11/23/2011
Dr. Larry Zaroff on Medicine and the Humanity
Larry Zaroff is a Senior Research Scholar with the Center for Biomedical Ethics and also a Consulting Professor in the Department of Anesthesiology and the Program in Human Biology. Recently, he was selected to receive the Human Biology Award for Excellence in Faculty Advising. He has also been chosen as Associated Students of Stanford University […]
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[ Music ]
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This is KZSU Stanford.
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Welcome to entitled opinions.
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My name is Robert Harrison.
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We're coming to you from the Stanford campus.
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[ Music ]
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[ Music ]
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Every now and then someone comes your way and you say to yourself,
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I have to get this person on the show.
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I don't care what we talk about, just roll the tape.
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Roll the tape for those of you who were born on the other side
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of the great divide is an antiquarian way of saying,
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hit the record command on the Macintosh computers outside
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of Studio B at KZSU where we do most of our recording here
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on entitled opinions.
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Well, our theme song is playing.
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Our production manager, Dylan Montinii, has the tape rolling.
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And I'm here in Studio B with someone I've been wanting
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to get on the show for some time now.
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His name is Larry Zeroff and the least one can say about him
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is that he is entitled to his opinions about a great many matters.
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A lot more than most of us, even if he is not the opinionated type
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at all.
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He is far more socratic than dogmatic, a doctor in the deepest
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ethical sense of the term.
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And you'll find out what I mean by that once we get this guitar solo
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out of the way and welcome him to the program.
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[MUSIC PLAYING]
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[MUSIC PLAYING]
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Larry Zeroff was born just about 80 years ago, almost 80 years ago,
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to the day in New York City.
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And on his CV, you can read the following.
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I'm quoting, "Following his residency in two years
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in the US Army's surgical unit, where he flew air vac.
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Larry Zeroff has had five careers.
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He focused for 25, 29 years on cardiac surgery,
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including a stint as director of the cardiac surgical research
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laboratory at Harvard.
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There, his work centered on the development
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of the demand pacemaker.
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He spent the next 10 years concentrating on climbing
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and did a first ascent of Chulu West, a 22,000 foot peak
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in the Nepal Tibet border.
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His third life has been at Stanford, where he received a PhD
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in the year 2000, and where he teaches courses in medical.
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Humanities.
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His fourth career has been as a writer, publishing
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in the New York Times science section,
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Ferrost Pulse atrium, and so forth.
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He now works one day a week as a volunteer family doctor.
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He has received awards as the outstanding faculty advisor
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for the human biology program.
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And in 2006, he was honored as Stanford's teacher of the year.
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And here are the titles of just some of Dr. Zeroff's
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publications in the New York Times.
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I have them here in front of me.
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As surgeons clasped the heart he reached for the soul
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about with addiction for the doctor who has everything.
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Is there a barber in the house?
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A meal, a smile, a word, thanks in a thousand ways.
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Drowning in science, saved by Shakespeare,
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teaching literature to pre-medical students,
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that was in Ferrost Spring 2010.
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And the most intriguing title--
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and I'm going to ask him about later on our show,
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Emily Dickinson's mystifying insight.
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So Dr. Zeroff, Larry, to me, welcome to entitled opinions.
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Thank you.
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So you spent 29 years doing cardiac surgery,
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and then you decided to spend 10 years climbing mountains,
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and then at a time when most people opt for retirement,
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you decided to come to Stanford and get a PhD
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in a completely different discipline, which
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was the humanities.
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It was technically in the history of science,
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but it was more of an English major and anything else
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as I understand it.
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So we'll try to take it one step at a time.
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Could you flesh out this itinerary starting,
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I guess, with your medical school and take it from there?
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As I remember, I never wanted to be a doctor.
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I always wanted to be a surgeon.
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Not sure of all the reasons for that,
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but it always seemed like the most romantic, exciting,
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difficult thing to do in the field of medicine.
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So that was my primary interest,
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and I recall our first days in the anatomy lab.
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I had three anatomical partners,
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none of whom were interested in surgery.
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They would go off and play bridge.
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They actually all became very famous doctors.
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I can't quite mention their names,
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but one became a world-class bridge player,
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and I'm sure it's because he learned nothing about anatomy,
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but I loved anatomy.
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Following my graduation from medical school,
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and I should add, I never finished college.
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I went to college for two years and never got a degree.
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Back then, you could do that by squeezing in courses
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over the summer.
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I took only science courses.
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I don't think I ever read a book.
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Those two years I spent in college or after.
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I was strictly interested in the sciences
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that would get me into medical school
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and make me a better surgeon.
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Following seven years of residency,
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was in what was called a berry plan,
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which allowed you to sign up for a commission in the army,
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and then you would be allowed to finish your medical training.
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So I went into the surgical research unit,
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which was the burn center for the entire armed forces,
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and there's no harder place to work in medicine
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than in a burn center.
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The wounds, these people suffer or horrendous,
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and taking care of them is very painful for them,
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highly difficult for the surgeons.
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As part of that program, my flu air vac,
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it was between the wars, but we picked up burn patients,
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thermal injuries all over the United States,
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and often outside of the country.
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It was an adventurous time, an exciting time.
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We went to places like the Dominican Republic
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and flew out the day that Kennedy got assassinated.
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There were other times when we lost engines at altitude
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and had to make emergency landings.
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So it was a great time and a great time for learning.
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We also had an extensive laboratory.
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Back then, we had all the money we could want
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for our research projects.
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So I'd say the army was a great place for me at that time.
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- Had you decided already then
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that you wanted to go into cardiac surgery?
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- Well, actually, that was after I finished all my training.
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And so I went as the professor of surgery,
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Francis Moore at Harvard said to me,
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when he saw me in an army uniform,
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aha, you went from the heart to the skin.
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It was quite a transition then.
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- Yeah.
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Well, clearly that must have appealed to your heroic temperament
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because I think that people who go into surgery
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have a certain personality type where it's high risk,
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it's incredibly intense, it's romantic
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and you're saving lives, it's altogether heroic,
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whereas being a family practitioner seems to be
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the antithesis in the personality types.
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- Yeah, the medical school.
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- Yes, Robert, there was all of that plus keep in mind
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that I had never made any money.
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I mean, first salary as a resident was 25 hours a month.
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So I went into the army, they were paying me $500 a month
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and there was a great incentive to fly,
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not just because it was exciting and wonderful and different.
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They paid you an extra $100 a month to fly.
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And after a period of time,
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when I recall, we lost an engine taking off
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from England Air Force Base in Louisiana
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and our helicopter lost its tail rotor.
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Once I realized why we were getting $100 a month extra.
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So after two years in service, you?
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- I went back to Harvard and I was director
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of the cardiac surgical research lab
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and that again was a exciting place
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because it was wide open.
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The golden days of research, money was always available
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and the outstanding event for me there was one day
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this little guy, I say little with all due respect
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named Berkowitz, not on the lab door.
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He just appeared out of nowhere.
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He was in Israeli electronics master
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and he was working for the American optical company.
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And in his hand, he had this,
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what looked like a ball of wax,
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it turned out it was the first demand pacemaker ever developed.
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That is, the demand pacemaker is one that turned itself
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on and off, works only when needed.
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Up until then, pacemakers were fixed rate,
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delivering a certain number of beats from it.
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Anyway, he arrived with his big bulky ball of wax
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and he explained what it was supposed to do.
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And I really wondered if this was the story he made up,
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but we decided to let him in the lab
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and eventually we worked it out and solved the problems
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and it became a leading item
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and what developed into the pacemakers today,
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which not only turned themselves on and off,
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but deliver shocks, correct, they were with me as
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and changed their rate according to your exercise pattern.
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That was quite an amazing event in my career.
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What about the practice of surgery itself?
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You've done a lot of that.
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- Yes, following those years in Boston,
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I joined another surgeon in upstate New York
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who was wanting to develop a program in cardiac surgery
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affiliated with the University of Rochester.
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And I took my research, that was another interesting thing.
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You want to maintain your research interest,
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but I brought my NIH grant there,
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but eventually we got so busy doing surgery
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that I had to actually turn back money to the government
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sort of unheard of, particularly these days.
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I was intensely busy with doing cardiac surgery
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and I was simply a surgeon.
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And I look back at those days thinking,
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yeah, I was a good surgeon, but I wasn't a very good doctor.
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I paid little attention to the humanity of my patients.
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I was interested in only in fixing the heart.
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That is, the heart is a pump.
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As far as the figurative heart went,
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the metaphorical heart, the soul, the spirit,
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the religious aspect of hearts,
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the thing that patients always thought about,
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that was foreign to me.
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There was nothing important in there for me.
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So I did the work and I paid little attention
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to the other needs of my patients.
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And to those days of doing cardiac surgery
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for most of 29 years, again, I don't think I ever read a book
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and I didn't start reading until I dropped out of surgery.
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And that was another important event in my life.
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- Okay, Larry, before we go to that point,
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I just, two questions about your practice
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as a heart surgeon because,
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if someone has heart trouble, maybe they don't need,
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the figurative heart, the soul heart,
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they need someone to fix the pump.
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And so two questions.
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One is, what satisfaction did you and have you derive
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from being in the business of saving lives?
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And then after you answered that,
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I wanna ask about this other art of forgiving yourself.
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- There was nothing, I don't think there's anything
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that gives you a bigger high.
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You can take any narcotic you want,
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but I don't think there's anything that gives you a bigger high
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than walking out of the operating room
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after knowing you've done a very good operation.
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And you feel like skipping down the hall,
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of course you don't, you feel like hauling.
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I did it, I did it, I took this patient who was dying
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and I saved his butt, but of course you never do anything
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as silly as that.
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But yet, it was a series of highs,
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but also in that type of surgery,
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there are a series of lows too,
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when you lose a patient, when you make a mistake.
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And I think the hardest thing for any physician,
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certainly in high risk specialty,
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is to forgive yourself.
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- Yeah, in fact, you have an essay there coming clean,
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writing surgical errors and the art of forgiving yourself.
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And I take that to be a personal confession, of sorts.
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- Actually, more to the point, I wrote a piece about a patient
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I was very, very close to.
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I won't, I'll give her the name Merri.
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And the title was my patient, my friend.
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She was one of the early patients that operated on
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for mitral valve disease.
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And in those days the operation we didn't,
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usually for mitral stenosis or a block mitral valve,
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was simply putting your finger in the heart
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and forcing the valve home,
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when so-called closed operation.
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I did that operation on her, and she was well for five years.
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And during those five years, she saw me regularly,
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I saw her family, I got to know her children,
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and every time she arrived in my office,
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she brought one of my favorite foods,
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a jar of dill pickles, just flavoured perfectly the way I liked it.
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So we became good friends.
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After five years she deteriorated,
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and her valve became more calcified,
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and I re-operated on her,
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through a different part of her chest,
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and replaced her valve with a mechanical valve.
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I did that because she was still young.
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That worked well for another five years,
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and during which we became even closer,
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lots of jars of pickles passed over my desk.
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After five, another five years,
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she began to have ambili to her brain.
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And even though she was on blood thinners,
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small flecks of tissue would break off
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and go to her brain from the interface
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between the valve and her heart.
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So after much careful consideration,
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consultations with her, family, and the cardiologist,
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we decided to remove that mechanical valve,
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and replace it with a bio valve, a pig valve.
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Re-operations are the heart difficult
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because of the adhesions.
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Three time operations are even more difficult.
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And during the operation, I made a technical error
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in excising her old valve,
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and I damaged the wall of the heart,
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and though I repaired it, she died in the intensive care unit.
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I made an error that killed my patient,
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and it was devastating, and we all make mistakes.
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We all make errors at harm patients,
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but because I was so close to her,
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that error never failed to escape me.
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I kept thinking of it, it prayed on my mind,
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and this went on for several years,
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and I tried to talk to other people about it.
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Other surgeons don't talk to you about the mistakes.
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Psychologist don't know a damn thing about surgery,
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and they don't really understand the situation.
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So really there was no one to talk to.
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And it represents a general problem
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when physicians make errors.
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There's no protocol.
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Hospitals don't have any means of assuring a physician,
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even though he made a mistake,
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he's still, or she is still a good doctor.
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Eventually, as you pointed out Robert,
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I was able to write about it,
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| 00:19:07.840 |
and then I gave a talk at the University of Iowa
|
| 00:19:10.800 |
about forgiveness, and then I started incorporating
|
| 00:19:14.840 |
the topic of self forgiveness in each of my classes,
|
| 00:19:19.640 |
both medical, school, and undergraduate.
|
| 00:19:21.640 |
And I've sort of gradually gotten over that,
|
| 00:19:25.520 |
but not completely, and I never will get over
|
| 00:19:28.480 |
that error I made.
|
| 00:19:29.920 |
So did that have anything to do, Larry,
|
| 00:19:33.400 |
with your decision to take a turn after 29 years
|
| 00:19:37.720 |
and explore a whole different dimension of,
|
| 00:19:41.440 |
you know, your personhood as it were?
|
| 00:19:44.280 |
- Yes, there were several reasons that I actually,
|
| 00:19:48.760 |
I started early, and I did the work for about 29 years,
|
| 00:19:53.920 |
but there were several reasons I decided to stop
|
| 00:19:57.160 |
at a relatively early age at 53.
|
| 00:20:00.160 |
One I became very enchanted with climbing,
|
| 00:20:03.920 |
and I didn't have the time to devote to climbing,
|
| 00:20:07.800 |
I didn't have the time to train and travel.
|
| 00:20:10.960 |
And a second reason was that my last child
|
| 00:20:15.960 |
was about to go to college.
|
| 00:20:19.280 |
Third reason I thought my marriage would do better
|
| 00:20:22.320 |
if I had some time to give it.
|
| 00:20:25.920 |
And the fourth and most important reason
|
| 00:20:28.520 |
you've alluded to, for me, complications and deaths
|
| 00:20:33.520 |
in patients were not something that I easily got over with.
|
| 00:20:39.440 |
They turned out to be cumulative, and honestly,
|
| 00:20:44.000 |
after all those years, I just couldn't bring myself
|
| 00:20:48.600 |
to go down from the operating room
|
| 00:20:50.960 |
or the intensive care unit and face another family
|
| 00:20:54.080 |
and tell them, your father, your brother,
|
| 00:20:57.000 |
or your wife died, I've been doing it too long.
|
| 00:21:00.480 |
Now, other surgeons don't have that attitude.
|
| 00:21:03.680 |
I've heard cardiac surgeons say after they lose a patient,
|
| 00:21:08.120 |
well, that's hard surgery, things happen.
|
| 00:21:10.880 |
But I couldn't do it.
|
| 00:21:13.440 |
So those were the reasons I decided
|
| 00:21:16.440 |
to drop out of surgery, and I spent the next 10 years
|
| 00:21:20.720 |
climbing, largely climbing, doing a lot about
|
| 00:21:24.080 |
door things living in Colorado.
|
| 00:21:26.480 |
- When did you start reading books?
|
| 00:21:28.960 |
- Well, it was interesting that,
|
| 00:21:31.120 |
for the first time I had some spare hours to read,
|
| 00:21:38.120 |
it was a way of relaxing after a hard day of climbing
|
| 00:21:42.120 |
or skiing or hiking, and I realized how little I knew
|
| 00:21:47.120 |
about the human condition.
|
| 00:21:50.320 |
I realized I didn't know what it meant to be a sick human being.
|
| 00:21:54.120 |
I didn't understand the importance of compassion
|
| 00:21:56.760 |
and empathy in medical practice.
|
| 00:21:59.760 |
In short, as I mentioned earlier,
|
| 00:22:04.040 |
I may have been a good surgeon,
|
| 00:22:05.440 |
but I was not a good doctor.
|
| 00:22:08.800 |
So after 10 years of living in the mountains,
|
| 00:22:13.480 |
I decided to go back to school, actually,
|
| 00:22:16.200 |
I went back to school to the University of Colorado
|
| 00:22:19.520 |
for two years in the English department.
|
| 00:22:22.680 |
I wanted to get a master's degree,
|
| 00:22:26.640 |
and although not many people know this about me,
|
| 00:22:32.600 |
but I actually flunked out of the University of Colorado
|
| 00:22:37.200 |
in the master's program.
|
| 00:22:38.560 |
They gave a final exam and I totally flunked it.
|
| 00:22:42.720 |
Never having taken a humanities course,
|
| 00:22:45.240 |
I suppose, had something to do with it.
|
| 00:22:47.360 |
I was just inept.
|
| 00:22:48.840 |
- This was in English literature?
|
| 00:22:50.080 |
- In English literature, I totally flunked out.
|
| 00:22:52.600 |
So I'm sure some of the professors I knew a Colorado
|
| 00:22:57.160 |
must have been astonished when they heard,
|
| 00:22:59.080 |
I got a PhD at Stanford.
|
| 00:23:01.680 |
I think of that as a great turnaround.
|
| 00:23:04.800 |
- So did you come to Stanford right after that?
|
| 00:23:07.920 |
- Yeah, flawed attempt at a master's?
|
| 00:23:10.600 |
- Yeah, so I came to Stanford and fortunately,
|
| 00:23:14.000 |
I was able to enroll in the Master of Liberal Arts
|
| 00:23:16.560 |
program and I was very, very lucky in that.
|
| 00:23:21.280 |
One of my poetry professors in that program
|
| 00:23:24.560 |
was Sherry Ross and she saw something
|
| 00:23:28.640 |
in my writing about poetry that intrigued her.
|
| 00:23:32.720 |
And I told her I wanted to stay on and get a PhD
|
| 00:23:36.160 |
and she introduced me to Tim Lenoir
|
| 00:23:39.320 |
who was then head of the History of Science program.
|
| 00:23:43.120 |
I didn't want anything to do with the History of Science.
|
| 00:23:46.400 |
I wanted to study English literature.
|
| 00:23:48.760 |
So I applied to the English department at Stanford
|
| 00:23:54.720 |
and although I was never officially told this,
|
| 00:23:59.720 |
I think the idea of having retired cardiac surgeon
|
| 00:24:05.880 |
in his 60s in their PhD program was a little too much
|
| 00:24:10.440 |
for the English department.
|
| 00:24:12.520 |
So even though I could have gone elsewhere,
|
| 00:24:15.240 |
I decided to stay at Stanford and Tim Lenoir's History
|
| 00:24:18.040 |
of Science program.
|
| 00:24:19.440 |
He was extraordinarily kind and generous to me
|
| 00:24:22.880 |
and he said, "Look, get your PhD with me
|
| 00:24:25.540 |
"and study whatever you want."
|
| 00:24:27.600 |
- Good for him.
|
| 00:24:28.440 |
- So again, I was lucky in, I knew Bliss Khan
|
| 00:24:32.720 |
and it was the former head of the English department
|
| 00:24:36.200 |
and I'd work with him in my Master's program
|
| 00:24:39.040 |
and he was kind enough to take me on as a PhD student.
|
| 00:24:43.600 |
So I actually ended up taking more English courses
|
| 00:24:47.120 |
than I did History courses, but I learned enough
|
| 00:24:49.800 |
about both disciplines that I felt,
|
| 00:24:53.560 |
I at least had my foot in the door of the humanities.
|
| 00:24:56.920 |
I could speak to what other people felt and understood.
|
| 00:25:01.320 |
I knew a bit about the history of mankind
|
| 00:25:06.560 |
and I could see how this would apply
|
| 00:25:09.240 |
to understanding patients.
|
| 00:25:11.800 |
And that's how I got into teaching the first course
|
| 00:25:15.880 |
I did with medically, medically, humanities.
|
| 00:25:18.240 |
You also had on your committee, Marjorie Pearloff,
|
| 00:25:21.240 |
who's been a frequent guest on this show.
|
| 00:25:23.240 |
- And she was at Tiger.
|
| 00:25:25.440 |
- Yeah.
|
| 00:25:26.400 |
- She was, I love Marjorie Pearloff,
|
| 00:25:30.360 |
she was brilliant and tough and she was actually,
|
| 00:25:34.960 |
I remember this, but someone in the English department
|
| 00:25:39.320 |
who knew about me complaining
|
| 00:25:41.240 |
because I didn't get in the program because of my age,
|
| 00:25:44.000 |
heard I was taking her course and told her,
|
| 00:25:47.120 |
well, you don't want him in your class.
|
| 00:25:49.640 |
And she took me anyway, which was a blessing.
|
| 00:25:54.160 |
It was a wonderful, wonderful class.
|
| 00:25:56.320 |
- Yeah, and her husband, Joe Pearloff,
|
| 00:25:59.400 |
is very well known cardiologist,
|
| 00:26:02.760 |
has that textbook on pediatric cardiology.
|
| 00:26:06.720 |
- Yeah, I'll tell you.
|
| 00:26:07.560 |
- Yes, and I use this textbook and he wrote a brilliant book.
|
| 00:26:11.280 |
- So you get your degree in 2000 successfully this time?
|
| 00:26:15.920 |
- Yes, amazingly, so I passed my oral exams.
|
| 00:26:20.920 |
- Yeah, and then you,
|
| 00:26:23.800 |
so how did you end up teaching the course?
|
| 00:26:27.520 |
We wanna talk about what you were doing at Stanford now
|
| 00:26:30.160 |
because it's very interesting.
|
| 00:26:31.600 |
This idea of medical humanities.
|
| 00:26:34.880 |
Now, what does that mean?
|
| 00:26:37.320 |
- Well, first, let me give some credit to Stanford
|
| 00:26:42.200 |
and to one other important person, if I may.
|
| 00:26:46.920 |
When I got my degree, I wanted to teach in the worst way.
|
| 00:26:51.440 |
So I applied to every junior college in the entire area.
|
| 00:26:56.440 |
They must have had a big laugh when they saw
|
| 00:27:02.320 |
some of my CV and resume.
|
| 00:27:04.520 |
Here's a guy in his 60s.
|
| 00:27:08.160 |
I think I was 68,
|
| 00:27:11.040 |
when I got my PhD, he's an MD,
|
| 00:27:15.680 |
and it's got a PhD even Stanford.
|
| 00:27:17.400 |
Why do we want him?
|
| 00:27:19.000 |
So I never even got an interview or any consideration
|
| 00:27:22.720 |
from a junior college,
|
| 00:27:23.640 |
and I was casually talking to Don Barr,
|
| 00:27:27.800 |
who was in the human biology program,
|
| 00:27:30.400 |
who was a family doctor at one time
|
| 00:27:34.920 |
and got a PhD in sociology.
|
| 00:27:36.720 |
And he said, "Well, why don't you teach a course here?"
|
| 00:27:38.920 |
That got me started in medical humanities,
|
| 00:27:43.920 |
and I went from one course to teaching three undergraduate courses
|
| 00:27:47.880 |
and one at the medical school.
|
| 00:27:49.520 |
- It's medical humanities a program
|
| 00:27:51.360 |
in the medical school at Stanford.
|
| 00:27:53.600 |
- Medical humanities shares a program with bioethics,
|
| 00:27:58.080 |
program is called bioethics in medical humanities.
|
| 00:28:01.840 |
And here's how it works when medical students
|
| 00:28:05.080 |
enter Stanford Medical School, they pick a concentration.
|
| 00:28:09.480 |
They're, I think, eight or nine.
|
| 00:28:11.600 |
They can pick a concentration in clinical research,
|
| 00:28:15.760 |
or immunology, or any one of them, number of things.
|
| 00:28:19.040 |
Or they can focus on bioethics and medical humanities.
|
| 00:28:24.040 |
And surprisingly, out of a class of some 80,
|
| 00:28:29.720 |
actually less than that,
|
| 00:28:30.880 |
because there are a bunch of MD PhD students,
|
| 00:28:33.680 |
but of those who are going through these,
|
| 00:28:35.760 |
we always seem to get seven to 10 students
|
| 00:28:38.760 |
who are interested in ethics in the humanities.
|
| 00:28:42.080 |
- Well, you and I met each other for the first time
|
| 00:28:45.400 |
when you had gotten in touch with me,
|
| 00:28:47.640 |
you had read one of my books,
|
| 00:28:49.120 |
and you asked if I would come and visit your class
|
| 00:28:52.320 |
and talk about gardens or to your,
|
| 00:28:56.080 |
this was the medical students.
|
| 00:28:58.440 |
- Yes.
|
| 00:28:59.280 |
- It wasn't a class of undergraduates.
|
| 00:29:01.120 |
That was a seminar that you're still teaching,
|
| 00:29:03.280 |
what is that called?
|
| 00:29:04.960 |
- It's called the Human Condition.
|
| 00:29:06.800 |
- The Human Condition.
|
| 00:29:07.800 |
- And in that class, we examine not just literature
|
| 00:29:12.800 |
as it relates to medical practice,
|
| 00:29:16.480 |
and I tend to do that part,
|
| 00:29:18.400 |
but we also look at music, religion, dance,
|
| 00:29:23.320 |
the whole gamut of what makes up the arts and humanities.
|
| 00:29:28.320 |
- And how do you make the link between the various arts
|
| 00:29:31.120 |
and medicine?
|
| 00:29:32.640 |
- Well, in literature, it's fairly easy.
|
| 00:29:35.640 |
We teach, we use writings that have either a medical theme
|
| 00:29:40.640 |
or they enable a metaphor of a medical theme.
|
| 00:29:46.480 |
For example, the one you and I have talked about,
|
| 00:29:48.760 |
Kafka's metamorphosis.
|
| 00:29:50.320 |
- Yeah, let me tell our listeners first
|
| 00:29:52.040 |
that when I went to your class,
|
| 00:29:54.360 |
I don't know if it was 'cause I visited twice,
|
| 00:29:56.440 |
and I think it was the second time around,
|
| 00:29:59.320 |
the, I presented the first hour and I stayed for the second hour
|
| 00:30:04.320 |
while you were discussing Kafka's metamorphoses
|
| 00:30:08.960 |
with the students.
|
| 00:30:10.200 |
And I sat there and I was really mesmerized by the way
|
| 00:30:13.360 |
that book, which I know quite well,
|
| 00:30:16.400 |
took on a completely different sort of aspect
|
| 00:30:19.920 |
when you started dealing with it.
|
| 00:30:22.560 |
And dealing with it also, again, not by lecturing,
|
| 00:30:25.400 |
but you have this very socratic method with the students,
|
| 00:30:28.280 |
and it's all Q&A and it's a very effective pedagogy.
|
| 00:30:31.920 |
So could you, for the benefit of our listeners,
|
| 00:30:34.960 |
reconstruct what you did with the metamorphoses
|
| 00:30:40.880 |
in that class?
|
| 00:30:42.200 |
I mean, the metamorphoses.
|
| 00:30:44.720 |
- Well, first of all, I connected the metamorphoses
|
| 00:30:49.520 |
with the onset of a plague,
|
| 00:30:54.520 |
and in many respects, it resembles a plague.
|
| 00:30:58.120 |
And specifically, I want of the students to understand
|
| 00:31:01.720 |
how it was like the HIV/AIDS plague
|
| 00:31:05.760 |
and how our reaction to HIV/AIDS
|
| 00:31:09.440 |
perfectly matched the reaction of Gregor,
|
| 00:31:13.000 |
who turned into a large cockroach,
|
| 00:31:15.200 |
the reaction of his family and to everyone who saw him.
|
| 00:31:19.000 |
It was a disease that caused great fear.
|
| 00:31:22.120 |
It was a disease that was not understood.
|
| 00:31:26.640 |
It was a disease that people, when they saw someone,
|
| 00:31:31.640 |
with this disease ran away.
|
| 00:31:36.400 |
Of course, there were times during the early days
|
| 00:31:38.720 |
of HIV when doctors refused to see patients.
|
| 00:31:42.640 |
They were left alone in a room as much as Gregor was
|
| 00:31:47.480 |
in his cockroach form.
|
| 00:31:49.720 |
No one wanted to go in the room.
|
| 00:31:51.960 |
And in broader ways, it resembles any severe illness.
|
| 00:31:57.600 |
One becomes isolated.
|
| 00:31:59.600 |
One loses hope.
|
| 00:32:01.600 |
One loses control over their life.
|
| 00:32:04.600 |
They feel helpless and hopeless.
|
| 00:32:07.600 |
And eventually, they give up everything that was important
|
| 00:32:12.600 |
to him in that story you can recall.
|
| 00:32:15.600 |
His family comes in and starts removing all his things
|
| 00:32:19.600 |
from the room.
|
| 00:32:20.600 |
They're so frightened, they won't call a doctor.
|
| 00:32:24.600 |
And they're so ashamed.
|
| 00:32:26.600 |
And shame played an important part of the early days of AIDS.
|
| 00:32:30.600 |
They're so ashamed.
|
| 00:32:32.600 |
They won't even call termin' X, or the zoo, or exibutum.
|
| 00:32:37.600 |
They forget he's human.
|
| 00:32:39.600 |
They forget he's a brother and a son.
|
| 00:32:42.600 |
In short, he is a pariah.
|
| 00:32:47.600 |
But this is a psychology of the caretaker.
|
| 00:32:52.600 |
And so there are nuances there between the family members.
|
| 00:32:56.600 |
The sister is the one who tries to hold out the longest.
|
| 00:32:59.600 |
But eventually, it starts wearing her down.
|
| 00:33:02.600 |
Yes.
|
| 00:33:03.600 |
And that's a good point.
|
| 00:33:05.600 |
And you end up understanding why the caretaker sometimes,
|
| 00:33:11.600 |
for their to preserve their own sanity, have to take a distance
|
| 00:33:14.600 |
from the suffering patient or a relative.
|
| 00:33:21.600 |
And it becomes a story read from that point of view, so tragic.
|
| 00:33:26.600 |
And yet quotidian, it happens all the time that someone can become
|
| 00:33:31.600 |
disabled or completely dependent and diseased in a household.
|
| 00:33:38.600 |
And all of a sudden, that allegory made perfect in that way.
|
| 00:33:43.600 |
I don't want to say perfect sense that Kafka never is transparent in that way.
|
| 00:33:48.600 |
But it is just perfectly human.
|
| 00:33:50.600 |
And I could understand.
|
| 00:33:51.600 |
I had no idea before I came to that class.
|
| 00:33:53.600 |
Why?
|
| 00:33:54.600 |
What you were going to do with the men and horses.
|
| 00:33:55.600 |
But then it turned out, I'm glad you raised that point.
|
| 00:33:58.600 |
Because I suppose I have said to each class, at least three or four times,
|
| 00:34:06.600 |
every quarter, disease and illness is sticky.
|
| 00:34:12.600 |
It affects the family as much as the individual.
|
| 00:34:16.600 |
And that's certainly true in the metamorphosis, where family life is turned upside down.
|
| 00:34:22.600 |
Empathy is ephemeral.
|
| 00:34:24.600 |
It can only last so long.
|
| 00:34:27.600 |
As part of the practice of medicine, we must take care of not only the patient,
|
| 00:34:34.600 |
but the caretakers.
|
| 00:34:36.600 |
As you point out, the caretakers wear out.
|
| 00:34:39.600 |
They need a break. They need to get away.
|
| 00:34:43.600 |
And that's true in almost every chronic disease.
|
| 00:34:48.600 |
So, Larry, I'm curious about some of the other works of literature that you've invoked in the seminars
|
| 00:34:54.600 |
or in your writings.
|
| 00:34:55.600 |
And I don't want to let our time run out before asking you about the Emily Dickinson piece that you wrote.
|
| 00:35:02.600 |
What was that all about?
|
| 00:35:03.600 |
What was her mystifying insight as you call it?
|
| 00:35:06.600 |
Well, I fell in love with Emily Dickinson, and that was due to a Stanford professor who gave a course in Emily Dickinson.
|
| 00:35:16.600 |
And if you look carefully enough in Emily Dickinson, as in most other writings, and incidentally,
|
| 00:35:25.600 |
I offer every class of students, one of my old T-shirts, if they can come up with a piece of literature,
|
| 00:35:34.600 |
not junk, but real literature in which pain and suffering does not make an appearance,
|
| 00:35:39.600 |
I haven't given away any T-shirts.
|
| 00:35:43.600 |
So, Emily Dickinson reeks of medical problems, psychological problems,
|
| 00:35:51.600 |
but I was most intrigued.
|
| 00:35:54.600 |
Of course, anyone who reads and knows how many things.
|
| 00:35:56.600 |
It would be intrigued by her eye trouble.
|
| 00:35:59.600 |
She had a lot of problems with her eyes and wrote extensively about her eyes.
|
| 00:36:05.600 |
And what was interesting to me, I began to see that she had some sort of understanding of what happens to the pathology of the eye.
|
| 00:36:17.600 |
When it becomes disease, and particularly when the eye is dying along with the body.
|
| 00:36:25.600 |
And step-by-steps in her poem, she takes us through the changes in the eye that occurs when she dies, the clouding of the cornea.
|
| 00:36:37.600 |
The loss first of color vision, which is due to the lack of oxygen, the cones in the eyes responsible of color vision need more oxygen.
|
| 00:36:48.600 |
So, when your circulation fails, your color vision goes first.
|
| 00:36:53.600 |
It's like pilots subjected to high G forces.
|
| 00:36:57.600 |
They black out, but they lose color vision first.
|
| 00:37:00.600 |
They become gray, then they totally black out.
|
| 00:37:03.600 |
And somehow, looking at her poem, she has put this all together.
|
| 00:37:08.600 |
Of course, it's mystical.
|
| 00:37:10.600 |
I can't prove a thing about it, but it just fit beautifully to the pathology of the death of the eye.
|
| 00:37:17.600 |
So, you would actually read individual poems as if she knew the physiology of this disease.
|
| 00:37:24.600 |
Exactly, exactly.
|
| 00:37:26.600 |
And it works.
|
| 00:37:27.600 |
Yeah, it works.
|
| 00:37:30.600 |
What are some of the other authors that have been fruitful for you in this regard?
|
| 00:37:37.600 |
Shakespeare, I gather.
|
| 00:37:39.600 |
Yes.
|
| 00:37:40.600 |
I teach King Lear, at least two of my courses.
|
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And I don't think there's any single work of literature that I know that tells us more about the human condition.
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Tell us more about what's important in the human condition.
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Tell us about relationships.
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And what's more important than relationships.
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And what's more important than relationships within a family.
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Because after all, they're the ones that are often the most tortured.
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In King Lear, we have the whole gamut of emotions between father and daughters, between sons, between father and sons.
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We have jealousy and hate and raw sexuality, death and dying, and regret.
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And recompense.
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Everything is in that play.
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But where does the medicine come in, if at all?
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Well, first of all, the medicine would come in any psychiatrist would look at this and understand the interplay between the various partners in a family or the various rivals.
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That certainly comes into play.
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And there are numerous direct references to medicine.
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Lear asked for a surgeon a couple of times.
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Lear declares, "Let anything happen to me, but I don't want to lose my mind."
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And there's one segment in which he says, "Oh, they told me I was perfect, but I'm not ag you.
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I'm mortal."
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It's wonderful.
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It is.
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And some other authors that you invoke.
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Well, I think I'd like to use authors who have a direct medical, in addition to Lear and Dickinson, who have a direct medical topic.
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For example, I think a very important book that we use is Camus the Play.
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Because, as I alluded to a moment ago, we've always had plays.
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We always will have plays.
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And everything in that book represents what happens during a play.
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There are always scapegoats.
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People become reckless and lawless.
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And the reaction of the doctor to the play to illness in which he becomes endangered.
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It's also important topic for students.
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Do you find him a hero or a model to be emulated?
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The doctor of yours, his name?
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Yes and no.
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Yes, because he stays on.
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No, because he disregards every other part of his life, including his wife.
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No, because he endangers himself far too much.
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I would never ask a student to go into a ward of Ebola patients who are coughing and have high
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fevers without the proper hazmat equipment.
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And then that's another topic we talked about.
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Do you also talk about the philosophical vision of a work like that?
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I don't know.
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The word that's often invoked is the absurdity of the human condition.
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In other words, there is no metaphysical ground.
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The only ethic possible is to rebal against the absurdity,
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and the notion of the human solidarity and the face of it.
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Absolutely.
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I tread a little carefully on here because I have found, if I talk too much about existentialism and the priest in that book in a negative way,
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a number of students who are deeply religious or take offense at that.
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So I have to present both sides. I don't present the priest as necessarily a bad person,
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but rather who tries to do the same thing as a doctor, but in a different way.
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What could I ask here now about the relationship between medicine and religion?
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How many students who make an existential decision to devote themselves to the care of others
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was what you do when you go to medical school, when you become a doctor, it's a life.
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It's full of perks, full of financial incentives and so forth, but it's ultimately a devotion to your fellow human being.
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And is there a high quotient of students who go into medical school who have religious motivations for doing so?
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There are all degrees.
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Of course, we have a number of atheists as in any class.
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We have a number, excuse me, students who are rather deeply religious and then comes out in our conversations.
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It came out just yesterday when we were talking about abortion.
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The story was of a young woman, doctor, who's working at a Catholic hospital and should she give information to another patient who needs an abortion.
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So the student feelings come out of it.
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There are significant numbers of them who are deeply religious, spiritual, and they will not change their mind.
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They'll continue to practice medicine and in that sort of religious background.
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Did religion play any role in your life at all?
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Oh, zero.
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Zero.
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No, absolutely not.
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So you can be a perfectly good doctor and be absolutely a religious, atheistic, whatever.
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It's not in any way the recommendation.
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I think you can be a perfectly good doctor whether you're an atheist or a Buddhist or a Hindu.
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I think if you remember the basic tenets of being a good doctor, it's not so much to cure people.
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But it's to relieve pain and suffering and to return a patient to the social activities that are important to that person.
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What about the first principle of the Hippocratic oath, the Larry, which is do no harm?
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Do you find, in general now, speaking about the medical profession and the pharmaceutical and all the kind of research,
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and the exciting new horizons of research, do you find that in the kind of zeal to ameliorate life or to do something good for people and children that always invoking the interest of the child or we can save this child?
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But that the first principle of do no harm is often overlooked if not neglected?
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I think that's very common, particularly in our technological world, in which words which can be a matter of life and death take a secondary position to getting a CT scan or an MRI when a patient might be better suited to not go to the hospital to be treated paliatively.
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I think this is especially true, and most of us who think about this subject agree that we overdo things when we are faced with a dying patient, an irretrievable situation, we still tend to have the idea of cure as our ultimate goal.
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That's sort of embedded in us in our medical school training.
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I don't think that's right. I think our main focus is to relieve pain and suffering, and oftentimes that means don't get all the test.
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I see examples of that every day in my work as a family doctor.
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Sometimes patients are more sensible than doctors, and sometimes doctors do things to protect themselves as much as to protect the patient.
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I recently saw a woman in her 90s. She had a big swollen left leg, and I was absolutely certain that she had a blood clot in her leg, and if that clot would break off and go to her lungs, she could very well die.
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But here she was 90, but still very alert.
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I said, "Well, you know, you need to go to the hospital and get on anticoagulants."
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She looked at me and she said, "I'm not going to the hospital doctor. Treat me as an outpatient. I don't want to go near that hospital.
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I hate that hospital. The foods lousy. I don't get the care I get at home from my daughter."
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I said, "Okay. I think you're right."
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Terrific. I'm curious about this article that you wrote in The New York Times in 2006 called "As Surgeons Clasped the Heart He Reached for the Soul."
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Very intriguing title. What was that about?
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I think that would fit three different articles I wrote. I'm sure which one it refers to.
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One was when I was a resident and I had a nun as a patient.
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That was kind of a cute story in that in the early days of cardiac surgery,
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patients who developed an irregular rhythm after surgery called "Acereal Fibrillation"
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were what we call "cardi averted."
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We'd give them an electric shock and the electric shock would put the heart back in a normal rhythm.
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Well, I suppose the point of this story is that patients over here,
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and this patient was a nun, and she was a lovely woman,
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a whisper woman. She was like a white cloud passing by. She couldn't away more native pounds.
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We did her valve operations. She did well, but she went into this abnormal rhythm,
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and we were standing outside her room. Of course, she was listening. It could have been a sermon.
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And she heard us say, "We're going to cardiovert this patient. She needs to go back to normal."
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What she heard, we were going to convert this patient.
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So, when I sedated her, she had a bad reaction to the dimmer all,
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and as I was wheeling her down the hall, she knew I was Jewish.
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We had that conversation, an atheistic Jew, is what she called me.
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She rose from her stretchers somehow and began hollering at the top of her voice,
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astounding all the nurses and all the other patients. I do not want to become Jewish, Dr.
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So, we finally, we had to get the priest up to calm her down,
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and finally, we, the dimmer wore off, and she understood that we wanted her to remain a Catholic.
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Well, I'm going to keep that word in my lexicon now cardioversion,
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because I teach Dante frequently, and you know, that's a poem about conversion,
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of turning something around, and the heart is really at the very beginning of the poem,
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where there's hard-heartedness, and then the very end of the poem at the last canto of the padaizo,
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is heart has been restored. It's almost like he's undergone a conversion of the heart through, you know,
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from sin to attention. So, interesting.
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I think that's a word I could use fruitfully in teaching Dante.
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To wrap up here, Larry, you said that you began being a good surgeon and not a good doctor.
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Do you feel now that your education and the humanities has turned you into a good doctor?
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It's absolutely, two of the most important things I've learned from being at Stanford is to listen.
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I learned to listen. I don't interrupt patients anymore when they're telling me this story.
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And what's wonderful, and I try to get this across to my students, if you listen, every patient has a story,
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every patient has a wonderful story, every patient has a story that's valuable, and if you're a writer,
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what could be better?
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Well, I wonder, remind our listeners we've been speaking with Dr. Larry Zairoff here on entitled opinions,
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and I'm Robert Harrison, I will be with you again next week, but I want to thank our guest, Larry Zairoff for coming on,
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and sharing his imminently entitled opinions about all those matters, I promise, at the beginning.
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Thanks again, Larry, for coming on.
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Thank you, Robert.
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You take care.
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Right.
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