EP. 76: STORYTELLING IS THE OLDEST MEDICAL TECHNOLOGY
WITH LAUREL BRAITMAN, PHD
The Writer-in-Residence at Stanford Medicine discusses why storytelling is core to a clinician’s work and shares how she is searching for her own voice through life’s losses.
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Episode Summary
Storytelling is the oldest medical technology — so claims our guests on this episode, Laurel Braitman, PhD, an acclaimed author and Writer-in-Residence at Stanford School of Medicine. Laurel offers a uniquely qualified perspective on the matter, having grown up in a medical family and now mentoring clinicians everywhere to help them fulfill their writing goals. She received her doctorate in History and Anthropology of Science from MIT, and her most recent work is a 2023 memoir titled What Looks Like Bravery: An Epic Journey Through Loss to Love. Over the course of our conversation, we explore the challenges Laurel has faced on her journey as an author, how creative writing can lead to better doctoring, and how we can find the courage to discover our own identities in the face of expectations others have of us.
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Laurel Braitman PhD is a writer, teacher and secular, clinical chaplain-in-training. She is the author of the memoir What Looks Like Bravery: An Epic Journey through Loss to Love and the NYT bestselling book Animal Madness: Inside Their Minds. She received her doctorate in History and Anthropology of Science from MIT and is the director of Writing and Storytelling at the Stanford School of Medicine’s Medical Humanities and the Arts Program, where she helps clinical students, staff, and physicians communicate more clearly and vulnerably for their own benefit and that of their patients.
Laurel is also the founder of Writing Medicine, the global community of writing healthcare professionals. Her work has appeared in the New York Times, The Guardian, Wired, California Sunday, National Geographic, Radiolab, National Public Radio and many other places. She splits her time between rural Alaska and her family’s ranch in Southern California.
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In this episode, you will hear about:
• What it means to be Writer-in-Residence at Stanford Medical School - 2:06
• Why physicians write and how storytelling can help clinicians - 6:42
• How Laurel’s writing career began and her advice for how to break into the writing world - 14:43
• What it's like to be in the medical field as an “embedded outsider” - 23:15
• Laurel’s most recent book What Looks Like Bravery: An Epic Journey Through Loss to Love, which details her experience of growing up with parents with high expectations and struggling through the grief of her father’s death - 28:15
• The importance of carving out time to reflect on your journey and your ‘why’ in the medical profession - 36:54
• Laurel’s advice for healthcare professionals who want to take the first step towards writing - 44:55
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Henry Bair: [00:00:03] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:05] And I'm Tyler Johnson.
Henry Bair: [00:00:06] 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 healthcare 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: [00:00:30] In seeking answers to these questions, we meet with deep thinkers working across healthcare, 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: [00:01:05] Storytelling is the oldest medical technology. So claims our guests on this episode, Laurel Braitman, an acclaimed author and the writer-in-residence at Stanford School of Medicine. Laurel certainly offers a uniquely qualified perspective on the matter, having grown up in a medical family and now mentoring clinicians everywhere to help them fulfill their writing goals. She received her doctorate in history and anthropology of science from MIT, and her most recent work is a 2023 memoir titled What Looks Like Bravery: An Epic Journey Through Loss to Love. Over the course of our conversation, we explore the challenges Laurel has faced on her journey as an author. How creative writing can lead to better doctoring, and how we can find the courage to discover our own identities in the face of expectations others have of us. Laurel, thank you for joining us and welcome to the show.
Laurel Braitman: [00:02:02] Thank you. I'm a huge fan of yours, and it's an honor to be here.
Henry Bair: [00:02:06] So Tyler and I know you primarily as the writer in residence at Stanford Medicine. So let's start with that to set the stage, Can you share with us what exactly do you do in this position and how did you first become involved with this work?
Laurel Braitman: [00:02:21] Oh, it's such a weird story. And that, you know, I actually think it's one of the braver things I've ever done, which is kind of waltz in to the bioethics center and ask for a job. I didn't even do it over email. What happened was that I thought that I was going to be writing a very different kind of book and I wanted to write about if physicians and other health care professionals who saw the end of life up close and personal, day in and day out, if they would make different decisions for themselves when it came to their end of life planning and choices. So I came to Stanford thinking I was reporting that book. I wanted to skulk about a hospital and do interviews and spend time with clinical students and faculty. That's how I appeared. And then what happened was that I started asking around. People were so kind to me, I wondered if I might be of help, if I could trade, as it were, some of my expertise or experience for some of the access I was getting to people's really heartfelt opinions about end of life medicine and difficult choices they either thought they may make one day or had made recently. So. So that's how I appeared. And the amazing, wonderful doctor Audrey Schafer, who I know you've also spoken to, she really rolled out the welcome mat for me and she invited me to co-teach a class for creative writing for medical students that she had been teaching for years and told me about Medicine & The Muse, the Program for Medical Humanities, Arts and Medical Humanities at Stanford. So it was Audrey and then also David Magnus at the Center for Bioethics, who really welcomed me and didn't think it was weird at all the idea of having a writer around.
Henry Bair: [00:04:02] We have also interviewed Dr. Magnus on the show. For those of our listeners who who don't know that Dr. Audrey Schafer is the founder of the Medical Humanities program at Stanford Medicine. So what do you currently do in this position, though? Like, I know that you mentor a lot of physicians who are interested in writing, but what kinds of programs activities do you do and what kinds of mentorship do you provide to doctors?
Laurel Braitman: [00:04:29] It changes almost on a daily basis depending on what the needs are. So when I first started out, I did about three hours a week at Stanford. I didn't know if anyone truly would be interested in creative writing and what that might look like. Being a writer in a medical school is an odd thing. When I tell people about it, they think I'm writing medical things for the medical school, and then I have to sort of walk it back and explain, No, that's not what I do. I work with clinical students, so PA students and medical students and then lots of faculty, so physicians, but not exclusively physicians, nurses, hospital administrators, anyone who does anything. At Stanford Medicine, I consider in my part of my purview and I help them achieve their communication dreams. Sometimes that's working with a graduating clinical student to help them write a better fellowship essay. I do a lot of that. Interview coaching. Helping people figure out how to best present their research at an academic meeting in a way that isn't going to just cause other people to fall asleep. How to do better PowerPoint presentations that are not just like the scourge of academic medicine, where everything is like tiny font and completely illegible and dense.
Tyler Johnson: [00:05:41] Let me now show you 197 kaplan-meier curves in the next 30 seconds.
Laurel Braitman: [00:05:47] Exactly, exactly. And also they haven't been like downloaded at full resolution. So they're like grainy, you know, like we know those presentations and it's not the presenters fault. They, for the most part, gotten zero communications training or support in something like slide design, public speaking. So everything from a fellowship essay, a research presentation to I want to write a New York Times best-selling fiction book, that's a heist book, which, you know, if you've read Grace Lee's Portrait of a Thief, anything and everything, I consider my purview. And no one ever gave me that assignment. But I feel like medicine is better if we don't put walls around clinicians' humanity. And so I have zero interest in deciding what's something that I can help someone with and what's something I can't If they come to me asking for help, telling a particular story, I'm going to show up. And help them.
Henry Bair: [00:06:42] So let's focus on a little bit, Hone in on the the more creative aspects. Now, this could be creative fiction, literary fiction, or it could be creative nonfiction like memoirs or those kinds of works. What are the reasons that clinicians or students write? Like in your experience, what people you've mentored or advised? Like, what are some of the reasons they want to do this creative work?
Laurel Braitman: [00:07:04] I think they are many. We all have many different reasons for doing this. Why do you do this podcast? I'm guessing it's because I know you are an incredible storyteller. You're also deeply curious. It's an excuse to talk to people that you want to talk to, right? It's an interesting thing. It's complementary to medicine.
Tyler Johnson: [00:07:23] All good answers. Did you take notes, Henry? We can use those the next time someone asks us.
Laurel Braitman: [00:07:28] Okay. But my point being, I don't think anyone comes to me for one particular reason. I think that they have something to say that they feel passionate about or they've seen something that they feel passionate about. Sometimes they come to me because something they've seen in the practice of medicine is broken and they're angry. They would like it to be done differently. They have been affected by injustice in the medical system in some way, in their training or practice. I think often people reach out to me because they've come into medicine because of stories they read something that got them excited about going into medicine in the first place, and they know that they could be a physician writer because what attracted him to medicine was medical stories. I think that's often the case. If someone didn't have health care, folks in their family, they found their way in through popular culture. Maybe it was even Gray's Anatomy. Even though no one will admit that once they get to medical school. Dr. Quinn, Medicine, whatever it is, you know someone's guilty pleasure. Tv Watch is often, I think, how they Wind up there...
Tyler Johnson: [00:08:32] I have to say that. I saw my first ever episodes of Gray's Anatomy recently. I found it wherever it streams or something, and I was like, Oh, I should probably see what this is about. And I watched it and I was like, What planet did this happen on? Like, it was very foreign.
Laurel Braitman: [00:08:48] I bet.
Henry Bair: [00:08:49] In your experience, just from talking to all these clinicians and students in these, as you just mentioned, you do coach, mentor, talk to people all across the spectrum. Anyone who works in medicine. In your experience, does storytelling help us become better clinicians?
Laurel Braitman: [00:09:07] I believe that, but I'm not a clinician, so I think you two should answer. I think expanding your empathy, which is what you have to do if you are going to write or speak or make films or radio very well, you have to practice thinking about your audience. But also particularly if you're writing fiction or narrative nonfiction, you are embodying something or someone on the page, and it's a practice of letting people see through your eyes, feel through your skin, whether or not you're writing first person or you are writing fiction. And I think that that can't help but make you if you're going to do it well, more empathetic. You know, you really can't write about what you feel or what you think until you've plumbed yourself to answer those questions or your work is going to be as good. So I also think it forces a certain degree of self-reflection that perhaps professionally known as asking you for. But that does really serve you as a clinician. And you know, you both know that there's not enough time often to debrief complex cases or things that might be emotionally challenging in clinic. And so I think having a creative practice that requires a bit of reflection, even if you're doing that to write fiction can rehumanize you in a way. And I believe there's no way that that that doesn't affect your patients as well.
Tyler Johnson: [00:10:29] Yeah. You know, it's really interesting because you are 110% right that the podcast provides Henry and I with this really great excuse to sit down and talk with really wonderful, interesting people all the time in a way that I'm sure we wouldn't be able to otherwise. And as we have done that, and many of the maybe not many, but a number anyway, of the people that we have spoken with are both physicians and authors. It's really interesting to hear them talk and to hear them outline like what the connection between those things is, right? So like occasionally we'll talk to someone who says, Well, really, I'm an author and then I happen to go into medicine. So that's the thing I write about. But really, I'm an author first, right? And then there are other people who say, well, no, I was a physician. And then as I was a physician, I was learning all these interesting things and having all these interesting experiences, and I needed an outlet for it. So then I stumbled on writing, and now I write as one of many outlets I could have chosen for, you know, the things that I find in medicine. But then there is this other group of people who seem to consider writing and the practice of medicine to be like the two faces of the same coin as if they're almost.
Tyler Johnson: [00:11:41] Different reflections of the same spiritual act or something, right? So like when Abraham Verghese talks about it, he talks about it very much this way. When Sunita Puri talks about it, she talks about it very much that way. And I think that's a very meaningful way to think about it. As I have thought about that possibility, it strikes me that many of the verbs that writers use to describe what writers do are also verbs that doctors, if they're thinking about it, deeply use to describe what doctors do, right? So things like discern, observe, witness, embody. Those kinds of things strike me as very much like in that overlap space. And so I guess there is enough of, you know, verbs are that's where the meat of the thing always is, right, is in the verbs. And I feel like when you think about that part of the overlap, it doesn't surprise me that there are some deep thinking people who really do view the practice of medicine and writing as sort of different fruits on the same flower or whatever, Right? Like different parts of the same thing. Have you had some of that sense as you have worked with at least some of the doctors you've worked with as you've worked to help them improve their writing?
Laurel Braitman: [00:13:11] Yes, I agree with you 1,000%. I tell people I work with all the time that storytelling is the oldest medical technology. I believe that with the core of my very being. When you think about the impact of that, I have many thoughts, but one is that the placebo effect is a measurable outcome of storytelling. Firstly, right, Like the stories that we tell ourselves about ourselves, about what heals or hurts us actually, we do know has the effect to change our our very outcome in a non-negligible way. So I think to me, writing clinicians is a spiritual act. It's also a medical technology, it's a way of healing one's self and others. And I also think, you know, when I have a skeptical student, I do. I say this to them, which is how many people can you hope to see in your clinical practice in a lifetime? Now magnify that a thousand x hundreds of times. That's how many people you can reach with your storytelling. I don't think one replaces another in any way, but I certainly think they're complementary. And that doesn't have to be like you writing op eds about your medical specialty or public health. I certainly like Abraham Verghese does it via fiction. So we can do this in memoir. We can do this in personal essay. You both are doing this via podcast. I do think they are, if not one and the same related technologies of health and really important for that reason.
Henry Bair: [00:14:43] Thank you for sharing that. Definitely interesting thoughts for our clinician listeners to be pondering. So would love to hear a little bit about your own origin story. Now, before you came to Stanford, before you became the writer in residence, can you trace for us your journey in writing? What was your career like and how did you become a writer?
Laurel Braitman: [00:15:05] Writing is interesting in that it's so different than medicine. Like you don't stand up on a stage and someone gives you your white coat and now you say you're a writer. So I'm not sure. Like when I would say I was a writer, I can tell you I bought a really hot pair of red leather boots with my first paycheck I ever got for writing something, and that felt like a big deal. Like when I was paid enough for my writing that I could buy good boots. That was a milestone, and that was probably 20 years ago. I studied biology. I always wanted to write. I knew from as old as, I don't know, a few years old, whatever. However old you are, when you realize that people can write books and that that was a job, that's what I wanted to be. But I didn't know anyone in my family who was a writer. I'd never met a living writer. My parents were supportive of me and whatever my dreams were, but they didn't know how to be a writer. It just seemed preposterous, like I want to grow up and be a unicorn. So I studied writing in college, but I always studied something else too, because writing just sort of seemed, I don't know, impossible or confusing. So I double majored in creative writing and biology as an undergrad and then always kind of did that, you know, whatever I was doing science wise, I always also had a kind of paw in creativity in one way, shape or form.
Laurel Braitman: [00:16:23] And I went to graduate school for history and anthropology of science and technology. And my personal focus was history of medicine and history of psychopharmaceuticals at that time. And I very boldly wrote a visiting professor down the street. I went to MIT and one of my favorite writers of all time was teaching. He was a visiting faculty member at Harvard, and he was teaching a fiction class. And I just point blank wrote him a letter, said, I'm not a Harvard student, I'm not an undergrad. I'm a graduate student down the street. Can I come take a class with you? Please, please, please, God, please let me come sit in the back row of your class. I won't be disruptive and I will do the work. And I don't care about the grade. I was just so excited he was going to be teaching a class. His name is Amitav Ghosh. He's a wonderful writer. He writes fiction. He has a PhD though in anthropology. He's written a fair bit about medicine but in fiction form. And he writes these big, beautiful, sweeping, multigenerational novels that take place in India or in Bangladesh. So I was just so excited he was going to be around. So I took his class and one day in class he kind of tossed off like, Hey, this is the last class I'm ever going to teach. It gets in the way of my own writing.
Laurel Braitman: [00:17:37] But if any of you you guys ever want to write a book someday come to my office hours and tell me your ideas. And if they're good, I'll help you. And I went home and I typed up this list of book ideas. It was like ten different ideas. And I went to his office hours and I read them off to him and he was like, Nope, nope, definitely not. Nope. Terrible idea. Nope. Oh, maybe. And then I got to one and he said yes. I had a grant at the time from the National Science Foundation. I was looking at unforeseen impacts of nanotechnology. At that point there really hadn't been a great popular book explaining nanoscience and nanoengineering to the general public, and I thought it was fascinating. And so I pitched this. I worked on it for a very long time, and he told me that instead of doing a final project, I could do a book proposal as my final project and if it was any good, he would show it to his agent. Long story short, he showed it to his agent. His agent said, Hell no, this is not a book idea. I was crushed for like five minutes, you know? And then I begged that agent kindlessly, which is what I tell my students now. You know, be relentless, but be kind and be humble, but be relentless. That's what I did. I begged him to tell me what I'd gotten wrong, like why it wasn't a book.
Laurel Braitman: [00:18:49] And he said I could have a seven minute phone call with him. So that's what we did. And he just told me what I'd gotten wrong in that seven minutes. And I'm telling you, it clicked. I realized like, I had no idea how to write a book proposal. And I said, okay, this is not a book idea, but I have another one. And he said, Well, I'm not going to talk to you again, so you can write me an email with no more than three lines of your book idea. And if I like it, you'll hear back from me. And if I don't, don't ever contact me again.
Henry Bair: [00:19:19] Gosh,
Laurel Braitman: [00:19:19] That's how I got my agent. It turned out again to not be that book. I had to write for another like three years on a different book idea before I got to the book idea. That was my first book. But that's what it takes, honestly. That's what it takes. You have to be kind and relentless and you have to be lucky enough to stumble across someone who wants to help you. So I'll never say no to a student who wants to talk to me about a book idea ever, ever. Because this was my experience. I feel like I owe it to pay it forward. And so now I have lots of meetings just like Amitav had with me.
Henry Bair: [00:19:55] It's really lovely. Are you able to share, like, what the feedback was from that first meeting? Oh.
Laurel Braitman: [00:20:03] I'll tell you what. This is actually helpful. This will be helpful for a lot of your audience who wants to write because it's what I mostly now see with people who come to me with book ideas. I had a topic, not a book idea. I was very good at coming up with topics like nanoscience, what it is, what shocks us about it. That's a topic. The next book I tried to write was like the surprising true story of aquarium fish, where they come from, how they wind up in your home tank and what you don't know about it. Okay, Both of those, they had great characters. They took place in interesting places. They were full of interesting tidbits of information, but they were like the kind of thing that you could share at a cocktail party. They didn't have a narrative to write something that's like 90,000 words, you need a story. You need the clothes hanger that you're going to hang all of those interesting tidbits on. You need something propulsive, you need tension. This to write a good book. I mean, you can write a bad book. This just tidbits and many people do. But I'm not going to help a student do that.
Laurel Braitman: [00:21:07] So you really need a story. And it took me years to figure out the difference between a topic and a story. It's sort of topic first and then sometimes it takes years mucking about inside that topic to figure out what is the book here and is there a book here? And if so, am I the person to write it and can I even report it? And do I have access to the information? So for my nanoscience story, I really did, I think, have kind of a book there. But the problem was that that the science was happening. The center of my story was an effort at MIT to use nanoscience to build a soldier of the future based on conceptions that the engineers had taken from sci fi. And I thought that was fascinating. I'm so interested in the times that science and medicine replicates fiction and not the other way around because it happens so much more commonly than we think. So that was what I wanted to do. The problem was that most of it was still classified, so someone's going to write that book. It's just not going to be for another 25 years.
Tyler Johnson: [00:22:08] There are much more embarrassing reasons than that to not be able to write a book that makes you sound like you're some kind of spy with inside access or something. So that's actually a really cool reason to not be able to write a book.
Laurel Braitman: [00:22:19] Oh well, most of them are, you know. But I had what, like ten ideas? I have so many book ideas going at any given time, and most of those are not writeable for all kinds of reasons. Sometimes they're, you know, you can't FOIA your way into a story. The information isn't in the public record, but sometimes it's like, Oh, do I want to be away for that long? Or there's pieces that I've written in the past that I don't know that I would be willing to do the reporting for now. I spent years living on various remotes over the span of years, living on various riverboats in the Amazon basin, reporting out that aquarium fish story. That's not something I want to do right now is be gone that long. I have different kinds of responsibilities. I couldn't do it. So whether a good story is the story for you to write depends on your life, depends on the market. Maybe you can't sell it and it has nothing to do with you. It's mostly outside of our control, but we like to pretend it's not.
Tyler Johnson: [00:23:15] So you have this unusual, very unusual perch, right? You're one of these people who's. You're like a sort of like a journalist who goes to report with the armed services. Right? Like you're embedded, you're down in the bunker, you're with the, in this case, medical folks who are doing what medical folks do. And yet you're not one of them or one of us. Right. In the normal sense, at least in the sense that you're not directly a health care practitioner. So I have a few questions arising from that interesting perspective. The first one is if you were doing like anthropological research and you had been sent to do a field study on this strange species of people called medical professionals, and now you've been embedded with them, you know, like Jane Goodall with the gorillas or something for many years. Like what would you report back to all of the normal people that you have learned about the anthropology of medical folks?
Laurel Braitman: [00:24:10] That it's human in here too, that there is suffering in here too, that there is mortality in here too. And often there is even more than there is out there. I have been embedded for a very long time. I was born embedded. My father was a cardiothoracic surgeon and also had terminal illness. And so I grew up in medicine in many ways, like as you know, someone who heard cases over the dinner table and had a medical vocabulary from a very young age, not because he talked about his disease, but because he talked about his practice and expected me to be able to spell necrotizing fasciitis from a very young age or, You know, be able to draw pictures that were color coded of the circulatory system. Mean this is the kind of household I grew up in. But then also seeing him navigate the world as a patient with illness. And so I've been here for a very long time, so I'm not sure that I have distance. I would say, like someone who just catapults in doing an ethnographic study in their 20s or 30s or 40s or 50s. So I'd say I'm already biased. But what I will tell you is that I do notice the strangeness, I think in a way that only early trainees and clinical students notice.
Laurel Braitman: [00:25:32] And I do try to tell them to hold on to that as much as possible. You know, once you've done a procedure 10,000 times or a thousand times or maybe even 25 times, it's not going to seem all that strange to you. But the first time you do it, oh my God, or the first time you learn why something is named the way it's named. The first time you lose a patient, the first time you really do anything in practice. I think it's very, very interesting. And the future you would be very grateful if you just took notes about it. Because once we do things enough times, we stop kind of noticing the story in it. In some ways, unless something goes spectacularly well or spectacularly poorly. So I do think it's easier for me to be a professional noticer since I'm not a practitioner myself. But I think that's true of anyone who's working in health care at the beginning or any time something new happens. So I think that's important and we should try to cultivate our noticing powers as long as possible.
Henry Bair: [00:26:39] Yeah, well, I am right there. So I started residency a month and a half ago, so plenty of procedures that are still firsts. Like I still remember the first procedure I ever did as an MD was an NG tube, a nasal gastric tube, which is where you shove this this long rubber tube through someone's nose, down their esophagus into their stomach. Usually this is to feed them because they can't swallow on their own. As far as procedures go, it's not crazy invasive. You're not, you know, stabbing them in a body part. You're not trying to insert a line down someone's vein or anything. Skin is not broken generally if you do it right. But it is, as I understand it, profoundly uncomfortable for the patient. And it was like the second day of my residency where I was driving this tube down, this patient's, this poor patient's nose, and it felt so bad. I cannot tell you how terrible because this person was awake. We don't anesthetize them. They're not sedated. They're just like struggling. There were two nurses holding his hand down. Oh, my gosh. It was unbelievably brutal to do it. And then three days ago, I did my 10th one and it was a vastly different experience. Like I've learned the key is just do it as quickly as possible. Patients struggle. I'm just like, Put it down, Put it down, Put it down. Yeah. So I'm trying trying really hard to hold on to the awareness that this is not normal, especially for the patient, Right? It might be normal for me, but this is a big deal. Everything we do is like a big deal for the patients, you know, trying to hold on to that power of noticing. So thanks for reminding us of all of that.
Laurel Braitman: [00:28:14] I love that.
Henry Bair: [00:28:15] You earlier mentioned your upbringing as a daughter of a cardiothoracic surgeon. Right? And as I understand it, that your experiences and your relationship forms the basis of your most recent book published earlier this year, What looks Like Bravery, An Epic Journey Through Lost to Love, which is a wonderful exploration of grief. Can you share with us more about the background of this book and the relationship that inspired it?
Laurel Braitman: [00:28:40] Sure. Well, this is what that book became that I thought I was going to report out at Stanford, which was Do doctors die specifically, Doctors die differently than the rest of us. Normies, who might make different choices around end of life. And I really didn't want to write about my own life. I felt like, who am I to write a memoir? But that was the book I wanted in the end to write and felt like I needed to write and felt like it was the only medium I had where I could convey some of my most hard won wisdom that I needed to be the voice. I wasn't interviewing anyone that I felt like had exactly to say what I wanted to say. So I couldn't find like a character to to speak the truth as I saw it. And so I was like, Oh, darn it, I'm going to have to do it myself. And I wanted to write a story that a younger me would have found helpful, is the truth. I think you're told often you're not supposed to write for a very specific, imagined audience, which is fair. That can feel too scary. But I think writing for a different version of yourself is a great way to figure out what you want to say. So that's what I did. I wrote a book that pretty much.
Laurel Braitman: [00:29:54] Me any age before yesterday needed this book. It's a story of growing up and coming of age and saying goodbye to the people we love and how to survive the loss of people that we love and become the people that we want to be, and to try to forge some meaning out of pain and suffering is really the story. It's also a love story of how on earth to be open to love when I know it can be taken away for no reason at all. And it's a love story to place. So it's also a story about my love of landscape and the places that made me along with the people. And also a story of the wisdom that I found along the way. So I did set out on a kind of inner and outer journey to make meaning of the hardest stuff that had happened to me. Everything from, you know, the loss of my parents to the loss of my house to wildfire to all kinds of things. Just the daily, small stuff that happens to all of us. That's the story. It's basically like, how do you survive it? Question mark. And the book is my answer to that. I don't have one answer, and I can only tell what worked for me, but that was my goal with this book.
Henry Bair: [00:31:07] Would you be able to paint a picture of of your relationship with your parents and then maybe take us through the loss and how your response, your emotional response, spiritual response to that loss evolved over time?
Laurel Braitman: [00:31:21] Sure. Specific to your audience. You know, I'll tell you that I was raised by people that had some standards for me that were intense, you know, and this is another reason that I love working in health care.
Tyler Johnson: [00:31:36] We have never spoken to a doctor who said that. That's the strangest idea I've ever heard.
Laurel Braitman: [00:31:43] Right. Just that, you know, that feeling of like relentless churn. Right. That your worth is tied to your ability to just grasp on to that brass ring. And once you get that brass ring to swing the hell of yourself to the next brass ring and get that one. And once you get that one, then get to the nut. I mean, I see this in pretty much everyone I work with at Stanford and beyond in various ways, right? We all have it for various reasons, and there is nothing wrong with wanting to do your parents proud. That really isn't the issue. This is what a lot of the book is about. And what my life has been about is trying to untangle what our parents want from us, for what we want for ourselves, and to figure out a motivation that's dual. Like there's truly nothing wrong with wanting your family to be proud of you, to be able to achieve in a way that makes sense to them, to give them a security perhaps that they have sacrificed in order to provide for you and your siblings or your children's children. I totally get this. The problem for me, you know, was that I went about doing all of those things.
Laurel Braitman: [00:32:53] My dad wanted me to get a PhD from MIT. He wanted me to write a New York Times bestselling book, and he wanted these things and I knew about them by the time I was 16 years old. And so the book is about, you know, what happens when you do those things. And then you look around. And I was still sad. My father died finally when I was 17. And his last gift for me, I opened six months after he died on my graduation day from high school, and it was a pen. And the note he wrote was Use this to sign your first book someday. Like Love You Dad. And here he was, like reaching beyond the grave, right? To give me this pen, which was incredible. But also what 17 year old, like, grows up to do this thing, right? Like I was gonna write like I didn't see a choice in a lot of ways. So it was something I wanted to do and it was a passion that he had recognized in me. But also I had this pen. I had to go sign a best selling book with it.
Laurel Braitman: [00:33:55] You know, the book is about many of these things that sort of just the tip of the iceberg. He wanted me to be good at a bunch of stuff that were very specific to him. So, like fly fishing, gouging a man's eyes out. If I was attacked, beating a man at pool, a lot of them were about like, so that I could show up men in a social situation. He really liked the idea of that, which I do too. So it's great. But it's a blessing and a curse. As with most wonderful or not so wonderful things our parents give to us. Right? That belief and that drive was amazing. I do not regret any of the things I did trying to do right by my parents and achieve the dreams that they had for me and had for themselves. But also, you know, I'm in my mid-forties now and okay, so I crossed some stuff off the list, like what happens when you reach the end of the list? And it didn't bring him back, right? Like, it didn't make sure that I was open to love. It didn't make me emotionally healthy. I had to set out and do those things myself, figure out what is the end of the story, to use that pen to write my own story after I had used it to check off the things on the list. And so I think that is my work for the second half of my life. And luckily it's the work of many people I work with at Stanford and beyond, you know, particularly in medicine, right? Like you're so busy getting to the point of getting accepted into training, training, doing the fellowship, getting the job, publishing the article, getting the tenure. Even if you don't go into academic medicine, right, you are well into adulthood. By the time you were like allowed to be left in a room with a patient with responsibility. And oftentimes that's the first time in someone's life in medicine where they look around and they're like. Do I like this?
Laurel Braitman: [00:35:42] Like, did I choose this? Right? Like. You know, you've been working towards something for sometimes maybe like 17, 18 years by the time that you're actually doing it, you know? So that can be a kind of aggressive moment, right, where you're sort of stunned like, Oh, I guess I'm here now. I guess. I guess this is it, right? That this is it feeling? Is it the core of a lot of really good writing and storytelling that the people I work with are doing? I would say, and I feel grateful to be in the weeds with that. And, you know, also figuring out like, okay, if I want to keep hustling, which I do forever, you know, I want to die with like 40 book projects open and working and a full slate of phone calls and meetings. Like I just I find joy in that. If that's the case, then I need to find a new fuel, right? It can't be to prove something to myself and others for this next phase of my life because I have realized that that's not a deeply satisfying way to make work happen for me. So what's then the fuel? Is it, God forbid, pleasure? So that's where I am now. And medicine feels like a really wonderful place to be asking these questions because I'm really not alone in them.
Tyler Johnson: [00:36:54] I have so many comments. First off, I think that's a really interesting and poignant way to talk about that. I'm paraphrasing you. If this is putting words in your mouth, then correct me. But what I hear you saying is you spent sort of roughly the first half of your life finding fulfillment by fulfilling your parents dreams. And then you need to spend the second life figuring out what your own dreams are and fulfilling those. Right. And you are absolutely right. So one of the things that's weird about medicine, right? I still remember so vividly. So I worked really, really hard as all pre-meds do to get into medical school, right? And I really wanted to go to what I then, you know, considered to be a really good place. And so I worked even harder to make that happen. And so I finally get accepted to like the school of my dreams. And I was like a month away. It was like mid-July. And I had spent so much sweat and tears getting ready for this moment. And then as I was falling asleep one night I had this waking dream that was so vivid, which I never have dreams. I was like on an old style toboggan, and I was at the top of a mountain and the toboggan was like teetering or what I thought was initially a hill. And it was like teetering like just on the cusp of, you know, pointing down and starting to run down. And then when it finally did, I saw that what I had initially thought was a hill was actually a mountain.
Tyler Johnson: [00:38:17] And I had this distinct impression that, like, as soon as you are like a semester into medical school, it's like the runners on the toboggan have caught in the snow and you have started to pick up speed and then you have no say in the matter until you reach the bottom, which is so far away that you can't even see it anymore. Right. And I was so frightened by this waking dream. I was at my parents house. I, like ran up to my parents and told them this elaborate thing that I came up with in three seconds about how medical school was the wrong choice and I really needed to go to business school because I would have so many more options. And I was like and I was signing my life away. As soon as I took out my student loans and everything was going to be over and like, you know, anyway, all of these things. So on the one hand, I look back on that and sort of laugh because of course my parents talked me through it and I went off in my Toyota Camry across the country to medical school. And here we are, right? So on the one hand, there's that. But then on the other hand, I was kind of Right. Right. Because of what you said. Right. It's like you do medical school and then I mean, it's not like someone stops you near the end of medical school and says, Well, would you like to do residency? You just start filling out the forms and then you just apply and then it's residency and then you're getting since I want to be an oncologist getting towards the end of that, then I just filled out the forms and then I went to fellowship and then I just, you know, and on and on and on.
Tyler Johnson: [00:39:33] And then one day you wake up and you're like 37, and it's like, Oh, and now I'm an attending. And actually the dream was pretty much true, right? And so I think the reason I tell that story is just to say that you mentioned that you feel like you kind of resonate with medical professionals in the sense that for a different set of reasons, you ended up in this same position where it's like you woke up halfway through your life and said, Oh, but actually, who am I and what do I want to do? But what I would say is that's the ones who are lucky among health care professionals, because for many of them it never happens. Right? Like if we had to identify specific impetus's or impeti, I don't know how you pluralize that word, but if we were to identify that for the podcast, one of the most concrete ones was this story that we've told before on the podcast of a physician coach who told us that she would go on walks with these people who are like literally some of the leaders in the world, in their field, right? The people who know the most about fill in the blank medical thing, who are like chiefs and chairs and deans and whatever they are of medical schools who were feeling really burnt out and alienated and whatever, and say, okay, forget about all the decisions you need to make.
Tyler Johnson: [00:40:44] Forget about all the specific problems in your department, Forget about all that stuff. Why are you a doctor? And that many of them. More or less don't know an answer anymore. Right? Because it's like at some point the treadmill of being in medicine is so consuming and so compelling in its way. It's like you forget that you were ever not on a treadmill. It's like you just come to accept that life is the treadmill and that all you're meant to do is to just run it. And if it starts going faster, well, then it must be that you're meant to run faster. So you better just run faster. Right? And I think that for many people, the awareness that the treadmill is not in fact life either never comes or they put it off for so long that then when it finally does come, it comes as this like devastating recognition and often with a sense of enormous and sometimes irretrievable loss for all of the people they didn't get to know the relationships they didn't nourish, the things they didn't get to do, the facets of themselves they didn't get to cultivate and whatever, because they had just come to assume somewhere along the way that the treadmill was life itself.
Laurel Braitman: [00:42:04] Yeah, I totally agree with you. I think that, first of all, having protected time to ask yourself why you do what you do is a huge privilege. But I also think that we wouldn't, you know, forgive the terminology, but we wouldn't be hemorrhaging people in health care quite so much if there were more opportunities for people to reflect on a regular basis and recommit to their purpose. You know, and I don't think to assume that someone answers like an application essay about why they want to be a doctor and then 30 years later or ten years later or even five years later, that that answer would stay the same is bananas, right? Like, doesn't mean you don't want to work in medicine anymore. But the idea that we have one kind of mission statement or statement of purpose and then that stays the same unless someone asks us to apply for something or like a grant or for an opportunity, you know, unless you offer protected time for reflection, those are the only times that people get asked professionally why they do what they do. And there's always a prize hanging in the balance. And I think that's dangerous. And then we wonder why depersonalization is at an all time high, right? Or why people are frustrated with what they're doing. I do not think that most people who work in medicine are scared of hard work. Not at all. Not at all. I don't think it's about how much time even you're spending in Epic versus it being in front of patients. I don't think anyone who works in health care is scared of hard work.
Laurel Braitman: [00:43:32] What I think drives people crazy and why they start to leave the field is when they feel like they're not showing up all day, every day and getting to do what they're meant to do. That there is a disconnect between their purpose and what they find meaningful and what they're being asked to do at work all day. And when the ratio of those things gets off, that's where burnout and overwhelm and frustration come in, You know, so do I think giving people the opportunity to, like rewrite a mission statement that isn't for a reason, except that I'm asking them to write or to write their obituary. How do they want to be talked about ideally 40 years from now, 50 years from now, 20 years from now? Or they are a company, they have to write a slogan for themselves, right? Like we can all tell you what, like the mission statement of like our favorite home meal delivery system is, right? Like we all know advertiser jingles, but we don't know our own core statement for why we do what we do. I think that's a problem. But it's not our fault. You know, we're too busy, as you said, on the hamster wheel trying to make enough money to get food on the table, trying to advance, trying to take care of the people that we're caretaking. But I think the institution that employ and serve us, those institutions, it would behoove them to give us protected time to help us reflect on what matters to us and to rewrite those statements as they change over time as they should.
Tyler Johnson: [00:44:55] Okay So I know that we're almost out of time and we want to be respectful of your time. But I want to ask, so usually at the end of the podcast we say. Some version of. So what would you tell younger medical trainees about what you wish you would have known coming up or whatever? But want to ask you a sort of specific version of our normal closing question, which is this. I would bet a good amount of money that there are many people who listen to this podcast who kind of have like a hunch that somewhere buried under their white coat and their, you know, handbook and whatever else, a writer is lurking. But then they're like, who has time to do that? And in any case, I'm not Abraham Verghese. And, you know, like, this is just all hopeless. So if they were to come to you and they were to say, Look, like I just whatever, I'm in a third year resident and I have like all of these things that happen and all like there's all these things, but like, how does a person even get started and want to be a writer? I want to write it down, but don't I have no idea where to begin? What would you say?
Laurel Braitman: [00:45:57] I would have them come to our writing medicine sessions, which are the first and third Saturday of every month.
Tyler Johnson: [00:46:04] They're not at Stanford, I'm saying, no.
Laurel Braitman: [00:46:05] No, those are for the public. So during the pandemic, precisely because it was the pandemic, I felt it was unconscionable to only continue to offer these sorts of resources and protected space for people at Stanford, which is already a very well resourced community. So I started doing it open to anyone, any health care professional around the world and or their loved ones. And we've had I think we've had over 15,000 participants at this point. People have published everything from books to op eds to poetry. And it's incredible. There's now a global community of writing health care professionals, most of whom had never written before or hadn't written since high school. So let me say this direct to you listener. If you haven't written and I don't know, 20 years, 30 years, ten years, if you're scared, take heart. Because that is the feeling of being a writer. The feeling of writing and being a public storyteller is terror that you don't know what you're doing. And I wish I had learned that earlier. The feeling of insecurity is the very feeling of doing the thing. It isn't proof that you're not doing it right. So harness that and come right with me or write in your journal. Or if you're not a writer, that's fine too. Voice notes are great. Leave yourself little voice notes in your phone as you walk to your car. Future You will be so grateful that you've recorded even a little bit of your current life and what you're thinking and feeling. So it's not even about putting pen to paper or fingertip to to mouse or keyboard. Sometimes it's as simple as sending a voice note with something that you feel strongly about or something tiny thing you noticed.
Tyler Johnson: [00:47:46] Well, okay, So now since it is available throughout the world, you have to tell people how do they actually access those sessions?
Laurel Braitman: [00:47:53] They can go to Laurelbraitman.com or writingmedicine.org and they can sign up for a session. They can also shoot me an email. But writing medicine would be the place to start. It's a very welcoming, warm community and there is no writing experience required. We meet on the first and third Saturday. I did it for free for three years as a public service and this year we changed to a pay what you can model. So it's $25. But if that is a financial hardship for anyone, they can send me a note and I will send them a code to register for free, no questions asked. No explanation needed.
Tyler Johnson: [00:48:31] Perfect. Well, we really appreciate you coming on with us. We appreciate the conversation and all of the good that you have done in fostering writing as a discipline among health care professionals in particular.
Laurel Braitman: [00:48:44] Thank you. Thank you both so much for having me and for doing what you're doing, showing that what doctors do is an art.
Henry Bair: [00:48:50] Thank you very much Laurel.
Henry Bair: [00:48:54] 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 www.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: [00:49:13] 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: [00:49:27] I'm Henry Bair.
Tyler Johnson: [00:49:28] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.
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LINKS
All are welcome to join Laurel’s Writing Medicine workshops, a pay-what-you-can public resource for healthcare professionals. Visit www.LaurelBraitman.com or www.WritingMedicine.org for more details.
