EP. 4: THE HERITAGE OF MEDICINE

WITH CESAR PADILLA

Mar 22

WITH CESAR PADILLA, MD

What can the history and legacies of medicine teach us about better doctoring?

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Episode Summary

The practice of medicine has a rich legacy, sharing common themes yet manifesting in myriad forms around the world. For Dr. Cesar Padilla, an obstetric anesthesiologist and clinical assistant professor at Stanford, this historical and cultural thread is vivid and alive, informing care and connection with his patients and students. In this week’s episode, we ask Dr. Padilla to reflect on his personal history and that of the wider medical field to gain insights on best practices for care across cultures.

Dr. Cesar Padilla is a first-generation Mexican American from Northern California. His parents emigrated from the Mexican state of Jalisco, settling in the Bay Area in the 1970s, where they worked in local factories. Cesar spent every summer of his childhood in Mexico, where his passion and inspiration for becoming a doctor was ignited. A graduate of University of Rochester School of Medicine and Dentistry, Dr. Padilla is now double-fellowship trained from Harvard Medical School in critical care medicine and obstetric anesthesiology, with additional training in critical care echocardiography. His research interests include critical care in obstetrics and addressing inequities in maternal/obstetric care. Dr. Padilla also serves as the Chief Medical Education Advisor for the Alliance in Mentorship, a non-profit organization with a mission of mentoring underrepresented students interested in medicine and is the Co-Chair of the inaugural Council of Anesthesiology for the National Hispanic Medical Association. Dr. Padilla is currently a clinical assistant professor at Stanford and hopes to connect, teach, and inspire the next generation of students pursuing medicine.
In this episode, you will hear about:
• Dr. Padilla’s childhood summers residing in a Catholic hospital in Mexico, and how that ignited his passion for medicine - 3:45
• Why Dr. Padilla believes the ‘art’ of medicine resides in human connection - 6:18
• The educational inequities & challenges Dr. Padilla faced as a first generation immigrant - 10:12
• How Dr. Padilla draws on the history of medicine to provide quality care - 16:24
• How clinicians can connect with patients when differing cultural backgrounds are involved - 26:06
• The one piece of advice Dr. Padilla wants all medical trainees to remember - 35:19
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] Our guest on today's episode is Dr. Cesar Padilla, a first generation Mexican-American from northern California. His parents emigrated from the Mexican state of Jalisco, settling in the Bay Area in the 1970s, where they worked in local factories. Dr. Padilla spent every summer of his childhood in Mexico, where his passion and inspiration for becoming a doctor was ignited. A graduate of University of Rochester School of Medicine and Dentistry. Dr. Padilla is now double fellowship trained from Harvard Medical School in critical care medicine and obstetric anesthesiology, with additional training in critical care echocardiography. His research interests include critical care in obstetrics and addressing inequities in maternal and obstetric care. Dr. Padilla also serves as the Chief Medical Education advisor for the Alliance and Mentorship, a nonprofit organization with a mission of mentoring underrepresented students interested in medicine. And is the co-chair of the Inaugural Council of Anesthesiology for the National Hispanic Medical Association. Dr. Padilla is currently a Clinical Assistant Professor at Stanford and hopes to connect, teach and inspire the next generation of students pursuing medicine. Dr. Padilla, thank you for being here and welcome to the show.

Cesar Padilla: [00:02:12] Thank you so much for the invitation.

Henry Bair: [00:02:14] Can you briefly tell us what your day as an obstetric intensivist looks like?

Cesar Padilla: [00:02:18] So those are sort of two different positions or roles. So, here at Stanford my appointment is in obstetric anesthesiology. I did work as an intensivist after I graduated fellowship. As I was thinking about this podcast and the name of the podcast - you know, "The Doctor's Art" - and sort of reflect on the role of what we do in obstetric anesthesia. It's really, I guess, more of an art in a lot of ways. So, what I mean by that is the bread and butter of obstetric anesthesia is providing safe pain relief for vaginal deliveries or cesarean deliveries and of course, being prepared for any type of emergency. So hemorrhage being the most sort of common. So I would say that my job pretty much starts 7 a.m.. We get signed up for the night before and Stanford being a referral center, there's quite a few patients that are higher risk, more complex. So I would say a lot of my job is risk stratification and that's one of the themes that I've really picked up on in my career. I really am interested in utilizing technology to recognize high risk patients. So I would say a lot of my day is preparation and of course understanding the science and the knowledge behind what we're doing, you know, behind the pain relief. And then, of course, our most common procedures that we do are epidurals and spinal anesthetics. So I would say that's sort of my primary role is in providing a safe experience for patients while at the same time recognizing who's at high risk.

Henry Bair: [00:03:45] And what first drew you to this very particular career path?

Cesar Padilla: [00:03:50] Yeah. I think that is a question that I think I'm still answering today. So let's take it back to my childhood. I would spend my summers in Mexico. There I had a very unique experience. So this is like from the time school was out in June till September. So I was there like three months. And the reason why my parents would send us there every summer was because they were just working here, and so it was just harder to take care of kids. It's just better to send us to Mexico, where this isn't a small town where you're with your cousins, you're with the community. It was just a safer place to be, in all honesty. So one of the things that I did over there is actually spent time in a convent. So, like, it's a little weird, right? It's like, whoa. Like, how? So, my grandmother's sister was a nun in a Catholic hospital, and the convent was within the Catholic hospital. So we would go visit our aunt and stay in this little guest room. This is from my earliest memories. I must have been maybe in diapers,like three or four years old, up until I was 18. So spent my summers in this 200-year-old plus convent, and my life was sort of just interacting with members of the hospital. So I was a little kid running around the hallways. You see patients come in, get treated, and then I would always go to the maternity ward.

Cesar Padilla: [00:05:09] That was I love that. So maybe it was there. I think maybe that's where I got the inspiration. There's no doubt in my mind that's where the human part came. The inspiration, the human connection, the warmth, if you will. That's where also where I saw the the obstetric sort of calling. And when I started medical school, I was just always drawn to obgyn. So actually my first career choice was obgyn. I was like, no, but I really like using my hands a lot. So then it was like a battle between obgyn and anesthesiology. It was like, Oh, I don't know. So I compromised, right? I did anesthesiology residency and then obstetric anesthesia fellowship. So it's kind of like I brought both worlds. To answer your question more directly. Maybe it was it was something that I saw growing up. And I think that's what really drives us as humans. It's like we we sometimes don't even understand the things we do like in the sense that our personality is made up of a lot of these things that were just passed along that are sort of nuances and things that are really sort of implicit in our nature. And I think there was something special in that... In those summers that that I saw that probably drove me to obstetrics.

Tyler Johnson: [00:06:18] You know, Cesar, I'm struck by listening to you. It's so interesting because the other day we were talking with a palliative care doctor, and a lot of our conversation with the palliative care doctor was about what it's like to be allowed into this sacred space that's walled off from almost everybody else, where palliative care doctors care for people as they're approaching death. And then we talk to you, and here you are at the welcoming of a new life, which you probably see multiple times a day, every day that you work. And it sounds like that experience is part of what drew you, not directly, as it turned out, into obstetrics, but into obstetric anesthesia. Can you just talk a little bit for our listeners? Because most people who are listening probably have seen maybe one or two or three births in their entire lives if they're doctors, but not obstetricians, maybe a few more than that in medical school. But can you just talk a little bit about what it's like for you sort of on the inside to be there with a front row seat to welcoming life into the world every single day you go to work?

Cesar Padilla: [00:07:18] I really like what you just said - sort of in the palliative world, how it's considered a sacred space, because I believe there's power in words. And you just said something that I think, in my opinion, touches on the foundation of what we do, which is the human aspect of it, right?. There's something just so sacred about this space. And I actually wrote a poem that relates an obstetric patient and the experience of giving birth with a dying patient - both different, different settings - because I actually saw parallels in both worlds. Like there's something... And I think what what drew me is that intense human energy. And what I noticed when I worked in the intensive care unit, there was an energy and I always would consider it an immense gift that I was able to be a part of these end of life discussions. And so the way that you presented it in this sort of respect, that's how I would present it to the residents and the medical students, because that's the platform that they have to understand. I mean, this is a sacred space and in the obstetric world, a front row seat is that raw human energy. But it feels so similar in both... In both worlds. It was like, yeah, you know, when a patient comes and delivers, you know, the best way that I could put it is, you know, it's an honor to be a part of a process that these patients and their partners will probably never forget. So there are certain things that I walked away with.

Cesar Padilla: [00:08:44] And one of those is that it's... It's in the details in what we do. So, for example, if a patient's having a cesarean delivery and the patient is anxious, understandably. What type of music do you like? It's a simple question for the patient. Oh, I like R&B. Just put some music on. Right. The little things. And it's remarkable how patients remember the little things. So my wife delivered over ten years ago, and she remembers the type of juice that the nurse would bring. It was a cranberry juice. But that detail is forever sort of imprinted in her mind. And I think that a lot of what we do in these high... Let's call it high energy, high impactful moments, right? Birth. It's in the details. You know, of course, you know, the science and the mechanics of doing an epidural and keeping a patient safe and troubleshooting and, you know, understanding the PKA and all this... the local. Yes, yeah, that's competency. But the art of being there and having a front row seat. And the best way I could describe it is it's... It's something that I that that never gets old, put it that way. It never gets old. And what I found myself more and more is that a lot of the purpose that I gain from the experience is when we bring in the art, when we bring in things that are connecting with patients on a different level or having conversations on a human-to-human level.

Tyler Johnson: [00:10:12] You speak with such enthusiasm about your work that I could imagine it might seem intuitive to our listeners that you just woke up one morning and were perfectly comfortable in your own skin. But I'm curious, you said some things from your biography. It sounds like most of the people in the generations above you had a very different educational background than you have. It sounds like you were sort of blazing a trail in your family to go into medicine. Of course, you're coming at this from a Latinx background. And I'm curious - were there ever moments when any of those things or maybe all of them combined made you feel isolated or made the journey to becoming a doctor particularly difficult? And if so, I'm curious, even if only in retrospect, how you've processed that difficulty and if you've been able to draw any additional meaning from what may have been difficult times on your journey to becoming a doctor?

Cesar Padilla: [00:11:06] Yeah. Thank you for that... For that question. Yes, it was difficult being part of this first generation, my parents basically got through middle school. They came here and... And I grew up 20 minutes away from Stanford in the East Bay. And, you know, we were talking about social determinants of health world. The social determinants of our environment weren't really favorable for a young Mexican-American kid. There was gang violence. There was all this stuff happening around you. You really don't understand that stuff. I actually dropped out of high school. I was in the 10th grade. I stopped going to class because, well, let me sort of paint the picture for our listeners. Just imagine going to school every day. You have to think about the correct color to wear, because if you don't you're going to get jumped. You're going to get beat up because you are in a territory of a gang. And this, by the way, goes back like... Like generations. Like, it's not just like a game that started last week. It's like a game from from the 1960s that started... snd so it's stressful. So you have friends all of a sudden I go to juvenile hall, friends that are getting caught up in gang violence and, you know, I was never a part of that. But all I knew that is that I didn't want to go to school anymore, so I stopped going to school. That was... That was 16 years old. That was an important moment for me because my my dad sat down and he's like, "Look, I get it. Things are rough, but we've got to make it happen."

Cesar Padilla: [00:12:37] So what we did was we used family members address from a different city, Fremont, California, which is a little bit higher income. And I was able to transfer to a different school district, safer school district, basically no gangs there. I had a fresh start. And then I had to make up the credits of being dropped out for I stopped going to school for four or five months, so I had to go to adult school at the same time. So it's quite literally in in high school from 8:00 a.m. to 4:00. And then at 5:00 pm I was in adult school till 9 p.m.. It was that experience that really shaped me, I think, in my perspective towards academic life, because when you're at adult school, the professors you have there, they want to be there. Does it make sense? It's almost like they're working with underserved kids and then you kind of learn what good teachers are about - Empathy. I mean, God, they they had to have love for that, for what they're doing. I mean, 6:00 PM and you're teaching a bunch of high school dropouts, you know, who are trying to make up their grades. But you felt that. I remember feeling that support. I remember feeling that... That connection. And then from there, well, I barely made it to not barely, but I made up the credits. And then I graduated high school on time. And then I had to enroll in a community college. But same thing in a community college. There were professors there that I felt... Like at community college I had professors who also taught at Berkeley and Stanford. That's pretty cool. And so you're like, "Whoa!" And then you work hard, the power of mentors.

Cesar Padilla: [00:14:10] But all of that, I think, shaped my sort of perspective in sort of understanding perhaps who I am on this journey. There was a lot of growing that I had to do, and there was a lot of pain along the way, too. Like a close friend of mine who was who was murdered, literally, he was killed in Union City, which is where I'm from. Close friend, grew up together and we sort of went on divergent paths, you know, while I was trying to make it happen at adult school and then graduating, he dropped out of high school and then got caught up in the wrong stuff. And yeah, so I mean, there's real life consequences to this stuff and I think I just understood that. What we have is just so precious. What we have in the sense of life, what we have, right? We have this opportunity. And when you're that close to just literally, you know what else? If you drop out of high school, like what else? To throw academics out and think, "Oh, that's not for me." Like to put yourself in that mindset. And then to grow out of that. To grow out of that and have that growth mindset that I can make it happen. I think that was something that perhaps gave me perspective. And I sort of when I approach residents and medical students, I try to just teach them that like, "Hey, it's a it's one step at a time. We all fell exams. It's okay. Let's go. You know, let's just go back to the basics. Let's, let's, let's grow through this, right?" Because I've been there. I know what it's like.

Tyler Johnson: [00:15:33] You know, one thing that I'm struck while you're talking about that is that part of the hypothesis or the impetus behind this podcast is this idea that medicine for all its intuitive meaning, many people would argue that it has become increasingly difficult to stay connected to that meaning, right? So, a lot of people talk about how they feel they're so busy or that the art of medicine has been bureaucratized or whatever to the point that they feel like they can't touch the meaning that drew them into medicine in the first place. So, I'm just curious, as you go about what I'm sure are very busy days. You're taking care of multiple patients. There are a lot of things going on at once. Like what, practically, do you do to stay in a headspace and a heart space to where you can still connect to the meaning, rather than just having it be a stressful list of stuff you've got to get done?

Cesar Padilla: [00:16:24] Great question. I mean, that is... That's it. That's the question, right? How do we ignite purpose and meaning in the current and future doctors? What really drives me is understanding that I'm part of this lineage of something greater. Like, we're part of something. Let's look at the history of medicine. I believe history defines us. We need to understand where we come from. So, the medical field, right? Who are we? Well, the idea for a hospital in the United States came from a medical student, Thomas Bond. Now, Thomas Bond was, you know, in the 1730s. He was a medical student rotating. And it's interesting to say that. Like, this is the 13 colonies, by the way, before the U.S. So how is it that a medical student, you know, can even work without hospitals? Well, doctors would make home calls. They would just go to people's homes. So Thomas Bond went to Europe and was in England and France, and then he stumbled upon these big charitable institutions. One of them was in Paris. The name was Hotel Du. And there he saw that a bunch of doctors from different specialties came together and they were treating people with infectious diseases, people with psychological conditions. It was like a multidisciplinary, like art of medicine. I mean, it was just like the best of awesomeness, right? It's like what we're talking about here. Like, imagine taking a podcast, podcast back then and taking it to like that hospital. This is in the 1730s.

Cesar Padilla: [00:17:55] So he came back like, infected with the idea. And so I think there's something to to this, because he came back with this idea to the to the colonies and he really wanted to do the same thing in Pennsylvania. And he was lucky. His friend was Benjamin Franklin. And they muscled through the political will and they got it done. And now it's in Pennsylvania Hospital. It's an affiliate of the University of Pennsylvania. I mean, quite literally, the foundation of our nation's medical culture came from these charitable institutions in Paris.

Cesar Padilla: [00:18:26] Now, why is that relevant today? Because that's who we are. And I honestly believe if we were to sit down with medical students, and why does this idea matter? And when you break it down into the meaning, and purpose and meaning, I think that gives us an understanding of our daily role. There are days when it's a task, it's task oriented. It's like, "Oh my God, I got eight, you know, whatever." Like there are shifts where like it's like it feels like every hour there's like two epidurals and you've got to do C-sections and you're like running around, right? But in the middle of that, there's always humanity. And I think it comes from understanding that history. I'm talking about the history of medicine, right? But also personal history. Like what did it take for our ancestors to sort of survive and to get here? So a lot of my personal motivation comes from that as well. It comes from my parents being immigrants and and the struggles. You know, they came here with the goal of providing us a better life. So there's certainly that. But just how awesome is it to just break down our role in what we do as medical professionals from a historical perspective. That's so profound, and I think that there's humanity there. There's humanity and there's purpose.

Cesar Padilla: [00:19:40] And and look, I'm throwing this word around a lot, purpose and meaning. But there's data that suggests that these are actually ideals that people sort of align themselves with - purpose and meaning. How do we align purpose and meaning to the next generation of doctors? You know, things that speak to them personally. And I think that's what I found in this journey, is I found an appreciation for history, whether it be in our field, but also history of our own personal familial history as well.

Henry Bair: [00:20:15] Thank you, Dr. Padilla, for sharing this very particular approach to patient care. It's certainly an approach that we try to explore more of on the show. So with that in mind, is there a pivotal patient encounter that you can think of that shaped this approach to medicine? Or, that epitomizes all that makes medicine rewarding for you?

Cesar Padilla: [00:20:37] Yeah. Well, I love these questions. So you guys are asking really, really great questions. A moment that happened relatively recently, but that sort of validates this approach that I kind of mentioned of understanding the historical context. I was on call not too long ago in labor delivery, and, you know, I've been at Stanford roughly a year. One of the things that struck me is there's a lot of Hispanic patients here. So I speak Spanish a lot. I Actually recently became a qualified bilingual staff because I was like, I have to, like because like I'm fluent. I don't want to call the translator at 3 a.m. to get an epidural like, Hey, I got to do this now.

Cesar Padilla: [00:21:18] A patient experience that really stands out is, you know, I was on calls with a with a Hispanic patient and, you know, after we placed the epidural, got her comfortable, we started talking about her journey as an immigrant. So she came from a small farm town in Mexico. My family comes from a small farm town in Mexico. And then I understood the history of rural Mexican medicine, particularly obstetric medicine. So midwives, for example, are very important in rural Mexican culture, and that actually comes from the Aztec and the Mayan. This predates the arrival of Spanish. Midwives were actually... The practice of midwives and, you know, sort of the practice of obstetrics was so central in the identity of Aztec and Mayan cultures. So much so that there was multiple female deities that were all about different aspects of obstetrics. Goddess of childbirth. Goddess of pregnancy. I mean, you still see those influences today. I mentioned earlier my grandmother's sister, who was a nun, my grandmother's cousin was a midwife. And you're called. 'Parteras'. So we're talking. And she mentions yeah, she's like, you know, we're in Mexico, this patient saying, you know, my mom was a midwife. And I'm like, "Oh, my God, we start talking." I'm like, "Well, tell me more." I'm like, "Isn't it incredible?" And the respect that she had for her mother's role, I honored that respect because I understood the historical context. I understood what it meant. Like I understood that when you just dig a little bit deeper in history, you see that the incredible impact that these practices had on shaping the identity of these cultures. And one of the things that we pride ourselves in, at least for a big part in Mexican culture, is being between the worlds of the indigenous and the Spanish. You know, we bring in a lot of these indigenous practices that are passed down along to us. And so she was mentioning this, you know, her mother being a midwife. And, you know, we just started talking. And then I brought in I brought in the Aztec history and I'm like, did you know that there were a lot of female deities that were actually revolved around this?

Cesar Padilla: [00:23:31] And there are specific examples that are powerful. If a woman died during childbirth in the Aztec empire, she was given the same ceremony of death as a soldier who died. So this is quite literally the same thing as a pregnant woman dying, getting the Purple Heart here. I mean, this is societal identity. This is Prime 101. When the Spaniards got to Mexico, they were freaked out by midwives because, you know, their approach to gender roles was very different. Much more misogynistic. So they were like, "no, no, no, we got to get rid of these midwives." So there was a clash of the cultures. But as I'm talking to this patient and I'm telling her this, she's like, "I had no idea." She's like, "Really?" She's like, "Midwives played a central role?" And then she said, "That makes me feel so proud." And that, oh my, it must have been 2 a.m. when I was having this conversation. But like when you're connected like that to a patient, you know, because we're speaking on different levels and think about what we're talking about, we're talking about generations. We're talking about these things that are passed along to us. We're talking about respect, admiration, all these things that are happening in this moment of like ultimate human connection. And it doesn't matter what time of the day that it is, but like that moment and it was probably a busy night, you know, it was like... But that moment itself, those are like little seeds that just give you so much motivation and sort of, in my opinion, keep me going.

Tyler Johnson: [00:24:59] You know, Cesar, one... One thing that I'm really struck by listening to you, a lot of people have made the argument over the last 20 or so years, particularly since the rise of the digital era, that while the digital era is supposed to be connecting us, right? Like that's the whole theory behind Facebook and social media. In fact, in many cases, we live in an increasingly atomized society. Right? And there's really good data to show that we feel more lonely than we used to feel. And we feel like we're cut off from people around us and, you know, the epidemic of loneliness and etc., etc.. But one thing that I'm really struck by listening to you is that you seem to have this knack for having an almost generational view of medicine. Like, I hear you telling your story, and here you are at two in the morning, having this encounter with some random patient that you had never met before. And you're drawing on threads from, you know, Aztec culture and from something you learned in a convent when you were four years old in some little town in Mexico, and your parents who immigrated here and you're Latino, I mean, all of these things.

Tyler Johnson: [00:26:01] I guess I'm curious, how have you fostered that sense? Because I can imagine and it sounds like just from the enthusiasm that you have when you're talking about this, that it's it seems to sustain you and it seems to nourish your sense of place within the world of medicine. But this is not something I've heard very many people talk about, so I guess I'm curious how you both, how you came to have that view, and how you nourish it such that you're able to sort of tap into that reservoir of meaning even at two in the morning when you're placing an epidural or whatever you were doing with that patient?

Cesar Padilla: [00:26:33] Wow. Well, I think it comes from the feeling of respect. Respect for what people have done that came before us. And that respect could be within the family. Like, okay, what my grandfather went through. Like, my grandfather was part of the Bracero program, which is a program that the Mexican and the US government had, and they would send people to work mainly low income, hard labor jobs. So my dad... My grandfather and my dad worked in farms along California. But it's easy to forget, you know, the struggle of what people went through before you, right? It's like, it's easy to be in the comfort of a modern society. But I think when you start to have that respect is start to put yourself in their shoes, right? Maybe that's where it comes from. Perhaps it's a place of respect and understanding that what we have is... I mean, look at the conflict in Ukraine. It's devastating. And when I see a conflict like that there's always a sign on my mind that says, like, not only are we so lucky to live here, but what if I was born into that situation? It could have easily happened, right?

Cesar Padilla: [00:27:39] Like this just it's sort of like this, this thing that we call life, we're sort of born into these situations, but always just understanding not only that, we are sort of. Privileged to be, you know, in a situation where in a society where we have access to education. But I think that the tone and the the perspective of respect is probably the foundation for what you're talking about. You know, perhaps. I've never actually quite thought of of that perspective. But it's also just history, in general. So what I mean is, you know, I always tell residents this and medical students - walk into a situation and question everything. Just question it. You're in ICU, you're having an end of life discussion, you know, and sometimes patients die. And let's say I'm talking to a resident. Okay, Let's go pronounce a patient. Well, what does it mean? What does death even mean? The very definition of death even changed in the 1960s, when the 1968 there was a convention with Harvard scientists where they declared brain death as a form of death. That's like... My dad was born in 1946. That's crazy to me. That's like, that didn't happen too long ago. When we sort of place this respect over what this work means and understanding that the work of the Harvard Docs in sort of proclaiming brain death as a form of death, like how does that shape our approach to to modern care? It's everything. It really is.

Cesar Padilla: [00:29:08] But I think it just what happens is when... when we have that approach, I think it makes it gives everything purpose and meaning. And there I go back again to those two... To those two sort of terms. But I think that's what happens, is when you have a respect for for for the work that people did, whether it's in the field of medicine or familial, I think that sort of enriches enriches a purpose.

Cesar Padilla: [00:29:34] Now, I mentioned that specific example of of the Harvard Docs, but even before that, it was in the 1950s that CPR was really invented. It was Peter Safer who was an anesthesiologist from Baltimore. He started the first ICU. What's incredible, in the 1950s, someone was like... It was him and a physiology physiology researcher James Hallam, who invented the concept of mouth-to-mouth breathing. And it's like, what? Like, if that happened 70 years ago, then what can we invent now? That's how I approach it. You know, take yourself out of this sort of situation and see ourselves as sort of lineage of something rich. And that's how we view medical education as well.

Henry Bair: [00:30:22] Dr. Padilla, I know that you also write quite widely on many of these issues that you've discussed. You recently wrote pieces on the history of the hospital in America, as well as the history of the definitions of death. So, for our listeners, we will post links to all of these articles and more in the show notes.

Henry Bair: [00:30:42] Moving back to something that you discussed earlier, I admire the way you bring the entirety of your lived experiences and your heritage to connect so deeply with patients who are of similar backgrounds as yourself. I was wondering what advice do you have for medical students, trainees or other doctors who are trying to connect with patients similarly, but with patients who might not be of the same background, may not share the same cultural vocabulary?

Cesar Padilla: [00:31:18] Yeah, that's a great question because as I'm sitting here talking a lot of our patient populations, for example, Southeast Asian, I want to know what the historical context of birth is... Is in the Southeast Asian community. Like, I want to know this, right? And so I think when you have respect for cultural heritage, it translates to other sort of aspects, right? So other other peoples as well. So, what I would tell people who perhaps are working with, you know, groups from a different cultural identity is... Number one is to take a step back and understand that, you know, race is a social construct. And this is what the American Medical Association said just a few years ago. This is the paradigm shift of medicine. Race and ethnicity is a social construct. Like, we are all basically biologically the same. Like, sure, there are certain diseases, you know. But for a large part, a lot of our outcomes, we know, are driven by the social determinants of health. And I think it's important to say that because we really have to understand that we're all in the same journey. It's natural for us to have affinity for our own culture, of course, right? But when we understand the role that social determinants of health, for example, play in rates of asthma, for example, let's look at certain parts of LA. My wife's from Los Angeles, and there are certain parts of LA that are just incredibly high incidence of asthma. Why? Because there's factories there. And then who's more likely to live there? And unfortunately, that falls along racial ethnic lines. Why?

Cesar Padilla: [00:32:50] So when we start to break this down, I think it gives us empathy. I really do. And so I would say, you know, to trainees is the best advice I ever got as a medical student. It was from my dean, my counselor Dean, Dr. Elizabeth Norberg, shout out the University of Rochester. She said, Never judge. Simple, right? You're like, Oh, never. But they stuck with me. I don't know. Never judge. You know, never judge patients, of course. And it was just so simple. But I think it was the way she said it. She just kind of looked at me. She's like, "Never judge patients." And I'm like, "Man..." Like, I think about that even today. But of course, I mean, it wasn't just like she saw me and she said, never judge patients. This was like at the end of a very rich and meaningful conversation. But I think I would want to say the same to trainees. You kind of sit down and just say, Look, like we're part of this lineage. Unfortunately, this is a situation of medicine in the U.S. where, yeah, we have a lot of advances, but we have also a lot of disparities.

Cesar Padilla: [00:33:55] And let's look at the lens of our society, of our structure, to perhaps understand these disparities a little better. You know, never judge. Of course, you know, that comes in being empathetic, being humans. And then I teach about history. I think it's important. It was an invited keynote for the Hispanic Heritage Month for the American Medical Student Association. And guess what I talked about? I talked about Aztec maternal health and the contributions of indigenous history and how it relates to current day disparities. And people reached out afterwards. People said that they were crying after that because they were like, I just never felt so touched by something within my heritage. But I think that you can even understand that coming from different cultural backgrounds, empathy, respect, you know, these themes. The art. We all have this basic scientific competency. We all took these step one, two, three, four, five. But what makes us... What makes this special, What makes this podcast, even, for example, special, is the art of human connection. And I think there are themes that are sort of underlying in this, and it's empathy, respect, love. And that's how I would approach trainees is just always just have this open perspective and always just try to understand your patient populations.

Henry Bair: [00:35:19] As our time draws to a close, I think it's very apparent through the course of this conversation that mentorship is tremendously important to you. Are there any lessons that you haven't brought up that you would like to share with some of our listeners?

Cesar Padilla: [00:35:34] You know, I would just say, regardless of where you come from, you belong in medicine. And I think it's really important to send that message out of belonging to medicine. It's really important, because it's really easy to feel sort of imposter syndrome, like, I don't belong. But you belong in medicine. And what I mean by that is, you know, there's richness in the idea of diversity and different opinions coming together. And I think that's what really is going to set the future for a better tomorrow.

Henry Bair: [00:36:00] Thank you again, Dr. Padilla, for your time and for sharing all of your wonderful insights.

Cesar Padilla: [00:36:05] Of course. Thank you, guys, for having me. I really, really appreciate it.

Henry Bair: [00:36:10] 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 thedoctorsart.com. 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: [00:36:29] 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: [00:36:43] I'm Henry Bair.

Tyler Johnson: [00:36:44] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.