this podcast, it's hard to imagine an interview that would be more personally inspiring. So we really appreciate your time and your example. Thank you so much. And we wish we wish you all the best in the beginning of your five year schooling.

Phil Pizzo: [00:38:54] Thank you so much. Bye bye now. Good luck to both of you.

Henry Bair: [00:39:01] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctors Art. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.

Tyler Johnson: [00:39:19] 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: [00:39:33] I'm Henry Bayer.

Tyler Johnson: [00:39:34] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.