EP. 78: THE MIND IN REBELLION: REFLECTIONS ON A CAREER IN NEUROLOGY

Sep 7

WITH STEPHEN HAUSER, MD

The Director of the UCSF Weill Institute for Neurosciences and world leader on multiple sclerosis shares how he helps patients come to terms with the reshaping of identity and personhood that often come with neurological diseases.

Listen Now

Episode Summary

Multiple sclerosis is the most common disabling neurological disease among young adults. It's a disease in which the body's immune system begins attacking the protective covering around nerve cells, leading to a wide variety of symptoms, ranging from vision problems to difficulty walking fatigue to dizziness to speech problems. Our guest on this episode, neurologist Stephen Hauser, MD, has led research that has been key to developing our understanding of this disease, and his work has resulted in treatments that have helped hundreds of thousands of people. Dr. Hauser is a director of the Weill Institute for Neurosciences at the University of California, San Francisco, and the author of the memoir The Face Laughs While the Brain Cries: the Education of a Doctor. Over the course of our conversation, we discuss not only his groundbreaking scientific work, but also reflect on how clinicians can help patients heal even when there are no medical therapies available, as well as how neurological disorders affect our sense of personhood and meaning in life.

Stephen L. Hauser, M.D. is the Robert A. Fishman Distinguished Professor of Neurology at the University of California, San Francisco (UCSF). He is Director of the UCSF Weill Institute for Neurosciences, an umbrella organization that links the clinical and basic neurosciences at UCSF to accelerate research against neurologic diseases. A neuroimmunologist, Dr. Hauser’s research has advanced our understanding of the genetic basis, immune mechanisms, and treatment of multiple sclerosis (MS). His work led to the development of B cell therapies for MS patients, representing a powerful new approach for treating all forms of the disease and the first therapy of proven value for progressive MS.
Dr. Hauser is a member of the National Academy of Medicine and a fellow of the American Academy of Arts and Sciences and the American Academy of Physicians. He is an editor of the medical textbook Harrison’s Principles of Internal Medicine. Previously chairman of the Department of Neurology at UCSF for 25 years, he has also served as President of the American Neurological Association, President of the Medical Staff at UCSF, Chair of the Research Advisory Committee for the U.S. Department of Veterans Affairs, and editor-in-chief of Annals of Neurology. He also served the Obama administration as a member of the Presidential Commission for the Study of Bioethical Issues charged with advising the President on issues that may emerge from advances in biomedicine and related areas of science and technology.
Dr. Hauser is a graduate of the Massachusetts Institute of Technology (Phi Beta Kappa) and Harvard Medical School (Magna Cum Laude). He trained in internal medicine at the New York Hospital–Cornell Medical Center, in neurology at the Massachusetts General Hospital, and in immunology at Harvard Medical School and the Institute Pasteur in Paris, France. He was a faculty member at Harvard Medical School before moving to UCSF.
In this episode, you will hear about:
• 2:07 - The childhood experiences that drew Dr. Hauser to a career in medicine, and specifically to neurology
• 8:15 - The ways in which practicing medicine was “simpler” 50 years ago
• 9:53 - Why Dr. Hauser chose to focus his career on multiple sclerosis
• 13:58 - Advancements in multiple sclerosis treatment over the course of Dr. Hauser’s career
• 15:37 - The importance of developing deep relationships with patients, even when curative treatments don’t yet exist
• 19:45 - The unique challenge that arises when neurological diseases affect a person’s central identity
• 25:49 - The enduring power of love that transcends the loss of a patient’s cognitive identity
• 31:50 - The biggest lessons that Dr. Hauser have learned from his courageous patients
• 35:10 - Dr. Hauser’s perspective on “failure” when treating patients
• 39:30 - Dr. Hauser’s hopes for the next generation of doctor scientists
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to the Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build 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: [00:00:27] 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] Multiple sclerosis is the most common disabling neurological disease among young adults. It's a disease in which the body's immune system begins attacking the protective covering around nerve cells, leading to a wide variety of symptoms, ranging from vision problems to difficulty walking fatigue to dizziness to speech problems. Our guest on this episode, neurologist Dr. Stephen Hauser, has led research that has been key to developing our understanding of this disease, and his work has resulted in treatments that have helped hundreds of thousands of people. Dr. Hauser is a director of the Weill Institute for Neurosciences at the University of California, San Francisco, and the author of the memoir The Face Laughs While the Brain Cries: the Education of a Doctor. Over the course of our conversation, we discuss not only his groundbreaking scientific work, but also reflect on how clinicians can help patients heal, even when there are no medical therapies available, as well as how neurological disorders affect our sense of personhood and meaning in life. Dr. Hauser, thanks for joining us and welcome to the show.
Stephen Hauser: [00:02:13] Thank you. It's my pleasure to join you today.
Henry Bair: [00:02:15] To kick us off, can you share with us what initially drew you to a career in medicine and then to neurology in particular?
Stephen Hauser: [00:02:23] Thinking back, diseases and especially diseases of the brain and the immune system seem to be all around me for my entire childhood. They were part of the landscape of my formative years. My brother was severely disabled. My best friend had a brain tumor. My mom's best friend had herpes virus encephalitis. My grandfather had Parkinson's disease. So it seemed as if brain diseases were calling to me. And myself. I was beset with immune diseases, with illnesses caused by an overactive immune system from my earliest memories in New Orleans as a child. I had terrible asthma, eczema that made my skin itch seemingly all the time. So in retrospect, I don't know that I had very much choice in the matter except to become a physician of the nervous system and the immune system. But I also know as a neurologist that our brains like to find simple answers to complicated questions. And the narrative that I've thought led me to become a neuroimmunologist is one that probably could be interpreted in a variety of ways. But I do think that it was diseases around me that had intense personal significance, that were at the core of my desire to be a physician.
Tyler Johnson: [00:04:01] You know, it's interesting because we've spoken with many people who tell a similar story, but some people we've spoken with on the podcast who are not directly involved in medicine actually have something of an opposite reaction. You know, they spent time around the medical system or around people who were ill. And for precisely that reason say, Oh, you know, I could just never do that for my career. I could never spend my lifetime being around that because, you know, it's difficult to be around other people's suffering or because it's difficult to see problems that you may have difficulty solving. So what was the thing that when you saw people around you who were ill or experienced your own illness, that then tilted you towards responding to that by saying, that's the thing I'm going to make my life's work. That's what I need to actually go into to try to address some of those problems.
Stephen Hauser: [00:04:51] It's so difficult to recognize. Very significant moments in one's life while they're happening. And sometimes it's only 60 years later, looking back that they still resonate. One such experience was when I was in summer camp and I write about this in the book and could barely function at night because of asthma, and a counselor named Dave took care of me and would stay up with me all night. I thought he was ancient. He was probably 17 and he would take me to the infirmary and tell me stories to help me breathe better. And I remember hugging him the last day of summer camp. I've never seen him again. But every day going into the hospital, I try to think of Dave and try to do as best I can for my patients. Reminded of the inspiration and the importance that he was to me in my life.
Tyler Johnson: [00:06:00] You know, I just have to say, hearing that story, obviously there's a deep simplicity to that. But it's so interesting. We spoke with a physician coach early on who talked about how she's been really struck by the fact that there are many, even very senior physicians who are sometimes the best at what they do in the world. Right. They are the world's expert in their thing, but who become burnt out and sort of alienated from their work. And when she asks them, forget about all of your current decisions and the things that are in front of you, but just why are you here in the first place? And that some of them, honest to goodness, just don't even know the answer to that question anymore. All of which is just to say that I think that like the simple power of that image, of a counselor who, you know, I'm sure was not any sort of medical professional, but who was just there with you, you know, through the difficult night, helping in whatever way he could. The fact that that still sticks with you however many years later and that you actually take that image with you into the hospital as inspiration for the work that you do, that strikes me as deeply beautiful and powerful.
Stephen Hauser: [00:07:11] It is important, certainly for me. When I was in training, I could smell the smell of the hospital as I opened the door. Within a few years, I realized I no longer could smell the smells of the hospital. And this desensitization is part of how our nervous system works. We alert and we're attentive to new things. And I think that that must also happen in many other areas. It's very hard to feel as deeply the 100th time as you did the first time. This can be called burnout. It can be called less engagement, but it's part of the way that our bodies work. And I think we have to recognize that as a challenge. Medicine is also so much more difficult now than it was 50 years ago for practitioners. And I think the risks of desensitization and of course, burnout are increased.
Henry Bair: [00:08:21] What do you mean by difficult? In what ways is it more difficult now?
Stephen Hauser: [00:08:25] 50 years ago, there was essentially no compliance, very little oversight, little record keeping. And somehow we seemed further away from the billing and collection part of medicine. There were no work reviews or contract calculations that needed to be done to measure our productivity. We would spend hours with individual patients. In some respects, the umbrella of an academic medical center, as residents, would give us the ability to do that. And I think medicine is more difficult now, not only because of the compliance, but also because of the number of patients who we are asked to see each day. And in addition to that, we know so much more than we used to know. We can do so much more. So the medical part of the interaction is far more complicated and far more important because we actually have a responsibility every time we see a patient to make sure that everything is being done that should be done and as little that shouldn't be done is done. So I think it's very complicated because our therapeutics and management have progressed so far.
Henry Bair: [00:09:53] So you've shared with us what drew you into neurology, but of course, you're most well known for your work on multiple sclerosis, which it's one disease entity I think we do spend quite a bit of time on, I remember, in medical school, because it manifests in such diverse ways and it can be tricky to diagnose it initially just because of the myriad ways that it can present. So can you share with us why you decided to focus your career on this one disease entity?
Stephen Hauser: [00:10:24] When I was a trainee more than 45 years ago, I met a young woman. Down in the emergency room who had flown back to our hospital in Boston where she had trained also. She was extraordinary. Accomplished, talented. Ambitious. Athletic. And was struck by the most explosive onset of multiple sclerosis I had ever seen. And I remember going down to the emergency room and seeing this young woman who was 27 years old as I was. Her parents at her side. And thinking that this was the most unfair thing I had ever seen in medicine. For me, that was the beginning. It was a specific patient and a specific meeting.
Henry Bair: [00:11:21] So that was early in your training?
Stephen Hauser: [00:11:24] Yes.
Henry Bair: [00:11:24] Right. And that moment was what fueled your desire to continue working on this on this one disease. So maybe share with us because to your point about how medicine has progressed, there are now a lot more treatments for for MS than there were, I would imagine. Can you share with us at the time when you first saw this woman in the ED, what treatment options were even available?
Stephen Hauser: [00:11:48] Looking back, we knew so little about multiple sclerosis. We thought maybe it was a virus. Maybe it was caused by the immune system. We had no treatment. And in fact, senior mentors would advise young people that we were very unlikely to ever understand MS well enough to develop a treatment and that it was a waste of a career to follow that path. The MRI scan wasn't even a rumor. People with MS have symptoms that can worsen when exposed to the heat. So when we thought somebody might have symptoms of MS, the staff, the nursing staff would usually put the patients in a bathing suit and then they would go in a hot tub that was on every neurology floor. And if their neurologic exam worsened after they were in a hot tub, we said, Well, this was likely to be MS. And then we would look in the spinal fluid. And if there was evidence of inflammation in the spinal fluid and especially an increase in certain types of chemical messengers called antibodies made by a kind of cell called a B cell; that that increase in antibodies called oligoclonal bands was diagnostic of MS. So if people had symptoms that were in multiple places in the nervous system on examination, worsened in the heat and had inflammation associated with it in the spinal fluid surrounding the brain and spinal cord, we would diagnose MS. But as I said, there was nothing that we could do. Except steroids, which barely worked. And we were also taught that the antibodies that were in the spinal fluid were diagnostic, but they had nothing to do with the cause of MS.
Henry Bair: [00:13:58] Just to give us a glimpse of the progress that we've made since you first encountered that fateful patient. What was the prognosis? What kind of life could an MS patient have expected back then versus now?
Stephen Hauser: [00:14:10] When I began my career in the 1970s, the average patient with MS would develop severe disability within 15 to 16 years. Placing them in a wheelchair or a bed-bound state. MS was a devastating prognosis, and because MS begins, usually early in adulthood, this extreme disability was occurring in people in their 30s and 40s very early in their lives. Today we are confident that with the marvelous therapeutic advances that most patients whose Ms. is beginning today can expect a life free from significant neurologic disability. This is really a fabulous advance and a magnificent change that has been made possible because of advances in molecular medicine, in our understanding of disease and in the chemical biology that industry can use to craft molecules, that can target specific disease mechanisms. It's really one of the great advances of modern medicine, I think.
Henry Bair: [00:15:34] Yeah, I mean, it certainly sounds like it. So by all metrics, this is a success story, I would say, in the science in in medicine, really. But at the same time, I remember when I did my neurology rotation in medical school, and I think that one of the things that simultaneously, dare I say, frustrated me with what I saw in the neurology clinic and at the same time was the reason that I admired neurologists so much, was that there were so many instances when the neurological disorders we were encountering in the clinics were extremely complicated. The diagnosis itself could take a very long time. And yet after we arrive at the answer, there are often not a lot of curative therapeutics we can provide for the patient. So in those instances, what do you do? How do you go from there? How do you comfort the patient when you have the answer for what they have, what's happening, what's ailing them? And yet you don't really have a whole lot of things you can offer to cure them of the disease.
Stephen Hauser: [00:16:42] That's a very profound and a very difficult question. Without compassion. Medicine is an empty science. On the other hand, we have a responsibility to. Tell our patients what is happening to them and to help them as best we can. Even when we can't repair damage or prevent future worsening. It's so much easier if the relationships are strong between the clinician and the patient. And this is why, for me, the joy of being able to see patients not only year after year but decade after decade and to get to know their children and their grandchildren is such an important part of what makes medicine rewarding. Knowing people, we know a little bit more about their differences. They know more about us, and the discussions can be more helpful to them. That's really our job. Even when we can't cure or even stop their disease, we need to be helpful. Understanding that people don't all want the same information given in the same way and that we all want hope. Part of hope is progress. And progress is technology and science. You're very correct that brain diseases were mostly a pre therapeutic part of medicine 50 years ago. But that's changing. And the remarkable advances against Ms. and other neuroimmune diseases are leading the way. But there are others. We can do so much more now for children with devastating inherited muscle disease. For migraine. And now, finally, the door is ajar for diseases of aging like Alzheimer disease, ALS. So I think hope is the other part of this. And one of the most difficult things for me to learn as a clinician and something I wrote about in this book are the times when I feel as if I've failed my patients. But they don't always see it that way. They know that I did what I could and they appreciate the help that I've been able to give them, even though I've felt deficient as a physician in arresting their difficult neurologic problem. I think relationships are such an important part of this.
Tyler Johnson: [00:19:42] If I can build on those thoughts that you're sharing. I was so touched in terms of your medical practice, you kind of started off with this story of a woman for whom you cared, who had this devastating onset of neurologic complications of multiple sclerosis. And the the thing that I wanted to bring up with that, from my perspective, the thing that is different for neurological diseases than other diseases that we might take care of is the fact that for other diseases that we take care of. I feel like it's generally understood that the thing that is sick is a part of the body that is separate from the person's central identity, right? So if you have heart disease or if you have lung disease or kidney disease, you know that your kidneys are not part of what makes you who you are. Right? But if you have a neurological disease, and particularly if you have a neurological disease that has cognitive effects, like just a moment ago, you brought up Alzheimer's disease. That is a core part of what makes a person who they are. Right? When you have a person who is getting progressively sicker from Alzheimer's, it's not like their heart is getting sick or their lungs are getting sick. It feels like the person, him or herself is slowly disappearing. And I was wondering if you could reflect for a moment on what is it like to take care of people who are, in some cases losing the very thing that constitutes their central identity?
Stephen Hauser: [00:21:19] I think that it's a sacred obligation. And it requires, above all, patience with compassion. And I think that our medical system. Makes it very difficult to be patient with our patients. It takes time for people with neurologic disease to even get into the consultation room. If speech is affected, it takes much longer to understand what's on their mind. If hearing is affected, we may have to repeat or think of other ways to communicate with our patients. So the five minute or even 15 minute consult can be very problematic for patients with neurologic disease. The other thing that neurologists learn and know is that. There is also no behavioral or psychiatric disease or problem that can't be exactly replicated by a brain disease. And that makes us understand that these are all the same types of problems in our nervous system. And one of the themes of modern neuroscience and medical investigation is to bring together all brain diseases under a common roof because we are studying these diseases with the same tools and we are treating patients with the same therapeutics increasingly, and we'll do even much more of this into the future. So I think when disease strikes Central command of our bodies, it becomes more important than ever to recognize how much of what is precious has been lost. We know this and don't have to be a medical practitioner to know that we will do anything. To try to keep vibrant and alive someone whose nervous system is functioning. But if the nervous system has died. Keeping the body alive makes little sense. So I think, again, that it is a sacred obligation to be a physician of the nervous system. But also it is an obligation of all physicians to be a physician of the nervous system because the vast majority of brain diseases arise from illnesses that are outside of the nervous system.
Henry Bair: [00:24:18] I was just reflecting on. So I'm training to be an ophthalmologist. The eye is an extension of the brain. There's a lot of neurological tissue there. In fact, one of the subspecialties of ophthalmology is neuro ophthalmology. And half of the neuro ophthalmologists practicing out there actually were trained as neurologists first and then trained in ophthalmic neurological disorders. So I was just thinking that when you have patients in the clinic and I've encountered patients in the clinic for whom vision is no longer something they have anymore, it is profoundly devastating to the patient when they lose their vision, because when they lose their vision, so much of their identity of what they enjoy doing right? Because I mean, if you think about it, which we often don't when you think about it, so much of how you spend your time, the people you spend time with, those interactions rely heavily on you being able to see them well, to put it simply. And when you lose that, that's like a big chunk of who you are and what you enjoy doing and what brings meaning to your life just gone. And it's like a different issue when you're talking about the cognitive abilities, the executive functions of the brain disappearing. But just from my perspective, as in ophthalmology, I definitely see that already. So thanks for sharing those reflections.
Stephen Hauser: [00:25:38] People with brain diseases will sometimes say that they feel they've become invisible to the world. It's important to keep all of us visible.
Tyler Johnson: [00:25:49] Well, and I think to the point that we were talking about earlier, you know, I remember when I I'm not a neurologist, of course, but I remember doing my neurology rotation during medical school. And the first time that I worked on the stroke ward. You know, one of the things that I don't think at least I certainly didn't know before I went to medical school is that the brain is largely organized geographically so that an injury to a particular part of the brain has a particular impact in terms of maybe you can't execute speech or maybe you can't understand other people's speech or maybe you can't move this hand or maybe you can't see with this part of your field of vision or whatever the thing is. And it's just such a profoundly strange notion to know that all of a sudden this core part of how you experience the world or interact with the world or whatever can just be erased right from one moment to the next, right? A person goes to sleep one night and can see completely normally, and then they wake up the next morning and all of a sudden they have a large visual field defect or the right side of their body is paralyzed or they can no longer speak. Right. Like I've tried to think sometimes what it must be like to have thoughts in your head, but no longer have the physical ability to articulate them. When yesterday you did. I mean, that's such a profoundly strange thing that I'm not even sure I I'm not even sure that I'm sure what a thought is if you can't articulate it because articulating thoughts is so central to what a thought means. I feel like neurology in some ways probes more deeply at the the nature of suffering and the nature of what it means to be human than any of the other branches of medicine for precisely that reason.
Stephen Hauser: [00:27:38] I think one of the sad parts of medical specialization is that neurology is no longer embedded within general internal medicine, as it was when my career was beginning. We were all internists and internal medicine organizations had neurologists as one of the areas, just as we had endocrinologists and cardiologists and pulmonologists, because I think it's a very essential part of medicine. It's not separate. In addition to trying to understand and empathize with our patients who have lost vision or have had a stroke and have deficits that they didn't have yesterday. There's another part of the way our brain is built that makes us sometimes not be able to recognize that something is wrong. The medical term for this is Xenos agnosia, but it's very common. So part of understanding patients and working with families when somebody has a brain problem is not only dealing with the deficit, but dealing with the patient's inability to admit to the deficit. This can make rehabilitation very difficult, as you can imagine. But then on the other side. Are these extraordinary qualities that are still there and sometimes are enhanced the way that people with visual loss may have fantastic abilities in music or other areas, or even people with frontal dementia may have a flowering of artistic ability, that there are attributes that are socially very valuable and worth loving, and their relatives and loved ones are still there and making sure that people understand that despite the neurologic problem, their loved one is still there with them.
Tyler Johnson: [00:29:48] Well, and to that point, you would know much more about this as a neurologist than I do. But I know as an oncologist, as you point out, we routinely deal with the neurologic sequela of oncologic diseases. And one of the things that has so touched me is people who are debilitated to the point that they almost become sort of neurologically unrecognizable from what they were at their baseline. And yet they have family members or loved ones who care for them regardless. And the fact that those family members care for them, even when their neurological or cognitive abilities are so diminished, I think says something really beautiful about the meaning of human connection and the power and endurance of love as a force that binds people together even when and also says something important about our intuitive grasp of what we mean to each other as people, that that meaning outlasts even the neurocognitive ability that allow us to interact with and appear recognizable to those who love us.
Stephen Hauser: [00:30:55] I couldn't agree more. I wrote in the book about a. A husband and wife. Their story. I saw them yesterday in clinic and they are the most inspiring example of what you've just said. This doesn't only apply to people with multiple sclerosis or other diseases. Remember how my parents took care of my ill brother. And I think that was as much a formative experience for me in why I wanted to be a physician as anything that ever happened. And yet, of course, it was subconscious. This wasn't evident to me at the time, but one sees out of the horrors of illness the very best in behavior and the very best in people.
Henry Bair: [00:31:50] So to your point about looking back and seeing the lessons you've picked up along the way in your journey as a physician, as a researcher, your book is subtitled The Education of a Doctor. And I'm curious to hear more about why you chose that as a title. What were the main lessons learned you would say you can draw out for us in thinking back about your life and career?
Stephen Hauser: [00:32:14] So as a scientist, I certainly was educated by the people I was educating in my laboratory and in the clinic. I think of the courageous patients who trusted us and permitted us to ask medical questions with their bodies, to treat them with therapies that we didn't know very much about at the time. And I think we've learned more in my field from the bedside than we have from all of the laboratory work together. One great example was when we found the B cell mechanism for multiple sclerosis tissue damage and began the clinical trial of B cell therapy, and we unveiled that trial on the last Sunday in August, in 2006, in Northern California. And we thought that Ms. was caused by these B cell producing antibodies. But we also knew that it would take years to deplete those antibodies if we killed the B cells because the B cells were transforming into a cell called a plasma cell that really made the antibodies. And to winnow that down would take years. So we wanted to see in that first trial just a tiny bit of a beneficial effect. And when we unblinded the study that Friday afternoon, what we saw was an immediate and complete more than 90% decrease of inflammation. It was an unheard of effect size in a clinical study. And it was the very best clinical study I could ever imagine. It was exhilarating because it defined a treatment that would later be shown to help hundreds of thousands of people. And at the same time, it told us that our underlying scientific idea was at least partially wrong, sending us back to the laboratory armed with better ideas. So one thing that I've learned so much from is, of course, the science. The second is from my patients. And they have taught me so much along the way, especially when the care that I give is not good enough to help them. And their forgiveness and understanding and support, despite my failure, is a very important lesson and part of my education.
Henry Bair: [00:35:10] That is a really interesting point and I'd like to maybe explore that in this way. So did what your patients teach you in those moments when you felt like you failed? Did what they tell you change your conception of what failure actually meant or what failure wasn't?
Stephen Hauser: [00:35:30] I don't think it has. I wish that it would, but I still lose sleep thinking about the patients I was unable to help. And even more the patients whose disease struck before we had effective therapies. Just this morning in our group meeting, we showed pathology autopsy results. From a patient of mine who is in the book who died of horribly progressive multiple sclerosis earlier this year. And he was an extraordinary person. And we began with his family's permission by telling the group about his life story. And he understood and was appreciative for the care he received. But I felt as if I failed him and didn't do enough and want to work harder and faster so that what happened to him won't happen to other people. So as a physician, I appreciate the kindness that patients have when I fail, but it doesn't decrease my motivation to responsibly get better answers.
Tyler Johnson: [00:36:57] You know, I'm struck when I listen to you speaking. So in my own reflection and thoughts over the past month or so, I've been considering the relationship between a sense of mystery in medicine and a sense of humility in medicine. And I hear so much of that reflected in the way that you approach both your science and your patients. Right. I feel like, as we were discussing before, you can make an argument that what happens in neurology is, if you will, more mysterious than any other branch of medicine, right? Like I remember when I got done with my cardiology block in medical school, it was like, Oh, the heart is this pump. And it has these certain inputs and outputs and V equals R and these laws of physics. This is like Newtonian physics. Like, I can get my arms around this. I can kind of predict, you know, if I give this medicine in this context, it's going to have this thing on the R and that's going to have this impact on the V and whatever. I can do this. And then I got done with my brain and behavior. Block And it was like quantum mechanics. It was like, this is spooky relationships. And I have no idea what's going on even after I passed my neurology, my neurology exam. But but what I hear in your talking, it strikes me that it takes a particular kind of attitude towards one's self, an attitude towards the world when you're faced with certainly not a failure, but a an unexpected result.
Tyler Johnson: [00:38:31] Right. You talked about how this drug that you thought was going to have maybe some impact had this overwhelming impact to the point that you had to kind of go- Of course, you rejoiced at the result, but had to go back to the drawing board in terms of what it meant for the science. And then by the same token, this patient who was really sick, who then got sicker and sicker and eventually died. I guess the the fact that both of those things, rather than leaving you desolate, the fact that both of them leave you saying, okay, we've got to pick ourselves back up and we've got to go back to the drawing board so that the next patient like this has a better therapy or so that the next time around I understand better what the heck is going on when this drug has an overwhelming effect? I feel like that ability to humbly sort of assimilate the results that don't come out the way that you want and metabolize them into motivation for doing better the next time is central, whether you're mostly a clinician or a scientist or both.
Stephen Hauser: [00:39:28] I think that's right. Tyler The other part of education in the subtitle is My hope that. Young people will take the baton from us. And bring medicine to a far better place than it is in 2023. Than it is today. I don't think that there's a career that is more exhilarating than being a physician or more ethical than being a physician scientist. And it's so much harder than it used to be. But the rewards are spectacular. And the most important reward is that your kids will admire you. And they certainly admire my wife, who is a physician scientist and a pediatric oncologist. I think it's a fabulous field, and I can't understand why only 2% of medical graduates decide to bring together medicine and science deeply in their careers.
Henry Bair: [00:40:41] Well, one of the things that I've noticed as I listen to you talk about your career is how many times you came upon something that just wasn't the case. And here's what I mean by that. So when you first stumbled upon multiple sclerosis, treatment options were limited. You told us that one of your advisors literally told you we might never know about this disease to find a treatment for it. And despite the fact that you heard that, you decided to dedicate your whole career to solving this difficult problem. I think that is profoundly inspiring. It's a testament to how much we don't know. But also how much can still be done for us to do better for the future. So with that, we want to thank you so much for your time, Dr. Hauser, for joining us in conversation, for sharing your story and all of your your wisdom.
Tyler Johnson: [00:41:52] Thanks so much.
Stephen Hauser: [00:41:54] It was my pleasure. Thank you, gentlemen.
Henry Bair: [00:41:59] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's Art.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: [00:42:18] 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: [00:42:32] I'm Henry Bair.
Tyler Johnson: [00:42:33] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.