Dr. Joseph Stern (00:00):
Life of compassion is a more rewarding one, and it's a more giving and generous one, and it provides better care for patients, but it also... it will lead to a richer life for you.
From Spaugh Dameron Tenny, it's The Prosperous Doc Podcast; real stories, real inspiration, real growth. A show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.
Shane Tenny (00:31):
Well, today, on The Prosperous Doc Podcast, we are going to talk about grief, and loss, and vulnerability, and compassion, and the impact they have or should have on us. And I'm reminded that just a week ago, my dear friend buried his wife, from COVID, and certainly, many of you have experienced more than your share of pain and fear and grief and loss over the pandemic. In 2015, my guest today, Dr. Joseph Stern, experienced the loss of his sister and her husband, his brother-in-law, in the span of two years, and it affected him deeply as a brother, and has forever altered his approach as a physician.
Shane Tenny (01:17):
Dr. Stern is a Neurosurgeon with Carolina Neurosurgery & Spine in north Carol Carolina, and he has written a book, Grief Connects Us, which really gives an open and honest account of his story and his family, and the look at the tension, which is unique to those in medicine, of being clinical and detached, and that tension with being compassionate and vulnerable. And so we're going to talk with him today about his perspective on being on the patient caregiver side, and how that has impacted his care of patients. So Dr. Stern, thanks so much for joining me today.
Dr. Joseph Stern (01:58):
Thank you, Shane.
Shane Tenny (01:59):
Would you start maybe back in 2014, and paint the picture of your life and family and practice, and the day you got the news about Victoria?
Dr. Joseph Stern (02:11):
So I'm a practicing neurosurgeon, and I'm pretty busy, and you get consumed with daily activities, and married with three kids. So it's a pretty busy life. Anyway. So out of the blue, my sister, Victoria, called and said that she had been diagnosed with leukemia, and was in the hospital. I live in North Carolina, in Greensboro, she lives in... or lived in Santa Monica, California. So it was a long distance between us. We really didn't see each other as much as we used to, and I felt bad about that.
Dr. Joseph Stern (02:42):
And so when she called, it a shock. But that was the beginning of this... what turned into a pretty harrowing adventure. She was admitted to the hospital, and basically spent the next five plus months in the hospital, without ever leaving, and occasionally left for a brief hiatus. But then she had a bone marrow transplant. She was diagnosed with something called AML, which is acute myeloid leukemia, and it's a pretty bad spectrum of leukemias. She had one of the worst possible chromosomal abnormality, something called monosomy 7, which carries about a 6% five-year survival rate. So it was pretty atrocious.
Dr. Joseph Stern (03:22):
And so I got to know her oncologist, who was super nice, and is actually interviewed in the book. One of the first things he said to me was, "Don't look this up, don't Google this. You're not going to like what you see." So, of course, I went to the computer, Googled it, and was like, "This is hard." And I deal with difficult illnesses, and coming to terms of that was pretty frightening.
Shane Tenny (03:46):
And you Said in the book that you and your family, you and your sisters and Victoria had been close as children, but, of course, geography and life had separated you. But this call that you got from her sharing her diagnosis rapidly threw you back into reuniting and reforming your relationship, as you spent time visiting, and helping, and translating all the medical jargon for she and her husband?
Dr. Joseph Stern (04:10):
It's funny, because my other sister, Caroline, felt badly, because she said she really didn't feel like she had much to offer. And I felt, in this situation... One of the nice things about being a doctor was had some knowledge, and I had some ability to interpret things. And so I did feel that... That felt really good, that she needed my help, and I was able to help her. But one of the things that quickly happened to me was I discovered utterly terrifying it is to be a patient. And when you're dealing with a mortal illness, how just your life gets totally turned upside down.
Dr. Joseph Stern (04:39):
And so I found, before I... This is in the book, but before I went there, I was taking care of a patient, and done brain surgery on him, and I just... All of a sudden, it's like life became too intense. The guardrails that I had put in place sort of disappeared, and I found it forced vulnerability, in the sense that I just was really set. So I decided I would get on a plane and go and see her, and spend time with her. That was just the most wonderful experience, because it was reuniting and sort of... you just start, you just reconnect. So it was very powerful.
Shane Tenny (05:17):
There must have been a moment when you went to see her, and you walk in the hospital where she had been, where she was being cared for, and realized, "Oh, I'm not the doctor here."
Dr. Joseph Stern (05:28):
Shane Tenny (05:29):
"I'm the brother of a patient." What was that like?
Dr. Joseph Stern (05:32):
Well, you how hospitals work. But the first time I visited her, she had already been transferred to City of Hope, which was a major tertiary or quaternary care center, from her initial hospital for her bone marrow transplant. And it was just a very... It was a surreal experience. And now, we spend all our time in masks, in COVID. But for being on a leukemia and bone marrow transplant ward, you're basically in gown, and gloves, and mask, and hat, and you spend your entire day like that.
Dr. Joseph Stern (06:01):
And so it was very strange. There were two moments, one when I followed the attending doctor out of the room, and she just looked at me like, "Where are you going?" And then later on, when my sister had had her transplant, I came back to it with her, and she ha developed some high spiking fevers, and then some kind of pulmonary infection. Then they did a bronchoscopy, and this pulmonologist was very nice and was talking to me, and then I just started walking back with him toward the OR, and he looked like. "You're not coming back here."
Dr. Joseph Stern (06:31):
So I definitely was a fish out of water, and I kind of... You recognized the patterns and the processes, but you realize it's not your place, and it feels surprisingly foreign. You know so much of what is done, but just being in another hospital, where everything is different, it feels... it's kind of eerie. I guess, from that experience, I felt what it was like to be a patient. I had a window that maybe I never had before, because I've all always been, patients are other people, I'm healthy, my family is healthy. And then, and all of a sudden, you go, no, you really get it, and it hits you in the head like a two by four, almost.
Shane Tenny (07:08):
Yeah. I want to ask you in a minute about how this has begun to impact the way you now interact with the families of your patients and things. But I know as... Victoria's leukemia, as you said, was very severe, and progressed rapidly. And one of the things that you described was just her... what I characterized as a vivacious personality, and her positive outlook, and just her choice to really be adamant about focusing on getting better, and not wanting to discuss even the possibility of death. And yet, given your experience, and ability to understand the vocabulary, you were processing all the information with a better recognition of the possibility. How did you find balancing what knew to be true with her, the patient's outlook and desire?
Dr. Joseph Stern (08:03):
So that was one of my biggest struggles in this whole experience, was that I knew that she wanted my help, wanted my interpretation of the facts, but only so much. She had drawn some very clear boundaries, she was not interested in talking about dying, she was not interested in talking about the possibility of dying. She wrote a journal of her illness, and she initially planned for it to be a one-woman show that she was going to perform. So one of the things about my sister is she's incredibly extroverted, and a great actress, and fun to be around. And I feel I'm the opposite. I talk to patients, and I'm fairly introverted.
Dr. Joseph Stern (08:41):
So this whole process has forced me to become someone different than I was. I feel a bit like it's like... My sister has affected me and changed me a little bit. But when I was there, she really would not talk about dying. And I really struggled with that. One of the questions that I asked... In the book, I did a series of interviews with patients and with doctors, and asked, how do you deal with that? And how do you... One of my friends, an oncologist said, "You really have to be with the patient where they want, where they are. You can't hit them over where they had with information or prognosis or..."
Dr. Joseph Stern (09:18):
I think a lot of times, doctors do that. They tell people facts or treatment details or like... Wen you're doing an informed consent, they get very blunt. And some people want to know a lot, and some people don't want to know any of it. And you have to go with that. What made me sad was I felt that there were missed opportunities, that when my sister's bone marrow transplant didn't work and she was... relapsed very soon after her transplant... They put her in a very bad prognostic group, with a very low likelihood of survival.
Dr. Joseph Stern (09:53):
Her oncologist knew that she was not to live, but never really sat down and talked with her. They tried other chemotherapy, and then I felt like it was a bit of a magic show, where they're distracting her from the reality. And I guess, if the patient doesn't want to talk about it, you don't have to, but I also feel that if you don't talk about it, well, then guess what, if you die, suddenly, you don't have a chance to say goodbye to your kids, you don't have a chance to say goodbye to your husband, and you just disappear. And I feel that that was a real loss for her and for her family.
Dr. Joseph Stern (10:24):
And so I do think that one of the things... To me, it's not sufficient just to say, "Patient doesn't want to talk about it, I'm not going to talk about it." Because I think there are a lot of ways of approaching patients with honest and direct communication, where they will talk to you, and they do need to talk to you about it. And so you can't just say, "Well, I'm not... This patient doesn't want to talk about the possibility of dying. Therefore, I'm not going to address that at all." To me, that seems like an abrogation of your duties, and also puts you in a very strange position, where, how can you really make treatment decisions and plans when you don't even address what's really going on.
Dr. Joseph Stern (10:58):
So I think there are different ways of doing it, but I think that you have to have those conversations. It was interesting, because Sean Fisher is her oncologist, and he said... Because I said, "It seemed that my sister was really completely in denial." And he said, "I don't think she was in denial at all." He said, "I think she got it right away, and she just didn't... she just took was not to go there." And so he said, "I did not think she was in denial." I felt that she was, because she just wouldn't talk about it. But I think in her heart, she probably... she knew that things were bad, and wasn't very likely that things would go well.
Dr. Joseph Stern (11:32):
One of the things that's interesting toward the end of the book is there's a study from Duke where they looked at people with exactly the same condition, and almost all of them choose the same thing. Isolated from family because of worry about infection, they're far from home, they're in hospitals for months and months and months out a time. Sometimes those patients will say that they've got a 90% chance of living, and the doctor will say, "Actually, it's about a 10% chance of living."
Dr. Joseph Stern (12:00):
They put their positivism and hope into treatments that sometimes aren't really probably the best things to do. Like, I'm not sure... And that was one of the things I also thought was a challenge, was I think a lot of doctors are more circumspect about the treatments that are being recommended, and maybe less likely to just say, "Oh, for sure, I'm going to do that. You tell me to do that, I'll do that." If you just run through this burning building, you'll make it through. Okay, I'll go. And I feel like I'm a lot more dubious of that. I'm less likely to just jump in and do whatever the doctor says, and I want to have some basis of, well, is this useful? Is this going to be helpful, or is this going to be too much for me to go through, or is the risk so high and the benefit so low? So I think as a surgeon, I become much more aware of that when I talk to patients, it's like, I'm... I think I'm more careful about recommending surgeries. And we about risks more honestly.
Shane Tenny (12:56):
Yeah. And to your point, we all know there's value in hope and psychology, plays a difference. But I think to your story, and the point you make, an unwillingness, I guess, to discuss those things ends up depriving the people who are left behind of the ability to say goodbye or pre-grieve or plan, or those sorts of things. And I think even about the scenario with Victoria's family, it was... I don't think not two years after she passed, her husband had an aneurysm, and you got another-
Dr. Joseph Stern (13:31):
Right. [crosstalk 00:13:32]. And this was really a horrible thing on top of a horrible thing, where out of dinner with some friends and with my wife, and got this phone call that Pat was in the emergency room at UCLA, and he'd had a hemorrhage in his brain, and he was in a coma. And he was on Coumadin, a blood thinner, for a heart condition. So I'm told all this, but they didn't say, "Oh, well, their son is sitting right here." They didn't tell me that. And so I said, "Oh, well, he's really screwed." And he said, "Well, his son is right here, and you're on speakerphone." I was like, great.
Dr. Joseph Stern (14:07):
So that was not really the greatest beginning of that situation. But what was interesting in that situation was like, it was the polar opposite of my sister's situation. First of all, I was Pat's healthcare power of attorney, so I was entrusted with making medical decisions on his behalf. My sister was someone who is completely conscious and awake and with it, up until the time she died, who was capable of having these discussions. Pat was not capable of having any of these discussions. He had no awareness.
Dr. Joseph Stern (14:35):
So it was very... It was a very, very different situation. And there, I found myself square in the world that I inhabit on a daily basis as a neurosurgeon, taking care of patients, and I just thought it was absolutely horrendous. And I understood what was going on, but I also felt that the kind of... Some of the doctors were wonderful, they're super compassionate, super caring, and some just felt very... it was a very tough situation. But one of the things that was interesting to me in dealing with my nephews...
Dr. Joseph Stern (15:08):
So their names are Nick Will. Nick was the bone marrow donor for his mother, and then did CPR on his dad after he collapsed. So how'd you like to have that as a 16-year-old kid? But one of the things that happened was, I was terrified to talk with them about the possibility that their dad might die. And Pat's brother and sister-in-law were there with us, and we sat down and we said, "We're going to have a conversation about this, and we're going to talk to you about this. And I think it's likely that he's not going to wake up, and that he is... We're probably going to need to discuss stopping."
Dr. Joseph Stern (15:50):
And I was really terrified about that. And I was completely shocked by the reaction from the kids, which was... First of all, they cried a lot, but then they were grateful. And they said, "Thank you for being so honest with us." And so, it was really stark, the contrast between what had happened with my sister, where they're all positive and believing she's going to get better, and then [inaudible 00:16:08] she's dead, and they felt like they had been lied to. And then in this situation, where we were pretty direct, and it was uncomfortable and we had a challenging, very uncomfortable conversation that we didn't really want to have, but felt we had to have. And in the end, it was very helpful to them.
Dr. Joseph Stern (16:23):
So I learned a lot about how to manage my myself in dealing with these conversations, and also, I feel like when you face one of these difficult conversations, or you face a difficult situation as a physician, there's a lot... there's a part of you that says, "I don't want to have this conversation, or I'm going to just finesse it, or do something else, or I'm busy, or we're not going to go there. I didn't feel so strongly before, but now I feel very strongly. It's like, I need to have that conversation. I'm not going to put it off or say, for another day, we'll talk about it. We have that conversation.
Shane Tenny (17:00):
Right. Yeah. It's the truth that actually sets you free.
Dr. Joseph Stern (17:04):
Also, I'll say that from my own standpoint, the thing I didn't recognize, and now I guess where I'm more passionate, is having that conversation and liberates me, too, because if I turn my back on this awareness, or I turn my back on this intensive emotional experience, because I'm uncomfortable, or I don't want to go there, or I hide from it, it doesn't go away. You just bury it. And then over were time, I think... Before we started, we were talking about burnout. And I think a lot of times doctors burn out, not because of the intensity of the emotions, but because of all the effort that they put into avoiding them.
Dr. Joseph Stern (17:45):
And so I feel that when you actually start to confront these things, and you deal with the situations, it's actually... it is actually a very positive experience, and it's something that I have really grown as a human being in this process, and that's one of the things that has been very liberating for me, is that I feel like I'm a better person and a better doctor, and patients get better care.
Shane Tenny (18:07):
Your [crosstalk 00:18:08] story. Yeah. Your story is one of love and compassion and learning to love differently. But I guess to the point you're making here, there's... you learned a lot about death that you didn't know, even after 25 years as a neurosurgeon.
Dr. Joseph Stern (18:27):
Right. Right. Yeah. And the thing is, I saw a lot of deaths in my practice, but it's really different when it's people... I think one of the things I thought, my own form of magical thinking... My sister was always positive, relentlessly positive. I believe that with training and skill, mastery of material, I could stave off death. And the thing is, you can't, you're powerless. So that's very humbling and sort of... it's tough.
Shane Tenny (18:58):
Through this journey, you were describing a bit ago, walking the halls and trailing some of the attendings, and realizing, "Oh, this isn't my place." And you started to get this growing awareness, like, I'm not the provider here. And I get the sense, you began to become self-aware of your own habit of detachment, and the tension that that was as a brother. I'm wondering if that awareness, or that intersection of detachment on the one side, and compassion on the other, is door you go through once, and then you now have new eyes when you see patients, or do you continually have to remind yourself when it's time to make yourself available to compassion, or when you need to be detached for the sake of your patients?
Dr. Joseph Stern (19:47):
I think that's a really insightful question, and I think it is both. I think it's a door you go through and you change. But also, like I... because I'm aware of it, I'm going through that door all day, every day. I think about it all the time. And so it's a more of an awareness. I think there's an awareness of myself, and also, I think one of the things that I have learned is that we as neurosurgeons tend to be fairly perfectionistic and very focused on procedures. And they're very important, but also, in the end, a lot of times they don't matter as much as we think they do. And so one of the things that I think is an essential skill to becoming more compassionate is to becoming self-compassionate, is to recognize, I am not perfect, I am going to fail, I cannot do... I've never done a perfect surgery. I strive for that, but I have to cut myself some slack, I have to humanize...
Dr. Joseph Stern (20:47):
If I'm going to humanize my relationship with patients, I have to humanize my relationship with myself, I have to be more tolerant of myself, I have to be more forgiving of myself. And that's a hard lesson, because I think we tend to be very hypercompetitive, hypercritical, perfectionistic, and those things are sort of dead ends. I think just the detachment and distance doesn't work, the perfectionism doesn't work, either.
Shane Tenny (21:14):
Yeah. In Fact, I wrote down one of the... something you wrote from the book that I thought was... it kind of jumped out at me. You wrote, "Admitting, accepting, and, ultimately, forgiving our failure is an essential part of becoming a healthy, mature, and effective neurosurgeon." And I think that you wrote that leading into this concept of vulnerability. And I guess that's what you're touching on, is there's that constant awareness and effort during the day to find the balance between being detached enough to go do surgery on someone's brain, and yet, vulnerable enough to empathize and show compassion-
Dr. Joseph Stern (21:52):
Yeah. I think both are critical features of an effective doctor, and, certainly, effective neurosurgeon is where I live. But the thing is, you have to allow yourself to be vulnerable, you have to... compassion means to suffer with. I have to recognize and appreciate your suffering. And then my commitment to you is, I'm going to help you, and I'm going to try to get you through that suffering. My commitment is not to do some perfect surgery on you, my commitment is to be there, and to be available and to care. And part of that is doing surgery.
Dr. Joseph Stern (22:31):
It's strange, because as I've gone... matured in my job, the surgery part has become less important. But I feel that by being a more compassionate doctor, first of all, I listen more, I don't talk as much, I'm much more interested in hearing what patients have to say and where they're coming from, I want to connect with them on a personal level. We'll talk about like their lives, their families, what's going on.
Dr. Joseph Stern (23:04):
But one of the problems is that if you become vulnerable and allow yourself to be vulnerable, you are not taught in medical school, or in training, how to switch it on and off. You're not taught like, how can I be vulnerable one minute, and then, as you say, go into the operating room and do complex surgery? That's where I talk about the concept of emotional agility, which is that I know that I need to be vulnerable, I see the ravages of doctors who aren't compassionate, and don't have vulnerability, don't have empathy for their patients, I think they tend to over operate, do, sometimes, unnecessary procedures, objectify patients, treat them as economic units. There's a lot of evil things that can happen.
Dr. Joseph Stern (23:50):
So you connect with your patient, you care about your patient, but you need to be able to flex between emotional connection, on the one hand, and dispassionate surgical precision on the other, and there's a big range, and nobody teaches you how to do that. And so that's one of the things that I'm trying to do with this book, is to chart a path, a different path, where people can learn new skills, where they can embrace what they do and not be afraid, but also to excel in all phases of their professional life.
Dr. Joseph Stern (24:22):
And I think the bleed over from the detached distant doctor is, you don't really have rich life experiences outside of work. I don't know how you can be detached and distant in a work position, and then suddenly switch that off and become open and vulnerable outside of work. So I don't think that works. So I think the thing is, you have to be able to balance those, but you have to be able to... If you live that life in all parts of your life, it's a much healthier and more rewarding experience.
Shane Tenny (24:56):
As a neurosurgeon, you spend 14, 15, 16 years in training. And so you may never do a perfect surgery, but you know if you did a darn good one. How do you know if you were vulnerable? If somebody is listening to this podcast, or somebody who reads your book and says, "You know what, this is right. I want to interact with my patients differently," how do they... How can you feel that, or how can you read it, or how can that?
Dr. Joseph Stern (25:18):
Well, I don't think you can fake that.
Shane Tenny (25:20):
Dr. Joseph Stern (25:22):
You have an open heart, and you are... There's a whole bunch of stuff that I have found very rewarding, one is some mindfulness. I started doing meditation. I feel that those get-ins are... they don't go anywhere, and they're ultimately corrosive, but there's some really positive ones, like kindness and generosity, and it just feels so much better, and that's-
Shane Tenny (25:49):
Have you had to change your clinic schedule to make more time?
Dr. Joseph Stern (25:53):
I've hired more people to help me, and I've... One of the things that's interesting is that empathy actually doesn't take much time. So, it's not like you have to devote more time. I think that's a common myth, is that people think, "Well, if I'm going to be empathic, that means I have to see fewer patients, and I have to spend more time." And it's like, no. It means making eye contact, it means listening, not just blurting things out, it means being more of a partner and less of a position of authority.
Dr. Joseph Stern (26:25):
There's a study that says that it takes 17 second and to establish an empathetic connection with patients. And one of the things I think I've noticed in my practice is if you invest that time early on in your relationship with a patient, you talk to them like you're really interested, and you want to know about them and what they're about, that carries over, that sets the framework for your relationship for the rest of your time.
Dr. Joseph Stern (26:48):
And so sometimes it actually saves time, because you already have established that rapport, and then you can have a more problem-focused visit down the road, and you don't have to reestablish it, because it's known. So, I don't think it takes more time, I think it takes a willingness to go there. I did a TED Talk, and one of the things I talked about was, I went into a patient's room, and it was late in the afternoon, and I had already been pretty busy, and there was a lot going on, and there was this young woman, and she was sitting there.
Dr. Joseph Stern (27:18):
She was a teacher, a fourth-grade teacher, and she had metastatic breast cancer to her brain, and so I had to put a reservoir in her brain to be able to give chemotherapy. Well, that's kind of end run, you're heading toward the end. She was young and vital mother and wife and teacher. And I sat there, and initially, I remember I just... I didn't want to go in there, and I didn't know how to handle it. I'm sorry, I'm going to get emotional here.
Shane Tenny (27:49):
That's all right.
Dr. Joseph Stern (27:50):
But I sat there, and I-
Shane Tenny (27:52):
For what it's worth, I cried all the way back on my flight from Dallas, so...
Dr. Joseph Stern (27:57):
Well, I sat with her, and I just started... I held her hand and I... I cried, because I had just lost my sister. Well, her name was Megan. And I asked her about what was important to her, and what she wanted. And the old me would've liked to schedule her surgery. It's a procedure. And I sat there, and she said she wanted to finish out the fourth grade with her school, with her class. And I realized that was what was important. So, we scheduled the surgery around that. Procedure mattered, it was something technical, but... It was important, but in the end, it didn't matter as much as her saying goodbye to her students, so I thought. It was weird when I cried in front of my patient. I would never have done on that before.
Shane Tenny (29:06):
I think it's a beautiful thing that you can see in your own life, here's what the old me would've done, and here's who I'm becoming, and what I'm giving to you as my patient now.
Dr. Joseph Stern (29:18):
Well, and she was very grateful and gracious to me. So that's the other thing, is like, I feel like... Have you read Compassionomics? Do you know that book?
Shane Tenny (29:28):
I don't. I thought a lot of being mortal while I was reading yours. [crosstalk 00:29:33].
Dr. Joseph Stern (29:34):
Compassionomics is a really good book. And one of the things they talk about is the science of compassion, that we know these things matter. They actually matter a heck of a lot. Patients remember when their doctors are compassionate. They don't remember all the procedures, they remember how they feel, or how people treat them. And those are the things that really ultimately matter. When I'm talking about my sister's experience, I don't remember her blood counts, I remember how did her doctor make me feel good or bad.
Dr. Joseph Stern (30:07):
And so I think we really underweight those things in our careers, in the way we do what we do. We are so privileged to do what we do. And most people, you either cease to recognize that, cease to see the gift that we've been given to do what we do. And I think it's really sad. Because I think if you keep that front and center, it's a great job.
Shane Tenny (30:35):
If you were designing or consulting with a medical school on their training program, or their residency program, or fellowship program, and things like that, to make suggestions on how to make space to teach compassion, what changes would you make to today's doctor training-
Dr. Joseph Stern (30:58):
Well, so that's not a theoretical for me, because I that's exactly what I'm doing and trying to do. I did a talk to Georgetown University Medical School faculty last week, and they're interested in what I'm saying, and they say they want me to teach the medical students. I've taught at several medical schools, and I'm teaching students. I'm adjunct faculty at UNC Chapel Hill, and that is really one of my really burning platforms, is I think we need to teach students better and differently.
Dr. Joseph Stern (31:32):
I went through a personal crisis to get to where I am. I should not have had to do that. If I had had tools, skills, some knowledge about all these things, I might not have been mature enough at that time to have made this plain sailing, I think it would always have been difficult, but it would've given me some skills. I felt like I had to reinvent the wheel for myself, and then learn about this. And then I discovered that really, people aren't being taught these things, and they need to be taught these things.
Dr. Joseph Stern (32:00):
I had a conversation with one professor at a prestigious medical school who said, "We don't have time in our curriculum to do this." And I said to her, "Actually, you don't have time not to do it." This is one of the core things you've got to do. Because what we're doing is we're selecting hypercompetitive, super achievers, not compassionate people, and then we want to turn them into the doctors we want them to become. Well, they're not going to be those people, they're going... These are very difficult skills to master, and we need to spend time and put our energies into training people.
Dr. Joseph Stern (32:35):
One of the things that had been hard for me in writing this book... I'm a fairly persistent person, and I think I got that from my sister. She used to try out for parts all the time and get rejected, and just go back for another audition the next day, and I learned that from her. And I think the neurosurgery thing is the opposite. It's hard to get into, but once you're in, you're in. And you don't have to constantly prove yourself. But I told an agent one time that I wanted to change the world, and that's why I was writing this book. And he said, "Oh-oh, well, that's a terrible thing. We won't be able to publish that."
Dr. Joseph Stern (33:10):
And it's like, well, why... that's why I wrote this thing, is I think we need to do better, and we need to do differently, and we need to change the world. And so, it's been a strange experience to recognize that something really needs to be done, and really needs to be done differently, and can be done so much better. And then to have that knowledge, and put it in a book... And I think it's a pretty good book, I think it tells... it says what I wanted to say.
Dr. Joseph Stern (33:35):
And then you realize, well, the world isn't really interested in changing. And you look and you say, we've been so nasty to each other with this whole COVID thing, and all the just meanness, and the lack of compassion, and I don't get it. I don't get it why we don't listen to each other, why we don't cooperate with each other, why we don't... aren't more generous to each other. And so, I bit strange that I feel like I know what needs... From my own personal experience, I know what needs to change, but convincing others is challenging.
Shane Tenny (34:11):
Yeah. Based on how you have changed, and the journey you've been on... To the point you're making, you wrote the book, hoping to impact your colleagues around the country, around the world on the way they interact with patients, and hoping to impact patients by receiving more compassionate care from their physicians.
Dr. Joseph Stern (34:33):
Yeah. They need to demand it. Because a lot of times people just suck it up and go, "Hey, wasn't very nice, but he's good a surgeon." It's like, no, he's not a good guy. [crosstalk 00:34:42].
Shane Tenny (34:41):
That Was going to be my question, which is, from the patient's side of the table, what can a patient and their family do to better communicate with their medical team, or to better demand the type of care they want?
Dr. Joseph Stern (34:57):
I think to insist on good communication, and I think to expect more of their doctors and their treatment team... And I do think that we're headed in the right direction. So I feel like a lot of these things are improving. Nothing I'm seeing here is revolutionary, it's all kind of... it's sort of obvious in some ways. And I do think that that people do recognize it's important, but I don't think they do enough, I don't think they realize how important it is. It's the exception rather than the rule.
Dr. Joseph Stern (35:29):
Depending on which doctor you get, you're going to have a different kind of experience, and big decisions may be made very differently because of how communication is made. One of the things that's great is with palliative care, there are people who are very available, very interested in helping you through these things. But I found with my sister and her husband's case, it felt more like funeral planning. That was not something that was available early on, that was available after we had decided to stop.
Dr. Joseph Stern (35:58):
So, all the hard decisions had been made. And then all of a sudden, you say, "Well, now we'll get palliative care." And it's like, okay, we're going to talk about... It's really end of life. And so I feel like that all needs to be integrated an awful lot earlier. And I think there's this weird split in medical practice, where you do full-on treatment, and then if things aren't going well, well then you bring in palliative care. Well, that seems a very strange way to do things. You should be having the palliative care discussions while you're making the treatment decisions. It's not like, oh, we're going to treat you, and then if you're not making it, well, then we'll bring in palliative care. I signed up for a course at Harvard Medical School on... it's a palliative care training program. So, I think there aren't many neurosurgeons who've done this, but it's kind of... For me, I want to try to reintegrate it more effectively.
Shane Tenny (36:47):
Yeah, that sounds phenomenal. I guess, just to wrap up, what do you hope are the key takeaways that a reader will walk away from your book with?
Dr. Joseph Stern (37:01):
What I said, I think that life of compassion is a more rewarding one, and it's a more giving and generous one, and it provides better care for patients, but it also... it will lead to a richer life for you. One of the other things that I thought was really, I guess, an important take-home message is that grief does connect us all, that we are all linked together. And a lot of times, I find that people don't... they tend to avoid grief, or they deal with it in private, they don't share it with each other, and I think it's a very important moment for people to come together. So, one of the purposes of my book was taking you on the journey of my journey, and also my sister's journey, but then showing how universal this is, that other doctors, other patients, they all go through the same thing, as well as giving some ideas of how we might do better in the future.
Shane Tenny (37:52):
Dr. Stern, thanks so much for sharing your story with us, and just what you've learned. I got a final question for you, and that is this. Through your life, you have, undoubtedly, bumped into so many amazing people, and built upon what you have been given. We all stand on the shoulders of those who've gone before us. And I'm just curious, if there's somebody, or a couple key people, that come to your mind that you'd to shout out here as being just instrumental in your own walk and journey.
Dr. Joseph Stern (38:24):
So, just two people from... or three people from my neurosurgical training. So, one was Dr. Hoff, who featured in my book. And he was a real mensch, he was a kind, warm, compassionate, decent man. A lot of neurosurgical training programs have been... traditionally been brutal and difficult, and his was very kind. So, I think he set me in good stead to be able to do what I've done. And then one of my junior residents, Sanjay Gupta, who's now on TV all the time, was kind enough to write the forward from the book, when he could have just said, "No, I'm busy. I'm not going to do this." But he did, and I really am very grateful to him.
Dr. Joseph Stern (39:02):
And then I had an article in the Washington Post a little while ago about a neurosurgical surgery I did with a professor named Donald Ross who was very kind, and also very compassionate. And it was as if I... I felt afterwards, we did a technically great job. But when I went and talked to the family, I was overwhelmed when I saw their little kids. And I was really so upset, I just punted, and I didn't really say what was really going on. And I felt, at that point, like a failure, like I had failed as a physician. And I just thought it was... It took me 20 years to come into terms with it.
Shane Tenny (39:41):
Thanks. Thanks for sharing, thanks for your story, and thanks for all you do for our community.
Dr. Joseph Stern (39:46):
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