EP. 48: CHOOSING HAPPINESS

WITH JOHN LELAND

Feb 8

WITH JOHN LELAND

A New York Times journalist shares what he has learned about happiness and aging from his conversations with and writings on octogenarians and nonagenarians.

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Episode Summary

In 2015, New York Times journalist John Leland set out to follow the lives of six people over the age of 85. What John learned shattered his preconceived notions about aging, loneliness, and loss. The resulting 2018 book, Happiness is a Choice You Make, became an international bestseller and delved into how these older individuals found wisdom and joy in the later stages of life. In this episode, John joins us to discuss the transformational exploration he undertook and lessons on living well he has discovered from this journey.

John Leland is a reporter at The New York Times, where he wrote a yearlong series that became the basis for Happiness Is a Choice You Make, and the author of two previous books, Hip: The History and Why Kerouac Matters: The Lessons of “On the Road” (They’re Not What You Think). Before joining the Times, he was a senior editor at Newsweek, editor in chief of Details, a reporter at Newsday, and a writer and editor at Spin magazine.
In this episode, you will hear about:
• How a college music reviewer came to write for The New York Times - 1:41
• How John’s exploration of aging began when he was initially—reluctantly—assigned to write a series of articles on old age and retirement - 5:04
• Reflections on how John’s expectations of aging — including loss, sadness, loneliness — were transformed over the course of this writing project - 9:01
• How John discovers his interview subjects - 11:38
• A discussion of John’s book, Happiness is a Choice You Make, and the lessons he learned from his subjects - 14:44
• Advice to young clinicians on finding moments of happiness in their careers - 26:19
John’s surprising realization that elders are not “depressed all the time” - 33:53
• A discussion of John’s recent article, in which he was documents the last days of Shatzi Weisberger, a nurse and prominent death educator - 36:53
• Reflections on how John’s relationships with older adults have changed his perception of death - 40:07
• Advice to clinicians on how they can better help older patients connect with what makes their lives meaningful - 45:03
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 Doctors 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] In 2015, New York Times journalist John Leland set out to follow the lives of six people all over the age of 85. What John learned shattered the expectations about aging, loneliness and loss. The resulting book, Happiness Is a Choice You Make, became an international bestseller and delved into how these elderly individuals found wisdom and joy in the later stages of life. In this episode, John joins us to discuss the transformational exploration he undertook and lessons on living well he has gleaned from this journey. John, thanks for being here and welcome to the show.
John Leland: [00:01:39] Oh, thanks for having me.
Henry Bair: [00:01:41] Virtually all of the guests we've had on the podcast are involved in the medical field in some capacity. You, however, are not. So can you tell us how you found your calling in journalism and how you became a reporter at The New York Times?
John Leland: [00:01:58] Well, I think most of us come here by entirely different passages. When I was in college, I loved music and I started writing about music for my college paper. And from there, some of the people I wrote for in the college paper went on to write for rock and roll magazines. And so I got into the journalism sort of through a back door, and I got into it just by by writing. After a while, the Peter Pan syndrome set in. I didn't want to be the old guy in the club anymore, so I just started to branch out a little bit and write about other topics, and I became an editor at Newsweek. At the end of the last century and sort of took a more, more general approach to what I was doing. And so from there, since 2015 or so, I've been somewhat focusing on the lives of older adults. And that's a little bit of what brought me to the stories that we'll talk about today.
Tyler Johnson: [00:02:53] So let me back up before we get to those stories which which we are going to talk about here in a moment. Can you just tell us? You know, I think that for many people who are in college or in medical school, certainly I know this was true in my medical school and is true where I work at Stanford. Now, The New York Times is the place to go, right? I mean, all the news that's fit to print. But I think a lot of people look at it, you know, it's called the paper of record or the it's supposed to be unassailable in its reporting of the facts and all of that. And so I guess I'm just curious, what is it like to be on the inside there? What's it like to be behind the curtain and be one of the people who is engaging in an enterprise that I think many people consider to be so important?
John Leland: [00:03:41] I imagine it's a bit like being at Stanford or being at Stanford Medical School; you get to be around the smartest people you could hope to be around and to be working with and to get the assistance from. I think one of the things that might surprise people about the Times is that it's a very collegial place. We get along really well. If I want to know something about housing in New York City, I can go to our housing expert who will know everything there is to know about housing. If I want to know something about the New York City Police Department, I can go to one of our police reporters who will know everything there is about police. And the same way you might go to someone in the history department and say, you know, what do I need to know about Precambrian medical rituals? And someone will say, "Well, here's my book on it." And so it's a little bit like that.
Tyler Johnson: [00:04:29] Yeah, it is funny that you mention it being collegial because I have this, I'm sure what's a very tired stereotypical view, but of, I don't know, editors running around with their ties barely loose and yelling at reporters to get their things in by the deadline. And I don't know, something something, something which probably has no resemblance to reality at all.
John Leland: [00:04:48] But that's. And there's a ticker tape machine running in the background, right?
Tyler Johnson: [00:04:52] Exactly. It's like All the President's Men all the time or something. That's sort of the that's the image that I have in my mind.
John Leland: [00:05:01] Yeah, we look more like the modern cubicle factory than that. Right?
Tyler Johnson: [00:05:04] And of course, all of it is on print all the time, right? The Internet doesn't exist in my my rosy colored view of how a newspaper works. So let's talk then about, well, the specific article that that brought you to our attention, but also more broadly, this sort of focus that you have had over the last number of years on the lives of older adults. Tell us a little bit about both -you started to mention this before, but tell us a little bit about what brought you to that work and then tell us a little bit about sort of what exactly you have done in that space, what your experience has been like.
John Leland: [00:05:39] I kind of got roped into writing about older adults. Again, I wasn't expecting to do this. I was we were starting a kind of pilot project and we're going to have two reports that we're going to do it. We're going to cover a couple of mini beats for six months or so. I might me and another colleague were the first writers in this, and they said, What do you want to write about? And I said, Well, I want to write about gay life and the creative class. And they said, Great. You write about religion and retirement. So. They weren't the topics that were that I was dying to write about. But I found that writing about retirement. I started off writing the stories about kind of men in their sixties who don't know what their identity is going to be when they leave their jobs. And they were interesting stories to do. But I gradually started to write about older people and under that beat, and I found that it was tremendously helpful because we're all going to be old, we hope, and also tremendously informative and moving because the stories about older adults, people in their eighties nineties, they kind of get to the emotional core right away When you're talking to somebody in their eighties and nineties, when you're talking to somebody who is the child of somebody in their eighties or nineties. You get to the emotional truth about life kind of right away. Some of the filters are gone. Some of the people don't give a damn what you think about them in ways that they might have when they were younger. And I use that because somebody did something I did and said my life improved when I stopped giving a damn what people think about me. A woman in her seventies or eighties, I think it was in a computer course. So as a journalist, that's just fantastic. People will invite you into this emotional heart of their lives pretty quickly in ways that they don't always with younger people.
Henry Bair: [00:07:34] So when you were initially invited to write something on old age and retirement, was there a specific story You're trying to uncover themes you are trying to explore or an angle you were trying to take?
John Leland: [00:07:50] My philosophy when I go into stories is I want to know what whatever it is I'm writing about looks like to the people who are involved in it. So I'm writing about personal debt. What does personal debt look like to the people who have $10,000 balances on their credit card or $20,000 balances on their credit card? When I was writing about older adults, I wanted to know what did life look like at 80? What did it look like at 90? What did it look like at 100? And I wanted to know from the real experts who are the people who are living it. Because you think about old age. So much of what we think we know about aging comes from people who have never been old. And it's imagine if, like everything you heard about Italian food came from people who had never eaten it. But we do that with aging We hear from. You could cover the aging beat just writing about gerontologist and geriatric geriatricians and end of life doulas and just kind of the people who we think of as the experts. But, somebody said that "old age is a foreign country: We don't know what it's like until we're there." You kind of got to talk to the people who are there.
Henry Bair: [00:09:01] And as you were embarking on that journey, in your mind, what were some of the preconceived notions, if at all, that you were bringing into that exploration? Like what were your notions about what old age was and what it was like?
John Leland: [00:09:18] It's a great question. I thought old age was just about loss. You at your peak, at some point you get to middle age and then everything kind of falls apart. And. I thought that what you write about with old age is what's lost between middle age and old age. And I didn't start to think about what's gained, what's just what's neither gained or lost, but just changed. What's different when you can't do all the things you used to do? What's meaningful in life? What gives your days value? And I had to turn to the people who actually knew that and actually lived it to learn that. Luckily, they were willing to teach me.
Tyler Johnson: [00:10:02] And John, could you reflect on maybe a particular experience or a moment that served as an awakening to you? Where to Henry's point, you came in with a certain set of ideas and then in either something that you witnessed with an older person or something that an older person told you, it shattered your preconceptions and gave birth to a new understanding.
John Leland: [00:10:29] I was writing about an 88 year old man living in Brooklyn. He was living alone in a walkup apartment of three flights of stairs. Bad heart. So for him just to get in and out of his apartment was excruciatingly painful. So, I thought visiting Fred was going to be a miserable experience, that he's just going to be unhappy all the time. And I would go to see Fred and every time I left him, I felt like completely uplifted because Fred made his life of the things he could still do. He just didn't think about the things that he had lost. He thought, What can I do today? What sort of dirty thoughts can I have today? What can be my fantasies today? I'm not going to get out and walk around quite like I used to, but I am going to get out. I'll go downstairs. I'll see the people. And the way that Fred made his life from the things that were still available to him was just a great lesson to me and that you can share with people of any age. You can't do all the things you'd like to do. How do you live? Really well now.
Henry Bair: [00:11:38] Maybe this is getting more. I'm just I'm really curious about how you went about tackling these these articles, these stories. How did you find your subjects? How did you find the people whom you wanted to learn more from?
John Leland: [00:11:54] Oh, it's kind of the the best part of my work. You know, you were asking me about the Times, I think kind of a unique luxury that we have at the Times is I get time to work on stories. I don't have to file three stories a day. I'm not constantly bumping up against deadlines. We have enough people here that I can have. Couple of weeks, months, two months, three months, sometimes to work on a story. So my partner is a former actress and she says 80% of directing is casting. And it's kind of the most fun part of the stories is just going out and meeting as many people as you as you can. In 2015, I did a year long series on people age 85 and up where I followed six people for that year, and it probably took me a couple of months just to find the right six people because I knew there were certain things I wanted. I wanted a gay man because I felt I didn't know what gay life was like 40, 50, 60, 70 years ago. I wanted a couple who had met late in life because I didn't know that story. And I wanted some foreign born people because in New York, at least, the growth of the older population is all foreign born. The native born population, older population is actually declining. So there were certain things I wanted and I wanted one ringer, somebody that I knew was going to be good to follow for a year.
John Leland: [00:13:22] Well, somebody that I knew would have great stories to tell and was good at telling them so. Jonas Mekas is a filmmaker. He left a long trail of interviews and writings, so I knew something about him and I knew he was going to tell me about appearing in a film that Yoko Ono directed. He was going to tell me about his friend's friendship with Martin Scorsese. So I knew no matter what happened, I would get great stories from Jonas living in displaced persons camp in in in Germany after the war. So there was going to be a long narrative that I get from Jonas. He was the ringer and he was he was not too famous. So he was not shielded from the vicissitudes that ordinary people go through. But he was famous adjacent, maybe. So that was something I wanted. And then I just went out and met as many people as I could and talk to them. And some people's stories overlapped. Some people seemed to Pollyanna-ish and I thought, like, they're not really being straightforward with me. I can't- you know, again, I'm thinking that old age is just about lost. So and then a lot of people's stories just kind of resembled one another. So I narrowed it down to six and just set out to follow them for a year and see how old age is making their lives miserable. Luckily, they had other plans.
Tyler Johnson: [00:14:44] So I'm curious, though, because I think you're right and we have had other guests on on the podcast previously who have talked about old age and aging. And I think, you know, in the United States in particular, we have in some ways surprisingly youth centric culture, right? If you look at most advertising, for instance. Right? Advertising in in a sense, I feel like never lies, right? Because advertisers will put whatever they have to put to get people to buy their stuff. And if you look at advertisements, advertisements make it look like anything from beer to jeans will make you younger, right? That's the sort of one of the selling points, which is just to say that I think our our culture really values youth and a youthful look which perpetuates or contributes to the idea that you mentioned that old age is loss. And so I guess I'm curious, as you followed people who are older and learned that that was not true, in what concrete ways what was it not true? So what were the things that people gained as they got older and how did that surprise and change you?
John Leland: [00:15:56] But we know there's a lot of research that that people's sense of contentment goes up with old age. People in midlife are sort of at the bottom. It's people talk about the U-shaped curve of happiness or the U-curve of happiness. Things are pretty good when we're young, and then we get to middle age and the kids are home and, you know, it's just a mess. And then as we get older, we lose some of our responsibilities and we become more content, more satisfied with our lives. So I saw some of that in people. I found that people were able to make decisions a little better. They didn't fly off the handle when things didn't go their way. They were used to that. There are ups and downs. They took losses in stride. More than I do. And more than a lot of younger people I know do because they they're used to loss. They accept that the things that they can do today, they won't be able to do tomorrow. So I found those things and I just found, again, this willingness to be open about your life and contemplate the things that are important to you about life and be really to think about death in an open way rather than to think I'm going to live forever and live your life as if you're going to do that. They knew that their time was limited and they lived as if their time was limited, which I think gives every day some value. If we think we have an infinite number of days, they don't really have much value if we think we have. 19 days left. Gosh, each day we're going to put everything we can into that day because tomorrow they'll only be 18 left.
Tyler Johnson: [00:17:36] Yeah, I can kind of feel momentum building even as you're talking towards a book that came out of these and other similar experiences. And even the title of the book is telling, right? I think it's happiness is a choice you make or something to that effect. Can you tell us a little bit about then, the genesis of the book and why you chose that title?
John Leland: [00:17:58] I've heard of this book. I came up with the title well before I started writing. A word of the book was something that came to me one day and I wrote it down and I taped it up by my bedside so I'd see it first thing in the morning and last at night. How did the book come about? As I mentioned, I had wrote a year long series in the New York Times. It's the stories were well received. The characters, I think the readership got to know the characters over time. I became very invested in the lives of these people. Over time, the series ends and something is missing from my life. I didn't quite know what it was. You know, I'm a newspaper guy. I'm used to walking away from stories writing about people and then moving on to the next story. I couldn't do it in this case. Something was missing and I didn't know what it was. And I started to think about what am I missing? And I thought it was kind of the lessons that I learned from these older folks, that I couldn't consult them every day. And I wanted to make finally go back and make sense of what it was. As I said in my journalism, I try to write about what things look like to the people who are living it. So the series in The Times is about what being over 85 looks like when you're over 85. The book. I wanted to also synthesize a little bit what I learned from being around these people and the ways that I was changed by it. And I also included my mother in this because my mother was in her nineties at the time.
Tyler Johnson: [00:19:26] One of the things that I feel like is always a tricky balance. We'll talk about your observations about death and dying in a moment. I bring that up only to say that we've encountered a similar dynamic when discussing death and dying with our patients is that on the one hand, we feel like it's important to to help sort of unmask the reality, both the good and the bad of things that people are often not familiar with, like age and aging. And so that your comments about that you came in with these preconceptions about what it was like to age and then had those shattered because of the experiences that you had with the people that you interviewed that really resonates with us. At the same time, I'm also struck like when I when I look through the articles that you've written over the years, there was one this was, oh, about a year ago you wrote called "How Loneliness is Damaging Our Health," which is just to say that I would imagine that there are also a lot of older people. There's a there's a term that I am forgetting right now, but basically for people who don't have any close relationships, don't have any close friends. All of which is just to say that there are some aspects undoubtedly of growing older that can be very difficult. And so I guess I'm curious, given that reality, which is also something that you have written about, how do you nonetheless stand by the thesis of your book that happiness really is a choice that you make?
John Leland: [00:20:52] I don't suggest that happiness is that we can choose happiness the way we choose our toothpaste. One day I'll got Colgate. In, the next day I'll get Crest. But I do think that happiness is something that we need to create. We need to carry around within ourselves. If we're looking for our circumstances to bring us happiness, we might be waiting for that for a long time. If we are finding what's meaningful to us and pursuing what's meaningful to us, sort of filtering out some of the issues. Understanding that, yes, there are hardships that we're facing, but we've dealt with hardships before. They've always been a part of life. Loss isn't something that singles us out to experience. Loss is just a part of what it means to be human. We're all losing something. You guys are. We can talk about it on a cellular level or an organ level. We're losing stuff all the time. But how we approach that loss makes a difference between being content with our lives and being discontent with our lives. You know, if you ask yourself who are the happiest people, you know? Just take a second to think of who are the happiest people, you know? Are they the richest people, you know? Probably not. Are they the healthiest people, you know? Probably not. Are the people with the fewest problems? Probably not. They may be, in fact, people who have really, really serious problems. But the way they approach those problems makes all the difference in the world. When I say happiness is the choice you make, we can't all become champion happy people in the same way. We all can't become LeBron James. It would be great if we could, but in the same way, we can make ourselves a little bit better at shooting baskets. We can do certain things to help us spend more of our time in the upper reach of our happiness capacity and less of our time in the lower reaches of it.
Henry Bair: [00:22:53] Earlier, you talked about Fred, who, despite his mobility issues, was able to savor the fact that there was another day and enjoy what each day had to offer. In your book, you also write about other people, some of whom had health problems, cognitive impairments, who had suffered loss and who were nearing death. Is there another story from the book you can share that illustrates how some individuals were able to, using your imagery, find a high point on their happiness spectrum?
John Leland: [00:23:28] Well, almost all of them, because they were all over 85, almost all of them had lost a spouse. They had one of them had lost a son. So they were everybody had experienced losses. I'm thinking now of John Sorensen, who had lost his partner of 60 years and felt that after Walter died, he just didn't want to live anymore. That's how he felt. And so this is something I wanted to investigate a little bit. What did he mean when he said he didn't want to live anymore? And I would go. And John. John loved to talk. Talking would always get him in a good mood and even talking about wanting to die. So I would have these conversations with him and he'd be really upbeat. And I would say, you know, John. Do you really wish you were dead right now? I'd say no, because we're having this conversation and I'd say, Well, I'm going to leave in a little while. Do you want to die? Then you'd say, Well, no, because Anne is coming tomorrow, and Anne would be Walter's niece, who was his main caregiver. And then Alex was coming next week, and he was one of his friendly visitors. And and Scott, who was his aide, was going to come, so didn't want to mean that. So when John said he wanted to die, he didn't really want to be dead. It's that he didn't want to have decline. So John was kind of faced his end. Directly. So what did John like? John loved old movies. Loved Seven Brides for Seven Brothers. Couldn't get enough of it. So he would watch it, you know, once a week or so.
John Leland: [00:24:55] And he was having vision problems, so he couldn't really see it that well anymore, but didn't need to because he knew the movie so well. He loved opera, so he would listen to his favorite operas. And unlike so many of us who put on our music in the background, and maybe we'll be thinking about who we're going to see later on or what we're going to cook later or this or that, or what some jerk said to us earlier today, John would focus in on it because he didn't know whether he would ever hear La Traviata again or ever Here he was smitten with the tenor Jonas Kaufmann, and he didn't know if he'd ever get to hear Jonas Kaufmann again. So he would listen to it as if it was the last thing he would ever do. And his opera was better than my opera just because he listened harder than I did. And at the end of each year, I would say, ask you live this year, are you glad you live this year? Do you wish you hadn't? And each of the six would always say they were glad they lived the year, and almost all of them had some bad things and some low moments during the year when maybe they wouldn't have answered the question in quite that way. But looking back on it, they were glad they lived. They were grateful for those moments they had. And I think that that kind of conscious practice of gratitude, which I saw in all six of them, was really important to their sense of well-being.
Tyler Johnson: [00:26:19] So let me ask you a question. I was really struck by your analogy a few minutes ago about basketball and LeBron James. The reason I think that the analogy strikes me is because I like to play basketball a little bit. And if I were to decide tomorrow that it was really important to me this year to get better at basketball, I know roughly what I could do, right? I could go to the gym and shoot free throws or work on my dribbling skills or whatever. Like I know how to do that. By contrast, though, many of our listeners, we probably have some older listeners. I don't know if we have anyone over 85, but but a lot of our listeners are younger right there in college or in medical school or in the early part of their medical training. And part of the impetus for this podcast is that, as I'm sure you have read and seen in your own reporting, probably there's an epidemic of burnout amongst doctors, which Henry and I take to be a particular tragedy, because what other profession should be more insulated against burnout, You would hope in some ways then than medicine? At least in the sense that it would seem like medicine should always have intrinsic meaning because of the nature of what we're doing. But right now, that's there is no insulation, right? Some very high percentage, 40, 50, 60% of doctors report that they're burnt out. And so I guess what I'm wondering is if there are young medical trainees or whomever who are listening to this and are thinking, gosh, you know, I'd sure love to go do the equivalent of shooting free throws to try to be a little bit happier or a little bit more grateful or a little bit more fulfilled or a little bit more or something. Are there practical daily practices that you could list for our listeners that from your reporting and observation would help them to to find their lives a little bit more meaningful or to help them to feel a little bit more, a little bit happier?
John Leland: [00:28:19] Well, you all in medicine don't want to hear this, but I've come to think that there is a wonder drug out there and it's a it's a gratitude journal. And I don't keep on myself, but everyone I've ever met with that keeps a gratitude journal has said that they write down one thing that they're grateful for on a regular basis, every day, every week. They all tell me that they are transformed by that. I found that though I don't keep a gratitude journal, I make a regular practice of taking that time to give thanks for something. I found that that's. One of the most reliable ways to improve my life. Somebody said to me once a meditation practice, it's easy to do. Hard to remember to do. And I think that's true of gratitude. Meditation also is good because meditation reminds us to put a space between. The things that are happening to us, the world out there and our reaction to that. If we have that little bit of space, we can execute some kind of control over it, or maybe not control. That's probably the wrong word, but influence over it, over the way we react to that, the things that are lives. Is this really the worst thing that's ever happened to me? Is what I'm reacting to, really what I think I'm reacting to or am I really reacting to something different? So those two things I think are pretty reliable. Allowing yourself to depend sometimes on other people. We think that the answer is to pull ourselves up by our bootstraps. Stand on your own two feet. Does it work at the beginning of life? It doesn't work at the end of life. And maybe it's not the best thing in between. It's not the highest virtue. Maybe reciprocity, generosity. Collaboration might be higher virtues than self reliance. So those are three things I think people can keep in mind.
Tyler Johnson: [00:30:13] Yeah. You know, one of the things that really resonates about your answer with me is that especially the first two things and arguably in some ways the third require some element of discipline. I don't think that we usually think of happiness as being something that we can come nearer to achieving by implementing disciplined practices in our lives. But I think there's really something to that. And I actually think that in particular for medical trainees, you know, if you're a medical student or a resident or a fellow, you may be spending 70, 80, 90, 100 hours a week doing your medical training. And the time that you have outside of your medical training is scarce. But I think that I'm just going to as somebody who has been through that, I'm going to plus one what you said in the sense that I found that for me. There were disciplined, in particular spiritual practices, prayer, which is sort of, I would say, my version, I guess, of meditation and in my case, reading holy books a little bit every day, like even if it was on my phone and even if it was 5 minutes while I was falling asleep in the call room on the 24th hour of a 30 hour shift, there's something about that disciplined practice that sort of to what you were alluding to, keeps you in touch with the universe, right? It reminds you that there is a bigger canvas than just the intense difficulties that are that are right in front of you in the hospital. And I feel like that's a potentially an undervalued but a really vital way to kind of keep your emotional and I don't know, philosophical sanity while you're in the middle of what can be a very a very intense training and life as a doctor.
John Leland: [00:32:10] I think also creating some sort of distance to remember the passion and reasons that you're doing this in the first place. Wynton Marsalis probably spends a lot of time playing the trumpet. Might take hundreds of hours of discipline in that in a week. I don't think it ever gets frustrating to him. You know, he doesn't think I can't hit that C It's going to drive me crazy because he's in touch with the passion and the love that brought him to that music in the first place. I like to think that our medical professionals are drawn to it by a passion and not just something that they fell into. That could be my own romance. But but it's too hard to go into if you don't have a passion for it. And if in the midst of the minutia of the day that are driving you crazy, you can sort of step back and look at it from look at yourself from 10,000 feet and think, I'm getting to do this because I've worked so hard to put myself in the position of being able to do this. You can just look at it a little differently. It doesn't make the frustrations go away, but just gives us a slightly different perspective on them.
Tyler Johnson: [00:33:21] Yeah, no, I think that's absolutely true. And that's one of the things that many of our guests who are medical practitioners have observed is that it seems like almost everybody who who does insulate themselves to some degree against burnout, at least part of that layer of insulation, is some kind of a often a pretty conscious, reflective practice to keep them in touch with the deeper reasons that brought them into the field in the first place.
Henry Bair: [00:33:53] Yeah. So you've already talked about some of the the broader lessons that you've taken from your conversations with these older individuals. You talked about the importance of relationships that many of these individuals have found or the strength to face another day by being in the moment and relishing in whatever that sense of being alive can can bring for you all the sensations that you can you can have in the thoughts that you can enjoy in a given day. What other surprising lessons have you learned from talking to these six individuals? Like, is there anything that that you were not expecting that turned out to help one of them or some of them find meaning?
John Leland: [00:34:38] I think the main thing was just that they weren't depressed all the time about being old, which is what I thought, and which my mother had said to me, you know, like, don't you get depressed being around all those old people all the time? And I'd say, No, it's exactly the opposite. So that was the main thing, kind of the resilience that people develop over time. You know, the lessons that I talk about. Are not new. They're not arcane. They're not hidden from us. They're in all of our wisdom literature. They're on all of our Hallmark cards. But we get the chance to see them lived out in real life. They become something different, right? And so just getting up in the morning and dealing with things, it takes a little bit of heroism. And if we can pat ourselves on the back for that heroism, I think we're ahead of the game. But you know that all of us, we're going to have a period of 10 minutes of time at some point today where we don't really have anything to do. Do you use that 10 minutes to call the friend that you haven't talked to in a long time? Or maybe we could use a call. Do you use that time to do something for somebody else? You know, I think that, again, thinking about the medical profession and putting some perspective on what we do, remind yourself that, gosh, you're helping people.
John Leland: [00:35:52] You're doing something for somebody else. All that effort you're putting into is not just for yourself. It's hopefully if you're a researcher, you're working on a medical advance. If you're a clinician, you're working on making the lives of your patients better to be able to think about. What? That's the difference our lives make. We all are in that little bit of a It's a Wonderful Life moment where you think like my life doesn't mean anything. And then if your angel could come down and show you what things would be like if you weren't there, you know, your medical folks can can take a step back and look at that. Well, you know, if Clarence came down and showed me, if I wasn't there, these people wouldn't have had the healing that they had. So it's not a tremendous insight that it's better to give them to receive. But, you know, in the older folks, I was able to see that that lived out and some of those other homilies that we live with every day, we're able to see them lived out in real life under circumstances that are really, really difficult sometimes.
Tyler Johnson: [00:36:53] I want to make sure before before we get to the end of our time to talk to you about the article that brought you to our attention, which was this article that that was published on the 9th of December of 2022 about I think her name is Shotzi WEISBERGER. I don't know if I'm saying her name correctly, but can you tell us a little bit about her in detail?
John Leland: [00:37:15] I met Shatzi in, I think, 2018 at a program called The Art of Dying, which was a thanatology program at the Open Center in New York. And she was taking it for the second time because she'd been brought back as an alum. This is very important to her. She'd been a trauma nurse for 47 years. I think she cared for people with AIDS at the end of their lives at a time before there were the protease inhibitors, before there were drug therapies. So she had come to this through a challenging life. And she said as a nurse, she always cared about how people came into the world and how they left the world. And now she was really wanted to to think about having an openness, about dying. Confronting death as something that's just part of what it means to be a person and not thinking about it is something terrible that happens to certain people that it's there with us, that we're mortal. The day we come into the world, we're mortal, the day we go out. So that became Shatzi's great passion towards the end of her life. In November of 2022, she was diagnosed with pancreatic cancer and she believed she had just a couple of months to live. And she called me, invited me to spend those last couple of months following her. And she was very clear: She wanted to be conscious, She was very negative on pain medication in palliative care. She felt that it just dopes people up and they're not able to experience it.
John Leland: [00:38:47] And she wanted to be conscious throughout. And I went to see her in the hospital. And I knew from a friend of hers that she was 92 at the time. She was eager to get back to her apartment so she could smoke pot. And so I said, Do you want me to bring you a gummy? And she said, Yes, I would love that. And so I brought her a gummy and signed on to spend the next couple of months with her. And it turned out she just had a couple of weeks. It also turned out that as anti-drug as she was and as adamant as she was that she was going to do this with her mind is absolutely clear, the pancreatic cancer had other plans and it was impossible for her to do that. And I think it was hard for her to accept that she was going to do it- death, that it made its own demands since she really needed those drugs. But she did it and she got to go out as close as she could to being doing it on her own terms. She wanted to be around the people that mattered to her. She wanted them to see her dying in ways that we often want to hide when we're when we feel like our bodies are in decay, when our digestion is no longer under our control. She wanted all that to be visible.
Tyler Johnson: [00:40:07] You know, we have talked frequently on the podcast with doctors who are intensivists, palliative care doctors, oncologists, doctors who take care of people who are very, very sick. And one of the things that we have discussed is that one thing that is a little bit strange about being a doctor is that you're given access to this kind of sanctum sanctorum. That is the time around dying that most of us, because modern life insulates most people from death. So effectively, most of us just don't have any access to that. Right? A lot of people can go through their entire lives and never spend much of any time with someone who's dying. And so as someone who came at this from such a different angle, of course, you're not a health care professional. You hadn't gone through medical school or nursing school or what have you, and yet you're invited into this place to very purposefully, consciously follow a person who is dying. What was that like for you on a on a personal level, if I can ask that?
John Leland: [00:41:13] Well, by then, the six people that were in my book had all died. My mother had died in June of 2020. So, you know, I've gotten used to getting that call that somebody has died. But. With the exception of my mother, I hadn't had the real chance to to spend that last time with somebody. So Shatzi I was going to do that and I knew that I could count on Shatzi to be my guide. I knew that she had thought a lot about this. She didn't need me to to comfort her. She didn't need me to fix any of her problems. The only responsibility for me there was to go and just be a witness to her, which is even an opportunity that your medical professionals don't have because they are there to fix some of her problems. So my conversations got to be maybe a little different from those. And it was tremendous, just tremendously moving to be there at the end. I was tremendously disappointed that we didn't have more time together. There was so much more I wanted to ask Shatzi about. There are so many more things that she was sure about that I wanted to challenge her on, but we just didn't have that time. And that's how it works, right? We'd all like more time sometimes, and it's not up to us.
Tyler Johnson: [00:42:36] Well, I know that our our time is drawing a little bit short. I think I've got two further questions. The first one is, how has all of this reporting changed you? Like, I don't even mean it's one thing to say, here's what I can articulate that I've learned. Right? In your case, you could write a whole book about what you could articulate about what you've learned. But I don't really mean that. I mean the the sort of like deep down in the innermost parts of you, in the part of you that is unconscious or subconscious that you almost observe about yourself, like how have you changed in spite of yourself as a result of spending time reporting on these older adults?
John Leland: [00:43:24] I think I went into this work like a lot of people, with a fear that someday old age was this calamity that might happen to me. And that kind of colors the way you go through your days. If you think it's like you're looking out the prow your ship and you're seeing the iceberg ready to sink you, everything's going to be miserable. If you start to think that old age is not such a miserable thing, that it's just a stage of life like any others, that there's going to be challenges in it and there's going to be rewards. Then you can look out the ship and see Tahiti in the distance, and that just looks a whole a whole lot better. And it doesn't just color the way you live those last years, but it colors all your experiences on the way there. And it's just a reminder to me to stop and think about where I am. You know, I heard the hospice nurse say one time she tells patients, you know, you're dying, but right now you're alive. How do you want to live today? And I think a week doesn't go by that. I don't think that about myself. I'm dying. But right now I'm alive. How do I want to live today? And to quote my meditation instructor, again, easy to do, hard to remember to do. But I try to do that. And I think that just when you get rid of that fear of aging, get rid of that fear of dying. A lot of the other fears don't look so bad anymore.
Tyler Johnson: [00:44:55] We'll wait for your next book, Your Tahiti to Come.
John Leland: [00:44:59] Somebody said, "One of These Mornings You're Going to Rise Up Singing" would be a good book title.
Tyler Johnson: [00:45:03] There you go. So my last question is this. As someone who is not part of the health care profession, but who has spent a lot of time talking with and observing people who undoubtedly spend a lot of time interacting with the health care professions. What can you tell our listeners about what you have observed that they can do that will mean the most to their older patients? In other words, how can we do a better job?
John Leland: [00:45:32] Anyone who has gone to the doctor's office with an older patient has had the experience of the doctor talking to you, not to the older person. Or looking at the computer rather than at the older person. I think that we don't always listen to our older adults and sometimes it's quite understandable. There's cognitive issues, there might be communication issues and the doctor's life is overscheduled. You talked about burnout over a moment ago. So he or she is pressed for time and it's more efficient to talk to Mrs. Jones's son or Mr. Jones's daughter. But. It's not going to be as meaningful to the doctors. I have found that palliative care. I think maybe the reimbursement structure is set up so they get to spend more time talking to patients. I've found them to be the most satisfied medical professionals that I've met. My data set is a little bit limited, but. You might think that how can palliative care professionals feel that way? Because their patients die almost all the time, right? And yet they get to have meaningful relationships in the ways that an orthopedic surgeon might not always have that same kind of relationship with somebody. And I haven't met one that hasn't felt transformed by one patient or another patient. And so I think that to whatever extent the reimbursement system allows you to to talk to the patients and listen to patients, I think they will get something out of it. But also you will get something out of it.
Henry Bair: [00:47:15] Yeah, I think that's really, really important because it's interesting that unless as a medical practitioner, you work in pediatrics or you work in obstetrics. So much of medicine involves caring for older adults because older adults comprise a greater population of patients and they have more health care issues to address. And I think in general, that's just the trend of the youth population we have. We are, which is increasingly aging. What's also interesting is Tyler mentioned so many times over the course of this conversation that you have a different window into the lives of these older adults. Because many times when we see patients in the clinic, it's to address very specific complaints, medical complaints, and often you lose sight of the ways that these complaints situate within the broader context of a patient's life and their relationships and what makes their lives meaningful and worth living. To translate some of the lessons you have learned over the course of of your journey. When physicians, when clinicians are trying to figure out how how they can best help their patients. What are some practical things they should be considering or they should bring up or practical things they can advise for their patients, for allowing their patients to better connect with what makes their lives meaningful?
John Leland: [00:48:51] You know, I think your oncologist maybe know this really well. You know, to ask the patients what's important to you? What do you want to be able to do? And we need to organize their treatment around what's important to them. You know, your patient wants to get to her granddaughter's wedding in Spain in September. Medically. Maybe she should start a round of chemo in in August. You know, I think the sensitive oncologists will delay that treatment, even though it's not the best thing for the patient's physical health. Because what's important to your patient is to get to that wedding in Spain in August. And I think it's things like that, understanding that that the goal in the person's life is not to get the absolute best care, but it's to live the life they want and the care needs to be supportive of that. And sometimes the absolute best medical care. Isn't the best thing for the patient.
Henry Bair: [00:49:55] Yeah. Yeah. I think it's so much about redefining what best care even means, right? For for a very long time, I think as certainly modern health care sees the best possible care as what helps the patient live the longest to maintain all of their organs functioning, you know, at the highest capacity possible, often at the expense of, as you put it, what patients actually value. So with that, we want to thank you again for your time for sharing your stories and your insights.
Tyler Johnson: [00:50:25] Thanks so much, John. We really appreciate it.
John Leland: [00:50:27] Well, thank you so much.
Henry Bair: [00:50:30] 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: [00:50:49] 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: [00:51:03] I'm Henry Bair.
Tyler Johnson: [00:51:04] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.