Go Left to Go Right
We meet mid-week at Panera Bread in the hospital lobby an hour before his first case. As the morning light builds outside the windows, the night shift workers trundle past, heading for home. A trio of nursing students whisper and giggle at the table behind us. Here’s a free piece of advice: don’t schedule a coffee meeting with a neurosurgeon (or a West Point army physician) unless you enjoy early meetings. Luckily, I’m a morning person.
Joseph Stern sips his coffee. Circle-rimmed glasses, silvered hair, he talks with a quiet, open intensity. He tells me, without a hint of grandiosity, how he wants to change the world through empathy. There is an element of whimsy to it, even rebellion. Yet as you might expect from an experienced neurosurgeon, physician leader, writer, inventor, and medical volunteer, his goals are rooted in objective data. Data that shows a lack of empathy leads to poor patient outcomes, lack of connection, and physician burnout.
The hour passes quickly and despite our different specialties we find parallels in every topic: writing, burnout, end of life care, and communicating with families. He tells me about a New York Times article he wrote on moral distress in neurosurgery, and the case he describes shares striking similarities to an experience I encountered the week prior.
After our meeting he sends me a review copy of his book, Grief Connects Us, and I take it to the beach for spring vacation. With the ever-changing colors of the Atlantic out the window, I read about his sister, Victoria, and her experience with leukemia. She shines through the pages, her journal entries and his descriptions of her struggles and triumphs. I follow her through chemotherapy, a bone-marrow transplant and ultimately relapse. As I read, I think of my own life, that day so many years ago when I stood alongside the other men in the family and held up my wife’s aunt’s casket after she succumbed to cancer. I remember the weight on my arms; the honor of being her pallbearer still washes me in silence.
Everything changed for Stern after his sister’s diagnosis. Suddenly, he found himself on the other side of medicine, in an unfamiliar city, an unknown hospital, caught in the uncertainty of it all. Instead of rushing from room to room, case to case, calling the shots, he waited for hours at his sister’s bedside for doctors to come and answer questions. He awoke at 5:00 am when phlebotomists came into the room for blood draws, then waited with fear and dread for the lab results. And he experienced empathy and, occasionally, its lack thereof from the staff.
When he returned home to his role as a physician, he recognized his sister’s plight in his patients—he could see their fear, anxiety, and helplessness. As his previous detachment dissolved, doubts came in. Not about his ability to perform the technical aspects of surgery, but of how to balance the depth of fear and suffering he saw in his patients with his own need to function and bring them safely through surgery.
Dr. Stern talks about the perception that doctors are not the same as other people—we are expected to handle tragedy without showing emotion, without harboring grief. Detachment is an unspoken rule engrained during training, an ethos. I’ve coded a baby in the ER and less than five minutes after pronouncing death walked into the next exam room to see another patient. But those feelings must, at some point, be given room to breathe. The failure to do so is all around us—substance abuse, suicide, failed marriages, burnout, and early retirement.
The paradigm shift for Dr. Stern was the notion for us to draw closer rather than retreat behind the armor of detachment. The idea that we can shield ourselves from the grief is a maladaptive fallacy. So too is the idea that we can open our hearts entirely, every moment. Instead we need emotional agility—the ability to embrace our vulnerability, move between powerful emotions, and derive power from facing difficult emotions. “Emotional agility allows the surgeon to operate with dispassionate objectivity one moment and move towards intimate connection the next, as the situation demands” (Grief Connects Us, Pg 208). As Susan David writes in Emotional Agility, agility allows us to accept that “life’s beauty is inseparable from its fragility.”
When my son was little, I watched the movie Cars with him so many times I can still hear some of the lines. I’m reminded of the racing car Lightning McQueen when he finally understands how to steer into a skid: “I get it, go left to go right!” With empathy the same seeming paradox exists – drawing near in the grief connects us in ways that protect both the patient and the physician. In many ways my own journey mirrors Dr. Stern’s. During my early years of training and practice I tried to keep my distance—all in the name of being professional. Then one day after everything went wrong, I offered a mother a hug. There was nothing else to do. She was alone, weeping, and my heart broke for her. Surprisingly, that hug, meant to extend compassion, also allowed me to accept compassion and forgiveness for something I could not control. An important part of this self-compassion is allowing us to forgive ourselves both for things we can control and those we cannot.
Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion (Release date May 11, 2021):