This is a lightly edited transcript of Apollo on Call 

00:19 

Welcome to Apollo on call, the podcast of medhumb.org 

00:23 

I’m your host. Dr, David Hsu, hope you enjoy the show. 

DAVID HSU 00:33 

All right, we are back here for Apollo on Call. I have been rejoined by the guru of pop culture, Dr Stuart Harman, the pediatric emergency medicine physician and director of the pediatrics residency training program at the University of Ottawa, and most importantly, our expert on all things The Pitt. Because we are here to have our follow up discussion about possibly the greatest medical television drama ever made, and this time, we’re gonna do it with spoilers. Stu, welcome back to Apollo. 

STUART HARMAN 01:09 

Thanks for having me back. I get invited to do a fair number of things, but I don’t always get invited back after I showed up once. 

DAVID HSU 01:17 

Well, the first episode was so fun, and we managed to make it fun, even though we didn’t spoil anything, right? So anyone who’s listening to this show, if you haven’t seen The Pitt yet, and you haven’t heard the first episode of our discussion on The Pitt, go back and listen to that one. This one is only for people who have seen the show or who have decided for some reason they don’t want to watch the show. They just want to listen to hear us talk about it. Spoiler alert. Either way, you’ve been warned. 

STUART HARMAN 01:39 

Spoiler alert. You’ve been warned. 

DAVID HSU 01:42 

All right. Now we have both finished season one of The Pitt. Where it stands is, apparently there is going to be Season Two, but we’ve finished Season One, and we’re willing to talk about every detail of the show, whatever comes up. We won’t hold back today. But the first question, the question that everyone asks, is, how realistic is the show? We dealt with this issue in the first discussion, and we came away from it saying The Pitt is very realistic. Not in the sense so much that everything is perfectly representative of a regular day in the life of an emergency room doctor, but the way they cram everything together makes it feel realistic to the audience. So even for us as physicians, watching it, the show brings out the feeling of what it would be like to be in the hospital after one of these long shifts or during these difficult cases.  

STUART HARMAN 02:39 

I think that’s what I said last time, that there are a lot of scenes where you’re saying no, objectively speaking, that doesn’t really happen, but that sure feels like what’s happening.  

DAVID HSU 02:49 

Correct. Now, having said that, I think we should talk about the same issue, because this issue comes up all the time when people talk about The Pitt is, how realistic is it? And this time, we can actually go into some of the details. What did you think the show did really well in terms of depicting that it was real? 

STUART HARMAN 03:11 

On a very superficial level, a lot of the procedures that they show them demonstrating, I’ve got to give credit to the special effects and makeup people, a lot of that stuff looked fairly real, not all of it, but some of it. 

DAVID HSU 03:26 

Right. And the actual medical sequence, you know, like a patient comes in, they have a pneumothorax, what’s the next thing to do? They really got their money’s worth with whichever medical experts they paid. Because it seemed to be very, very accurate, right? 

STUART HARMAN 03:42 

Yes, 

DAVID HSU 03:44 

And I know this, because I was watching the show with my wife, and she’d be calling out, “they need a Blakemore. Get the Blakemore”. Meanwhile, I’m sitting in the background, like, what’s a Blakemore? I don’t really know. And I’m not asking my wife, because I can’t admit to her that I don’t even know what the next thing in the sequence is. But she had trained as an internist, so she had seen a lot of these things in real life. It was really astounding to see that the show was being very, very realistic. And even the things that I did understand, like a lot of the psychosocial Family Medicine stuff, okay, this is pretty accurate. Pretty close to how we’d be handling things in real life, with a few little exceptions. 

STUART HARMAN 04:17 

Yeah, I found it fun, perhaps, when I was watching some of the pediatric cases to guess what the answer was going to be. And in none of them did I feel like, Oh, that’s a cheat. That’s not right. It’s like, oh, you know what, for what you presented beforehand, that diagnosis makes sense. Although I think I mentioned before that there are a few diagnoses that I guess were less based on the medicine, and more based on what would be an interesting case to put on a TV show.  

DAVID HSU 04:48 

Now, since you’re the pediatrics guy, I’m gonna ask you about this. There’s a big case in the show where a girl drowns, right? And I have never actually seen a small child die in the emergency room or on the wards. As a family medicine trainee, you only get so much exposure. And fortunately, these things don’t happen every day in an emergency room. But I have heard people talk about it, and my wife has also talked about it a few times. They saw some younger patients, although she didn’t work with actual children, but in her case, it would be maybe young adults, the 20 year old, 21 year old. 

Even those cases, as a physician, you just feel gutted, because these people have their whole life ahead of them. So for these things to happen, it’s such a tragedy, and The Pitt drags you through this with a young girl who drowns and drowns saving her sister because in a swimming pool accident. Now, you’ve dealt with this kind of thing in real life. How accurate was the representation of this case? 

STUART HARMAN 05:50 

I think it’s fairly accurate in terms of just the medicine side of when someone’s drowned. You hear these stories about falling through the ice, freezing, cold water, drowning, where you warm them up and actually you bring them back. And I think the easy route to take on a TV show might have been to do that. Might have been to say, Oh, she’s cold. We warm her up and she’s back to normal. But that isn’t realistic in the case of somebody who’s drowning in not really freezing water. Really that person just wasn’t getting oxygen, and so if you don’t have oxygen, eventually everything shuts down, including your heart, and then you’re gone. And if I’m not mistaken, that is the case where the child — it goes to what you call asystole, right? They completely flatline, right? I think that’s the part of the show where the parent is saying, okay, well, you can shock her now, like do the thing with the paddles. And talking to a lot of my friends who’ve watched the show, when they talk about what sets this show apart from maybe some other less researched medical dramas, or even just TV shows in general, they really liked that part. They really liked how in real life, when you have a flat line like that, you can try to treat it by giving them epinephrine medication to make the heart beat. But that flat line represents that the heart is doing nothing, and the heart is not a battery that just runs out of electricity that you can shock it, put in more electricity, and it starts back up again. The electricity is to reset the rhythm of the heart when the rhythm is not compatible with life’s rhythm. But if there’s no rhythm at all, the heart’s not beating at all, and you’re flat lined like that, you can’t shock them back. And I’ve definitely seen movies and shows where they did shock somebody from a flat line and the heart comes back, or they did chest compressions, and it went from a heart not beating to the resumption of normal heart activity. So that part was realistic. And even that extra element of having the parent sort of saying, can’t you do this is a little over dramatized in my experience. But definitely, I’ve had parents who are sort of aware of something they’ve seen on TV, and they’re wondering, well, can’t you just try this? Can’t you just try it? So I thought they captured that well. 

DAVID HSU 08:06 

Now you and I have talked about medicine on the air on Medical Dads. We’ve talked about life in private for years, but I’ve never asked you this question. How often do these cases really happen where you see a case that you’re really gutted by because you are on the front lines of this in the peds ER. How often does it happen, is my first question, and then I’ll ask you my second question after you answer this. 

STUART HARMAN 08:32 

So, I mean, drowning, specifically, in my city, we have a couple of drownings a year, and most of them don’t actually make it to the emergency department, because the person’s found, you know, significantly after the time that they’ve drowned. So they happen. They happen enough that we still have —  

DAVID HSU 08:49 

How about, not necessarily a drowning, but like a tragic, senseless death of a child. 

STUART HARMAN 08:54 

Any child that died — well, are we just talking about, how often do we see children die in the emergency department, or die somewhat unexpectedly in the emergency department? 

DAVID HSU 09:03 

I think that’s what the show is trying to hit with this. That’s the note the show is trying to hit on this case. 

STUART HARMAN 09:08 

I would say those happen, those happen several times a year. It’s not every day, it’s not every week, even. Sometimes it’s not every month. And then you’ll have a month where it happens twice. 

DAVID HSU 09:23 

This is to you, or just to the department, because you’re not there every hour. 

STUART HARMAN 09:27 

I’m talking about the department on the whole. To me, it happens enough times, but not so many times that I can’t — I was going to say not so many times that I can’t remember the cases. But actually, that’s not — that’s not exactly true. It’s happened enough times that there are ones that I wouldn’t remember unless somebody reminded me. But I would say, well, once every couple of years, I’ll personally be the person there. For a case where we don’t bring them back, non-survival in the emergency department setting. 

DAVID HSU 10:06 

So this is my second question, and I’m very curious about this, going beyond The Pitt, because The Pitt is just focusing on what’s happening in the halls of the hospital for that shift. How do you handle this as a medical doctor, when you go home after you’ve had these things happen. They’re super emotional, draining. Are you able to process it in some way? Are you compartmentalizing it and not talking about it with your family or do you bring it up at dinner? What happens to you, Dr Harmon, when you go home after a case like this? 

STUART HARMAN 10:43 

I don’t think they addressed this on the show The Pitt, but there is this element of you see some of these terrible things, and it’s not always a death, right? Sometimes you see some things related to child abuse or just catastrophic injuries, where the person survives, but you know that their outcome afterwards, it’s not gonna be great. I’m a pediatric emergency doctor, so it’s all children. So there is definitely this real life aspect of not really being able to go home and just talk about that with your spouse. Just unload all that stuff all the time. Because, my wife, she definitely signed up for better or for worse. You know, sickness, health, richness, poorness, all that, but not specifically to be my therapist, where I can come and put so much stuff on her that now she is going to have her own trauma, right? So that people ask my wife, how do you deal with having to deal with hearing about all the horrible things? 

DAVID HSU 11:45 

Well, she’s also, she’s not a physician, right? So she would be, she’d be facing it with a different perspective. She’s a teacher, so it would give her a different perspective. And it might be, it’s not good or bad. It’s just, it would be different. 

STUART HARMAN 11:58 

That’s a good point. People listening to this podcast, as opposed to the one you and I usually do together, don’t know that my wife is a teacher. And you know, people choose their careers based on the type of things that they like to do, expect to do, what they handle well, what they don’t handle well. So you wouldn’t expect people who don’t go into medicine to necessarily be well equipped to hear about that type of death, those types of tragedies, all the time. So there is this element of when I go home, I can talk a bit to my wife, but I consciously try not to overdo it. So how else do we deal with it? How else does a physician — how else do I process these things? 

DAVID HSU 12:45 

I mean, you strike me as being a very jovial guy in general. I’m sure most of their regular listeners to medical dads would agree. And even the people who are going to hear us on Apollo on Call will agree. You’re pretty jovial. It’s hard to imagine you simmering or stewing, for lack of a better word about a case that happens, but I’m sure that this job is difficult, right, and your job in many ways is more intense than my job. As a family doctor, things do happen. A lot of times they’re not happening directly under my supervision. And even then, I’m sometimes just like — feels like a huge thing has hit me on the head, and I need a week or two to slowly, pace my way through it. But the stuff you’re seeing and the stuff The Pitt people are seeing is a whole different level. That’s why I’m curious. 

STUART HARMAN 13:33 

You know what I think, what aspect of this is for a lot of people, when something, when a tragedy, just happens, simply being aware of it or witnessing it doesn’t necessarily affect you in an unshakable way, compared to if you feel that there’s some element of that that’s your fault, right? Some element of that, well, it’s your responsibility, and you could have done more. So it’s not every time I have a bad case that I have a long process that I have to go through to get through it and move on. But from time to time, there are going to be those cases where there is some sense of what could have been done differently. What more could I have done that day? Or if only this thing had happened or lined up just right? Those can sort of rob you of sleep a little bit. Plus, there’s a whole other element that you’re accountable for some of these things, right? So you never know if somebody is going to launch a complaint or a lawsuit or something along those lines. And I think actually for a lot of physicians, that sometimes robs them of more sleep than the actual case itself. Sometimes even a case that went well and you did everything right can rob you of a lot of sleep if other people don’t think you did it right. But so, yeah, that’s a little bit of a peek behind the curtain for old Dr Harmon here. Sometimes there are some of those that you have a sense of responsibility about it, that affects you a bit. But I do feel like I have a fairly good outlook on all of that. You know, I think I’ve come to grips with the limitations of being a human being and just the fact that, for me, if I often look at it, okay, some terrible thing happened, somebody was in a car accident, or someone had something really horrible happened to them, and if I wasn’t there, that thing would have happened anyway. So me being there, I’m exposed, I’m aware of something, but it’s not like being aware changed anything. And at least I could try to help in some kind of a way. I think that that outlook has helped me manage quite a bit of this. 

DAVID HSU 15:59 

Not a bad way to think your way through it. I think I hear what you’re saying. A lot of times these bad things happen. And sure, sometimes it’s like, you know, as a physician, we made a mistake. And so you’re kind of thinking, okay, could I have done better? A lot of times there’s nothing obviously that you did wrong, but it’s just, could I have done things a little bit differently? Maybe we could have achieved an even better outcome than whatever outcome we had, right? And so that kind of thing, it’s hard to let that go as human beings, if we care at all about our patients, right? And a lot of times these things are out of our control, but we kind of wish that it was still within our control. And you do see elements of this playing out on the show, right? Like the older doctor, Dr Robby, he’s seen all this stuff before. So for him, he’s seen good and the bad, and he has to balance it. And these younger people who are coming through and training and seeing things for the first time, they’re getting caught up in stuff like, oh, I had a patient die, right? Like, this happens to Whitaker a lot on the show at the beginning, it’s almost like a comedy at the beginning, right? Everything he touches goes bad for a while. He’s like, maybe I’m just not cut out for this kind of thing. But you realize that’s also part of being a doctor, right? That you have to learn that you can’t save everybody. A lot of it’s out of your control. You do your best, and then you move on to the next one, because the system needs you to keep functioning. 

STUART HARMAN 17:19 

 In the show, I noticed that they did try to do some debriefs. You saw that with some of the cases where they get everybody together and try to do what we call a debrief. We do that. We do that at my hospital, if somebody dies, certainly. 

DAVID HSU 17:32 

And you have, like, a moment of silence and stuff. I’ve never actually seen that in real life. 

STUART HARMAN 17:36 

The moment of silence, I would say that is not routine. We don’t always do a moment of silence, but what we do is something where we get everybody who is involved in the case together after the case is over, you give people five to ten minutes to go and sort of clear their head, try to get everybody back together, not in the same room where the case happened, where everybody’s looking at it, but in a different room. And you go through this debrief, where you try to find out from people, first of all, does everybody understand what happened? You go through the medicine of the case, describe what happened. Then you give people an opportunity to ask questions, or to say, well, how come we didn’t do this? Or should we have done that? And then you get a chance to talk through that. And then there’s an emotional part to it too, where you just like, give people a chance to express what they’re feeling and acknowledge that and talk through that. And like what you were saying, after you’ve been around for a while, you see certain things. It’s very different than when you first start out. So often with these debriefs for children who’ve died by time they’ve got to the emergency department or in the emergency department, I’ll start off by setting that stage for everybody, since some of the people in the room this is the first time they’ve lost a patient, and explaining that on TV, or what we are often led to expect is that when someone needs to be resuscitated where their heart stops, or something like that, that 80% of the time, if we do everything right, we’re going to bring them back. Whereas that, that’s not the expectation of the statistics, right? For some of these cases, they’re coming in with less than a 30% expectation, 30% chance, that you could actually bring them back from that, sometimes less, right? Sometimes the patients come in and they’re gone. And so I’m often explaining that to the group, that there was no real, real hope. It would have been a bit of a miracle. And sometimes we do pull off miracles, but just so that they understand that. 

DAVID HSU 19:26 

So you’re telling me that when you do the debrief, you actually reference television. 

STUART HARMAN 19:31 

No, no, I won’t say, I won’t say, oh, you know, if you’ve been watching a lot of television, you think we’d bring this back. But I’ll say it more along the lines of, what we have to keep in mind here is that although it can feel like or people may come into this with the expectation that we’re going be able to reverse this, most of the time, that’s not what it is for this case, this patient actually came in asystole. 

DAVID HSU 19:53 

This was actually a known thing on the original ER. When ER came out, people would watch the show and track how often they got out the paddles and charged it, and people survived, right? And, wow, 80% of the people on the show survive, right, and it would create this false expectation for patients. You’re just like, oh, beep, okay, get out the paddles. We can bring them back, right? And, and it makes for great television drama, but it’s not realistic, right? I think in this show we have a bit more of a realistic view of it. A lot of the patients are dying, and it’s gut wrenching to watch, but I think they did a pretty good job of balancing that. The doctors on this show are — they’re heroic, right? And we can talk a bit about this, but they’re tempered by the reality of their limitations as physicians. 

STUART HARMAN 20:43 

One thing that I worry about what this show might do that’s going to create a false impression. There were so many times over the course of this one season where one character is doing some kind of medical procedure and other characters are telling them, Don’t. Stop. That’s dangerous. You’re going to kill the patient. And the person will be saying something along the lines of, this is unconventional, I read a case report once. They’re treating it like it’s fine to do these Maverick moves, right? And it always works out, even if it’s the Junior trainee trying something that’s way out there. It never fails, and that, I think in real life, that’s not how that goes. Not to say that people can’t do — I do feel a little bit like the emergency department in particular could — that type of work in the field of medicine can potentially attract a certain type of personality, right? Because people have different ways of how they react under stress. I don’t just mean when you’re stressed, but when you have something critical happen. There are people who, their natural instinct is to sort of slow down, stop, go inward and think through things, which sometimes is the right approach, but sometimes you miss the opportunity to make a quick decision that you should be doing. But then there are the other people who are faced with any kind of pressure situation, their thing is to act, and they don’t necessarily slow down to think. That’s their instinct, is to act. And they have to fight that instinct to slow down and think. And if I was going to generalize the stereotype, I would say for some the quick acting is what can be attract them to emergency medicine, and I would hate for people to watch this show and get the impression that, like, yes, that’s the way I should behave when I get into medicine. And there’s going to be lots of opportunities for me to do that and be rewarded for it. 

DAVID HSU 22:32 

Right. This is something that the show is spinning a little bit, and because they’re making the pace of the show so fast that you have to be problem solving that way. And emergency medicine is faster than most other forms of medicine that are practiced. But this is a really, really extreme way of portraying it. 

STUART HARMAN 22:49 

Yeah, and it would be more collaborative in my hospital, at least. Even if you do need to do this crazy procedure that’s a Hail Mary toss, it wouldn’t be with your supervisor or with somebody from some other service, because apparently the surgeons in this show like to come down to the emergency department and tell you what not to do. But it wouldn’t be with some other service on the sidelines saying, don’t do that. I’m going to bring that patient to the operating room instead but you do it anyway. And then they say, oh —  

DAVID HSU 23:15 

All’s well that ends well, that’s repeatedly on the show. 

STUART HARMAN 23:20 

That’s the theme of the show, all’s well that ends well. 

DAVID HSU 23:23 

Now, here’s a case that a lot of people have talked about and written about. It’s the case of the Advanced Directives. There’s an old man right in the middle part of the season. He gets brought in. He’s having difficulty breathing. He’s already got pretty advanced dementia. There’s a son and a daughter. They’re arguing about what they should do, because dad has already said he doesn’t want to be hooked up to a ventilator. He doesn’t want any heroic measures taken. And then the son says he’s in agreement with dad’s plans. The daughter says, we want to keep him alive. I haven’t spent enough time with dad yet, right? And they’re having an argument about this, this specific case, did you feel this was realistic or not from what you’ve seen? 

STUART HARMAN 24:10 

I was going to ask you the question, because in pediatrics, these advanced directives are something that are made with the parents. I’ve had cases where we didn’t have an Advanced Directive, and the parents had to make the children — adult children of grown up parents — had to make a decision. So I remember distinctly one of these cases when I was in medical school, we’re really not sure. So are we starting chest compressions and resuscitation, or are we not? And the family, we were waiting for the family to make that decision. And in pediatrics, we’ve had cases certainly where the parents were not in the head space, where anybody was able to get them to agree to an Advanced Directive, and so we’ve had to make this decision on the spot. But I was going to ask you, is that actually legal in Canada that you could be an elderly person who has written an Advanced Directive stating what your wishes are, and that goes out the window? 

DAVID HSU 25:06 

To the best of my knowledge, what happens in real life is not so cut and dry. So just because you have an Advanced Directive and you’ve indicated what your wishes are, when you actually get into the hospital in that moment, my experience of it is, the family can still go against the advanced directives. There was a case that was a family that I knew pretty well. I had looked after the elderly parents, both of them for many years, and unfortunately, it was a very strange case, because the lady had developed Creutzfeldt–Jakob dementia, like mad cow disease, which is a really, really severe form of dementia. Actually, backtrack. The lady had just developed really, really severe dementia over a couple years, and she got admitted to hospital with some other sort of, like must have been a broken leg or something, and there was this whole dilemma about, should they do any measures to prolong this lady’s life? Her quality of life was already very, very, very poor. It was very severe dementia. The children, the children that were living in Canada, were all on board with, you know, no heroic measures. Do Not Resuscitate, right? And then suddenly there was another child who wasn’t even in Canada. It was a long-lost son or someone from China, calls long distance to the hospital and says absolutely not. We must do everything for mom and dad, right? And in this case, the family had already agreed there was a plan, and I think the husband was on board with the plan, and he would have been the substantive decision maker. The children were in agreement with the plan, but they couldn’t get 100% consensus, right? There was this other voice, and as soon as the hospital heard that there’s this other voice, they’re like, whoa, we’re gonna back off. We can’t execute this because there could be legal ramifications later. So it was almost to the point of whether legally that written document or the substantive decision maker document held water or not, didn’t matter anymore. It was we need to get everyone on board. And I’m not even sure that’s the right thing to do, but that was actually what ended up happening in real life. So they ended up prolonging this lady’s life for x more months/years and it was very interesting to me to watch this happen. A lot of times, we’ve seen these things happening in real time. You and I can debrief about the show in detail and break down, what’s the law, what’s the ethics? Right? We can teach a whole course on it, ask all our students to write an essay about what they saw. But in real life, you have five minutes, right? The person’s about to code, do we do this or not? And you get this phone call from China, and it’s like, okay, everyone, we can’t decide now, right? We’re in a log jam. 

STUART HARMAN 27:57 

 I had looked it up at one point after that show, because I was so curious as to what the law is in Canada. It seems it’s not exactly the same in every province. So province to province, there’s differences, but the general consensus seems to be that if you have an advanced directive that’s written at the time, when you, as the person writing it, are competent, then that’s legally binding, and other people can’t overturn that unless they are petitioning to say that you weren’t in your right mind when you wrote it, or that you’re you know, they would otherwise say it’s invalid. But that situation of two adult children coming in and saying, oh, we’re not following dad’s advance, I don’t, I don’t think that that’s the way that’s supposed to work here. 

DAVID HSU 28:35 

Right. But in real life, I think what’s happening is the doctors want the family to feel like they’re getting heard, right? So they’re giving the daughter the option, which I guess is what’s happening in my patient’s case, right? They’re allowing this child who isn’t even present to be heard and let them sort it out as a family. Because otherwise, if we just let, you know, the brother decide, and then the sister doesn’t get any say in it, this is going to become a huge issue for them afterwards. So it’s almost better to let them work work through this thing as a family, which is the approach of the show. I think that probably is the best option, honestly. We’ve gotten into discussions about things like advance directives, and it gets really complicated. It’s an Advance Directive. It was written. It was scribbled on a piece of paper, right, and the date is wrong. Is it still valid? Like, these issues appear all the time, right? If you look up, what do you need to indicate your will? All you need is a piece of paper that you wrote down what you want done, and you sign it right? And that can be a will. But will it hold up in court? Will it hold up after you die, when people examine it under a microscope? No one really knows, right? So it’s very, very complicated. 

STUART HARMAN 29:47 

But if anything good came out of that episode of the show, or if something good could come out of people listening to the podcast and listeners talk about it, hopefully it would be that someone listening or someone watching would be motivated to say, okay, let’s actually set up advanced directives for our family members and talk about it now, instead of at the time, this analogy that’s often made of, you know, if you’re on an airplane and the plane is crashing, that’s not the best time to be going over instructions for what you’re going to do with an oxygen mask, and that is tough, right? Better to do that before it happens, when everything is safe and when everyone’s thinking clearly 

DAVID HSU 30:26 

Except before it happens, you don’t really know what it would actually feel like to be in that situation, right? Today, if you ask me about advanced directives, I have a certain opinion about it, but when I’m actually facing life and death, right? I might have a slightly different answer at that point. 

STUART HARMAN 30:45 

I think what Dr Hsu is saying is that, before the plane takes off, put the child’s oxygen mask on, after you put your oxygen mask on. I agree with that concept, but when that plane is crashing, in that moment, he might change his mind to be like, You know what? Both oxygen masks. I want them all. 

DAVID HSU 31:01 

Save yourself. Man, physician, you cannot heal other people if you cannot heal thyself first. Now, here’s the question about that case, though, so the brother and the sister have this long, emotional conversation guided by the doctors, where they eventually explain why it is that the sister isn’t ready to let Dad go, and it’s because she didn’t have a great relationship with dad, and they have this long, teary, emotional conversation, and this type of conversation I’ve had with my patients in the family doctor office, because these patients, because I know these people so well. I’ve known them for years. So then when something happens to their family, they come in and it’s also not happening at the moment. So then they come in later, and then we have a talk, and it’s kind of like a debrief and they can explain why their marriage is struggling, or why their relationship with their son isn’t what it should be, and so forth. And that’s the coolest part of family medicine for me, but I’m wondering, because as I was watching the show, I don’t know, I’ve never been in your shoes, or not much, right, in an emergency room setting, and I feel like there, this is a bit forced. If I was in the emergency room, I don’t think I’d blab out all this stuff to the doctor who I just met, right? I’d probably be more inclined to go back and talk about it with my GP or my buddies, right? But with this in the emergency room, in the moment of, just like unloading all the stuff about my childhood, Is that realistic? 

STUART HARMAN 32:35 

That’s exaggerated, but not completely unrealistic. 

DAVID HSU 32:37 

Okay, so it does happen. 

STUART HARMAN 32:39 

Yeah, you’d be surprised in the emergency department, how often we find ourselves using up a fair amount of time on some of these things that are more probably appropriately addressed elsewhere. But this is just where they’re coming up. So this is where we’re going to talk about it, where sometimes you’re trying to get somebody on board with what to do, or what the next step is to take, and you find yourself spending a lot of time doing that, and some physicians are more willing to do that than others, and some physicians are more naturally inclined to that than others. I think in peds emerge people are maybe more inclined to do that just by nature of being drawn to working with families and children in that way, but it does touch on this character of Slow Mo that they have on the show. 

DAVID HSU 33:24 

Right. So this character is the trainee who spends too much time with her patients, so everything is getting backlogged because she’s not seeing patients quickly enough. 

STUART HARMAN 33:37 

There definitely are trainees and sometimes even staff physicians who can be a bit like that. And the show makes it seem very noble that they all are the same. Well, I guess the show isn’t saying that they’re all the same, but this show presents a very noble version of that, where it’s just because I care so much about these patients and giving them the positive experience that I get drawn into doing these things. But it is true that by the time you’re now having just chit chat and conversation with the families, that actually is becoming a bit of a detriment to the other patients in the department that you need to be spending time with. But I feel there are also sometimes situations where people are spending too much time with the patient, maybe because they enjoy that part more than they enjoy going to see the next patient whose problem might be more challenging, or sometimes the easiest part is the part that’s just building rapport. And actually, I’ve certainly met patients who it doesn’t matter how much rapport you build with them, if you can’t also nail the medicine part, then none of that rapport is going to mean a thing. 

DAVID HSU 34:48 

Well, ideally you should do both. But that gets into this whole art of medicine. I thought it was interesting that the show actually addressed this, right? That the doctors can work at different speeds and the different speeds do affect how the system runs on a whole. It also affects the quality of the medical care, right? So there are patients who are getting brushed by, right, like they’re coming in with issues, and the doctors don’t even have time to deal with it, that if they spent a little more time, they might unearth something. And so we see both sides of this on the show. It’s quite interesting, because it gets into the whole business of medicine being a human-being endeavor, and that means it comes with a lot of variability, right? You have the slow doctor, the thoughtful doctor, you have the fast-thinking doctor, you have the doctor who’s not so good with patients. And there’s always two people in the room, right? It’s not just the Doctor, the patient is also part of this interaction and affecting it. So I liked how the show presented this issue to us. 

STUART HARMAN 35:46 

I also liked that the show didn’t give us an answer or didn’t tell us what’s right and what’s wrong. They had that character slow mo, and they did show that actually sometimes that being slow is causing an issue, and the element of the staff physician actually trying to teach that you can’t just be slow because you’re not confident enough to make a final decision, or that you’re always afraid you’re going to miss something, because that is not a good type of slow to be, that you’re doing unnecessary tests, spending unnecessary time because you’re afraid of what you’re going to miss. But then, on the flip side, they also had it where that character realizes the patient has mercury poisoning because she took the extra time to connect with the patient and to look into it. 

DAVID HSU 36:27 

There is also a scene, if you remember, Collins comes up to her and is like you’re doing a good job, so don’t listen to all the doubters, and you keep on doing you, which I think is a really good message too. There’s no right answer the way that the show presents it, which I thought was quite true. That really is the thing. I feel like I’ve experienced this as a teacher in family medicine, where sometimes these students come through and they’re a little bit slower, and it’s like, wow, a lot of the people in the department are really piling on this person. They feel like they should be faster, and they’re missing the point that actually this person is really honest, and they’re very good with the patients, and maybe the level of expectation for what we have for each individual person doesn’t need to be exactly the same. It certainly isn’t, when they’re actually working. 

STUART HARMAN 37:14 

I feel though the reality of what should be done is quite nuanced, or is in between this, because definitely you’ll have trainees who can be slow enough. People just keep telling them, you do you. And if people sell the narrative that this is actually the best possible care, right? Because that patient is going to be so satisfied the more time you spend with them, you could spend an entire shift with one family, right? That could definitely happen. So — 

DAVID HSU 37:41 

That would not be good medicine. Basically, is what you’re saying. 

STUART HARMAN 37:43 

That would not be good medicine. But then you also do reach a certain point where you do actually have to say, I gotta do me. I gotta be comfortable with what my approach is. And there are some doctors who I’ve known, who’ve been great doctors, who get great patient feedback, who do spend more time — are a bit slower, but I wouldn’t tell them to change. I don’t think I could make them change, and I don’t think they would be better by trying to be faster. 

DAVID HSU 38:13 

I mean, it gets into this question where, what do you think is a good doctor for you. If you were the patient and you walked into the Pitt because you had some injury, which doctor would you want to treat you? And everyone might have a different answer. So maybe you tell me which out of all those people, who would you want to treat you? 

STUART HARMAN 38:38 

Honestly, what you want is the doctor who is the best at getting the diagnosis. 

DAVID HSU 38:41 

You think so? 

STUART HARMAN 38:42 

Yeah. I mean, I think pretty much universally, if the person at the end of the day gave you the right answer and treated you and you got better, then that’s the doctor you would want, even if their bedside manner was slop, even if they were terrible. 

DAVID HSU 39:03 

I don’t think that’s true.  

STUART HARMAN 39:06 

I think it’s true if you actually do get better.  

DAVID HSU 39:10 

That’s only if you think of medicine as a purely zero sum or a binary thing, where there’s a right answer and a wrong answer, right? Which it’s not. It’s a human being thing. 

STUART HARMAN 39:19 

Well, I mean, everybody wants it all, right? Everybody wants the doctor that’s got great bedside manner and the right diagnosis. But if we posed it as a question of you can get a doctor who’s super nice to you, but you don’t get the right diagnosis, would you rather have that or a doctor who’s terrible bedside manner, but definitely you’ll get better? 

DAVID HSU 39:37 

Okay, but let’s talk about The Pitt, all right? You’re not allowed to pick Dr Robby, because I think we would all pick Dr Robby. He seems to have it all at the beginning of the shift, but clearly he’s a flawed character as the shift goes on. But okay, maybe you can include Dr Robby out of all these people you walk into the emergency room during that 15 hour shift, which of the doctors would you be glad to see the most? 

STUART HARMAN 39:58 

Yeah? You know that doctor, Dr Robby, he does have that kind of thing where all his flaws are the things that are self-destructive. He burns himself up for the job. So most patients would definitely like the doctor who’s got all these great qualities and yeah, but at the end of the day, the doctor himself is — 

DAVID HSU 40:15 

All right. I feel like you and I could talk about The Pitt endlessly, yeah, but we must. move forward a little bit here. 

STUART HARMAN 40:22 

We should just have a whole other podcast series on the show. We’ll call it the Bottomless Pitt, where we come up with endless things to say about this show. 

DAVID HSU 40:30 

Now, just thinking broadly from a medical humanities standpoint, because this is Apollo on Call. What do you think about the show overall? Like a meta thing in terms of medical humanities? 

STUART HARMAN 40:43 

I think the show is actually not a bad thing for physicians and even for non-physicians to watch and take home talking points from some of the various scenarios that they put in the show. The scenario of sickle cell disease patients, the scenario of the end-of-life discussions, even the scenario where it’s just a throwaway thing, I kind of wondered why they put it in there, because they didn’t follow up on the plot thread. But there’s a character who misses a urinary tract infection and a patient who comes back, and another character who makes a suggestion, are you sure it’s not because she’s obese that you just biased against obese people, that you fat shamed her and so somehow missed the diagnosis. And the character who otherwise seems very understanding of people, is sort of saying, oh, I don’t think so, but I will reflect on that. I thought it was weird in the show, but for people watching from a medical humanities point of view, it’s a good talking point, a good starting point. Hey, do we think that we have unconscious bias against the obese that maybe affects the way we treat them medically. 

DAVID HSU 41:46 

I thought overall, that the show does a really good job of championing medicine and portraying doctors as heroes, and I don’t think we get enough of that anymore in a way that really hits home. Maybe I’m just jaded from working as a physician. I feel like in this day and age, and I’m talking about doctors themselves — this show doesn’t talk about this — but I think maybe we should talk about it a bit. There’s a lot of this talk in medicine about how doctors are not paid enough. There’s not enough money in medicine. There isn’t a single character in this show that is portrayed as being in it for the money. But you and I went to med school, we did our training. There are many people around us that are in it for the money. Right? That character is missing on the show, and I think they deliberately omitted it, yeah, because they want us to see the heroism part of being a doctor again, which I think is actually a cool thing, because we don’t hear this enough anymore. 

STUART HARMAN 42:51 

It’s true. I mean, I will reflect that this show is taking place in an American hospital. So maybe nobody’s saying anything about money, because they’re being paid so much more than we are here in Canada. 

DAVID HSU 43:01 

Well, they’re all residents and trainees. So they actually are not. One of the students, Whitaker, has nowhere to live. He’s slumming it in an empty ward in the hospital. 

STUART HARMAN 43:12 

That’s true. All the all the doctors and residents complaining about their salary on this show are all hiding out together with all the other sub specialists and specialists that should be showing up to the ER to see patients apparently don’t on the show, since the only characters we see outside of the emergency are surgeons and the odd other person that wanders through when, in real life, there are other people in hospital coming to the emergency departments besides the emergency docs. 

DAVID HSU 43:36 

Right. So it does seem like we’re painting a picture of people who ultimately, for better or worse, no matter what personality type they have, they are in the job because it is their calling. And that’s not completely accurate in real life, but it does reflect well. I think people need to see this. And I think you talked about this in the first episode we did. This is not a bad show to watch for doctors to remind you of why you got into medicine. You know, because we lose sight of that during the day-to-day grind of a long career. For sure, we lose that.  

STUART HARMAN 44:09 

Yeah, this wasn’t lost on me either watching the show. I reflect on how lots of physicians I’ve talked to about the show have told me that they didn’t make it through the first couple episodes, that they just saw it and it’s too overwhelming, or it’s just too intense. And the show does have a bit of a weird intensity, where at the beginning, people are having scalpels dropped in their foot. I kept expecting some main character to have some weird death in the show, but that said, I watched the show to completion because you told me to, because we were going to talk about this podcast. So I knew from the beginning, I’m pushing through. And one thing I thought the show had some serious value in that the characters don’t quit, right? They’re going through all this crazy stuff, and they have this thing of I’m doing this. And I felt a bit inspired by that, or at least I felt a little bit like, yeah, like in every other area of my life that I’m trying to use television to emulate what I should be, this too. I should try to be more like Dr Robby. 

DAVID HSU 45:09 

I definitely got that feeling. Like at the end of the season, I was like, Screw it. We should just all go back and do our jobs. I got to stop podcasting all the time and get back to the core thing that I do, right? And then I went back to work, and I was like, yeah, I could kind of see why I need to do more podcasts. Now. Season Two of The Pitt is coming. It is going to be a real thing, right? And I’m not sure how they’re going to structure it. What does Apollo on Call want to see out of Season Two of The Pitt, if we had any say in it at all? 

STUART HARMAN 45:43 

I think I said on the previous podcast my spiel about how I thought it actually exists perfectly as a singular entity, but aside from the fact that maybe there shouldn’t be a Season Two at all, what do I want to see? Well, there’s a few plot threads that we’re all dying to see how it plays out, right? So what does happen with this doctor who’s using drugs because the show — that aspect is a bit unrealistic — like the way the staff person just exploded on him, the actual medical system treats those doctors as patients. A doctor with a drug addiction is treated as a person with an illness, and the medical system is actually quite supportive of those doctors and helps them to get recovery if they’re willing to admit they have a problem. So now that he’s been forced into that situation, will we see him come back? Will he be allowed to work in an emergency department, or will he come back as a family doctor with a thriving practice, but who’s not allowed to have access to drugs. 

DAVID HSU 46:44 

Will Dr Robby even call him out for it officially, it seemed kind of ambiguous, right? Because he took Langdon’s pills, it looked like he was about to flush them down the toilet. So maybe he wasn’t going to mention the thing to anyone. He deliberately didn’t tell any other people about what was actually going on. So it’s possible that he even buries this issue and allows his prodigy student to continue. But I’m not sure where they’re going to go with it. There’s a lot of ways this thing could play out. 

STUART HARMAN 47:11 

Especially because they have that other character who knows, I forget what her name is, Santos. So Santos knows, and I don’t think her character would let it drop if they had Season Two, so maybe there’d be that. Also, we need to find out what happens with Gloria, the charge nurse. After getting punched in the face and her saying that she’s not coming back, they really kind of left it a little bit like Robby thinks she’s coming back. 

DAVID HSU 47:40 

In real life, that character definitely comes back. In real life, that’s just a bad day. She might need a month off. You know she’ll be back. This job is in her blood and also, the actress that gives that performance, this character is actually one of the best characters on the show. There’s no way she’s not coming back. 

STUART HARMAN 47:58 

Maybe that character doesn’t need the paycheck, but that actress definitely needs the paycheck and won’t walk away from that money. 

DAVID HSU 48:05 

Now, if you were doing this Season Two, and one thing about Season One is they did this whole one hour, is a one hour of real time — 

STUART HARMAN 48:15 

 which I think only partly worked. After a while, they were a bit constrained by that gimmick 

DAVID HSU 48:22 

Right. Now, most likely they would continue that gimmick. I don’t see them changing that because it’s such an important part of the show’s description, right? So how do they top this? Like, how do they do a Season Two? The reason a regular eight hour shift, or a 12 hour shift stretches in the 15 hours is right at the 12 hour mark, this mass casualty event happens. So are we going to jump forward a year in Pittsburgh when another crazy mass casualty event happens? What plot line could they possibly put into this thing for next season? 

STUART HARMAN 48:58 

I would imagine it’s just a regular 12 hour shift, and then they extend it with three hours of them doing the paperwork that piles up so you have a 12 hour shift. 

DAVID HSU 49:06 

This is why you’re not writing television, right? You would want to go for uber realism, like we want the medicine to be totally true to life. 

STUART HARMAN 49:17 

Well, I mean, you haven’t read my exciting fan fiction that I wrote about that other doctor coming to grips with her bias against fat people. 

DAVID HSU 49:26 

Hour 15, Dr Harmon goes home, but is unable to talk to his family about all the crazy things he sees, and just goes and takes a nap. In this show, we don’t really see that. We see these people — they are soldiers, right? Literally, right? The mass casualty event happens, and these people are drawing their own blood and pouring it back into the patients. 

STUART HARMAN 49:47 

Never done that, I’ll tell people. I’ve never done that. 

DAVID HSU 49:51 

So this show tells us that people are thinking of medicine as their whole life. This is a calling beyond the calling, which, on the one hand, earlier, I said it’s kind of nice that we get this heroic portrayal. On the other hand, it’s kind of unrealistic, and maybe we need a bit of a reality check also. 

STUART HARMAN 50:08 

Yeah, that’s an insightful answer. Too bad listeners will never be able to hear it, because we’re going to have to edit that in such a way that none of your patients think they’re going to lose their family doctor in the next 10 years. 

DAVID HSU 50:17 

I don’t know. If I was in charge of Season Two, I feel they don’t necessarily need a mass casualty event, but I actually wanted to see more of some of the night shift doctors, so I thought maybe they could start the season with a little bit of an overlap the first couple hours with the doctors from the night shift, like the Asian doctor, because I definitely felt like I could have used a little bit more Asian representation on the show, and that guy that was sipping on the cappuccinos, he was the man. 

STUART HARMAN 50:43 

What about Santos? I thought she was the Asian represented by that show. 

DAVID HSU 50:47 

Well, that’s true. Santos is also there, but her character is a bit of a train wreck. So you were saying, like, which doctor would you want as your physician?  

STUART HARMAN 50:55 

Not her. 

DAVID HSU 50:57 

Definitely not her. But I could imagine season eight of The Pitt, by then, she’s going to be an attending, and this whole place is going to fall apart. 

STUART HARMAN 51:04 

Actually, you know maybe the doctor I would want is Dr Abbott. He seemed to have his act together. You know, when he’s not at the edge of the roof. 

DAVID HSU 51:12 

He’s a nut job. Also, he knows his medicine the most. So I guess that makes sense, because that’s what you’re looking for. But this guy, if you recall, he had threatened to jump off the building at the beginning of season one, right? The show opens with him about to jump off the building. 12 hours later, he comes in. I heard about the mass casualty event on the police scanner. Like, he goes home, he’s listening on his shortwave radio for the next time he’s going to get called in. Like, yeah, this is definitely the guy you want as a doctor. 

STUART HARMAN 51:44 

As long as he could treat me before his shift is over. Then, all right. 

DAVID HSU 51:49 

All right. Well, at the very least, we both really enjoyed watching The Pitt, but moreover, we really enjoyed talking about The Pitt, which is why we have these two very long episodes about this show. We hope that our audience has caught some of our love for the show, our passion for The Pitt. And you have plenty of time. You’ve got maybe half a year to catch up on this thing, and then Dr Harmon and I will see you when it’s time to roll out The Pitt Season Two discussion on Apollo on Call. 

STUART HARMAN 52:22 

Do you have some kind of way for people to discuss back their insights or things that they’ve learned from listening to the podcast or watching the show?  

DAVID HSU 52:29 

Yeah, you can put comments on MedHum, feel free. You can send us little notes about our discussion if you want. 

STUART HARMAN 52:43 

I’d love to hear what people thought of our take on the show and what their take on the show was. 

DAVID HSU 52:49 

Until then, until the next time we discover some medical humanities, pop culture thing that we need, Dr Harmon, we will bid adios. 

STUART HARMAN 52:59 

See you in Season Two, folks. 

DB 00:03 

“And when the tennis was over, I was empty. I had no crutch, nothing to make me feel special. The world was gray and dull. When she offered me the needle from the very first shot, I was hooked. It just seemed to fill the hole, he said, putting his fist over his chest, Right here. ” from The Tennis Partner

DH 00:25 

Welcome to Apollo On Call, the podcast of MedHum.org. I’m your host. Dr. David Hsu, hope you enjoy the show. 

DH 00:38 

All right. We are back for our monthly Apollo On Call episode, and this is a special episode of Apollo On Call. I am joined here today by my co-host, Mr. Dave Bryant. Dave and I do a regular podcast called the Sports Literati podcast. If you haven’t heard of this, what we do on the Sports Literati is we break down a sports book every month. Actually, it’s like every two months, right? But we’re trying to bring the love of reading back for sports fans. And I thought, You know what, we should do a collaboration episode where we bring Sports Lit and MedHum together, because these are my two pet projects right now. So you know how when you go to the store and they have a designer, and he’s merging with Nike, and they put the big X sign between them, right? This is Sports Lit X Apollo On Call. 

DB 01:34 

Yeah, this is very exciting. I’m so happy to be here and part of this crossover episode, this is exciting, Dave, and I can’t wait to dig into the book that we’ve read this month. 

DH 01:44 

Right, and so the quote that Dave read is from The Tennis Partner by Abraham Verghese, which is a seminal work of medical humanities. It is, you know, on a lot of reading lists for medical trainees, and it’s actually a great sports book. I mean, the title kind of gives it away. It’s a great tennis book also. So checks off all the boxes. I actually read this book maybe 15 plus years ago when I was training as a doctor, and I kind of forgot about it. But recently, when I got in touch with MedHum and we were thinking about what would be a good thing to read, this book popped out. It was sitting on one of the tables at my mom’s house, and I flipped through it. I’m like, I kind of really want to read this again, so I made Dave read it. So we’re ready to go and talk about The Tennis Partner by Abraham Verghese. 

DB 02:36 

Absolutely. And Dave, I personally want to thank you for bringing this book into my life. That’s what I think about this book.  

DH 02:44 

Wow, he’s never thanked me for anything before. 

DB 02:47 

First time for everything. I’m not as well-read as you are you. I mean, you’ve probably read 1000s of books over the course of your life. I mean, for me, it would probably be in the hundreds at most, but I have to say, probably about 80 to 90% of the way through this book, I was sort of getting through the book, and I sort of talked to my wife about it, and I just told her, I think this might be the best book that I’ve ever read in my life. I’ve read some classics, right? You read some of the classics from high school. I’ve read Shakespeare, I’ve read Catcher in the Rye, I’ve read all these classic books, but none of them hit me the way this one hit me. And I know that probably sounds like high praise, and an exaggeration, but I don’t know, in my current mindset, this is the best book that I’ve read in a long time.  

DH 03:47 

Well, normally we don’t tell the audience if we really liked the book or not. We always leave it to the end. We have this thing on Sports Lit where we kind of decide whether this book will belong in the pantheon of great sports books. But I feel like you already cast your vote and it’s over, like this book is already going to be on the list.  

DB 04:04 

Are we still doing a pantheon even though this is a crossover episode? I feel like it’s not a pure sports book, so it doesn’t qualify in that sense.  

DH 04:13 

We will see, we will see. We’ll leave that discussion till the end. All right, I’m going to give everyone the two minute drill of what this book is about. So Abraham Verghese is a well-known physician, medical educator and writer. He, I believe, is currently teaching at Stanford University, and because of his writings, he’s a well-known name in the world of medical humanities. The Tennis Partner is one of his earlier books. It was written in the early 1990s and describes a period of time when he had moved to Texas. Specifically, he’s living in El Paso at the time, and he’s an internal medicine physician. He’s a specialist in infectious diseases. He had actually been working with a lot of AIDS patients in the 1980s when AIDS was becoming a thing. So this actually is part of this story too. 

While he’s in El Paso, he befriends a medical student named David Smith. The only reason he befriends David Smith at the beginning is because he hears in the medical hospital grapevine that David is a former tennis professional. And since Verghese is a tennis nut, and I can relate to that being a tennis nut myself, you know, he makes a point to befriend this guy and say, Let’s go hit some tennis balls. And he’s a very good recreational hack tennis player, and so the book talks about him and David getting to know each other on the tennis court, and also him teaching David on the wards and showing him the ropes of the hospital. David, at the time, I think he’s a third- or fourth-year medical student at the beginning of the story. 

The backdrop of this is that his personal life, Abraham’s personal life, is starting to fall apart. He’s still living with his wife at the beginning of the story, but there are cracks in their marriage, and they’re kind of working towards gradually separating as the story goes. So in some ways, David is filling this gap that he needs for companionship while he’s in this new town. 

Trouble is, as the story goes, we’ve kind of discovered that David has his own demons. He’s been in medical school for several years. He’s been in and out and in and out because of a history of substance abuse problems, and so these problems start to escalate as the story goes. And Abraham finds himself getting sucked into David’s orbit, befriending David, getting to know David’s girlfriend. And then when things start to unravel in David’s life. It kind of takes Abraham with him and the whole thing starts to spiral out of control. I won’t give away the actual ending, because I think people do need to read this, but it is a gut-wrenching finish, and basically is the story of these couple years. It’s a memoir of Abraham’s life, of this time period when his marriage was falling apart and he befriended David and this very, very complex relationship that teaches him and us something about medicine, something about life, something about death, something about the value of friendship and, most importantly, the value of tennis. 

DB 07:23 

Yes, indeed, tennis is does feel like the connective tissue that binds the story together. It’s almost like a character in itself. What struck me from your intro there is that although this is one story in one book, it’s weaving many stories together and this is an incredibly layered book. One thing, you have the story of these two men pursuing their medical careers at different points in their career, right? You have a story of addiction, you have the story of family dynamics, what happens to a family amid a divorce. You know, at its core, this is kind of a bromance, right? You have these two guys who really have not many other people in their lives besides each other, and the tennis is what brought them together. And they’re basically pals, they’re basically best friends, essentially, by the end of the book. This is also a period piece in a way, right? This is set in the late 80s, early 90s. It’s a different time in North America, it’s in the time of the AIDS epidemic. Dr. Verghese is an infectious diseases specialist, so he’s sort of right at the forefront. He’s seeing this happen, he’s seeing the AIDS epidemic happen right before his eyes. And this is a particular period of time in America. It’s also the story of El Paso, a border town. One thing that I love is when an author is able to paint a very vivid picture of a place that I don’t know anything about. And I don’t know much about El Paso. I’ve never been to El Paso, but what’s notable about it is that it straddles the border between the United States and Mexico, and that’s what makes it an interesting place. It makes it a unique place where you have the American influence and you have the Mexican influence. It has an interesting geography and topography that he goes into. It took me to that place. His writing was so vivid that it took me to that place in time. It is such an incredibly layered story. 

DH 10:02 

Absolutely. It’s so layered, we probably haven’t even described every layer. There’s still a few other layers, I think, that you didn’t touch on.  

DB 10:12 

Yeah, here’s another one. It’s basically a love letter to tennis. It’s a lifelong passion of the authors, and a lifelong passion of his tennis partner as well. And both of these passions sort of collide together and it makes the book what it is.  

DH 10:35 

Yeah, I read this book about 15 years ago, and I don’t think it registered on me. I didn’t appreciate it that much. It was this time reading it, the second go around, that I was like, You’re right. This book, it’s not even just that it covers these topics and these themes, it’s just so well-paced, and the language is so right all the time, right? It’s just such a really smooth read. And then in the final third, it just ratchets up the tension and it turns into The Wire, actually. I mean, people who listen to us normally know that we love The Wire. And so it takes you to a really dark place at the end, but it is a great story.  

DB 11:23 

Yeah, absolutely. And he’s such a talented writer. I’m so impressed by Dr. Verghese. First, I’m impressed by his technical acumen in medicine. I don’t know, all these little vignettes that he sort of described, like how he sort of looks at patients. It’s very interesting, as you sort of get into his mind, right? But he’s such a beautiful writer. The story is littered with just these beautiful anecdotes and vignettes. I mean, it’s clear he has a lot to say. There’s all these metaphors throughout the book. I mean, I would love to give an example, I can’t think of one right now.  

DH 12:03 

Well, you will have a chance in the final quote. You get to read one more quote. 

DB 12:09 

I can find one. I can uncover one. But it’s just there’s these beautifully done metaphors throughout the book linking often medical terms with his actual life.  

DH 12:22 

Right, or even linking El Paso, some of the things that are particular to the community, like the indigenous community around that part of the desert with what’s actually happening in the hospital, or what’s happening with the illness. There’s so much to talk about and we don’t have all day. Let’s try to cover a few things that we want to hit. Give me something that you want to talk about, about this book. 

DB 12:50 

So, I mean, since it’s called The Tennis Partner, I feel like we should talk about the tennis a little bit and but I’m not thinking about tennis as a sport, I’m thinking more about tennis as a conduit and as a ritual. And I think the book makes the case that there’s a big value in having rituals in your life. That it becomes clear to me over the course of the book, that it becomes a ritual for both these guys, it’s just a part of their week. If they go a couple weeks without it, they feel a little bit off. And I think that’s what rituals are, right? You’re so used to doing it, it becomes part of your life. And when you’re not doing it, something about your life feels off.  

DH 13:45 

I think it’s more than just a ritual. I think it’s almost like a haven from life for both of them. Because both of them, when we meet them, are struggling. David is struggling with his personal issues, and we don’t know that yet, right? We think he’s just a busy medical student. Abraham on the surface, is a dude with, you know, married, two kids, doctor, all the students look up to him. So they’re both putting on this veneer that, No, life is great. But actually they’re both cracking underneath slowly. And so the tennis is a thing that gives them some salvation for an hour each time they play. At the beginning, it’s really great, the tennis brings them together. When you play tennis, it’s like you’re imagining that you’re – Verghese does this all the time. He imagined that he’s John McEnroe. He imagines he’s Björn Borg. And so it’s this release. But then, as they play longer, you start to see the real-world things seep into the tennis. Sometimes they get angry at each other, they’re not always there for each other. At some points, David starts to get into some nasty rows with his girlfriend, and he doesn’t show up for tennis, and Abraham’s like, Why is he not here, right? Is she more important than me? There’s all sorts of these little mental games that they’re doing to each other around the tennis. So it’s not even that straightforward that, Okay, we just meet up every time, play, have a good time. It becomes layered with all the typical insecurities and anxieties that human beings have that I guess occur in all friendships, but especially occur in relationships, real deep relationships with people, like your girlfriend doesn’t call you right away, it makes you edgy. This type of stuff starts to happen to the characters in the story. So it is a conduit to bring these two people together, because without tennis, they wouldn’t have been brought together. But it also shows how complex human interaction can be, over something as seemingly straightforward as, Hey, meet me after your shift, let’s go hit some tennis balls. 

DB 15:58 

Those are some great points, actually. It also struck me, now that I was listening to talk in that because they’re both going through such problems in their own lives, the tennis is like a therapy. It’s like a therapy session for them as well, almost like an unspoken therapy session where you just whack a few balls, you express yourself. It’s a way to express yourself non-verbally, doing something that you love. 

DH 16:28 

Right, this is probably the only sports book we’ve read that talks about sport in this way, right? So sometimes we read sports books, and a lot of them talk about professional sports, which ultimately are sort of a silly endeavor, right? People are getting paid to play child’s games and then we as fans are watching and with bated breath to all the things that they do, and trying to feel amazement all the time. But this book is actually talking about sports for real. Regular people bringing their regular lives, and how your lives can be enhanced and changed by sport, which is a bit of a different thing, and I think it’s a cool way to think about it, because I’ve always felt this way about sports.  

DB 17:12 

Yeah, I mean, it doesn’t have to be played at a professional level to have value, right? That’s what we’re seeing here. You don’t have to be the world’s greatest tennis player, to play tennis and enjoy tennis. You can play it for fun. That’s what sports should be, actually, it should be a fun endeavor. Shouldn’t be a professional high-stress endeavor. If you want to shoot some hoops, go shoot some hoops. If you want to put on some skates and skate around and play some shinny, go do that. 

DH 17:42 

Now, I want to ask you a question. So you’re not in medicine, but you’re a dentist. Actually, I didn’t tell people this in the onset. So if you haven’t heard Dave talk before, he’s a dentist. Looking at Abraham’s relationship with David, there is some boundary issues occurring here. He is supposed to be David’s teacher and in medicine, and probably in dentistry, we’re always taught to try to keep a nice boundary between you and your patient, right? You don’t want to be going out to play tennis with your patient or go out for drinks with your patient, because that can get kind of weird. You also want to keep a boundary as an educator. You don’t want to take your students out for coffee too many times. Maybe if you become really close friends, you’re going to be less impartial when you have to grade them or evaluate them or make some tough choices. Abraham, because his love for tennis, throws all this out the window. He’s like, I gotta hit with a pro, and that’s more important than all that stuff. That’s how this starts. Do you feel like he goes way over the line of boundaries, or is what he does in this story still acceptable to you? 

DB 19:01 

That’s something I hadn’t considered, and this is a really good point. It does feel like they need each other at some level, beyond just your typical mentor-mentee relationship. It starts off that way. That’s what they are, that’s literally what they are. They’re not friends. David is a student, and Abraham is his teacher. And, yeah, within that relationship, there should be boundaries, but this relationship evolves, and it clearly evolves over time, to the point where they become, as I said earlier, best friends. And once you get to that point, it’s hard to go back. It’s hard to put the toothpaste back in the tube at that point, right? To answer your question, yeah, I think he is overstepping. If you’re really looking from the viewpoint that he’s overseeing multiple students, with one of his students, specifically, he’s spending hours every week hitting a tennis ball with him, and going out for coffee, having meals together, knowing about each other’s personal lives, he’s been into his home, they’ve been to each other’s homes. 

DH 20:23 

Right, if you describe it in a certain way, it almost sounds a little creepy.  

DB 20:26 

It’s dicey, it’s very dicey. If I was one of these other students who’s not getting this preferential treatment, I’d feel a bit put off by it. But you know, this relationship was allowed to fester, and it was allowed to continue, and then it became something else. 

DH 20:45 

Well, maybe not even fester. Flourish, for a while. 

DB 20:48 

Flourish, exactly, and it became something else. So it’s kind of like once it becomes that other thing, at that point, it doesn’t seem that questionable anymore. 

DH 20:58 

But what happens later in the story, if you remember, is when David gets back into trouble with the drugs, and Abraham finds out. His duty should be to go to the school and say, All right, our student, I found out he’s on drugs again. We need to do something about it. But actually, what does he do? He tells David, Look, they’re coming to do a test. Get out of here and sober up before your test and clean your system before you get tested. He’s actually trying to help his buddy out, right? And so it shows just how far he has gone in terms of over the boundary at that point. But what I will say to your point too, is that the fact that Abraham, at the end of this, is willing to write this story down and share it with everybody, I don’t know if it absolves him of it, but clearly he must have understood everything that was happening. I mean, if you wrote this down and published it, it’s possible that the board of directors in your university or something will be like, Okay, you need to be a slap on the wrist for inappropriate behavior with students, or at least get a warning or something for future, right? He was actually very honest about everything that happened, and I thought that was the really interesting thing about this. Because I was like, You know what, if I’m going to write a memoir, I probably would leave out a lot of this stuff. So he was pretty brutally honest about it, and I do respect him for it. And it kind of shows, I think he knows he’s over the line. He definitely says words to that effect in the later part of the story.  

DB 22:38 

For sure. I mean, it’s a classic moral dilemma, right? Where do your loyalties lie? Is it with your friend or is it with the system that you work for that provides your salary?  

DH 22:51 

I was just asking my wife this question. It was on an unrelated topic. Just last night, I was like, You know when you apply to dental school or medical school, they’ll give you that scenario, right? During the interview, they’ll say, You know, you and your buddy have been working together for years, but you notice that he’s showing up for his shifts drunk. Do you report him to the hospital admin or do you sit down and talk to him? What’s the correct choice, right? And this exact scenario basically pops up in this book, and Abraham makes his choice and has to live with it.  

DB 23:22 

And I think it all depends on, I mean, to answer the question is, how good of a friend are you? Or how good of a friend is that person to you? 

DH 23:31 

Well, that’s the real answer.  

DB 23:33 

What’s the size of the transgression, right? 

DH 23:35 

The official answer is, you salute and report all the news back up to your superior. But the real-world answer is quite a bit more nuanced.  

DB 23:42 

It’s not realistic to, I don’t know, when there’s people involved in relationships, that always gets skewed, and it becomes a gray area. 

DH 23:55 

Right, so the alternative is for Abraham, or anyone in his shoes, to say, I’m never going to befriend my students. I’m going to keep a stone wall barrier. And I’ll admit, I teach medical students, and I’ve actually played tennis with them because of this book. I’ve gone to shoot hoops with them because it’s a nice way to get to know people. But you do become aware that there is this line, and if you go over the line, it could become uncomfortable.  

DB 24:23 

Yeah, that’s true. I just remember my second or third year out of dental school, I was an associate at a practice where the owner of the practice noticed I was getting very friendly with the staff in terms of, like, we were hanging out. And he pulled me aside, and he said, If you want to become the boss one day, you can’t be friends. You can be friendly, but you can’t be friends. That’s just the reality of it, right? And I always remember him, you know, telling that to me and I sort of took it to heart at some level.  

DH 25:00 

Is it true? You’re a boss now, do you feel that way then? 

DB 25:05 

I don’t feel like I’m friends with the staff. I’m friendly with the staff, you know, to have a positive work environment, right? But, no, yeah, I wouldn’t say I’m friends with them.  

DH 25:20 

I guess what he means is if you decide at some point you need to change the staff, you need to fire somebody or do something for the sake of the business, it’s much harder to do that once you’ve entered the true friendship zone. 

DB 25:34 

Yeah, absolutely. Your decision-making becomes skewed, and if you want to let go of someone, it becomes much harder and if you want to talk to someone about changing their habits, sometimes it becomes much harder. It does sort of color the relationship.  

DH 25:51 

But it does seem to be looking at it purely from the vantage point of pragmatism, for the sake of the financial health of the business and the most efficient decision-making possible, not having friends is the way to go. But that seems to be somewhat empty, in a way, like look at our book here. What happens if Abraham does this and says, Okay, there’s a tennis player, but I’m gonna resist the urge to go for a hit, and he just won’t befriend him, right? So this never happens. Are we, as a world, better off without that happening, or are we better off with the way it actually happened?  

DB 26:28 

I mean, I would say we’re better off with the way it happened. And I would go even further. I would say that if they never found each other, I’d be worried about both of them. I mean, with David Smith, the former pro, I mean, that’s self-inherent in the book, right? It’s obvious in the book. But I think with Abraham, with Dr. Verghese, he went through a lot of trials and tribulations. I’d be worried about his mental health if he didn’t have this tennis in his life, right? Because it felt like he was veering down not a great path. He was living in his own apartment away from his family, with basically a cardboard box as his table, with no furniture. I mean, it has all the hallmarks of someone who’s undergoing a depression.  

DH 27:21 

Right, at least a major midlife crisis.  

DB 27:23 

Yeah, absolutely. And he sort of glazes over it in his book, because it’s not really the main topic of his book, but I felt like if he didn’t have the tennis and he didn’t have David Smith in his life, he could have veered down a very dark path.  

DH 27:37 

It’s possible. I didn’t feel that at the time I read it, but maybe that’s because we’re hearing it from his learned writing voice, right? He sounds like a very put-together guy. And even as he described living with the cardboard box, he described it in such a beautiful language that I was like, Well, this guy is still okay. I never felt that he was that close to falling apart, really. Except that when you take a step back and think about it, yeah, he’s living in this less than ideal living situation, and he’s hanging out with a med student every other day, he has no other friends, he has no other family around. Yeah, he’s pretty unbalanced at this point. So I think you’re right. And then, moreover, the fact that they went through this experience and then have this story to tell, like, it is a beautiful story. Sometimes people are like, Why do stories exist? Why do we need novels? This book is so good that it’s kind of like, this is why this story needs to exist.  

DB 28:40 

Yeah, absolutely. And the fact that it’s based on a true story, actually is a true story, only adds to it. I have a question for you, just to change topics for a bit here. The main sort of crux, the main shadow that sort of hangs over the book is a story of addiction, right? And not just any addiction, a drug addiction, an injectable drug addiction that really, it leaves one of the characters very much in a bad place. And part of the topic of the book is that there’s other medical professionals who go through this addiction. There’s an addiction center for doctors. 

DH 29:34 

They fly David to one of these centers. 

DB 29:35 

Yeah, and it made me think, Okay, they’re making it sound like this is not uncommon, right? A lot of medical careers are very stressful, and it can lead to this kind of thing. I don’t have much exposure to this. I’m wondering what your exposure to this is. Have you noticed this? Have you ever encountered this in your career?  

DH 30:00 

Very limited, also. I’ve never seen it firsthand, but I think this book is kind of old, right? This book comes from the early 90s. I imagine that when this book came out, this would have been something rather shocking to read about. I didn’t feel shocked by it. I mean, I’m re-reading it now, but even when I read it years ago, I wasn’t shocked by it, even though I haven’t seen these things happen. I guess it comes up in the media in other forms of discourse about doctors, like medical television dramas, it often happens. I think we kind of know this idea that doctors can also do bad things. Maybe in 1990 that was kind of really new to be talking openly about it. But I think now it’s not a surprise. 

DB 30:52 

I’ve always felt like most medical professionals, most doctors, are pretty put-together mentally to be able to get through undergrad and to get through a degree in medicine. It’s hard to do, right? It takes a tremendous amount of willpower and discipline that usually these people are more insulated from this kind of thing than other people, but this book paints a different picture. One thing I actually do remember from the first week of dental school, a lot of it was just orientation, and there was this dentist, or former dentist, who gave a talk, and basically he tells his story about how he became addicted to drugs after becoming a dentist, and it was a pretty heart-wrenching story. He was still a fairly young guy. I don’t remember if he continued to work as a dentist, but what I remember the most was his voice, and his voice sounded off. He sounded like someone who had been badly damaged by drugs. That’s what it sounded like to me, and it kind of scared me a little bit. Maybe that was the intent of the of the talk, but I think part of it was just to give us the idea that, okay, there are resources to help you with these kind of issues. But this was the very first week of dental school where we were exposed to this. We never talked about this ever again after that. Well, it was an interesting introduction to dentistry.  

DH 32:30 

I feel like there’s always that joke, right, like dentists have a suicide rate that is higher than, I don’t even know if that’s true. 

DB 32:38 

It’s not. 

DH 32:40 

But between dentists and doctors, I mean, you alluded to it. It’s a very high-stress training, and the job can eat up your whole life. I feel like this book, as we talk about addiction, I’ll admit that even my medical training, I didn’t really understand a lot about addiction. If you pulled me aside two years ago, three years ago, and said, Well, why do people become addicted to fentanyl or to opioids? I would have probably said something like, Well, they took it, they took it multiple times, and after a while, biochemically, their body just decided, chemically, it needs this drug, and then the patient, or the person can’t stop using it right? And that the use of the drugs somehow chemically rewires them, and now they need it all the time. That was my very primitive understanding of addiction, and it was only in the last couple years that I started seeing all these people talking about how actually most addicts have some underlying trauma, right? There’s some void in their life, something in their childhood, something has happened, and they’re disconnected from people, and now the addiction is a thing that springs up to fill this void, and it’s not a good thing. It fills it temporarily, but they need to fill it again and again, and then you need more hits then. I had never even heard about this. I went to medical school, I did residency, I worked for many years, and I don’t work in the field of addictions, so I guess I’m not seeing this all the time. But then actually understanding that, which is our new way of understanding addiction, and then going back and reading the tennis partner, I was like, Okay, this kind of makes sense. Abraham doesn’t write this explicitly, but he does talk a little bit about David’s complicated past, or what little he knows about it. I think there’s a part in the book where I think it’s David’s mother passes away, and they actually send them back for the funeral, and it turns into a disaster. He comes back from this even worse than before because it brought back all this pain from his previous family life. So I feel like our understanding of it as a society is starting to change, but probably we don’t talk about it enough. These days when we see it on the news, it’s like, Well, the reason people are getting addicted is because the drugs are being allowed into the country, and we need to close the borders and stop the Chinese and blah, blah, blah, blah, blah, but what actually is happening is there’s some broken down people, emotionally, mentally and that we’re not dealing with that, we’re trying to cut this thing off at the border, right? And I think this book is really good at painting David as a really complicated person. It doesn’t judge him as being good or bad. He’s just a guy with a really complicated past. He’s a great tennis player, he’s super attractive, apparently, there’s women falling all over him, and because of that, he can be a jerk to the ladies, but he can also be very childlike and innocent at times. He’s a very complicated character. I think the book did a really good job of painting the picture of addiction and making it much more nuanced than what we’re used to seeing.  

DB 35:56 

Absolutely, one thing the book did not explore, which is a little bit of a void in the book, as I see it is, they weren’t able to explore his backstory. So you talk about this trauma, these holes in your life. We don’t know what those holes are, it hints at it a little bit, definitely, some stuff happened, we don’t know what, but it’s clear he does not have a great relationship with his parents. They’re halfway across the world in Australia. He’s about as far away from them as you can get, really.  

DH 36:35 

I mean, it’s by design, I guess. Most of the time, we don’t know what the real cause of it is, and since the story is written from Abraham’s point of view, they never get to that point where David can share this. He would have needed to get better from the addiction, and maybe years down the road, share, and that’s not happening in this story.  

DB 36:54 

Yeah, and maybe he’s not even aware of it himself, right? There’s something that’s going on. He knows that he didn’t have a great childhood, he knows there were some traumas, he’s still trying to process it, as many people tend to do. They’re processing it throughout their life, right?  

DH 37:11 

I think that’s a really interesting thing to think about. But why don’t we flip it the other way and say, Well, what about Abraham? His life is kind of messed up at the, well, throughout the story. Why is his life messed up? And he is actually Mr. Introspection, he’s given us everything he can about his life. Do you feel that you understand why his marriage falls apart? Or is it as simple as he’s working too hard, he’s never home? I don’t think that’s it.  

DB 37:35 

Well, he had an affair, right? I think that was the breaking point.  

DH 37:38 

Right, so why did he have an affair? 

DB 37:40 

That’s the point of no return. That was a symptom of the underlying problems. But his wife took the kids and left and went to India, and that’s when he had the affair, they left him. But why did they leave him? I mean, it’s a variety of reasons, he was a bit vague about that part of it.  

DH 38:00 

Right, so maybe even he doesn’t know, right? These things are possible. A lot of times these things happen, we kind of look back, and try to make sense of our actions. They are sometimes rooted in our past, sometimes they’re not. But he does tell a bit about his parents’ relationship and his parents, I think, were separated too. I think at one point he alludes to that he’s doing the same thing that his parents did to him. So he’s a little bit aware of what’s going on, at the very least, at this point in time. But it’s interesting to think about it. These are complicated characters, much more complicated than most fictional characters, actually, because you can really see their inner flaws. 

DB 38:45 

Yeah, absolutely. One moment that I want to bring light to, and I see it as almost like you can divide the book into two parts, right? There’s the first half and the second half. The dividing line is, there’s a time where they have a drink together, and they discuss, and the truth comes out of them, and they tell each other their truth. They’ve been basically hiding behind the tennis for a long time. And Abraham comes clean about how he’s getting a divorce, and him and his wife are going to be separated soon, and he’s gonna be separated from the rest of his family. They had never discussed that before. And David came clean about his addiction issues and how he had to repeat multiple years in medical school, right? And I felt like after they were able to confide each other their truths, the story sort of took a different turn after that. It became much more of a friendship after that, and they let their guard down a lot more after that. Before that, it was the tennis that really kept them together, but I feel like after that, now they’re really intertwined from a relationship perspective. 

DH 40:11 

When you say it that way, it makes me realize there’s another angle to this book. I guess you mentioned it, the bromance thing, but I think this is really a man’s story, you know? Because I don’t know how true this is, but I definitely feel like as an adult, middle-aged guy, it is hard to nurture friendships. And this book shows how difficult it is and how strange it is even for them to start to become friends. There’s so many rules in place to block friendship, right? And because of the circumstance, because of the tennis, they’re able to get past that barrier and get to this point where they can openly share stuff. How rare is that in life?  

DB 40:58 

Yeah, that’s true. I mean, I would say once you get past the age of 30, it does become exponentially harder to make friends.  

DH 41:05 

Maybe it’s not a guy thing. Maybe it’s true for women too. So maybe it’s just an adult life thing.  

DB 41:08 

Possibly, I think, Okay, first thing happens once you get in a relationship, and then you get married, that that starts to take up a lot of your time, right? Then next thing, you have kids, maybe one kid, maybe two kids, now, the second kid is here. 

DH 41:25 

Right? And now you’re rising up in your career, and your mentor told you, just be friendly to people. Don’t actually be friends with them. So all these people are out, right?  

DB 41:34 

Yeah. So then your friends are basically the friends that you had before, but then you’re gonna lose some of those friends because you’re just not going to have the time, or they’re in a different space, a mind space in life, right? You’ll tend to relate better to the people who are going through the same thing as you are, so usually people with kids as well. Maybe your kids can have playdates with each other. That’s how you maintain those friendships.  

DH 41:55 

Okay, so then I’ll ask you this, because we’re about the same age, and we’re both going through adult life, if something like this was happening to you, do you feel like you have people in your life that you could talk to about? Because it takes a long time for Abraham and David to break this veneer for him to admit that he’s having marital problems and stuff. Do you feel like you have a couple people you can turn to? 

DB 42:16 

If I was having marital problems, or if I was going through addiction issues? 

DH 42:20 

Or something major crisis, the things that normally we wouldn’t talk about to casual friends, because people are like, Hey, how’s it going? It’s good. Things are good, right?  

DB 42:29 

Things are good, fine. I’m good. I’m fine.  

DH 42:32 

Taxes suck, right? But I’m good.  

DB 42:36 

Well, I don’t know, can I come talk to you, Dave? 

DH 42:39 

You definitely can talk to me, but we have to do it around the guise of talking about a sports book every month. 

DB 42:45 

Right, maybe we should record it on a podcast. No. I mean, I feel like I do. There’s people out there that I can talk to. How many people? Not as many as there used to be probably. 

DH 43:01 

Right, a few, right? I would say there’s probably a couple.  

DB 43:03 

There’s a few, and these are people who I’ve known probably most of my life. It’s not going to be someone new in my life.  

DH 43:10 

That’s what makes this special, right? This friendship is like Haley’s comet. It appears very rarely in life that you would meet a new person that you have a big age gap with. Abraham and David are different generations, big age gap, different culture, different standing in the hospital. The hospital is probably, you know, the education system forbids them to actually become friends, so they have to get around all these things. And the thing that lets them bypass all this is they both love to play tennis. So that’s kind of neat.  

DB 43:45 

I think it is a beautiful story when you put it that way. I am a sucker for a good bromance. I don’t know what it is, just having that sort of companionship. It’s a little bit off topic, but I was recently watching re-watching a movie that I really enjoy. It’s called End of Watch. I don’t know if you’ve ever heard of it before. It revolves around a bromance between these two cops who are partners. Jake Gyllenhaal is in it. Michael Pena is in it. They have so much natural chemistry as friends, right? They’re both married to their wives in the movie, but they have such a connection throughout the movie. And it made me think of that, because I love myself a good bromance, and Tennis Partner is as good as any. It’s as good as that.  

DH 44:37 

All right. Well, since you’re sharing about your love of bromance, I will tell you the thing that I’m a sucker for in stories is mentor-mentee relationships. I don’t know why, but I think, you know, in the original Star Wars movie, my all-time favorite character in Star Wars is the old man, Obi-Wan Kenobi. To me, that is the coolest character. This is a grizzled old guy who’s been through the wars, bad stuff happened to him. He should be really down on his luck, really cynical, but he’s been charged with the task of teaching Luke something, and I thought that was the coolest thing, because he’s just paying it forward. And that’s why this story works for me too, because this is the mentor-mentee, right? Abraham wants David to become better, almost to the point where it’s getting a little weird, you know, like in the later, Abraham’s an internal medicine specialist, and he specifically does infectious diseases. He secretly has this thing where he really wants David to go into internal medicine. And when David tells him, I want to do emergency medicine, or I want to do surgery, he gets all offended, right? He’s like a jilted lover, right? So, he can’t handle that. But I love that there is this element of the old teaching the new, and trying to push the young guys to become better. I love that. 

DB 46:05 

Yeah, Abraham is very honest emotionally throughout this book, to the point where it is a little bit odd and uncomfortable. But I think that you love the mentor-mentee relationship. It goes back to your love of college basketball coaches like Bob Knight. Leaders of young men, teaching them not just about basketball, but about life. Coach Dean Smith.  

DH 46:31 

I love that. I mean, it’s also just my relationship with my own mentors, right? Your mentors teach you, and then you grew up and you mentor the next generation, and it’s like this cycle. It’s great. I love it. I love teaching and learning. So I guess that’s part of all this.  

DB 46:48 

It’s great. So, one thing that struck me emotionally in the book was towards the end, when David had his relapse. That part of the book kind of frightened me, kind of scared me. Just the turn that it took in what happened to David, what took hold of him. 

DH 47:13 

You’re talking about the last relapse. 

DB 47:14 

Yeah, and who he turned into, it freaked me out, basically. And I don’t know, when something like this happens, it’s always like you get the idea that you’re not that far away from something like that. It’s possible, life is a bit crazy, and one wrong turn, you could end up like that. I don’t know that that’s true, necessarily, but it did freak me out in that way a little bit.  

DH 47:43 

Be more specific, you felt like that could happen to any of us, that we could take one wrong turn and suddenly lose everything? 

DB 47:50 

Yeah, I mean, because David’s throughout, I’m gonna say 80 to 90% of the book, comes across as a very normal human being and a relatively bright guy, right? And, you know, on the surface, I guess it’s purely on the surface. 

DH 48:12 

I would say maybe for 40% of the book, he maintains that veneer until you start to see the cracks. His relationship with his girlfriend, I think is one of the early signs that this guy’s a bit of a mess. Then you start to meet some of the people that knew him earlier in medical school, and you start to hear what other people think of him and it’s not that straightforward. So I think by the end, I’m not that surprised that this is happening. All the seeds have been there for a long time. 

DB 48:40 

Yeah, it’s supposed to, but I was just struck by how fast it happened and how extreme the changes were. That’s probably what’s what scared me the most is how he basically turned into a werewolf, essentially. 

DH 48:54 

Yeah, I mean, we’re joking about it, but it is actually quite frightening, what happens at the end, right? He becomes completely disconnected from all of them. 

DB 49:03 

Yeah, we don’t want to spoil it completely, but yeah. 

DH 49:06 

People can tell where we’re going with this.  

DB 49:08 

Yeah, absolutely. Any other thoughts about the book, Dave? Any other favorite parts, or any anything interesting to share? 

DH 49:17 

I think we covered all the main things I want to talk about, except this thing of should we put it in the pantheon of greatest sports books of all time? 

DB 49:27 

I mean, for us to do that, it would have to be a sports book.  

DH 49:33 

All right, so let’s answer that question.  

DB 49:34 

I think this is loosely a sports book. I wouldn’t call this a sports book. I think it’s a bromance that weaves many topics into it, one of them being a regular tennis game, but that’s not the story. Even though that is in the title, that’s just a reference to a person. It’s not necessarily a reference to the sport in particular. To me, this is not a sports book. What do you think?  

DH 50:01 

All right, I’m gonna try to convince you that it’s a sports book. Without the tennis, the relationship doesn’t happen, right? And it’s not just a conduit for them meeting the first time. The tennis recurs throughout the book multiple times. They have multiple conversations on the court, there’s this whole journey of how, I think they even watch tennis together on TV. It is really a vehicle for them to further their relationship over time. It also is a vehicle for them to play out a lot of their feelings towards each other. I think usually when they play, David kind of lets Abraham hang with him, but later in the story, at some points where he’s feeling volatile, he pounds Abraham. And I think Abraham beats him once, and stuff. So there is some sports action here, but there’s a lot of subtext to what’s going on. I think without the tennis, the story doesn’t even happen. So I will make the case that I think this is actually a sports book. It talks quite a bit about Abraham’s tennis life, as a recreational tennis player and a tennis fan. Enough that I think it should qualify. I just want to play the pantheon chimes. But I would call this a sports book, and a medical humanities book, and a bromance. 

DB 51:29 

Okay, I mean, I guess you could say – we talked about this in the beginning – it is many stories weaved together, and one of those is a book about sports, and that sport being tennis. Okay, you’ve convinced me, Dave. But now the question, does it deserve a spot?  

DH 51:46 

Well, now that we’ve said it that way, you called it one of the greatest books you’ve ever read. I will not call it one of the greatest books I’ve ever read, but it is a very good book. I would vote for it to go into the pantheon, but I’ll let the deciding vote sit with you.  

DB 51:58 

Well, I think we obviously know where I sit with this. This is such a slam dunk case for the pantheon.  

DH 52:06 

A smash, not a slam dunk.  

DB 52:09 

It’s an overhead smash, easy, no thought involved, this book belongs in the pantheon.  

DH 52:17 

All right. There we go. Play the music. 

DH 52:29 

All right, so we’ve inducted another book into the pantheon. But seriously, whether it’s a sports book or not is not that important of a distinction. This is just a great read, and I’m happy that it hits sports so that you and I could talk about it. I’m happy that it’s part of medicine and medical education so we can talk about it. From a humanities standpoint, it’s a great book. We tried not to give away too much of the nitty gritty details, but I think even if we gave some of it away, people should just read it. It’s such a deep book. There’s so much going on in it.  

DB 52:58 

Yeah, if you’re listening to this right now, I hope you’ve either read it or you plan on reading it because it’s well worth your time and it’s well worth your energy. It’s a must read.  

DH 53:10 

I was reading it at the swimming pool one day during my kids swimming lesson, and a guy saw me reading the book, and was like, Is this book good? I’m like, yeah, it’s good. He’s like, I’ve been meaning to read this. And I was like, Oh, are you a doctor? And he said, no, it’s just a book that I’ve been meaning to read, but if you said it’s good, I’m definitely going to read it. So, whoever you are out there, I hope you got to it, because this is actually really worth it.  

DB 53:33 

Yeah, you know what? It is rare, actually, to see someone else physically reading a book. I take my son to Taekwondo, and occasionally there’s this other parent there, and he’s usually reading a different book each time. I’m always curious to see what he’s reading.  

DH 53:49 

Do you talk to him? You should talk to him. You should tell him that you are part of a literary podcast, and now you’re also on a medical humanities podcast. They’ll be blown away.  

DB 53:57 

Dave, it’s extremely hard to make friends at this age, extremely hard. There’s a meme that I always laugh at where you’re given two choices, talk to the parent of another kid at the playground, or put your hand in the blender. I look at the blender and I think, maybe the blender.  

DH 54:17 

All right. Well, anyways, maybe you can take us out with a quote. Have you found something to show us one last taste of The Tennis Partner? 

DB 54:31 

Within your secrets lies your sickness, Dr. Talbot had said to me when I talked to him long after David’s death. If David never sustained a lasting recovery, it was because he never let go of his secret. There were some bars that never came down. His secret is still with him. He still walks alone. 

DH 54:53 

Apollo On Call is produced by MedHum.org. Special thanks to my co-host, Mr. Dave Bryant. To hear some more conversations between Dave and I, please check out the Sports Literati podcast available on Spotify or Apple, or wherever you get your podcasts. The theme song Un Sospiro performed by my wife, Dr. Justina Sam. For more medical humanities content, please check out MedHum.org. Thanks for listening. 

Web image by Ahmed