Adam Stern, COMMITTED: Dispatches from a Psychiatrist in Training

[1:34]Zibby Owens: Hi. I'm Zibby Owens, and you're listening to the award winning podcast, Moms Don't Have Time to Read Books. If you like this podcast, you will love my new anthology called Moms Don't Have Time to Have Kids. Check it out, and you'll hear from 49 authors about all sorts of things moms don't have time to do. All the authors have been on this podcast. Also, check out my TikTok at with Zivvy and Tracy, my other podcast, sex talk with Zivvy and Tracy. Check out moms don't have time to write on Medium, and, of course, my new publishing company called Zibby Books. And now back to our daily author interview site and a quick hello from some of my kids. Hi. Hi. Hello. Enjoy the show. Adam Stern, MD, is a psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor of psychiatry at Harvard Medical School. He has written extensively about his experience as a physician, including in The New York Times, The Boston Globe, The New England Journal of Medicine, The Journal of the American Medical Association, and The American Journal of Psychiatry. He lives with his family near Boston. Welcome, Adam. Thank you so much for coming on moms don't have time to read books to discuss committed dispatches

[2:40]Adam Stern: from a psychiatrist in training. It's so great to connect with you. Thank you for having me. No. This is such a pleasure. I sort of eagerly dove into this book. I'm so interested in psychology, psychiatry, and I actually worked on an inpatient unit once myself in the psychiatric unit in Westchester. Anyway, so I came into it with, like, super excitement and interest and was just, like, devouring it. So thank you for this fantastic read and sort of insight into not only you, but what it's like to be in in a residency program and on all of that. So, anyway, I really enjoyed it. Why don't you tell listeners a little bit about why you decided to write this book and and the time period it covered and all of that? Sure thing. Yeah. So I've always wanted to be a writer. I've always written I I I suppose it's a little bit hard to know what defines a writer versus someone who writes and nobody reads their stuff or or very few read read their stuff. So I've I've been writing my whole life, and it wasn't until actually sort of this a few years ago, some circumstances changed. Was I actually diagnosed with cancer like many millions of Americans out there. And so for the first time in my life, I actually was writing from the perspective of not just a physician as I am, but also a patient and the intersection of those things. And I found that self disclosure in this radical kind of way was really powerful. For whatever reason, it was finding, my pieces were finding homes in really well read outlets, and one of those pieces got the attention of a a literary agent who offered me the opportunity to make a proposal. And when we sat down to really think about what kind of book could I write that's never been written or that, you know, really would captivate readers, the thing that really jumped out at me was this ability or this opportunity to be able to talk about how does someone go from a really eager, wide eyed medical student, medical school graduate, to what we all think of as this sort of strange cerebral psychiatrist kind of thing, there's got to be a journey there. And when I thought back to my own journey in residency, it wasn't something very mysterious or deep or anything, it was really filled with self doubt, things that everybody can sort of connect to, self doubt, learning, connecting with your peers, relying on each other, and I just so happened to meet my wife in training, and we had friends that life you know, that have become now future lifelong friends, and, you know, so I thought I can tell this story in a way that I don't think has ever been told and hopefully I can make it interesting for the reader by especially even people who aren't necessarily interested in medical memoirs, they might be interested in the stories behind the people in the book and the sort of interpersonal drama that I hope comes through. Well, I don't I don't feel like it was overly medical in any way at all. I think it was very approachable. And a lot of it was about you, I mean, which was great, you know, because you really got us into your life and your head. And, you know, even till, like, the very end, you were still doubting if you had been matched by mistake to the Harvard program. I was like, no, it's okay. Which, you know, I'm sure a lot of people have impostor syndrome, even what you just said about being a writer. I mean, you can be a writer without being published. It doesn't take the publication to make you that way necessarily. I think the more that I achieve, the less I the more I realize that that the achievements have nothing to do with the value of who you are as a person. You know? And so it's a sad thing that it's taken as many years as it has for me as an individual to come to that realization, but it's something that I feel more and more strongly every year. You mentioned as part of your, you know, self doubt, if you will, that you didn't have the skills for memorization that so many of your peers did and how you felt like that sort of shifted you even into a certain course of psychiatry where you didn't have to use that rote memorization as well. And I've always wondered, like, how do doctors keep the entire, like everything in their heads, all of the every single thing that could go wrong with a person? I mean, I I don't know. How did how did the people do it who how did the other people do it? Like, what did they say? They just naturally were able to memorize? I I feel like it's really Certain certain people in my medical school class just have this gift to be able to take in huge amounts of information and then be able to re present it on the exam, etcetera, etcetera. What I would say though that I think is important is that for any young listeners out there or people interested in medicine, or any kind of field where you're gonna be studying a lot and trying to memorize and learn material, no matter, if you picture yourself ten years from now, you're very likely not going to be needing the details of everything that you've memorized for the exam. Really, the education is all about learning how to learn and then how to apply those lessons, right? And so if you think of any of my peers that went into anesthesiology or radiology or any form of internal medicine, they remember the language of psychiatry, they remember the language of another field and how it fits in the context of medicine, but they don't necessarily remember all the details that they memorized for those exams. Another part I found really interesting was how your own depression sort of ebbed and flowed with the with the tides of the training and how you weren't alone in that, of course, with all of the the essentially that were presented all of the time and particularly during the loss of one of your patients, which really obviously hit home as I'm you know, which, you know, which I understood. I'm sorry. Can't get a sentence out today. But how did you cope with that, and how has it sort of followed you now? Right? Like, how do you manage I guess my question really is, how do you manage your own emotions, which, of course, ebb and flow sometimes at higher and lower peaks and valleys when you are your job is to take care of other people's mental health? That's a great question. I think that one of the challenges that one of the skills that you have to sort of cultivate over the course of any kind of medical training is the ability to compartmentalize because, and you have to do that on both sides of the fence. So you have to be able to focus on your kids and your family and the things that you care about in your life when you're at home and not be spending as much of that mental energy worrying about what's happening back at the hospital. At the same time, when you're at the hospital, you need to have faith that your kids are doing okay and everything's going okay in the rest of your life and focus just on the patient. Doing those things, it doesn't come naturally because our minds are sort of naturally sort of inclined to be a mishmash of all kinds of thoughts and worries and concerns and it all adds up to a certain degree of anxiety. So it came with practice and then as I wrote about in the book, being able to see someone objective that can sort of tell you, medicine, there's a phrase called negative outcomes, and every field has negative outcomes. Surgery, medicine, psychiatry has negative outcomes. If you're a family medicine doctor and you treat someone from the time they're born all the way till they may pass away, eventually all of your patients will pass away and that will be a negative outcome. That kind of idea is sort of foreign to someone in psychiatry because in psychiatry, we have negative outcomes. People die by suicide in psychiatry. People end up in the hospital with very serious illness. And at the same time, it's never something that we want or expect. And so you have to be able to live in that world and not have it devour your own, the rest of your world. And that ability to compartmentalize came with experience and also a little bit of training. I thought one of the lines that stayed with me was when you first encountered this dramatic scene with schizophrenic patient, and they had to, you know, tie the patient down and you were really sort of traumatized right at the beginning. And the nurse said, Don't worry, doctor, you'll get used to it. And you were like, I don't want to get used to it. Like, this should always be horrible. And I think that's so important. It's such a valuable lens. Right? These are people and people's feelings, and I don't know. I thought that You're 100% right. And even beyond feelings, it's people's lives, and we can become numb, you know, in any field. We can become numb to the humanity behind whatever it is that we're trying to do. And so in psychiatry, there's a lot of misery and pain and suffering, and you do also have to sometimes work to, while on the one hand you're compartmentalizing to protect yourself and your family and the rest of your world, you have to work to remain vulnerable with your patients because if you're not empathic with them, you're not gonna be doing as good of a job with them in trying to to care for them, and it's a challenge. I feel like you charted the evolution of your ability to do that so well by the time you got to the anorexic patient at the end of the book and you had a chance to kind of redo and start from scratch with a new patient and the moment when you were smiling. And she's like, Why are you smiling? And you're like, Am I? I'm just ready to get to work. That was so great. I was just so I don't know. It was very inspiring the way you made it through all of this and all the work and everything. I just have to ask, like, what's up with your brother these days? Because I feel like I got very interested in him in the book. Alright. Well, first of all, I'm gonna tell him that, you know, the the biggest bookfluencer in the world is asking about him. He'll be so excited about that. Please, hardly, but thank you. He will, no, will be super excited. My brother's doing great. He's a cardiologist. He actually ended up working in the very same office, in the same system down on Long Island that my father works in. So they have this wonderful thing going where they get to work together and even cover each other's patients, and they have that, and it's something that I love for them. And my brother and I, my brother's my best friend and always has been, And so I'm just so happy for him and and his family, and they're they're just doing great. Awesome. So neat that you ended up in med school at the same time. That's so That was that was a really funny, strange sort of going through it in parallel, it was this it opened up this degree of sibling rivalry that I never in a million years would have imagined. Yeah. I hope my kids don't end up in med school starting at this age. I mean, I don't think any of my kids will end up in med school, so it won't be an issue. But Well, if you if you if you want them to go, then tell them not to go. And if you if you don't want them to go, then maybe tell them it's a great idea. And and and, you know, that's how it worked out in our household anyway. Interesting. Yes. Okay. I'm open to any parenting tips you wanna share on any on any front. You know, suicide also played a role in the book and not just in your patients, but one of your cohort members also you referenced at the end, which I'm so sorry for your loss. That's terrible. I've lost a really close friend to suicide as well, and many people have at this point. I think by the time you get to I mean, I'm 45. I don't know how old you are, but, like, at some point, it it it touches so many people. How do you when you're going, you know, through both your clinical life and personal life, how do you kind of make sense of that and sort of carry on the knowledge that, especially with patients, that's like a negative outcome to be avoided? And how do you deal with it in your personal life too? Like, how do you reconcile those those two?

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[16:55]Adam Stern: Yeah. So I think my instinct and most people's instinct, especially in the field, is almost always to try to dissect it and figure out where did it go wrong or how could I what did I miss? How could I have steered things in a different direction? And and those instincts are usually not adaptive. They're not helpful because, a, they're just second guessing things that have changed. You you know, ideally, you probably made the right choices when they happened. B, these are very often people who die by suicide are the last people that you would necessarily have guessed would. And so psychiatrists are charged with this terrible, enormous responsibility of trying to predict suicide. So if someone comes through the emergency department, we do a risk assessment and try to figure out, you know, I'll just give you a very concrete example. In the modern age, a kid at college says that they post online somewhere something vaguely suicidal, just something very, very vague but clearly hinting at suicide. And that person comes into the ER and they end up seeing a psychiatrist. That psychiatrist has to somehow figure out, is this person a risk or not? And the answer is obviously there's a degree of risk and there's a degree of unknown, right? And so we're not very good at predicting these things. We have certain modifiable risk factors that we can do. So things like removing lethal means if someone's a gun owner, you can try to help reduce the risk by protecting them from their own access to that kind of thing. Things like substance use are increased risk factors. But then there are certain things that are totally non modifiable. Someone's male gender, over age 65, past suicide attempts, family history of suicide attempts. These are all things that either they happened or they're or they didn't happen, and they play into this sort of overall decision that you're trying to make. I don't even remember the original question, but but I I feel I like, I've I've just been talking about suicide for long enough. I'll just pause and Okay. Alright. I'm so sorry about your own cancer journey. Can you share a little more about that or what you're comfortable talking about? Yeah. Absolutely. I've been dealing with this on January 19. It'll be four years, and I feel incredibly fortunate. You know, I was very unlucky to get this. It was kidney cancer. It was a pretty large thing. As many kidney cancers go, they're sort of quiet. They don't cause a lot of symptoms until they get to be problematic. And so as it works, I happen to have access to some of the best care in the entire world, and I've worked pretty hard to put myself in a position to then thankfully be very lucky. Next week, actually, I'm going to have my sixth surgery since this diagnosis happened. Oh my gosh. Every time one of these things, and I've had, I think, three different systemic therapies, one of which was in an almost ICU kind of setting. So it hasn't been easy, but in that span of four years, I have had a second child. I have written this book. I've written essays that ended up in The New York Times and The New England Journal of Medicine. I have taken all these opportunities. I've gotten to see, my, at the time, one year old, now grow up into a five year old and learn who he is, I can't wait to see who he is at six and hopefully at 16. So it's been an incredible journey of unknowns but trying to become okay with the unknowns, trying to live your life despite the unknowns. And I'm just so thankful that I've had that opportunity. A lot of the people who were diagnosed right around the same time as me haven't been so lucky. And it's been eye opening. I wouldn't wish it upon anyone, but there are certain aspects of it that I think have been insightful for me. Are you glad in this case that you you have all your medical training, or would it be easier not to know? It's a it's a double edged sword because on the one hand, you know, I can read the literature. I can I follow when there's, you know, the largest cancer conferences and all the researchers get together and new data's released? I follow it just the same way that I think a lot of oncologists do and I can understand it at the exact same time. I I can read those survival curves as well as anyone. I know exactly how, you know, what the data says and what the limitations are. So, you know, at this moment, my disease is not curable for more than ninety percent of patients who have it. So I like to be a realist about these things and a realist that holds on to hope. You know, those are the two principles that I carry with me all the time. And so far, it's served me really well, I think. Wow. Well, I will share my hope and, you know, all the good wishes. Wow. That's a lot to do on top of being ill. Like, all these things, you get it's hard enough for people to write a book when their life is going great. Do you feel like it really helped you? Like, do you feel like all the writing has been therapeutic for you? Yeah. That's actually why I write to begin with. You know, I started off by talking about am I a writer, am I not a writer, know, that kind of thing. And I think that I've always written because I am generally an introverted person, and I sometimes can feel overwhelmed with the world around me. And writing's always, since I was a little boy, writing's been a way for me to just sort of like process the world. And when you get hit with the asteroid landing on your front door of cancer, suddenly there's a lot to process. And so I started writing these essays. The very first one was about this idea of, at that moment, my five year survival rate was like fiftyfifty, essentially. And that was before we knew various things about how it had spread. And so I wrote this essay about the cruelty of a fiftyfifty survival rate. It's not ninety percent and it's not ten percent, a coin flip, and you may as well flip a coin, that kind of idea. And by writing that essay, was able to take these emotions that I was having and sort of articulate them. Then once it got out into the world and actually was put out on Boston's NPR radio, I got to go to the studio and record it, and and my voice was out to the world. People what I love is it's almost like a kinda sonar writing. If you write and and people actually do read what you've written, it can sort of bounce back, and you realize that you're connecting with people you've never even met with. And one of those one of those things is the ability to connect, I should say, is just really something that I I hold on to very tightly. I love that writing as sonar. I haven't heard that before. I love that. That's amazing. So what's next? Now you're doing publicity for this book. You're a psychiatrist. You your kids, whatever. Like, what are your hopes and dreams for the next little stretch? More writing, more essays. What are you up to? Yeah. Absolutely. So I would love for someone to someone with a really great skill set and an interest to turn this book into a movie or a TV show, and I'd love to be a consultant on that. That would be like that would be like my dream where I just get to sort of show up and talk about, like, you know, what it's really like, and then other people do the hard work of making it good. That would be awesome. But, you know, generally, you know, I I I after the book came out, I spent a number of months working on something just specifically for my two boys that I had bound privately, and it's just sort of been yeah. And and I wanted to do a real I've I've been working on it for a long time, and I wanted to finally sort of put a bow on it, and then I can get started on volume two. You know? It doesn't mean that the story is over, but I wanted them to have this thing that I had written just for them. So there there's that. And I'm also just thinking of I have an outline of a really, what I think is a really cool idea for a novel. And I'll just, it's only an outline, I'll just give you the very, very, very broadest idea of it, if I may. Please. Is like, from I I'm not that creative, so I'll just make the protagonist a psychiatrist like me. But from that perspective, dealing with the aftermath of, like, what happens in a small town if everyone's Internet browser history was, like, published suddenly, like, online, available for everyone to to see. And so almost like everyone's secrets being suddenly sort of revealed to each other in a way. I think that that idea is so has so much potential as a a work of fiction. Not to, you know, pull the wind out of your sails here or whatever. There is a book similar to that that I've covered. It's okay. It's not exactly the same. Every book is different. Sarah Shepard's book, and I'm blanking on the name. It's one word. It's like a long word, probably like eight letters. I'll look it up and send it to you. But it's where a campus there's like a campus wide issue with the servers and all everything becomes public. Not the browser history. It's more the emails. But as a comp, it would be a good good comp for your book. Yeah. I'm gonna have to read that. And But, yes, browser history would be I'm always so worried about that. Everything I enter, I'm like, what if this ends up somewhere? You know? What does this say about me? It's so Because we we search the strangest things, and and there's no context. Right? In our heads, there's context, but for everyone else, there's no context. Yeah. No. I love that. That's a great idea. I'll have to read that and make sure I I do something totally different. It's it's no. It's totally different. And it yeah. It's definitely more email based now that I'm remembering. Reputation. It's called Reputation. Okay. Alright. Reputation. Everyone go out and buy Reputation. And I'm sorry. I didn't mean to okay. So it was nine letters, not eight letters. Anyway, do you have plans for a podcast? Because not to sound weird, but you have, like, a really great podcast voice and demeanor. I feel like you should do some sort of podcast, and you have this great sound whatever. So I don't know. Throw that in the in the bag of ideas unless you have one and I don't know about it. I don't have one, but I'll I one one bit I'll tell you is that one of my favorite parts of doing this book was the ability to go the opportunity to go to a studio in Cambridge, Mass, which is like a rock and roll studio, but that's where I recorded the audiobook. And I've never done anything, like, really. Like, if one tells me they listen to the book, I love it even more because it's I feel like I was, like, just on a long car ride with them, telling them about my journey over these four years in psychiatric residency. So that's that's one but I appreciate that. Never done a pod never, you know, had aspirations to do my own podcast. Awesome. Alright. Well, do you have any advice for aspiring authors? My advice is to write the thing that you wanna write and for you, ideally. And so, you know, writing for other people, usually not a good idea. But if you write something and even if no one else reads it, you're happy that you wrote it or that you feel like it's been a productive use of your energy and your headspace, then do it. I never really in a million years imagined that this kind of book would happen and that I'd be able to do it. And so you just never know what can happen. If you take away if you're somehow able to overcome the fear of trying something and it not living up to some idealized version of it that you have, then then the sky's the limit, and you can achieve all kinds of things. So that's my advice to anyone out there. Take a shot. You know? Do your best. If it's something that you wanna do, go for it, and be proud of it no matter what happens with it. Love it. Well, if you ever wanna brainstorm what podcast you should do, let me know. I feel like you should put add that to your repertoire. If I if I may be so bold, you know, once I made it into the the Zippy orbit and I became aware of all the all the things going on, I became aware of the viral sensation, Sex Talk with Zippy and Jason. And of all of your work, that's the one that, on my commute to work, I can't not listen to it. Oh, yay. And you one of the recent ones, you guys were talking about the variety of audience members that you have, like people are and I was like, yeah, like, you know, add, you know, like Harvard psychiatry to the list. Like, we're listening, You know? So it's amazing. Oh my gosh. I'm gonna tell Tracy. That's great. Do. That's the problem with podcasting is and not the problem, but, you know, you just never know who's listening. You never know who you're who hears, who is it who it's I mean, every so often people email or DM or say something. But, yeah, it's mostly like I just sit here at my desk and wonder. I mean, I see the numbers, so I know people are listening, but you just never know. So anyway, thanks for telling me that. We have so much fun doing it. And, yeah, it's such a blast. I laugh so hard. So anyway, awesome. Well, thank you so much, Adam, for coming on, and feel free to stay in touch and, you know, best of luck with everything, and I'll be rooting for you. Thank you so much. Okay. Take care.

[29:40]Zibby Owens: and sign up for my virtual book club and meet lots of authors on Zoom every other week. Thanks so much to Steve and Ryan at Texture Sound for the sound editing, and thank you to Morning Moon Productions for providing this fantastic intro and outro music.