The Doctor's Art

For a profession like medicine in which suffering — be it physical, psychological, existential, or spiritual — is so commonly encountered and experienced, we have developed remarkably little shared vocabulary to talk about what suffering means. That is, if we even have the conversations at all.In early June 2024, during the American Society of Clinical Oncology annual conference in Chicago, we hosted a live podcast event at Northwestern University's Feinberg School of Medicine, gathering Sunita Puri, MD and Jay Wellons, MD, MSPH to explore the great problem of suffering. Dr. Puri, a palliative care physician and author of the best selling book That Good Night: Life and Medicine in the 11th Hour (2019), last joined us on Episode 74: The Beauty of Impermanence. Dr. Wellons, a pediatric neurosurgeon at Vanderbilt University Medical Center and author of the memoir All That Moves Us: A pediatric neurosurgeon, His Young Patients and Their Stories of Grace and Resilience (2022), last joined us on Episode 28: The Brain and All That Moves Us. The four of us, the guests and co-hosts, start by sharing our personal encounters with suffering, both in our patients and in ourselves, before discussing our philosophical approaches to and practical strategies for accompanying patients through suffering, managing spiritual distress, contextualizing our own humanity in these encounters, maintaining our own well-being, and searching for meaning amid these tragic moments, if it is possible. After our main discussion, we also answer audience questions about managing the sometimes unrealistic and complicated expectations patients have of clinicians, and the role of interfaith discussions among healthcare professionals.We thank Kelly Michelson, MD, MPH and the Center for Bioethics and Medical Humanities at Northwestern University for making this event possible.In this episode, you’ll hear about: 3:58 - Stories of confronting suffering, both in professional and personal contexts29:02 - Practical tips for coping with suffering and uncertainty as a physician31:53 - The importance of psychological safety in feeling and expressing your emotions as a physician 36:52 - Being present in the moment while accompanying patients through difficult times40:00 - Helping doctors re-connect with the deeper reason of why they feel called to medicine 42:24 - The inexplicable relationship between love and loss 52:04 - The deep sense of meaning inherent in the work of a physician and what makes it “real” 54:41 - Q&A: How physicians can better navigate the challenging expectations patients have as well as medical skepticism1:04:05 - Q&A: How we can better incorporate interfaith dialogue into medical training and practiceDr. Jay Wellons is the author of All That Moves Us (2022) and can be found on Twitter/X at @JayWellons5.Dr. Sunita Puri is the author of That Good Night (2019) and can be found on Twitter/X at @SunitaPuriMD.

Robert Sapolsky is a neuroscientist and primatologist at Stanford University, renowned for his insights on stress and behavior. In this engaging discussion, he argues that free will is an illusion shaped by our genetics and environment. He explores how this perspective can change our approach to crime and mental health, advocating for compassion over blame. Sapolsky also delves into ethics within a deterministic framework and reflects on the paradox of self-deception in navigating life's challenges. His thoughts provoke a deeper understanding of human agency in an unequal society.

Dr. Samuel Wilkinson, a professor of psychiatry at Yale University, offers a fresh perspective on evolution and its implications for human existence. He discusses how an existential crisis in medical school spurred his exploration of life's purpose. Wilkinson argues that evolution can align with spiritual beliefs and emphasizes the necessity of personal relationships for mental well-being. He delves into the complexities of human nature, the debate on free will versus determinism, and the importance of reconnection with one’s purpose in medicine.

Mark Lewis, MD, is an oncologist deeply shaped by cancer, both personally and through his family's journey. He shares the emotional toll of watching his father battle the disease and his own cancer diagnosis linked to a genetic syndrome. Dr. Lewis discusses the transformative power of faith in his healing, the impact of advanced treatments like immunotherapy, and the importance of empathy in doctor-patient relationships. This heartfelt conversation navigates resilience, hope, and the delicate balance of science and spirituality in medicine.

The Bill & Melinda Gates Foundation, with an endowment of over $50 billion, is one of the largest and most influential philanthropic organizations in the world. With a focus on addressing global health, poverty, and education, its initiatives have led to the reduction of malaria mortality by 60% over the past two decades, the near eradication of polio, increased educational opportunities of millions of students, and improved sanitation conditions for millions of people in developing countries. For six years, oncologist Sue Desmond-Hellmann, MD, MPH was the CEO of this organization. Prior to that, she served as Chancellor of the University of California at San Francisco, as well as President of Product Development at Genentech, where she oversaw the development of Herceptin, Avastin, Rituxan, and other blockbuster cancer drugs that are now staples in the arsenal of many medical oncologists.The topics of our discussion in this episode are as varied as Dr. Desmond-Hellman's career. We discuss, among other things, how seeing the work of her pharmacist father encouraged her to pursue a career in medicine, how her early experiences treating HIV patients in Uganda spurred her to tackle global health challenges, how she discovered a passion for product development in the pharmaceutical industry, how she reconciles the ethical quandaries of developing medications that can cause serious adverse effects and that can sometimes cost hundreds of thousands of dollars per dose, what her mission while at the Gates Foundation was, and her perspectives on the role of artificial intelligence and human health and well-being, now that she has joined the board of directors of OpenAI, the company behind ChatGPT.In this episode, you will hear about: 2:50 - How working in her father’s pharmacy led Dr. Desmond-Hellmann to a career in medicine4:56 - A brief summary of Dr. Desmond-Hellmann’s multifaceted career trajectory15:36 - What the day to day work of pharmaceutical drug development looks like 18:30 - The challenging ethical concerns that surround drug approvals especially as it pertains to safety concerns23:44 - Dr. Desmond-Hellmann’s experiences in Uganda that forever transformed her views on poverty 27:55 - The aims of the Gates Foundation 30:47 - How Dr. Desmond-Hellmann views her work both in the non-profit and the for-profit sectors 37:15 - Dr. Desmond-Hellmann’s mission when she took on a leading role at The Gates Foundation 38:38 - How Dr. Desmond-Hellmann thinks about shaping the future of AI as she takes a seat on the board of OpenAI45:14 - Dr. Desmond-Hellmann’s advice for medical trainees and clinicians on how to navigate the many opportunities available to them along their career pathDr. Sue Desmond-Hellmann can be found on Twitter/X @suedhellmann.Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. 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 or send an email to info@thedoctorsart.com.Copyright The Doctor’s Art Podcast 2024

Ira Bedzow, PhD, is a multifaceted expert in ethics, medicine, and moral leadership, serving as the executive director of the Emory Purpose Project. He discusses how identifying personal values can lead to meaningful leadership and healthier relationships. Bedzow also explores the ethical dilemmas faced by clinicians, the connection between burnout and loss of purpose, and strategies for students to align their aspirations with their values. His insights challenge listeners to think deeply about purpose and ethics in both life and profession.

Terminal lucidity is a mysterious yet well-documented phenomenon in which someone at the end of life—including those who have suffered strokes or other brain injuries, or those afflicted by dementia—suddenly returns with mental clarity and is able to recognize loved ones and engage in meaningful and emotionally rich conversations. It challenges our fundamental understanding and assumptions about the nature of consciousness, brain function in the context of severe illness, and personhood. In this episode, Alexander Batthyány, PhD, a cognitive scientist and the Director of the Viktor Frankl Institute, offers insights on terminal lucidity from his years of study on this phenomenon from a philosophical, ethical, neurological, and psychological perspective. He is the author of the 2023 book Threshold: Terminal Lucidity and the Border of Life and Death.Over the course of our conversation, he shares how witnessing terminal lucidity in his grandmother has shaped his life purpose, why he chooses to use the word “soul” in his academic research, the role of spirituality and religion in making sense of terminal lucidity, the limits of our scientific and materialistic understanding of the brain, what terminal lucidity reveals about the dignity and unpredictability inherent in the human condition, and what it ultimately teaches us about kindness and compassion. In this episode, you’ll hear about: 2:31 - The personal experience that drew Dr. Batthyány to study terminal lucidity 6:34 - An exploration of human dignity12:26 - The importance of talking and thinking about the human “soul”18:26 - Definition and phenomenology of terminal lucidity23:57 - What is known about brain functioning during episodes of terminal lucidity 31:44 - Advice for caregivers, family members, and clinicians if a patient experiences terminal lucidity36:55 - The prevalence of terminal lucidity 40:14 - Whether individuals who experience terminal lucidity have insight into their condition42:15 - Why phenomena like terminal lucidity matterDr. Alexander Batthyány is the author of Threshold: Terminal Lucidity and the Border of Life and Death (2023).Dr. Batthyány can be found in Twitter/X at @Alxdr_Batthyany. Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. 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 or send an email to info@thedoctorsart.com.Copyright The Doctor’s Art Podcast 2024

David Skorton, a leader in medical education and former president of Cornell University, shares his inspiring journey from aspiring musician to prominent cardiologist. He discusses the impact of his immigrant background and the significance of arts in medicine. Skorton emphasizes humility in leadership, the value of learning from every healthcare interaction, and the need for inclusive decision-making in organizations. He also explores the evolving landscape of medical education amid technological advancements and advocates for diversity in healthcare teams.

In spring of 2020, Cornelia Griggs, MD was finishing her nearly decade-long training to become a pediatric surgeon in New York City, when COVID-19 struck and life fell apart. The hospital was flooded with mysteriously sick patients for whom no known treatments existed, basic supplies disappeared from shelves, and each day at work took on an existential burden as she wondered if this would be the day she caught the deadly disease herself. Dr. Griggs describes these dramatic stories from the early days of the pandemic in her 2024 memoir, The Sky Was Falling. Today, she is a triple board-certified pediatric surgeon, having completed medical school and pediatric surgery fellowship at Columbia University Medical Center, and her adult general surgery residency and surgical critical care fellowship at Massachusetts General Hospital, where she currently practices. Over the course of our conversation, Dr. Griggs describes the course of her challenging training in medicine, why it takes “a little crazy” to succeed as a surgeon, harrowing moments that defined heroism amid the throes of the pandemic, how she continued working even when giving up was the easy option, and more.In this episode, you’ll hear about: 2:26 - What initially drew Dr. Griggs into the field of medicine and to the speciality of pediatric surgery 14:35 - Why the operating room is a “safe space” for Dr. Griggs19:36 - The sense of alarm that Dr. Griggs experienced in the early days of the pandemic that drove her to write her viral New York Times op-ed, The Sky is Falling 28:26 - How Dr. Griggs fell into an “investigative reporter” headspace as the pandemic raged around her in New York City 30:26 - The sense of fear that enveloped both patients and the medical community during the first months of the pandemic 40:27 - A moment during the early pandemic when Dr. Griggs seriously considered leaving the city and her post in the hospital46:30 - How ICU nurses brought dignity and humanity when tending to seriously ill COVID-19 patients51:16 - The hopefulness Dr. Griggs carries in seeing the large number of people who have entered medicine since the pandemicDr. Cornelia Griggs can be found on Twitter/X at @CorneliaLG.Dr. Griggs is the author ofThe Sky Was Falling (2024).Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. 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 or send an email to info@thedoctorsart.com.Copyright The Doctor’s Art Podcast 2024

In this engaging discussion, Linda Fried, a respected researcher and Dean at the Columbia University Mailman School of Public Health, shares her insights on addressing the health challenges of an aging population. She reflects on her unique journey from social work to medicine, highlighting how early experiences shaped her view on justice and healthcare. Dr. Fried discusses the consequences of over-medicalizing health issues and the critical role of community in enhancing joy among older adults, advocating for a more holistic and equitable approach to health.